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Toni Talks about PT Today

Therapy Has to be Challenging

Published October 9, 2008 7:43 AM by Toni Patt
Two weeks ago my friend Bee resumed her riding lessons. After the first lesson she complained that "it was too hard" and said she "didn't like being corrected" like that. She blamed it on the horse. She rode a different horse for the next lesson. This one was much easier to ride. Bee's lesson went better. Afterwards Bee announced that "it wasn't her, it was the horse." She knew she rode better than that. She didn't have an answer for me when I asked her how she expected to get better if she never did anything challenging.

So what does this have to do with PT? It has a lot to do with the patient's perspective on therapy. We're always asking them to do something hard. We're always picking on their weaknesses instead of strengths. Like Bee the first time, I always give my patients the harder horse. I tell them we wouldn't have to do this if it was easy. To help a patient improve I have to help them master increasingly difficult challenges. The body adapts to what is asked of it. So I have to ask for more each time.

I've had many patients like Bee. They want the easy horse. Unlike Bee, most patients realize the problem is them not the horse. For whatever reason, these patients don't want to work that hard at therapy. The problem is easier therapy brings slower progress. Hard and easy are relative terms. What's hard for one patient may be easy for another. My challenge is to find the right level of difficulty for each patient. I work in acute care. I don't have much time to get someone moving. I tend to make things more challenging because every minute counts.

Not all patients agree with me. They don't think harder is better. Some want easier horses. Some don't want to ride. As a result I spend a lot of time encouraging them to participate with therapy. I can only make something as challenging as the patient is willing to attempt. If a patient doesn't want to try standing I can't force it. I know standing is a good thing. Unless the patient agrees with me and is willing to try, it won't do any good to attempt it. I try to never make things too difficult. I want my patients to succeed. Success makes them feel good about therapy and keeps them motivated.

I don't think Bee's riding will improve very much because she isn't willing to work at it. She hasn't figured out that to improve she must work on her weaknesses.  Patients seem to understand that. Many can tell you exactly what the problem is and what to do about it. They're usually right. I've had patients admit they need therapy but still refuse to participate. My job as a therapist is to find the happy medium between hard and easy while at the same time encouraging the patient to work with me. The patients that do that make progress.  The ones that hem and haw may make progress but it takes so much longer.

posted by Toni Patt


Interesting comparison and understand your perspective however in Bee's scenario, horses are intelligent animals they do respond differently especially to non experienced riders such as not responding to commands or producing an unscheduled dismount. Some horses simply are more tolerant than others and there is nothing wrong with learning to ride with a calmer horse. When learning to ride on a "challenging" horse can be discouraging, frustrating and especially dangerous . Comparing to coaches, personal trainers, athletic trainers, etc it's the ability to motivate the individual in order to overcome their comfort level and perform at their best. It's not Bee but rather Bee's instructor that has the challenge to problem solve and improve Bees riding skills. It's our challenge as well to find techniques that will motivate and produce positive outcomes.

TOM , PTA November 2, 2008 11:26 AM

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