Interview with Elizabeth, physiotherapist
How did you become a physiotherapist?
I've always been attracted to the health professions. I myself had a few problems with a knee when I was younger, which led me to consult physiotherapists. To become a physiotherapist in the Nancy area, at the time there were 50 places for 1,500 applicants. I was 17 when I took the exam, and I passed. I practised from 1983 until two months ago, when I retired as a young pensioner.
Can you tell us about your career?
I started out as an assistant in a law firm in 1983, then opened my own practice in 1984. At first, I set up on my own, then the business expanded. I was joined by associate assistants, a partner and my secretary, who was my right-hand woman for 27 years.
I worked a minimum of 12 hours a day, 6 days a week, for 42 years. I'd arrive at the office around 6:30 a.m. and leave around 8:30 p.m., with a lunch break of 30 to 45 minutes maximum.
I also made house calls three times a week: Tuesday afternoons, Thursday mornings and late mornings on Saturdays. Sometimes more, when I had to replace a colleague at short notice.
If someone had told me ten years ago that I would have so many patients in my last years of practice, I wouldn't have believed it. The number climbed to around 200 patients a week, while continuing to make house calls. These were often elderly patients or those suffering from severe neurological pathologies, such as Parkinson's disease, who could no longer get around.
A few years away from retirement, a nursing home was set up a kilometer from my practice. I thought this would relieve the pressure on my practice, but it didn't happen. So I decided to stop, so I could get some rest. One thing's for sure: I loved my job!
How do you explain this strong demand?
I'd say it's multi-factorial... I'm in a department, the Vosges, where the density of healthcare professionals is not very high. There's a shortage in certain areas. At the same time, the population is ageing, and the demand for care is increasing.
My practice also benefited from excellent word-of-mouth. I spent at least 20 minutes with each patient individually, which wasn't always the case elsewhere. The result: people come, doctors send their patients...
A patient who needs to strengthen his muscles can work on his own, while the practitioner takes care of another patient at the same time. But for certain pathologies, the treatment really needs to be individualized. I'm thinking mainly of neurology and all patients who come for an infection, or a serious pathology.
What changes have you witnessed in the profession?
The profession has become much more feminine. 40 years ago, it was very male-dominated. Now it's predominantly female. Today, it's still mainly women who look after the children in the home, and inevitably this has an impact on the possible workload.
The younger generation - and this is understandable - sometimes refuses to make home visits or carry out certain types of care, as these acts are very poorly remunerated by the Assurance Maladie. There's talk of home visits costing 2 euros... If you hand an electrician 2 euros, I doubt he'll come back a second time! (laughs). It's also particularly stressful. Over the last few years, going round to see my patients was almost like going round with a stopwatch in my hand, saying to myself "if you've chosen to take ten minutes with a patient because she wasn't in the mood, you're going to have to try and get those ten minutes back somewhere else".
And then there's the arrival of new technologies like virtual reality, which helps us a lot. I think it's going to grow. It's being introduced more systematically in physiotherapy schools, and I'm convinced of its benefits for our patients. I myself have trained trainees and staff in VR. They're always very interested, especially as it's a real plus in their training.
How did you integrate H'ability's virtual reality solution into your practice?
In the course of my reading, I discovered that virtual reality could be put to good use for physiotherapists and rehabilitation in general. I subscribe to Kiné ActualitéI read Kiné ScientifiqueThis has enabled me to learn a lot, and to be a bit of a local pioneer in the field.
What then motivated me to invest in this equipment was my patients.
While we're on the subject of home visits, when you visit patients who are too old or suffering from serious pathologies, you're stuck in a structure that's not your own, in a very restricted environment. This quickly leads to repetitive and monotonous exercises. Virtual reality has enabled me to do something different. For me, it's an excellent complementary tool.
How do patients react to the solution?
