• News New Blog Banner

  • The Good Stuff: Members and the Profession in the Media, July 2019

    "The Good Stuff" is an occasional series that highlights recent media coverage of physical therapy and APTA members, with an emphasis on good news and stories of how individual PTs and PTAs are transforming health care and society every day. Enjoy!

    "Life is always going to find a way": Dakota Kay, PT, DPT, who grew up in the Navajo Nation in Kayenta, Arizona, endured hunger and homelessness in pursuit of his undergraduate degree and DPT. (Inside Edition)

    Back to basics: Theresa Marko, PT, DPT, MS, explains the importance of exercise that strengthens the lower back. (livestrong.com)

    Staying strong and giving back: Nelson Almeida, PT, DPT, describes how he doesn't allowing speaking with a stutter to stand in the way of being a great PT, and how he's helping other individuals with stutters become confident in their abilities. (WLRN News, Miami)

    The hip new thing: Karena Wu, PT, DPT, shares her perspectives on how to choose the best pillow for hip pain. (bustle.com)

    Mythbuster: Chris Wilson, PT, debunks 6 common myths about back pain and how to treat it. (Wasilla, Alaska, Frontiersman)

    Gaining in the poles: Jon Schultz. PT, MPT, has launched a Nordic urban poling program at his clinic. (WFLA News 8, Tampa, Florida)

    A song of ice and…heat: Robert Gillanders, PT, DPT, evaluates the pros and cons of ice baths and hot therapy for recovery. (Yahoo! Lifestyle)

    Hanging leg tuck and overhead throw, anyone? Amy Schultz, PT, DPT, explains why the hardest exercises in the US Army's new fitness test may be good for cyclists. (Bicycling)

    PT Ninja Warrior: Conor Galvin, SPT, has been wowing viewers across the country with his skills on "American Ninja Warrior." (Riverhead, New York, Times-Review)

    Water you waiting for? Patrice Hazan, PT, DPT, MA, provides tips on exercises that can be performed while in the pool with family and friends. ("Your Carolina," WSPA TV, Spartanburg, South Carolina)

    Rising falls numbers, and what to do about them: Mindy Renfro, PT, DPT, PhD, and Leslie Allison, PT, PhD, editor of the Journal of Geriatric Physical Therapy, discuss recent research into rising rates of falls-related deaths among Americans who are older, and how falls prevention programs can help made a positive change. (Kaiser Health News)

    Physical therapy's role in addressing developmental delays: Beth Ennis, PT, EdD, explores the role pediatric physical therapy can play in helping children develop. (MD-Update)

    Finding that tweet spot for phone-viewing: Eric Robertson, PT, DPT, has some suggestions for avoiding neck pain from overuse of handheld devices. (Popular Science)

    Exercise after giving birth: Susan Clinton, PT, DScPT, and Marianne Ryan, PT, BS, offer advice for women who are ready to begin (or restart) exercise postpartum. (New York Times)

    Quotable: "With physical therapy, you can see patients make so many strides, and miracles happen," she said. "I've been in PT, and I've witnessed these miracles, and I believe that physical therapy is a field through which I can make a difference in the world. I believe I can help people realize, during their worst times, the strengths they may not know they have and watch as they make amazing progress." Heather Callahan-Williams, University of North Georgia student, on her plans to pursue a degree in physical therapy. (University of North Georgia News)

    Got some good stuff? Let us know. Send a link to troyelliott@apta.org.

    APTA Programs Earn National Recognition

    APTA has once again received national honors from the American Society of Association Executives (ASAE)—this year, for APTA resources on financial literacy and student debt management, as well as for a collaborative program that helps aspiring physical therapist (PT) and physical therapist assistant (PTA) education program directors hone their leadership skills.

    ASAE announced that APTA was the recipient of 2 "Power of A" awards: a Gold Award for the association's Financial Solutions Center, and a Silver Award for its Education Leadership Institute (ELI) fellowship program. ASAE's Power of A (the A stands for "association") Awards are the industry's highest honor, recognizing the association community's valuable contributions on local, national, and global levels.

