14- FOXcast PT: Carole Lewis, PT, DPT, GCS, MPA, Ph.D., FSOAE, FAPTA

Welcome to FOXcast PT, a podcast for clinicians made by clinicians. It’s brought to you by FOX Rehabilitation. Find out more at foxrehab.org.

Jimmy: Welcome to FOXcast Physical Therapy. I’m your host, Jimmy McKay, and we are just wrapping up a really, really great event here at our home office in Cherry Hill, New Jersey. This is a capstone event. We get to do this once a year with some residents here at FOX Rehab, and we had panelists come in and give their two cents about research.

Carole: I like doing that.

Jimmy: You like doing that! She knows her two cents. Well, I have to give your intro first, Carole. Let’s see a troublemaker, a prolific writer, a presenter and clinician, author of the recent bestselling e-book “Physical Therapy For the Older Adult,” and editor of the award winning “International Journal Topics in Geriatric Rehabilitation.” Dr. Carole Lewis, welcome to the show.

Carole: Well thank you! It’s quite a party here!

Jimmy: Yeah.

Carole: You know why? They did a great presentation.

Jimmy: It’s always good to get this amount of people together and talk about the thing that you geek out on and you love a lot. What do you usually hear these Capstone events? Because, this is not your first rodeo.

Carole: No, no it’s not my first! It’s actually only my second.

Jimmy: It’s your second rodeo, okay.

Carole: This one they really tackled a huge topic.

Jimmy: Right.

Carole: In terms of, you know, are specialists better? And how do you measure that? And what are some of the issues?

Jimmy: Right.

Carole: So that was good. The other one that I saw was on balance falls.

Jimmy: 10, 15, 20 years ago – this wasn’t really a thing!

Carole: No.

Jimmy: This wasn’t a thing in education…

Carole: No.

Jimmy: Or PT extended higher education

Carole: You couldn’t get this many excited physical therapists together to talk about geriatrics.

Jimmy: Right. And how you can!

Carole: Now you can!

Jimmy: So what did you take away? What were your take home points from the, uh, from the presenters and the students.

Carole: That it’s really hard to identify what the factors are because part of it is the culture you’re in. You know, they were comparing therapists at FOX with therapist who had their GCS, and part of the problem is I think FOX does a great job of educating their therapists. So it’s kind of hard to figure out if the, if – and they didn’t have all that much significance. They realized it because they were comparing kind of apples to apples. Here’s well-trained therapists and well-trained therapist getting their GCS, or having their GCS. They did show really good issues in terms of what are they doing in terms of measurement, what are they doing in terms of frequency, duration, the kind of care they’re giving – do they mix it up? So that was kind of cool.

Jimmy: So you’re able to look at that and synthesize that so quickly and someone like me who’s been out of school for two years, I’ve got to take my time and really pay attention. But you’re watching a presentation and you guys are jotting down notes – what you want to ask, what you want to question, what you want to give comments on. You did mention comparing a lot of different variables. It is hard to tease out

Carole: A lot of variables.

Jimmy: And that’s why we call it research…

Carole: Yes.

Jimmy: Because you’re going to they’re gonna take this idea, they’re going to take all your notes, go back and say “OK, how do we ask and answer that question this time?” So we want to get into some stuff that you’re excited about.

Carole: OK.

Jimmy: Let’s talk about some geriatrics, interests in geriatrics, education in PT programs right now: How do we get more students coming out of PT programs to think about working with this population? Because, it’s an important one.

Carole: Well, I think there’s, first of all you have to expose them to it in physical therapy school. And I’ve been screaming this for years – that every school should have a dedicated course to geriatrics.

Jimmy: Right! I know a lot of them don’t!

Carole: I know!

Jimmy: a lot of them it’s a module within school.

Carole: I know, I know. And, and I do think it’s getting a little better but it’s not there yet.

Jimmy: Right.

Carole: So my, my thing to therapists is: go out. You know, even if, you know, if there are any schools in your neighborhood, say: “Hey – I want to teach.” And one of the things I do is I teach in the medical school. So I take those fellows in geriatrics and I teach them about physical therapy because if they’re more aware… You know, so you do a module – you do something on postural screening or flexibility testing or how physical therapists treat somebody who’s had a CVA and then you go to these programs and you say: “Let me show you how somebody treats somebody older with a CVA versus somebody younger.”

Jimmy: Right.

Carole: You know maybe they don’t have a module in geriatrics but “I know you teach this in neuro – let me come out and show you how I work differently with somebody in a skilled nursing, or in a home care setting.”

Jimmy: Right.

Carole: And get them excited about it! Because to me it’s one of the most challenging and rewarding settings you could ever be in.

