Sunday, September 12, 2010

Am I a Teacher? Or am I a Therapist? (Elise)

I first became interested in physical therapy because it was a health-related profession. Science had always come pretty naturally to me, and I liked the idea of being able to help people. As I shadowed PTs in different settings (hospital, outpatient, schools), I began to realize and appreciate the relationships that PTs formed with their patients. Unlike physicians who are confined to what seems like 5-15 minute interactions with patients, PTs are given longer treatment sessions. What evolves when you can take the time to really listen and understand a person’s injury experience? A trusting relationship. It is this, which I find most rewarding about being a PT.

Now that I have been working in the field for over 3 years, I realize that my job certainly involves helping others through health promotion. But a lot of my job is actually teaching: teaching others about their body/injury, instructing exercise programs, educating about equipment options or environmental changes, and training others how to change their lifestyle to prevent re-occurrence or further disability in the future. In PT school, I knew I would have to come up with an exercise program for a patient, but I never thought too much about the method in which I would instruct them. Did I consider what kind of learner my patient was? Did I introduce the program in a meaningful way? From my experience, I now realize that there are many crucial components to effectively teach individuals new ways to move:

  1. Patient-Centered Programs: The patient should be at the forefront of developing the exercise program. I can provide suggestions on what muscles should be targeted and typical methods for strengthening, however it is up to the patient to tell me: how often they can perform it; is the gym/home/outdoors a more effective environment; are others (family, friend, caregiver) able to help or do they feel better doing it alone? As a student, I would often assume that the exercises would be a priority for the patient regardless of how I set it up. Now I realize that in order for a patient to be compliant with their program, it must “fit” into their daily routine and not be overly time consuming (ex: giving a 30 minute exercise program of leg lifts and bridging vs. incorporating heel raises into putting dishes away in cabinets or standing balance exercises while brushing teeth). Similarly, in therapy when working on walking (gait training) or transfers, I need to consider what environments are most meaningful to the patient. Would they rather practice on a real couch or bed compared to the therapy mat? Would home training be more effective?
  2. Individual Learning Strategies: The patient’s capacity and ability to learn must be factored in. Is the patient a visual learner, in which case I should write out the exercise program with pictures to present them? Is the patient a kinesthetic learner, who would rather just stand up and start doing the exercises right away? Is the patient an auditory learner who needs to verbally repeat the instructions and positions back to me for retention? These strategies come into play not only in instructing an exercise program, but also when teaching a patient a new way to transfer safely out of bed, or a different method for ascending/descending stairs.
  3. Forget about Errorless Learning: An individual must be given an opportunity to make “mistakes” in movement. Errors help the brain to learn what went “wrong” and to make adjustments for the next trial. A teacher who interrupts the patient or is constantly providing feedback (verbal or tactile) on the nature of the patient’s performance is interfering with the patient’s natural feedback loop – and prevents the patient from learning through experience what feels “wrong” (less efficient) and how the ideal movement strategy feels.
  4. Time for Reflection: The patient needs to be given time to reflect on their performance. What did they do well in therapy? What exercises felt good? What could they do better next time? Reflection is a key aspect for learing in any experience. It challenges the individual to critically analyze their technique and evaluate how it could be improved. After the patient provides their evaluation of progress/performance, then the therapist can offer their feedback regarding performance, as well. Reflection also helps to improve a person’s self-awareness. I try to ask my patients for a therapy goal prior to their next session. This helps the patient to take ownership over their program, as well as provides me with insight into what is most important for them in their recovery.

These are just a few of the ways that PTs need to consider their role as a teacher within therapy sessions. There are so many aspects of the patient that a therapist must consider in order to help a patient reach desired goals. The patient’s learning strategy is just one example of a way for a therapist to improve his/her interaction with the patient in order to maximize the patient’s outcomes within the plan of care.

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