Academy of Neurologic Physical Therapy



Academy of Neurologic Physical Therapy Historian Committee Inspirational ConversationInterviewee: Kathleen Gill-Body, PT, DPT, MS, NCS, FAPTADate of Interview: July 2017Transcription of Full Audio InterviewStart of Transcription: Timestamp 00:00:01End of Transcription: Timestamp 00:31:14Interviewer (I): So, I'm meeting today with Kathy Gill-Body. She's currently the adjunct clinical associate professor at the graduate programs in physical therapy at MGH institute of health professions in Boston. She also serves as the senior physical therapist at Newton-Wellesley Hospital in Newton, Massachusetts. Kathy was one of the first neurologic clinical specialists and is a Catherine Worthingham fellow.? So, tell me what your role was in the IISTEP and the IIISTEP conferences.Kathleen Gill-Body (KGB): Okay, in the IISTEP conference I was a participant, so I went to that conference as a clinician currently working at the time at MGH at the hospital, Massachusetts general hospital, and I was on the rehab unit there working with all kinds of, all kinds of patients with all kinds of medical diagnoses. And my role at the IIISTEP conferences, I was one of the co-coordinators with Darcy Umphred from the pediatric section.? And so, we oversaw the, you know sort of the soup to nuts of IIISTEP.(I):?So, you know the large span of time between IISTEP and IIISTEP, tell me what was it like, what was the state of PT practice at the time of IISTEP and how was that affected by attending IISTEP? For you.(KGB): Well, yes it was very different then.? So, from what I can remember, we were in an era, at least from my practice, so I was an early practitioner at that point in time, and you know I had gone to school in Boston and stayed in Boston to work. And so, my practice was heavily influenced by what I learned and what the people around me did, and I hadn't really seen much outside of Boston. Boston is heavily PNF, and so in terms of you know we were really thinking about what was the right therapeutic exercise for the patient.(I):?Right.(KGB): And I know I had recently decided to get NDT certified and so I had taken that step, and I think then the first session and we had to go back like three months later and do the second weekend or that's how it was structured at the time. So, when I went to IISTEP, my mind just kind of blew up because it was clear that the thinking was going much more towards sort of these initial frameworks of thinking about clinical decision making and practice, and moving towards standardized early measures of function, but we were heavily impairment based, still, I would say at that time. So, there was that sort of shift towards thinking about function.? And I would say the other big thing that I came back with was the, you know, really beginning to think differently about patients with the same diagnosis in terms of how they presented differently and how they were people, and what some of the sort of personal factors were that might impact their response to therapy.? And one of my most memorable things that I do remember from IISTEP was Patty Lee, his presentation. I don’t think you were there. Patty presented this framework of a patient with TBI, it was like a case report, it was later published.? And she just did a beautiful job exploring the questions that a therapist could ask herself or himself and the decision making for going through all the various elements of what we now refer to as the patient-client management model, but we didn't have a name for it then. And then asking a bunch of questions about practice.? Introducing the concept that therapy is practice and therapists are coaches, and that really wasn't how we saw ourselves at that point in time, at least not in Boston. So that was, you know, I came back and I really started thinking very differently about my patients and looking across my patients, and started to think about patterns, and started to think about not just doing things with my hands on the patient, but taking my hands off the patient, and allowing them to make mistakes, and you know that was sort of the beginning of those shifts in thinking.? In IIISTEP, you know I had a different perspective for IIISTEP partly because I was lucky enough to be one of the organizers and therefore very involved in the programming planning, and we had some amazingly bright people who had connections that were in the research world, and in the science world, and they had started to bridge those gaps as physical therapists, that we needed to start to bridge and they were sort of at the forefront of that. Like Becky Craig, like Carolee Weinstein, like Ann VanSant, and then there were a number of beginning researchers like Diane Damiano and?Eddie Filforte?and Laura Boyd, who had just started to enter this research world, and they were starting to really make some links with practice. So, you know when we were planning the agenda and the experience for IIISTEP, I was just, you know that's when my mind kind of started blowing up before the conference because I was just so amazed to hear what was happening with Jeff Klime's work, with Randy Nudo's work, with all these people that were doing such relevant work with animals and sometimes with people that was relevant to PT practice, and we were, I think largely as a profession, at least in neuro PT, unaware of that work.?And so as we play in the programming committee, the program as it evolved, you know I was so excited by the time we got there to understand that we were going to really start to understand and learn more about, you know, plasticity and different interventions that actually had now been started to be studied for their efficacy, and the shift towards, again, a more complete shift than had started at IISTEP, but towards you know really thinking about things more on an enablement model with the patient as opposed to a disablement model. Now what are the impairments? What's the patient's problem? What are the resources? What's left? And how can we use that?