Realizations from my first clinical experience
Clinical education can be mind-blowing sometimes, especially for a first year DPT student. Within my DPT program, most of our ClinEd happens during our third year, which consists of three 12-week internships. However, at the end of every semester, starting in the very first year, we also spend one week in the clinic in teams of 3-4 students. We stay in the same setting for a whole year, then for our second year transition to a different setting (same team) for another three semesters.
I make up ¼ of a team of total sports/ortho nerds. We are all former collegiate athletes – two soccer stars, one wrestler, and one XC/Track runner (hi!). We work with local sports teams, study for the CSCS exam, read Gray Cook and Jay Dicharry, get way too excited about learning FMS, and we play around with kettlebells for fun.
…And we were assigned to spend our first year of clinicals in a pediatrics hospital with a specific emphasis on the neurologically involved child. I’m sure you can imagine how far our eyes rolled back in our heads when we first found out. The dread we all felt leading up to our first clinical last November was palpable.
Duke DPT’s Dr. Laura Case teaches pediatric PT basics in a very hands-on way
Well, I wish I could say otherwise, but that first week was indeed pretty dreadful. We knew nothing about children, the only skill we had was vital signs, and there was one particularly bad day where we were all chastised for not knowing the lyrics to “itsy bitsy spider”(side note: I do know all the lyrics, I just really cannot sing to save my life). It was not fun. And so the dread leading up to our second week, this past April, was even more intense than our first go-round.
BOY WERE WE IN FOR A SURPRISE. This time around, our clinical instructor unhooked us from the leash and let us run free. Armed with our new skillsets of goniometry, MMT, and PNF, we discovered something really important.
Unless you’re post-op, medical diagnosis and patient population are relatively unimportant when it comes to physical therapists’ treatment. You know what IS important?
Our CI introduced us to a preteen girl with mild hemiplegia due to cerebral palsy. She had weak hip abductors and extensors and poor core control. We met her on a Tuesday, and on Wednesday evening, our CI came to us and said,
“our Tuesday patient is coming back tomorrow. You are running the treatment session. See you at 9am!”
Yikes, right? Turns out, four first-year sports-minded DPT newbs can combine to make one really good neuro-peds physio. Why? Because MOVEMENT.
The interventions we came up with for this patient were based on our CI’s movement-related goals, and all came from the strength and sports “arena”.
Our CI’s first goal for this patient was, roughly “will complete sit to stand with neutral pelvis and hip-knee-ankle alignment”. Aka no hunching over, no knee valgus, no foot pronation. I suggested we work on sit-to-stand with a theraband around the patient’s knees, using verbal and tactile cues to get her to “push out” with her knees against the band. Another teammate would use tactile cuing to set her pelvis in neutral and help her get the feel of a sit-to-stand with back straight and core “on”. This happens to be the exact same intervention that my own physical therapist does with me to work on abductor strength for my personal functional tasks – running and cycling.
Another goal was to achieve similar mechanics in a half-kneel to stand transition and in single leg stance. For the former, one of my teammates suggested using cable “chop and lift” patterns in kneeling and half kneeling, also with a theraband. This is something he uses with his strength and conditioning clients, and also relates to PNF patterns.
And, what do you know? Our patient did exceptionally well with all four of the exercises we gave her, as well as with active-assisted lower extremity D1 and D2 patterns . We found ways to apply our sports/ortho/S&C knowledge to a very different patient population. Did we have to modify? Of course we did, but our modifications were based on the patient’s strength and age-based ability to understand our cuing, NOT based on her medical diagnosis. An eleven year old girl with cerebral palsy can do the same exercises as a twenty-six year old strength athlete BECAUSE THE BASICS OF HUMAN MOVEMENT ARE THE SAME FOR ALL HUMANS! And our interventions, as physical therapists, are (or should be, at least), all about movement. The APTA’s mission statement, after all, is
“to transform human society by optimizing movement to improve the human experience”.
Every person moves differently, and yes, certain medical diagnoses like CP are associated with “hallmark” movement patterns, but we are all human. The basics of human movement, and especially of GOOD human movement, apply to everyone – runners, crossfitters, the elderly, pediatrics, neurological patients. This, I think, is what makes us as physical therapists so versatile. We don’t need years of internship and residency training to specialize, because the basic premises of movement are the same regardless of the patient in front of you. It’s easy, especially as a brand-new student, to get caught up in medical diagnosis and put people in boxes, but really, movement doesn’t belong in a box.
Movement is for everyone. Movement matters most. I hope we can all, as students and clinicians, remember this when we see a patient that’s outside our clinical “comfort zone” or when we’re assigned a clinical setting that’s not our favorite.