PUBLICATIONS

A case description I wrote that was published in  PT inMotion, 11/2016, about a very young child who stopped screaming in distress during her physical therapy treatment when she learned to say "I want to."     https://www.apta.org/apta-magazine/2016/11/01/defining-moment-i-will-help-you

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When I was small, I watched my mother teach creative dance at the local nursery school. At an age when most children want to be firefighters or ballet dancers, I told her I wanted to use movement to help people.

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I was able to do that many times during a rewarding 20-year career as a physical therapist, and I took particular pleasure in helping young children like 3-year-old "Alice."

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It was the beginning of the preschool year. A pretty girl with long, slightly curly blonde hair walked by me with her class. She was smiling, and looked happy and energetic. Her teacher pointed her out to me as 1 of the children I would be treating. This was her first year of full-day preschool.

 

Alice had severe visual impairments, global developmental delay, and spastic cerebral palsy. As her excitement increased, so, too, did her spasticity, while her functional capacity decreased. For example, when she was excited during music class, her legs would spring into hyperextension, her body would stiffen, and she would laugh and giggle until her intensity subsided. I soon discovered that she also overreacted, but in a different way, when she felt excited about physical therapy.

 

We met for our first session in the parent room of the preschool. I'd expected to see the same smiling, energetic child I'd observed in the halls, but, to my surprise, she was screaming. That was her reaction, her teacher said, to the news that her physical therapist was coming. She screamed throughout the session, stopping only once she'd left the room.

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At the beginning of every subsequent physical therapy visit, Alice stood screaming at the threshold of my treatment space. For several months I tried, in a number of ways, to comfort her. I took her hand. Sat next to her. Took her to a different room. Invited a friend to join us. Still she screamed. I felt terrible about putting her through this twice weekly. I reviewed, and reviewed again, my sessions to identify where I'd conceivably gone wrong.

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I talked to Alice's mother, who tried to ease my guilt by noting that Alice had screamed her way through 2½ years of early-intervention physical therapy. The school pediatrician urged me to continue our work because it helped keep Alice's spasticity from dominating her movement. They succeeded in reassuring me that I, personally, wasn't the cause of my young patient's distress. But I had to wonder why she'd screamed throughout her early-intervention treatment, and whether she was going to do that with me, as well.

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Through it all, I sensed Alice's good will toward me. I felt that she knew I liked her, and that she reciprocated the feeling. Her screaming wasn't angry. She didn't seem scared of me. She didn't refuse to come to physical therapy. I was perplexed. My feeling of helplessness pained me.

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I didn't tell her to be quiet, however, or attempt any form of behavior modification, because I became convinced that Alice's screaming was her effort to communicate with me. Determining what she was trying to say was far more important than was keeping her quiet. I, and everyone within earshot, came to regard her screams as the soundtrack to her sessions. I started wearing earplugs.

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Seven months into her treatment, while I was offering her a ride on the hobby horse, something happened that changed everything. Alice stood immobile in my doorway and screamed, "I want to! I want to! I want to!" She finally had found the words to express what her screams could not communicate. "I want to," in the context of her immobility, meant "I want to—but I can't."

 

I felt both shock and relief, then the weight of Alice's despair. Had she felt that she could ride the hobby horse, she would have done so. Armed with this insight, I spontaneously, reflexively told her, "I will help you."

 

Those few words made all the difference, facilitating her treatment from that day forward.

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I looked back on my actions up to that moment. Hadn't my welcoming smile, encouragement, clear direction, and cooperative spirit from the very start communicated "I will help you"? No. All along, I'd needed to express aloud what I assumed my actions were saying. My behavior hadn't sufficiently acknowledged the deep conflict within her. My spoken words, however, did.

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"I will help you" communicated, "I understand that you feel as if you can't do it. We'll work together—you and me. Then maybe you can do it."

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With those few words, I'd simultaneously acknowledged her despair, offered my help, and shared my hope with her.

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Alice's screaming reflected the side of herself that so wanted to participate and accomplish, pitted against the side that felt immobilized by anxiety and despair. By making no effort to silence her, I'd given her the opportunity to shout her struggle until she could identify her wish and express it herself. When she knew that she "wanted to," she could grab the lifeline I'd been offering her all along.

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Speech also liberated Alice to rejoice in her own successes. For example, after climbing the stairs to say hello to her teachers in the cafeteria, she loudly and repeatedly proclaimed, with a gleefully triumphant smile, "I did it, I did it, I did it." After descending the stairs to return to her classroom, she again shared, "I did it, I did it, I did it."

 

I answered, "Yes! You did it! And you did it all by yourself."

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At such moments Alice and I were drunk with delight. Her painful screaming had transformed into a proud "I did it." She still screamed, but it could be, and often was, a scream of triumph. Together, we rejoiced in her successes.

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Alice could have given up on me. Instead, she helped me understand the depth of her despair, enabling me to respond with the offer of hope she needed to hear. Her physical therapy treatment gave access to her unexpressed feelings about movement. It was the avenue through which I helped her cope with those feelings.

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Alice's response was her gift to me. The words "I will help you" helped many other reluctant children participate in physical therapy. I shared that lesson, too, with students.

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Alice invited me to use all of myself as a physical therapist. I accepted her screaming and hoped to find out what it meant. I struggled with frustration, self-doubt, and feelings of helplessness, but I also trusted in my belief that Alice and I were working together. I employed everything—my clinical skills, self-knowledge, insight into our relationship, curiosity, and imagination—to identify the best treatment path.

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I'm retired now. But I remember the children with whom I worked. They challenged my mind, body, spirit, and feelings in a unique way. They gave me many gifts. Because of them, I can look back and reflect that, yes, I fulfilled my childhood wish. I used movement to help people.