Physical therapy helps people recover from injuries, manage chronic conditions, and improve physical well-being. Patient education is a vital part of that process because it helps people understand their condition, treatment plan, and role in achieving lasting results.
Children can be scary.
I’m not talking about the teleporting dolls of horror movies – just regular pediatric patients.Some people have the natural ability to relate to children, and others might feel like they’ve been knocked out of their usual rhythm of patient communication. How do you explain pathologies to a 10-year-old? How do you make a personal connection, take an efficient subjective history, and get patient buy-in?
As a PT student during a pandemic, trying to practice pediatrics on baby dolls and my adult classmates, I’m curious. After all, somewhere in the world there is a scientist who has dedicated a significant portion of his life to studying kleptoparasitism in kangaroo rats (Kline et al. 2018). Surely someone in the research community has figured out how to talk to kids?
In their book, The Art and Science of Motivation: A Therapist’s Guide to Working with Children, Ziviani et al. emphasize the importance of empowering children by including their input and values in the therapy plan. Older children and adolescents especially benefit from selecting their own personal goals for therapy.
Here are some general recommendations from the authors for talking with children:
Verbal messages: Use words that the child will understand, depending on their age. Talk about how the child feels about the session and their goals. Use language that is “realistic, empathetic, encouraging and responsive”.
Nonverbal messages: Avoid using a “sing-song” voice, speaking loudly or overbearingly, and interjecting while listening. Instead, make eye contact with the child, and use a calm, positive tone of voice. Use facial expressions and body language to show that you are interested and enthusiastic about the session. Take time to listen to your patient and pause to wait for their responses.
Autonomy: Giving children choices and listening to their perspectives
“There are a few things you’ve mentioned you’d like to do; what do you want to do the most?”
“What do you think might happen if…?”
“How are you going to do it?”
Relatedness: Empathetic listening, feedback
“I understand…”
“It seems like this is hard for you….”
“Let’s see if we can figure this out together”
“Who can help you work on this?”
Competence: Affirm a child’s abilities
“Oops, it didn’t work out. Let’s think about other ways/strategies”
“What skills will help you to do it?”
“What will make you feel you can do it?”
I’ve summarized some general recommendations from Ziviani et al. by age:
Age 4: Try to match the child’s sentence length (avg. 4 words). Listen for descriptive words that the child uses and incorporate them into how you describe the therapy. Respect the child’s desire for independence. Understand that these children will become frustrated easily if they cannot accomplish a goal.
Age 5: Offer choices, and help the child find words for their emotions.
Age 6: Adult expectations influence the child’s self perception. Ask the child for explanations or directions, and ask about their feelings.
Age 7: The child describes personal experiences and understands 5-step directions. Use complex tasks and mirror the child’s developing gestures.
Age 8: The child is beginning to compare themselves to other children and seek social acceptance. Involve child in goal planning discussion and peer engagement.
Age 9-10: Use humor to make therapy more interesting.
Age 11-12: The child is developing responsibility and self-reflection. Encourage them to think about their behavior, thoughts and emotions, and to take more responsibility. Here are some specific phrases that Ziviani et al. suggest using. They are tailored to three psychological needs of a child: Autonomy, Relatedness and Competence (ARC).
We all want to feel like we are making choices in our care. We want to feel heard, and we need genuine encouragement. Kids need the same. There’s no need to fear.
Over the past four months or so I have had the opportunity to see healthcare during the COVID-19 era from the perspective of a patient. This has allowed me to personally feel how the changes we have made to keep providing patient care during a global pandemic have impacted our patients. This opportunity has allowed me the chance to see the good and the bad of telehealth and social distanced health care. To begin I want to start by saying all the health care providers I have worked with have been wonderful and are all phenomenal providers, and second this is only my perspective and is not meant as a fully encompassed view of the current state of health care.
I wanted to start by stating how weird it is to go into potentially life changing appointments while sitting at home and staring at a computer waiting for the doctor in the virtual waiting room. The setup just feels a bit odd, one minute you are sitting there drinking your morning coffee in your PJ pants and then all of a sudden you are in a deep virtual conversation with a provider about information that changes the trajectory of your day to day life. Before you know it the zoom, or google chat room closes and you are left sitting there trying to process the news in your living room. The good news is many doctors have understood this concept and are willing to sit in the virtual chat and discuss details for as long as you need, however the difficulty with this is that there is always an abrupt ending to the call and the patient is still left sitting there with their mind racing and the urge to google what they were just told. One thing I have found that has helped is that when a doctor gives life changing information many of them have allowed me the opportunity to schedule an in person visit after the virtual call to follow-up and do the physical examination.
