Nancy Devine – Physical Therapy

1. In 10 words or less…. What exactly do you do?
Physical therapists help people move efficiently and functionally without pain.

2. Why did you choose this health profession?
I chose to be a physical therapist because I like to be active and help people after an injury return to doing what they need and enjoy doing.

3. What do you find most rewarding about your health profession?
The most rewarding aspect of being a physical therapist for me is the interaction with my patients. As a physical therapist, I really get to know most of my patients and their families in a way that is not possible in many other health care professions. Often, in my area of practice, I recognize my patients are teaching me about what is most important in life, while I am teaching them how to maximize their capabilities after experiencing a stroke or a spinal cord injury.

4. Is there anything that you don't like about being a __________ (health profession)?
The worst part of being a physical therapist is the constant struggle between identifying what physical therapist services are truly needed by a patient and finding funding to provide those necessary services. Sometimes it seems as if insurance company coverage attempts to make determinations of the need for physical therapy services rather than someone with the skills and knowledge of a physical therapist. I strive to be a strong patient advocate who can clearly state the examination data supporting the need for services and the expected outcomes in a reasonable time for a reasonable cost using research when it is available, but the reality of our current health care system is that rationale, evidence-based recommendations are not always funded.

5. Does require a lot of college to become a __________ (health profession)?
YES! Currently a minimum of 7 years is required to become a physical therapist. Currently you must have a bachelor’s degree (4 year degree) and the necessary pre-requisite coursework to apply to an entry-level doctor of physical therapy program (3 year degree). You may choose to become a physical therapist assistant which requires an associate’s degree (2 years). Physical therapist assistants are licensed practitioners who work under the supervision of a licensed physical therapist and perform many of the interventions planned for the patient.

6. What was the best part of your college experience(s)?
The best part of my college experience was the clinical affiliations I attended as a student physical therapist. During the physical therapist curriculum, students are required to work under the supervision of a licensed physical therapist for 6-8 weeks in 4-5 different practice settings. Applying what I had learned in school in a real clinical setting with a physical therapist supervisor and real patients allowed me to integrate the information and skills in a way that enhanced my learning and further reinforced that I had selected a profession I enjoyed.

7. What are you responsibilities for on any given day/week?
My typical responsibilities are to provide initial examinations for new patients, implement treatment plans for current patients and to document the care provided. Most of my patients have a neurological medical diagnosis such as a stroke or spinal cord injury. As a physical therapist, I assess the changes in the patients’ bodies that are due to their medical diagnosis, or other events in their past medical history. Once I have a good understanding of which parts of their body work well, and which parts are impaired, I develop a list indicating which areas may be improved through exercise and which problems may need to have some form of adaptation such as using a brace or learning to use a wheelchair instead of walking. I develop a plan for treatment sessions, as well as a home exercise program, that will help the patient be as independent as possible in completing the necessary activities during their day (transfers, moving from place to place) as well as some activities of interest (employment, recreation). I am often actively assisting patients with transfers, guarding them while they are walking on levels, stairs or outside, and exercising along with them as they develop strength and endurance. My days go by very quickly and I often wish I had more time with each patient.

8. What has been your best day as a __________(health profession)?
It is challenging to select a “best day” as a physical therapist because I have multiple ones I could describe. I will describe one relatively recent day in which I worked with a patient who had damaged the spinal cord in his neck when he fell off a mountain bike. Initially, he could not walk or move his arms very well and the plan was to order a powered wheelchair for him. Based upon research evidence, I recommended a new treatment intervention that indicated he should be able to learn to walk rather than use a powered wheelchair. I had never personally used this intervention, but the evidence suggested it should be effective based upon my examination findings. Several other physical therapists and I worked to obtain funding to purchase some needed equipment to implement the intervention and then worked diligently in applying it. About 4 months later, the patient was able to take his first steps on his own and within 2 months he was able to walk household distances independently. Since then, he has learned to go up/down stairs and across grass and uneven terrain. The day I observed him walking for the first time, I felt I had truly made a difference for this person based upon my knowledge, skill and perseverance.

