By Mirella Deisher, OTD, MS, OTR/L, CHT
Virtual Hand to Shoulder Fellowship, LLC
Founder & Faculty
I started learning about the upper extremity and hand well before I was an occupational therapist. At 20 years old, I acquired a left hemiparesis and hemisensory deficits, and it was my physical therapist that provided me with my early education into the world of physical rehabilitation. Ultimately, she also became a role model and inspiration for me on several levels. I want to share why because it's the reason I became so passionate about what I do as a hand therapist, and now as an educator.
My physical therapist was invested in helping me restore strength and sensation to achieve as normal of a gait as possible. It wasn't just about being functional; the quality of movement mattered. She made me aware of the details in how the body moves. She tuned me into how my abdominals contribute to elevating my hip. She'd push and poke into my glutes, anterior tibialis, and plantar flexors to help me feel what muscles I needed to activate. She'd tell me how the hip needed to stay steady over my leg as I loaded it in stance, she'd tell me when I needed to start pushing off, then immediately dorsiflex my ankle to clear my toes. She'd tell me when and how to move my trunk and swing my arm. She took videos and showed me what I needed to be thinking about as I walked.
She treated me with one goal in mind, restoring a normal gait, and she gave me the knowledge and tools to continue doing the work well beyond my rehab stay. It didn't matter that I started out paralyzed; it didn't matter that I had no sensory feedback. She was also unimpressed with the compensatory knee locking that I discovered to get myself to stand. In fact, she reprimanded me for these compensations because she knew what the tradeoff was.
Being functional was easy, fueled from sheer will and fear of dependency. However, being functional wasn't good enough for her, and she didn't allow it to be good enough for me.
She never once mentioned the word "plateau," and after I was discharged from inpatient rehab, she came to my gym and looked at the workout I created as I continued to try to restore my body, now with equal attention to my upper extremity. She assessed my gait on the treadmill and talked to me about normal mechanics because she knew, without sensory feedback, I needed to attend to and direct my motions cognitively.
She continued to informally work with me even six years later, after I had become an occupational therapist. She’d meet me after work at the outpatient clinic that I was now working at and share some new ideas in getting me to load and strengthen my left lower extremity; then we'd go to dinner as colleagues and friends. Her everlasting efforts to help me recover, not compensate, for my impairments days to years after their onset is what inspired me to become the hand therapist I am today. Her resolve to help me walk with normal mechanics made me feel that there was always hope and kept me focusing on possibilities. I wanted to do THAT for my patients, because by then I understood that it was in the trying that recovery happens. However, to be able to do this required a level of knowledge I didn’t have even after becoming an occupational therapist, so I sought it out and never stopped learning through formal education, reading literature, and even from my own impairments.
Therefore, when I tell you I'm passionate about hand therapy and passionate about knowledge and learning, this is my "why." I believe that working at the impairment level is equally important to working at a functional level. Even without words, it's sending a message as to what's possible, and it's only possibilities that keep people inspired and invested in doing the work.
My PT set an example of excellence that I aspired to because I understood that it was her knowledge and resolve to help me go beyond a functional gait that made me believe it was possible, enough to work tirelessly for it. In fact, even after 30 years, I still work on maximizing my physical abilities, because trying for possibilities is just part of who I am now. Subsequently, the work I’ve put into trying to recover has translated into everything else in my life which has made me resolved that being functional should never be our goal; being as excellent as we can, no matter what that ends up looking like, should be.