BY JOHN HOBBS MA ’14
January 21, 2019
It was while rehabilitating a patient, whose right side had been affected by stroke, that Beth Fisher MS ’80, PhD ’00 noticed something peculiar.
While practicing to stand up, the patient naturally pulled his left leg beneath him to support his weight. With his right leg, though, he used his hand to move it beneath him.
“Why do you use your hand,” she asked him. “Because it’s easier,” he responded. Fisher challenged him to do it again, using his affected leg instead of his hand. Much to the patient’s surprise, he was able to use his right leg the same way he had his left. “I didn’t know I could do that,” he said.
“He’s five years post-stroke, and he’s just discovered that he has an ability that he never had before because he had solved the problem in a compensatory way, so there was never any reason to try to solve it in a different way,” said Fisher, a professor of clinical physical therapy.
It was lessons learned from these types of patient interactions that Fisher hoped to share with her audience while delivering the 24th annual John H.P. Maley Lecture at the NEXT Conference and Exposition in Chicago earlier this year.
“We, physical therapists, tend to be too impairment focused,” she said. “If you strengthen a limb over and over again, but someone gets up and walks in a way that doesn’t use that limb, it’s a big waste of the patient’s time.”
In her lecture, titled “Beyond Limits: Unmasking Potential Through Movement Discovery,” Fisher argued that physical therapists are unwittingly limiting their patients’ rehabilitation by focusing too much on the impaired limbs rather than looking at ways that they might be compensating to get from point A to point B.
“If we’re not able to see how someone’s automatic choices to compensate are masking an underlying ability that they may have, then we’re never going to reach their full potential,” she said.
Citing the brain’s plasticity and ability to relearn movement, Fisher urged her colleagues not only to identify compensatory actions in their patients but also to task these patients with activities that challenge those actions to maximize their patients’ rehabilitation efforts.
She added that these compensatory behaviors are not limited to neuropathology, citing a recent dissertation by Ming-Sheng Chan PhD ’18 that showed patients fully recovered from ACL reconstruction surgery were still avoiding the use of their affected leg.
“During the speech, I said that physical therapists are far too educated to simply hold someone’s gait belt as they figure out how to get around,” Fisher explained. “That’s not our job. Our job is to help our patients reach their full potential.”
Fisher holds a dual appointment at the USC Division of Biokinesiology and Physical Therapy and the Department of Neurology at the Keck School of Medicine of USC. She is the director of the Neuroplasticity and Imaging Laboratory.