Caitlin Boland: A Physical Therapist's Experience Treating Patients with a Brain or Spinal Cord Injury

Gaylord's ThinkFirst Program is part of the National ThinkFirst Association, which is committed to educating youth about the devastating and life-altering consequences of poor decisions that can lead to a serious brain or spinal cord injury.

In this episode, Megan Palmer, OT and Gaylord's ThinkFirst Program coordinator, interviews Caitlin Boland, PT, DPT, about her role as a physical therapist at Gaylord and how she made her career choice. Treating patients with these conditions can be very rewarding but there are challenges as well. Caitlin discusses how different her role is as a therapist at a rehabilitation-focused hospital as compared to a typical PT setting.

Gaylord Specialty Healthcare is a long-term acute care hospital located in Wallingford, Connecticut.  www.gaylord.org.

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Transcript

Caitlin Boland Podcast April 2022

Host: Welcome to the Gaylord Specialty Healthcare podcast. This podcast will feature patients, families, and medical professionals dealing with serious illnesses or injuries and is meant to inspire, bring hope, insight, and a message of belief that life after a traumatic illness is possible. 
 
 Host: Welcome back to the Gaylord Specialty Healthcare podcast. I'm your host Megan Palmer for the ThinkFirst series. Today I'd like to introduce Caitlin Boland to all our listeners. Caitlin is actually a physical therapist at Gaylord Specialty Healthcare and has been working here for almost 10 years. She has experience treating patients with brain and spinal cord injuries and is our wheelchair seating and positioning specialist, Caitlin, welcome to our podcast, and thank you so much for coming in today to share about yourself and how treating these brain and spinal cord patients have really become your niche. 

Guest: Thanks for having me.

Host: Of course, why don't you tell everyone actually, what is physical therapy?

Guest: So physical therapy is basically movement therapy helping people regain function and strength and improve quality of life.  

Host: All right, so tell us a little bit about what kind of populations you work with here at Gaylord. 

Guest: So, I see a little bit of everything. I am split between the brain injury and the spinal cord units. So, I have a couple of patients on each floor, typically. 

Host: So what kind of populations do you work with here at Gaylord?

Guest: So, I'm actually split between for rehab patients split between the spinal cord injury and brain injury floors. I have a couple of patients of each on each floor. I also work with medically complex patients. So, patients on ventilators or multiple wounds, things like that. 

Host: And you love brain injury and spinal cord injury the best or you would honestly treat whomever - as a physical therapist?

Guest: I would say. Yeah, I love brain injury and spinal cord injury the best. 

Host: And did you always like this population, did you know you wanted to work with these patients way back in college? 

Guest: So actually, when I was first looking at going to college for physical therapy, I was looking at becoming an outpatient therapist. So, I injured my ankle playing soccer and kind of got into physical therapy that way and thought that that's what I was going to do. It wasn't until I did my internships the last year of college that I decided that this is really what I wanted to do and where I wanted to be. 

Host: Isn't that crazy how different like orthopedics is from neuro when you're treating those kinds of patients. 

Guest: So yeah, so different. It's a world of difference for that. Now did you, where did you pursue your physical therapy degree? 

Guest: I went to Springfield College in Massachusetts. 

Host: Oh, nice. Did you grow up in Mass or was that an out-of-state reach?  

Guest: I grew up in Connecticut. I have family that lives in Massachusetts very close to there, so that's kind of what brought me there. 

Host: Springfield College is my alma mater as well; I have to say, just a few years before you. And then getting out into the field was Gaylord your first job? Did you kind of like look around at the orthopedic world first? What did you, what did you do after college? 

Guest: Well, I was actually a student here at Gaylord, so this was my last clinical affiliation. So I interviewed, I think I interviewed before I left here, but there were no jobs open at that time. So when I got out of school, I worked at a sub-acute nursing facility for probably about three months until the job opened up here and then I came back. 

Host: Oh wow. So as soon as there is a spot here, you knew this was the place that you wanted to be?

Guest: Definitely. 

Host: And why is that? What do you like about Gaylord? 

Guest: Well, I think that the patient population here is just something that you don't see anywhere else. It was so rewarding when I was here as a student, just giving people their lives back, being able to get people to walk and home to their families. And it was just something that you don't see a lot of other places. 

Host: No, definitely not. And so it brought you back to that brain injury and spinal cord injury population. And what sort of intrigues you about brain injury patients? What do you love most about treating them? 

Guest: Well, I think brain injury and spinal cord injury, both when patients come here from the hospital, there's so much rehab potential for them and it's a challenge. You know, that you see different deficits that you wouldn't see in many of other populations, differences in tone and muscle strength. I think there's just a lot, everyone's a little bit different. So it makes you think on your toes, which is why I like both of them. 

