Ep. 40 | Bryant Alonso, OT, Acute Rehab Team Leader and Tiffany Kouadio, DPT

Transcript

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- Welcome to another episode of What Brings You in Today? I'm Taylor Fisher. And I'm Kara Hope Hanson. And we just wanna thank all of our listeners for tuning in and subscribing to the podcast. Please continue to like, subscribe, leave us reviews and give us all the feedback about what you enjoy about the podcast.

- And if there are any topics that you might be interested in or any special guests you'd like for us to have on, you can let us know at sgmc.org/podcast.

- So today we're here with Bryant Alonzo OT, an acute rehab manager, and Tiffany Kouadio DPT, which is a doctorate of physical therapy just for everyone. So what brings you in today?

- So we are here to educate everybody on the role that acute rehab plays and SGMC Health.

- Okay, sounds good. So can each of you introduce yourselves and maybe talk about what led you to pursue a career in therapy?

- Sure. I'm Tiffany Kouadio and I became interested after I did a semester for speech therapy actually. And I found out it wasn't for me. I've always liked to be active and help others. So PT just kind of fit that and there was the program at, at my university. So I decided to switch over to the DPT program and happy I did. Okay.

- So I've been at SGMC for six years, two years in leadership, been an OT for nine years. And my, how I got into to therapy, I was originally gonna be a PE coach and I was, I played baseball in college. I was actually over in Albany and I separated my shoulder and had to go get physical therapy. And in those conversations with the physical therapist that was performing the therapy on me, she educated me on all the other disciplines of PTOT and speech. 'cause I, I had no idea. Most everybody has heard of pt but maybe not so much occupational therapy. So I went home and just kind of googled it because it sounded interesting and one thing led to another and the next thing you knew I was, I had changed my, my career path to occupational therapy. So.

- Wow. Okay. So Tiffany, for anybody who doesn't know, how would you explain the difference between OT and pt?

- So, physical therapy, we focus on restoring a person's physical function, mobility, their strength. We focus on moving. And so we do that through a natural means or adaptive means, especially in the hospital. Sometimes patients come in and they cannot functionally get up and walk without an adaptive device. So we bring a walker or a cane what so have you. But the goal is to maximize the patient's independence in the safest way possible so that it improves their quality of life and their mobility.

- Okay. And is that OT and pt?

- So that's pt, I'll let Bryant talk about ot.

- That's physical therapy.

- So with occupational therapy we are in this specific setting, we are looking at the individual's ability to perform ADLs. So activities of daily living, so bathing, dressing, toileting, things of those natures. And also I ADLs. So higher level skills, so being able to keep cook in the kitchen, clean your house, those types of things. So we're looking at primarily in this setting, yes you do need to be able to perform functional mobility like Tiffany hit on, but we are looking more at fine motor skills, gross motor skills of the upper body as well as strength and you know, the cognition that also plays into that, for example, with our stroke patients. So another thing I also want to hit on is not represented today is speech therapy for our acute rehab team. And they play a huge role on the acute side of the hospital where they primarily focus on the speech language cognition as well as swallowing and voice. And they are, and Tiffany can attest, they are vital to our everyday doings on the acute side for rehab.

- They are, yeah. And I would mention too that all of our roles come into play when a patient has an illness or injury typically, especially in this setting. So that's how we come into the picture.

- That's

- Right.

- Yeah, definitely. So Tiffany, how would you determine when a patient is ready for therapy when they're still in the hospital?

- So a patient has to be medically stable when they come in nine times outta 10. They're not medically stable and doctors and nursing staff have to get them stable. So we look at a lot of different things from their lab values to their chemistry to their hemodynamics. So when we chart review, we do a thorough chart review, we look at all of that and then we make sure all of those numbers and values are within our parameters. We have parameters for therapy where we can or cannot work with patients. If those are good we go. And then also on the orthopedic side, we just have to make sure that specialists who need to attend to them before we get to them have seen them and have given us clearance. So a patient can come in and be stable medically, but they might have a broken hip or a broken shoulder or something. And we have to hold and wait until a specialist comes in and sees them first to give us clearance. So, but above all they have to be medically stable in order for us to treat them or evaluate.

- Okay. And what are hemodynamics?

- Those are our, your blood pressure, your heart rate. Okay. Your vital signs that you can see on the monitors. I, I just

- Have to ask 'cause I'm in marketing and I don't know.

