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Dr Brian Weis: All right. Well, hey, welcome back to the Get Wise with Weis Podcast. I have a very special guest here today. I have Mr. Ryan Cotgreave, who is our Director of Physical Medicine, Acute Inpatient Rehab and both Pulmonary and Cardiac Rehab. So, Ryan, you obviously got a lot of things going. I mean, it's taken me half the podcast just to say your title. But particularly over the last couple years, you have really led some great expansion of our physical medicine resources. Just to start off with, would you kind just maybe give us an overview of just some of the things that have happened over the last couple years in your department?

Ryan Cotgreave: Yeah. So, just like you said, we focus on both inpatient and outpatient. And some of the fun things that we're doing on the inpatient side is increasing the bed size of our inpatient rehab. And we're actually completing a full remodel, that should be done within the next month, of that space. And then, we have our outpatient services. And that's probably where we've grown the most. We've really started to try to really focus on taking our service lines out to the community. So for the longest time, Northwest had a lot of their services that were located here within the hospital. It's not the easiest to get to us. And so we started to really relook at how we wanted to make it easier for patients to get to us. So that's where you'll see our new therapy center over on Georgia Street. You see our sports and ortho clinic that is located at verger in the town square area. And then, we also have a Wyatt Clinic set up, that's just physical therapy for the population. It's just easier for them to get to, and we've really seen a great response from them.

And then lastly, what we'll be talking about today is our pediatric therapy. And we started to really dive into how can we make it convenient for pediatric patients to get to us. And we really said, let's keep them at the hospital. Couple of different reasons. First of all, we have nice parking for them, dedicated spaces. But then, also our pool's here. We have a great expansive aquatic program that we've really been able to utilize, and we've seen a lot of benefits with our kiddos.

Dr Brian Weis: Well, let me tell you, one thing for me being a primary care physician, I have really come to appreciate the vast benefits people can get from physical therapy and a lot of obviously from what your folks offer. So I mean, I send a lot of patients for gait and balance retraining. So for older people who may be having trouble with falls or imbalance, you guys do a fantastic job, everything to sports medicine to chronic pain. People don't realize that chronic back pain, things like that, that really physical medicine and physical therapy is really the first approach before even think about surgery or some of the more aggressive interventions. So, your folks have helped a lot of my patients. But let's focus on the kids, because again, I walk in the hospital. I see a lot of these kids and their parents out in the waiting room there. Tell me about what kind of children come for physical therapy? What services do you offer for kids?

Ryan Cotgreave: Yeah, so we offer physical, occupational and speech therapy. But when we actually look at the diagnosis of the kids we see, it's anything from a developmental delay, specifically when we look at diagnoses, we're looking at anything from autism to spina bifida, you name any kind of different diagnoses like that and we see those here at the hospital. We have some people that maybe they're just having some delay in speech. And I think that's one thing that, as a parent myself, we're kind of always comparing ourself and our kids to our friends' kids. And sometimes, you know, we think, "Oh, is this patient delayed?" And I was talking to one of my speech therapists just this morning about just this specific topic. And she was just saying, "My thing is I always encourage parents if they feel like that their kid is delayed, bring them to the professionals and let us look, because we may be able to look at the kid and say, 'No, they're good. They're right on par. They're meeting their milestones, no problem.'" But at the same time, we may actually may be picking up on some things that the parents haven't picked up on.

Dr Brian Weis: Yeah. When I was a kid, I actually went for speech therapy for a number of years. And boy, it made a big difference. Now, there are still things I have trouble saying, like "I think I might have made a mistake" or "I could be wrong on this," those are still tough to get out. But for the most part, what a difference that made for me as a kid is, you know, the pronunciation. Even my daughter came here, same thing. She was evaluated for some potential issues and overall felt, nope, you know, she was right on par and they just needed a little help here and there.

Ryan Cotgreave: So I think that's what's so important and I've noticed that based upon even how speech-heavy we are in the pediatric outpatient side. We have five outpatient pediatric speech therapists. We have two pediatric PTs, a pediatric PTA, and then we have a pediatric quota in the pediatric OT. So again, you can see that we also recognize that the speech area is where we're noticing probably the most need for our kiddos.

