Great Expectations for Physical Therapy
As I was leaving for vacation last week my Dad called to let me know my grandmother had fallen (while taking out the recycling) and had broken her hip. She had also badly injured her shoulder when she fell, although it wasn't broken. It sounded like she was doing well, but I thought about her many times while I was gone.
After I returned home I learned grandma had an ORIF and was discharged from the hospital to a subacute rehab facility as she was non-weight bearing for approximately 6 weeks. I called my Dad and told him I would drive to visit her and watch one of her therapy sessions.
The day I visited her was 11 days post-injury and 7 days post-admission to the rehab facility. As I have worked with many hip ORIF patients in the past, and knowing my grandmother was completely independent prior to her injury, I walked into the therapy session with some general expectations of what her mobility should look like.
She was supervision or light min assist for bed mobility. She was able to boost herself to the edge of the bed by weight-bearing in both arms, but at times needed light assist due to weakness and pain in her left leg. She and the therapist did a standing pivot transfer to a w/c (supervision level, while maintaining her NWB status), and then she was taken to the therapy gym.
Her entire therapy session for PT was supine therex. The therapist cued her through the line of exercises -- hip abduction, adduction, straight leg raises, ankle pumps, heel slides etc. Her therapist was a very kind woman who had obviously developed great rapport with my grandparents. She was calm and very patient, taking notes and offering rest breaks when the pain became overwhelming for my grandmother. Meanwhile, my grandfather and dad are sitting in the gym cheering her on and both impressed with the progress she had made.
I was livid, as I had expected much more out of her therapy than mat exercises. I had to confront the therapist, but in a manner that was calm and would not disrupt my grandparents' relationship with the facility. "Have you been doing any gait training?" I asked. The therapist responded that it was difficult to do so with her sore shoulder and NWB status.
I agreed, but pointed out that the shoulder was able to boost with bed mobility, and therefore would also do well with weight-bearing through a walker. It is the therapist's responsibility to teach patients how to maintain NWB status, not to avoid ambulation out of fear or because it is easier. Furthermore, supine therex is very rarely skilled therapy. Supine therex should be homework the patient does outside of therapy sessions.
I brought my grandmother's walker back to the therapy gym, where we walked 6 feet x 2 trials. She maintained the NWB status and said her shoulder didn't bother her at all. "I just have to think about not stepping on my foot," she said. I nodded to my Dad and suggested that her therapy should include more walking. He agreed, but like most of our patients' families, he did not know what to expect.
I expect all therapists, especially those working with my family, to get more into a 45-minute session than a few exercises. I would hope all therapists can defend their reasoning for choosing certain interventions over others, and would target all activities towards maximizing progress.
*I suppose I should disclaim here, that my feelings are obviously magnified by the fact that I am related to the patient. Secondly, I don't know all the details of her case -- I have not read her chart. Finally, I don't know the details about the facility she is at, their policies or relationship with physicians. I am writing my perspective as I see it, regardless of my biases or pieces I may be missing.