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Toni Talks about PT Today

A CEU Course Got Me Thinking

Published April 22, 2009 9:41 AM by Toni Patt
Saturday I went to a CEU course on neuroanatomy. That isn't something that lends itself to a full day of lecture but I made it through. The last hour or so is a blur. My brain stopped processing before the class finished. The instructor included treatment suggestions relative to specific structures. I have a new appreciation for theraband.  She also expressed her opinions about treatments and dysfunctions resulting from various injuries.  One thing she said has stuck in my mind.  Instead of treating the various impairments such as weakness or decreased ROM we should concentrate on treating function. She was speaking of chronic neurological patients who aren't going to get more return but it applies to many of our patients.

Her statement surprised me because I've always treated that way. As much as possible I work on functional activities. It never occurred to me that other therapists did something different. From what I've seen we're all pretty function oriented. I'm sure many of us fall back on to strengthening when we don't know what else to do.  That doesn't happen too often. Granted she presented things that hadn't occurred to me.  I just don't think her statement is correct. If all we did was strengthen patients we'd have gyms full of unilateral body builders who aren't able to do anything else.

She made another point about how we, meaning PTs, forget about sensation when we're assessing gait or whatever else. That was a "doh" moment for me. Neurologically-impaired patients are going to have impaired sensation. If sensation isn't traveling up the spinal column adequately the brain is unable to properly control movements. A patient with a cerebellar stroke is a good example. They have good strength but are all over the place when they move. Her point is that we have to include sensation in our treatments or in its absence teach compensation techniques. 

From that statement on her bias came through.  Every gait, balance or transfer problem resulted from poor sensation.  She said coordination deficits don't arise from weakness but from impaired sensation.  Yes, sensation is a part of it, but coordination won't improve until the muscles are strong enough to complete the movements.  The woman knew a lot, but she lost me right there.  Nothing in PT is all or none.  Movement is a combination of multiple systems working together.  Ideally impairment of one can be compensated for by another.  There is more and more research supporting neuroplasticity as an explanation of why brain injury patients improve. 

I'm sure she had a good reason for saying that.  She certainly got me thinking.  I don't pay as much attention to sensation as I should.  I realize I need to incorporate things into my treatment that increase sensory feedback.  I need to use more visual cues.  Until this weekend I didn't realize how important sight was for altering perception.  I used mirrors for visual feedback.  Now I realize I need to incorporate vision into treatments including simulating visual distractions to help pts prepare for the real world.  My patients will be walking more on the nursing floors and less in the gym to help with that. 

All in all it was a good course. It got me thinking.  I came up with some new treatment ideas as well as new uses for old things.  I agree PTs need to focus on function.  I don't agree that sensation is the answer to everything.  I am more aware of its importance for transfers, ambulation and fall prevention.   I now have a better understanding of how CVA location is related to presentation.  I also have a better grasp on when improvement means making the best of what a patient has instead of trying to get more out of the patient.  The next few weeks are going to be interesting as I try out what I've learned.

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