- Okay,

- Sure. And they're, especially with our stroke population, really with those folks, we can do potentially harm to them if we, we get there and they are not, like she's saying medically stable. So our chart reviews are extremely important and the communication between the interdisciplinary team is vital. So we, on daily basis we are calling physicians and communicating with nursing staff to make sure that we are okay to start the therapy process.

- And you mentioned stroke, but what other kinds of patients would you see with like their different issues?

- Diagnoses? Diagnoses, diagnoses? Yeah. Our cardiac patients and our cabbages, strokes, cabbages, orthopedic patients, those are kind of our big three, but there's a lot of different diagnosis that fall under all of those. And then we have some patients who just come in and they're not, they might have nausea and vomiting and they're just not feeling well enough to get up and move. And so they might need certain medicines before we come in and see them or we'll make their vomiting and nausea worse. There's also our vestibular population that comes in who comes in with dizziness and they feel like the room is spinning, et cetera. There are certain things that need to happen or not happen for us to come in and do a, a good evaluation of the patient or an assessment of the patient. I think those are the, those are the big three,

- Big trauma I'm sure with us being a trauma, a level three trauma center that yes, we see a good amount of those

- Patients. Yeah, that's really good. You mentioned that because neurosurgery is a big two here and they do our neck, our subdural hematomas, they fix the, any of the cervical fractures and things like that as well. So yes.

- And now with Dr. Keith on board for orthopedic trauma, we've actually developed a really good relationship with him. He's come down to our department, we oriented with him early on in the process because every surgeon is different and they have preferences for some, you know, their patient population. So it's very important for us to get to know our surgeons so that we're on the same page.

- Yeah, I know what comes to mind for me is, you know, the story we did on our hurricane volunteer, which we've talked about before on the podcast, I think Mr. Steve Wise, who did a patient testimonial for us. So he's okay with us talking about this, but he needed rehab when he was in the hospital. And I remember seeing the, well, I don't remember physical therapist working with him and you know, I think they'd formed a close relationship and that is a significant trauma where he needed help kind of getting his body back Absolutely. To where he could be discharged.

- That's right.

- Or he was actually moved to another care facility, but to where he could get, you know, more mobility.

- Sure.

- So can you walk us through how the discharge planning process goes? And you know, how therapy continues after patients are discharged?

- So as soon as we get the order and that the order for therapy for PTOT or speech comes directly from a physician. So once we get that order, we do our chart review and then we go in and perform an evaluation. Obviously everybody wants to go home, right? That's, that's the goal. But unfortunately not everybody can. So we perform our evaluations both PTOT and speech, you know, if appropriate and we determine based off of what their prior level of function is. Okay. So if you come in independent and we find that you're needing mid mod, moderate or maximum assistance, you may have to go somewhere else for, for therapy services. Another facility such as a, you know, a, a post-acute rehab setting is what we, what we call it just for some more short-term rehab. There is the, the possibility. And Tiffany can tell you sometimes if we're able to work with you a few times, you may be able to progress to being able to go home with home health, which is always the goal. But that is not always the, the case, unfortunately.

- Yeah. Are there areas of treatment that our therapists specialize in?

- Yes, so I very, very fortunate, I have some phenomenal therapists, maybe not necessarily certifications, but I would call them experts in some fields. So I'm gonna brag on Tiffany. Tiffany has a lot of experience with pediatrics in NICU and she actually came, she, she voiced a couple weeks ago with our new women's and children's building. You know, that there may be a possibility for physical therapy services, you know, depending on the acuity of the patient, we may be able to look into getting physical therapy involved over there. So I also have a couple of physical therapists who are certified in Parkinson's. I have one who is a certified in strokes as well as vertigo. So like Tiffany was saying, those vestibular evaluations, they can be tricky, very tricky. So it, and they take time to run through the process to determine what needs to be done. And lastly, I have a physical therapist who is a certified strength and conditioning. So we have a lot of, a lot of expertise and what's awesome and how we work well as a group. If I do assign somebody who they know, maybe somebody knows maybe a little bit more or a better way to, to go about it, they will communicate with that therapist and discuss what's best as far as the, the, the how to perform the treatment.

- I think it's fascinating. I've never thought about anyone being, you know, specializing in Parkinson's, but I'm sure that's very important in what you guys do and the, the specific types of treatments. Can you talk about that just a little bit?

