[00:00:01] Pete: This is Neurology Now, the podcast that explores the fascinating and complex world of neurology. Join us as we explore the human brain and beyond with expert guests who share their knowledge and insights. Welcome to the Neurology Now podcast.

[00:00:16] Pete: On today’s show, we welcome Rachel Peterson from the Minneapolis Clinic of Neurology. And Rachel, we are going to get into physical therapy and all of the things that surround that and the work that you do.

[00:00:29] Pete: So thank you for taking the time to join us here today.

[00:00:32] Rachel: You’re welcome, thanks for having me.

[00:00:34] Pete: Well, let’s first just start with you. I think your journey into your work is quite fascinating. I understand that you were teaching Spanish and you were led to this path in this field. Can you share real quickly how that occurred?

[00:00:50] Rachel: Well, I didn’t actually make it to teaching Spanish, but my initial major and career goals were to be a Spanish teacher. So I did begin [00:01:00] college going down that route. But, you know, I kept kind of looking back into things I had felt in even growing up and wanting to be in the medical field and just kind of did some research and learned that there was a career in physical therapy and it was basically like being a teacher, but more in the medical field. And helping people with their struggles and their journey to getting better.

[00:01:25] Rachel: And that just really appealed to me. So about halfway through college, actually, I really did a pretty dramatic pivot to get my prereqs in and pursue physical therapy school and this career.

[00:01:39] Pete: It’s interesting because when you get into teaching what you do, coaching, all those things, it’s getting people to do things that they don’t want to do to get to where they want to go.

[00:01:47] Pete: It’s kind of a common bond that people that do what you do have. Is that one of the most rewarding parts about what you do?

[00:01:53] Rachel: The rewarding part, I think, is when it is successful and, yeah. When you can have that conversation I always [00:02:00] tell people that we’re a team.

[00:02:01] Rachel: Like, I am not going to make you do anything. Like, we need to discuss and talk together and decide and be on the same page of where we want to go, what your biggest concerns are. Because even within a diagnosis, different people are in different places in life and they have different goals of what they need to accomplish, how their problem is affecting them. So I really need to get to know them and what would be most beneficial for them, and kind of convince them that way.

[00:02:31] Rachel: You know, I think some people do come in the door thinking that I’m just going to tell them a bunch of stuff to do and nobody likes to be told what to do. And I get that. And so, I’ve learned not to just tell them what to do, but more ask them questions, learn about them, and let them know they have a say in what we do.

[00:02:51] Rachel: I will give recommendations and we’ll work together. We can change things that aren’t working. I try to really empower them and kind [00:03:00] of take the stress off of me in a way too. Like, this isn’t me just doing this for you. We’re working together.

[00:03:06] Pete: So what is your area of work specifically?

[00:03:11] Rachel: Well, I’ve been at this neurology clinic for about eight years now. Prior to that, I was at a pain clinic for about 10 years and I’ve also done some specific spinal work. You kind of become an expert.

[00:03:24] Rachel: But in the patients you see, I think I’ve really had a great career in learning with really complex types of diagnoses. I’ve never worked in a straight line. I’ve done some nursing homework, but there’s so many settings. But like I said, you kind of learn to be an expert in what you see.

[00:03:44] Rachel: And I think it had a good base in learning about people with chronic pain. That was quite a variety. You learn to treat a patient as a whole in that setting and learn to deal with a lot of other issues that are going to affect how you [00:04:00] progress and how they are going to progress.

[00:04:02] Rachel: Within that setting, there was a lot of neck pain, a lot of headaches, a lot of back pain which I’ve carried forward to this clinic. Since I’ve been here for the last eight years, I’ve also seen a lot of vestibular issues, both the easy to treat peripheral vertigo type stuff and then some more complex issues where people just feel off and swaying.

