#Physicaltherapy and the Boring TED talk

 As an attender of many TED events over the years, I often yearned for #physicaltherapy to make the stage on such a universal platform.  My wish was granted through the release of this past March’s TED2015 talk:  #Physicaltherapy is Boring, Play a Game Instead by Cosmin Mihaiu the founder of Mira Rehab, a software platform designed to make physiotherapy fun and convenient for patients recovering from surgery or injury.  I am of the adage that any publicity for #physicaltherapy is generally good so despite my criticism and issues of this talk, I am genuinely thankful that at least our profession had the stage at TED-even for a short stint.

Unlike most 18 minute TED talks, this one clocked in just below 6 minutes and had it been the very video game that Cosmic has invented and wants to engage physical therapy patients, it would have been below a single medicare unit and therefore would have to be billed as group therapy raising the red flags of CMS for audits or simply the PT wouldn’t have even charged. But let’s not let economics get in the way since Mr. Mahaiu whose company is in London is not likely steeped in American 3rd party billing conundrums.

Mr. Mihaiu recounts an accident in his youth in which he broke his arm and once the cast was removed he was “forced to flex and extend his elbow hundreds of times day for 6 weeks”. He found it boring-thereby taking another six weeks to regain his range of motion. His mother, victimized by frozen shoulder had a similar experience with needing to do exercises at home which she found boring and it took 5 months before she was feeling better.  Admittedly at this stage of the talk, I was intrigued. Unfortunately, he completely lost me with his explicit definition of physical therapy:

 I required physical therapy, a process of doing a suite of repetitive exercises in order to regain the range of movement lost due to an accident or injury. At first, a physical therapist works with patients, but then it’s up to the patients to do their exercises at home. But patients find physical therapy boring, frustrating, confusing and lengthy before seeing results. Sadly, patient noncompliance can be as high as 70 percent. This means the majority of patients don’t do their exercises and therefore take a lot longer to get better. All physical therapists agree that special exercises reduce the time needed for recovery, but patients lack the motivation to do them

 

Taking a component of what we do and extrapolating as the only thing we do would be like saying the job of a baseball player is to spit tobacco. I am sure the UK physios would take issue with this definition as well but the bigger issue is that we have to eradicate this image that physical therapy is the home exercise and range of motion profession (addressed in this blog previously HERE and HERE).  We can deliberate and debate the differences in the role of a PT in a broken arm and a frozen shoulder but suffice it to say that a patient taking some responsibility for one’s own rehab and being “bored” are not the responsibility of the PT’s.  Doing arithmetic tables, spelling tests, and repetitive memorization are also boring but foundation to something larger-a point completely missed in the talk.  

Of course, using video or games in #physicaltherapy is not new or unique. We have been told that PT clinic’s equipment would be replaced by Wii Rehab. While there is clearly some use of this approach (e.g. vestibular), we are already aware that this technology trend was just a fad and that aren’t any PT clinics in Toy’s R Us. Besides, at $400, I highly doubt you will see Mira Rehab’s software as any type of disruptive force in rehabilitation.  I am often reminded that these approaches are simply marketing outpacing research and application.  I sincerely hope Mira’s software stays in the lab for testing for a long time before any market adaptation of yet another attempt to displace PT patients to a substitute or home market.

Maybe one day we will get us a full 18 minute TED talk on how physical therapy is the most undervalued and underutilized system and is a key solution in reducing healthcare costs in musculoskeletal medicine.  And hopefully, unlike Mr. Mihaiu’s home repetitive experience, the presenter can recount their experience with a compassionate, empathetic physical therapist who listened, cared for, used their hands and evidence based skills to enable recovery without the use of drugs, imaging, surgery, or even animated videos.

Thoughts?

@physicaltherapy



 

 



10 responses to “#Physicaltherapy and the Boring TED talk

  1. Dave Kittle says:

    THANK YOU, LARRY! When I first listened to this talk, I was surprised to the hear the negative connotations of physical therapy treatment of the speaker and his mother. I was immediately turned off. Gamification will not solve PT or HEP engagement. Patients will not buy the Wii (if they don’t already own it) just to complete their HEP. Also, like you mentioned above, this is nothing new. I’ve hardly seen outpatien facilities purchase a Wii console for their office, let alone buy ANOTHER software product on top of it. Practices/owners won’t be jumping out of their seats for this “innovation.” Thanks for posting this, Larry, as well as including direct quotations for others to read the ridiculous statements regarding physical therapists, our field, treatment, home exercises and engagement.