    Launched in 2017, the APTA Financial Solutions Center is a free online financial resource that includes a customizable financial education platform featuring learning on topics such as student loan debt, repayment options, loan consolidation, budgeting, and mortgages. The center also features a student loan refinancing provider that offers eligible members a discounted interest rate. In addition, the center links to certified financial planner information, scholarships, awards, grants, and the APTA Career Center, among other resources. APTA has identified student debt burden and career earning potential as challenges to the long-term sustainability of the physical therapy profession, a key element in the association's strategic plan.

    APTA's ELI program is a yearlong educational experience that includes online learning, direct mentorship, and 3 in-person meetings focused on helping PT and PTA program directors connect with resources and develop the skills they need to be innovative, influential and visionary leaders. Partners who help APTA promote and support the ELI Fellowship include the American Council of Academic Physical Therapy, Academy of Physical Therapy Education, and PTA Educators Special Interest Group.

    "We're proud to be recognized by ASAE this year, but it's even more gratifying to know that members see the value in these programs," said APTA CEO Justin Moore, PT, DPT. "Just like the awards we've received in previous years, this year's honors are a testimony to our members' level of engagement with their association, and their investment in building a professional community."

    The most recent ASAE awards marks the third consecutive year APTA has been recognized by the association industry group. In 2018, APTA, the American Occupational Therapy Association, and the American Speech-Language-Hearing Association received a joint Power of A Gold Award for their collaborative effort to end the hard payment cap on therapy services under Medicare, and APTA's membership renewal efforts earned the association a Gold Circle award for an outstanding member retention campaign. In 2017, ASAE recognized APTA's public service announcement video for its #ChoosePT campaign as the winner for best video of the year, as well as the entire #ChoosePT campaign as one of the nation's top public awareness campaigns.

    APTA Centennial Website Makes Its Debut

    Since its beginnings, APTA has shown what can be accomplished when members are connected and engaged—it's a sense of community at the heart of the association's greatest achievements, and now it's a key element in plans to celebrate APTA's 100th anniversary in 2021. That's where a new APTA centennial website—and you—come in.

    This week, APTA launched what will become the definitive online resource highlighting the association's first century, complete with multiple opportunities for members to contribute to the effort.

    The easy-to-navigate site will evolve over time, serving as a destination not only for gaining a better understanding of the association's history but for sharing artifacts, stories, and memories, learning about opportunities for centennial-related public service initiatives, and keeping up with the latest on just how APTA plans to mark its birthday in 2021.

    In fact, right now APTA is asking members to contribute ideas, photos, and thoughts via a submission form at the bottom of the webpage. Of particular interest: members' opinions on the most important milestones in the physical therapy profession.

    Check out the new site and find out how you can get involved, then be sure to revisit in the coming months for more opportunities and announcements.

    Summer Reading: 8 Great APTA Blog Posts You Might've Missed

    Graduations, vacations, family reunions, binge-watching season 3 of "Stranger Things"…it's entirely understandable if you've been a little distracted over the past few months.

    Not to worry—PT in Motion News can help, when it comes to catching up on some engaging reads. While you were out dominating the Slip 'n Slide, contributors to both the #PTTransforms and APTA Pulse Blog were exploring a range of issues, from the personal to the societal.

    Wondering what you missed? Here are quotes from 8 notable posts, with links to the articles.