[00:04:27] Rachel: And then I’ve also had an opportunity to work with Parkinson’s patients. We have a larger population of patients with Parkinson’s here in Coon Rapids at my site in the Minneapolis Clinic of Neurology. And I’ve really enjoyed working with that population and it did cause me to seek a certification in that population, the LSVT BIG certification. That’s been helpful along with all the education that needs to happen.

[00:04:56] Pete: Great stuff. Obviously we hear about physical and [00:05:00] occupational, but what’s the difference between the two?

[00:05:02] Rachel: Well, as a PT, I can tell you exactly what I do, and then a little more vaguely about what OTs do. There is some overlap, first of all, and it might depend on the region of the country or the type of clinic you’re in.

[00:05:15] Rachel: For example, Some upper extremity stuff is, it’s usually treated by either PT or OT carpal tunnel, different neuropathies pain, rotator cuff, those kinds of things, there’s kind of some overlap. I guess PT works a lot with balance, total body weakness, pain, problems with transfers, walking those kinds of things. That’s kind of broad, but OT2, especially at our clinic, gets more into cognition issues and the patient’s ability to do their daily activities. We also have OTs that are really specialized in vision training, which works well with PT with our vestibular patients.

[00:05:58] Rachel: But yeah, OT is [00:06:00] known as being more the cognition and the vision, and their daily activities. Can they manage their meds and do they need supervision? OT does some driving assessments here, so yeah, those are some of the differences.

[00:06:12] Rachel: But like I said, it can depend on the clinic, the region of the country and each individual therapist’s specialties and experience.

[00:06:20] Pete: I bet if we poll the average American, maybe 1 percent would know the difference. Unless you’re involved with it, I think many people really, really understand, and it’s really helpful to know the differences.

[00:06:32] Pete: If there is a misconception about what physical therapy does and you wish people understood a little bit better, what would that be?

[00:06:40] Rachel: A lot of people come in with a lot of fear and it could be because of past experience. It could be because they just got a diagnosis and they have no idea what it means, mostly for their future. What does this mean? Am I going to be in a wheelchair? Am I going to not be able to live independently?

[00:06:57] Rachel: And what the heck is this PT going to do to [00:07:00] me? I’ve heard horror stories. Pain and torture is what people tell me PT stands for sometimes. So, first that they don’t have to be afraid. I don’t want to hurt them. We don’t have to hurt you to make you better. Certainly, hard to predict how you’re going to respond to some things.

[00:07:17] Rachel: So there could be some discomfort, but I really want people not to be afraid and to feel like they can really tell me anything. I hear a lot of stuff. I think I’m able to slow down a little bit more than some other medical providers and kind of listen to the story, listen to their story a little more.

[00:07:38] Rachel: I want them to feel heard and seen and make sure I understand what they’re saying. So I think that’s a good start with helping them to not be afraid that I’m just going to start yelling orders at them to exercise no matter what. It’s a lot more than exercise.

[00:07:56] Rachel: There’s various things we can do. I don’t have one set plan that I’m going [00:08:00] to do with the patient when they walk in the door. We’re going to decide it together and I want it to be a good experience for all.

[00:08:07] Pete: So it sounds to me like there’s a high level of communication that’s required in the interaction. And as well as psychology, because it’s so much different.

[00:08:15] Pete: And I assume that would be one thing that’s really important as a patient and as a provider such as yourself, that you have to kind of understand that it’s a dialogue communication and the work that goes into it, but it’s a psychology too.

[00:08:30] Rachel: Definitely the communication and building that relationship that they feel comfortable communicating. There are definitely so many past experiences and mental health issues and fear and trauma that all affects somebody’s pain experience and their ability, their motivations. And so yeah, you have to talk about those things too.

[00:08:52] Pete: In your years at the Minneapolis Neurology Clinic, you’ve obviously been there for quite some time, as you mentioned earlier in this [00:09:00] podcast. How has that been a big part of your approach and impacted your experience as a therapist?

[00:09:06] Rachel: This clinic has allowed me to learn and explore both what I’m interested in and what the needs are of the patients I see. There’s been a lot of flexibility.