Another area that has been interesting to see is that there seems to be no set appointment length with patients during this time. My experience has been that my virtual appointments last anywhere between 6-45 minutes. This has been an adjustment as a patient because many times you go into physical appointments and can expect to be seen for around 20-30 minutes. My best virtual appointments have been with the doctors that take the time that would normally have been filled with physical examination and discussed research and things to try at home and scheduling in person visits as necessary. My less effective virtual appointments were doctors just telling me physical lab results that have already been uploaded to my patient portal and ending the call with no clear conclusion. As many professionals try to navigate this new era of health care one area that can not be lost is bedside manners.
One area that I have enjoyed about being a patient in this time is that it has expanded the network of clinicians I can see. I was able to see my PCP back in Minnesota, while still going to school in New Mexico and then within the same week see a specialist down in New Mexico. This type of care has allowed for a wider variety and a larger network of providers to work together. It makes it feel almost like you have your own personal pick of providers as long as they are covered by your personal insurance. This makes getting second opinions easier and more efficient than before.
Telehealth has provided many challenges for providers to work through on their end, but one area that can not be forgotten is the patient’s experience. The struggle of having to log into a virtual chat to hear news that could alter an individual’s whole life and having that chat end leaving them sitting in their living room is unprecedented for many individuals. Having had the opportunity to live this reality has made me recognize the struggle our patients are going through. The lack of face to face interaction has taken a piece of the compassion out of a professional field that strives to provide our patients what they need during major life changes. This isn’t to bash on telehealth. I have actually thoroughly enjoyed being able to utilize telehealth as a patient, it is just to remind ourselves that our bedside manners are even more important when social distance creates barriers to the compassion that many of our patients need. Through our own continuing education and experiences I think telehealth can become an important piece of health care going forward.
by Jonathan Lewis, SPT
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August, 2017 Newsletter
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6 New members joined bestPT in July 2017. Each new member benefits from and contributes to our network strength.
Let’s welcome bestPT newest members!Samantha Monahan of Bassett Physical Therapy, Stanleytown, VA Sopia Polanco of Bit-By-Bit, Fort Lauderdale, FL Christa Johnson of Comprehensive Hand & Rehabilitation Waterford, MI Shalaina Russell of Kalispell Rehab, Kalispell, MT Michele Kurkowski of Kiwi PT, Highland, MI Norma Garcia of Two Trees Physical Therapy & Wellness, Ventura, CA |
Looking at the landscape of physical therapy practice management, we see a playing field tipped to benefit the payers and hurt the provider. The relationship between payers and providers is adversarial, but billing networks offer solid strategies that allow providers to get back into–and win–the game. The “network effect” allows a large number of unique providers to capitalize upon their strength in numbers. Please help us strengthen that network. | |
 | If your friend schedules a demonstration of the system, we’ll send you a $25 Amazon gift card! |
 | For each friend that you refer that joins our network, we’ll credit you $50 each month the office is contracted with us through the first year! |
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 PTA: First Choice for a Second Career Many PTAs began their work lives in other occupations but have come to find a home in physical therapy. While their individual reasons may vary, many of these professionals are resuming their studies as older students focusing on a second career that is more satisfying than the work they had previously done. Work that is emotionally fulfilling, stimulating, varied, all the while being educationally affordable and serving a hot job market. (by Eric Ries, at PTinMotion)
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6 New members joined bestPT in June 2017. Each new member benefits from and contributes to our network strength. Let’s welcome bestPT newest members!Lauren Sahagian of Big Sky Pediatric Therapy, Austin, TX.Colleen Lafferty of Bit-by-Bit, Ft Lauderal, FL.Sarah & Linzie Schwindt of Health Rehab Solutions, Kalispell, MTAdrienne Martinez of Prime Therapy & Pain Center, Riverside, CA.Bruce Wihongi of Kiwi Pt, Highland, MI |
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