    "It's the path we take when we embrace the idea that every day deserves our heartfelt best effort—not just to live that day to the fullest but to shape the future more than it shapes us. Because we want to pay it forward. Because we demand that we leave something better than we had for ourselves." -2019 Presidential Address  

    "Many black professionals have been conditioned to mask parts of their natural selves in order to avoid exclusion from professional and academic opportunities, whether in school or in a career setting." -Pressure: A Commentary on the Black Physical Therapy Student Experience  

    "When [patients] leave the hospital, they're weaker and more likely to have a fall at home. This is an unintended consequence of falls regulation and misaligned incentives." -'Bedrest is Bad': New #everyBODYmoves Campaign Is Combatting Hospital Immobility  

    "Sometimes we need to take a step back and look at things from above the ground and see that one therapist over here seems to be getting patients a little bit better, a little bit quicker… The data that the Registry will collect will help us better direct patient care, as well as identify continuing education needs." -Notes From the Field: MIPS, Quality Improvement, and the Physical Therapy Outcomes Registry  

    "After having my first academic year and clinical rotation under my belt, I sought to shift gears and get back into what made me the most happy: involvement. I decided to extend myself beyond the classroom by applying for a leadership position in my state's student special interest group." -Why Doing More Than Studying Made Me a Better Student  

    "When conducting focus groups in medically underserved communities in Chicago about residents' knowledge and use of physical therapy, my colleague and I heard several things. Two statements in particular stuck with me: 'Physical therapy is for the rich and famous,' and, 'Why don't you put a physical therapy clinic in our community?'" -Our Profession Should Be Community-Minded—and Community-Invested  

    "A few days later my grade was posted. I nonchalantly logged into the grading portal to find a 65%. Was I seriously that bad at this whole physical therapist thing? Am I just walking through life overly confident in my abilities?" -I Don't Care About My Grades  

    "Witnessing the patient's request and partaking in his end-of-life directive really forced me to contemplate and consider our physical therapist scope of practice and our role in complex situations." -Reflecting and Coping With End-of-Life Care: A Student Perspective

    APTA Members Can Now Get $175 Off MedBridge Subscription

    MedBridge, a leading provider of health care continuing education, is now a part of APTA's Member Value Program (MVP). That's good news for APTA members, who can now save $175 off the regular $375 subscription to the company's extensive list of offerings.

    The addition of MedBridge allows APTA to expand the range of educational resources offered to its physical therapist (PT), physical therapist assistant (PTA), and student members by opening up discounted access to more than 1,000 MedBridge-sponsored video courses and live webinars. For more information, APTA's MedBridge discount webpage.

    "This offering increases the value of APTA membership and supports our members in their ongoing commitment to provide the best possible care,” said APTA CEO Justin Moore, PT, DPT.

    APTA's Member Value Program provides discounts and other opportunities for APTA members, in addition to standard member benefits. To maximize the value of membership, visit the APTA Member Benefits and Value page.

    News From NEXT: Rural Health Care has Plenty of Challenges, Promising Opportunities

    When it comes to rural health, there's no denying that there are demographic and financial challenges that can affect care. But there are also opportunities for improvement, and physical therapists (PTs) and physical therapist assistants (PTAs) need to be ready to advocate for—and when necessary, create—those opportunities. That was the message of a session on rural health care delivered June 14 during APTA's 2019 NEXT Conference and Exposition in Chicago.

    The session explored the factors that make rural health care different from health care in more urban areas---factors that in some instances point to the need to rethink how funding is allocated. Presenters pointed to the possibility that the US Centers for Medicare and Medicaid Services (CMS) might be in the early stages of doing just that. Meanwhile, they said, the possibilities for better patient access through telehealth need to be seized in the short-term.

    Presenter Jeremy Foster, PTA, boiled down the status of rural health care into a single sentence: "We have all these conditions that are worse in rural settings, but the money's not there."

    Foster led attendees through a tour of the demographic elements that create challenges, including a higher percentage of people who describe themselves as having "fair or poor" health compared with those in urban settings, and a generally older population. Other disparities include higher rates of tobacco use, an average annual income gap of $9,242, and life expectancy that averages 2 years shorter than the life expectancy of the urban-dwelling population.

