Hi, my name is Cliff Stanford. I’m a physical therapist assistant. I’ve been licenced here in the state of Oregon for ten years, this year. I graduated from Mt. Hood Community College in the physical therapy assistant program back in 1999. I work in an out-patient orthopedic clinic with two other physical therapists, and we have a support staff of 8 here in this setting as well. I’ve also had the opportunity to work in other settings, but this setting here is an in an out-patient orthopedic clinic is what I like the best. Patients are generally in a closer position to getting back to what ever it is that they were doing, whether sports and activities. It’s a really, really cool field, man. We get to impact people’s lives on a daily basis. And it’s a lot of fun. I really dig it. Typically I try to get into the clinic about 15 minute prior to my first patient. And it gives me a chance to pull charts and look at my day – even game plan a little bit – maybe make some notes, so when the patients get here it makes an easy transition from one treatment to the next. Today I’ve got about 14 patients on my schedule. So by reviewing the chart with that number of patients it just makes it lot easier transitioning from patient to patient as the day progresses My first patient this morning, Tim, had a total knee replacement – total joint replacement. I think Tims’ surgery was about three weeks ago. Tim actually has a history prior to his joint replacement – he’s had a couple of other surgeries. And he’s really been limited in his range of motion. And one of the things that we really want to make sure of is as this new joint is healing that he gets as good a range of motion as he has available to him. And so doing things like the leg press – we’re working on, not only his strengthening, but improving the flexion or bending in his knee. Scar looks good, bro. Yeah, he does a good job…. We want to be sure that Tim is as stable as he can be when he’s doing normal activities. He’s going to be doing some fishing and spend some time on the boat, so we need to make sure he’s got that stability as well as range of motion and strength in his knee. So those are some of the things that we’re working on specifically with him, in addition to the healing that’s going on in that new joint that he’s got in there. So when patients come in to see us, their first visit is spent with the physical therapist. And the physical therapist will assess the patient, look at the referral from a physician. And create a treatment plan for that patient. And then as a physical therapist assistant all of my training is in carrying out that treatment plan – instructing patients in physical therapy, exercises, using modalities to help address pain. And when the patient comes back for follow visits, I may get an opportunity to work with that patient. Yeah, let’s start off with the ultra-sound…. Working in physical therapy, we really work hard to provide patient privacy. In an out patient setting, often times, we’re working with patients on a lot of therapeutic exercise. But also, it includes some manual therapy – some hands on skills. And so you really have to be considerate of the patient’s privacy – making sure the patients are draped properly. But you also have to be very comfortable with working with patients in very close proximity. So this is Jean. Jean and I have had to opportunity to work together for a couple months. Jean had shoulder surgery and since has lost quite a bit of range of motion. So we’re just doing some, what we call, joint mobilization. And it’s really an idea of going in and manually repositioning the joint and doing a little bit of stretching to the joint capsule. Often times, when we’re lacking range of motion in joint is because the joint capsule has tightened. So for this part of the treatment Jean’s just going along for the ride. She’s not helping at all – just staying nice and relaxed. Now, Jean, I want you to start helping me. OK And so having very good communication skills is important. We want to be sure that patients are a part of their treatment – that they’re totally involved with their treatment. Good, Jean…. Jean’s been doing a home exercise program. And she’s been really consistent with that and I think that’s a big part of why she’s made that gains that she’s made. Let me see, when we started at the very beginning…. Yeah, you were at 30 degrees. Which is what, about here? (Chuckles) So you were probably about right there. Almost 80 degrees range of motion, you’ve gained. Good. So what’s next? Let’s do some strengthening. You’re going to lean over towards your right arm…. And so there’s a trust factor. That’s a big part of what we do in physical therapy. …to the right…. So what we’re doing here is to working on getting a little weight baring through that shoulder joint. I can do these at home. Yeah, yeah.,,, I may get to see as many as 17 patients in a day. We see patients – they’re scheduled every half hour. And so sometimes it gets a little bit busy. We have our support staff here – physical therapy aids, who can assist us in our treatments. I do those sometimes, too. Oh, do you? One of the great things about this field, there’s so much interaction between clinician and patient, patients really become part of our extended family here. All right. See Ya! All right, young lady. Good work today. That’s one of the things that we pride ourselves on really connecting with the patients. So Matt crushed his hand between a washing machine and a wall, Something like that. So we’re coming along really good. We’re going to start off with some paraffin and hot wax. And so what we do with the parafin – what we’re really doing is coating his hand with a warm wax We utilize the heat from the wax and it traps Matt’s body heat. And it’s a great way to start off if we’re going to be doing any joint mobilization and trying to improve range of motion, also decreasing pain. So, Matt, I think Ryan wrote in the plan to start doing some functional stuff today some lifting with the cable machine. I still want to get in there and work the joint a little bit. How would you rate your pain in the last 24 hours. Virtually none. It’s stiff still. Yes. I’m having a hard time being able to grip and hang on to something. So