Host: Yeah, you're learning something new every day, every day with these patients. And then also you've got like the families too right there trying to cope with their loved one’s injury and this new person because brain injury just completely changes that son, that daughter, whoever from who they used to be. How do you help the families in that situation as well? 

Guest: I think, you know, it's really rehab for everyone. I think now is kind of a tough time with COVID and not being able to have as many family members or friends here as we typically have seen before. But even in working with patients with brain injury with spinal cord injury, just being able to, you know, contact their family regularly, and let them know about progress, providing education to all who are involved. We have a lot of support groups here. So making sure that families can get involved with that as well. 

Host: That's true. What do you see as far as trends like how di young people get hurt? How do they hurt their heads? What are you seeing out there? 

Guest: Oh gosh, a little bit of everything! Car accidents, a lot of falls, you know, just walking or falls out of a tree, lots of different things. 

Host: Could be substance abuse or just young kids kind of being around negative decision-making with their peers and things like that really can lead to some crazy things that they do.

Guest: Definitely, we see it all.  

Host: We certainly do! What are some of the tips or tricks that you have to work with someone who's so extremely behavioral or combative and they're just, you know, that's not really them? But how do you get them to move through those stages and get towards being better? 

Guest: Well, I think it's a little bit different for everyone....but you also find that...a lot of times I'll think, you know what if this was me or my family member, how would I want to be treated or what kind of thing would calm me down. So, I think it really helps to get to know the person that you're working with and know what they like, know what makes them happy, and have a lot of patience.  

Host: That's a great point like finding what they used to be involved in or things that they used to like in their own personal life to kind of help them in their therapy session. 

Host: That is super important definitely or like having the family too, bring in pictures and things that remind them of who they used to be. 

Guest: Yes, they need the motivation. 

Host: When do you see the most recovery with these patients? 

Guest: Well, with these patients usually, not necessarily all, of their recovery will take place while they're here. Recovery happens most rapidly within the first six months to a year out. But really, I mean the amount of progress that a lot of these patients make in just a month or two while they're here is amazing. 

Host: Absolutely. It's a sort of a lifelong process after that, just trying to get back to their life. I know you remember Courtney Beckwith quite well. Courtney was in a drunk driving accident and had a severe traumatic brain injury that left her in a coma for over a month, paralyzed her left side, and caused significant brain damage. And you and I, Caitlin, were actually her primary therapists while she was here, can you believe that was eight years ago? Almost nine I think in May. 

Guest: Really? Yeah, wow, that was a long time ago. 

Host: But having her in our ThinkFirst presentations, I watched the videos and I see the pictures again, and it just brings back how real and how different Courtney was initially after that injury. Like is she one of the bigger patients that really sticks out in your mind rehabbing traumatic brain injury?

Guest: Yes, absolutely. From when we first met her, she hadn't been out of bed, she required two of us to help her set up and now even when she comes back for appointments or anything seeing her walking through the hallway, it's amazing. 

Host: I know what were some of her behaviors that you remember that we had to work through? 

So, Courtney had something called a diffuse axonal injury, right? The DAI. Where basically when she was in that car accident when her car stopped her brain didn't and it hit all sides of her skull causing bleeding and bruising all over. Now we know, the brain controls everything about our body the way we move, the way we think. It really greatly affected Courtney's personality, her impulse control, and her behaviors. And so what were some of those things Caitlin that we really dealt with while we were trying to rehab Courtney?

Guest: It definitely changed throughout her stay. When she first got here. She would do things like bite or pull hair. She couldn't talk when she first got here when we started hearing her voice. She was very - she had a very flat affect. So there wasn't much. She wasn't smiling a lot. There wasn't really any range of personality. And then as she continued throughout her stay it was really interesting to see how that changed and how she got a little bit of that back and she would joke and she would smile and it was really interesting.

Host: I'm sure like as a parent too, now you have kids as well, like watching your child go through this recovery process, never having treated a brain injury patient before is just so scary for her parents to be like, that's not my Courtney. I remember just trying to help them get through it too, just justifying that this really is not your daughter, she's just trying to heal that brain is trying to heal.

Guest: It's now having kids and thinking about it is, yeah, it's scary. 

Host: It wasn't a perspective like, yeah, you know, this is the reality of these injuries and how they can kind of steal your baby away, and Courtney obviously evolved into - she can walk, she can talk, she's presenting at some of our presentations now, but that took a long time and that's the process with these brain injury patients that we work with and then, you know, switching gears a little bit, you also treat patients with spinal cord injury. Now, that's a huge debilitation, you know, they're either paralyzed on all four extremities, arms, and legs or maybe just two and can't walk anymore. But what do you love about treating those kinds of patients? 

