A few months ago, I found myself mediating an argument between two physical therapists — Simoun, an orthopedic practitioner, and Rosa, a neurotherapist. Their argument was centered on whether patients who sustained neurologic insults, such as a CVA, can recover their functions. When I investigated how this argument began, I discovered the trigger was Simoun’s treatment of a patient who had a stroke.
The patient’s stroke had resulted in right hemiplegia. Simoun had the patient doing overhead pulley exercises for her upper extremities. Since the patient’s left hand was hemiparetic, Simoun secured the patient’s hand on the handle bar of the pulley with an elastic bandage. He also had instructed the patient to use her right hand to pull down on the other handle bar in order to “range” the left upper extremity. The patient had to perform three sets of 20 repetitions.
Upon seeing the patient’s exercise set up, Rosa approached Simoun discreetly and asked for a rationale of the exercise and why he had secured the patient’s hand to the handle with a bandage.
Simoun explained the patient did not have enough strength and endurance to sustain her grip on the pulley’s handle bar. As for the exercise, it was meant to facilitate active-assistive ranging of the left shoulder and elbow in order to prevent muscle and soft tissue tightness.
What irritated Rosa was Simoun’s comment before he returned to the treatment area. “The patient already sustained damage of the nervous system,” he said.
“There is no way you can recover from it and, essentially, the patient is already a vegetable.”
Rosa framed her response to Simoun in the form of a question. “What about neuroplasticity?”
Feeling challenged, Simoun replied, “You mean spontaneous recovery?” This was the point in their argument when I arrived and was asked for my opinion.
Instead of giving a straight answer, I replied by showing them a series of pictures of a pink tabebuia tree in my yard that I have taken over the last 14 years. The tree is deciduous and bears pink flowers in the winter, reminiscent of cherry blossoms.
I told Simoun and Rosa that I planted this tree in my yard from a seedling way back in 1997. It took seven years for the tree to fully mature and display its magnificent blooms in early 2004. I also showed them a picture of how its blossoms formed a carpet of pink flowers on my yard and driveway that became a picture backdrop for my neighbors.
But the tree’s glory was short-lived as, in the summer of 2004, three successive hurricanes uprooted it. I was advised by my landscaper to chop it down and remove its roots from the ground.
I also consulted with a botanist from a prestigious university on what to do. He concurred with my landscaper’s advice and said that even if the tree comes back, it won’t bear flowers the same way it did.
I decided to chop down the tree but leave its roots in the ground. Although it may not bear flowers anymore, should it come back, it will provide some shade in my yard and perhaps a nesting place for birds.
Every year since 2004, I have taken a picture of my tree — from a stump on the ground to a few shoots and eventually, a tree that is full of green leaves that fall off in the winter, exposing seemingly dead branches throughout the season, without its flowers. However, every year I continued to prune and fertilize it.
It is still a beautiful tree in its shape and form, but without the flowers that attracted me and my neighbors to it — until this year. The final picture in the series of photos I showed Simoun and Rosa was taken last winter. After 12 years, my tree dropped its leaves, exposing branches full of pink flowers, some of which have blanketed my yard and driveway.
Simoun said he understood what I meant, but my analogy was with a tree, not a human being. I said if a tree can reorganize itself with some pruning and fertilizing, how much more can a human being, whose brain has been found to have plasticity?
Our role, as therapists, is to help patients capitalize on this plasticity through intentional selection of evidence-based treatment strategies.
Rosa closed our conversation by asking for the last picture I showed them. It was a good reminder of the lesson she learned from my pink tree. She apologized to Simoun for arguing and asked if he would switch patients, with her taking over the patient who suffered the stroke. Rosa said she was running out of treatment ideas for her patient with tendonitis.
Then, she asked if I have another plant story for her orthopedic patient. I didn’t, but I do have one about a bird nesting on the tabebuia tree. But that will be for another day.