All my PTs work in a barren environment that does not make them aware of the cognitive demands I have to deal with while walking. In-patient and out-patient PTs walked me in gyms that have equipment and people sitting around the periphery. When two clients who are walking approach each other the PTs look at each other and decide who will stand still while the other person moves first. I had the luxury of concentrating fiercely on my hemiplegic leg. Home health PTs walked me around the block in the middle of the day when nobody was outside. Walking in wide empty spaces didn't prepare me for tasks that force me to think while I am walking. Football coaches do not stop after they have players throw and catch footballs and do foot agility drills. Football players eventually have to stop concentrating on their body and start thinking about strategy so coaches have them play football with their teammates. Athletes and musicians are trained to make the transition from exercise to function so why are stroke survivors not getting the same kind of help?
My fantasy is that home health PTs will meet clients in the community in the middle of the day. At a restaurant, they will help stroke survivors walk sideways between tables and go down stairs that have a railing only on our hemiplegic side. At a store - walk in circles around racks of clothing and stop for people who aren't watching where they are going. At a hair salon - sit down in the chair without tripping over the big metal footrest. At church - get into a pew, close the door of the bathroom stall, and turn around in front of the toilet regardless of which side the grab bar is on.
A PT cannot be with me every time I try a new activity. However, PTs can make clients safer by helping us understand that walking requires problem solving as well as physical mobility. After you rehearse dealing with barriers in the community, go home to rest, and then plan a real outing.