The New Physical Therapy

Modern PT does more than help patients recover from injury and surgery. It helps keep them in condition to prevent problems. Here’s how.

Mimi Schiller, a geriatric physical therapist with Fox Rehabilitation in Wilmington, helps patients improve their balance, mobility and strength to prevent life-threatening falls. Photograph by Joe del TufoFox Rehabilitation physical therapist Mimi Schiller of Wilmington recalls a 90-something patient complaining about weight training.

 
“I explained to him that studies have shown muscles will respond and get stronger, no matter what age you begin to train,” Schiller says.
 
Strong muscles are important for the elderly, because good muscles promote good balance, which helps prevent life-threatening falls, Schiller says.
 
“Ask anyone who is elderly what their greatest fear is and they will tell you it is the fear of falling,” says Schiller, a geriatric physical therapist of 27 years. “We try to show them how improved balance, mobility and strength can help them remain in their assisted-living environment instead of slipping into conditions requiring more intense nursing home care.”
 
As much of today’s physical therapy is as aimed at prevention of injury and general physical decline as it is geared toward the traditional idea of helping people recover from injury or surgery. According to the American Physical Therapy Association, licensed and certified physical therapists can assist in relieving pain associated with arthritis, back and knee pain, osteoporosis, stroke, overuse injuries and limb injuries, thus improving mobility. According to a survey sponsored by the association, 88 percent of physical therapy clients say the care they received helped them return to normal activity, increase mobility and reduce pain.
 
Effie Elliott, manager of Bayhealth Medical Center’s Outpatient Rehabilitation Center, says physical therapy has evolved from an early focus on performing services for patients to teaching patients to help themselves.
 
“We stress education and prevention and home exercise over intervention on our part,” says Elliott.
 
Graham Robbins, director of rehabilitation services for Beebe Medical Center in Lewes, says his goal is to prevent patients from returning to rehabilitation by optimizing their independence. “We stress the education components so that patients can speed rehabilitation and strengthen the body to better prepare it against re-injury,” Robbins says. “The strategy today in physical therapy is to do more sooner for better outcomes. There’s less reliance on bed rest.”
 
Specialization is another area where the latest in physical therapy thinking breaks with its past.
 
“There are more certified specialties than before,” says Elliott. “Specialization helps therapists be more focused, and they can serve as mentors and trainers to other therapists.”
 
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Since its beginnings in 1995, Pro Physical Therapy has developed several specialized programs. “We believed there were several niches where specialized skills were needed,” says Chris Noga, Pro’s senior vice-president for business development. “One of those niches was in the area of hand therapy.”
 
Because of the frequency of injuries and the complexity of the hand (including the arm to the shoulder), an intensive program for certification is required. “A certified hand therapist will spend two years covering 4,000 hours of training under the guidance of a hand surgeon followed by an exam,” Noga says. Pro Physical Therapy currently employs 10 hand specialists.
 
Aquatics is another niche program.
 
“Aquatics are a way to deliver physical therapy treatment without the pain associated with weight-bearing activities,” Noga says. “The buoyancy and therapeutic temperatures maintained in our pools can get patients started on the road to recovery sooner and restore functionality more rapidly.”
 
Other specialties include pediatric physical therapy, which considers special developmental issues, and vestibular rehabilitation therapy, also called balance rehabilitation, a response to ailments suffered by a large population of aging baby boomers.
 
“Our balance activities include movements such as reaching, standing and stepping,” Schiller says. “We also emphasize balance-strengthening movements such as sidestepping and crossover and backward walking, all designed to improve gait function.”
 
Therapies to improve both balance and strength are used to help people manage new prosthetic devices.
 
“There are three main phases of recovery of function following a loss of limb,” says John Horne, founder of Independence Prosthetics and Orthotics in Newark and Dover.
 
Immediately after surgery, rehabilitation focuses on a patient’s ability to safely transfer from bed to wheelchair and from auto to home. “The focus after surgery is to restore a range of motion, particularly around the hip joint area, since that joint will be providing the bulk of compensatory support and motion,” Horne says.
 
After a post-surgical period of about six months, rehabilitation seeks to improve balance through gait training. The patient progresses from a walker to a cane to moving without external assistance. After the patient is fitted with a permanent prosthesis, therapy shifts toward helping him learn the mechanical limitations of the device and develop new, automatic habits of motion.
 
Pro Physical Therapy operates a Women Serving Women Program at the Hockessin Athletic Club. Staffed by female physical therapists only, Women Serving Women helps clients deal with issues of incontinence, dysfunction associated with pregnancy, pelvic floor pain and other orthopedic needs.
 
“We are staffed at the center to deal with the specifics of breast reconstruction surgery as well,” says Noga. “Working with cosmetic surgeons, we focus on issues that include scarring, weakness, abdominal pain and imbalance.”
 
In the modern world of physical therapy, there’s no need to live with pain while trying to restore your physical condition. And there’s no need to say, “I’m too old for this.”

 

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