Week 7

Hello all! Returning to my project after spring break brought a pleasantly calm week. By that I mean no patients pranking me and minimal construction work on the new building, although one of the techs did tell me I was rude when I walked in with my coffee without bringing her one. I guess what I’m saying is that working at CAP is feeling more and more normal. This comfort has allowed me to interact more knowledgeably with the patients, even answering their questions about their exercise routines and the general physical therapy. Feeling pretty accomplished, I was probably walking around the office looking like this:

Unfortunately, I walked into my first shift not knowing what my research question for the week would be. Not the most accomplished. However, after hearing one of the patients say he would be back to give his therapist a gift even though he had finished his last therapy session, I decided to focus on another patient-based question. This particular patient remembered my name after I told him once, and before he left he wished me luck on getting into the colleges we had talked about two weeks prior!

The question for this week (inspired by the very kind knee-rehab patient): just how important is a good relationship between patients and therapists/techs for the therapy process?

Although this isn’t necessarily knee and hip injury specific, I think looking further into the patient-therapist interaction is crucial for my research about treatment specialization and individuation. One of the things I’ve noticed throughout the past weeks is how friendly all the patients are, regardless of their pain levels or anxiousness to finish their therapy. Even though some of the patients are not always in the best mood, they thank their techs and therapists and engage in conversation either with the techs or even the other patients.

I think the comfortable relationship reduces patient apprehension about their rehab. Especially for post-operative patients, the majority of their doctor’s visits aren’t necessarily as upbeat and enjoyable as the physical therapy appointments they have. Much of the effort at the office goes into ensuring that the patients will go through their rehab with minimal pain, which I think along with the interactions with the techs/therapists creates an enjoyable therapy process.

Within the final weeks, I will be seeing if I can sit in on an initial patient evaluation to see exactly how the therapy regimens for knee and hip patients are made. Until then, I will continue with my observations of patient-therapist interaction and routine specialization. See you next week!

Week 6

I took my spring break this week, so no new post!

Week 5

Hi again! Welcome back to my blog, this week there will be many more dog gifs and an answer to my newest weekly question. Since I explored the surgeon's role in rehabilitation a few weeks ago and have been researching the therapists' roles throughout my time, I decided to look further into the patients' roles as I hit the half-way point of this project.

This week I ask: how do patients influence their own therapy regimens?

Working the same days each week means that I see a lot of the same patients, and I've started to be able to recognize them (both by name and injury). I think this is in part with how much more comfortable I am at my site. Now that I'm able to help set up with heat, ice, or electrical stimulation, I've been pranked twice by patients pretending to be shocked after I place them on the lowest electric current. The first time I was definitely surprised and nervous I had burned the patient, so I looked at him kind of like this:

Other than choosing to prank the interns and PT techs, I wondered what other decisions the patients could make regarding the therapist/surgeon designed therapy routine. Obviously, the patients are ultimately in control of the intensity, number of repetitions, etc. based on their ability and pain levels. However, I wanted to know how and if they could be more in control of their therapy outside of those factors.

One of my favorite parts of this project and my observations so far is the relationship between the techs and therapists and their patients. Many of the patients will jokingly "complain" that their therapist is going hard on them during the appointment if the number of repetitions or weight is increased. While they're not truly angry, some of the patients definitely look like they would be willing to do this to their therapists:

Luckily, I haven't seen any actual altercations between patients and therapists, mostly because the patients are clearly thankful for both the techs and therapists and the treatment they are receiving.

Something I began noticing was that several of the patients were leaving the office either with handwritten notes or printed packets describing several of their usual exercises. This way, the patients would be able to go through the parts of their exercise regimens they could do at home. I thought this was a great way for the patients to take control and have an independence with their rehabilitation.

Overall, I've been focusing a lot of my energy on the relationships and individualization of treatments more generally. However, after one of the therapists said that the knee was the "step child" of the hip, I'm excited to start focusing more on knee and hip injuries for the second half of my project!

Week 4

Hello everyone!

Welcome back to my blog, I hope nobody has been missing my writing and dog gifs too desperately. Here's something to incorporate both just in case:

Since this is my fourth week working at CAP and my third in the new building, I'm starting to feel much more comfortable with the equipment, patients, and staff. As I've (slowly) gotten more familiar with everything and began to research the therapy process more closely, this week I came up with the question of how often and to what extent are the regimens altered during the patients' appointments?

Moving away from the surgical side of the rehabilitation I had been looking into the past two weeks, I decided to focus back on the more specific therapist/technician relationship with the patient. Before getting into my observations regarding my question from this week, I'll briefly explain what the general therapy process is for a patient.

For new patients, they are either referred by their surgeons (in post-operative cases) or come in on their own. Prior to beginning the actual rehabilitative regimen, the patients meet with one of the physical therapists for an evaluation, in which the patients' injury, range of motion, symptoms, and other abilities are assessed. The "eval" will help the therapist to write up the exercise regimen based on what is observed regarding the injury. Following this, the new patients go through the exercises written on their charts, closely observed by their therapist and guided by a tech. For patients who have already had their evaluations, when they enter the facility, they are either given heat before beginning their exercises, or immediately go into the regimen depending on their pain levels. After following the therapist-written work-out, the patients go to get ice or electrical stimulation (the game ready unit) and meet with their therapist again to discuss their progress and receive a massage. Most days the inside part of the office looks a little like this:

BUT on Wednesday, I actually saw a patient receiving suction cup therapy, which is used to loosen connective tissue and reduce pain. While this is unusual, I think it's interesting that it is offered and used for certain patients! After meeting with the therapist and receiving ice, the patient is free to go.

Alright back to my question: how often and to what extent are patients' exercise regimens changed while the appointment is in session? One of the days I was working alongside a tech, the patient was flying through one of the exercises for her ankle rehabilitation. After talking with the therapist, they decided to add weight to her squat work-out, and with a little ASU-level skill (# in innovation!) I was able to help by fastening two 5-pound ankle weights onto either end of a PVC pipe so that the bar she was lifting was a little lighter than the metal one usually used as she struggled squatting that. While it wasn't changed on the original notation, the tech wrote in the specific column and row for that day and that exercise that weight was added for the squats.

I think that this flexibility with adding/subtracting weight, increasing/decreasing repetitions, and other minor alterations helps to specify each patients' rehabilitation as they progress and their ability changes and improves. Further, this really shows the understanding and trust between the therapists/techs and the patients.

Next week, I will continue to look into what else is a factor in the individual and specified nature of physical therapy and find more dog gifs to add to my blog! Thanks for reading :)