    Access to care is, of course, a significant problem in rural areas, Foster explained, and though critical access hospitals (CAHs) often provide high-quality, patient-centered care, current funding systems tend to be based on population more than on need. Under those assumptions, gaps can arise when a smaller population begins to experience conditions that lead to worse health conditions.

    This must change, Foster said, because CAHs are providing much-needed care and economic benefits that are worth supporting, including contributing more than $7.1 million to local communities annually through wages and benefits, and providing needed care---an average of 39 million outpatient visits, 809,000 adult hospital admissions, and 82,000 infant deliveries per year.

    "There needs to be a lot more research around rural health care," Foster noted, but he added that providers in the rural setting have a responsibility to be "trustees of the money we receive."

    Brendon Larsen, PTA, BS, took a deeper dive into the current state of CAHs and rural health care in general, saying that rural health providers are challenged to care for a population that is considered "older, sicker, and poorer" than its urban counterparts.

    CAHs’ challenges include an aging infrastructure and a workforce shortage that isn't limited to clinicians, Larsen said, with CAH leaders reporting a 61% shortage in applicants for nonclinical and administrative support positions. At the same time, the type of services provided by CAHs is evolving, with outpatient treatment now making up 60% of CAH gross revenue. The problem, he explained, is that many funding assumptions around rural health care are rooted in inpatient care. When those factors are added to ever-increasing regulatory burdens, CAHs and other rural health providers find themselves struggling to stay afloat at a time when the need for better patient access is increasing---including the need to respond to the nation's opioid crisis.

    But could some relief be on the way? Maybe, said Larsen: CMS has formed a Council for Rural Health that is looking at developing a rural health policy initiative. The idea, Larsen explained, is to apply a "rural lens" to CMS programs, with the aim of maximizing providers' scopes of practice, empowering patient decision-making in rural areas, supporting new partnerships, and further expanding telehealth opportunities in rural areas.

    Of those potential improvements, telehealth could be of the most immediate benefit, explained Carmen Cooper-Orguz, PT, DPT, MBA. Cooper-Orguz rounded out the program by describing the promise of telehealth, and specifically telerehab, for improving patient access to care.

    There are more 'cans' than 'cannots' when it comes to telerehab," Cooper-Orguz told the audience while running through a list of the assessments and treatments that could be accomplished remotely.

    The problem, she explained, is that while most providers understand the potential for telerehab, the on-the-ground conditions for providing it need to improve. That will take action from the physical therapy community to advocate for changes to payment policies, state licensing laws and regulations, and provision of rural broadband.

    Cooper-Orguz believes one of the most important ways for PTs and PTAs to pave the way for better policy around telerehab is to press for adoption for the Physical Therapy Licensure Compact in all states. By dismantling geographic boundaries to practice, the compact opens up the possibility for increased use of telerehab---but only if compact adoption is accompanied by licensing laws and regulations that permit remote practice, she added.

    News From NEXT: Understanding Personality Types Can Enhance the PT-Patient Relationship

    Understanding one’s own personality, as well as the personalities of coworkers and patients, can make physical therapists (PTs) and physical therapist assistants (PTAs) more successful in both their workplace and home life, according to Jacky Arrow, PT, DPT. Arrow presented “He Said, She Said: How personality and communication can improve patient education” on June 14 at the 2019 NEXT Conference and Exposition.

    She pointed out that in communication between the PT and the patient, “It’s not their responsibility to come to us or to meet us half way. It’s our responsibility to meet them.”

    She first recommended that the attendees determine their own personality types. She mentioned several tests but focused on the Myers-Briggs Type Indicator, which places a person on 4 scales: extraversion vs introversion, sensing vs intuitive, thinking vs feeling, and judging vs perceiving.

    For example, Arrow explained, an introvert typically waits to be asked a question and then needs time to construct an answer. Extraverts, on the other hand, tend to be talkative and fast-paced. Regarding body language, extraverts tend to lean forward and talk with their hands, while introverts pause before answering and often sit back, sometimes with arms crossed. When treating patients who are introverts, she suggested, provide information in advance or tell them you plan on asking specific questions. Be prepared for follow-up questions either later in a session or at the next session. A strategy to working with extraverts includes active listening, thinking out loud, and planning talking points.

