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The News from Cuyahoga Falls This Forum tells a story, meanders, but never strays too far from what clinical life might teach us.

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Old 02-10-2008, 12:50 PM   #1
Barrett Dorko
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Default Cattle Call

It’s been a quiet week in Cuyahoga Falls…

Nothing like the right words in the right place at the right time. Nothing.

Today I noticed the words Natural Magic on a silver colored case in a small room at the skilled nursing facility where I’ve landed this week. Just reading it I felt better. I thought, “Maybe I can work those words into some marketing…” I mean, what’s more popular than those two concepts today?

Eddie Arnold’s Cattle Call was huge cross-over country western hit over fifty years ago and I remember my father mentioning it several times but I never heard it until I sat in a Starbucks one morning this summer. It captivated me and after I’d spent the $.99 to download it I added it to the playlist I’d been quietly enjoying in my tiny corner of the office. In amongst all the Art Tatum jazz piano and Livingston Taylor covers of classic tunes (great harmonica accompaniment) Cattle Call stands out.

Therapy, such as it is in these buildings, seems to be something that takes place at a certain time and in a particular location. It is something given from the therapist to the patient and consumed as is possible by individuals with wildly disparate abilities. I know you could make the case that all of this is true on some level and that the way this thing we call therapy is delivered can be justified in any number of ways. Before you do, let me say that I already understand that.

What troubles me is the repetitive and mindless nature of the work when approached in that way. I’ve long had the sense that therapy can emerge from the patient and that a few minutes of authentic and thoughtful interaction without any emphasis on goals, repetition, effort or exhortation might be all that’s needed for an enduring transformation in function and feeling. Maybe I’m wrong. After all, a lot of this stuff is hard to measure.

Somehow, playing Cattle Call for a few patients seemed to help. They all remembered it and swayed to its lullaby-like rhythm. I suggested making it the official theme song of the PT department but it didn’t happen.

Maybe it was the song title the boss didn’t like. Go figure.

Maybe something like Natural Magic Call would have worked a bit better.
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Old 02-10-2008, 01:17 PM   #2
NateM
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This post comes at an appropriate time for me, Barrett. I work 2 days per week as a per diem homecare PT for a visiting nursing service in my area. I started last February, at which point I had to go out on visits with other therapists to "observe."

On these visits, I was struck at how much of the routine revolved around the therapist mindlessly counting out the reps as the patients performed their exercises. I sat off to the side struggling to keep my eyes open and my interest from wandering. I knew I couldn't possibly do things in that manner, so I made a pact with myself to be different.

I follow an approach similar to what you describe. When I first meet a patient, we discuss their reasons for homecare, their families, past work situations, etc., followed by a look at their current abilities.

I then briefly run over some exercises, but I tell them that my purpose is not to count reps like some kind of humanoid pedometer. I have them tell me what they would most like to accomplish with our time for that session together. Whatever it might be...attempting stairs, perhaps a little trick to help with getting into the shower...whatever. I've even spent time at a kitchen table with a woman as she cried about the stresses she felt trying to care for her epileptic brother while she recovered from her surgery. I just sat and listened...I think I could even feel her relief when she let out a long, slow sigh at the end, and we laughed a bit about some trivial things afterward.

To me, this is part of the therapy, and I think your post touches on that gracefully.
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Old 02-10-2008, 09:55 PM   #3
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Barrett

I haven't heard Cattle Call for a very long time; I grew up with US hill billy records every night, coming from Shreveport, Louisiana.
Cattle Call was one of my sister's and my favourites, along with all of Slim Whitman's doleful songs.
Recently I was in a music shop where they were playing Johnny Horton; suddenly I noticed the teeny boppers, the oldies and in-betweens come alive, swinging and foot tapping quietly to the profound beat of North to Alaska, Sink the Bismark and Battle of New Orleans.
I bought the CD. I might even look for Eddie Arnold.

Nate,
The very idea of any PT doling out repetitive exercises day after day is mind-numbing. Doesn't matter if the recipients are aged or teenagers; it is so far from therapy it is scary.
And they get paid for doing this!


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Old 02-10-2008, 10:02 PM   #4
Mary C
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Thumbs up

Nate, you're a therapist first, a physio second.
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Old 02-10-2008, 10:58 PM   #5
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Thanks for the kind words, Mary.

What a unique opportunity this has been. I've always believed that orthopedics was my primary interest, but I find my few homecare clients to be very interesting, engaging and appreciative beyond what I see in the outpatient clinic where I work full-time. And it's a two-way street--I gain from my time with them as I hope they do with me.

One of my clients this afternoon mentioned her anxiety over her living situation, her boredom with her lack of stimulation in her apartment and her disappointment in her physician at her mention to him that the pain meds weren't working.

We climbed the stairs to the ground floor several times as she requested, each time she was gaining in confidence and in spirits.

Back in her apartment, we talked about why she was bored and what bothered her about her doc. She mentioned the lack of back soreness and a nice tingling of relaxation in her legs now that she was relaxed.

On my way to the door, she quietly said, "I'll see you Tuesday. And Nate, thanks for the talk."

It's nice to have those times.
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Old 02-10-2008, 11:30 PM   #6
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Welcome to the wonderful world of the chronic chrawler. They are such marvelous people. Making a change in their lives, no matter how small, just makes your day.

I can remember the physio who dismissed me as "just looking after chronics" to the md's in our area. I've since moved and the attitude of the physios around me is the opposite. I'm the daring one now. I'll tackle anything (or just about.)
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