Weighing the consequences of silence.

"Just Do It," the tagline of a prominent athletic wear company, might just as well advertise physical therapists (PTs) and physical therapist assistants, given their dedication and determination to helping patients meet their goals. But what happens when "Just Do It" becomes "Who Done It?" Consider the following scenario.

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Sarah is a PT in an outpatient pediatric clinic in Ohio. She finds working with children deeply gratifying, if often challenging.

She is treating an 8-year-old boy named Mikey who has cerebral palsy with a right hemiparesis. His grandmother explains that the boy recently moved in with her from his previous home on the West Coast because "the situation with his mother wasn't stable." Mikey's grandmother strikes Sarah as a caring person, but, for whatever reason, Mikey is withdrawn during therapy, seldom speaks, participates only grudgingly and without enthusiasm, and clearly isn't adhering to his home exercise program. Sarah tries her best to engage him, to little avail. "Now you know what I'm up against," Mikey's grandmother says resignedly.