[00:09:16] Rachel: I have a lot of autonomy in this position to learn what I need to learn or treat how I need to treat. This clinic is wonderful at allowing collaboration between the doctors, amongst therapists, with the PA, and the NPs, neuropsych. And everyone’s very open and collaborative with managing patients.

[00:09:36] Rachel: We can easily discuss and make recommendations to each other. That’s very helpful. I think that provides a great experience for the patient to feel like they have a team because a lot of the stuff here is complex, requires communication between the Providers the multidisciplinary team. And I think that really benefits the patients.

[00:09:58] Pete: Over the years, and this [00:10:00] is just an anecdotal thought of mine, I never really maybe noticed because I was younger. But it seems as though Parkinson’s has become more of a discussed topic. Has that increased over time?

[00:10:14] Pete: And if so, either with that or with other thing, have there been any other advancements in PT for you that have you excited?

[00:10:23] Rachel: I don’t have the numbers for you as far as the incidents of Parkinson’s diagnoses. It does seem to me that it is increasing and just like everything else, whether that’s because we’re better at diagnosing or people have better access to health care or if it’s actually increasing, that can be an unknown.

[00:10:43] Rachel: I will say my grandfather had Parkinson’s prior to me becoming a therapist. I was younger then, but I know there was no treatments. There was no physical therapy. I know specific to physical therapy, that field has really advanced in the last 20 years. To where we [00:11:00] know, we know exactly what sort of movement dysfunction somebody is going to have. And then we can kind of try to get ahead of them. So early intervention is so, so important for these patients.

[00:11:11] Rachel: The education and the early intervention, like I said, that’s the best scenario. Doesn’t always happen. So when it, someone is a little more advanced before they’ve sought treatment and come to see me, they might be falling quite a bit. They might really be losing their independence, unable to walk.

[00:11:29] Rachel: We did just get a new walker called the step walker, and that is specifically designed for patients with Parkinson’s. It has a few strategies to help combat some of the common problems, gait problems someone might have, like freezing and fascination.

[00:11:46] Rachel: So there’s a laser to help with freezing. There’s adjustable tension on the brakes to help with fascination. There’s a metronome to help with freezing.

[00:11:55] Rachel: I just got it this year, so I haven’t used it with that many patients. But it’s just nice [00:12:00] that someone’s out there proactively designing. Okay, a regular walker still doesn’t help because it’s just going to get away from them, or they’re going to fall back, or it doesn’t help them with their freezing, which is a huge problem. So it’s exciting that someone’s out there addressing these problems. And it might not be perfect, but they’re trying.

[00:12:20] Rachel: And there’s new education every single year. I think the outlook for someone with Parkinson’s and some other neurological disorders is so much better. And there’s so much more we can do now than even 20 years ago.

[00:12:34] Pete: From a broad brush perspective, if you were to look at all the various things that you deal with from different patients, what would you say is the biggest benefit someone would receive from PT?

[00:12:48] Rachel: I think it’s very individual, and part of it lies in the person. And if we can get through that initial fear or lack of motivation, or if we can just start the [00:13:00] process and kind of get them to buy in, I’ve had some amazing stories, you know, and I learned from these people all the time. I think some quick and easy successes I’ve seen are when somebody’s been having vertigo.

[00:13:16] Rachel: And I don’t know why, but sometimes they will keep going to the ER, they’ll keep going to the doctor for three months and six months. And over a year and nobody ever sends them to PT, they give them some meds and they do a brain MRI and say, good luck.

[00:13:33] Rachel: But then I’ve had these patients come in and we do some vestibular testing. We see that they have positional vertigo, which is actually usually quite treatable, and within two to four sessions, they are 100 percent better, and they just can’t believe it. They can’t believe they’ve been suffering for so long.

[00:13:52] Rachel: And I don’t know why that education isn’t out there. I’m not saying I can help everyone, but I can figure out pretty quickly [00:14:00] whether I can or can’t, and it really is a low cost, low risk way to maybe feel better.