(I):?It's a big model shift.(KGB): Huge, huge shift. And so you know, we had very, I had so many aha moments at that meeting where I would, things would kind of just click in my brain, and I would say, "oh! so that now makes sense" and I can think of a couple of ideas where they were discussed or presented to try and do things a little differently, whether it was with practice or with strength training, with patient groups that we thought really didn't need strength training but hmm, yeah they do. And so, I felt like I was able to come home from IIISTEP with some really, you know, different ideas and concepts that were emerging that I could use in practice.?But my most, most memorable moment was I was sitting in one of the case discussions for IIISTEP, and we had arranged those similar to how they are happening here at IVSTEP, but a little differently.?We had arranged them to be paired presentations between a clinician and a researcher, and we had invited people to submit cases that would meet with some of the themes for IIISTEP that would basically demonstrate, you know, application of this new information.?So, something we would probably today call translation but we didn't have that word then. And so, I was sitting in one of the cases on spinal cord injury, which was not something that I really did then or do very much in my practice now.?And we were hearing some of the early work about activity therapy and how plasticity seemed to be related after spinal cord injury to the behavioral experiences that patients had within therapy. So that whole concept of that, and there were people after the eloquent presentation that was done by this pair.? There was small time to do questions and answers and somebody got up to, somebody had been sitting, a gentleman had been sitting two seats over from me, and he stood up and walked to the bike with crutches, bilateral forearm crutches, and he asked a really relevant question about some elements of the locomotor training program that was being discussed, that was sort of this emerging therapy at the time. And he, so his question was answered, and then there were discussion, were you here? You weren't there. The presenter asked him back a question, and he went on then to identify himself and he was an orthopedic surgeon who had had a spinal injury, and he was not a physical therapist so here he was at IIISTEP and he was a patient effectively.? He had a spinal injury four or five years ago and he had partial recovery. I think he had an accident jumping on a trampoline, and which is something he did as like this leisure sport with his buddies and his wife had always been yelling at him for it but he did it anyway.? So, he had an incomplete cervical spinal cord injury and he had regained some ability to walk but he had to stop his practice and he was from the Utah area. And he had to, he walked minimally and he had wanted to walk more so he did a bunch of research on the internet and he connected with, I believe it was Andrea Berman, it was one of our sort of people that had presented or was working in this area; his PT did. It was a community based therapist and it could be anywhere type setting, and she offered some advice and they collaborated over the phone, and basically the therapist and this patient and some family members went to home depot and they made him in his house on top of a treadmill, a body weight support system with cables.(I):?Wow.(KGB): That would help him stay up so that he could do and implement this intervention at home, and they worked over several months and he was able to achieve over ground ambulation at first with a rolling walker outside in the community and then with bilateral canes.?(I):?Wow.(KGB): But his walking was very slow, and then he was, he got very involved in the spinal cord injury community and all of this, and he was then tapped, he was invited three or four months, no six months before the Olympics to be the individual to deliver the torch and light it at the last part of the journey for the Olympic torch. And he had to be able to walk at a certain pace to do it, and his walking speed was too slow so went back on the treadmill and they did another couple of minutes.(I):?Upped the speed??(KGB): They upped the speed, they increased the intensity, and he was able to achieve his goal. So that was such a chilling experience, and we ended up, so there I was sitting in the room as one of the organizers of the meeting, and there's a patient in the room and like there shouldn't be a patient in the room, right??(I):?Right.(KGB): And then he tells a story and there was no way that he was, you know, ever going to be invited to leave, like everybody just really, really appreciated his story. And he came to several other sessions, and we identified and thanked him for his participation at the closing ceremonies when we were at the Olympic stadium. I don't know if you remember that??