Flexibility in Excellence
Plasticity in practice creates success
Monday November 23, 2009
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“You may have a patient that’s tough and wants to get out there, so you need to talk their language and meet their demands, or maybe you have someone who’s shy and may need a push,” says Zidek, who’s worked her way up the PT ranks, beginning as a PT aide following high school. “People who are really good in the field have those special skills that they’re able to change with the patient’s personality — you have to be what that person needs to get the best result,” she says.
But Zidek’s shape-shifting talent extends beyond the roles of friend and counselor, coach and therapist. When she finds herself at a loss as to treat an especially puzzling case, she reaches out for help.
“What makes a good therapist? It doesn’t matter how well-versed you are — it’s the ability to humble yourself to say, ‘I don’t know,’ and go and find out,” Zidek says. “A successful PTA is one who is an active part of the team, asks questions ... and has good communication skills with the patients, families, and therapists.”
With emerging science dictating near-constant changes in the way neuro rehabilitation is practiced, excellence is a constant pursuit. Therapists who’ve made it their life’s work to achieve it agree that quality is rooted in communication, creativity, innovation, and passion.
More than Words
For those PTs and PTAs aspiring to greatness, the spoken word is just the beginning of communicating with a patient, says Beth Fisher, PT, PhD, director of Neuroplasticity and Imaging Laboratory in the Division of Biokinesiology and Physical Therapy at the University of Southern California, Los Angeles.
“I think a great neuro-therapist has to be able to manipulate all aspects of a task — how a patient is set up, knowing how the environment is set up, using hand and verbal instructions,” says Fisher, who is also the director of the Neurologic Physical Therapy Residency Program at USC’s Rancho Los Amigos National Rehabilitation Center.
Fisher acquired invaluable hands-on training in the 1980s when she enrolled in a series of continuing education courses on neurodevelopmental treatment, or NDT.
While the approach has been widely criticized because its results are rooted in feedback rather than evidence, the hands-on skills taught in the system are essential for a successful practice, Fisher says.
Unfortunately, the importance of hands-on therapies has diminished with an increase in the use of non-manual therapeutic principles, Fisher explains. “But with the really lower-level patients there’s no way you can do some tasks without helping them with their trunk and use their legs.” However the patient manages to move, the use of observational movement analysis will increase the feedback therapists can offer.
“An excellent therapist has to watch what [patients] are doing, needs to understand how that movement should be performed and the movement it requires,” Fisher says. “And if they don’t have enough motion, teach them how to do it so they’re not having the abnormal stresses causing the pain.”
Mindful Approach
The multidimensional approach necessary for effective communication is the same tactic required to create a complete treatment plan for patients with complex brain injuries. “Because so many different areas are affected with a central neurological diagnosis, everyone works together, and it can be challenging to be able to talk with different disciplines to provide that approach,” Zidek says.
Within the realm of neurological sciences, understanding the myriad parameters of neuroplasticity improves therapists’ ability to prescribe alternate treatments. “One really important aspect of rehabilitation [at] this point in time is knowledge of the workings of experience-dependent neuroplasticity and experience-induced neuroplasticity to understand the diagnosis and what’s appropriate,” Fisher says.
Applying the principles of neuro re-education invites therapists to focus on function, while remaining open to changing treatment approaches according to patients’ responses. “If you’re going to get good at a task, you train doing that task — if I’m going to get good at walking, I don’t get good at it by lying down and doing leg exercises, [I] get good by walking,” Fisher explains. “I don’t think we should discard the hands-on, motor skills aspect of being a master clinician, but a good neuro-therapist should understand the difference in those fields and should not be thinking so much about the clinical exercises so much as most task-specific training and skills practice.”
Inspiring the Future
There is perhaps no better opportunity for aspiring neuro therapists to learn and apply multifaceted therapies while focusing on excellence than through mentorship.
The mentors Fisher was aligned with when she began her residency at Rancho were invaluable to her education, she says. “Mentorship over the patient, spending actual time with a mentor and a patient where you’re working on a skill, not only helps teach things that will help your patient reach their goals, but you are challenged to argue the direction you are going.” Zidek credits her mentors while working as an aide with igniting her passion for the field. “The more questions I asked, the more they taught me, and the more then taught me, the more consistent we were with the patient’s plan of care,” she says. “These therapists were not OK with the norms; they pushed themselves to be better daily, and that wore off on me — I wanted to be one of them.”
But her colleagues aren’t the only people Zidek views as mentors. “There’s not a treatment that’s gone by that I haven’t learned from a patient,” Zidek says. “Maybe it’s a life skill, or maybe they’ve found a new way of performing the activity at home, but they all bring a quality to the treatment.” It’s these moments of quality that drive Zidek toward excellence. “The passion is getting the patient better quicker, giving back the quality of life, allowing them to live their lives as a family member,” she says.
“Sometimes we can’t do as much as we’d like, but it makes me very happy to know I am sending them in the right direction.” •
Robin Huiras is a contributing writer for Today in PT.
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