Physical Therapy at Hogwarts

Photo Courtesy of Rich Gordon

What would physical therapy look like if it took place at Hogwarts School of Wizardry and Witchcraft? (School of Harry Potter and his friends throughout the series of books by J.K. Rowling). Would it be held in the hospital wing or would we get our own separate space?  Would there be kettlebells and barbells involved?  Do the railings on the moving stairwells remain in place for stair training or might they disappear mid-session?  Could we play tug-of-war with a giant for some strength gains and dodge fire from the nostrils of a dragon for our agility and plyometrics?  There are plenty of choices of creatures to use for hippotherapy.  And would the only sport we're looking to return to be Quidditch?  Or would there also be other activities that these wizards would be trying to return to that would need improved physical function?

I wish I had counted how many times Harry Potter (and his friends) were injured and sent to the hospital wing as I worked my way through the series. Definitely some unique mechanisms of injury in each novel.  I'm currently reading the seventh book, my first time through the entire series, and it has been really fun especially because I can talk to patients about it a lot. There's one injury in which Harry hurts his arm and a charm is placed that removes the bones from his arms entirely. I found this funnier than I probably should have, picturing a hand and arm without bones to give it any structure.  A jello arm.  Or maybe more like an octopus.  

Reading the Harry Potter books is just one thing I've been doing so I can better connect with my patients.  They are, after all, kids! But it gave me the chance to think about reality in comparison to the fictional fantasy world that Harry lives in.  Would physical therapy at Hogwarts look like it does at my current job at Seattle Children's Hospital?  Or more like my previous jobs?  Because those do not look the same.  What I do now is not what I did as a new grad physical therapist four years ago, and I can't imagine my care will look the same next year as it does today. There's evolution in this profession, if you put some effort into it.  As a physical therapist, I think you really need to grow and learn constantly - and as much as you put into it, the more you can get out. Sometimes I just can't help myself to keep learning because it pays me back in dividends with patient care.

As I’ve mentioned before in this post, I currently have a student on clinical affiliation working with me at Seattle Children's.  She's my first student. She knows it. I'm having a blast... you'd have to ask her if she is. Despite the fun, at the end of the day she's here to learn. I don't think she's here to learn exactly how I evaluate and treat patients.  Her evaluations don't look like mine... but she understands why I choose to use the methods I do, and she's got her own system that she's working on improving. I think she's here to learn ways to better communicate with patients to help them get better and continue perfecting her own ways of helping her future patients.  If you watched me evaluate and treat a patient - and then each of my coworkers evaluate and treat the exact same patient - the things you would see would be different from each treating therapist. We have different levels of experience and different opinions on what we find most effective - and overwhelmingly I think we all agree that as long as the patients are getting better, it might not actually matter what specific way anything is done. 

So through this teaching experience, I've been trying to emphasize soft skills with my student (mine. I’m claiming her) because I don't remember that being emphasized so much for me. I don't remember anyone telling me to take the extra few minutes to get to know the person I'm working with before considering the problem they'd like me to help them solve.  I did have one clinical instructor tell me that “what I lacked in knowledge, I made up for with personality” which seemed like an insult on my intelligence but now I look at it as if my class clown personality is a good thing. The longer I've been doing this, the more I recognize the value in connecting with patients and their families. According to dictionary.com, soft skills are "personal attributes that enable someone to interact effectively and harmoniously with other people." I'm working on my soft skills with my student just as much as I've committed to working on them with the patients I work with.  To an extent - some of soft skills is the personality you have and were born with.  But as I've learned more about the soft skills and have spent more time around kids, I've learned that soft skills can be developed and deserve attention.  

In healthcare, therapeutic alliance is a specific soft skill.  Wikipedia presents this definition: therapeutic alliance is "the relationship between a healthcare professional and a patient.  It is the means by which a therapist and patient hope to engage with each other, and effect beneficial change in the patient." This book chapter goes into extensive detail on therapeutic alliance - in case you want more detail and the history of this concept.

Ariel tiara for my birthday... thanks coworkers!

I'm a pediatric physical therapist which means that every day I work with kids who are experiencing pain and I try to convince them to do various activities which may be uncomfortable or scary for them.  If they don't trust me, it doesn't go well.  So I have to earn their trust, and I have to earn it quickly. With kids, therapeutic alliance can be achieved in numerous ways.  You have the obvious choices: sports they play, favorite video games, instrument they’re learning, how school was that day, what their favorite subject is, clubs or hobbies they participate in, sometime religious organizations are a favorite past-time, or the really young kids usually have a favorite Superhero or Disney Princess.  I can't tell you how many times I've admitted that Ariel is my favorite Disney Princess.  I can't tell you how many times I haven't been able to answer if I like Marvel or DC... I can't keep them straight!  My coworkers decorated my desk with Little Mermaid everything for my birthday last month - complete with a tiara!  I also love to ask what they kids are reading... because I love to read and have often read the books they're talking about, or can get them telling me about their favorite characters.

So, in an effort to better connect with my patients (and my boss who loves all things HP and who I devote far too much time trying to be besties with) I'm almost finished reading the Harry Potter series for the first time. It shocks me how many kids have read these books... I love it. That's no short book series! And they can tell me their favorite parts, or if they were a Harry Potter character for Halloween, or that they wish Quidditch was a real thing they could do, or they're wearing socks from their Harry Potter house today.  The list goes on.

When my student completed her first evaluation working with me, she did a great job.  She measured the right things and asked enough questions to help get the patient started on the road to recovery.  But the kid had really unique vibrant-colored hair.  We went through the feedback of how things went, and I think my student may have thought I was a bit crazy when I asked if she had noticed the patients hair... because if I had been treating the patient, it would have been the first thing I commented on. Without a doubt.  The hair had nothing at all to do with the kid's pain or functional issues... but everything to do with making them more comfortable, getting them talking and seeing how we interact.  I pointed out that if she had taken the extra minute to discuss the kids hair color, she probably could have achieved better therapeutic alliance, because you're relating to the patient. 

With kids it can almost be easier to connect, but some you really need to dig to find a topic they’ll open up about. If you find a topic they like and don’t know much about it, let them teach you!  Everything I learned about motocross, horseback riding, Aquaman, dancing, certain cuisines of various countries, European Soccer, some of the lingo the kids use these days - I’ve learned it all from my patients.  Once you develop a little trust and repoir, you can more easily provide patients with realistic expectations of what's going to happen with them moving forward, which is essential to their physical therapy outcome.

To the PTs who are finishing their clinical affiliations - or to new grads who haven't yet learned much about the soft skills - I urge you to consider the soft skills as you complete your schooling. This is yet another reminder from me of how the words we use matter, like I wrote about here.  The benefits of how you will relate to your patients will be worth it, and the patient care is, in my opinion, more fun.  And at the end of the day, wouldn't it be great if we all were just having fun?!

In the words of Albus Dumbledore, Headmaster of Hogwards, "It is our choices, Harry, that show what we truly are, far more than our abilities."