>> Good afternoon, and thank you for joining
us for Ask Us Anything About Physical Therapy.
I'm Barbara Schindo
Imagine you go through something that greatly
changes your physical capabilities whether it be
a stroke, a surgery, or a traumatic accident.
How do you get your body back to a new normal?
That's when providers are going to work with
you to treat your pain, restore function, and get you back to
a healthy lifestyle.
I'm joined today by Nancy Lokey who is a
clinical case manager with the Department of Physical Medicine
and Rehabilitation at Penn State Health.
Nancy, thanks so much for joining us.
>> Thank you.
>> Absolutely.
So we say physical therapy, but
that's really just one service of the whole process
of rehabilitating.
A more encompassing term is
physical medicine and rehabilitation.
Can you tell us what that is?
>> Sure can.
Physical medicine and rehabilitation is also
known as physiatry or rehabilitation medicine, and the doctor that
does this is called a physiatrist.
A lot of times people mistake them
as psychiatrists or podiatrists which is way, way,
way different.
A physical medicine and rehab doctor, they
specialize in the diagnosis, the treatment, the management of
conditions, illnesses, and injuries that affect the brain, the spinal
cord, the muscles, the bone,
ligaments, tendons, and thereby altering
somebody's function or their ability to move.
So a physiatrist's focus is all about
function and all about getting somebody back into their lifestyle
maybe in a different way, and the ultimate goal is to get them
to their highest functional level, back home,
in the community working, enjoying life.
>> So, what sorts -- this is a very --
this is going to be a very broad
question so I think this might -- so what sorts of treatments
and therapies are used for people who suffer a stroke
or have a surgery or a traumatic injury?
>> So, that is a very broad one.
It would all start out --
it's very individualized.
So the physiatrist,,they work
with a multi-disciplinary team and on that team you
would have a physical therapist, an occupational therapist,
a speech therapist, a recreational
therapist, a music therapist, a nurse psychologist,
a dietician, a vocational rehab.
So really a lot of people and
depending on the needs of that person, you would use that
whole team to help.
So after a surgery you might
need physical therapy or you might need
a brace or a wheelchair.
You would have the physical
therapist that would be helping you with strengthening
and with mobility issues.
You would have the occupational therapist
that would help with learning how to redress in a different way
or using adaptive equipment and parenting, those kinds of things.
So it's really the therapeutic
recreation specialist is going to help you get back
into the community.
Do outings that after the therapist have
taught you all the tools that you need, you will then go into
the community with them and practice that so that you get that chance
to do it a dry run so to
speak before you get home.
>> So, there's not necessarily
one process for any one ailment?
Anybody who have a surgery, who
needs some type of rehabilitation, that's going to be
individualized to them.
>> Correct.
There's certain things that
you would do maybe similarly but each individual
one would have their own treatment plan depending
on the team's assessment.
>> So could you describe how the
rehabilitation process works?
Take us through the process and how it impacts
recovery for folks who have to go through it.
>> Sure.
It's huge.
It stats from even before an injury.
We can be in the recovery process,
and it goes on to lifetime.
So it spans a huge amount
of time of somebody's life.
So we call it pre-habilitation and pre-habilitation,
if you have maybe a scheduled surgery or
amputation or you're going to get a medication like chemotherapy,
we would be very instrumental in helping you build up your core strength.
We'd call in a physical therapist
and the occupational therapist, build up your core
strength, build up your strength, get you at your best ability
so that you can go to the surgery
and come out a step or two ahead.
>> So sometimes this happens
before the treatment even happens.
>> Yes.
And then after an injury, you're in the acute care hospital, they bring us in,
and we help to identify potential
complications and treatment plans.
Get them started early so that we
can decrease that hospital time.
We can decrease complications.
We can decrease length of stays, and
then we also give that mode of -- what level of treatment
is necessary?
Do you need an acute rehab, acute rehab?
Okay, here we go.
Acute rehab or outpatient or home or a day program?
All of those things.
Do you need aqua therapy?
The physiatrist is going to look at how this
injury or disease has affected your function and do you need help
with learning how to dress and learning how to drive, needing a wheelchair.
