Health Care

YSU Physical Therapy Students Learn Science and Art

YOUNGSTOWN, Ohio – As he steps off a treadmill, Levon Johnson is dripping sweat. He needs a quick breather, he says, before he works his way through an impromptu obstacle course.

The work is hard, but that’s the point of physical therapy, he says.

“It’s work but it’s a lot of fun. They want you to get better but they don’t want to be a taskmaster,” he says.

For more than a year, Johnson has been a patient at Penguin Physical Therapy, an outreach program created by the physical therapy program at Youngstown State University. The East Palestine native was living in Milwaukee when he suffered a stroke two years ago, which required him to move back home.

When he first arrived at the clinic in the basement of First Presbyterian Church, he had almost no control of his left leg, dragging it behind him.

“They basically started off with a lot of work on my gait. It was in bad shape,” he says. “Initially, it was stepping up on things, maintaining my balance, learning to transition from off the ground to standing back up.” He pauses. “They’re all things that you take for granted.”

Today Johnson walks, for the most part, without a cane and only a slight limp.

As part of the Midlothian Free Health Clinic, one of the notable features of Penguin Physical Therapy is, except for one professor, that YSU students comprise the staff.

Founded just over a year ago, the clinic keeps in line with the program’s education goals. Beyond being good doctors and therapists, YSU’s mission is to teach students how to reason through their cases rather than rely on memorizing their textbooks.

“One of the goals here is to have our students be good decision-makers,” explains Dr. Nancy Landgraff, chairwoman of the physical therapy program. “No two patients are alike, so there’s no recipe or protocol to treat a patient. … You’ll hear sometimes that it’s science and art because so much of it is based on what we see, what we hear, what we feel, in a patient.”

The emphasis of YSU’s program is to teach medical reasoning, not memorization.

“They can clearly pass exams. It’s not about reading information from a textbook,” says professor David Griswold.

To teach this, students are assigned cases to study. As they progress through the nine-semester curriculum, the cases get more and more complex.

In one instance, students might be told about a patient who recently had a total knee replacement. After the students develop a plan for rehabilitation, a professor will introduce co-morbidity, such as high blood pressure or diabetes. From there, the students must develop a new plan that takes those factors into account.

“That way, they can start simple and as they go and learn more, we can make those cases more and more difficult,” Griswold says.

On this day in a clinical laboratory class in Cushwa Hall, students take turns lying on tables as their classmates measured the circumference of various points of their chest as they breathed. The goal of the lab was to mimic patients with damaged spinal cords.

“We wanted to examine how those difficulties transfer to problems with breathing and making a determination [whether] they need a ventilator or what sort of therapeutic interventions we could utilize to improve their breathing capabilities,” explains graduate assistant Michael Gorgacz.

Each year, only 30 students are accepted into the physical therapy doctoral program – roughly 10% of the applicants. The candidates are judged on their undergraduate grades, their Graduate Record Exam scores, references and the quality of their observations in off-campus medical centers.

Some prerequisite classes are required, but as long as a student has completed them, his baccalaureate can be in anything. Many students in the program come with degrees in exercise science or biology, but Landgraff has seen business majors and dance students come through the doors.

In addition to clinical labs and their rotations at clinics around the country – some students are in the midst of rotations in Florida, Colorado and Washington – the curriculum includes pathology, imaging, pharmacology and neuroscience classes, among others.

What attracts many students, the department chairwoman adds, is the ability to interact with patients. Physical therapists usually work one-on-one with patients in 30-minute or hour-long sessions with a treatment plan written specifically for that patient.

“It’s a buzz word, but we are ‘people people,’ ” Landgraff says. “It’s the relationship that most physical therapists find is key.”

It’s that interaction that drew second-year student Jenny Parpart into the program. While she’s always harbored an interest in physical therapy, she studied biology in college and got a job as a high school science teacher before returning to school.

What sets the field apart are two things, she says: the number of specialties students can pursue and the relationships with patients.

“It’s a medical field, so you’re helping people who are sick. But you’re not helping them with medicine, you’re not giving them injections,” she says. “You’re helping them learn how to move to help them heal themselves. It’s impacting patients to take a hold of their problems and use their bodies to heal.”

By its nature, physical therapy is a hands-on field of practice that rarely works in isolation. Therapists work alongside physicians, surgeons, social workers and occupational therapists who focus more on functional tasks – the skills of daily living. Landgraff offers the example of physical therapists tending to a patient’s ability to sit upright, while occupational therapists work on a patient’s ability to put a shirt on.

Part of the education physical therapists must go through is learning how to navigate an increasingly complex and cooperative health care system. And with YSU’s push for students to be involved in the communities they’re a part of, the students are taught not only to be doctors, but also be advocates for their patients.

It’s here that Penguin Physical Therapy comes into the mix. Patients are referred to the student clinic if they are uninsured or their coverage runs out. In every other way, the clinic works the same as any other.

“We work very much so like a – quote-unquote – regular physical therapy practice because there is such variability in clinics,” says Dr. Cara Carramusa, director of clinical education for the department. “It provides us an opportunity as a program to give back to the community as clinicians. … YSU is a big piece of this community and it’s great to have partnerships within.”

Among the patients that students have worked with are those suffering neck pain, aneurysms and, like Levon Johnson, strokes.

“To be honest, if I could come here even when I did have insurance, I would,” Johnson says with a laugh. “I’d recommend it to anybody.”

After graduation, students’ can follow a multitude of career paths. In school, classes are geared toward teaching students as generalists, capable of finding work in almost any physical therapy office. Meanwhile, their education outside YSU is what provides them an opportunity to specialize in certain areas.

For second-year doctoral student Parpart, the most interesting aspect has been learning about the role physical therapists play in neonatal intensive-care units. There, the doctors’ work often includes using splints to provide posture support, helping newborns eat and developing educational programs for parents.

What initially spurred Gorgacz’s interest in physical therapy was his experience as an athlete as he grew up and looked at becoming a physical therapist for athletes. Through his clinical at Hillside Rehabilitation Center in Howland, he also became interested in the neuroscience of physical therapy, working with patients who suffered strokes and spinal cord injuries.

“It’s great to see the adaptations they need to go through every day function,” he says. “I didn’t know how many avenues there are in the physical therapy profession. I was only in the outpatient setting for my personal experience.”

Griswold’s expertise, meanwhile, is in vestibular physical therapy – working with inner ear disorders, whose symptoms can manifest themselves as anything from dizziness to vertigo.

“No. 1 here is we make sure they’re ready to go out and practice at a safe level,” he says of the importance of clinical education. “They learn the basic foundational information here and when they’re on their clinical rotation, they’re putting it into action.”

And the ultimate goal of the physical therapy program at Youngstown State is putting that knowledge into action, training PTs to help their patients regain the motor skills necessary to perform daily functions.

“We’re working to get people as functional as possible. For some people, it’s 100% function,” Landgraff says. “For others, because they have some diagnoses that make them unable to reach 100%, then we go to what they can do.”

Pictured: Penguin Physical Therapy patient Levon Johnson suffered a stroke two years ago and has since regained his ability to walk properly with the help of students like Alyssa Sansone.

Published by The Business Journal, Youngstown, Ohio.