Guest: Well, spinal cord injury, there's so many different, again, everybody presents a little bit differently. I will say what I like about spinal cord injury is it's very, the movements that you teach are very, very calculated. It's definitely like, you know, it's not just getting up and trying to have somebody walk and move their legs for them or something. You really have to teach people how to use what muscles they do have. 

Host: So it's very strategic.

 Guest: Yes, strategic, that’s the word. And so, you know, you have to teach the strategy and it's really, you're teaching somebody how to get through their daily life and you know, using only what they have and it's a lot for them. I think mentally, you know, it's a lot to take it all in and be so new out of injury and then have to learn a whole new way of movement. But it's again it can be very rewarding to help people get back to moving independently. 

Host: And you really have to know your stuff too as a therapist. Like what muscles do, what movement, and how you can use them to compensate for others. 

Guest: Oh yes, definitely. It's interesting now that, you know, I feel like in the beginning, I had to, you know, look it up. So where you know, somebody had an injury at the, in the thoracic spine, in the, in the middle of the spine basically, you know, what muscles might they have and what don't they? And now it's all just like second nature it's great and that's so different than ortho so different, right?  

Host:  I mean, Ortho injuries, what would that entail? 

Guest: So an orthopedic injury would be like a broken bone or muscle. Yeah, strains, ligamentous tears, tears, things like that a lot of times as we know with broken bones, you know, 6 to 8 weeks, typically, things heal and you have to strengthen your muscles maybe, but usually, it's a little bit of smooth sailing after that. Whereas brain injury, spinal cord injury, and these neurological diagnoses, it's just definitely a longer road to recovery. 

Host: Yeah, You're, once you're injured, basically you're injured, injured for life, like, right, you know, that the nerves and the way that the brain interprets them and how they move their muscles and body. Again, it's just different. Just is not the same person as they were before that injury. 

Host: So you're right, you get up and you heal and then you walk, you play sports again, like whatever it is very, very different. And with spinal cord injury patients, what do you see as the trends for them getting hurt? How do they get these injuries? 

Guest: Oh gosh, a little bit of everything. Again, definitely a lot of car accidents, I've seen, like swimming and diving accidents, you know, we see a lot of things that the unheard of. So like a surgery that might have ended with some complications or, again, you know, looking at substance abuse and just bad decisions that people make or a fall that somebody might have had and you name it. 

Host: And unfortunately like gunshot wounds too.  That seems to be, it's always been big...we're hearing about it a lot more. The awareness of it is a lot more. And then you actually got your certification in wheelchair seating and positioning, correct?

Guest: Yes, I got my "assistive technology professionals" which is what it's called. So it's wheelchair seating and positioning somewhat. But it's also a lot of communication devices and things like that as far as assistive technology is concerned. 

Host: Well, that's really cool. So like what kind of things do you do for the chairs or think, what do you help? How do you help people with that specialty?

Guest: So I do all of the evaluations for custom wheelchairs for inpatients here at Gaylord. I oversee our fleet of custom wheelchairs that we have for patient use. I help basically I am the go-to person for anyone if they need any sort of special seating for a patient while they're here.  

Host: And you have to order a lot of these custom wheelchairs. How does someone actually qualify for one of those? 

Guest: So it depends on, it honestly depends a lot on the diagnosis. Insurance will cover things based on somebody's diagnosis and then we have to just justify things medically. So, if somebody needs a power wheelchair, we would have to make sure that we would rule out why a person can't walk, why a person can't propel a manual chair, and then qualify them for this power chair.

Host: that seems to be a difficult job. 

Guest: It is, it is again; it's very rewarding though because you're giving these people their mobility back. So it's it can be a lot of paperwork and a lot of fighting with insurance companies but worth it.

Host: That's a huge part of them becoming independent, again regaining mobility, being able to come like, just even seeing them in and out of the gym by themselves from their room down to the gym and back is a huge eye-opener and a big part of being independent when they've been stuck in a hospital bed, for so long after their injury.

Guest: Absolutely. For so long after their injury. 

Host: Yeah, these people are amazing things that they can do, and the things that we watched them do, it just, and it’s still incredible every day, definitely. And so we had mentioned earlier your mom of two now, correct? Yeah, we've got little ones, how old are they now? 

Guest: Three years and the other one is 10 months old as of today. 

Host: Oh my gosh! Happy birthday, Carter. How do you think treating patients with this diagnosis has influenced your parenting? 