All of those aspects.
>> Okay.
You are watching Ask Us Anything About Physical Therapy
with clinical case manager, Nancy Lokey.
We welcome your questions for Nancy if you are
watching this live or if you're watching this on playback, if you
have a question you can just put it right in the comment field,
and we will do our best to
get an answer for you.
And speaking of questions, you had mentioned
occupational therapy, physical therapy.
So we had a question from
Scott and Scott wants to know, "What is the difference
between those two?"
Those are two terms you hear a lot
when it comes to rehabilitating.
>> It is, and they're oftentimes confused.
Yes.
So, a physical therapist generally focuses on lower body.
They focus on mobility, strengthening,
balance, those types of things, as well as then an
occupational therapist will focus on activities of daily living.
They'll focus on your dressing skills.
They also can work with balance
and strengthening as well.
They can work with you on parenting skills.
They can work with you on meal prep, cognitive.
>> More day to day.
How you function on your day to day.
>> Yes.
>> Okay.
Very helpful.
I had been confused by those two terms as well,
and I think we have another question
that was submitted from Heather.
She wants to know, "Why is it so important
to have acute rehab after a stroke?"
>> It is very important and there's somewhat
of a myth around that, I think, out there.
But after a stroke, it's really
important that you go to acute rehab so that you can maximize
your function and start that recovery process early
so that you get the therapist in there, physical
therapy, occupational therapy, speech therapy.
You may have swallowing issues, speech
issues, and the longer you wait, the more difficult
it is for you to try to get back what you have lost because of the stroke.
>> That's a really good point.
You made a good point about the
importance of that type of therapy.
What about people with a
more kind of minor pain?
Like they haven't had a major traumatic
accident but maybe a sports injury or maybe, I don't know, they
slept on their neck wrong or something and they are feeling --
you know, you feel like you can't move your
neck, and you have to move your whole body or you hurt your ankle
playing basketball.
Do those people benefit from
this type of rehabilitation?
How do you know if you need it?
>> Absolutely.
I would say when in doubt, do it.
So it's funny you say that because I
have a personal experience on that one.
So in my job I use the computer a lot.
So I was -- I woke up and
I literally could not move.
I had electric feelings going down my neck.
My daughter had to take me
to the emergency room.
I have been in rehab, physical
medicine rehab for many, many years, and I needed a physical
therapist, and they taught me how to do exercises to decrease
that pain and that muscle tension.
So yes, when in doubt, we can generally
help any other discipline or anything that affects your
ability to move or function, you need a physical medicine and rehab doctor
to help guide the way, guide the therapist
in what modalities, and the collaboration with the other teams
is so, so important.
>> So there are also some folks who
say go through a very traumatic injury that drastically changes
their capabilities.
Like they may wind up being a wheelchair user.
What kinds of care is needed to
help them function their best and have a good quality
of life?
>> So, it takes a village, and
that village is the rehab team.
So we come in bright and early with
the consult team in acute care.
We get the therapist involved early to
start that movement, that range of motion.
We look at what adaptive equipment.
The wheelchairs, a lot of people will just
go online and just order a wheelchair.
That's so not the thing to do because a
wheelchair is very important in your mobility, in your shoulder -- you
end up with shoulder overuse because of using a wheelchair,
so if you don't have the right
one it could be detrimental to you having a good
quality of life and having less pain.
All right, and the question was?
>> It was, how do you -- well,
this could be for anybody who needs some type
of physical rehabilitation.
How do you, kind of, I guess, expectations
set and help them make it a lifestyle change for a long-lasting
type of therapy for physical rehabilitation?
>> Okay.
So, it is a mindset change.
It's a matter of bringing also in the
nurse psychologist so that they can help with the coping strategies
and understand, and it's a process.
People go through the denial and
all of that, and we're cheerleaders.
The whole team is cheerleaders, and each small
step is a huge gain, and really they have to get there and realize
that life isn't over.
It's just going to be done maybe in a
different way and there's no limitations.
The only limitation is the
limitation they place on themselves.
>> Thank you.
I think we also had a question
from Rosemary on Instagram, and let me make sure
I am saying this right.