Dr Brian Weis: Yeah. And what I hear you're saying is it sounds like you've got some people specially trained in young people, pediatrics. What does it take to be a pediatric occupational therapist or physical therapist or speech therapist?

Ryan Cotgreave: Patience. Lots of patience.

Dr Brian Weis: Yes.

Ryan Cotgreave: You know, that's where I office, is actually in the outpatient pediatric clinic. And so I'll be the first to admit, I am an adult-minded physical therapist. That is where I'm at. That's where I specialize. I know my lane and I stay in it. And, as we started to remodel this area, it just happened that that's where my office landed. And I can tell you right now, I absolutely love being where I'm at. Does it get loud sometimes? For sure. But you know what? That's also amazing when I walk in to my office. And I've got these kids yelling at me saying, "Hey Ryan. Hey, Mr. Ryan," and it makes me just know and remind me on why we do what we do, and also being firsthand to be able to watch these kids, make the progress that they do. We had a little girl that she could only sign, that was all. And as she has continued to work with her speech therapist, she now is knowing my name and is communicating more and more to us. And it's just so great to be kind of that fly on the wall, watching these kids progress.

But to dive a little bit more into what makes a therapist and what kind of credentialing that they have to have that's different from other areas, our kids, they deserve that. They need these therapists that are specialized in different areas. And so one of the things that a couple of our speech therapists did is they went and their ADOS certified. And so they're able to actually administer the test that can help physicians diagnose, a pediatric patient with autism and really interesting. We're the only area in Amarillo that will actually perform the ADOS testing on adults as well. There are a lot of adults that are walking around within our community that have autism, but they've never been diagnosed with it. They've always probably thought that they just were a little bit different than their friends or a little bit different than their coworkers, and that's probably what it is. And so we can administer the ADOS testing that would then help at least give them some answers maybe to some of the struggles that they've found themselves struggling through.

Dr Brian Weis: Yeah, I've had the same experience you had. You know, when I walk in the hospital a lot of times, I see these children run to their therapist. And just over a matter of weeks, you can see the difference, whether it be a physical concern they have or something, but when you see the joy of the kids and you see the joy of the therapist too. I mean, they can tell that they love their work. They are committed and truly dedicated to what they do.

Ryan Cotgreave: Yeah. I always think about that because I'm the type of guy that at eight o'clock, get starting my work, with like my cup of coffee. And I'd look at these therapists and at eight o'clock, they are handed these kids that first of all are extremely excited to see them, but may not be having the best of a day. And they may be upset, they may be crying and to sit back and just watch our therapists handle these kids on a Monday morning at 8:00 AM, it also makes me think, "What a blessing the parents are to these kids," because we always talk about that is that for one hour a day, a week or whatever the kid comes in, we know we're able to instill whatever wisdom we have in these kids, and these parents that we do parent education with different strategies and things. But ultimately, these parents are with the kids for 24 hours a day. And that's the thing that we just have a heart for not only the patients, but also for the parents as well, because a lot of parents are struggling and they don't know what the right answers are. And that's where our therapist then can lean in and can provide that wisdom and that knowledge to be able to help these parents find maybe some answers that they don't know, or at least point them into maybe some support groups or those kind of things that will just, again, maybe make some sense for these parents.

Dr Brian Weis: Absolutely. I think it's so critical for people to realize they are not alone, that there's other people, struggling through some of the same challenges as with their kids. Now, obviously you mentioned parents but, you know, children are in school, they're working with a number of adults. I imagine that you'd probably get some referrals either through the school system, obviously through physicians or stuff. I mean, how are children referred to your facility?

Ryan Cotgreave: Mainly, what we see is through family medicine, is the main referral source that we have. And it's just a networking of our relationship too with Texas Tech. We have some referrals that come through there. So it's as easy as if you feel like that your child would benefit from at least just even a consultation, that if you mention that to your family physician, then they can make that referral over to us. And it may be an assessment and we say, "No, they're right on track. But it also might be something that could really mean the difference between them staying on track in school or not.

