By Karen Angelo
Justin Cormier was researching how to best treat neck pain when a struggling patient arrived at his clinical placement at Athletic Evolution Physical Therapy in Wilmington, Massachusetts.
“The patient suffered with many symptoms that were crushing her way of life,” says Cormier, a recent graduate of the doctor of physical therapy (DPT) program. “She had neck pain, restricted head movements, dizziness, nausea, constant headaches and fatigue.”
This was one of more than a dozen hard-to-crack cases that DPT students presented at a showcase on campus in May. Alumni, faculty and staff asked questions and provided input to the students, who have all since graduated from the program. Another group of students presented their service learning projects in the community.
“This inaugural student showcase provided our doctoral students an opportunity to present their work with patients that was conducted under the supervision of a physical therapy clinical supervisor,” says Erik Swartz, chair of the Department of Physical Therapy and Kinesiology. “This opportunity further enhances their learning and served as a culminating event prior to graduation.”
Cormier reviewed coursework and research on the portion of the body’s sensory system that creates the sense of balance. With input from Assoc. Teaching Prof. JoAnn Moriarty-Baron, an expert in vestibular rehabilitation, Cormier developed a plan of care that included evidence-based techniques. Upon evaluation, Cormier discovered that the patient had been cleared of having a concussion in early 2021. As a result of not receiving treatment for a concussion, she suffered residual negative health effects for nearly a year.
“We were able to get the patient started with a solid treatment plan,” says Cormier. “We attacked it from all ends, starting with neck range of motion, joint mobilizations, soft tissue massage and then focusing on neck motor control and strength.”
During treatment, Cormier and his physical therapy supervisor referred the patient to an ear, nose and throat physician for further evaluation.
“I knew this was going to be a big complex case from the start,” said Cormier, who was recently hired by Athletic Evolution Physical Therapy as a physical therapist.
“With this experience, I learned to be more objective with my plan of care by using data, research and validated tools to track patient progress.”
Physical Therapy for the Mind
At the showcase, John Madonna Lendvai shared his experience treating patients with cognitive behavior therapy (CBT) – a proven form of treatment that can be effective for depression, anxiety, traumatic injury, chronic pain and substance abuse problems.
“Using CBT helped my patients better negotiate their own preconceived notions about themselves, which made physical rehabilitation more successful,” says Madonna Lendvai, who was hired as a physical therapist at Performance Physical Therapy in Plainville, Massachusetts. “CBT is not a passive form of therapy. A clinician and the patient look at learned behaviors that prevent adaptation to aspects of life. They break these down into physical sensations, emotions, thoughts and reactions. It’s kind of like PT for the mind,” he says.
While traditional physical therapy targets physical rehabilitation, CBT targets cognitive restructuring.
“The combination of the two can help improve a patient’s impairments and outcomes, leading to a better quality of life,” says Madonna Lendvai, who initially used CBT while treating patients on his clinical rotation in Encompass Health Rehabilitation Hospital of Braintree. “I found it beneficial for patients who struggled with anxiety and fear avoidance after a traumatic event, including COVID-9 intubation, traumatic orthopedic injuries and major heart surgery.”
A Holistic Treatment Approach
Abigail Colangelo treated a 39-year-old man who faced substance abuse and mental illness issues along with shoulder pain that had never been treated.
After researching scapular dyskinesis, an abnormal function of the shoulder blade, Colangelo developed a care plan for the patient at her clinical rotation at Physical Therapy Plus at Burbank Campus in Fitchburg, Massachusetts.
The patient mentioned to Colangelo that he had felt like health care providers didn't listen to him because of his history with substance abuse. “I made sure that he felt heard, keeping his psychological difficulties in mind during treatment,” says Colangelo. “I learned that the emotional and psychological aspects of physical therapy treatment can be even more complex and more important than the physical aspects."