Physical Therapy Has Changed a Lot Over the Years

Interviewer: How has physical therapy progressed in order to help get patients back to the activities that matter most to them? We'll explore that next on The Scope.

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Interviewer: Rehabilitation physical therapy has changed a lot over the past few years and as a result, patients are able to get back to the things that matter to them more quickly and in better ways. Randy Carson is a physical therapist at University of Utah Health Care. Let's first start by taking a look at what it looks like, what it looks like today and maybe what it might look like in the future. So 20 to 30 years ago, physical therapy, what did that entail?

Randy: So in my area which is inpatient rehab a lot has actually changed. One of the main things is the amount of time that we get with patients. So in the past somebody might have a stroke or a spinal cord injury or a traumatic brain injury and we'd have them in inpatient rehab for two, three, four months, sometimes even six months with like a spinal cord injury. Now we have patients for three weeks maybe even four weeks. On the outset we might have someone for a month and a half.

Interviewer: So that doesn't sound good. I would want more time with my physical therapist. But I'm sure it is a good thing.

Randy: Well, it's been good and bad. And I understand why you would think that's not a good thing. And it's not in the sense that the body doesn't really heal any faster.

I think one big misconception that people in rehab are different than you and I. But in all actuality it's you, it's me, and we're one car accident away from being in there. So if you break your neck in a car accident, there has really not been a lot of change in our body's ability to heal a spinal cord injury. So we are under a lot of constraints that quite frankly are insurance driven to get people home quicker.

But like you said there's some good. The good that's come out of this is patients obviously spend less time in the hospital and it's also shaped our practice a little bit in the sense that we're a lot more aggressive with patients than we used to be. So if you had six months, you took six months to get someone better. And what we're finding is if you have six weeks, you're finding yourself doing things that you didn't dare do in the past. And it's really pushed the limits on intensity of exercise, and maybe less of a linear approach that's taken towards patients and making them better.

So a good example of that would be, you know, a stroke patient that can sitting, doesn't have sitting balance because the stroke has altered that. In the past we would work on sitting 'til no end until they could do it. Now we might even bypass sitting and go straight to standing, which is absurd to think about working on standing when someone can't even sit. But what we've learned is that you skip a step like that and sitting balance falls into place on its own. That's something we've learned because of being pushed to be more efficient and be faster.

Interviewer: Yeah, and as we look at the past and the present too, I think that research has even shown that that more aggressive approach is better.

Randy: Yeah exactly. And I think the research has actually almost found that. It's looked at, we used to spend this amount of time with patients, now we are spending this amount of time with patients. But our outcomes haven't actually suffered and in some cases are even better.

Interviewer: Yeah, expectations have increased and outcomes have increased as well. What are some of the other differences between say 20 to 30 years ago and today?

Randy: I'll actually talk about something that's not different. A physical therapist's main job is to working with a patient and be one-on-one with a patient and there has not been a replacement or you might call it an advancement. I would consider it maybe not even an advancement if we lost that opportunity to work on patients.

And then as far as equipment goes, it's been both the same and some differences. We still use bare bones equipment of our hands and our skills and mats and wheelchairs and crutches and walkers and canes. And that hasn't changed and I don't really see that changing. But what's been exciting is the introduction of things like robots, robotic treatments, treadmill training where we can actually put someone in a harness and suspend them over a treadmill and use training on that. You kind of name it as far as devices have been a big, big, change in the last 20 years or so.

Interviewer: Yeah, that one-on-one hasn't changed but some of the technology that allows you to do some of the things you haven't been able to do has changed.

Randy: Yeah.

Interviewer: What about the future? I would imagine that one-on-one is still going to be a big part of what physical therapists do because there is no one size fits all. Every individual is an individual. Just because two people had a car accident doesn't mean that they've responded to it in the same way. So what's in the future?

Randy: I think the general trend in the past and now is smarter and more efficient. And I think we'll probably move to that direction, keep moving in that direction. I think in the past we haven't really set up a facility to optimize care. And we're talking about building a new rehab center right now. And to build a facility that's a little bit smarter, patient focused. So I see that as a big opportunity for growth as far as smarter and more efficient. And we're probably going to be pushed to get home people even a little bit quicker, even though I feel like we are probably hitting the boundaries there. And then technology is definitely going to be a continued growth area in therapy.

Interviewer: What out there in technology? You mentioned a couple of things like the treadmills. Is there anything out there that is kind of out of your reach at this point that you are excited to see maybe come into fruition?

Randy: Yeah, right now robotics is in more of a tease phase. They're out there and they're not really that useful yet. But I think they are going to become second nature useful and really easy. For instance, right now to walk, you know a lot of our patients don't have tolerance to walk long distances, so it may take 30 minutes to set them up in a robotic gate training kind of device right now, to walk two minutes. So obviously that's very inefficient. So I think the set up time and the devices have a long way to go and I think they'll get there for sure.

Interviewer: Any final thoughts? Anything that I should have asked? Anything you feel compelled to say?

Randy: The one thing that I would stress is if you ever find yourself in a rehab center, when you look at it, it kind of looks like a war zone, you've got people in wheel chairs that are not able to stand. They might have two or three people helping them to stand, or devices helping them to stand. But I would just stress that they're the same people as you and I and you could find yourself there.

In fact, we've had a lot of people that work at the hospital be in rehab. We've had celebrities be in rehab, we've had a lot of people be in rehab. So if you ever find yourself and you take a look, it might be kinds of shocking when you look at it more like a portrait or picture. But if you come back day after day and you see the tremendous progress that people make, you really kind of get rehab then.

So if you come once you'll be shocked and afraid to ever step foot in there again, but if you keep coming back day after day, you really see that miracles that people . . . you know they wheel in or maybe even wheel in a wheelchair or wheel in a bed when they get there and they walk out of there. That's really the beauty of the job I do.

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