ABSTRACT

Consider the following scenario:

A young female athlete, age 19, was referred for 7 weeks of physical therapy after a surgical procedure in which her right shoulder was reconstructed. The young woman was unable to move her right arm to perform simple tasks such as writing, brushing her teeth, or removing a shirt without assistance. The young woman had two, 2-hour sessions per week with the therapist. Therapeutic goals were established at the outset of therapy, and the goals were mutually defined based on the athlete’s desire to continue playing her sport. Moreover, the goals were discussed throughout the therapy. The therapist gathered cultural assessment data during the first few visits and came to understand the education values, religious practices, food traditions, and family functions that might influence the goal setting and ultimately the success of physical therapy. During week 4, the therapist began assessment for readiness to terminate the patient at the end of week 7. Both the patient and therapist discussed gains and what was necessary to maintain the gains. The therapist inquired about support systems at home to assist in maintenance, especially prior to returning to her university athletic trainer. The young woman was able to communicate gains in the same language used by the therapist, and explained and demonstrated what techniques should be used at home to strengthen the muscles and maintain range of motion. Specifically, the young woman was given a prescription of daily exercises and tools for documenting daily exercises to maintain the therapeutic gains. The therapist and patient had a mutual understanding that failure to comply with the “beyond therapy” protocol would result in setbacks, and the setbacks might compromise the therapeutic gains of the 7 weeks of physical therapy.