Caitlin Whyte (Host): Welcome to Healing Heroes PDX, the podcast series from the specialists at Shriners Children's Portland. Today, we are discussing the vital role of physical therapy at Shriners Children's Portland. Our guest is Joel Cowley, a dedicated physical therapist who has been part of the Shriners Children's Portland team since 2018.

Joel specializes in Sports Medicine and works closely with patients who have a variety of neurological and orthopedic conditions, including cerebral palsy. His ability to engage with children of all ages makes therapy a more enjoyable experience, and we're excited to have him share his insights today.

Joel, what are the most common reasons you see kids and adolescents in your therapy room?

Joel Cowley: There are so many reasons. So, I have the privilege of working in a bunch of different settings with a bunch of different patients. So, I see a lot of our Sports Med patients. So, fractures, knee injuries, dislocations, things of that nature. So, I'm one of like four of our PTs that are on like a Sports Med team, which is a great fun group of people. And then, I also work a lot with children with cerebral palsy. And then, I also get to work with our inpatient team, so patients after surgeries that are staying on our inpatient unit or patients that are in halo traction for long periods of time. I get to do it all, and it's fabulous.

Host: Well, what can families expect when coming to see you for the first time with a physical therapy need?

Joel Cowley: I think the first thing is fun. I try to make it as fun as possible for everybody, because I think I build long relationships with these kiddos. They get to see me for a while and try to make it as fun as possible so that they're interested in doing their rehab. Hopefully, they feel heard while they're with me is another. I really try to listen to patients and families to really understand what they're coming to see me for so I can get to the bottom of it.

And then, after all of that, it's thorough assessment of the problem so I can figure out what we need to do. So, we do range of motion, strength screening. We will do functional testing, whether that is having them do certain movements or running them through an outcome measure. So, looking at your overall gross motor skills, things like that to really try to narrow down what you're here to see me for and how I can be helpful.

Host: What is important for kids and their parents to know about participating in physical therapy?

Joel Cowley: Great question. I feel like important things to know, it is a team effort. It should be a team, and I'm just one member of the team. I think big parts are we're going to do our examination. We're going to be thorough about prescribing, exercise and things for us to do to meet your needs, but it is a team effort. And there's going to be pieces of it that are going to be homework that we're going to ask you to do and participate in exercises to do at home to get better. Because we can't do it all. I think that's one piece to it, is like everybody has a part to play on the team.

And also, that you can make sure that I am doing my part as well. I mean, my job is to come up with exercises and explain things in a way that everybody understands and everybody's on the same page. And if I'm not doing that or you feel like, "Oh my goodness, this isn't working for some reason. I'm not understanding what he's asking me to do," or "He keeps giving me a bunch of exercises and it feels like it's too much," then you bring those things to the team and say, "Hey, you've given me eight exercises. I feel like I can do two. What can we do?" And we try to come up with something to collaborate together. I feel like if at any point to stress, I think that's the one, is your opinions and your thoughts matter. It's not a you-have-to-do-everything-that-I-say-because-I-know-what's-best and I never want that to feel like that in PT.

Host: Well, what would you say makes the physical therapy experience different at Shriners Children's than another facility?

Joel Cowley: It's fun. I mean, it's fun a lot of places. Shriners Children's Hospital makes it fun, but I feel like we have such a fun team here, full of just really dedicated physical therapists, occupational therapists, speech therapists, doctors. I feel like that piece of the people that we have here make this place really special.

I also think that it's special here, because we do have such a good relationship with everybody in the building. Shriners Hospital is a big place, but it's also small enough in the fact that I know the surgeon, I know the people that you're talking to downstairs. And if there's an issue or there's something we have concerns about, I have no difficulty going downstairs and just asking a question. And I feel like in the other spaces that I have worked, that can sometimes be challenging and sometimes be limiting to the care that you can receive. Like I have to send a message or I have to really go out of the way to try to talk to the surgeon who is busy doing something else. Our surgeons are busy. They do a lot of things, but they're always available for questions. And I think that's something I've really appreciated.

