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  • This Is Why

    The following just appeared in the December '07 issue of PT Magazine, an organ of the American Physical Therapy Association. This Is Why is a back page essay they've been running for a few months, each written by a therapist explaining something about the origins of their career. I wrote this a few months ago and was asked to copy it here by a few who don't have access to it otherwise.

    This Is Why
    by Barrett L. Dorko, PT


    Berta’s Passion
    The contagious joy of “dancing.”

    I read recently of a man who became a physicist so his work might “provide cover” for his actual goal—to build a time machine. As I read this, I was struck by how easily I might say the same. I am a physical therapist, and I introduce myself as such to anyone who asks. But I always feel a strong desire to explain more fully what that term means—to me, anyway.

    In 1973, while a student at Ohio State University, I drove a rickety car from Columbus to New York City to see a lecture by Berta Bobath and her husband Karel—the physical therapist and psychiatrist, respectively, who founded neurodevelopmental treatment (NDT) for cerebral palsy and other developmental disorders. I remember Berta standing tall in front of about 300 of her peers, perfectly confident and almost glowing with a zeal for her work that I’d never seen in anyone.

    Even then, I knew that the provisional knowledge offered by truly scientific investigation really shouldn’t result in such abundant confidence, and that I probably should have been suspicious. But on that day, Berta’s passion overwhelmed all that. I haven’t been the same since.

    I watched quietly as she handled the patients brought to her, most of them complaining of pain. Years later, the physical therapy historian Jay Schleichkorn, PT, PhD, allowed me to contribute to his book The Bobaths: A Biography of Berta and Karel Bobath,1 and I wrote this: “I watched [Berta] Bobath handle others. Years later I would read Oliver Sacks’ description of a highly regarded medical colleague: He understands patients as nobody else does. When he works, you see a binding-together of patient and practitioner in learning, teaching, communicating, and understanding. There is really no technique—just an amazing display of perception and attendance to the present moment, and a perfect willingness to change contact and instruction as dictated by the patient.2 This is precisely what I saw as Bobath ‘danced’ with the patients.”

    I soon was to find that few of my colleagues shared my enthusiasm for this sort of care. Eventually I concluded that Berta’s method lacked two essential elements most manual practitioners insist upon—coercion and judgment. She didn’t take her patients where she wanted them to go; she followed them. Her touch was a catalyst for processes within the nervous system that she barely understood. Her method had run ahead of the neuroscience necessary to explain it, so she let her husband Karel worry about that, and she never presented without referring to his understanding.

    Soon after joining a private practice in northeast Ohio, I attended a basic course in joint manipulation taught by the legendary Stan Paris, PT, PhD, FAPTA. His method of handling could hardly have been more different from Berta Bobath’s, but again I saw a fearless and open display of certainty and passion for an idea and method, and again was irresistibly drawn. I became the first physical therapist employed by Stan at the Atlanta Back Clinic in 1975 and spent the next 4 years immersed in the world of manual care as it flowered in North America. I was fortunate to have been present and a participant in huge shifts and battles that took place within our profession. I’m convinced there never will be another time like that.

    In 1979 I returned to Ohio and watched my mother move unconsciously yet therapeutically as she succumbed to Alzheimer’s. Eventually, I sat beside my father’s deathbed as he composed a poem about the care he’d received from his physical therapist—distinguishing this from the therapist’s training—and these two insights became major themes in my practice and my writing.

    I see patients no longer, but I often travel and teach, relating what 35 years of seeing patients taught me. I often talk about Stan, and when I’m feeling especially courageous I relate the lessons I learned from my parents. But it is Berta Bobath’s passion and courage that truly compels me, and I always speak of that.

    She is where my career began. I feel her presence still.


    Barrett L Dorko, PT, a longtime private practitioner, now teaches workshops for Cross Country Education. He lives in Cuyahoga Falls, Ohio.


    References
    1. Schleichkorn J. The Bobaths: A Biography of Berta and Karel Bobath. Tucson, Arizona: Therapy Skill Builders; 1992.
    2. Sacks A. Awakenings



    SIDEBAR BOX

    This Is Why spotlights a particular moment or incident that either propelled the writer toward a career in physical therapy or reconfirmed the reasons why he or she became a PT or PTA in the first place. APTA members are encouraged to submit brief essays (600-800 words) to Eric Ries, associate editor, manuscripts, at ericries@apta.org. If possible, please include a “mug”-style photograph (.jpg file). Submissions are subject to editing. Authors of pieces selected for publication will be notified.
    Last edited by Barrett Dorko; 15-12-2007, 12:46 AM.
    Barrett L. Dorko

  • #2
    I thought I'd bring this to the top of the list again and say a couple of things. I've had some emails about it.

    If you like the piece, let the editor, Eric Reis, know. I found his help invaluable. His email address is linked in the last paragraph. I have also written his boss regarding the usefulness of an article about bulletin boards such as this. I have found that therapists are completely unaware that such a thing actually exists. If I were to ask forty sitting before me about them perhaps one would have some familiarity. I'm not kidding.

    So far, the editor at PT Magazine has not responded in any manner. If we are ever to have any sort of significant impact others must first know that we exist. An article in this magazine would certainly help.