Jimmy: Yeah.

Carole: You know, it has so much to it. But if you teach it as something that is boring…

Jimmy: Or even worse you stay away from it.

Carole: Right.

Jimmy: You don’t mention it at all.

Carole: Right. You don’t teach anybody.

Jimmy: Right.

Carole: And then they think to themselves: “You know, well, I don’t want to work there – I don’t think about it!

Jimmy: Yeah, not surprising if you have PT programs that do not have any people that are excited about it, you have students who are not excited about it.

Carole: Right.

Jimmy: It shouldn’t, when you say it like that it shouldn’t be surprising, but we have that.

Carole: Right. I don’t usually teach in the PT schools. But I did teach recently at one of the schools.

Jimmy: Where’d you go?

Carole: Well I went to three – I went to Delaware, G.W., and Howard.

Jimmy: OK.

Carole: I did like a one-month spree.

Jimmy: Tour.

Carole: Yes, yeah. And I always ask before I start the class: “How many of you are going to go into geriatrics?” And a pitiful one or two hands goes up. The most wonderful thing was after doing my classes in two of these settings therapists came up to me and said: “You know what? Now I’m going to going to go into geriatrics.”

Jimmy: Wow.

Carole: And it’s that easy to make a difference! You know, we know so much and we’re not sharing it. Therapists here could go to Jefferson or any of the schools in the area say: “Let me just do a module for you.” And believe me, the teachers would be happy! You know, if they do a little less work…

Jimmy: Sure.

Carole: You do a little of the work… and you get, you get students fired up.

Jimmy: Yeah.

Carole: So, sorry, I just had to share that.

Jimmy: No, a little exposure can go a long way.

Carole: Yeah.

Jimmy: Especially when it’s with someone or from someone who is very, very passionate about that topic.

Carole: And doing it!

Jimmy: And doing it. So we know prevention and wellness is a hot topic in physical therapy but not so much in geriatric physical therapy. Why is that? And then what can we do about it?

Carole: Part of the problem is we don’t offer ourselves up in that capacity. When I graduated school, you were a success if you never saw that patient again. And now we’re learning no other business gets rid of their customers.

Jimmy: Right.

Carole: When somebody graduates, let’s say, from physical therapy after a hip fracture, you know, you don’t say: “Hey, never see you again.” You say: “Hey – if there are any problems…” or even better you say “you know, your hip is better but now let me do a full body assessment.” And in many cases you may have to pay out of pocket, and that I think is okay! I mean, people pay personal trainers, you know they pay 300 dollars to get their hair done…

Jimmy: Massage therapists.

Carole: Exactly.

Jimmy: On a regular regular basis.

Carole: Exactly, exactly. So let me look at you and see if your exercise program that you’re, you’re going to go back to is the right thing for you. I mean, heck! You broke her hip… Or even, well the other places I do it is community centers, assisted living facilities, I go to one of the low hanging fruit is functional medicine offices. You go in, you say: “You know, you’re doing all these extensive tests on your patients. You know you’re looking at their nutrition, you’re looking at, you know, all the parameters – Let me look at their body!”

Jimmy: Right.

Carole: And they, all of a sudden you see these physicians eyes going…

Jimmy: Light bulb moment!

Carole: Ding, ding, ding, ding!

Jimmy: Yeah.

Carole: And, you know, they realize that “Right, I’m not looking at their posture, their strength, their flexibility, and I’ve just sort of sending them to an acupuncturists or a massage therapist. I should be study to a physical therapist!”

Jimmy: Right.

Carole: And your role is, yes – there may be some hands-on, there may be stretching and soft tissue, who knows what. But there’s also a lot of “I’m going to design a program…”.

Jimmy: Education.

Carole: “That you are gonna do! That is gonna be specific to you.” But my favorite is AARP did this whole thing about Ruth Bader Ginsburg. You know that whole RBG workout?

Jimmy: RBG!

Carole: Okay. So they showed her, I think last month in the Bulletin. And, you know, they showed her doing her workout, and I looked at her and thought: “oh my gosh! Look at that lady! She obviously is doing a great workout but she doesn’t look good.” You know her posture is pretty terrible. I think it’s not the whole picture! It’s not the total package. And people are going to these personal trainers thinking they’re getting everything but they’re not. You know, we need, we can add so much to that.

Jimmy: Value.

Carole: And we don’t, especially for older people.

Jimmy: So you talked about it from the provider’s point of view in terms of saying: “Hey, we need to educate other health care providers. We need to be better advocates.” How do you do when you get in front of an older adult and maybe their mindset is in that PT is very reactionary. I go to a PT after I’ve hurt myself. How do you frame that real quickly to someone and say: “PT can be there, be there for you before the fall.”

