If we spend between a half hour to an hour to locate equipment for one patient so they can be aligned and positioned correctly imagine what that does to productivity when we see eight to 10 patients a day. So, who is supposed to be responsible for the wheelchairs where I work? Nursing and the maintenance department.

I go back and forth with this. On one hand, if the therapy department is not responsible for the wheelchairs, we leave it up to nursing and maintenance to find the equipment to properly align the patients in chairs and give up one more skilled assessment that we are trained in. On the other hand, if we spend an hour locating all the equipment for one patient then properly align and position them for comfort and safety, there is no guarantee the wheelchair will still be in the patient's room the next day. 

A big problem is when all the wheelchairs are cleaned. They are taken from the rooms, lined up, sprayed and wiped down weekly. But no one writes room numbers on the chairs prior to doing this. So imagine the confusion when the chairs are returned to each station. One nurse I met at a facility had the maintenance department weld the footrests onto the wheelchairs. This solved the missing footrest dilemma but interfered with transfers because the chairs could not be properly positioned at bed side. A suggestion at one place was to use wire to attach the footrests to the chair itself. This worked until a patient received a skin tear from the wire. 

My solution:  Nursing should be responsible to find and locate the wheelchairs and footrest and maintain this for every patient in a facility. Since we are using the interdisciplinary approach and teamwork is the key, all patient care departments should take some form of responsibility for the patients. Then when the patient is evaluated or on the next treatment session a proper assessment of wheelchair seating and positioning can be made by us. We can then use a sticker from the patient chart and place it on the back of the wheelchair.

Another issue is the shortage of chairs. This is a facility and administrator decision but should be brought to their attention by both nursing and the therapy department. If a facility has a shortage of medicine for patients what do they do? Order more. Yet if there is a shortage in equipment that provides mobility and strengthening, the process to order more is much slower. I have yet to see a facility run out of needles for patients but theraband takes weeks to get. Anyone else have solutions or ideas about this?

When our second DOR left it was apparently supposed to be a secret. I ask you, how do you hide something like that? She was not to tell anyone in the facility, including us, that she was leaving, and because it was a secret we all knew about it. 

I have worked at places where there is backstabbing and little "secrets" that only a few employees know about and I find that childish. If an employer wants to take a position they should be up front and honest with the department. Don't you think we would find out on Monday morning when the new DOR is taking charge that a change occurred, or are we that dense that we wouldn't notice? Come on employers, we're not that stupid.

I have worked at places and when a PT/PTA was "let go" we explained to the patients who asked that he/she went on to better things or that they found a new job. Easy explanation and understandable by the patients in long term care who are used to seeing our smiling faces everyday. But this time...it boggles my mind, why the secret? Am I supposed to tell the 90-year-old-patient, "I don't know what happened to our boss; she just didn't come to work."

An employee is the backbone of the company. No surprise there. But if I have no idea what my employer is doing and when they are doing it, how can they expect me to carry it out. Maybe I should ask more questions. 

We are like that at my facility. No matter how busy, no matter how many upset folks we have, we smile, joke and put our patients at ease. There are five of us in the department and each one of us brings to the department the best of what we possess. 

Of course there are frustrations but we don't let the little things interfere with patient care. If a patient comes to the department unannounced we put them to work regardless of whose caseload they are on. We work for the betterment of the patient. 

The meetings we attend, the phone calls made, and even the charting we do are all part of getting the patient well and ready to move to the next level of care. If we can do all of this with the attitude of Mr. Rowe, then the job just got easier. I have even expressed that we should have the demeanor of Spongebob. 

People will laugh at me. Here I use two figures on T.V., one who performs only a fraction of any job and does not have to deal with the politics in a facility and the other, well, he's a cartoon. But look beyond that. It is their attitude and their outlook on situations that we can learn from. When our department gets busy and stress begins to creep in, I always keep in mind two of my favorite folks on T.V. and things gets easier for me. And this brings me to one last thing. When people look at us are we displaying what we want them to become?  

I have asked myself that question and have been told by patients and family members, "Oh, you're the assistant, can I talk to the therapist?" So, like everyone else who wanted to better themselves I went back to school.

My resume is quite impressive. Lots of jobs in different settings, plenty of experience, publications, CEUs, certificates and, of course, several degrees.

I have been told if I do not like being a PTA I should go back to school to become a PT. Sounds like a great idea until I took a look at tuition costs for me to become a PT. I would be better off becoming a nurse. So I went to nursing school. It didn't work out the way I planned and it took me away from my family too much so I abandoned that after a year. (I was taught great assessment skills though.)