[00:14:06] Rachel: So when you’ve been suffering for so long and then all of a sudden you feel better quickly, it’s like so overwhelming to people, and that’s cool to see.

[00:14:14] Pete: I saw that actually happen real time with a loved one to the script that you said, get the meds and then have it just recur and then go through physical therapy.

[00:14:25] Pete: And then it was one of those things where you don’t know how good you can feel after that’s better. I’m sure those are like the success stories for you that you love, probably fuels what you do. Are there any others like that? You kind of shared one right there. Is there anything that stands out to you where you’re like, “Whoa, this is really cool.”

[00:14:43] Rachel: One measure I use early on is can you stand up out of a chair five times without using your arms. It’s correlated to fall risk. So if you can’t, you’re associated with a higher risk of falling. And if you can, you have a lower risk of falling.

[00:14:50] Rachel: So it’s kind of a quick goal and quick exercise that I use. I kind of smile when I can tell someone’s really struggling the first day, they can’t do it. They think I’m crazy, [00:15:00] how can I ever do this? But you can tell kind of the patients that they’re gonna figure this out pretty quickly.

[00:15:05] Rachel: So it’s kind of just nice to see. We give them exercises, we practice, week by week, they can almost do it, then they can do it once, then they can do it a couple times, and then it’s five times when it’s really slow, and then it’s five times when it’s a little faster, and then, several weeks later, they look great. People like the numbers, and seeing that quick progress and see their work pay off.

[00:15:26] Rachel: I try to find lots of ways to demonstrate improvement to the patients because sometimes day to day, you’re already down, you’re already frustrated, you’re already worried and in pain. And so it’s sometimes hard to see day to day that some things are improving, not everything. It’s not perfect, but we are making some gains and sometimes being reminded of that can help keep someone motivated.

[00:15:49] Pete: That’s awesome, tangible feedback, right? It just matters so much. We, people need to measure success. And sometimes they don’t know what it is. Hearing from a professional like [00:16:00] yourself, the way you share that, that can help you just extend it further. That leads into your professionalism and the things that you do and the certifications.

[00:16:10] Pete: I mean, there’s a lot that goes into this, isn’t there? Can you share what that’s like and how it matters?

[00:16:16] Rachel: A lot of people don’t realize this, but now and really for about the last 15 to 20 years, the PT profession has been a doctorate, entry level doctorate profession. It’s a lot of school. There are therapists that have been practicing for quite a long time. So they might have a different degree, but they also have quite a bit of experience.

[00:16:36] Rachel: So yeah, first of all, even to become a physical therapist, you have to be really pretty dedicated to the program because it’s at least seven years of school. Getting your undergrad and then your entry level doctorate.

[00:16:49] Rachel: And then we do have continuing ed requirements, 20 hours every two years, which really isn’t that much. But it does force you to kind of decide what direction you [00:17:00] want to go, what you want to learn more about, because really all your learning, it happens after school and after you start practicing and deciding what you want to specialize in.

[00:17:11] Rachel: Our profession has many specializations. The APTA has several, one of them being neuro, and we are exploring that with some of our therapists the neuro specialty There’s an M. S. certification that several of our therapists have. There’s the, like you said, the Parkinson’s BIG certification that some therapists have.

[00:17:33] Rachel: It just kind of shows that you’re really motivated and dedicated to getting good results with these people that you’re seeing and trying to help, taking that extra step to make sure. And like you mentioned with Parkinson’s and with everything, there’s always new research being done, new treatments that come out, even if I’m not prescribing a medication which PTs don’t do, it’s helpful to know what new meds they’re trying [00:18:00] for their MS, the side effects might be or different nerve medications.

[00:18:04] Rachel: Because things do change a lot, you need to stay on top of what’s going on, both specific to your world and healthcare in general.

[00:18:12] Pete: I know this is probably a kind of a tough question to answer in terms of like a timeline because every case is different. But what would you say like on average, maybe you can kind of go through the different things, whether it’s back or a Parkinson’s type thing.

