As Us Anything About… Physical Therapy

A female physical therapist kneels down as she places her hands on both sides of a man\'s knee. He is seated on the floor, with a brace on the knee. Various physical therapy equipment is in the background, out of focus.

Physiatrists — physicians who specialize in physical medicine and rehabilitation — work with patients to treat pain, restore function and get them back to a healthy lifestyle. Nancy Lokey, nurse coordinator with the Department of Physical Medicine and Rehabilitation at Penn State Health Milton S. Hershey Medical Center, provides valuable insights.

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Description – The video begins inside a rehabilitation lab in the Hershey Center for Applied Research building. Two people are standing next to each other. Standing from left to right are Nancy Lokey and Barbara Schindo.

Barbara Schindo – 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.

Nancy LokeyThank you.

Barbara Schindo – 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?

Nancy LokeySure 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.

Barbara Schindo – 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?

Nancy LokeySo, 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.

Barbara Schindo – 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.

Nancy LokeyCorrect. 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.

Barbara Schindo – 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.

Nancy LokeySure. It’s huge. It starts 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.

Barbara Schindo – So sometimes this happens before the treatment even happens.

Nancy LokeyYes. 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.

Barbara Schindo – 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.

Nancy LokeyIt 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.

Barbara Schindo – More day to day. How you function on your day to day.

Nancy LokeyYes.

Barbara Schindo – 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?”

Nancy LokeyIt 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.

Barbara Schindo – 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?

Nancy LokeyAbsolutely. 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.

Barbara Schindo – 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?

Nancy LokeySo, 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?

Barbara Schindo – 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?

Nancy LokeyOkay. 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.

Barbara Schindo – 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.

Nancy LokeyOkay. 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.

Barbara Schindo – 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.

Nancy LokeyCorrect.

Barbara Schindo – 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?

Nancy LokeyWe 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.

Barbara Schindo – 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?”

Nancy LokeySo, 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.

Barbara Schindo – 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?

Nancy LokeyYes. 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.

Barbara Schindo – Well, thank you very much for joining us today. Again, we welcome your questions. Nancy, thank you so much for joining us.

Nancy LokeyMy pleasure.

Barbara Schindo – Thank you.

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