Carole: Sometimes I’d tell them about other people. This beautiful lady that I saw – 72 years old, fell, ended up having traumatic brain injury because her calves were too tight.

Jimmy: Wow.

Carole: How easy is that to fix.

Jimmy: Right.

Carole: But nobody told her about it! So, you know, something as simple as that = these little stretches or tweaks that they could do now that in the future could keep them doing so much better in terms of function and health and feeling good. “Oh yeah, I work out – I have a whole program.” So I’ll say: “Okay, let me see you raise your arms in the air” and they have this horrible posture, you know their arms go up halfway…

Jimmy: Yup.

Carole: And I show them! “Okay, watch me” and I have my arms go up halfway and then I show them good posture and my arms go up all the way. And I say “You could change that!”.

Jimmy: Right.

Carole: You know, so that, you know, in ten years from now you can’t lift your arms at all even put a coat on.

Jimmy: Yeah.

Carole: “Now is not bothering you here, but it’s going to.”

Jimmy: Sure.

Carole: And, and they get it. They get the visual.

Jimmy: And that’s what PT should be.

Carole: Exactly!

Jimmy: Yeah.

Carole: Why wait? You know, why take somebody who’s so darned stiff, you know, 10 years down the line – get them early!

Jimmy: So something that you and I both share in terms of a soapbox, which is communication. Me because I have a background in it, and you because, well, you love talking. But we don’t advocate for ourselves and that goes for, you know, physical therapists along with occupational therapists, speech language pathologists – we don’t communicate the benefits enough.

Carole: Right.

Jimmy: I think we’re, we’re almost scared to pat ourselves on the back maybe?

Carole: Right, right.

Jimmy: I’m not sure. What do you think the reason is?

Carole: I don’t know. I don’t know, but I see it not just in what you’re doing here – trying to get the word out and communicating. I even see it research!

Jimmy: Really.

Carole: I get a little upset when I see therapists really backstroking and say: “well we sort of proved our efficacy…” And these studies are much stronger than some of the studies I see in the medical literature!

Jimmy: Right.

Carole: And yet we are very careful. And I don’t know what that’s about. That makes me sad because I do think we don’t have the funding that some of these drug companies…

Jimmy: Oh, not a chance.

Carole: Yeah, yeah! That, that they have, so, so our outcomes don’t always look as dramatic. Or they do and we backpedal on them. So I think the first thing is we really need to expand on what we do – get that information out there to the public, talk about it! Share it with your friends.

Jimmy: Own it!

Carole: Write articles. I mean I think the greatest is the cities that have therapies with their own column. You know, or their, or their own TV shows or talk shows.

Jimmy: Sure!

Carole: Those are, those, we need that so badly. Then we need to be on an even keel with physicians. And I always have…

Jimmy: How do we do that? That’s the million dollar question.

Carole: Well, we have our body of, well, I teach the schools! And the way we see patients is. You know, if it’s somebody that’s, uh, kind of neuro- musculoskeletal, they step back! They let me take the lead when we see that patient.

Jimmy: That’s great.

Carole: But, but everybody should do that!

Jimmy: How did you start that? Because that’s not, that’s not everywhere. We know that’s not everywhere.

Carole: I know, I know. The way it happened is I would teach them! And first they’d come into my office. They’d do every Wednesday afternoon in my office. So they watched me with patients. And then, um, we decided to go to the VA together, and to go to a couple assisted livings together. And I actually watched them see a patient. I was watching them. And this lady came in and, you know, and she had a shoulder problem and they’re out there doing all her other stuff… But then they get to her shoulder and they go “how’s your, how’s your shoulder?” And she goes: “it’s okay…” And they say: “Well, are you going to physical therapy?” and she said yes. And they said: “Does it feel better?” She goes “I don’t know…” “How long you’ve been seeing the therapist?” She said: “Three months.” And he said: “Well, well what do they do?” She says: “Well they put this little thing on my arm that, that tingles…”.

Jimmy: Oh no.

Carole: Oh yes. And they said “Okay.” So they said: “Do you want to continue?” And she said: “Yeah.” So they wrote her a thing for another three months and they walked out of the room! I got out into the hallway and I went: “Oh no. Oh nooooo.” I said “let’s do a do over.” We went back in the room…

Jimmy: Same room.

Carole: Same room.

Jimmy: Same patient.

Carole: Same patient. I said: “Excuse me,” and I said “We’re, I just want to come back, ask a few more questions.” I said “Raise your arm.” This lady literally had 40 degrees.