- So with any form of, I guess specialization, especially with, with Parkinson's, you know, they present, they, they may need a little bit more time to complete tasks. So just knowing the how to utilize those strategies and maybe what adaptive equipment to introduce to them if they have not been, you know, already introduced to it.

- Yeah,

- Just knowing how to best serve them, not only improves their, their level of function here, but also sets them up for better success when they leave SGMC

- And big for Parkinson's is just their range of motion and their mobility. A lot of times you'll notice kind of a clear sign is when they start to shuffle their gait, so at risk for falls and tripping. And so we have to educate them to move big and long and educate family with that as well because they need those constant reminders.

- Definitely. We kind of talked about, you know, we're hoping to have therapy in the, in the new building and the pediatrics and all that stuff, but where else would you find in our current setup, where do you find therapy?

- So we have OB acute therapy, we have our inpatient rehab,

- We

- Have in Lakeland, we actually have a post-acute rehab setting, so a swing bed and an outpatient. And I'm very excited. We are introducing an outpatient here in Valdosta coming very soon, in the next few months. So we have some pretty big projects going on and I'm, I'm very excited about the, the future of therapy with SGMC health.

- Are there any unique like challenges or rewards that come along with working in those different settings, whether that's maybe the er, pediatrics, ICU?

- I mean, I think there, I think there are more rewards than challenges with a patient. You just never know what you're gonna get. I think the biggest reward is remembering that patient is a person. When we come in, we are literally trying to improve that person's ability to feel good about themselves, to move when they, it's one thing when you're, you know, you're, and that happens a lot of times you were walking the day before, they'll say it, I was just up walking and doing my yard work yesterday and now I'm in the hospital. And so I think it's rewarding to be able to be an individual in that plan of care who restores their mobility and function because it's, it improves their quality of life significantly for those who are able bodied and were doing higher level activities prior. I think some of the challenges come in just sometimes with the, the dynamic of the patient. We are the lifters, we are the movers. And so sometimes we really, and that comes with our training, knowing how to effectively mobilize a patient out of bed into a chair. It might look easy, but for some patients they may need a lot of different adaptive things from our bodies just to be able to get there. So sometimes that poses a challenge, but also shouting at our rehab techs, they come and help us. So that

- Could not, because

- Sometimes

- Could not do it without

- Them. We could not move one patient by ourselves sometimes. So sometimes, sometimes the challenge comes in with that. But the reward I believe is just seeing the patient recover and, and just get back to feeling like themselves. Some of them even yesterday, like, can I take you home with me? Aw, it does a lot for them to feel like they got up and they walked. Yeah. They're just like, I was able to walk today. And you're like, yes you were. So it's very rewarding when we are able to play a part in that role of getting them better and outta here.

- I can't even imagine because okay, this is not anything that I would've needed rehab for. So this is not a good comparison, but I have a habit of pulling muscles in my back, which I have done twice in the last probably year. And you don't realize how important your back is until you literally can't get out bed or, you know, stand without being in pain or, you know, perform those daily living activities. And so for someone to, to struggle with that, I mean I'm sure you guys are like angels to them and they do wanna take you home. Do you have any, any stories of patients that stick out to you that you know,

- So I have you

- Helped them with that?

- I have one in particular. It was during COVID and SGMC highlighted it extensively, so I don't know if I'm allowed to. I'm say then it, so Jenna bowling, I had, we had all been following her story from when she was here initially intubated, sent down to Florida for, for more extensive treatment ecmo. And then I got to the point where she was doing better and reverse transferred back to us. So I was the o occupational therapy therapist that saw her on the west side primarily. And we tried to, we tried to send the same therapist and, and cases specifically like hers just to build that continuity, kind of like what, what Tiffany was saying, we, we want to build that rapport so they feel comfortable with us. So myself and the physical therapist who was also working with her, I cannot tell you how weak she was initially and to watch her improve over the next, you know, 14 to 17 days on the acute side of the hospital, you know, just sitting on the edge of the bed and your oxygen going down into the, the seventies, that's scary. So on top of everything else that she was battling mentally to help her improve to the point where she could stand up and walk around the, the room and go to the toilet and you know, get into the, you know, you talk about somebody who was completely independent, you know, elementary school teacher and now she needs help, you know, just to feed herself, but to watch her make those gains and then eventually get discharged to our inpatient rehab and so on and so forth. And now she is doing fabulous. She's back teaching and just to, to know where she was and to watch what therapy was able to come together and, and do to, to improve her, her quality of life and get her back to that independent level. That's, that's my most rewarding story here by far.

