The Evolution of Knee Rehab
An Interview with PTA, Candice Cawood.
Candice describes her history of PT work in both outpatient and home care therapy. And she explains how significant is the impact of the X10 on the evolution of knee rehab.
To listen to the full interview click the Play Button above. You can read excerpts from the conversation below.
My name is Candice, and I have been a physical therapist assistant for nearly 17 years. My career started in outpatient care. I did that for five years. Afterwards I was in home care for 11 years. I loved being in people’s homes, loved the connection that you get when you’re at that level with somebody. And then my friend, Director of PT at X10 Erin Rempher, introduced me to X10 Therapy.
I have worked with probably every diagnosis you can imagine. These are conditions that you would be well enough to be home for, but not well enough to be out in the community for. Of them all, joints have always been my favorite. I’ve always been fascinated by them: how you can take something that doesn’t work, and put these new parts into it, and rehab it? And it just completely changes your world.
My Knee Patients Before X10
In home care, when I would have a knee replacement patient, during the first couple of sessions, I would just give them basic exercises. But really it is more about just being there, creating a relationship. There has to be a trust that somebody is coming into your home and you are not feeling well. There has to be compatibility and a level of trust. So the first couple of visits are always pretty easy-going, ‘let’s see what you can do. Here are a few exercises that I want you to start on.’
During the first three to five visits I’m really amping people up, asking a little bit more of them, asking them to do more, starting to work on their gait patterning. If they’re going eventually to transition to an outpatient clinic, we address stairs, getting in and out of the house, and doing, a car transfer. And of course working on the infamous range of motion.
Knee Range of Motion
We know that getting to a 90º bend is critical. We also know beyond 90º, you have to be somewhere between 110º and 115º to be functional. And then going beyond that, 130º is a healthy knee. We never saw that with our patients in home care.
In fact, I rarely saw people pass the hurdles that we set for them. When they reached somewhere between 90º to a 100º we would put them into outpatient care. And I would have been with them for somewhere between two to five weeks depending on what their doctor’s protocol was, and what insurance would cover.
My Knee Patients Now with X10
So transition your brain from that to the X10 program. It blows my mind every time. When working with knee patients so many of them move so quickly to 0º and 115º. And you’re just thinking, Oh my goodness!
It’s not something that we would’ve typically seen in the home. And we’re doing it on a very consistent basis. I’m sure that my supervisors in home-care would’ve thought like I was some sort of superwoman if I was doing that with my patients. It is a big step forward in the evolution of knee rehab.
Coaching at X10 Therapy
Since I’ve come to X10 Therapy I work with between seven and 10 people a day. Most of them will be phone calls. And then there are the texts. It depends on where you are in the process, and how you’re doing. I have some of my people who are close to the end, just a few days away from the pickup of the X10 machine. They’re very independent. A lot of the time they are at the point where they’re starting outpatient therapy so they don’t have the same kind of time and attention that we had at the very beginning when I could talk to them every single day. Of course, I always reach out when I see people hitting milestones like 90º, 100º, 110º, 115º and beyond.
Data from the X10 Machine
Within 10 to 15 minutes of a completed session, the X10 machine sends your therapy results over to our coaching desktop with all of your X10 information so I can access it. I start my mornings with a quick scan through everybody’s range of motion numbers. I look for those who may have hit a milestone that they’ve been working towards.
To learn more about the wireless data reporting on the X10 click on the picture or here.
There are also people who, because of a variety of external factors, might be struggling a little bit. I can keep a careful eye on them every day. I always know who may need an extra phone call or special guidance. Sometimes it’s simple, sometimes it’s not.
One of the things that is so remarkable about the X10 is that it’s providing consistent feedback to the patient through the screen that they get to watch. It delivers constant, immediate feedback. Once patients really start to understand the machine, and are reading their numbers in real-time, it can be very positive for their motivation to do better. It’s quite amazing, the whole thing.
The Evolution of Knee Rehab
When I started 16 years ago people would stay in the hospital for five days. Now they do these surgeries on an outpatient basis. They go home a few hours later. It’s amazing to me how far things have come. A lot of people have home care, so we’ll be doing exercises just to start helping to re-fire the muscles, to get things going again.
I know that this is an elective surgical procedure, but it’s still traumatic. The surgery affects the muscles and the nerves and everything around the knee capsule. One of the things that we do with the X10, somewhere between day two to four, is pump both the leg and calf. Each exercise has a strengthening component to it. We call them the Pump Test and Calf Test.
The beauty of those two exercises is that one of their jobs is also muscle pumping, which helps with the swelling reduction. It’s kind of a two for one.
The Sensitivity of the X10
On the X10 we have two rollers and a foot plate on the “arm” of the machine. And they all have sensors in them. That’s how this machine is so sensitive to everything that you do, how it provides feedback to the patient immediately and the remote coach wirelessly. It’s not going to be completely pain-free, but it keeps pain in control because it’s so sensitive to the ever-changing condition of your knee.
When explaining swelling I tell people to visualize a sponge. If you have a sponge filled with water and you squeeze and twist it, what’s going to happen? That stuff’s going to come out.
By pushing down and contracting all of those muscles and then relaxing, we’re pulling the fluid from the knee, just like the sponge. And then it’s your lymph system that picks up that fluid and, hopefully, wastes that out. Of course, there are all different types of scenarios, and sometimes that does not happen right away, but it definitely helps the process. For more on knee-swelling click here.
The expectations for patients on the X10 are so much greater than with other methods of recovery because we know what they can do with it, and how much further ahead they can get with it. This is in part because they’re doing it three times a day and it’s doing the work for them. To learn more about patient results on the X10 click here.
A big ‘Bee’s Knees thank you’ to Candice Cawood for such generosity with her time. If you are lucky Candice will be your coach should you ever need the X10 for knee surgery recovery. To listen to the full interview click on the Play Button above.
We call it a “Meta-Blog.” We step back and give you a broad perspective on all aspects of knee health as with this article on ‘The Evolution of Knee Rehab’.
In this one-of-a-kind blog, we gather together great thinkers, doers, and writers. All our work is related to Knee Surgery, Recovery, Preparation, Care, Success, and Failure. Meet physical therapists, coaches, surgeons, patients, and as many smart people as we can gather to create useful articles for you. This is for you if you have a surgery upcoming, or in the rear-view mirror. Or maybe you just want to take care of your knees to avoid surgery. Executive Editor: PJ Ewing
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