Then I got to talking to some other PTAs who would consider the option to become a PT if the courses were made more available to them. Most of us had 10 plus years in the field and were fairly adept at our skills and confident in our knowledge that we could become PTs if we wouldn't have to take A and P, chemistry, biology, etc., all over again. Apparently some schools "expire" the courses on the transcripts if they are more than 5 years old. Does human anatomy and the basic chemical make up of living organisms change that rapidly?

What a PTA with 10 plus years of experience would need is primarily evaluation and assessment skills. Yeah, we could throw in a couple of review courses (keep them condensed and brief) then get on with the clinical part of the program. I think a one-year intense clinical training program for a PTA with 10 years in the field would be a good transitional program. How many of us with that many years in the field would actually do it if it was a year program?

There weren't any available. But the athletic trainer book was more acceptable than one written by a therapist. Imagine that. 

I am sure there are PTAs who enjoy writing, just look at ADVANCE magazine and there are articles written by assistants. More of us need to take this a step further and write a book.   

I did. Well, not exactly. I wrote about two chapters of an assessment book and pitched it to a high profile company that specializes in therapy books. I was sent a notice that they were not interested until enrollment increases in the PTA programs. Fair enough. Other publishers did not even bother to respond.

Since that time I have seen several books written by PTs for PTAs.  Perhaps my ideas were not what they were looking for at that time. Maybe there is a PTA who could deliver a book that publishers are looking for. 

I know PTAs have written books. These books should be available to every PTA program for them to use either in class or as a reference. (This is where I could have shamelessly plugged my own book of therapy if I had bothered to finish it, instead I will plug my poetry book.) 

The bottom line for PTAs is to get out there and write, research, educate and encourage one another about our profession. And for those PTAs that are currently doing this, please continue, we need you.

It's a challenge to take on one or two students, but it is worth the time and effort knowing that some knowledge was passed along to others who will also share that knowledge in their career.  I enjoy the time I spend with students and I like the questions they ask.  The best thing is that when I can't answer the question I could say, "That's a great question, why don't you look that up and let me know what you find."

But I don't say it. I could, but that would not be fair to the student. I hardly ever quiz them on anatomy (Where is the articularis genus muscle and what is its function to the structure it affects?) I would rather question their clinical judgment to situations in patient care. I figure they get all the book work and A and P stuff in school.

I've had them practice their hand placements in the ICU with comatose patients to allow them to get a better idea on how to stand at the bedside and what to look for and feel for at end ranges at different joints. I've gone on field trips with them to stroke centers and assisted living places to allow them to get to know the resources in the area they will be working in. 

I bring them into meetings and let them listen in to the phone calls that are made-the tedious stuff that we do-to allow them to see what it really is like. Sure it would be easy to show them the facility and within a week let them see patients while I kick back and answer their questions but they would not really be learning what its like to be a PTA.

I encourage them to speak to the social workers in the facilities and if they feel comfortable with it they can discuss treatment with the MD if appropriate. I've known some PTAs who were treated like aides during clinicals.  If that happens, it's time to find another place to be for four to six weeks. 

I also figure it is better for a PTA to be the CI for a student PTA because the student can actually see what we do. The student can learn when to defer treatment to the PT and get a better idea about scope of practice. Who better to learn from than a seasoned professional in the same job?

Some places may not allow the PTAs to be CIs and that is ridiculous. How can a student PTA learn to do a job effectively if they are not trained by peers? How will they know when to take the initiative and when to discuss patient care with the PT prior to treatment? Doctors train doctors, nurses train nurses and PTAs need to train PTAs.

As much as I dislike complaints about our profession, every once in a while I like to get things off my chest.

Productivity
Until my employee handbook expressly states what my productivity will be, I do not worry about it. My yearly evaluation has nothing about productivity so my work cannot be based on it. If productivity is such an issue why don't our employers put it in writing?

In all the years I have worked and all the jobs I have had, only one employer did and it was for a per diem position to be between 75 and 80 percent. None of the full time positions ever mentioned productivity in their offer letters.

Insensitivity
I have three children. Two of them have disabilities. One has Aspergers and Bipolar Disorder, the other has Complex Partial Seizures affecting her bilateral temporal lobes.

Looking at them no one would suspect it. Even a conversation with them would reveal little in the way of their diagnosis.