Guest: Oh wow. Well, I think that it's taught me to have a lot of patience, again, you know with my kids. It's also made me, I guess, not take things for granted. You know, you see how things can just get ripped away from people very quickly and I think that it really makes me cherish what I have. And I also think that you just want to keep your kid in a little bubble. You know you hear all these things that happen and you're like, wow! Like my daughter is three, but when she's 16 and driving, I am following her around!

Host: No car for you, no keys!

Guest: Exactly! 

Host. No, it’s true. You have to weigh like benefits of knowing about this information and seeing these patients, but also just living your real daily life. Yeah, that's a tough one. I feel the same way. And is there any like favorite patient story that sticks out in your mind that you have, that you really want to share with us?

Guest: Oh gosh, I have a lot of favorite stories. A lot of favorite patients. Courtney is always a top one. She really, I mean made a complete turnaround. She is just amazing and everything that she's doing now and I love that she's using her brain injury to teach others, which is great. I recently had a patient discharged after being in the hospital for almost a year and was able to return to her two young kids that she had at home. Walking climbing stairs, she was amazing. She is one of the hardest workers I have ever met every day. She gave it 100% what she what kind of diagnosis that she had. She had a very complex medical history which left her with severe weakness to the point that when she got here, she could barely move her legs. She had wounds all over her feet. And I think when I first met her, because she actually started here before I came back from maternity leave, and when I first met her, she was just working on getting up to standing in the parallel bars for the first time. So she just...it was amazing.

Host: And that's why you do what you do right? 

Guest: Absolutely. 

Host: Would you recommend physical therapy to other listeners out there who might be searching for a career, looking into the health care field? 

Guest: Absolutely. I think there are so many different avenues within physical therapy, you know, you don't you don't have to work in a hospital but I would obviously recommend it. But there are so many different things you can do with it. There's you can work in outpatient therapy, home care, in a hospital setting, inpatient rehab setting, there are just so many different things you can do with it. 

Host: And what would you suggest? How do they start that process of like going towards physical therapy? 

Guest: I think that the best thing to do is to shadow, to contact a local facility or whether inpatient or outpatient, but just to shadow a therapist and see what it is they do every day. 

Host: Oh definitely kind of get your feet wet, see if it's something for you, and then look into schools or colleges that have it. 

Guest: And I think most schools now are actually requiring people to have shadow hours before they commit. 

Host: Yeah, because I think PT is now a doctorate program, correct, everywhere. So that's a big commitment for somebody for financial reasons for school for time. So yeah, you really want to know that you like it before you get into it, definitely. But so rewarding.

Guest: So rewarding. 

Host: And to everyone out there, I just have to read this card that Caitlin shared with me. It just really sums up how much of a difference you make in people's lives and what you mean to them as a physical therapist. You know, you're not only their therapist, you become part of their family and their recovery and like this big chapter in their life when they're dealing with something so awful to make something beautiful out of it. So, I just would love to share this card if you don't mind. It says “Dear Caitlin, I don't even know where to begin working with you has been such a blessing. You've challenged me and encouraged me. You lifted me up when I've felt down and you've always had a positive word to share. You have been my biggest cheerleader and celebrated all of my triumphs. You made me feel safe and provided a secure environment for me to heal. I've greatly enjoyed getting to know you and swapping stories of life and motherhood. I don't think I could have done this without you. I will be forever grateful to have had you as my physical therapist.” That is so touching. You must have just gotten this card and melted.

Guest: Well yeah, now that you read it out loud, I got a little teary there.

Host: It's just so beautifully written and just like expels exactly how you can make a difference in someone's life. So after hearing this out loud and maybe it was easier when you read it to yourself. 

Guest: I think it was. 

Host: How does this job really impact you emotionally?

Guest: I mean these people, we see them every day and they become our family. I mean it's hard, it's hard to leave it all at work with this job. You do go home and have thoughts of your patients and you know, I hope the best for them and when they leave I mean we're so happy for them that they get to leave and go home. But we miss them. 

Host: Yeah, you're like, now it just ends right? Just sort of let them free like a little bird. You know, flies out of the nest. 

Guest: You know, always like here's my information. Please reach out and let me know how things are going. I want to hear from you. 

Host: And that's the amazing part of what we do and keeps us coming back for more right. 

Guest: Yes.

Host: Well Caitlin, that pretty much sums up exactly what I feel from you to just working with you every day upstairs and I'm so happy you got to share it with all of our listeners out there. 

Guest: Me too.  

Host: So thank you so much for coming on. And we hope you guys all enjoyed this podcast series about physical therapy and we hope to hear from you again soon. 

Guest: Well, thank you for having me. 

Host: You're welcome! 

Host: Thank you for tuning into the Gaylord Specialty Healthcare podcast. We hope that you will join us again to hear more stories that bring hope, insight, and a message of belief that life after a traumatic injury or illness is possible.