Stan Cohen – Senior Wellness

A pet peeve about physical therapy, balance training and seniors

Posted on: December 16, 2010

This is my first post in quite some time.  to be honest, I’ve been very busy working on my seniors and family care givers website and have not had much time to think about blogging.

But, just this past week in one of my classes at The House of Good Shepherd I had quite a conversation with one of the independent living residents.

The women, let’s call her June, was in class last month and was telling me that the following day she was going for therapy and was going to have to “walk the plank”.  I asked her about this and she informed me that part of her therapy was going to be working on her balance by walking heel to toe on a 6″ wide board, about 8 feet long.

I asked if she was comfortable with this idea and she said “no, I don’t have very good balance and I am afraid of falling over”.  Since she was new to class I asked her if she knew anything about the rolling walk, or the heel first method of stepping.  Again she said no.

We proceeded to practice this simple “Tai Chi” style of taking a balanced, heel to toe rolling step. First as baby steps and worked it into a slightly smaller than normal step. We then did this near a wall where she would finger touch for balance and she tried the heel in front of the other foot toe walk.

To her surprise, she felt comfortable with it. Still needing practice, and lots of it of course, the thanked me and we went our separate ways.

Just yesterday, the first day seeing her since, she told me that she amazed the therapist by having no trouble on the board using the method I showed her.  I asked if the therapist mentioned the walk and she said no, but he was very interested in what she was doing”.

I continued to ask questions on what they were teaching her at physical therapy and she said “they don’t teach me anything” and “I learn more in this class about building my balance and safety then with them by far”.

Now, this is the bottom line of my peeve. I am not a physical therapist. I teach common sense movement based in Tai Chi theory.  I am not a “licensed professional”  from any institute yet I hear these similar type comments from most of my elder students.

The question is, why don’t they teach people how to walk, how to stand, how to build balance and leg strength using simple exercises that are withing their range of capabilities?

I would love some comments on this issue.  Have you experienced this and if so, how do you work on building your capabilities?


7 Responses to "A pet peeve about physical therapy, balance training and seniors"

Be assured that physical therapists DO teach patients how to walk, to stand, build strength and sense of balance. In fact, that is exactly what we do. Perhaps the patient you spoke with misunderstood the PT and her anxiety about the upcoming treatment clouded the whole picture of her rehab. That task of walking the balance beam can seem daunting but, PTs do address standing, walking, strengthening as well as many other techniques that are specific to each patient and their individual limitations. I am guessing that you were not given the total picture.

I would urge you to ask as a team member and provide the patient with positive ways to alleviate her fears rather than for you to bash another professional and their approach. PT’s have many years of education and achieve patient goals in many ways. Don’t get caught up in negative banter. It does not become a professional or instructor of any sort. You made your own assumption that the PT would not do anything but have the patient walk the plank. Shame on you. I have worked closely with Tai Chi instructors and I have not met one yet who felt that they had sufficient education to question a medical professional.

Judy, thank you for your feedback. This was the kind of comment I was hoping for. It opens up discussions.

I have found in working with seniors for the last 3 plus years that the method of instruction I use in my classes works well with them for some reason. I make sure they understand that what I show them is not based in medical or scientific training. I show them what makes common sense to me, and they relate to the method.

Yes, what I teach is based in Tai Chi theory and practice, however it is shown very differently. I would love to work with a few local therapists here in NW NJ however they all say, we are trained in our proven methods and have no need or desire to see what you do.

That is the main peeve, the closed mindset of those I have run into.

As a physical therapist I find it unsettling and surprising that you are meeting resistance when it comes to continuing education. At my clinic we go out of our way to take classes, either from PTs or not, to learn new ideas/techniques or just different ways to educate and present information. I’ll take inspiration from anywhere I can. For instance, I often incorporate pilates for core strengthening and use a metronome or music to help patients with coordination and to “get a rhythm.” Ironically, I stumbled upon this site while looking for new ideas for a difficult patient I have right now.

I am also shocked because the APTA has published many articles about the benefits of tai chi in a multitude of populations. We are encouraged to explore these alternative techniques and to creatively incorporate them into our practice.

Perhaps if you presented your case in a different way you would be better received. At my job we have a career ladder and have incentive to take cont ed, even if it doesn’t count for CEUs. I can speak from experience when I say that as a PT, our days are crazed. We are spread thin with keeping up with paper work, doctors and insurance. Often its frustrating because it keeps us from what we love to do.

I respond well to structure vs spontaneousness. If you put together a lunch inservice perhaps, maybe ordered some pizza, and gave people some notice you might be able to get PTs, OTs and nurses together. It would also be good if you could bring some handouts that the PTs can give as homework.

One pet peave that I actually have it that often times patients are taken too literally. For instance, I was treating a patient with osteoperosis for neck pain. I would do soft tissue work, stretching and gentle mobililizations. Well… she told her doctor I was doing manipulations, which is contraindicated. I got a very angry phone call from the doctor who obviously assumed I didn’t know what I was doing. It’s easy for things to get lost in translation.

I hope this helped disperse some annoyance. And if these therapists truly don’t want your help, which I find hard to believe, please don’t let a few bad apples ruin the bunch. Personally, I would welcome your input.

Good luck!

I stumbled upon this post when I googled “balance beam” and “therapy”. And I am very happy that I found it! You see, I have a four year old boy that exhibits very similar neurology to someone that has had a stroke, and have also had one doctor suggest that whatever disability it is, it appears similar to Parkinson’s. Currently we have a provisional diagnosis of autism, which makes it easier for schools and therapists to offer some sort of assistance. We have been working with Occupational Therapists for 2 years now, and until I read this post NO ONE suggested Tai Chi as an additional form of therapy. But it suddenly makes sense- slow movement, balance, posture, range of motion…..simple movements that we could both learn and benefit from, and that I could reinforce at home. Our therapists do not actively suggest much of anything, they simply measure progress on a monthly basis. It really is unfortunate that it comes to this. Sometimes I feel like they give up on him because if the word autism comes into the conversation they assume that there is nothing they can do. I wonder if this is the same way therapists (and other medical professionals) view the elderly as well. It makes me very sad.
Thank you for posting your thoughts on this. You have just opened a world of possibilities for a four year old boy!

Jenn, please let me know if you make progress with this. On the top right of this page there is a link to a very good site with some free online samples of some wonderful Qigong exercises you can try with your son. Keep in mind, at his age he very well may not have the attention span for this type of exercise. However if you reinforce the idea of moving as slowly as he can even doing simple everyday movements it may “take” in his head.

I am a PT with 20 years of experience. I have always been dismayed with colleagues exercise/general knowledge. To that end, I created my own exercise device that seniors can do, sitting safely at home. Otherwise, I call it “basement of a VA, circa 1960” exercises.

Bart, please tell me more about this… I have a curious mind and want to know 🙂

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