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Toni Talks about PT Today

It Only Looks Routine

Published July 27, 2010 9:43 AM by Toni Patt

I heard something interesting last week. I was working on weight bearing on a hemiplegic limb. The patient's husband was watching. After 10 or 15 minutes of watching me sitting next to the patient he told me I sure was getting a lot done for just sitting there. I realized something. I knew I was working. I was stabilizing a knee, pulling weight on to a leg that didn't want to go there and maintaining erect posture. To the patient's husband it looked like I was just sitting there.

That would probably be true for any outside observer. Unless I'm actually walking with someone I'm usually sitting next to patient with hands on. Even though the patient may be moving, there is no visible therapy occurring. To a casual observer it looks like I'm not doing anything even though I'm usually doing a lot. That observer has no idea of the thought process prior to the therapy. I have to consider what I want to challenge, how hard I want the challenge to be, how I can use the environment, what position I want and safety.

If and where I sit is determined by the patient's ability. Usually I'll sit next to the hemiparetic limb so I can work on the knee and weight bearing. Sometimes I sit on the other side so I can prevent cheating. All an onlooker sees is me sitting while my patient is doing the work. Patients know the difference. Sometimes it's obvious I'm helping the patient but all of my patients seem to be doing the same thing. In reality each patient might be doing the same thing for completely different reasons. You'd never know that by looking.

A lot of thought goes into what PTs do. I can only speak for myself but I'm usually working on three or four things at the same time with one activity. I don't have much choice since lengths of stays are so short. I'd be foolish not to. Every so often someone asks me what I'm doing or why, especially if I'm "just" sitting in my chair. Those people quickly change their minds once I explain. The difference between merely sitting and sitting while doing is one of the ways we define skilled intervention.

Anyone can sit next to a patient to prevent falls. A PT sets up a challenging activity to facilitate function while providing facilitation of desired muscles, sitting next to the patient to prevent falls. Sometimes I have a tech help me if I really can't do it all. Then it looks like we're both just standing around while the patient works. The same principle is true in every practice setting. It only looks like we're not doing anything.

I do have one idiosyncrasy. I have a favorite chair and refuse to use any other. It is light weight, lacks arm rests and slides easily along the floor. The seat height is perfect for me to block knees. I use it for gait training because I can slide it along next to the patient. At least then it looks like I'm working. It takes a lot of coordination to slide the chair, keep my balance, advance a limb, block a knee and shift weight smoothly. And no matter how fast I am, the patient always tries to go faster so it looks like a perpetual game of catch-up between us.


This can be frustrating.  People assume since it is physical therapy they will see their parent/wife/son/daughter up and walking and then they will be better.  Sometimes a brief summation during the activity to whoever is there to explain what you are doing and why will quiet them.  But in the end everyone thinks if thay are not up and walking therapy is not taking place.  

The Peds comment was funny, when I did peds in school other teachers, janitors, etc would make those comments.  There are some things you let go of and try not to justify but to explain what is going on.

Jason July 30, 2010 10:34 AM

Great post.  I bet you write excellent progress notes.  A lot of PTS know how to get results, but don't know how to paint the picture on paper - you do that well.  I've noticed that in many of your posts - one of the reasons you are writing a blog, no doubt.  Ever thought about teaching a documentation workshop?  Not as exciting as some other topics, but it certainly is needed.

Janey Goude July 29, 2010 12:02 AM

Reminds me of my days in Pediatrics when people would say "all she does is play with them"!

Aubrey Bailey July 28, 2010 8:28 PM

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