So I got all kinds of reactions. Some people immediately said, "Really? Great!" Others were more reticent. I'm thinking of a patient with Charcot's disease who didn't want to try the helmet at all. With the help of his daughter, we managed to get him to give it a try. Afterwards, when I didn't have the equipment with me, he'd say: "Oh, you didn't bring it with you? It's a shame, it's a real change, it's really good!"
This patient I'm talking about suffers from Charcot's disease. It's a progressive paralysis that evolves very quickly. He was a prisoner of his whole body, but still had relative mobility in his upper limbs. Virtual reality allowed him to escape, to let off steam. As he still had motor skills in his upper limbs, I had him play boxing games, for example. In this type of game, I could see that he was able to let off a bit of steam, by forgetting about his wheelchair, and thanks to the headset.
What progress have you seen in other patients?
There are many, but I immediately think of one patient in particular. A lady with major cerebral degeneration. She no longer recognized anyone and had very limited mobility. My scope of action was just as restricted. All I could do to maintain the condition of her upper and lower limbs was conventional mobilization.
Then I decided to take this lady on little trips. With the headset on, I launched travel sessions (to the sea, the mountains, etc.). One day, when her daughter was also present, I took her mom to a virtual educational farm. She turned her head in all directions. She was actively looking for the animals hidden in the farm...even though she normally had no head rotation.
At the end of the session, this lady even kissed her daughter. Something she hadn't done in... a very long time. And that was it. When we put the helmet on, we were both in tears. It was an extremely moving moment and one I'll never forget.
We think it has awakened an emotion, a memory. You realize, as you're doing here with the travel games, that it can actually awaken something very intimate in the person and make them react. I think that even for people with degeneration or advanced senility and all that, virtual reality can be interesting to try out.
Have you also seen any positive effects against kinesiophobia, especially in children?
There's no question about it with kids. The day you tell them "today, we're going to work a little less conventionally" and put a helmet on their head, they're the happiest in the world.
The kinesiophobiais a very interesting thing to combat with VR. You can capture the patient's attention, and he forgets his handicap or worry. In mirror therapy with hemiplegics, for example, it works very well.
I'm thinking of a kid who suffered brachial plexus paralysis at birth. He still had the after-effects of this paralysis, and rehabilitation was necessary to mobilize him. Systematically, we had to do a little strengthening, a little counter-resistance... very specific things in analytics, which he didn't particularly appreciate. In fact, when I retired, he gave me a cactus! Beautiful, but a cactus nonetheless! His message was one of subtlety! (laughs).
Getting children to play helps them swallow the length and repetitiveness of physiotherapy sessions. It's a great tool for them. On the way out, the kids were saying "I'm going to tell my friends that I did virtual reality at the physiotherapist's", and that's great.
Conversely, has H'ability enabled you to help elderly patients maintain their independence?
Ah yes, yes. I'm thinking of a patient, just under 80, whose doctor had prescribed reinforcement. This gentleman had become depressed following the loss of his wife. He had lost his balance and was at high risk of falling. In addition to traditional methods, we were able to improve his balance and prevent falls using games.
I'm thinking of exercises like soccer or catching stars. From the moment you get someone to play, to catching things at height... for people aged 80 and over, these are sometimes gestures they no longer dare to do, or only with a cane, for fear of falling.
Whereas in this context, it's a reassuring setting where they can make any gesture, knowing they're safe under the practitioner's benevolent eye.
Now that you've retired, what do you remember most?
It's not easy. There are so many of them. But I'll always be grateful to my patients. They've said thank you so much. As I approach my last day of work, I've been spoiled rotten. I was spoiled with flowers, chocolate, books and everything. My daughter dropped by one evening, saw the boxes of chocolate piling up and even said "the chocolatier made his turnover for the month with you!
Really, I'm enormously, enormously grateful.
And then there were all those patients I mentioned and others who touched me enormously. This gentleman with Charcot's disease who put his helmet on with a big smile... these are memorable memories that I'll treasure for the rest of my life.