    Another example she provided related to judgers vs perceivers. Judgers respect rules and deadlines such as structured activity, she said, and they prefer a specific plan of care with milestones. Perceivers tend to be flexible with rules and deadlines and are open to adjustments in a plan of care. For those reasons, judgers do better with a written program calendar, while perceivers like to link progress to big-picture goals. To illustrate, she suggested that if the goal is to have a patient do an exercise for 30 seconds, tell a judger to exercise for 30 seconds. Tell a perceiver to sing the song “Twinkle Twinkle Little Star” to gauge the elapsed time.

    Understanding the personality types of colleagues also can be beneficial. “Knowing the other personality types fosters better working relationships. And it allows PTs and PTAs to practice their skills with those of other personality types,” Arrow said.

    News From NEXT: Attendees Rebuild Toy Cars to Aid Children’s Mobility

    PVC ratchet cutters, screwdrivers, and wire strippers may not be among the tools usually used by physical therapists (PTs) and physical therapist assistants. But at the APTA NEXT Conference and Exposition session "Go Baby Go: Mobility Research, Design, and Technology," those and other devices---such as electrical tape, collections of screws, a power drill, and myriad other items---were literally part of a clinician’s toolbox.

    Jason Craig, PT, DPhil, and Skye Donovan, PT, PhD, led the session, which addressed the importance of mobility for young children. The program---conducted on both June 13 and 14---primarily focused on actually converting 9 battery-powered children’s ride-on cars into effective, affordable mobility devices. Go Baby Go is a national program developed by Cole Galloway, PT, PhD.

    The cars that arrive from the toy manufacturer are designed to be operated with a foot pedal. But Craig explained, "Most kids can't operate a pedal, so we have a large button that can be positioned anywhere on the car." Usually the button is in the steering wheel---which was where conference participants placed them in the 9 onsite cars---but the location can change based on the child’s need. "We've placed it behind the head when the goal is to improve a child's posture," Craig said. "We placed one on the seat so the car would move only when the child stood up; it stopped as soon as he sat down."

    In addition to enhancing interventions, the modified toys serve another purpose. "This is about providing the children an experience they haven't had. By providing these cars, the children can explore the world," he said.

    It's also affordable. The cars as modified cost approximately $150 "versus thousands for a motorized wheelchair."

    Pointing to an array of unmodified, rideable cars on tables in the room, Craig then told the session attendees: "We need you to build these, because the kids are coming in later today for their cars." Each car was accompanied by an information sheet on the child---including his or her name, age, diagnosis, and interests.

    The session attendees worked in teams of 4 to 6 to modify the cars---disconnecting the pedal power control and connecting the large red plastic button the size of a small plate to the center of the steering wheel. The task was challenging not only because many PTs weren't familiar with the hardware tools and wiring schematics but also because of variations in both the cars and the needs of the children.

    About an hour into the session, the children and their parents began arriving, with the children telling the PT team working on "their" car what customizations and decals they wanted. Most of the cars were finished that day---a few needed additional work---and the session ended with the children test-driving their cars around the room and down the hotel's halls.

    The Good Stuff: Members and the Profession in the Media, June 2019

    "The Good Stuff" is an occasional series that highlights recent media coverage of physical therapy and APTA members, with an emphasis on good news and stories of how individual PTs and PTAs are transforming health care and society every day. Enjoy!