But not even that. It's kind of the nurses, I have really good relationships with them as well. I talk to people on every single floor. Like when everybody can have a chance to communicate and talk and find time to be together, it makes the care better for the patients. And I think that's one thing that Shiners has that we can offer everybody.

Host: Absolutely. Well, on that note, what makes for a successful PT experience for the patients?

Joel Cowley: Having a great care team, people that are all on the same page. Great communication, so everybody knows what they're doing and what they need to do. From like the PT, the patient, the doctor, the nurses, everybody kind of understanding what their job is and how they can best accomplish that.

I think success also looks like it's fun and that you've learned something in a fun way, so you know how to move your body different and you start to feel better. And then, the overall success is the patient getting back to the things that they want to do. I think that is one of the most fun parts about this job is that, by the end of the time that we're hanging out with each other, patient is feeling better. They're back to activities that they want to be doing in a way that is successful and good for them. And I think that's the biggest thing, and that's what I hope all of my patients are getting out of it.

Host: Now, one of your specialties is also Sports Medicine. A physical therapist plays an important role in the life of a student athlete. So, what does this mean to you to be part of that journey with them?

Joel Cowley: Oh, I am ever so grateful to be a part of that journey and to be allowed. Like I said earlier, I'm just one member on that team, but I really do get to appreciate how much time I get to spend with those kids and have some little bit of influence and participation. I feel like a lot of times, sports med injuries are hard on kids. Sports tend to play a really big role in their lives. And when that's taken away from injury and possible surgery, it can be a long journey. And I really appreciate getting to be a part of that, just one piece of that puzzle to get them back to doing the thing that they love and want to do

Host: I understand that you do a lot of work with patients with cerebral palsy. Can you tell us more about that work?

Joel Cowley: Yes, I can. So, cerebral palsy is one of the patient populations that we tend to work with a lot here at Shriners from very young ages. So, that's something that is very fun and different in the aspect of the patients that I treat. Sometimes I'll start seeing these kids when they're as old as one and see them throughout their lifespan, which can be really interesting and really fun.

 PT has changed a lot over the years, and we are moving into more of an episodic care model, especially for patients with a diagnosis like CP where they might have different needs throughout their lives and sometimes they're going to need to rely on physical therapy to get them doing things and get them moving, and get them strong and independent. Sometimes they're going to be in a really steady space and feel good and have a really good grasp of all of the things they need, and they're not going to need it as much.

And I feel like that kind of relationship makes the PT-patient relationship kind of fun and interesting in that setting. Young kids, getting them to learn how to walk, getting families comfortable with what this diagnosis may or may not mean for their child. Things to look out for, ways to incorporate exercise activity into their lives from a young age so that they are getting strong and avoiding as much as possible other complications, and secondary issues, I think, is really enjoyable and fun. I appreciate that role that I get to play in those kids' lives. And I think that's part of what makes it really fun to work with those patients.

Host: Wonderful. And Joel, you also work with same-day surgery patients. Can you talk about how that is different? And maybe walk us through an example.

Joel Cowley: So, I kind of lump same-day surgery and inpatient into each other a little bit. But same-day surgery is patients that are having a surgery that are leaving the same-day or leaving the very next day. It is an interesting time to be a physical therapist, because I have to deal with pain a lot more, I feel like and taking it things at a slower pace. After surgery can be a really challenging time for a patient. They're hurt, they're in an environment that they're not familiar with. There can be so many different things that are complicated and make it challenging. But to be able to be a piece of that puzzle, my job is to come in and make sure that you can mobilize safely in your new situation. Whether that's you can't put weight on your leg now and you need crutches and to be fit with a wheelchair, or you can put weight on your leg, but it's really painful and we have to come up with a strategy that you can get back to moving safely, to be able to do all the things that you need to be able to do as a young person. I do a lot of crutch-fitting. I do a lot of stair-training. I do a lot of parent education about how to best manage some types of pain and what we can do to avoid swelling and complications.