I only mention this because some people have a difficult time understanding why I need/want time off. Employers need to recognize that some of us do not live to work. I have appointments I need to attend; I have a family that needs me. And for heaven's sake, let me use my sick time or PTO/vacation time when I need to go.

If employers are not sensitive to my needs and family issues, it is time to look for another position.

Other Employees
We're a team, right? But does everything we say have to be repeated to our managers? Doesn't the manager have enough to worry about? I have told the team I am working with, "What we say in the therapy gym stays in the therapy gym."

I am professional enough to know when an issue is really bothering me and when I just want to gripe about something. If I want the manager to know something, I will tell them. I have even encouraged others to talk to the manager if they have an issue that concerns them.

There are times in my day that I want to question policy issues to get another opinion or two about it. This does not mean I hate the employer. It does not mean I am going to form a union and strike. I only want to get an idea of how others feel about it, that's it.

Insurance Companies
I could go on forever about my dislike of the insurance industry. My big question is "What methods do they use to determine when a patient is ready for discharge?" I know some look strictly at gait distance and discharge when the patient reaches 50 feet, even though they were max assist to stand with a Berg Balance of 20.

Most do not even care about the ADL skills. Some of our patients couldn't get dressed but could walk 100 feet, so they were sent home. We have tried to pin them down by asking what they look for, but we have yet to have a definitive answer from the insurance companies we work with.

My other question is, "When did we as therapists give up on fighting for the patients?" Is it because we know if we argue with them they will not refer any patients to our facility, or did we just get too tired of fighting? Do we only argue certain cases and leave others? And how do you determine that?

Most days are not complete for me until I begin my day with 450 minutes of work, a frantic phone call from my wife about two appointments occurring at the same time and who's going to pick up our son from school, all of us griping about how the facility runs and the insurance companies discharging half our patient load for too much progress or lack of progress. Oh, the humanity!

Not only that, I have a small library at home (once encompassing our two car garage).

Often the subject of the book is unimportant to me.  It is the way a writer will tell a story. Within the first page or two I can tell whether it will be a book I will enjoy reading. 

I read Asminov (I love science fiction), Grisham (I think the books are better than the movies), Roald Dahl, Elizabeth Gilbert, Edgar Allen Poe, all sorts of biographies and countless other authors and subjects that I could name.  All of these are read purely for pleasure and each one exposes me to a new format, a new idea, and even a different outlook on life. 

For professional reading I will often turn to the Internet and do searches on a particular subject that I am interested in at the time. Several years ago I was doing a search on the history of therapy and some of the pioneers of our profession.  I found a great site.

www.mediamd.com/ptjay

Jay Schleichkorn, PhD, PT, sent me two of several books he authored; one was about Signe Brunnstrom and the other was about William John Little, MD.  I devoured the books in a relatively short time.

When we look at history of any profession or genre of stories we can see that it changes over time.  Once there were healers and restorative aides and now we have Therapists.  Once there were petroglyphs then printed books now there is the internet and e-books.  The concept doesn't change it is the way ideas are progressed that changes. 

The concept of our profession is healing, that does not change. It is the way we perform that skill that changes by new technology, new ideas, and understanding that the foundation the PT pioneers laid down for us has allowed us to progress to where we are today.

Except, if the patient or family member speaks another language we can communicate in.  I live in Southern California, guess which language is spoken second only to English in my facility?

But Spanish is not the only language I have used to communicate with patients.  I have also spoken Cantonese and Armenian.  Now I am not fluent in a foreign language by any means and my accents are usually way off,  but I do try to pick up a few key words and phrases to better communicate with patients in their native tongue.  I know of facilities closer to Los Angeles where Tagalog and Vietnamese are the most widely spoken language in the facility and if you are a therapist working there it would be a good idea to pick up the language so you can better communicate with staff and patients. 

Over the years I have heard therapists say, "Why learn another language?" 

But didn't that therapist learn Latin and Greek (the roots of medical terminology) so they could better communicate with others in the health care field?  If we want to better communicate with our patients we should try to learn their language. 

I have lived in Turkey and the Netherlands when I was younger.  While there, we traveled to different places and countries.  We would not have survived if we were unable to communicate with others.  We, at times, had to order food, drinks, exchange money, etc. all in another language.  We did it, we survived, and if one is persistent enough to navigate through a foreign language they can do it too. 

The internet offers multiple sites for learning.  One of my favorites is http://www.mangolanguages.com/.