- And as a mom to be able to take care of your children.

- That's right.

- We're from the same hometown. I'm from Lakeland as well. So

- Yeah,

- Her story was definitely one that I followed closely and I'm very glad that we played a part in getting her.

- Yes.

- Well again, that's an amazing recovery

- And that was a total team effort. I get, you know, when you talk about the interdisciplinary team, the role that, you know, respiratory therapy played into that along with the nurses and you know, Dr. Bill with pulmonology, I mean it, we were all on board on the same page and to watch how that story ended was just so rewarding. Yeah.

- What about you Tiffany? Do you have any special patient?

- I don't think I have just one, but I will say that I have enjoyed being able to work on the acute side and the inpatient rehab side. I think I see that's where I see the most carry over and continuum of care. So I'll see patients on the acute side and they're very ill and then they'll get up to inpatient and I'll be up there. I've seen a couple where I'm like, oh, is that so and so I can't believe you're walking. Yeah. And the patient was, I mean, two weeks prior in the ICU with a EVD drain, not able to mobilize out of bed to chair without two persons and then they're going home, walking with a walker, they're talking. So seeing those type of recoveries success stories is, has been rewarding during my time here. But I think every day is a story too. I was telling Brian that before, like I don't have exactly just one, but like anytime we can get a patient up and mobilize them and they feel good about moving, it's a, it's a rewarding day for them and for us. And so we get, we get to experience that daily, which is good.

- So how do you go about like setting goals for patients? I know it's gonna depend on where they're currently at, but whether that's, you know, walking with assistance or you know, feeding yourself, how, how do you, how do you approach that?

- So we approach it, like you said, when we evaluate the patient, we find out what they were doing before and then we pretty much try to establish goals that will create the mode, the highest level of independence for that patient. And for some that might be a moderate level, they might not be able to move without someone giving them 50% of assistance. And for some that might require them to move with men assist or none. So we basically base it off of the patient's abilities prior and then we try to make, we try to restore their function. We try to restore their mobility to their initial function. So even if it's farfetched for a patient who might need a modest assist today, I still might make a modified independent goal within a week's time because you just never know how the patient's gonna progress. And so we just base it off of how they were doing prior. And the same for our lower level. It doesn't mean that they're any less, it just means if you were able to roll in the nursing home before you came here, we want you to be able to roll for cleaning in the nursing home when you leave here. So it just depends on the patient's ability.

- And I just want to add, we get asked all the time as far as what our role is in acute therapy. So our job is to get you to the next level of care. So some people get very upset that we don't see them every single day. We wish we could, but it's just not feasible, especially with the growth that we've had over the last couple years. But our, our job is to make that discharge recommendation and then we work extremely close with our social worker case management team along with the physician and we're trying to get them to the, to the next level, whether it be home, which is ideal or to another facility.

- Right. Our goals are not made to necessarily be achieved here, but they are there. Yeah. That goals, that's right to achieve in whichever setting we feel is most appropriate.

- Okay. What advice would you give to someone who's recovering from surgery or a trauma and they're nervous about going to therapy?

- Yeah, therapy. You know, I think people associate us a lot of times with pain and torture. Like, oh, there's a therapist, but we are really here. Not to hurt you, but to help you. And I think it's important for patients to understand that mobility Inc speeds the recovery process. It speeds it up. And so the more immobile you are after surgery or an injury, the, the more bone density you lose daily, the more muscle mass you lose daily. And so if you wanna speed up your recovery, then therapy is going to be pertinent to your overall recovery process. So just reminding them it's, it's a part of it, but it's a big piece.

- And I think the best example to give would be a patient who has fallen at home and has, you know, required a, a surgery by, you know, Dr. Keith for example, or the trauma. If you've fallen already and you've just had a surgery and Tiffany comes in to to walk you that initial, you know, that first time they're probably gonna be terrified. But like she said, we have to build that rapport and to try to educate them on the importance of putting weight on the, the recently repaired, you know, hip or what have you because it is so important in the, the process to return to their prior level of function.

