How Do You Define Functional?
I'm having a debate with the PTA I work with. We can't agree on the definition of functional. I want to use it to describe activities, as in they are functional. She wants to use it to describe actions as functional, such as in functional ROM or strength. Her position is that a person can perform a functional activity without functional measurements.
Now this would be a great discussion for a roundtable panel or debate. We could argue for hours where the line is between functional and non-functional. Our problem is more basic. I write treatment plans to develop functional mobility such as gait and transfers. She works to increase ROM and strength. I agree there must be adequate ROM and strength to perform mobility. I just don't think entire treatments should be devoted to obtaining them.
I've lost count of the number of conversations we've had concerning tight hamstrings. Every patient she works with has tight hamstrings. That can be a problem. But to me, inability to ambulate is a bigger one. They were probably tight before whatever brought them to therapy.
Contractures are another sore spot. Contracture management really isn't skilled therapy. It can be managed by splinting and positioning. My PTA wants to keep patients on caseload to stretch out long-standing contractures. These are ambulatory patients who lack full hip and knee extension but are generally independent.
I feel like I'm always the bad guy because I keep asking why. My first question is always about the patient's functional status. My second is, "Why do you think it will help?" I admit my treatment ideology is very neuro-oriented. We never strengthen for strength, only for function; the same with stretching. Gait doesn't have to be symmetrical if its energy efficient, safe and functional. I just can't believe a few more degrees of hamstring length will make that big of a difference.
I've talked to her. I've talked to the rehab manager. I don't know how to bridge this ideological gap.