9. What has been your most memorable case/patient as a __________(health profession)?
My most memorable patient was a woman in her mid 40s who had a severe stroke that would have killed her if she had not been in the hospital receiving treatment for a different health issue at the moment of her stroke. Due to the severity of her stroke and a history of polio, she was not expected to achieve much physical recovery. This woman defied all the odds and is currently independent in all of her daily activities and works 40 hours/week. She went from being in a coma to being a person filled with more life than any other person I have met. She was originally from New York and would not settle for anything less than being fully independent. Despite my knowledge and skill, I have to attribute her recovery to her perseverance and strong desire for independence. When she was capable of being discharged home in a wheelchair in the care of her husband, she would spend up to 4 hours just making her bed because she was not satisfied with how her husband would do the task. She pushed herself harder than any other person with whom I’ve worked in order to be as independent as possible. This woman always had a smile on her face and a joke to share with everyone present in the physical therapy gym. She never appeared to focus on what she had lost and always kept her focus on what she could do better. She regained her ability to walk but has not regained the full ability to use her left arm. Despite only using one arm, there are very few things she can not do in life and for those tasks she has family and a multitude of friends who are more than willing to help her. She is a remarkable person and has taught me to keep my own focus on how I can achieve more in every thing I do.

10. What is the craziest case/illness that you have seen as a __________(health profession)?
The craziest case I have seen as a physical therapist was a man in his late 30s who had damaged the spinal cord in his neck during a bar room brawl. He could not move his arms or his legs. During his first week on the rehabilitation unit, the occupational therapist (OT) working with him suggested it would be beneficial for him to get into a pool to see if he could use the buoyancy of the water to assist in moving his arms. I agreed to assist him in the pool. The patient was lowered into a therapeutic pool using a lift and the OT and I assisted him out of the lift onto a ledge in a seated position. Due to the depth of the water the OT asked if I would stand him in the pool to allow him to float his arms on the surface of the water. I performed the transfer and within a few minutes, the patient was able to stand independently in the water without my assistance. He had begun controlling his legs himself. The patient was even capable of taking a few steps and within 10 minutes had learned to walk independently in the pool. The OT worked with his arms as well but without any change in his ability to control them. When it came time to exit the pool the patient requested to use the stairs and to walk out of the pool. The OT and I attempted to explain how the water reduced gravity and provided stability and that he was not ready for walking outside of the pool. The patient asserted his confidence in his ability so the OT and I decided to allow him to try it since we could always lower him back into the pool safely if his ability changed as he ascended the stairs. The patient walked up the stairs, into the shower room and received assistance to shower and dress, and then walked back to the rehabilitation unit. Everyone on the unit was looking at the OT and me as if we’d conducted a miracle. It turned out that the injury to the spinal cord was limited to the center of the cord and had spared the connections to the legs while permanently damaging the connections to his arms. Once he was in the pool he was able to relearn how to control his legs and maintained that ability when returning to land. This was the most unusual experience in my career as a physical therapist.

11. Is there any advice you would give someone thinking about becoming a ____________(health profession)?
My advice for someone thinking about becoming a physical therapist would be to contact physical therapy practices in your community and offer to volunteer in order to observe what physical therapists do each day. Physical therapists may practice in hospitals, in school settings, in privately owned practices and in nursing homes. Volunteering in one or more of these settings provides the opportunity to learn more about what physical therapists do each day and whether you would enjoy working in that capacity. Volunteer hours are also required for admission into a physical therapy program.

12. What can students do now to start preparing to enter into the Health Profession world?
Students who are interested in entering the Health Professional world can begin by becoming as informed as possible about how the body works. Taking classes in biology, anatomy and physiology may provide a good foundation for understanding how the complex human body functions. Developing skills for studying and understanding scientific information in a classroom and laboratory setting will assist students in the future when taking a heavy load of rigorous health care professional courses. Having opportunities to repeat exposure to content, such as anatomy, may aide retention and understanding of the information. Developing the skills to work with a wide variety of people would also be beneficial.

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