Jimmy: Oh no.

Carole: And I go “So, is that what it was like three months ago?” She said: “Pretty much.” Three month! And then I said: “What exercise does your therapist do?” She said: “Exercise?” So, I went back and I said: “Look it – you know, you need to at least have somebody move there arm if it’s an arm, and you need to ask are they doing exercise!”

Jimmy: Right.

Carole: And if they’re not you need to send to another therapist, I said, or call the therapist and say: “look it – what do I do?” You don’t know enough to ask the questions for this. So if you feel like that, call somebody, call me just like you would look it up at the PDR. Call a therapist – see what they should be doing

Jimmy: Yeah.

Carole: And send them to somebody else that’s doing that.

Jimmy: Wow it’s a great story.

Carole: Yeah.

Jimmy: So that’s how you asserted yourself in a great way, advocated really for the client for the patient there, and at the same time, because of the audience you get in front of, you were able to show your value and show your skill.

Carole: And we shouldn’t be afraid to do that. And I know there are an awful lot of therapists in their certain settings that are more conducive, like the hospital.

Jimmy: Right.

Carole: I do think therapists really can shine there when they do rounds and they talk about what they do. But there are, there are other settings where because we need referrals and whatever it’s a little tougher. Oftentimes I’ll send articles to doctors and say I know you saw this and I know probably they haven’t, but…

Jimmy: You’re being polite!

Carole: But if you wanna talk about it, you know, maybe we can do lunch. And then you, they see that you know your stuff that you’re kind of on your toes. It really is kind of a great way to get the word out there

Jimmy: Sure.

Carole: And get on that level with them. So, docs call me if they have somebody – “Hey, I don’t know what to do,” and vice versa.

Jimmy: Yeah.

Carole: So we need to get on that level.

Jimmy: Love it. Get on that level. Everyone needs to get on Carol’s level. Now! Tradition on the show is your FOXtale. So we ask that you tell a story about an older adult that you worked with that really left an impression on you. Can you think of somebody.

Carole: I saw somebody yesterday.

Jimmy: OK.

Carole: She’s 98 years old and she had excruciating back pain. Turns out it was an SI problem. She’s somebody that I’ve been seeing now for a year.

Jimmy: Wow.

Carole: All right. Her back pain is gone. I just see her to tweak her program about once a month.

Jimmy: A wellness.

Carole: Yes, for medical wellness, she pays out of pocket. And she told me her niece had back pain. So she actually showed her (her niece is 75), showed her the SI techniques to fix her back and her niece got better.

Jimmy: Wow. And if that doesn’t show the value of a physical therapist’s education and communication skills along with therapeutic alliance making sure that patients are only bought in, did what you said, then shared what you said with her niece.

Carole: Funny.

Jimmy: That’s a great FOXtale. Carole, appreciate you coming out as always when you do stuff here at FOX Rehab, and what’s coming up? We’d be remiss if we didn’t mention the book? How’s the book going? We talked at CSM not long ago.

Carole: Yeah, no – it’s out! It’s doing well. It’s 2000 pages, it has 400 videos.

Jimmy: I love that 400 video part, I really do.

Carole: I know! And you push on the, you know, the reference and it pops up. Yeah, you get the reference so you know the strength of the evidence and the techniques you’re doing. So it’s, it’s very cool. It’s all, there’s no paper.

Jimmy: Yeah.

Carole: It’s all on your iPad

Jimmy: It’s Carole saving trees.

Carole: Yeah.

Jimmy: Alright, give them, ah, give them the title more time.

Carole: “Physical Therapy For the Older Adult.”

Jimmy: And what’s the easiest way for them to get it? They can get it a variety of ways, but what’s the way you like them to get it?

Carole: Well, better to go to Wolters Kluwer – to VitalSource.

Jimmy: OK.

Carole: Because that’s where all the eBooks are.

Jimmy: OK.

Carole: Yeah, like we don’t have as many total eBooks in our profession, none that are total.

Jimmy: Well that’s the way it’s going, and you’re demonstrating why.

Carole: But it’s, it’s VitalSource, so that’s where you get those.

Jimmy: Excellent.

Carole: And the nice thing is you can download it twice. Shush – don’t tell me my boss.

Jimmy: Don’t tell anybody, I won’t tell that you can share a copy with somebody maybe.

Carole: It’s not that expense.

Jimmy: All right, Carole Lewis- appreciate you dropping by here on FOXcast PT.

Carole: OK, thank you!

Jimmy: Thanks for listening to FOXcast, a clinically excellent podcast. It’s brought to you by FOX Rehabilitation. Listen to other episodes or read articles and position papers at foxrehab.org.