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Healing in motion

Physical therapy often makes the difference in how quickly people recover from injuries and illness

Posted: Sunday, October 08, 2000

Steve McGee barely remembers the crash.

He saw a flash, perhaps a color.

"It happened so fast," said McGee, thinking back to the collision that seriously injured him April 19 near the Seward Highway-Sterling Highway intersection about 30 miles north of Seward. "I read something like it takes two seconds for images you see to be filed away in your memory. I don't have any of those. I've got about a four-hour gap there."

When he awoke, he learned his two close friends and business associates, Martin Richard and Ladd Macauley, had died in the head-on collision caused by another vehicle.

Therapists try new treatments

Stiff joints and damaged muscles aren't the only ailments tended by physical therapists. A new and somewhat controversial form of therapy is being used for cancer patients.

Martha Valentine, director of physical rehabilitation at Bartlett Regional Hospital, doubles as a physical therapy patient.

Valentine recently had four cancerous tumors removed from her neck and decided to apply a physical therapy technique to help recover from the surgery. It's called "craniosacral therapy" for pain and immune response.

During the procedure, she lies on a table and a therapist manipulates 10 areas on her body to help speed recovery. The theory is that the cerebral spinal fluid is a hydraulic system from the brain down through the spinal cord. The manipulation of the potentially affected areas frees the restrictions, leading to less pain and enhanced immune response.

"Some people don't believe in it," she said of the new therapy. Still, she said, "There are a lot of things therapy can do. I want to encourage more programs for cancer patients. Through therapy I'm learning about it first hand."

When she goes to Seattle to continue her cancer treatment, she is going to study more about craniosacral therapy. Another area that interests her, she said, is called lymphedemia massage, which can be used to treat cancer patients whose lymph nodes in other areas have been affected.

Valentine's staff also provides scar massage, stretching and strengthening exercises, relaxation exercises, and visual imagery as a part of its services.

"By some stroke of luck, I got out and they didn't," he said. "I haven't totally accepted it. For a long time I thought, 'Could I have done something, like hollered, to avoid this?' "

His emotional pain may never heal completely, but he's had great success in overcoming the physical damage he sustained, thanks largely to physical therapy.

McGee is one of a number of Juneau residents who have turned to physical therapy to speed recovery. Those in the physical therapy business hope to use October, Physical Therapy Month, as a springboard to educate people that their efforts can provide a critical link in regaining abilities and skills lost following surgery, illness or an accident.

"It's the evaluation and treatment of muscular and skeletal dysfunction and pain," summarized Melissa Doucette, a therapist at Juneau Physical Therapy. She said therapists promote "flexibility and strengthening. It's a combination."

 

Physical therapy differs from occupational therapy and speech therapy. Physical therapy tends to stress alignment of the spine and its use for standing, walking and balance. Occupational therapy deals more with what is referred to as the ADLs activities of daily living according to Kathy Stepien, a physical therapist at Bartlett Regional Hospital's Physical Therapy Department. That would include getting dressed, showering or bathing, using the toilet, brushing hair and teeth, and other hygienic activities. Speech therapists emibility and strengthening. It's a combination."

Physical therapy differs from occupational therapy and speech therapy. Physical therapy tends to stress alignment of the spine and its use for standing, walking and balance. Occupational therapy deals more with what is referred to as the ADLs activities of daily living according to Kathy Stepien, a physical therapist at Bartlett Regional Hospital's Physical Therapy Department. That would include getting dressed, showering or bathing, using the toilet, brushing hair and teeth, and other hygienic activities. Speech therapists emphasize treatment related to eating, swallowing and talking.

Most often, the therapists said, physical therapy is covered by insurance providers as long as a doctor prescribes the treatment. Typically, a co-payment plan covers 80 percent of the cost, leaving the patient to pay the balance.

However, Doucette added, the patient is limited to a certain number of visits, depending on the nature of the treatment.

"There used to be more of a window," she said. "You have to be able to prove that you're making progress."

While this can be frustrating for her profession at times, she said practicing physical therapy in Juneau is rewarding.

"Juneau is such a young, active place," she said. "The ultimate goal is independent home exercise."

McGee's saga

Auto accident victims such as McGee are common patients for physical therapists.

McGee suffered fractured cheek bones, a fractured shoulder blade, a bruised heart and a punctured lung in the crash.

"My whole left side was wiped out," he said, noting that side of his body took the brunt of the southbound pickup truck that swerved over the centerline into his traffic lane.

Most of his rehabilitation was focused on his shattered left knee. He couldn't put any weight on the leg for three months after surgery.

Leah Davis, owner of Kinetic Physical Therapy, was McGee's therapist.

"We worked on a range of motion getting him ready to walk. It's called pre-gait," Davis said. "We were getting it strong enough to walk when he was ready."

A benefit of working with Davis, McGee said, is that she owns a mobile service she loads up her van with exercise and diagnostic equipment, then goes to her patients' homes. That's convenient for someone who can't walk.

 

Early in his therapy, McGee couldn't even straighten his leg, so Davis put him through numerous exercises to accomplish that task first.

"I would have to say it didn't feel too good," McGee said of the exercises. But he added, "The only way I was going to be able to walk again without a tremendous limp was if I put up with this stuff."

There was lots of bending, stretching and some weight training, still without putting any weight on his foot. After three months, his physician, Dr. Alan Gross, allowed him to go into the Augustus Brown Swimming Pool Davis is a big proponent of aqua-therapy. In the pool, McGee made great gains quickly.