(I):?I do remember that, but I didn't know the story.?(KGB): Yeah, the back story, and later he shared some slides and stuff with us so that. (I):?That's really cool.?(KGB): Yeah, it's very cool, in fact yeah, we should probably give you those slides.(I):?Yeah.(KGB): Because I have a slide of him on his home apparatus on my computer at home, and then I have a slide of him at the Olympics.?(I):?Wow, what an amazing example that was unplanned.(KGB): Totally unplanned, and his contribution gave us, you know, gave the people in that conference, in the room, and then later in the entire conferences, we just really wanted to share the story, like such a personal perspective on trying to reduce the barriers that exist when novel therapies evolve and they make sense, and then there's some beginning science, and then there's all these how and what ifs and how could we and it doesn't get reimbursed, and this therapist and this patient figured it out.?(I):?Right.(KGB): And it was just such a great example, yeah. And she brought him to the meeting, like didn't ask anybody. It was a great example of not deciding to ask permission, but perhaps apologize if it doesn't work out, and she made a good call because he was, he really added value to that meeting and we wouldn't ever have thought to do that. Right, so anyway.?---TIMESTAMP 00:14:39---(I):?So that brings us to our next question which is, we all know that neurology section or academy members can be a little wild and crazy at times. What sort of either behind the scenes or in front of the scenes crazy things happened either at IISTEP or IIISTEP that you remember?(KGB): At IISTEP, you know this wasn't crazy or wild, but I think something that, we had one afternoon off it was so hot we all went to the pool. And what I remember is that I met some like famous people at the pool.(I):?(laughs) Right?(KGB): And that was really cool, you know they were in their bathing suits and flap and Carole Juliani, right, talking to her about spasticity in the pool.(I):?While you're hanging out in the pool.(KGB): Oh my god, and like she can have this conversation with me and I'm just like, you know, amazed. And so, we had a lot of great conversations and fun and we had a big party.? I was off campus for that meeting; I don't get on campus housing, I don't know why.? And we had a party at our place and like, you know, all these famous people came, and it was just, it was great, it was really great to just be people with people. Um, I also remember meeting Kenda Fuller in the pool, and she had just taken the NCS exam a year ahead of me, and I decided I was going to do it, and I'll never forget what she said, what she told me, what she shared with me was that she had taken it the first time and not passed. But she had decided um no we took; did we take it together? Oh no no anyhow, I think I took it the third year, so she must have taken it the first and the second year so she was going to take it again, and that's because she came out of it and said she could pass it.? She would just have to think about the questions and you know.(I):?Yes.(KGB): And so I thought, "well that's great, I'm going to definitely do it" so that was a very influential kind of conversation because I thought, well if this person who we had talked about balance, and she was doing some of the same work in Colorado that I was doing in Boston, she can do it so that's great, and so we started some really nice relationships at these meetings. People that you met and we stayed in touch with, so Kenda went and she took it and she passed, and I went the following year and took it and I came out of the meeting and I thought out of the exam I thought, "I have no idea if I passed that exam." And I did but by one point.(I):?(laughs) Isn't that fabulous?(KGB): Unbelievable.(I): But that's all that matters, right?(KGB): And I tell everyone the story that's taken the exam because if she influenced me and her resilience and her persistence, and her like "eh I can do this" and I want to do it. Her motivation like really made me take the step and then I want people to know that because, you know, it could have gone either way and I would have gone back again. So, I sort of remember, you know, those kinds of more personal moments. And then from IIISTEP, honestly it was a blur. Um, so.(I):?You have to talk about, you have to talk about it.(KGB): To put me on the bull was just a nut.(I):?So, what happened with the bull?(KGB): Well honestly, I wasn't at that. We had a planning meeting that night so I didn't get to go to the events so I only heard about it. Were you there?(I):?I actually, I was there.(KGB): So, I can't tell the story, but what I can tell is that Sue decided, what I understand happened is that Sue decided to instead of riding the bull for fun, wager bets and generate revenue for the section.?(I):?Right so it ended up being a fundraiser essentially.(KGB): Exactly how long she could stay on it and don't you know the damn Sue Whitney? stayed on that bull and since then, well within days of the conference ending that Sue Whitney on a bull videoing pictures streamed across the country and most of us still have those and she carried that even to CSM the following year. Yeah so yeah, we had to get our, I guess our energies out.