    The editor's name is Donald Tepper and his email is donaldtepper@apta.org.
    Barrett L. Dorko

    Comment


    • #3
      I read it again and again...it is beautiful. What a wonderful way of explaining how to work with a patient or how we are supposed to work with a patient. \

      Mariette

      Comment


      • #4
        Mariette,

        I presume that the words you like especially are those from Oliver Sacks. In an old thread titled Oliver, Ian and Me he also says this about his recovery from a neurologic disorder, “…(my) inversion, or perversion, or subversion of will was precisely the means by which a recovery was effected.”

        I’m convinced that this is what Bobath encouraged in her patients, and no less than Sacks came to understand the same thing though it took him until ’84 to do so. I was in the middle there somewhere.

        Has anybody else written Don Tepper yet?
        Last edited by Barrett Dorko; 15-12-2007, 10:05 PM.
        Barrett L. Dorko

        Comment


        • #5
          I hear that there may a bit of confusion. Donald Tepper donaldtepper@apta.org is the one who should receive emails about running an article about BBs like this. Eric Reis is a writer and occasional editor, but Tepper is the one in charge.
          Barrett L. Dorko

          Comment


          • #6
            Thanks for clearing that up Barrett. I sent off a note supporting the idea.
            "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

            Comment


            • #7
              As did I.
              Cory Blickenstaff, PT, OCS

              Pain Science and Sensibility Podcast
              Leaps and Bounds Blog
              My youtube channel

              Comment


              • #8
                Thanks Jon and Cory. I can't help but think that numbers of letters are the only thing that will impress the editor. Ironically, numbers are what we lack, which is why we need an article about our existence.

                I'm getting dizzy.
                Barrett L. Dorko

                Comment


                • #9
                  Why don't you just go ahead, coordinate, and start a pain special interest group?
                  Start a newsletter, make some noise as an organized group within APTA and see where you can get to.
                  Diane
                  www.dermoneuromodulation.com
                  SensibleSolutionsPhysiotherapy
                  HumanAntiGravitySuit blog
                  Neurotonics PT Teamblog
                  Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                  Canadian Physiotherapy Association Pain Science Division Facebook page
                  @PainPhysiosCan
                  WCPT PhysiotherapyPainNetwork on Facebook
                  @WCPTPTPN
                  Neuroscience and Pain Science for Manual PTs Facebook page

                  @dfjpt
                  SomaSimple on Facebook
                  @somasimple

                  "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                  “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                  “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                  "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                  "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                  Comment


                  • #10
                    Done
                    Christopher Bryhan MPT

                    "You are more likely to learn something by finding surprises in your own behavior then by hearing surprising facts about people in general"
                    Daniel Kahneman - Thinking Fast and Slow

                    Comment


                    • #11
                      I dropped him a note as well.
                      It would make a great article.
                      Jason Silvernail DPT, DSc, FAAOMPT
                      Board-Certified in Orthopedic Physical Therapy
                      Fellowship-Trained in Orthopedic Manual Therapy

                      Certified Strength and Conditioning Specialist


                      The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

                      Comment


                      • #12
                        A pain special interest group already exists. Last I looked they were into focused on various e-stim machines.

                        They have a call out for submissions though. Maybe that would be a good start.

                        http://www.orthopt.org/sig_pm.php
                        Last edited by BB; 18-12-2007, 06:56 AM.
                        Cory Blickenstaff, PT, OCS

                        Pain Science and Sensibility Podcast
                        Leaps and Bounds Blog
                        My youtube channel

                        Comment


                        • #13
                          great essay Barrett!!! Dancing with our clients is exactly where we need to be. Allowing the body to flow to where it knows best with gentle influential guidence from the therapists. It is truly amazing what can be accomplished when we step out of the way and follow instead of lead the treatment to a predetermined end point of our choosing, even if we truly do not have a full grasp of the mechanisms involved.

                          "Her touch was a catalyst for processes within the nervous system that she barely understood. Her method had run ahead of the neuroscience necessary to explain it, so she let her husband Karel worry about that, and she never presented without referring to his understanding. "

                          Excellant passage
                          Enjoy the season
                          bob mollica pt

                          Comment


                          • #14
                            BB, I see it's tucked into the depths of the ortho section.
                            That means, everything it comes up with will be 'subject to approval' from the ortho meme mentality that dominates, or it won't see the light of day. Correct?
                            Diane
                            www.dermoneuromodulation.com
                            SensibleSolutionsPhysiotherapy
                            HumanAntiGravitySuit blog
                            Neurotonics PT Teamblog
                            Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                            Canadian Physiotherapy Association Pain Science Division Facebook page
                            @PainPhysiosCan
                            WCPT PhysiotherapyPainNetwork on Facebook
                            @WCPTPTPN
                            Neuroscience and Pain Science for Manual PTs Facebook page

                            @dfjpt
                            SomaSimple on Facebook
                            @somasimple

                            "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                            “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                            “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                            "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                            "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                            Comment


                            • #15
                              Actually, my experience with Joe Kleinkort PT PhD regarding laser therapy suggests that pain subgroup(he's past president) is largely alt-med types, completely divorced from the OMPT people.

                              So that's great.
                              Jason Silvernail DPT, DSc, FAAOMPT
                              Board-Certified in Orthopedic Physical Therapy
                              Fellowship-Trained in Orthopedic Manual Therapy

                              Certified Strength and Conditioning Specialist


                              The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

                              Comment

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