Solving the Patient Puzzle

LAS VEGAS--This year's Linda Crane Memorial Lecturer was Mary Massery, PT, DPT, of Massery Physical Therapy in Glenview, IL. Her challenge for attendees: Are therapists ready to take on the diagnostic role?

She presented a little boy named Danny, now 15, as a diagnostic puzzle. His original complaint was immobility of the trunk and spine. At first, Dr. Massery thought maybe his issues were musculoskeletal. But further investigation proved that Danny's situation was much more complicated than initially thought.

Born 34 weeks early at 4 pounds, Danny had incomplete differentiation between his trachea and esophagus, sub-glottal stenosis and esophageal atresia. By age 9, he had had 34 surgeries. It was determined that restrictions secondary to surgical scarring had caused musculoskeletal restrictions which limited his lung growth, which limited his neuromuscular movement strategies. 

"It's not musculoskeletal,” Dr. Massery said. "That's simply the expression."

Dr. Massery said therapists must incorporate several pieces to every motor evaluation and examination. These include the obvious—the musculoskeletal and neuromuscular—and less obvious pieces—the cardiovascular/pulmonary, integument/fascial and internal organs systems. All pieces must be taken into account in order to discriminate between the cause and the consequence of the impairment. She also believes the pulmonary system is the thread that ties the puzzle together and should be an integral part of every motor assessment from the head down to the toes.

"We need to prove that we will dig deep to find the 'real problem,' not take the easy road," Dr. Massery said.