Tuesday, March 29, 2011


Evelyn by Susan Jansen

As people struggle with the challenge of physical disabilities, what part does feeling good about their appearance factor into their ability to work towards regained function?

We like to envision ourselves striding into a conference or social gathering with it “all together”: the clothes, the hair, the pose and the savoir-faire. Whether in informal business attire or street chic we love the power of looking good.

One day at a residential and out-patient specialty center I was introduced to an attractive and very well dressed mother and daughter seeking therapy services. The daughter who was 21 years of age had sustained a head injury during a motor vehicle accident the year before. As the mother spoke her daughter nodded with “yes, yes”. She had been attending a local private university and it seemed was on track for a very good life. Now the mother just wanted her daughter to appear pretty.

Seeing the young woman walk I understood the concern. She walked with a cane, a flexed arm and a stiff leg. From their point of view, like an ‘old person’. Not vibrant, attractive, sexy, not like a prospective wife and mother. Although treatment strategies have evolved since then, the desired results would still be unattainable.

Today I confine my clinical practice to those who are 85 years or older - the elderly. If you haven’t reached that age yet, you might think folks should be pleased if they could walk at all. You would be wrong. There are several reasons older persons start to withdraw and become isolated – how they appear is part of that progression.

Currently I work with a delightful 88 year-old who has had several joint replacements, continuing degenerative joint disease and a few other assorted conditions. She is well educated, continues to be involved intellectually, a wonderful take charge and let’s do it sort of person. But she doesn’t like to mix and mingle much. She has been relegated to using a 4-wheel walker, useful but not elegant. She’d like to use a cane “more practical” she says out loud, but “more acceptable” to herself. To meet this concern, periodically, I have her perform walking trials with a cane – not only borderline unsafe, but inefficient, taxing and ungainly.

This past week when I greeted her with the requisite “how are you doing”, she responded “Fine, but. . .” and described how someone - a gentleman - she regards highly mentioned that her last knee replacement had not worked because she was “walking so badly”! Even with prompting about the accolades from neighbors - all women - who believe she is doing well, to her she is not doing well enough.

Although not a typical candidate I gave her instruction in using two canes (which luckily she had) and within the first 3 feet of using them she positively radiated. She wanted to walk down the hall, walk all the way down and back. Frankly, she looked aristocratic. She then enthusiastically performed the strength exercises she is supposed to be doing on her own; and willingly made an appointment to re-see her orthopedic surgeon about a lingering knee problem.

This is not a miracle or a feel good story. Physical therapists are frequently involved with gait training interventions. Sometimes the person has no residual impairment or altered pattern. But many develop a new pattern of walking and some find that acceptable and may even be grateful. Others will want to look good, as well. I was not able to help the college student twenty-five years ago. Today I have given my elder patient some hope, something to look forward to.

What I can’t control or even anticipate is the audience that each of these young and elderly woman have in their lives. There is a complicated interaction we have as we move through our day with those around us. Until we are good at something we may prefer to be by ourselves, but once proficient we want to show off. Trying to look good for others when one has a physical disability may be part performance, part learning. The late Robert Zajonc (1) put forward a literature review on social facilitation theory in the mid-sixties. It might be time to dust off this topic again. We have increasing numbers of people living with physical disabilities for longer periods of time. To face this challenge we need durable understanding about the person and their audience.

(1) Zajonc, RB, Social Facilitation, Science, New Series, Vol. 149, No. 3681. (Jul. 16, 1965) pp. 269-274.

Art courtesy of Susan Jansen. Ms. Jansen may be contacted at susanjansen@gmail.com.

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