01 Oct Notes from a Physical Therapist at Specialty Hospital of Central Jersey
Physical therapists, or PTs, are one part of the interdisciplinary team at Specialty Hospital of Central Jersey. This clinical team also includes physicians, consulting physician specialists, nurse practitioners, physician assistants, nurse managers, charge nurses, floor nurses, wound care nurses, respiratory therapists, occupational therapists, speech therapists, dietitians, social workers, case managers, nurse’s aides, and rehab aides. This gives an idea of the breadth of expertise provided and the size of the team. This wonderful group of professionals at Specialty Hospital works extremely well as a team. Truly the whole is greater than the sum of its parts. As individuals, they are very experienced and excellent at what they do. These professionals have dedicated their lives to helping others and provide care 24 hours a day, 365 days a year. Specialty Hospital also has an impressive staff to patient ratio.
Specialty Hospital is a hospital, not a rehab facility. It is an LTACH, or long term acute care hospital. Patients that are in an LTACH are there for a reason. This reason basically is that they need longer term hospitalization, are acutely ill, and require the acute level of care that is provided there. They may be there for weaning off of a ventilator, care of complicated wounds, or may be medically complicated, among other reasons. An LTACH has also been described as a step down ICU, or as the level of care between an ICU and a regular hospital floor. But typically the duration of stay in other hospital units is less than in an LTACH. These are patients that need to be in a hospital longer. If you were to ask me, “What is the real specialty of Specialty Hospital”, I would probably say, “Taking good care of very sick people”. Then I would probably add, “They are also very good at weaning people off ventilators, assisting with healing wounds, and dealing with complicated medical problems.”
PTs in general work in many settings and with patients of all ages. PTs are experts in movement. They help restore functional ability and independence, improve mobility, relieve pain, and prevent or limit physical disabilities. They assist with recovery from injury or illness. They restore, maintain, and promote overall fitness, health, and independence. They are the experts in examination and treatment of musculoskeletal and neuromuscular problems that affect the ability to move and function.
PT goals might include assisting a person to become as safe and independent as possible. Sometimes they may teach patients other ways of doing things in an effort to compensate for physical or functional deficits. Treatment will generally include education of patients and their family members.
Examples of actual treatment might include working on strengthening, bed mobility, sitting and standing balance, transferring sit to stand or bed to chair, standing, walking, and improving activity tolerance, among other activities. The treatment is individualized, and may change on an ongoing basis. It is the physical therapist that will walk into a hospital room and get a patient that is weak, sick, in pain, discouraged, and has multiple lines, tubes, and monitor wires to sit up or stand up for the first time.
The physical therapy approach at Specialty Hospital will depend upon the patient’s status. It is adapted to the individual. The patient’s status may change from day to day, even moment to moment. The PTs at Specialty Hospital of Central Jersey have many years of experience. They are flexible and adapt to the status and the situation at the moment. They also work within an ever changing environment, with fluctuating medical status of patients, and with multiple other staff members needing access to the patient. PTs need to work around the primary reasons that a patient is there, which is the medical treatment. Medical treatment comes first, and therapy is secondary. More intensive therapy might come after discharge, such as in a rehab facility, where therapy may be the primary focus and where patients are not as ill. At Specialty Hospital patients are acutely ill. They need more time to recover before they are ready for intensive therapy. More is not always better. In fact, overdoing activity can be detrimental to recovery and health. We adapt to the patient’s tolerance on an ongoing basis. And some patients are not even capable of any movement on their own. In some cases this changes over time. But if a patient cannot move at all, we cannot make them stronger by moving them passively. The patient has to initiate movement in order to get stronger.
Much less officially speaking, PTs may also sometimes be a source of motivation, support, encouragement, and assistance. They develop rapport with patients. Personally speaking, I have been critically ill, and therefore I empathize and fully understand the experience.
I once overheard Dr. Lebowitz, our medical director, tell a patient’s family member that we do not provide miracles; we just provide the place for them to occur. (I am paraphrasing, as I don’t remember the exact words). PTs also provide physical therapy, not miracles. We play a part in recovery, and we use our skills, experience, and knowledge to the best of our ability and as a part of an excellent and cohesive team. Incidentally in addition to the staff, that team also includes the patient and their family. We all play a part in the care of the patient and supporting them. Most of us that have worked here for a while have in fact seen some miracles. But we don’t take credit for any of them. And we don’t guarantee or provide them. We are just glad to be a part of the patient’s care and a part of the team at Specialty Hospital.