A quick translation site is http://www.babelfish.altavista.com/.

But I do have a question that has not been sufficiently answered.  If I speak in medical terminology in front of the patients can I get in trouble?

When I first graduated from PTA school and began work in a hospital I did not even consider wearing scrubs. I wore khakis, a button down shirt and a tie. I gave up the tie after several months but kept with the pants and shirts and continue to do so even today. 

The neurologist we take our daughter to (she has bilateral temporal lobe epilepsy) dresses like he just came out of a GQ photo shoot with Annie Leibovitz. Why can't therapists look like that? 

I don't suggest we all dress in suits and ties, but pants and button down shirts are professional, so are polo shirts, especially if the polo shirts have the company logo on them. 

Now, let me discuss scrubs-not the T.V. show but the ones some people wear. Look around at your work site, count how many departments wear scrubs. Then consider your patient; they see countless people wearing scrubs coming in and out of their room and they can become confused as to who was who. (Are you the housekeeper? the nurse? the doctor?)

Better yet, let me wear sweat pants and a pocket T-shirt to work. Aren't they the same comfort level as scrubs? I could even coordinate the colors of the sweat pants and pocket T's. Since I have to bend, squat and constantly move, wouldn't that be a better style of dress for the work I do? There is not much difference between pocket T-shirts and scrub tops. Would the patients respect what I had to say, would they still think I was a professional?

Well, maybe if I wore a lab coat over my pocket T-shirt and sweat pants, that would look alright wouldn't it? I would look professional; I could even embroider my name in the lab coat.  What do you think?

He had a complex history prior to breaking his leg at home and going through extensive rehabilitation at our facility. His wife was extremely supportive with all the efforts he made and was always positive in the care he was provided.

When he was transported to our local hospital I went to visit him there. I am glad I did. He had a stroke that evening and was placed on hospice care before coming back to our facility. 

I have visited patients in the hospitals before, and have even driven one home on a Saturday when he was discharged. 

Am I going too far? When I visit I try not to discuss medical conditions or their care, I go to visit with them as a friend, a concerned friend. I worry about my patients when they leave for the hospital and do not return within a day or two. 

Now, I don't visit with every patient but those that I feel a connection to. There will always be patients that we will never forget, those that somehow touch us or remind us of a family member and we can often feel like one of their family when we treat them. 

This of course takes a toll on me mentally. It's as if I have grown attached to my patients and I want them to succeed and get better no matter what. I ask myself if it is worth the mental drain it takes especially when a patient passes away. Some might wonder why I do it, what purpose does it serve to visit a former patient that may or may not come back to our facility. My answer: I do it because I care. 

After sitting in a crowded room for what seemed like days several of us potential jurors were sent to a courtroom. After painfully long instructions we were asked several questions about our families, children and whether we could be fair jurors in this case. 

I answered all the questions truthfully and became juror number two. 

Over the course of two and a half days the case was presented and we all went to the deliberation room to "deliberate" the case. Once seated in the room we took a vote and I was the lone dissenter, voting undecided.  The others, all 11 of them voted guilty immediately without a discussion of the facts and conflicting testimony. 

I often wonder how many times this happens, we make a decision based on what we want to hear and not even try to understand the other person's side of events. It is very easy to label, judge, or convict a person but it takes courage to stand up and say, "Wait a minute, lets examine this, lets take another look at these events."

I tried to understand my fellow jurors and some of them expressed that they did not get paid for jury duty and wanted to get back to work or school. For them it was easier to say "Guilty" than to discuss the case so they could continue on with what they do best. 

For me, I want to be absolutely sure I don't condemn an innocent person.

Working in therapy for the last 12 years has allowed me to know what equipment is the most useful as well as equipment that has less value in treating patients in a nursing facility. Although it is not an all inclusive list, this should cover all the equipment one needs to provide care to a variety of patients with the best treatment options. 

