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What’s Your Function?

What’s Your Function?
Loren Isler-Wallander

Loren Isler-Wallander uses an ultrasound device that employs heat to promote healing, one of the many modalities available to today’s physical therapists.

Cathleen Bastible remembers the day several athletes from a local college wound up in Noble Hospital after practicing too long in the heat, and the day a local police academy made the same mistake. And, for that matter, the time she stood in the vault of a local bank, showing its employees how to properly carry heavy bags of coins.

In her 14 years with Noble Hospital Sports and Rehabilitation Center, Bastible, the center’s executive director, has seen a wide range of injuries stemming not just from sports, but the hidden hazards of daily life — hidden, that is, until patients are made aware of their lifestyle mistakes.

“We’ve seen an uptick in tendinitis due to the setup of people’s computer workstations, things like that,” she said. “We do a fair amount of education. Some people lift for a living, and we teach them about body mechanics. Or their chairs aren’t adjusted properly. There are so many daily tasks we’re doing wrong. And we’re passing it on to our kids — they’re using computers four times as much as we are. We could be raising a generation of people with wrist and arm problems, and I’m convinced we’ll all be deaf from wearing iPods.”

The educational component is critical for everyone who comes through the door, said Bastible, whether it’s giving a pregnant woman exercises to help her manage back pain or showing athletes how to stay injury-free. It’s no coincidence that most sports-related visits occur early in the season, when players aren’t always properly conditioned. “We work with coaches on drills that help stave off problems.”

“Neck and back injuries are the most common,” said Keith Riedy, one of Noble’s physical therapists, “but we also see a lot of joint replacements; knee, hip, and shoulder problems; tennis elbow; hand and wrist injuries; and we’re the only clinic in Westfield that has an occupational therapist.”

True to its name, the center handles its share of sports injuries, including athletes from Westfield State College and the city’s public schools. But its services are far more extensive, encompassing gait deficits, or problems with walking, as well as balance issues, general weakness, recovery from strokes and amputations, Parkinson’s disease, and wheelchair evaluations, just to name a few.

“Let’s say you hurt your back,” he said. “You’d have a comprehensive evaluation to determine whether you’d benefit from pain modalities, electrical stimulation, heat and ice, etc. The general focus is on flexibility, strength, and function, and our goal is to get you back to your previous level of function as soon as possible and resolve your pain. Typically, people are here 10 to 12 visits — two or three times a week, depending on the severity of the injury.”

Riedy has been in the field 23 years and has seen technology advance, but he takes an old-fashioned approach when describing the core of physical therapy. “These are still the best tools,” he said, holding up both hands.

For this issue, BusinessWest visits the rehabilitation center, located in downtown Westfield, for a look at how those hands — and generous doses of common sense — are helping patients reduce their pain and get back to daily life.

Bringing It Home

Loren Isler-Wallander, a physical therapist at the center, said the field has seen some dramatic changes over the years. “It was underutilized, and there was a time when maybe it was overutilized, but I think the relationship between physicians and physical therapists is growing, and they’re beginning to understand how they can work with us.”

What that creates is a structured continuum of care between Noble Hospital, individual physicians, and outpatient rehab, he explained. And some of those patients are being referred with serious issues that have to be resolved faster than ever because insurers are paying for fewer sessions than in the past.

That, again, is where the education component comes in; although a patient might go in for rehab twice a week, he’s given exercises and activities to incorporate throughout the week, and needs to be responsible for his own care, both during the rehab period and after.

“It’s no longer a passive experience,” said Isler-Wallander. “It’s a much more collaborative partnership. I give people a lot of homework. If they’re here two days a week, those other five days they’re on their own, so they’d better be doing something.”

That said, the staff at Noble Hospital Sports and Rehabilitation Center want patient visits to be as cheerful as possible, and the design of the center, open and well-lit, reflects the upbeat attitudes of the staff, said Riedy, most of whom have been with Noble for 15 years or more. “We try to keep it animated and light,” he told BusinessWest. “When people come in here, they’re in pain; we don’t treat just the pain, but the whole person. And laughter can be the best medicine.”

Luis Amaral finds the environment infectious, too. In a practice boasting several veterans in the field with 20-plus years of experience, he’s is a relative newcomer, joining the center in 2002.

“It’s been my experience with people I’ve worked with that most of us got into it because we had something wrong and had to go to physical therapy ourselves,” Amaral said. “With me, I happened to injure my knee.”

After a few doctor visits had him in an immobilizing cast, he decided to give physical therapy a shot. “They gave me some exercises and some treatment, and within a few weeks, I felt much better. I thought, maybe there’s something to this stuff.”

So much so that Amaral began looking at it as a career. He originally intended to be a physical therapist assistant, but went on to earn his master’s degree and become a full-fledged PT. Since then, physical therapists have required doctorate-level education; current PTs are grandfathered in, but Amaral went back to school to earn his doctorate anyway.

“Basically, they’re trying to get you better faster,” he said of the additional education necessary today. “Over the past few years, the profession has become heavily into evidence-based practices, and a big part of that is being able to design and review research and studies and apply that to your practice.”

Isler-Wallander agreed that rehabilitation has become a much more holistic practice as the profession has moved away from what he called a “seat-of-the-pants” approach and toward scientifically based treatments that consider the whole person.

“Physical therapy has changed its focus from just going through exercises to focusing on people’s function and how they can get back to their daily lives,” he explained. “What’s important to them, and how can we get them back to that? It’s not just treating the wrist; can they pick up a coffee cup? It’s not just reducing pain in the knee; do they like to garden? Then let’s get them back to gardening. So not only is there a more scientific basis for what we do, but we work with referral doctors as a team to focus on these functional outcomes.”

The reward, of course, comes when a patient has a breakthrough that leads to that restored function and quality of life.

“I love seeing people get better,” said Riedy. “Not everyone gets better, of course, but if we treat 10 people and one or two get better, they make it all worthwhile. There are people who never thought they’d walk again, and they’re walking. With other people, we just want to make them more functional within their pain tolerance, and get them back doing some of the things they like, returning to work, sports, and leisure activities.”

Even with the additional education necessary to enter the field these days, physical therapy and rehabilitation remains a hot career choice because the need is only expected to grow as Baby Boomers get older, Bastible said.

“They’re expected to live longer and stay more active” than previous generations, she said. “They don’t want to slow down; they don’t see themselves that way.”

And why should they, these therapists say, when so many tools — starting with those hands Riedy talked about — are available to them?

“The best thing is when someone who hasn’t been able to get resolution somewhere else comes here, and you help them get better,” Amaral said. “This may sound selfish, but it makes you feel good to be able to do that, to hear someone say, ‘I don’t want to live like this,’ and then at least see them able to carry on with their lives. It’s a good feeling.”

Joseph Bednar can be reached at

[email protected]

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