Defining Moment A Different Kind of Group Therapy Identifying and addressing a chronic need. By Patrice Hazan, PT, DPT, GCS, MA | February 2016 Listen to 'Defining Moment' Cheri walked into our facility, GroupHab Physical Therapy, flashing a big smile. "I don't have to wake up at 5 in the morning to ask my husband to put my shoes on me before he goes to work!" she exclaimed. "I can tie my own shoes!" Hearing that simple, joyous declaration of independence, I knew I'd made the right decision to focus my new practice on wellness and prevention for individuals with chronic conditions. Cheri, who is 55 and has cerebral palsy, gets teary-eyed describing how the facility has transformed her life. When she came to us she was walking with 2 canes, falling at least once a week, and feeling she had nowhere to safely exercise. She feared losing her ability to ambulate. But then she discovered us. We offered her an opportunity to participate in physical therapist (PT)-led group exercise for wellness and prevention. We gave her a complete assessment, then worked with her individually for a few sessions, identifying ways to modify and adapt our existing exercise classes to her specific needs. She now participates in our aerobics class at the balance bar—where, she says excitedly, "I feel like I'm dancing!" She also takes rehabilitative yoga, which gives her a good workout while enhancing her strength, posture, and balance. "I'd felt so left out in the past," she tells me. "But now I love telling my friends, 'I'll see you later, because I'm off to yoga.'" Another client, Betty, has Parkinson disease. She and her daughter had repeated a discouraging pattern before GroupHab came into her life. Betty would complete physical therapy excited about her progress. But she ultimately would find her home exercise program to be too repetitive and unable to provide her with the balance and strengthening support she'd received in the clinic. Within months, mother and daughter would be back at the physician's office, seeking another referral to physical therapy. They'd also been less than satisfied with existing community resources. The local senior center offered free exercise classes, but Betty found the chair class to be insufficiently challenging and overly repetitive. The standing class, meanwhile, was too difficult for Betty, and too crowded. Betty and her daughter also investigated a local health club, but found no viable options there to challenge Betty's dynamic balance and gait. So, when Betty and her daughter heard that our new facility—we opened last year—was offering PT-led exercise classes for wellness and prevention, they immediately signed Betty up. We assessed her as being ideally suited for our "StrengthHab" class, which took her through different functional strengthening and balance exercises each session. As Betty's condition improved, the exercises became increasingly challenging. Betty's daughter told me recently that this has been a life-changer for her mom. It was difficult to create the right class mix. Initially, I did a lot of research to develop exercise classes specific to a disease or condition: Parkinson, osteoporosis, arthritis, balance, and falls prevention. I thought clients would eat up classes packed with exercise and PT-led education and guidance about their specific condition. It turned out, however, that the most popular classes were focused more broadly on improving participants' functional capacities, were music-filled, and were perceived as being, well, more fun. Our offerings, accordingly, have evolved. Every client gets a detailed physical therapy assessment. We identify client goals and provide disease-specific education. We then recommend appropriate classes based on each person's functional capabilities—with individualized instruction in precautions, modifications, and adaptations. In addition to StrengthHab, our wide range of classes is reflected in their names: Strong and Steady, Arthritis, Strength and Stamina, Well and Fit Functional Strengthening, Spinal Stabilization/Core Strengthening, Rehabilitative Yoga, DanceHab, and Simple Step. Here's another testimonial. Karen was disheartened. Her chronic knee pain had lessened with physical therapy, but she still felt very unhealthy. She wanted to improve her overall strength, balance, and endurance. PT-led group exercise was the answer to her prayers, she says. "Each person in class has a different story," Karen notes, "but we're all working toward the same goal: to be as strong as we can be. The exercises," she points out, "always can be adjusted to be a little more challenging. The bar is always there to hold onto if we need it. The chair exercises are awesome." Karen's husband says he is "amazed" by the improvement he's seen in Karen's abilities and outlook. He has personally thanked me. There are so many other patient stories I could share. For many individuals, I feel I've been able to accomplish more in group exercise therapy than I could have 1-on-1. Group classes facilitate a holistic approach to wellness—improving participants' endurance, strength, flexibility, balance, and posture while providing them with a much-needed outlet for social support. This is a cash-based business model that offers our profession a wealth of opportunity. As movement experts, PTs can be leaders in health, wellness, and prevention for individuals with chronic conditions. Are we doing everything we can for this population of patients and clients, or can we do more? Is it enough for us to provide these individuals with home exercise programs and recommend that they avail themselves of community resources? Or, given our knowledge and experience, might more of us explore the idea of creating and executing PT-led solutions that can make a profound positive difference in these individuals' lives? I absolutely love what I do. I hope more of my colleagues will consider joining me! Patrice Hazan, PT, DPT, GCS, MA, is the founder and chief executive officer of GroupHab in Simpsonville, South Carolina.