    Feeling the beat of pain management: Don Walsh, PT, DPT, MS, associate professor of physical therapy at North Georgia University, has teamed with professors from the school's music department to offer a drum circle as part of a pain management program—an idea funded in part by Move Together's Pro Bono Incubator. (Gainesville, Georgia, Times)

    Helping to shape health care policy: Alan Meade PT, ScDPT, MPH, has been appointed to the US Centers for Medicare and Medicaid Services Advisory Panel on Outreach and Education. (CMS announcement)

    Assistant coach/PT: Maral Javadifar, PT, DPT, talks about the path that led her to her position as an assistant coach for the Tampa Bay Buccaneers. (ESPN)

    Foam roller risks: Danielle Weis, PT, DPT, has a few words of warning for foam roller fanatics. (wellandgood.com)

    I like big putts and I cannot lie: Morgan Lemos, PT, DPT, describes how physical therapy can keep golfers on the course. (NBC2 News, Fort Meyers, Florida)

    Quotable: “Physical therapy and occupational therapy are important to him because he’s trying to gain the strength to stand from his chair for his badge pinning and salute for the national anthem." -Jessica Greenfield, whose 11-year-old son Miller aspires to become a police officer as he struggles with the challenges of a neurodegenerative disease. Miller was recently accepted as a cadet in the Sacramento, California, police department. (CBS13 News, Sacramento)

    Strength, courage, and inspiration in fighting cancer: Michelle Masterson, PT, PhD, delivered a moving speech at a cancer survivor celebration held by the Eleanor N. Dana Cancer Center at the University of Toledo Medical Center. (Toledo, Ohio, Blade)

    Bringing a PT perspective to CMS: Carmen Cooper-Orguz, PT, DPT, MBA, has been named to the US Centers for Medicare and Medicaid's annual advisory panel on hospital outpatient payment. (Federal Register)

    Sculpting a PT vision: Richard Smith PT, MS, has retired from his clinic position and is now making his mark as a sculptor. (Fairfield, Montana, Sun-Times)

    Getting in the swim of things: Laura Diamond, PT, MSPT, MS, leads a swim team of patients, family, and friends that competes in local fundraising events for cancer research. (Lincoln, Massachusetts Wicked Local)

    A PT's testimony on serving in the military as a transgender woman: Army Capt. Alivia Stehlik, PT, DPT, testified to congress about the contributions made to national defense by her and other transgender individuals in the military. (NBC News)

    When discomfort takes off: Blake Dircksen PT,DPT, offers tips on the best way to sit on a long flight. (lifehacker.com)

    Get some rest: Alika Antone, PT, DPT, discusses the importance of adequate sleep to good health. (South Sound Magazine)

    Don't stand for sitting: Kasey Kruse PT, DPT, outlines the risks of too much sitting, and what can be done to address them. (CBS News11/21, Dallas-Fort Worth, Texas)

    Quotable: "We physical therapists hope that people will begin to see physical therapy as a necessary and tremendously helpful part of maintaining a healthy lifestyle. Eventually, we hope people will come to physical therapy for an annual check up, so that we can spot dysfunction before it becomes painful and problematic." –Rena Eleazar, PT, DPT, on helping people to understand when they should see a PT. (Self)

    Helping heroes regain independence: Whitney Anderson, PT, DPT, shares her pride in being part of a rehab team that helped a wounded warrior gain independence through use of an exoskeleton. (KFOR News 4, Oklahoma City, Oklahoma)

    Easing plantar fasciitis pain: Chris Wilson, PT, outlines ways to manage plantar fasciitis at home. (Frontiersman)

    Got the (tummy) time? Tricia Catalino, PT, DSc, and Jill Heathcock, PT, MPT, PhD, discuss the importance of "tummy time" for infants. (New York Times)

    Worth the weight: Keaton Ray PT, DPT, ATC, provides pointers on how to start weight training the right way. (nextavenue.org)

    The Lakers' PT advantage: Judy Seto, PT, DPT, has been named director of sports performance for the Los Angeles Lakers. (lakersnation.com)

    The keys to more years in the driver's seat: Heidi Piccione PT, DPT, recommends movements that can build flexibility to help older adults keep driving. (Tampa Bay, Florida, Times)