Host: Gotcha. And I know some of your patients are here in the inpatient unit, and how does that experience differ from someone who's coming in, say, once a month or so?

Joel Cowley: Well, I get to see you a lot more frequently. Some of our patients a lot more than they would want to maybe. Our inpatient unit, we have patients that are in halo traction for their spines. We have patients that have just had spine surgery or bigger hip surgeries and things of that nature. And I feel like it can be very similar to our same-day surgery, but sometimes we're having to deal with more, whether that's more discomfort because the surgery was bigger or more equipment, more challenges to our mobility, and that's usually why they're staying on the inpatient a little bit longer.

I think it is a little bit more complex. There can be a lot of moving pieces between making sure that you're comfortable enough to do the mobility, that you have the right equipment right away, that you can move with teaching. You may need more support for transfers and things like that. So, it's a lot more education, more education on our part to teach families how to best support the patient with their mobility. So, I think those are the biggest things that make it different than somebody that is doing really well and just kind of needs like a check-in here and there to give them some exercises and move them onto their next phase.

Host: Absolutely. Well, Joel, to wrap up our episode, you know, it's so clear that you are passionate and in love with your job. Could you tell us about your experience and what drew you to Pediatric Physical Therapy?

Joel Cowley: How much time do you have? Because, I mean, I love telling the story.

Host: Let's hear it, yes.

Joel Cowley: I mean, it's a pretty long story though. So, I feel like I've always worked with kids throughout my lifespan. I started off as a lifeguard at, I want to say like 15, 16. I did that and taught swim lessons for a very long time. That built into me coaching, swimming and coaching, water polo. And I just always knew that working with kids would be a part of my life, I think. I've always enjoyed their energy level. They like silly things and I like to be silly. So, we've always worked well together.

And then, getting into physical therapy, I have to thank my mom, shout outs to Terry Cowley. I didn't know what I wanted to do when I got out of high school. I went to college for a little bit, and then quickly dropped out because I had no reason to be there. And my mom took that in stride and said, "Here are some things that I think you might be good at. And physical therapy was on the list." And I said, "Hmm, sounds interesting." So, I did some research, I did some job shadows and I said, "Okay, this will be fun." And then, I went on my way, and started schooling. During that time, I tried to keep up working with kids as much as I could. So, I started volunteering at Shriners with their recreational therapy department when I was about 18 or 19, I think. And I did that for several years. So, I worked with kids to teach swim lessons. I would go up and do skiing and snowboarding with them every spring. I think they're just wrapping up with their spring ski and snowboard program right now. Shout outs to Caroline, who does a fabulous job running the rec therapy program.

And I just tried to stay as involved as I could. And then, finally made my way to PT school. And there, I got to experience different settings, and it was really clear that Pediatrics was still for me. I got the opportunity to work at Legacy, or Randall Children's Hospital as a student, and I just loved every minute of it. It was really fun, really enjoyable. It was everything I thought it would be. And then, after school, I got the opportunity to work at Doernbecher Children's right away, which was fun. Then, a job opened up at Shriners. And that was very exciting for me. Because I knew when I got into PT school that Shriners was going to be a place that I was going to work. My mom still works here. She works for corporate, but she worked as a medical transcriptionist for my entire life. So, I've always had a soft spot in my heart for Shriners. I've been around here, well, since 1989, my mom was pregnant with me when she was working in this building. So, I've been here since then. And I am happy that I get to be here now and still get to do something that I love, work with people that are amazing, and just have fun every day.

Host: Well, thank you Joel, for your joy and your work and for being a great guest today. And that concludes this episode of Healing Heroes PDX, with Shriners Children's Portland. For more information on our therapy programs, head on over to our website at shrinersportland.org, and thanks for listening.