- Yeah. And I think reassurance is key too. When you mention that, I do think it helps patients to know like, you're not gonna fall. That's right. You're gonna be okay. That's right. You're like, okay, I got it. And then you teach them and they're just like, wow, I did it. So yeah, reassurance is important as well. Just giving them that confidence in

- Themselves. That's right. Yeah. You're not just gonna let them fall in the floor at the hospital, you're gonna catch them if they do stumble stomach.

- So what are some simple things people could do at home to stay mobile?

- Just move. I think that it's important to know that you can move even in an adaptive way. You can move sitting in a chair and for some patients that's what they have to do because they're not ambulatory. So our wheelchair level patients go ahead and do your leg exercises, your arm exercises. In our soc in our advanced media technological world, YouTube has everything. So if you look up exercises for the elderly or for those who need to, for the sedentary, for those who need to do exercises in sitting, you can find a 20 minute video to do. And for our older population, our elderly population who needs more socialization, there's, is it called silver

- Shoes still sneakers,

- Silver sneakers, yep. They can go out into the community to get active with other elderly persons. I've never heard of that.

- Silver sneakers.

- So it's just a group of older people who get together to exercise together.

- Correct, correct.

- Okay.

- Yep.

- Yeah,

- So, and just basic recommendation, you know, three times a week, 30 minutes a day of just some form of movement and for some people the highlight of their day and what they may only be able to do is just to go get the mail and that's perfectly fine. That's it. That's perfectly fine. But just, you know, meeting you where you're at in, in, in that moment with everything that you have going on. So, you know, a good, a good recommendation for people who are able, you know, eight to 10,000 steps a day is ideal. But we know that not everybody can do that, especially people who are home bound. So, but like she said, you just gotta keep moving, you know, the better shape you're in when something traumatic were to happen to you, the, the better chances you are going to have a, a good recovery.

- Yeah. And it's very important to stay mobile as you age. I've always heard that because you know, the older you get you do lose that, that bone density 1% and that muscle mass. So can you just talk real quick about, about how important that is for, you know, I know you're older and you may not wanna move around, but it is very important.

- Well, as you get older, you, your bone density decreases and your muscle mass decreases and you're more at risk for fractures. And I think that's what you're trying to prevent is a fall that will result in a fracture that will result in you being immobile. Sure. And so in order to prevent that, you have to try to stay mobile and like I said, like he said, for those who are higher functioning, getting up and actually walking around and moving. But you would be surprised, I forget where I saw it, but it was a video of a person, I think their elderly grandmother, she might've been in her nineties, but it just showed the sequence of her getting up to stand daily with help just to sit, to stand back and forth from the, that's all she could do. But it allowed her to be able to transfer from sit from bed to chair daily. I think they did it over a span of months or years, I forget how long. But it allowed her to be able to maintain that function for a longer period of time as opposed to her having been, you know, immobile and not being able to move. So just the, that force of your bones and your muscles moving

- And - Daily and the, you know, sitting to stand or open chain movements as well is, is vital. It's very, very, very important. And even for our, like our older population, the ones who, we get some 92 year olds, 90 something year olds who are strong and you ask them what they're doing, they're like, I, I worked on the farm all my life, you know, they moved everyone, anyone who is functionally well at an advanced age, they moved and they continue to remain active. So it does play a huge role.

- Yeah. That's one of the only reasons I continue to go to the gym other than like, you know, all the health reasons and I, you know, everything. But I just think when I'm old I don't wanna not be able to move and walk and do all these things. So I'm just, that's one of the things I think about. Yep.

- Alright, well thank you guys so much for joining us today.

- Yes. Thanks for having us. And

- We do have one more final question. This is our favorite one to ask, but what is your favorite meal to eat here in the cafeteria or the allspice?

- Yeah, I'm like pescatarian. So I like the tuna sandwich when I do eat fish and then on days when I don't eat the fish, I love that you guys have a plant-based burger. It's called the Impossible Burger and that is my Friday meal. And so I am really thankful you guys have that option. I love it. I love it.

- I typically bring my lunch every day, but I us some, like she said on Fridays I may treat myself to a cheeseburger with some curly fries and a diet Dr. Pepper.

- Yeah.

- Or a grilled chicken sandwich.

- Two good options. Yeah, definitely. Everybody loves those

- Burgers. Yes.

- Well thank you again, both of you for coming in today and thank you to all of our listeners for tuning in for subscribing and please continue to do that and continue to let us know what you would like to hear more about at sgmc.org/podcast. So thank you and until next time.