All my PTs work in a barren environment that doesn't 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. 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'm walking. Football coaches don't stop after they have players throw and catch footballs, do foot agility drills, and tackle partners. 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 shown how to make the transition from exercise to function so why aren't stroke survivors getting the same kind of help?
Immediately after my stroke I had to concentrate fiercely on my hemiplegic leg. Yet my PTs never expanded their focus to environments that demand more. My fantasy is that home health PTs will meet clients in the community in the middle of the afternoon. At a restaurant, 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 hairdressor's chair that has a big metal footrest and sit up after you lean back in the sink where hair is washed. At church, get into a pew, close the door of a bathroom stall, and turn around in front of the toilet regardless of which side the grab bar is on. After you rehearse dealing with barriers in the community, go home, rest and plan a real outing. A PT can't 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.