(I):?The things that people will do, the crazy things people will do to raise money for the section or academy.(KGB): It was a great example, I was sorry that I had missed that.(I):?Um.(KGB): Now let's remember our yellow jackets. We all wore yellow jackets to be identified as IIISTEP members, I'll just say this quickly. So, there's this whole series of pictures that people want to take to have a historical record of these meetings and the people and all that and we took pictures Monday, and it was a day like this morning here, it was a little rainy. And we took them at the front of the auditorium inside because it was so rainy. And the only thing that showed up in the picture were the jackets.(I):?(laughs) You couldn't see the people at all(KGB): Right just a bunch of neon chests.(I):?Right, right (laughs).(KGB): So, they made us come back the next day and they turned the lights on and we got the pictures done.?(I):?So um, so I have to tell you that I am a great admirer of yours and for a variety of reasons, but one of the reasons that I admirer you and the work that you have done in your career is that you have been able to and have intentionally bridged that clinician researcher gap and also been an amazing teaching resource, and I think that's something that is difficult for many people to do, and so I wondered if you had any advice on how you about doing that and how did you do it? I mean because that's a big task.(KGB): Yeah, so I've just been so blessed to be in an environment professionally where all those opportunities were available to me. So you know I got out of PT school and I went to work at the MGH where I had done a clinical affiliation and so that's just a very vibrant, you know, high cognitive load type of practice, and across professions, you know, it's fast paced and so that, you know, that's an environment that's very stimulating and there are people around you that are always learning, so I was stimulated to continue to learn and so, you know, five years after I graduated, MGH opened a post-professional program for physical therapists at the MGH institute which had previously just been our nursing program. So, that was an advanced master’s degree back in the time when we were still?baccalaureate trained. So, I had the opportunity to do some advanced clinical training, and the educational model was one that was clinically focused, that involved an advanced clinical preceptorship component, as well as the research component, so I was able to go out to Ranchos Los Amigos and work there for a couple of months, as well as I had to do a thesis and that required pretty much a vigorous research proposal and actually doing data collection, the whole nine yards, and the expectations were really crazy. But I did it part time and so by the time they finished that program I felt like I had a really good experience in clinical research, and then there were people attracted to the faculty at the MGH institute that were interested in doing clinical research, and so I was able to get involved in opportunities to do that and I took those opportunities, and so I feel like I've um, and then later in my career I decided I wanted to do some teaching, and Margaret Shenkman who was on the faculty at the IHP then said I need a clinical person to teach this course with me. And again, that was the model. Um, it's still the model of the IHP today and so I was able to get involved in teaching. So, I did these various things and basically was able to collaborate with people in that setting in Boston, and you know at one point in time, I did less clinical work and I worked on some grant writing with Dave Krebs, and we got funded to do some trials, and then my time would be maybe four days I would study and one day in the clinic, and so I just had lots of opportunities to be flexible and to shift around. So, I never had to do what people have to do often which is to try to do scholarship, teaching, and practice at the same time. So, and then later I decided I wanted to step back and have more time at home for my family, and I was in my best job ever at that point, I was on the faculty full time with the institute but I had a day a week in the clinic, and I had some relief time from the institute to coordinate the studies that other therapists were then doing back in the PT department at MGH, but it didn't work. The balance didn't work at home because prior to that, I was able to, I always felt like my kids and my job, which I loved, were number one and equal. And every day I'm not going to get everything I need on each side of the, you know, bucket, but generally I did and I felt like I, you know, things weren't, you know, not always smoothly, but they were good and they were equally important and the same priority and what I found is the kids got older and my kids are great, but as a parent, that my husband and I both being on the fast track there was no room for error.(I):?Right.