Optimizing an individual's function is at the heart of practice for home healthcare physical therapists and occupational therapists. The American Physical Therapy Association's and American Occupational Therapy Association's visions, while overarching to the broad spectrum of practice areas within the professions, support and speak directly to the work of home healthcare physical therapists and occupational therapists. Specifically, the American Physical Therapy Association's vision is: "Transforming society by optimizing movement to improve the human experience" (American Physical Therapy Association, 2018) and the American Occupational Therapy Association's Vision 2025 is: "Occupational therapy maximizes health, well-being, and quality of life for all people, populations, and communities through effective solutions that facilitate participation in everyday living" (American Occupational Therapy Association, 2018). An individual's function is intertwined with the optimization of movement. Therefore, the human experience, both that of the patient and the therapist, can be improved through physical therapist and occupational therapist interventions aimed toward improving function.

Function is not only a component of an individual's experience and quality of life, but it can also be what creates a person's sense of having a positive experience. Function entails "the purpose for which something is designed or exists" (Dictionary.com LLC, 2018) and a more active definition "to perform a specified action or activity" (Dictionary.com LLC). When therapists ask patients about their personal goals, we often hear: "I just want to go to the toilet by myself," "take a shower by myself," or "leave this house by myself." When considering both the purpose of these actions, in combination with the ability to perform them, the efforts of home healthcare therapists can have a far-reaching impact on transforming the lives of the individuals receiving care, their caregivers, the community, and even society at large. As an added benefit, improving a person's function is what can bring joy and fulfillment to the work life of home healthcare physical and occupational therapists. What better place to see functional success than in the home where the person resides and performs a significant volume of his/her activities of daily living? In this Focus on Therapy, I share two stories in which interventions with a functional aim improved the human experience for both the patient and the therapist.

A patient with a recent hospitalization resulting from an exacerbation of preexisting cardiopulmonary compromise was referred for home healthcare physical therapy. The examination found the range of motion, general strength, and gait pattern to be within functional limits. However, the patient's diminished cardiopulmonary and muscular endurance limited the majority of activities in the home and community. The social history was significant for lifelong participation in professional dog showing and the individual's dog had just been returned to the home post hospitalization. The patient's functional goal was to care for all aspects of this dog, whereas the therapy goals related to endurance and return to community ambulation. Although traditional therapy interventions were employed, the treatments synthesized a shared vision of the patient's purpose, functional needs, and the physical therapist's goals. This included taking the dog on leash walks inside and outside the home, managing dog waste using proper hygiene and safety, and providing the 15-lb dog with sink baths and grooming.

The patient loved the social connection and independence caring for the dog provided. As the therapist, I was able to incorporate safety training, balance and other neuromuscular activities, ambulation distance progression, dyspnea and rate perceived exertion monitoring, and education on various methods to optimize function including energy conservation. The patient reported good compliance with the home exercise program as it incorporated the dog into various aspects of the strength and endurance program. Anecdotally, the patient seemed to become more cheerful as the intervention time progressed. As a therapist, I felt very satisfied that I was able to provide the patient with fun activities to do with his dog, and it made me feel joyful to see the patient work toward the goals in such a positive way.

A second patient's story strikes a chord when considering the importance of function, but has a more serious tone. The individual was referred to home healthcare after a recent total hip replacement. The impairments identified on the first visit included diminished strength, range of motion, balance requiring an assistive device, generalized decreased cardiopulmonary endurance, and gait asymmetry due to pain. During the evaluation visit, the skies began to darken across the open farmland of the rurally located home. Tornado sirens alarmed and the patient and I could see a funnel cloud advancing in the distance. Although stair training is not usually my first choice of intervention given the patient's acute inflammatory process, it did become a functional priority for the safety of both the patient and me during that visit. As we sat in the basement waiting out the storm, the patient shared relief that I had been in the home to provide the needed education and safety on the stair descent and ascent. That particular week had further tornado warnings in this patient's community beyond that evaluation encounter. The functional training and education provided during that first visit gave the patient the skills and self-efficacy to handle the basement stairs and keep herself safe. I, in turn, was thrilled to impart practical knowledge to the patient who utilized the newly regained functional ability.

Although I suspect most physical therapists and occupational therapists have their own "stories from the field," I encourage each of us to reflect on the functional importance of what our work provides in optimizing movement, improving quality of life, bringing joy to our patients and ourselves, and in transforming the society we serve.

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