Matt has to go back to moving appliances. So a big thing that we’re concerned with that we have to focus on is grip strength. Because we want to be able to make sure that his grip strength is what it needs to be as he’s moving appliances around. It’s really a test of grip strength and grip endurance. …huffin’ and puffin’ already. Yeah, you know it…. So this is a great wrist strengthening activity. But, you know, it’s 10 pounds and as you go you begin to fatigue, we want to test and see what is your endurance like. What does it feel like to grip that heavy of a weight for this long. Again. And rest. So on your first visit, the strongest you could squeeze was 24 pounds. Squeeze it! Squeeze it! Today you squeezed 95. So an improvement of… a significant amount. So because we’re using a direct current and we’re driving that medication through the tissue…. use a little alcohol swab here, so that if there’s any on the skin, we don’t want to drive that into the tissue as well. And I’m going to add an anti-inflammatory medication to the patch. So the side with the medication on it is going to go right over that joint that’s irritated. There we go. And so this unit here increases the current to, again, drive that medication into the tissue. So we’re going to let that run. It’s going to run for about 20 minutes. Then we’ll take everything off and you’ll be done for the day, sir. OK. I actually have a number of rolls here at my job. My primary roll is clinical – working with patients on a day-to-day basis. But here, I also have an opportunity to do some administrative work. I’m a director of Sports Outreach. So I get out in the community and meet people and build programs out in the community. I’m also the coordinator for clinical education here for our company. And so I design and set up monthly meetings with all the clinicians within the company. … she and I have been talking via email and so she’s going to do it on May 6th … We get together once a month to do continuing education within our company. It just helps us all grow our clinical skills. If we go to continuing education courses, we bring that information back and share it with the other clinicians here in the company. So during my week I have time blocked out to do those other tasks, as well as my clinical tasks. And through the American Physical Therapy Association, I went through course work to become a certified clinical instructor. It’s a part of the continuing education that I get as a licensed PT assistant. … and you’re going to feel it. But the water only gives you as much resistance as…. As students come through the program and are doing their internships here with me, we get an opportunity to sit down on a regular basis and communicate about the treatments that the students are carrying out with patients. You know, that’s a good example, because you’re going to run into that. A patient doesn’t believe they’re going to get better. So what do you do in terms of monitoring their progress. I think what I did today was just address her immediate concerns and say well, here we’re seeing some very temporary results…. As those muscles get stronger and used to doing it, you can do that…. As students go through, give them an opportunity to know that this is something that can be a part of what I do out of the formal education program. My first patient of the afternoon is a young lady named, Kelly. She’s got low back pain – significant low back pain, actually. So we’ve been doing a lot of work to just decrease her symptoms. So how are you doing? I don’t think I feel a lot better…. No. There’s a lot of hands on in what we do. Working with patients who have had a back injury or a lower back injury – doing soft tissue work or some massage is part of what we do. And so being comfortable with that at the same time, again, we have to sure the patients understand what we’re doing. Making sure they’re educated as to when we are in physical contact with them, why we are, what our goals are. And so having very good communication skills is important for that very reason. …. five, half way there. How are your symptoms? Well, I’m getting a lot of numbness in my leg and tingling. OK So should I keep doing that? Being prepared to change at the drop of a dime. When patients come in, often times, we have a plan for what we want to do with them that day. But sometimes we’ll have patients who come in and they’re really doing poorly, their not feeling very good. So, being able to, on the fly, address that and deal with that. And make the patient continue to feel comfortable and confident at our skill level to address their pain – yet continue to progress them through their treatment. Those are things that I think are really key to what we do on a day-to-day basis. … five and then relax, unless your symptoms get worse. How does it feel. Let’s see…. You’re definitely upright a little bit better. Let’s go…. Brandi is a young lady we’ve been working with for knee pain. And she’s going to be going in for – what will start out being exploratory procedure on her right knee. Our job at this point is to try and keep her as mobile as we can and as strong as we can going into the surgical procedure. Because that going to make the rehab that much easier. So today Brandi did quite a bit of exercise and we finished up with some modalities for pain. And now I’m going to do a taping technique to see if we can knock back some of the swelling that Brandi has in her knee. So another technique that I learned going to a continuing education course after getting out of PTA school. Straighten it…. Brandi: Straighten it! Are you kidding! No. You know we never like to see that, but it’s also part of the job. So being able to handle that, being able to deal with patients, maybe not feeling quite as good as when they got here – that’s a part of the job too. It does get better…. Often times at the end of the day you can be a little tired, a little fatigued – not just physically from working, but also mentally or emotionally – depending on how patients did that day. But is all a part of the process. It’s all a part of the impact that we have on patients. And it’s definitely something that I love being a physical therapist assistant. And I wouldn’t trade it for the world.