Chairs, Stairs and Ramps
"Watch my hands and legs!" I yelled to the HOH, 781.2 patient. I demonstrated the sequencing of getting up and down from a chair.
I took him to the stairs after that, again demonstrating with verbal cues for the patient to do as I do. The ramp was next. A quick demonstration and away he went, going up and down the grade like a pro.
Chairs, stairs and ramps have become a staple in my therapy routine. Not only do I find it functional for most patients, but all three challenge a person's balance and mobility all the while strengthening the legs and arms.
I try to ensure all the patients I see can at least get up and down safely from a chair, go up three to four stairs with a rail and ascend and descend a ramp without losing their balance.
The PTs don't always write goals for these and sometimes I am questioned about why I am doing it when there is no goal for it. The simple reason is that it works and I get results. Sometimes my treatment techniques are unrehearsed and unorthodox.
I remember I put Bag Balm on a patient because the PT and myself knew it worked. It was not in the protocol that I helped develop but was very effective. We could not tell the DOR or the administrator because they would not understand and they would want the MSDS and a whole lot of documentation to "prove" it worked.
Just like we know ice decreases edema and swelling, and after a TKA treatment the patient should probably apply ice to their knee. But we don't have an order for it. Like I told another PTA, "Why don't you call the surgeon out of surgery and ask him if it is okay to apply ice to a knee?"
What do you think the surgeon is going to say? This is an example where direct access is beneficial. It is also an example where goals and POCs should be written broadly enough for us to do our jobs without much interference and interruptions in a patient's progress.
Another example is the usage of groups. If a PT doesn't write it, we can't do it (or so I am told). If I see a benefit for a patient, should I ignore it because it was not written?
"Oh, I am sorry Mrs. Smith, I can't walk you today because the PT didn't write a goal for that and it is not in your plan of care." Yes, this occurred. The PT did not write a gait goal and questioned why I was walking them. I will discuss more of that later.