    Journal-publishing how-tos: Christopher Kevin Wong PT, PhD, and Jean Fitzpatrick Timmerberg PT, MHS, PhD, share what they've learned about starting up an academic journal (they're cofounders of the Journal of Clinical Education in Physical Therapy). (Columbia University Medical Center newsletter)

    Let's dance: Michelle Reilly PT, DPT, explains how dancing can be an effective alternative to the gym when it comes to staying physically fit and active. (Omaha, Nebraska, World-Herald)

    Quotable: “There are times where somebody else has the knowledge that a physician doesn’t have to be the leader. A good example would be if physical therapy or some other modality is more important to the patient progressing. In those instances, the physician shouldn’t be necessarily calling the shots.” – Jason Higginson, MD, chief of pediatrics at eh Brody School of Medicine at East Carolina University, and co-author of JAMA module on working in interprofessional teams. (American Medical Association newsletter)

    Got some good stuff? Let us know. Send a link to troyelliott@apta.org.

    News From NEXT: For Optimal Outcomes, Look Beyond Compensation Patterns, Maley Lecturer Says

    "Any movement-related profession—personal trainers, athletic trainers, dance therapists, yoga instructors—who can observe impairments such as a weak muscle can try to fix it," said Beth Fisher, PT, PhD, FAPTA, in delivering the 24th John H. P. Maley Lecture on June 14 at Combined Sections Meeting. However, too often the "fix" involves the patient compensating with movement patterns that interfere with the ability of an affected limb to improve to its true potential. Fisher argued that with their level of education and skill, physical therapists (PTs) can and should identify and help the patient recover that capability.

    During her presentation "Beyond Limits: Unmasking Potential Through Movement Discovery,"

    Fisher said that in earlier clinician practice with patients with stroke and brain injury she continually hit ends points with her patients, but she realized "these were my endpoints and not the patient's, [because] at least 1 aspect of the movement abnormalities…were the results of compensation." Given the brain's ability to continuously alter its structure and function, and the body's ability to achieve movement goals in more than 1 way, people with an impairment tend to progress toward the movement pattern that is most efficient—achieves a goal using the least amount of energy and the fewest body parts. And while a compensatory solution may get the job done overall, this easy route that comes naturally may not lead to optimal improvement, thus denying the patient the best possible outcome. In fact, "the compensations [patients] choose may be the source of the problem—may actually predispose the problem to occur," Fisher said, by keeping the patient from exploring better ways to achieve their movement goals.

    She asked: Is this really the best we can do? "If we want to reach someone's full capacity, then we need to go beyond this limited choice that patients come up with on their own without a physical therapist," Fisher said. However, she argued, PTs have been academically trained to view movement from an impairment-driven perspective—the assumption that a patient's compensatory movement pattern results from an impairment that is masking his or her capability. And so both PT and patient expect that compensation will provide the best—or only—results.

    "If I have minimal expectations," Fisher asked, "how is that going to impact my patient's expectations? What is that going to do for recovery potential?" Instead, as professionals with the expertise to look beyond compensation approaches, PTs must encourage potentially riskier, more-difficult solutions. "With what we know about brain plasticity, it is our job to help patients realize that they have more options," she said.

    By modifying that implicit choice, the PT can help patients discover a capability they may not have even realized they have. "The most rewarding moments I have had in my career have come when I hear ‘I didn't know my leg (or arm) could do that,'" Fisher said.

    She noted that PTs can't ignore impairment, "but if we are only viewing the problem from that perspective then we and our patients will reach a plateau-minimizing capacity."

    Instead, every student and every therapist should include the perspective of looking at how a movement choice can mask capacity. "We need to start from the bottom up," Fisher said, "and teach students to observe movement and hypothesize how implicit choices—not just impairments—may be driving movement faults." Otherwise, "we have limited patients and their potential to discover other options for movement by a perspective that does not consider the choices they make."