[00:18:27] Pete: What’s the typical timeline someone can expect for their treatment path?

[00:18:32] Rachel: Like you said, it does vary. If it’s one of those vertigo patients, it might be two or three visits. Most of my patients for a variety of things, I probably see about six to ten visits and that would be to establish an exercise program and see what works, what doesn’t.

[00:18:49] Rachel: Sometimes we do caregiver training. So they’ll bring their husband or wife or daughter or son or parent. Because we do see younger patients sometimes. So kind of making them a part of the [00:19:00] process and making sure they understand as well. Trying different manual therapy techniques, allowing them the time to have an effect.

[00:19:08] Rachel: So yeah, kind of that 6 to 10 for a lot of patients. I have two patients on right now that are, about their 24th visit, kind of a more of a maintenance situation where it’s a diagnosis that’s not going to necessarily get better. But we are trying, we see them regularly.

[00:19:26] Rachel: One person it’s so that keep him out of a wheelchair. That’s what he tells me. And so far so good. But he needs that every few weeks to come in and to have that guidance. But it’s pretty rare that I would see someone for that long. We try to give people the education they need, the tools they need, the program they need, and then promote independence. And teach them that this is for you to manage now if it’s not better, which some things don’t get better, but they become more manageable, and that’s what we need to teach them in [00:20:00] that time.

[00:20:00] Rachel: Insurance doesn’t pay for PT forever in most cases, so we do always have that kind of over our heads, like, is this still going to get paid for? How do we code this so it’s still appropriate? It’s unfortunate we do have to think about that, but of course we do.

[00:20:15] Pete: Of course, that’s part of the game, right?

[00:20:17] Pete: If you had one thing that you could say, if I could like just pre qualify every patient that comes through the door and say a couple things that you would love for them to know that would make the process better, what would that be before their first session?

[00:20:33] Rachel: I can help with this, but this has to be kind of driven by the patient. They need to be ready for therapy. Sometimes I have people come in that are not ready. Whether it’s because they’re too busy or they don’t think it’s going to help. Someone just told him to come.

[00:20:49] Rachel: We’re not going to be able to move forward in that situation. So coming through the door, I hope that they’ve maybe done a little research, maybe have a little motivation. Like I said, I can [00:21:00] help with that, but if we could be on the same page from day one, what the path we’re taking and we’re going to give it our all, that would be helpful, I think for both me and the patient.

[00:21:09] Pete: So from afar, I’ve always observed is there are those that take ownership in wanting to improve and get better. And then there’s another bundle, which will say, get me better. I think it’s a team effort that the two come together.

[00:21:25] Pete: If you do the things that you’re expected to do and do your research and understand why this is working and what you need to do to make it better and take all of the great things that you’re doing, I think you just increase routes.

[00:21:38] Pete: To me, that’s common sense, but maybe that doesn’t necessarily happen.

[00:21:42] Rachel: Right. I can only do so much and I know that I’m not going to put all of the stress of the success or not success on me. I do as much as that I can, but yeah, they definitely have to meet me, I don’t know if it’s halfway, but we have to be that team, like you said.

[00:21:56] Rachel: We can certainly change things and that’s where the [00:22:00] communication comes in.

[00:22:01] Pete: Rachel, this question I’m going to ask you, it’s kind of intriguing. You’ve sort of touched on it a little bit with the coding and things, but as the lead therapist for PT, what are some of the challenges that you have experienced in this industry? And what I noticed on your notes, is it seems like it’s more systemwide as opposed to anything. Is that what you think the biggest challenges are?

[00:22:26] Rachel: Healthcare is tough. And I can’t speak for the doctors and some of the other providers, but I think it’s across the board that insurances are challenging sometimes to deal with. I actually I’m doing a two and a half hour lecture on insurance coverage. What are they wanting now, how do we justify? It’s hard because there’s always this sense that you have to work extra hard to justify what you’re doing instead of just doing it.

