Take That Step

TL;DR: Through their experience as physical therapists and physical therapist assistants the authors have all encountered and should appreciate the palpable disquiet that patients can feel when they have to take a next step.

Abstract: Some years ago I was working with a young man who was critically burned in an automobile accident. After many days of recovery from the initial trauma and early surgeries, it was time to start him walking. He was interested in getting up and moving around despite the reasonably severe mobility impairments he experienced. When he later recounted to me the initial trials of weight-bearing movement, he confided that he was actually frightened as he wondered “Will I be able to do this?” We worked for a few days on simply taking a next step. As he improved and we were ready for him to really work on his gait, I remember trying to be very clear and consistent with my instructions. After establishing the strategy to get him ambulating, I positioned myself at his side and said, “All right, now take the first step.” I repeated my instructions and then said again “now the next step” and again “the next step,” and then yet again my insightful direction “now the next step.” I suppose I repeated that phrase a monotonous number of times because at some point in time this young man interrupted me before I could speak again and asked with an appropriate amount of mockery, “So, gee…what's the next step?” Through our experience as physical therapists and physical therapist assistants we have all encountered and should appreciate the palpable disquiet that patients can feel when they have to take a next step. The challenge of that next step often can be overwhelming for even the most participatory of our patients and clients. Whether a literal step, the first motion of a newly replaced joint, an obstinate scar, an inflamed joint or muscle, a challenging neural deficit, a developmental ordeal, or…well, we know how the list of the …