What is the best exercise for a lumbar radiculopathy?
I guess that means moving side to side?
Moving side of hip to knee.
>> Okay.
So what I'd like to say there is it's a good idea to have the physiatrist in there
to do an assessment to make
sure that we are exactly, we know what therapy
is going to be the best therapy.
Having the physical therapist involved
with that to give their point of view as well and then they
collaborate.
There's really no cookie-cutter
answer for everything.
It's really individualized and it's best to consult
with a physical medicine and rehab doctor.
>> Sure.
That makes perfect sense.
So it's not like there's one best
exercise to do for that particular ailment, but it's finding a
program with your team to help you rehabilitate the best you can.
>> Correct.
>> And I note too that, you personally, kind
of, spearhead a lot of activities for folks who have these big
life changes and their capabilities are drastically changed.
What types of activities do you offer
and do to kind of help them get back into the best life
they can have?
>> We offer several things.
We have multiple support groups.
So in those support groups
we offer educational lectures from our physicians
and from community services.
We also do a lot of community outreach
where we're doing airport outings so that people can
try to go through TSA, learn how to get on
an airplane whether they have a sensory disability
or a physical disability, we
give them that opportunity to go through security and
see what it's like.
We also have adaptive ski day where we
collaborate with other community organizations so that people can
try out the adaptive equipment and go snow-skiing.
We do -- this area is great for hunting so
we coordinated with Cabela's and a couple of other organizations
and had lots of vendors for adaptive hunting and fishing and outdoors
so that people know there's things you can do.
The big one that we do is my
Rec Fest, and I absolutely -- it's near and dear
to my heart because it's multi-faceted as far as its goals.
We want to let people know
that they can get out there.
For health and wellness you need
to exercise, and a lot of people with a physical disability
whether it's a psychological barrier or it's a physical barrier
or a financial barrier, they
won't get out there.
Rec Fest gives them the opportunity to come out,
try the adaptive equipment in a safe environment.
So the adaptive things that we have is
we did adaptive kayaking, adaptive scuba, adaptive fencing,
rugby, basketball.
We had opportunities for those with autism.
We had opportunities those with visual
disabilities, hearing disabilities.
We had adaptive dance, and we
bring all the community resources that we can find for
all ages in one spot.
So it's kind of like one stop shop.
We bring the local colleges in to teach the
students early on about adaptive equipment so that we can dispel
the myth that those with a disability don't need to exercise
or can't have a good quality
of life like anyone else.
>> You are watching Ask Us
Anything About Physical Therapy.
I'm here with Nancy Lokey who is a clinical case
manager in the Department of Physical Medicine and Rehabilitation
at Penn State Health, and we have a question from Amy.
"If I think I might need physical therapy,
can I just call to get an appointment or should I reach
out to my PCP, reach out to my doctor first?"
>> So, in order to go to physical
therapy you need a doctor's order.
So the recommendation you would need either your
primary care physician can give you an order.
The whole picture piece is you can
call physical medicine and rehab, get an evaluation
by a physiatrist to determine what modalities you may need,
and then guide your physical therapy that way.
>> Okay.
So call your doctor first and get a doctor recommendation on physical therapy.
Again, we welcome your questions for Nancy.
If you have a question whether you're watching
live or on playback, you can just put it in the comment field
below this post and we will do our best to get an answer for you.
I just have one other thing
I wanted to circle back on.
You had mentioned
doing kind of
pre-treatment for somebody who's going through cancer treatment
which is something I did not realize that was a component
of physical therapy or rehabilitation.
So I think that there's a lot
that people don't realize.
Like even a very minor surgical procedure
might require some rehabilitation.
Is that right?
>> Yes.
And I don't think people understand that,
and even other disciplines in the hospital.
So this is a great opportunity
for us to let people know that physical medicine
and rehab is out there.
They can consult us.
We're glad to help, and our physicians can look
at how to get the person back into their home and into life with
adaptive equipment or different therapies that will help them
with an increase in their quality.
>> Well, thank you very much
for joining us today.
Again, we welcome your questions.
Nancy, thank you so much for joining us.
>> My pleasure.
>> Thank you.