(KGB): And so I had to reorganize and I tried a bunch of things for like a couple of years to try to change how much time I spent at work, or to, um, drop this responsibility and go a little bit less time, and it didn't work. So, after two years I made the really hard decision to leave my job at the institute, and to take no job. And I did that for five years so that I could be at home because the kids were just growing up, and, you know, we make the joke that most people don't, if they have children, they don't go back to work when they're infants, but that was really to me the very predictable time where it was easy to work and balance everything, and it was when they got to be in school, in second and third grade, that they started changing so much in their, as their world opened up, and the issues in their predictability, and helping them, and being parenting them was not something that was easy or comfortable to delegate to a nanny.? It just didn't work. So, then I had this time where I took all my courses that I was teaching in the programs, in the MGH institute, and by that point added an entry level program, so I was teaching two programs, and I took the back to the advance program which we still had at that time, and I transitioned my courses to online. And so, I was able to do online teaching for a while from home, and just get involved more in APTA, and sections things, and community things which was what I wanted to do. So, I feel like, and then more recently I felt like I needed to get back to the patient. I missed being with patients. I felt like I was able to maintain contact with colleagues, I can come on a couple editorial boards, so I feel like I'm well able to connect with research things, and am involved in some things in the section that keep me involved professionally on different levels, but I miss patients, so that's when I went back about eight years ago to treating patients, and so that's been great. It's a very flexible place, and I've done a couple of studies there because that's what they're interested in, and I still, and I actually have gone back to teaching at one day a week in the course that I develop, and now I'm a "TA" in that class.(I):?(laughs)(KGB): Which is great because I get to see what's happened with this course, these courses that I developed ten years ago. What's changed, what's, you know, been updated. So, I think the advice would be to really look around and take advantages of opportunities that are in people's settings, and look for mentors. I mean I had a tremendous number of mentors. Now I feel like I have a tremendous number of people that follow me, you know.(I):?Yes.(KGB): That I mentor, and that's great too because I, you still learn from them. So, I don't, I guess I don't have any specific information except to be, to look for opportunities to get involved because they, those opportunities have been, they've led to other opportunities.(I):?Right.(KGB): New experiences, and so. It's been fun.(I):?What's been the most rewarding thing that you've done so far?(KGB): As a PT?(I):?As a PT, well, yeah.(KGB): So, I can't pull the parent thing?(I):?(laughs)(KGB): Um, the most rewarding thing. Hmm, that's a really hard one. Probably teach. If I had to really, I don't know though because I love the research I've done. I am really, that's a really hard question for me because I'm a Gemini.(I):?(laughs)(KGB): And so, I see things from more than one perspective, do you know what I mean?(I):?Right, right.(KGB): So, and I'm like that. Um, I don't know. I guess the best way for me to answer it is I don't think there's one. I think that at different stages in my life, I had different favorites. So, for example when I was at the IHP teaching, I absolutely loved, that was ideal for me because I worked with the, you know, that was ideal. When I had the opportunity to do this clinical, this beginning clinical research with Dave Krebs and others on the vestibular system, it was amazing experience, I loved it, I would have done it for years in full time. You know if things had worked out differently. Right now, I love my patients. Right now, I wouldn't, I wouldn't want to work less with patients. I just absolutely love being it have come full circle. And then being able to mentor and sort of teach in the clinical thing, and do these smaller research studies in the clinical settings so I'm kind of still doing a variety of things, you know?(I):?Right, right.(KGB): And, I wouldn't change where I am now for anything, and it's probably because I get to do a couple of different things(I):?Right.(KGB):: Um, but there are times when I wouldn't have wanted to do this.(I):?You would have wanted to do what you were doing then.(KGB): Exactly, so I think I've just had different changes, I can't identify one.(I):?That's a sign of a really amazing career, right? When you.(KGB): Yeah, maybe.(I):?So tell me what you do for fun.(KGB): What do I do for fun? I, um, visit my kids who are both away at school now. You know we're an empty nester, yes.(I):?Yeah.(KGB): Um, I travel. My husband and I love to travel.(I):?Where do you like to travel to?(KGB): Uh, Europe, Italy, he's a New Zealander. We've been back there a bunch of times. We're going to Belgium in a couple of months.? So, lots of places, lots of places.Interviewer: Anywhere, everywhere?(KGB): Yeah. Um, and then around home, I love to read, I've gone to a couple of book clubs, and I work out a lot. Though not this week.(I):?(laughs) So this hasn't been the week for it?(KGB): Yeah, um, yeah.(I):?So, you're walking the talk? As we were talking about in the course of this week.(KGB): Yeah, yeah.(I):?That's good.(KGB): Yeah.(I):?Thank you.(KGB): You're welcome, you're welcome. ................
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