1. Theraband. Red and yellow has served me well in every environment. I will usually have the length longer than usual (about four feet) to accommodate for the height of a patient as well as wrapping it around the back of a patient's wheelchair for upper body work. Most of us know the most beneficial activities to do with our patients with the theraband for upper and lower body exercises.
2. A 12 inch ball. A patient can squeeze, throw, place one foot on it and balance, kick it, etc. 
3. A 32-38 inch ball. The patients can sit on it, bounce it, roll it up a wall, kick it, etc. 
4. Mat table. For rolling, sit balance, transitional activity from supine to sit, sit to stand, etc.
5. Floor mat.  For fall recovery, static and dynamic balance activity.
6. Stairs. This is a functional activity for patients and can simulate a curb. Going up and down with and without a rail works on balance and stability for center of gravity awareness. 
7. Ramp. This is also functional and works on balance and stability. Having a patient stop in the middle of the ramp can be extra challenging for static balance.
8. Gait belt. What would therapy be without one? It can also be used to resist patients when they walk as well as provide lateral sway to assist with advancing gait.
9. Home exercise programs. With pictures and clear descriptions of each activity.
10. And one of the most important items that I have used is another language. Although my command of another language is not fluent, I do have a list of words such as stand up, walk, right, left, where is the pain, etc.  A language guide is definitely a must have in a facility with non-English speakers. There are auto-interpreters on the internet as well but the accuracy is not always 100 percent with the phrases.

I did not include upper and lower extremity weights because the theraband can provide the resistance needed during a therapy session. When multiple patients are seen theraband is also a quick and easy way to facilitate an exercise session.

Before there were machines for resistance or gel centered balance discs there was us, the providers of the therapy sessions. If we can provide care that tests the patient's limits without a lot of equipment, then we know we can give our patients quality care in any environment and make an assessment that can only benefit our outcomes in the care we provide. The equipment used should only be an extension of what we can provide, it should not be the only thing we provide.

Last year I worked three jobs. So far this year it has been only two, but I am working on my third and it is only the beginning of the year. Some may ask why I would want that many jobs in one year and why I would want to "job jump."

Let me explain. Last year I quit one job and took another so I could be closer to home with my family. I also worked per diem for another company, hence, three jobs last year. One might wonder why I don't stay at one place and be content. Why work with so many employers and why seek out even more?

The benefits of multiple jobs can be similar to having multiple degrees. With more education it gives a broader perspective and often a greater insight to situations that arise in life. If I have a greater knowledge with multiple employers I may be able to find systems that work more effectively and efficiently with less time expended on the task.

I can also learn from those who have a greater understanding in tasks that I have not done. I can then take those tasks and teach others in the many places that I work. Some of these tasks include a non-conventional approach to patient care like those listed below.

1. Find a room that has low or no light available to it and have a patient find objects in the room such as books or clothes. The patient can use a flashlight if no light is available. This can simulate a home environment in which the power is out as well as spatial awareness and balance with patients. A list can also be given for the patient to find three things in a specific order around the room. This activity should be done with closer to normal supervision with higher level of activity patients.
2. Water balloon toss. Not every patient will enjoy the possibility of getting a little wet but it can induce a lot of laughs and most patients will enjoy just being outside in good weather. If the patients do not want to toss them back and forth you can see how far they can throw them and have some competition between each of them. They can stand and throw or sit in a wheelchair and toss the balloons around. As a side note, when I worked in Palm Springs we threw them at other staff members; like I said not everyone enjoys getting wet.
3. Badmitton. This is a hand-eye coordination activity as well as a balance challenge and an upper body range of motion challenge. The rackets are light weight and the "birdie" will not be injurious if it hits someone or something. Again, being outside will be beneficial for the patient and this can be done as a group activity.  I have also played volleyball using a beach ball and a long length of theraband as a net when the weather was rainy.
4. Obstacle course. This is done in a non-traditional way across different terrains, up and down stairs, around and between chairs, desks, people, cars, etc. We have also rolled objects in the patients way as they were walking to simulate small pets as well as "accidentally" bumped the patient to simulate them being at a mall or grocery store with a lot of people around. Having them carry a bag or box can increase the challenge. Even those who require the use of an assistive device can carry a bag while trying to maintain balance in the parking lot walking between two cars parked close together, just like the real thing.
5. Have the patients call the Bingo numbers or make announcements in the facility. This is great for those who have difficulty with memory, sequencing and speaking clearly. Of course some patients may not feel comfortable speaking to a large group so a group therapy activity with four patients of bingo may allow the patient to be more comfortable.

The list should not stop here though. I have had patients use the internet to look up information about their knee or hip surgery. Often this was their first exposure to the internet. It is not so much as about seeking outside-of-the-box thinking but more of using every opportunity and non-conventional approaches to better serve our patients and challenge them as well as ourselves to provide a variety of activity they will remember in their rehabilitation process. Often this type of thinking and doing will separate us from our competition in the field of restoring patients to their full recovery of activity.