Dr Brian Weis: So you don't need necessarily a specific diagnosis, so you just need basically a concern and your team can do the assessment and kind of evaluate it from there is what I'm understanding.

Ryan Cotgreave: That's correct. Yes. And so it really goes down to, if you have a concern that your child is developmentally delayed in any way. Some of the things that we've even noticed though, talking about this is that even like on a speech aspect is we'll have older kids that we feel like they're not progressing as quickly as maybe their friends are, maybe the way that they form their words is different. And we start realizing that a lot of times it has to do with the kids at home. Like they have younger brothers or sisters, and so mom and dad are doing, you know, "baby talk." and so then, the older kid is thinking that's the correct way. And then now, it becomes a habit. And so it may not necessarily be anything within the brain itself that is causing this delay. It could be something that just the environment that the kid's in.

Dr Brian Weis: Fascinating. I never thought about that. Interesting. So, obviously, Ryan, one thing you have expressed a great deal of excitement about is the program to deal with individuals with autism.

Ryan Cotgreave: Yes.

Dr Brian Weis: I know you are just delighted that we could get this up and running. And obviously, we have recognized that autism is a spectrum now. Everything from, as you mentioned, people who might be very mildly affected by it or Asperger's syndrome all the way to the person who is non-communicative and unable to speak. Tell us a little bit about what kind of service do you have to offer folks that either believe they may be affected by autism or do and are seeking help for that?

Ryan Cotgreave: Yeah. So first thing is kind of I had touched on earlier, obtaining the diagnosis is the first thing. There is a large part of our community, that has never received the diagnosis. And so that's where the ADOS testing comes in and that's why that aspect is necessary and really the growth and the idea of starting an autism program here was birthed out of the fact that we started to hear of families having to travel to the Dallas Fort Worth area, just to get the testing to then have this diagnosis. So then they can start actually receiving some of the benefits that come along with that, the financial benefits, the financial aid that comes along with that. So we said what can we do to get this started here? There's one other pediatric therapy clinic here in town that offers that, but they were just so overwhelmed that we said what can we do to help our community out? And so, that's why we started it, really was just a community service to try to get these kids diagnosed. And in a way where they're not having to spend hundreds of dollars traveling out of this area. So once that diagnosis is received, then they start coming back for therapy.

As they come back for therapy, one of the things that we really focus on is play-based therapy. It's different than probably some other strategies that you see in other clinics in Amarillo. It is very important to us to have a very accommodating, relaxing and fun environment. And if any of you all have ever come by our clinic, you'll see that the kids are laughing, the therapists are laughing, there's quite a bit of running. And because of that, kids learn when you bring therapy down to their level. And that's where the play comes in. I've even as an adult-minded therapist stepped back and thought, "They're just playing." And then, as I'm watching more and more, I start seeing our supervising, pediatric therapist, her name's Kim Miller. I start watching her and I start to realize that as they're playing, she's saying specific words and she's repeating them and she's then having them repeat them. And I'm like, "Okay. Now, I'm catching on to what she's doing here." So it's fun to watch that interaction and every single one of our therapists approaches therapy in that way. And there's been research actually done here in Amarillo that has been published worldwide that, placing individual with autism within the pool that may be non-verbal will actually increase their chances of communicating. And we're talking about a couple of times in the pool, and then now the patient starts to say words, even maybe just making sounds, but that's a step in the right direction.

Dr Brian Weis: Wow. That's fascinating. You know, it is interesting in the world of neuroscience now, we all know you see young animals playing, you know, kittens, puppies, you know, have that play. And we, as humans, are no different in the development of our brain and our bodies. That play serves a very valuable role in terms of learning function, learning social interaction. And so much of today, kids are put into classrooms and instead of necessarily going out and playing outside after playing baseball and all, they're on computers or in front of screens. And there's just a lot of concern about the fact that we are denying these children that play time, which is critical for development, brain development, body development. And I'm just curious to hear how therapeutic this play can be for these kids.

Certainly, one thing I've noticed, looking at some of the patients that have come to your facility is a lot of them are severely challenged with mobility and things like that. And obviously, in terms of mobility aids, communication aids, is your staff helping that? I mean, can they help design a program for children to best enhance their function?