"We'd walk across the pool and try to run across underwater," McGee said. "We did lots of different things like that. After every session my leg felt good."

He's come a long way in a relatively short amount of time. He still can't run Gross said it'd be about six months before McGee fully recuperates but still considers himself very lucky.

"I still have some pain, some parts in there don't mesh together quite right yet," he said. "With an excellent surgeon and what I consider to be an excellent physical therapist, I'll be OK. Without that I would not be anywhere near as back to normal as I am."

Mobility for the immobile

Another patient of Davis' is Ann Blackwell. Blackwell, who will admit only to being "in my 80s," had surgery on her right knee after it mysteriously began to stiffen.

"It was quite a sudden thing. I had pain down the front," Blackwell said. "It was hard to get in and out of a car or to sit down."

After surgery she said she couldn't even lift her leg off the floor to put her pants on.

Eventually, if you're one of Davis' patients, you will end up in your bathing suit. And so it was in late September that Davis and Blackwell met at the pool.

Davis pulled up in her van, opening the sliding door to display the tools of her trade: two big inflated balls used for a variety of exercises; large elastic bands for resistance training; a fold-away treatment table; ice packs and hot packs; a briefcase carrying her ultrasound and electrical stimulation unit; and a laptop computer with software that customizes workout programs.

In the pool, Davis used none of that. The resistance provided by the water is all she needs.

"Water allows me to have people do exercises that on land they couldn't do," Davis said, noting the buoyancy allows many more movements of affected muscles. "You don't have the impact on your joints."

Davis had Blackwell do all kinds of leg extensions, deep-knee bends, dolphin kicks, trunk-twisting movements, running in place, and running forward, backward and sideways, among other exercises.

 

"That was a nice workout," Blackwell said upon finishing the approximate 45-minute session. "I certainly did things I never did before."

Strokes and burns

At Bartlett Regional Hospital's Physical Therapy Department earlier this month, Leona Gran, 84, recounted how a stroke in September radically changed her life.

"I was waiting to go to work at the Driftwood Lodge (where she works as a bookkeeper). I was waiting for my ride," Gran said.

She had a stroke while waiting.

"I don't recall it. My daughter kept calling me and couldn't get an answer," Gran said.

Remembering the frightening situation reduced her to tears.

"My son Rick came over to check on me, to see why I wouldn't answer the phone," she said.

She was left paralyzed in her left hand and left leg. This is her third week of therapy and she's seeing some improvement.

"It's slow progress," said Stepien, her therapist at the hospital.

She said Blackwell is undergoing a complete rehab program physical therapy, speech therapy and occupational therapy overseen by a physician. Blackwell is an inpatient and totals three hours every day of various therapies.

"You get very tired," Gran said. "You just want to lie down."

Post-surgery patients and stroke patients are leading candidates for physical therapy. But there are many other examples.

Stan Barge, 60, knows this all too well.

"I think the public feels like it (physical therapy) is for muscular, skeletal treatments," Barge said. "Apparently they (therapists) do a lot of wounds, too. This is a whole other aspect."

He has first-hand experience based on a recent burn accident.

"I got a tall Americano from a local grocery store. I got in my car and went to put the coffee on the dashboard and I hit the steering wheel," Barge said. "It spilled and went into my high-top tennis shoe. I couldn't get it away from my skin."

When he went home to change clothes, his skin peeled off with his sock.

His therapy at Bartlett consists of lots of daily whirlpool treatment. That part is fine, it's the part where his dead skin must be pulled off that causes the discomfort.

"It would harbor bacteria if we left it there," said Mary Veale, his therapist.

She said the whirlpool used to be just about the only treatment burn patients received. "We do a lot of different treatments now. (The whirlpool) is becoming less standard. There are a lot of different dressings that promote healing," Veale said.

Still, for an infected abrasion or cut, the whirlpool is a good option because it cleans out the affected area, she said.

Also, Barge is doing a lot of flexing exercises with his foot to prevent the loss of mobility that can happen with scarring.

"When it scars," Veale said of the burned skin, "it tends to shrink."

The exercises keep the skin loose. Barge also must wear a compression sock for about a year.

"It helps prevent scarring," Veale said. "It holds the scar flat, keeps it from growing thicker."

Patrick Ripp, a physical therapist at Juneau Physical Therapy, said he tends to specialize in manual therapy a manipulation of the spine and extremities but such a generic description really doesn't describe what he does.

He said the job of a therapist isn't just manipulation. Identifying the source of the problem is a key. If someone comes in with a sore knee, he doesn't simply treat the knee.

"I look at all joints in the region. I'm looking for tight joints I can manipulate, but not necessarily just that," Ripp said.

For instance, he deals a lot with orthotics, or problems related to the foot. He sees many runners, he said, who want their feet treated, when many times the source of the problem is related to the hip or spine.

Early last week he saw a woman with a sacroiliac problem.

"That's the low part of the back where the pelvis connects to the tailbone," he said. "I found she had one side too tight while the other was too loose. The loose side was compensating. I'll get the tight side moving, set her up with strengthening exercises to better control the pelvis."

He said a hard fall on the buttocks as long as three years ago, could have caused the initial problem.

"It's amazing how well the body compensates for an injury. You have to look around, above and below (the area in discomfort)," he said.

"We're experts in biomechanics, how things work together. How does one area affect another? How do we strengthen it?"



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