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08/11/2015

PTs Talk PT - Todd Biesterfeld of Aurora Rehabilitation & Therapy Services

Todd Biesterfeld on changing the patient management algorithm for concussions
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Todd Biesterfeld, DPT

Supervisor – Aurora Rehabilitation & Therapy Services
West Bend, WI

CSMi: YOU WORK BOTH IN A SUPERVISORY CAPACITY AND AS A HANDS-ON PHYSICAL THERAPIST – WHICH ASPECT OF THE JOB DO YOU ENJOY MORE, AND WHY?

TODD BIESTERFELD: I enjoy each for different reasons. The patient care responsibility is rewarding in the cooperative relationship developed with patients in helping them achieve their goals, or provide them with proper direction to other practitioners if goals are unable to be achieved. The supervisory responsibility allows me the opportunity to participate directly on the direction of clinic growth and development in regard to programs, as well as facilitating the professional growth of clinical staff.

HOW MANY OTHER THERAPISTS DO YOU SUPERVISE?

14.

WHAT ARE THE BIGGEST CHALLENGES INVOLVED IN THAT ROLE?

Maintaining a relationship on a personal level with each of the staff members given the professional and personal time demands on everyone. I consider getting to know everyone on an individual level necessary to effectively serve them in my supervisory role.

WHAT HAVE YOU LEARNED IN A SUPERVISORY CAPACITY THAT YOU WOULD NOT HAVE LEARNED IF YOU WERE STRICTLY A HANDS-ON THERAPIST?
The importance of clinic culture in achieving group success, with the group being everyone who is a stakeholder in the department, including administrators, physicians, therapists, support staff and patients.

DO YOU WORK AT ALL IN POST-CONCUSSION REHABILITATION? IF SO, TELL US HOW YOU EFFECTIVELY TREAT PATIENTS IN AN AREA WHERE THE TOOLS AND TECHNIQUES ARE CONSTANTLY CHANGING WITH NEW RESEARCH?

We have broad collaboration and communication among all groups of specialists involved with managing patients who have sustained a concussion. We have annual meetings with the rehabilitation staff, primary care physicians, urgent care and emergency room physicians, neurologists, neuropsychologists, athletic trainers and school nurses to discuss what is new in their specific field along with any situations that have arisen that may have fallen outside our existing management pattern. We then use this information to update our patient management algorithm and distribute that among each of the groups to keep everyone on the same page.

HOW HAS THE ROLE OF THE PHYSICAL THERAPIST CHANGED WITH RESPECT TO CONCUSSION DIAGNOSIS, TREATMENT, AND MANAGEMENT?
Rehabilitation staff in our concussion management algorithm assist the physician in THE diagnosis of concussion, activity restriction recommendations and patient education. Recently the role has changed by initiating treatment with those patients who present initially with memory or cognitive impairments, balance disturbances and/or neck pain or headaches. These signs and symptoms correlate with patients who have a delayed recovery compared to those without this presentation. So, in an effort to minimize the impact of those symptoms, rehabilitation is initiated with speech therapy, vestibular rehabilitation or orthopedic care as appropriate. This is in addition to a guided return to activity once symptoms are improved.

ON THE PT SIDE, WHAT HAVE YOU FOUND DIFFERENT ABOUT THE JOB THAN WHAT YOU EXPECTED WHEN YOU WERE A STUDENT PREPARING FOR THIS CAREER?

The degree to which non-clinical knowledge is a part of a patient's plan of care. In school I had assumed the plan of care was based on the physical impairments and evidence-based treatment, along with the tissue inflammation and repair process. I had not anticipated how much the plan of care would be dictated by other factors, such as patient living and transportation resources, reimbursement plans, personal preferences.

WHAT ADVICE WOULD YOU GIVE TO A STUDENT WHO IS CONSIDERING A CAREER IN PHYSICAL THERAPY?

If physical therapy is your passion, I would encourage them to pursue it as a career choice. I would set an expectation that they should be prepared to never stop learning, adapting and challenging conventional wisdom. Future success in physical therapy and health care in general will require this attitude and more to thrive in the constantly changing environment.

IF YOU COULD SHARE ONE TRICK OF THE TRADE YOU’VE LEARNED IN YOUR CAREER WITH A PEER, WHAT WOULD IT BE?

Never forget to connect with each and every patient, the impact of a personal connection and expression of genuine caring can and often is as much a part of the eventual outcome than the treatment provided.

WHAT ONE MOMENT IN YOUR CAREER DO YOU LOOK BACK ON AS THE MOST IMPORTANT

When I began in more of a clinical leadership role, my perspective changed from day-to-day patient treatments to that of a broader appreciation of everything that is a part of effective clinical care and patient service. This expanded point of view significantly impacted how I thought and the way I considered everything that impacts the patient and since that time I believe my day-to-day patient care has become considerably more successful.


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