Linda's journey began after a fall that landed her in the hospital for 4 days. From there she went to a rehabilitation hospital for 2 weeks and then to a nursing home for 2 months, where she was told she would never walk or stand for transfers and should get used to using a transfer board. Despite the therapy she received, she was told she didn't have the strength, coordination, or balance to safely perform a standing transfer. Linda returned to her daughter's home discouraged.

She had accepted that she would never walk again, but her goal was to stand to transfer. Seeing her determination her home therapists collaborated with Linda to set a goal of standing and pivoting to transfer with assistance. They began with standing using a walker which Linda proved she could do. Her legs were weak but over the course of a few visits she was standing with less assistance and her confidence grew. The next step was to have Linda stand and pivot. Again, she performed well, determined to prove the staff at the nursing home wrong. In 2 weeks, Linda had achieved her goal of standing, pivoting, and sitting with minimal assistance. And in another couple weeks she performed the entire transfer with supervision only.

Wanting to push Linda further than even she thought she could go, her therapist suggested she try walking. Linda took on the challenge and, in a few visits, walked 20 feet using a walker with contact guard assistance. With growing confidence and increased strength, Linda even succeeded in performing a safe car transfer with minimal assistance. After success with transfers to and from her recliner, walking short distances in the home, and car transfers, Linda's next goal was to safely transfer from her wheelchair to the bedside commode using her walker. Again, she tackled this goal head on and in a few visits was transferring safely using a walker. But the next goal would prove to be more challenging. Linda's daughter suggested she might be able to stand at the commode and pull her pants down and up by herself. This would require a new level of balance and coordination. Working with her therapists, Linda and her daughter developed a method using suspenders to assist Linda in pulling her pants up and down and in a few weeks, Linda was completing her toileting with supervision only.

What was next? Her daughter wondered if Linda could walk down the 30-foot ramp outside their home. At first, Linda balked. There was no way she could do that. But she had already accomplished so much more than anyone ever thought she could, and she had now walked more than 30 feet in the home without assistance. With encouragement, she agreed and once again realized she could accomplish more than even she thought. After descending the ramp, the next step was to ascend the ramp with the walker. Not one to disappoint, Linda walked up the ramp.

How does a woman who was told she would never walk again and have to use a transfer board the rest of her life, set all that aside to eventually get rid of the transfer board, walk a hundred feet with a walker, and become independent enough with morning activities to discontinue caregiver services?

Here are a few suggestions:

Listen to your patients. Linda had goals of her own. Wishes. Desires. She had things she wanted to do, milestones to reach, goals to achieve. Rather than tell her what she could and couldn't do, her home therapists-both physical and occupational-listened to her and worked with her to develop therapy goals based, not on what they thought was feasible, but on what Linda dreamed of accomplishing.

Let them try. Linda's therapists didn't immediately write off her goals as being unreasonable. They gave her an opportunity to reach them. They worked with her, offering guidance and suggestions, to achieve victory after victory. As her therapist would say when Linda suggested she wanted to do something: "There's only one way to find out: let's try it."

Set specific, reasonable, and achievable goals. Opt for a sniper approach to achieve goals rather than a shotgun approach. Set a specific goal, make sure it is achievable, and develop a treatment approach to reach that goal. Once a goal is accomplished, celebrate, and set a new goal, then redesign a treatment approach to reach that goal. Once goals start getting checked off, the patient's confidence level will grow, excitement will build, and further successes will follow.

See the potential in every patient. Sometimes, patients just need someone to believe in them. They need someone to cheer them on and encourage them to push on. They need someone to see through the murkiness of their current situation and believe that their goals are within reach. As clinicians we can take on that role and help them navigate the clutter and see what is achievable.

Finally, to come alongside patients and celebrate with them as they accomplish goal after goal, we need to make the treatment about them, not us. As clinicians we are there to serve our patients. Too often we may feel we know better than they about what is best for them. Sometimes we do, but we would do well to be careful not to impose our own will on them, not to set our goals for them, not to cast our expectations onto them. But rather, we should talk to them, listen to them when they share their goals, desires, challenges, and expectations. We should believe in them. Then use our expertise to work with them to achieve those goals that are indeed within reach.

Therapy has long-lasting benefits for children with cerebral palsy

NIH: Cerebral palsy is a group of disorders that affect movement, muscle coordination, and balance. Children with hemiparetic cerebral palsy (only affected on one side of their body), are sometimes treated with constraint-induced movement therapy (CIMT). In it, a child's better functioning arm is restricted with a cast or splint to help promote use of the affected arm and hand. The study included 118 children, ages 2 to 8 years old, with hemiparetic cerebral palsy, randomly assigned to a control group (conventional forms of rehabilitation therapy), or one of four treatment groups: high or moderate doses of CIMT with either a lightweight, full-arm cast worn continuously, or a part-arm splint worn just during treatment sessions. The "high" dose group received three-hour sessions five days per week (60 hours total). The "moderate" group had 2.5-hour sessions three days per week (30 hours total). The research team evaluated hand and arm function at the start of the study, after treatment, and six months later. The assessments were "blinded," The children in the high-dose group had the greatest skill improvement. This included greater ability to move the arm and hand, as well as improvements in reaching, grasping, and manipulating objects. High-dose CIMT produced the greatest gains both after treatment and six months later, regardless of whether a full-time cast or part-time splint was used.