Week 3

Hi there! With my third week of the project and second week in the new building down (I've finally stopped pushing the pull doors), I've learned so much about physical therapy and the unique interactions within the field. Last week, I was noticing that surgeons had an invisible role for the post-operative patients, and I decided to research the surgeon-therapist-patient relationship further this week. My question for this week: how often/do the surgeons determine the rehabilitation protocol for ACL, general knee, and hip reconstruction patients?

After doing a quick search for the specific ACL treatment protocol for the Mayo Clinic (one of the surgery locations patients come from for therapy), I found that physical therapy is required for ACL injuries and patients can choose to use a brace and/or crutches for stability. Many of the ACL reconstruction patients who come in do wear a brace, which can be unlocked for certain therapeutic exercises.

Fortunately, those with the knee braces also use crutches to walk around and don't end up looking like this clumsy pup. Based on a frequently asked questions page from Columbia University Shoulder, Elbow and Sports Medicine Service, patients must wear the brace for 4 weeks following their surgery.

Many hospitals and surgeons have similar timelines for when patients can stop using their brace, participate in sports again, and even begin driving after their operation. Normally, the first post-op follow-up appointment occurs within the first two weeks, with following appointments being decided by the doctor (often every month). However, my on-site mentor informed me that many of the surgeons CAP works with do not provide set protocols when they refer their patients for physical therapy. Those who do (about 1/4 of the post-operative cases) might meet with the therapist regarding what is expected. Dr. Jeschien also told me he prefers when surgeons don't include the protocols as much of the rehab process is dependent on individual progress and ability rather than set weekly or monthly deadlines to be reached.

I found this especially interesting. There isn't a definitive 6 month or year time in which a patient's therapy will be done, but the recovery is based on the therapist (and surgeon) opinion of how well the recovery is progressing and what they are able to complete.

As I've started to understand more about the surgeon-therapist-patient interaction, I'm anxious to begin research on other factors that impact the specialization of rehab!

Week 2

Hello again!

To start, I will include my question I used to guide my second week of research: what role does the surgeon play in the formation of post-operative patients' rehabilitation?

This week was the first week in the new location. While there is still some construction occurring on the second level, the downstairs is completely finished and functional. Unlike what I had previously expected, there is still the same "inside"/"outside" divide between the facilities, with the treatment tables inside and the work-out equipment outside. A new addition is the courts which are used by club teams, but the patients definitely use them for specific exercises such as lunges and running. Here is a (fairly low quality) picture of the new site!

Out of site on the right hand side are where the treatment tables are. Again, this is where patients can receive restorative treatments. One of the most used is the game ready, a sort of localized ice bath, where a control unit and body wrap (either shoulder, knee, or ankle) are used to activate air compression and cooling in order to draw heat away from the injury and stimulate healing. While most of the patients receive some type of ice packs, I did notice that a large number of the Anterior Cruciate Ligament (ACL) repair patients used the game ready instead.

With my second week, I was beginning to understand what was happening at my site more. The physical therapists' shorthand for specific exercises on patient charts were actually interpretable and I felt like I knew my way around both the "inside" and "outside" facilities. Because of this, my new question was slightly more specific. I noticed many of the patients were in PT for hip or knee surgeries, and I began wondering how the surgeon-therapist interaction impacted the therapist-patient one. After seeing some charts for ACL and hip surgery patients, I saw that a few had several extra pages stapled to the back from the surgery office with deadlines and goals to meet post-operation. I also picked up a sheet that had a basic description of post-opertive knee exercises. After seeing these two things I felt pretty accomplished, and a little like this:

While the relationship the surgeon has with the rehabilitation protocol isn't as direct as the physical therapist and techs', there is definitely a large influence on how the therapy should be executed and on what schedule. For knee and hip injuries, this definitely seems to limit the individuation at the expense of time efficiency, but the PTs still have flexibility to add extra work-outs or reparative treatments they believe will benefit the patients most based on their age, mobility, etc.

I'm very excited for the upcoming week and what else I will be able to discover about knee/hip injuries and the therapist-patient relationship!

Week 1

Hello all and welcome back to my blog!

This week I started interning at my on-site location, Center for Athletic Performance and Physical Therapy. While my first day meant filling out paper work regarding patient confidentiality and interaction limitation, I was extremely excited to begin observing appointments to learn more about doctor-patient interaction. One of the most important things I learned about this site in particular are the different areas. The "inside" is made up of treatment tables, where patients can receive ice/heat packs, stretch, or get isolated muscular massages. On the other side, the "outside" is structured more like a gym, with work out equipment throughout for patients to go through their rehabilitative exercises. However, starting next week the inside/outside split will be a downstairs/upstairs division, since the entire facility will be moving location to a larger building! Luckily the staff and patients will remain the same and I will be able to continue my research.

Another interesting division is within the staff. The physical therapists are those with their doctorates and primarily work with patients "inside", performing fire cupping massages, kinesio tape wrapping, and other restorative treatments. The PT techs are either physical therapy school or undergrad students, who guide patients through their exercise programs "outside" or other stretches "inside". As an intern, I'm able to move between the two areas, primarily reading charts and observing regimens during down time "outside" and helping with laundry "inside" during busier hours.

For each week, my on-site adviser asked that I have a question to guide my research. The first week brought a more general question: what level of independency do the patients take with their exercise programs? After watching several outside exercise programs, I noticed that several patients ask the PT tech to explain each exercise and watch their form. However, others who have had more appointments only require the occasional check-in to confirm the number of repetitions or weight amount their therapist wants for them. Some patients ask to do their hardest exercises first and finish with the easier ones, showing that there is a certain flexibility. One of the common requirements for almost all of the knee and hip patients is the "alter g" which is an anti-gravity treadmill to reduce pain upon movement and leaves you looking a little like this:

So far, other than the alter g, there seems to be some similarities between the majority of knee/hip exercise regimens such as squats, lunges, and other quadricep stretches. The specialization seems to occur both within the "outside" workouts and the "inside" treatments, and depending on the patient's fatigue or pain level, certain parts of the program may be skipped or new steps may be added.

I can't wait to see what else I will be able to discover about how the regimens are created and how the doctor-patient interactions are unique for each injury, especially in the new building! Stay tuned for more observations on the physical therapy field and dog gifs next week.