The Way We Used to Do Things
Ever had a flashback to something you were embarrassed to admit you did? That happened to me last weekend. I was listening to a lecture on the use of NMES post-stroke. The speaker was talking about early use of NMES and being beyond the days of using it in the hopes something might happen. I immediately remembered doing just that.
It was many, many years ago and I'm still embarrassed. I can remember talking with other therapists about how to use it. The practice was to pick a joint, usually wrist or ankle, dig out the innervation charts and crank up the juice. OK, we might have been a little more sophisticated. Even our best efforts were very hit or miss.
I don't recall any guidelines for intensity, wave form, on/off cycle or duration. We used gel and rubber electrodes. Patients were generally passive. Their contribution to the treatment was to attempt to move the joint when they felt the electricity. Maybe the therapist helped move the joint during the contraction. Today I cringe to think about it. There was no scientific rationale or evidence to support the intervention.
That's a far cry from where we are now. Use of NMES is one of the most researched topics in physical therapy. Appropriate patients are selected based on functional goals. In the past, we may have been happy to see movement. Today, we target specific movement patterns and work with patients toward goals. Application of NMES is based on evidence.
I'm sure the same could be said about other interventions back in the day. To be fair, we didn't have the evidence and research then that exists now. Nor did we have the technology that enables us to refine techniques and applications. Use of modalities was more widely accepted. Bed rest for a week or more was common after orthopedic surgeries. We weren't aggressive with what we did.
We were doing the best we could with what we had. I feel like I've had to relearn the practice of physical therapy twice since graduating. The profession has changed that much. So now I can laugh at myself and NMES and maybe a few other things. I rarely think about how we used to do things. I'm curious about how we'll be practicing when 2011 is considered "back in the day."