by John Cooper, PTA
As a physical therapist assistant (PTA) who works routinely with lower-limb amputees, I’ve found that many patients don’t know how to bring up their concerns or ideas, for fear of not being heard. People often assume: “I am on the therapist’s time, so they won’t be able to listen to me or hear what I have to say.”
Nothing could be further from the truth. Good communication between you and your therapist holds the key to a successful outcome. It’s much easier to restore function and regain quality of life after limb loss when you develop a strong partnership with your PT.
Clinicians call this relationship “the therapeutic alliance,” which is defined as “the sense of collaboration, warmth, and support between the client and therapist.” A strong therapeutic alliance enhances your motivation, gives you a sense of ownership over the treatment plan, and helps you trust that the therapist has your best interest at heart. Learning to express your concerns and fears with your PT can only strengthen the bond. The phrase “You don’t know if you don’t ask” comes to mind.
I’ve had many amputees tell me they’re unsure or nervous about what to expect during a PT session, especially an initial evaluation. For lower-limb amputees, an evaluating therapist will discuss goals for walking distance, balance, and stability, as well as weight transfer for sitting and standing. They will want to watch you don your prosthesis and walk in parallel bars (the same setup you’ll find in your prosthetist’s office). You should also bring some prosthetic socks to the appointment, so you and your therapist can discuss proper fitting, appropriate sock thickness, and other aspects of maintaining a supportive, comfortable fit.
It might be necessary during a therapy session to MacGyver a solution when a socket or residual limb isn’t fitting well. This is often an ongoing frustration for my amputee patients. But it can also be an opportunity to build the therapeutic alliance. Brainstorming with your PT can often produce better results than seeking solutions on your own. Communication really comes into play here. You need to be honest about what’s working and what isn’t.
The same goes for the exercises, stretches, and other activities that are part of your therapy. If you’re having trouble replicating any of these activities at home, you have to speak up. If you don’t have the same amount of space or type of surface that’s available in the clinic, it might make it difficult to perform the actions. The PT session is the time to bring up those issues. In addition to describing the problems you’re experiencing, you can offer potential solutions. Tap into your creative side and think outside the box. The therapist can help you refine your ideas to eliminate any barriers that prevent you from practicing at home.
It’s also important to discuss the comfort and intensity level of the exercises being performed. A therapist relies on your feedback concerning fatigue, pain, soreness, redness, or wounds that might have developed or worsened during therapy. They also need to know if the workload is too light to provide an appropriate challenge. Your therapist should ask you about these factors, and they’re relying on you to provide honest feedback. To get the most benefit from PT, let the therapist know if a certain task is too easy or too hard. You might also consider keeping a daily journal to record muscle soreness, skin irritation, or other problems. These sometimes do not occur until days after a session, so keeping notes can help you and your therapist reflect on what changes might lead to better outcomes.
Above all, let your PT know if any of their suggestions conflict with your personal goals or reccommendations from other members of your interdisciplinary care team. Doctor and prosthetist appointments are typically spaced further apart than PT sessions, so it takes effort to keep everyone on the same page. If you’re getting contradictory advice, ask the clinicians to communicate with each other. If you’re scheduled to see your prosthetist soon, ask your PT to write a progress note that details your progress and any challenges you’re having with socket fit, balance, gait, or other important issues.
A biblical proverb tells us that in a multitude of counselors, we may find safety. Follow this guidance, and you’ll develop the type of therapeutic alliance that leads to great outcomes.
John Cooper is a physical therapy assistant (PTA) with Human Performance and Rehabilitation Centers (HPRC) in Columbus, Georgia.