[00:22:54] Rachel: And then because you have to document everything you do and why you do it. It’s hard that sometimes take away from your [00:23:00] treatment because I can’t be 100% 1:1 with every single patient when I also have to be remembering what we’re talking about what we’re doing and writing it down.

[00:23:10] Rachel: It’s also hard because we have our schooling, our education, our ethics that tell us what we have to do. And then insurance companies can also have different rules. Not that they’re in opposition, but they’re just an addition. Certain insurances want a co-signature, but some don’t.

[00:23:28] Rachel: And some allow direct access, where you don’t have to go to a doctor. Some you need prior auth, some you don’t. Some you can’t bill certain things a certain way, and others you can. It takes away from patient care at times, but as professionals and all across the board, you just learn to deal with it and I’m trying to make that balance the best you can and , do what you need to do. It’s not my favorite part of the job.

[00:23:52] Pete: Yeah, I wouldn’t think so either knowing your personality from how we’ve been discussing here, it’s dealing with people. We’re not going to fix how all of that [00:24:00] works, obviously, in our conversation. But I think the more that it’s talked about, and it’s more brought out front, the more the dialogue occurs, and maybe some positive things can occur.

[00:24:09] Rachel: Another tough thing about insurance is if we’re going to add to the conversation and educate people, they can kind of decide how much they want to pay us too. We can bill them a certain amount, and they can pay us what they want.

[00:24:23] Rachel: In our field, it is becoming very, very difficult because, inflation, like everything costs more, but in some cases, insurance companies are deciding to pay us less than they did before, or not very much more. And that is also a huge struggle with, declining reimbursement, I will say.

[00:24:44] Pete: That’s an interesting factor for sure. Final question for you, when you look back over your career and everything that we talked about today, what is the biggest surprise and the greatest thing that occurred from your serious [00:25:00] 180 pivot there in careers? What’s the best part about what you’ve done and why?

[00:25:04] Rachel: Well, I would say never regretted it or looked back. And like a lot of people, you don’t quite know what you’re getting into, even in school and you do your clinicals. But like I said, I’ve never regretted anything. I feel very, very lucky for the career that I’ve had and the places I’ve worked.

[00:25:22] Rachel: My greatest surprise, I’m not sure. I think you never know, like you never know who you’re affecting and how much. You might try so hard and like, you think they’re doing great and they don’t even seem to care. But then there’s people that you’re not even sure what they’re thinking. You’re not sure if they think they’re getting better, if they’re happy, if they’re frustrated.

[00:25:42] Rachel: But then they’ll send you a message. I just had a really nice message from a patient this morning. And that was a surprise, I don’t know if they hadn’t expressed that before. You don’t always realize the impact that you’re making. I guess sometimes it’s little things like, it’s not that they had this huge, meaningful improvement, they’re [00:26:00] brand new, but it’s just something small, like I was able to play with my grandkids, and how valuable that those small things can be.

[00:26:07] Pete: You’re right, the small things can be the big things that really matter. It makes it so rewarding and worthwhile. So Rachel, I know you got to get back to work. I’m sure you have somebody to see. You’ve been outstanding on this podcast and we appreciate your time insights and thoughts to what you do and why this is such an integral part to people’s health and moving forward.

[00:26:29] Pete: So thank you for joining us today.

[00:26:30] Rachel: Thank you for having me.

[00:26:32] Pete: Thank you, rachel Peterson from Minneapolis Clinic of Neurology, thank you for joining us for this episode of Neurology Now.

[00:26:39] Pete: We hope you found it informative and engaging. If you enjoyed this episode, please subscribe to our podcast or stay up to date and help us educate our community and beyond.

[00:26:49] Pete: We do welcome your feedback, comments, and suggestions for future topics, so please feel free to reach out to us through our website or social media channels. That’s going to do it here [00:27:00] for our podcast.

[00:27:01] Pete: I’m Pete Wagner. So long everybody.

[00:27:03]