Tools to Treat the Whole Patient
Estimated Reading Time: 3 minutes
Many of us enter and graduate from physical therapy school with a fairly good idea of where and what we want to practice.
Whether it is in an outpatient or inpatient setting or one of the many different specializations offered, the general message is "pick one."
But what if you don't know which one to choose?
I'm here to say, maybe you don't have to.
During my time in physical therapy school I knew that I wanted to go into neurologic rehabilitation. I also knew that I had exactly zero interest in orthopedics.
Fortunately, my program offered electives our third year and I capitalized on the ability to spend time teaching neurologic-based coursework, dissecting brains in the cadaver lab, and participating in a service trip for survivors of stroke in Jamaica.
Then like many new therapists do, I accepted a position in a residency program with a full expectation to receive advanced training in the specialty field I wanted to pursue. It was an incredible experience. But as I started treating patients in an outpatient day program setting, I started realizing that I was missing a big piece of the puzzle.
Sure, I had learned about early mobilization techniques, proprioceptive neuromuscular facilitation (PNF), neurodevelopmental treatment (NDT), amplitude training, and various other traditionally neurologic-based skills. But there was one impairment that I struggled to address—pain.
I found that many of my patients with hypo or hypertonicity, spasticity, or chronic postural deficits frequently struggled with neck, back, or extremity pain. This pain often was one of the primary causes of functional limitations. And I and many of my coworkers would subsequently hand off these patients to the orthopedic therapists.
Although our patients certainly improved significantly in our care, I couldn't help but think how incorporating manual therapy skills and strengthening and conditioning principles might further improve our patients' quality of life and add to my toolbox.
In school we are frequently taught orthopedic and neurologic principles in separate semesters and in complete isolation of one another. But in reality, these principles from both specialties are highly interwoven within just about any patient with a traditionally orthopedic or neurologic condition.
A patient who enters your clinic with knee pain is more than just their diagnosis, the same as an individual with Parkinson disease. Limiting yourself to being an orthopedic or neurologic therapist makes it more difficult to see the whole person, not just their condition.
So how do you do it? Can neurologic principles really benefit your orthopedic patients and vice versa?
At APTA's National Student Conclave 2018, I will talk about how to bridge the gap between orthopedic and neurologic rehabilitation. Having now completed both an orthopedic and neurologic residency, I have gotten to experience practice settings ranging from the neuro ICU to the football field.
And while the patient populations in these settings are vastly different, I am able to pull techniques and principles from each that can be applied to a wide variety of individuals, from those with chronic strokes to postoperative ACLs. I have been able to fill in those missing pieces from earlier in my career, and my goal is to help give you the tools to do the same.
Lindsay Walston, PT, DPT, is a board-certified neurologic and orthopaedic clinical specialist. She currently works as national education coordinator and physical therapist for PT Solutions. She has taught multiple continuing education courses and frequently guest lectures at several nearby universities. She is an active member of the Georgia Chapter and the Programming Committee vice chair. Walston graduated from Emory University's Neurologic Physical Therapy Residency in 2015 and PT Solutions Orthopaedic Physical Therapy Residency in 2017. You can contact her at Lindsay.Walston@ptsolutions.com.