  2. Eric Kruger says:

    Larry,
    I agree with you. These types of technocratic tricks are no replacement for what should be the bread and butter of PT rehab program–dedicated compassionate attention and the ability to adapt ones program to accommodate for boredom, pain, lack of resources, time constraints, distress etc.
    The logic that people like video games because it alleviates boredom and PT is boring therefore for PT + Video Game = no longer a problem of boredom is weak, IMHO. There is nothing new about creating reinforcements that speak to each individual patient. Fordyce wrote about this extensively in his seminal work . In fact this approach has been the center of behavioral treatment of illness. This is something long neglected in PTs biomedical reductionist approach into the body for the source of pain and dysfunction.
    In fact, people will become bored with video games just like they do anything else in life. What is the point of getting up and down because you are told to by a PT or having an avatar mimic the same motions while on a screen? To make interventions valuable we must move beyond simple avatars, bright shinny lights, and goals by talking with patients about their values and the things that they find meaningful in their life. The art for the skilled therapist is to craft an effective and persuasive regimen out of the latter of these things.
    Perhaps in some cases this might involve a game–after all Las Vegas knows all about the benefits of shinny lights, catchy sounds and intermittent reinforcement. However, in many cases we may have to roll up our sleeves and dig deeper with our patients.
    Technology is the muse that both drives the ingenuity of human progress but unfortunately usually comes riddled with a sequelae of human problems. When we focus on technology to solve human problems we often miss the fact that our bodies and minds have an entire evolution of both hardware and software platforms designed to solve these very same problems. Chiefly when it comes to injury and rehabilitation dedicated, compassionate and non-judgmental attention that focuses on signaling (through words and actions) to the distressed patient that they are okay is paramount. We as therapists need to spend more time cultivating our skills at this low-fi technology rather than crafting more advanced attention grabbing tricks.

    Eric Kruger

    1. @physicaltherapy says:

      Eric, great points. Both psychological concepts of “adaptation” and “habituation” suggest that the introduction of non boring games would eventually become boring! The larger point might be the idea that we somehow have to make every act of rehab without discomfort including without boredom. I just can’t buy into that.

  3. Sean Collins says:

    Well said. Completely agree with the post and the comment by Eric Kruger. Simply doing the same intervention with a game is not innovative, novel or revolutionary intervention. The profession is in need of real innovation and technology cannot provide it until human’s rationalize it, embody it and implement it.
    #scollinsptscd

  4. Thank you Larry, I too am a huge fan of Ted Talks, and could not have been more disturbed with this particular one. The over simplification is what bothered me the most. I also strongly agree with Eric’s post, looking at the bodies as if they are isolated mechanistic systems. What was so over looked was how we connect as people in this profession, we teach people to have better understandings of who they are in the world, and to move towards better integration. Again, thank you for being our voice on this issue, and I look forward to other comments as well.

  5. David Boyce PT EdD OCS ECS says:

    What I find funny is that the shoulder abduction was performed incorrectly. You need to ER the shoulder during abduction to clear the GT. another reason why a REAL PT beats a virtual one every time!

  6. David Boyce PT EdD OCS ECS says:

    What I find amusing is that the shoulder abduction was performed incorrectly. You need to ER the shoulder during abduction to clear the GT under the acromion. The reason a REAL PT beats a virtual one everyday.

  7. David Levine says:

    Hi Larry – As a PT and a TEDx organizer I was also not super happy with this talk! I was suprised so many people liked it and found PT “boring”. You mention attending TED events – which have you gone to? I was recently at TED Active 2015 – great meeting!

  8. Agree with you Larry and the others that have expressed similar sentiments. We seem to hear a story like this every few years. Many don’t remember, “The Great Back Debate” in which the physical therapist was quoted as saying, ” Steven Smith, a physical therapist at the Schuldt Performance Center in Deerfield, Ill., uses massage on back-pain sufferers to loosen up tight muscles and increase blood flow. It’s not exactly a spa-like experience–Smith uses an electrical vibrator to distract patients from the pain of his fingers pushing into their muscles. “You’ve got to get in there deep to break those spasms,’ he says”.
    Newsweek – the Great Back Debate

    How about ultrasound, Tiger Balm, and bumpy balls PT? Oops…another not so great representation of PT.
    Dr. Oz and physical therapy

    We can’t let this less than stellar promotion of our profession overshadow the numerous quality studies from Gelhorn, Fritz, Childs, Delitto, and many others proving our value. We just need to do a better job of informing our local communities of the value we provide.

  9. Agree with you Larry and the others that have expressed similar sentiments. We seem to hear a story like this every few years. Many don’t remember, “The Great Back Debate” in which the physical therapist was quoted as saying, ” Steven Smith, a physical therapist at the Schuldt Performance Center in Deerfield, Ill., uses massage on back-pain sufferers to loosen up tight muscles and increase blood flow. It’s not exactly a spa-like experience–Smith uses an electrical vibrator to distract patients from the pain of his fingers pushing into their muscles. “You’ve got to get in there deep to break those spasms,’ he says”.
    Newsweek – the Great Back Debate

    How about ultrasound, Tiger Balm, and bumpy balls PT? Oops…another not so great representation of PT.
    Dr. Oz and physical therapy

    We can’t let this less than stellar promotion of our profession overshadow the numerous quality studies from Gellhorn, Fritz, Childs, Delitto, and many others proving our value. We just need to do a better job of informing our local communities of the value we provide.

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