Ryan Cotgreave: We do. That would fall more under the physical therapy side. A kiddo that comes to us, maybe they're already in a wheelchair, we're going to assess to say, is this the right chair for this kiddo? And then, what we'll do then is we'll make recommendations. And we work real close with a company here in town called New Motion. They're extremely responsive and very interactive with us. They actually come on site with us as we're doing the wheelchair evaluation. They are certified and extremely knowledgeable in all of the different components that are out there when it comes to maybe different features to a chair that need to be added. And that allows us then to make sure that the patient is getting what they need. Unfortunately, too many times, a patient is sat in a chair, fitted for a chair and insurance pays for it. And they're only going to do that ever so often. And so you've got to make sure that when you're fitting a patient for a chair, that you're getting everything added to that, that patient may ever need. So that way, it's not seven years before you're, you know, getting another chair and having to add other features. So, yes, without a doubt, if we need anything, even as standard as forearm crutches or walkers or anything like that, we will make sure that we're fitting them to the patients and making sure it's the correct setup for them.

Dr Brian Weis: Yeah. Fantastic. I certainly seen parents interact with their children through tablets and, obviously, aids to help with the communication for children who may not be able to verbalize.

Ryan Cotgreave: Yes. So that's just something that's really special about one of our speech therapists. That's almost all that she does, is different eye gaze machines, tablets and being able just to watch these kids communicate to their therapists, because then we know they're also going to be communicating to their friends. She's getting these tablets set up for them so that they can use their eyes to be able to choose the words or choose the icon that will communicate what their needs are. The frustrations that a lot of these kids have on not being able to communicate what their needs are. I can only imagine what that would feel like. And then, now we're putting something, connecting it to their chair, if they have a chair, where they are now able to say they're hungry or they're thirsty. What an absolute life-changer, not only for the patient, but for the parent or the caregiver as well.

Dr Brian Weis: I can't imagine. Absolutely. And I think that as the technology progresses, you know, these tools that can be used for these patients are just incredible. So well, Ryan, we've covered a lot of ground today. So if I'm a parent and I am concerned, maybe I have a child I think maybe having a struggle or a challenge, how can I get them in to see your folks?

Ryan Cotgreave: Yeah. So easiest way is talking to your doctor, that's the easiest way. And if you're struggling on what to say, or what you need to tell the doctor in order for them to refer you correctly, you can easily call us at (806) 354-1774. That's going to get you connected to our outpatient pediatric department. You can also go to our website, which is nwths.com. You'll see an icon that says rehabilitation. And then once you click on that, you'll see an icon that says pediatric therapy. You'll be able there to see all the services that we provide. The diagnoses that we cover and really on the diagnoses, we should just label a lot, we should just write "et cetera" at the bottom because we will absolutely treat anything that comes, because that's how our therapists are.

Dr Brian Weis: Yeah, fantastic. Well, you know, I think clearly what you're showing is that particularly children, a small investment in time and effort now can have huge returns for the rest of their Life. the team you have is fantastic. I enjoy watching them and I truly appreciate you being here today. Anything I might have missed that you wanted to bring up about the services you offer or the incredible folks you get to work with?

Ryan Cotgreave: I've been so excited to have a team, like I said, that we have, but at the same time we also have the facility now, within the last year and a half. We've completely remodeled the facility. For those that were somewhat familiar with our clinic that was based at the hospital, used to about a quarter of it was pediatrics and then the rest was adults. And we let the pediatric therapist take that whole area. And I was like, "There's no way they're ever going to fill this up," and they have and more. And so we've completely remodeled it though. And it is kid-friendly now. And you can tell when those kids walk in, they're excited to see their therapist they are excited to be there. And any of the screaming and the crying that you hear is normally because they don't want to leave.

Dr Brian Weis: Well, don't tell anyone after hours I go in and play with all the toys too. Well, it was my pleasure to have Ryan Cotgreave here with me today to talk about pediatric physical medicine and, again, wonderful services. So yeah, well, once again, this is another Get Wise with Weis. and we'll catch you next time. Thank you.