Physical Therapy: Part of the Long Road for Transplant Patients
If you have a stroke, traumatic brain injury, or some other debilitating physical disability, it’s a pretty good bet that you will need some form of some physical therapy.
What might be less well known is that transplant patients need therapy, too. They can also benefit from the continuity of care that can occur when the transplant unit and the rehab team work together.
Before their transplant, many patients already have difficulty with daily activities like getting in and out of the bathtub, getting out of a chair and going up and down stairs. If they didn’t have those difficulties before transplant surgery, then they do tend to have good reason for inpatient therapy at MossRehab afterward.
“The transplant population has a unique set of concerns, so most of the time, they’re getting physical and occupational therapy,” says David Van Why, MD, clinical director of Medical Rehabilitation in MossRehab’s Tabor Unit at Einstein Medical Center Philadelphia. MossRehab is the physical and cognitive rehabilitation arm of Einstein Healthcare Network.
“A lot of patients have overall weakness and functional decline before getting their transplant,” Dr. Van Why says. “The majority of these folks have muscle weakness, particularly in their hip and shoulders, which makes it difficult to do things like get out of bed. After surgery, in many cases, people have a lot of swelling, which makes their limbs heavier, which means it takes even more energy for them to do their activities, and that can be another factor that limits their mobility.”
Therapy and Seamless Continuity of Care
Another limiting factor for patients, Dr. Van Why says, is abdominal pain. That’s not necessarily specific to transplant patients, but it is a serious concern. “They have difficulty moving around after such a large procedure.”
Therapy begins relatively early in the process following transplantation, Dr. Van Why explains. Patients are evaluated once they have become stable enough to be moved into therapy. That’s after patients have had their breathing tubes removed and they’re able to get up and out of bed.
One of the advantages of providing physical and occupational therapy for transplant patients is that it provides seamless continuity of care.
“We have a good working relationship with the transplant team,” says Dr. Van Why. “When patients come into the hospital for their transplant, we have a more encompassing system. The benefit of doing that is that instead of having a variety of different doctors who are doing the consultations, we have a better continuity of care system. I know all of the concerns of the rehab side that I see on a routine basis, but I also look for some common concerns that I see so I can help intervene early on in patients’ care.”
The transplant team and MossRehab instituted this system several years ago.
Helping Patients Succeed
Dr. Van Why has found the work richly rewarding.
In medical school, he leaned toward orthopedics as a specialty. Then, a friend who worked at a children’s camp for adaptive skiing made him aware of the possibilities of rehabilitation. Additionally, he was swayed by some of his lecturers in medical school.
“I found it very fascinating because of all the things you can do to help people out when they’ve experienced some of the most earth-shattering experiences of their life,” says Dr. Van Why. “I really enjoyed the physical and psychological aspects of helping somebody understand what’s going on with them, helping to alleviate some of their fears, providing encouragement and helping them succeed by providing realistic goals for recovery.
“The other part I like about rehab, particularly inpatient rehab, is you get to spend a lot of time with patients, and you build relationships. You get to know their family. It’s all very challenging, but when you can make a very difficult situation more manageable for people, it’s very gratifying.”