Nelson Marquez, PT, EdD, Physical Therapy Editor

Nelson Marquez, PT, EdD

During one of the few weekends that I was able to tend to my yard, I saw my next door neighbor whom I had not visited for awhile. I learned that his wife, Mrs. Jones, sustained a stroke a couple of months ago and he requested if I could see her.

Mrs. Jones suffered a right CVA and had been receiving PT services at one of the PT clinics in our area. She had a very good recovery in her left lower extremity, enabling her to walk without any assistive device and perceivable gait deviations. However, regaining her left upper extremity function remained problematic. My observations of her movements revealed weakness of her left shoulder, elbow and hand muscles. She was able to actively flex and abduct her left shoulder up to 90 degrees, actively flex her left elbow up to 50% of its available range and flex and extend her fingers within 10% of its available range. The latter was due to tightness of her finger extensors and minimal edema of the right hand. For the most part, my neighbors were quite satisfied with Mrs. Jones’ progress in PT, but were very concerned with the slow return of her left upper extremity functions.

When I asked her to describe the treatments that she had received from her PT, I had to control my gasps as she described her treatments: Electrical stimulation of her left shoulder and wrist muscles, 2x/week for 30 minutes per session. Mr. and Mrs. Jones even showed me pictures that they took, showing the placements of the electrodes that were used. They said that these pictures were helpful as they had decided to purchase an electrical stimulation unit, similar to what they used in the PT clinic. They thought that the increased frequency of its use would facilitate quick recovery of her left upper extremity functions.
They proceeded to describe the exercises that they performed with her in the clinic. With both hands clasped in front of her, she extended her elbows and began performing chopping movements. She was also excited to show me a package that she recently received, containing some exercise equipment that they purchased: colored cones that she said she had stacked in the PT clinic.

When I asked her if she was provided any home exercises, she claimed that her PT had not given her any additional instructions. She became curious and asked if she should be doing any other exercises at home.

I was in a quandary as I did not want to be in conflict with her current PT or undermine her PT’s plan of care. I explained to Mrs. Jones that since she was under the care of another PT, it would be difficult for me to provide her additional exercises as these may conflict with her PT’s plan. Instead, I coached Mrs. Jones to ask her PT for a home exercise program. I showed her some illustrations from a therapeutic exercise book that I had at home, depicting some closed kinematic chain exercises that she can inquire about. It was tough, but I resisted the temptation of giving her a full treatment out of respect for her PT.

As I wrapped up my visit with Mrs. Jones, her husband, who was in the living room, turned their television on. A familiar jingle for an insurance advertisement came on: “Like a good neighbor …”

Upon hearing the jingle, Mrs. Jones turned toward me, and with a meaningful look, she said, “Nelson, that song is for you – thanks! I got the message during this short visit.”

As I crossed my neighbor’s yard on my way back home, the song kept on playing in my head. I hoped that I had been a good neighbor, not just to Mrs. Jones but to my PT colleague, as well.

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