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Toni Talks about PT Today

Why Didn’t She Facilitate the Knee Extension?

Published December 23, 2009 9:17 AM by Toni Patt
Yesterday I was standing in the hall watching another therapist walk with a hemiparetic patient.  I made a comment to the person next to me that I wouldn't have done it that way.  I didn't understand why she wasn't facilitating knee extension in weight bearing.  I was told that I'm the only one who does it that way.  I was told that once before.  I thought it was in reference to technique choice.  Now I think it was meant in terms of philosophy.

The therapist I observed has been at the facility awhile.  I assume she's been doing the same things most of the time because they work for her.  That's what most of us probably do to varying degrees.  Over the last few years I'm changed how I look at my neuro patients.  Naturally my treatment approach has also changed.  I think I've been getting better results so the changes were positive.  Now I wish I would have asked her about what she was doing.  It got me thinking.

Which is better?  Doing what you've always done because you're good at it and you get good results?  Or, changing what you're doing as you learn new things and improving technique as you go?  Obviously the other therapist felt comfortable with what she was doing.  She was probably looking at various things to tell her what she needed to change or work on more.  I've seen some of her patients after they come to rehab. They're usually ambulatory, but I have a lot of cleaning up to do.

Here's another thought.  Instead of technique, it might be process-oriented.  She sees patients in the acute part of the hospital.  She only has a few treatments to get those patients mobile.  I see patients on the rehab unit.  I have more time to work with them so my focus is a little different.  It's been awhile since I've done any treatment on the acute side of things so I'm not the best judge.  It seems to me that you would still want to make the gait as good as possible to prevent fall risks, etc.

It could be an old school, new school thing.  Even though I have more than 20 years of experience, I'm very new school oriented.  The other therapist has enough years of experience to be considered old school.  There are significant philosophical and theoretical differences between the two.  Back in the day, it was enough to get someone walking.  Now the expectation is higher.  Newer therapists have been taught differently and their practice patterns reflect it.

Back to my original thought - why didn't she facilitate the knee extension?  I'll have to wait until I see her with another patient to ask that question.  I'm not questioning her skill.  I want to know if there was a specific contraindication arising from the patient or whether it was the way she generally did things and why.  I think that comparing her way versus my way would be an interesting comparison.  I'd probably learn something.  Although I would still try to facilitate the knee extension in stance phase.

Everybody does things differently.  Evidence-based medicine recognizes therapist skill as a key element in treatment selection.  Evidence only supports a treatment if the therapist is able to perform it adequately.  I know there are lots of things that, despite the evidence, wouldn't work well for me.  I'm going to keep on trying to build on what I learn with each patient.  I never want to do something because that's the only thing I know how to do.


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