Martin Lawler has experienced several transformations in the 30 years he has helped people recover from illness, injury and surgery.
After receiving a bachelor’s degree in physical education at Capital College in Ohio and a master’s degree in exercise science from the University at Buffalo, he spent the late 1980s and early ’90s helping patients in cardiac rehab programs, which were much more common back then than they are today.
Then he went back to UB for a physical therapy degree, and spent most of the past two decades in traditional PT roles: helping patients try to regain their range of motion after physical setbacks.
Only recently has it occurred to members of his profession that the work they do also can help cancer patients.
That’s the idea behind the new Survivor Steps program, which Kaleida Health launched this summer to assist patients through surgery, recovery and remission with the help of physical, occupational and speech therapy.
“Orthopedic doctors, neurological doctors always use therapy because they see that patients have debilitation,” Lawler said. “Cancer has debilitating side-effects from the chemo and radiation, but nobody has ever really ordered therapy and rehab. We see this as a greater opportunity for these people to live better, at a higher level, and maybe not become as debilitated throughout their cancer treatment.
“We can have such an impact on a person’s quality of life.”
Lawler, a Cheektowaga native who lives in Williamsville, manages rehabilitation therapists for Kaleida at Millard Fillmore Suburban Hospital and Buffalo Therapy Services in Amherst, as well at DeGraff Memorial Hospital in North Tonawanda. The goal at each of the three sites is to help patients recover and, hopefully, keep them living at home.
What conditions are your patients looking to overcome?
With the outpatients, it’s probably 60 to 70 percent here at Buffalo Therapy Services for orthopedic diagnoses versus neurologic diagnoses. Occupational is pretty much the same split. Speech is almost all neurological. At the hospital, it’s a big mix. People can come with anything from stroke, total knee replacement, total hip replacement or a medical debility that would require us to evaluate their ability to go home.
How is that decision made?
It’s all about safety and the ability for a patient to mobilize in their environment. It’s going to be individualized. If someone lives in a ranch-style house, they don’t have to do stairs. If they have family members who can physically help them out, that would be one of the factors. Do they live alone? If they live in a two-story home, where is their bathroom, on the first floor or the second floor? If they have to climb stairs every time they use the bathroom, we will assess their stair climbing ability. If they have issues, they’ll have to go to rehab. We’re lucky we have rehab facilities where people can go and recover, and ultimately get home.
At the hospital, we have a discharge planning department. Discharge planning — which is made up of nurses and social workers — generally starts upon the person’s arrival in the hospital. We get an idea what their home situation is. The discharge planning team will ask questions, we’ll ask questions. It’s rather redundant. Sometimes a patient gets frustrated. But sometimes they’ll find we ask the questions differently to get a better idea of how the home is structured. We’ll get really specific: ‘How many stairs do you have to climb to get into the house?’ ‘Do you have a railing?’ ‘Is it on the right or the left?’ ‘How do you get out of bed, on the right or the left side?’ ‘Your bathroom, how is it structured?’ ‘How is the stairway structured — does it go up to a landing and then you have another set of stairs?’ We’re specific in what we ask because now we can practice those things with the individual as best as we can to mimic the home situation.
Now that the staff has been trained in the Survivor Step program, how is the cancer rehab program working and how can a patient plug into it?
We’ve decided to focus initially primarily with breast cancer patients and to expand to other types of cancers. Donna Gefaller, an RN, is our coordinator; you can contact her at 568-3511. She and two therapists will try to educate the patients who are coming in for breast surgery about what’s going to happen in the hospital, and present our program and how it might benefit them if they have problems afterward.
Donna will do some follow-up calls down the road. Ultimately, we need a physician’s referral to come to rehab. They can be seen by physical, occupational or speech therapy. We have a nutritionist on staff. We have a massage therapist who’s going through the training now.
If there’s somebody out there who had surgery two years ago and is still suffering the effects of chemotherapy or radiation, and they feel they need therapy, they can come to the program. … We expect in the future for most people to come see us during or after their chemo and radiation treatment. That’s when most of their debility from their cancer treatment will occur. Radiation is tough because it causes a lot of fibrosis and it’s not really functional material, so you’ll get stiffness and decrease range of motion that’s going to be difficult to maintain. The goal is to minimize that.
