Staff Spotlight: Linda Cates, MS, PT, NCS
When she was 18, Linda Cates, MS, PT, NCS suffered a knee injury that required surgery. The recovery process consisted of having a physical therapist forcefully repeatedly snap her knee into place five days a week. After she recovered, Cates decided to become a physical therapist herself. In this week’s spotlight interview, Cates discusses working patients with neurological issues at Duke, how her own injury gives her insight into her patients, and how physical therapy changes the lives of the people she sees.
What are your responsibilities as a physical therapist? What does a typical day for you look like?
Within the PT department, I am a clinician. My day is spent treating patients. In my past, I have been a coordinator (manager of in-patient rehab and held a full time faculty position). Since 2000, I have worked at Lenox Baker (Mondays and Wednesdays) and Morreene road (Tuesdays) clinics treating people with neurological issues, providing falls prevention training, bracing, and also work with people with lower extremity limb loss (prosthetic training). On Tuesdays, I cover the Duke ALS clinic, which I have done since its inception in 2000. I also serve as a mentor to other PTs in my area.
How did you decide to become a physical therapist?
I was very involved in athletics growing up, but when I was around 18, I sustained an ACL injury which required surgery. The surgery was performed before the use of the arthroscope and the method of regaining range of motion in the knee was by manipulation (or forcefully bending the knee) by a physical therapist. I spent a year on crutches and 6 months having my knee snapped five days a week.
This exposed me to a lot of physical therapy. Looking back, this was state of the art surgery and therapy. I am now appreciative for the fortitude of my therapist. However, at the time, I did not feel the same. I was, however, eventually able to return to competitive athletics at the college level.
How did you decide to focus on patients with neurological conditions? What kinds of patients do you see most often?
I initially thought that I would end up in sports medicine. However, once I started my therapy program, began my clinicals, was a teaching assistant with a nationally renowned physical therapist who specialized in neurological research and began work at Duke University Hospital, I found out that I liked everything--acute care (pulmonary, medicine), in-patient rehab, enjoyed working with people who required amputations, but most interesting to me were those with neurological diagnoses. Although most could not be “fixed” or cured, it was fascinating to see the brain-body connection and the accomplishments that people could make. It was exciting to see that focused exercise could help this process or in some cases, the use of properly prescribed equipment.
Currently, I work with people with ALS, Parkinson’s disease, multiple sclerosis, stroke, neuropathies (including CMT, idiopathic). I also see people with balance issues from a variety of causes (vestibular, cerebellar ataxias, etc)
What do you enjoy most about your work?
I love the variety in my day. I may see 11 people a day but no one has the exact diagnosis or similar presentation. People on my schedule are quite complex in nature. It keeps me thinking all of the time.
I enjoy meeting people from various backgrounds. Working at a large teaching tertiary care hospital has allowed me exposure to diagnoses that I might have never seen in a less intense environment. I have the freedom to treat patients the way I feel that they should be treated. I attribute this to my department and Duke as a whole. This challenges me to keep up with the changing information in the field of neurology and physical therapy. Technology is also important and has changed my practice. Genetics appears to be the wave of the future and it is amazing to see how people who have diagnoses that I treated almost 30 years ago are now surviving longer or have had cures/modifications to disease progression.
How does your own experience undergoing physical therapy affect how you interact with patients? How does it affect how you interact with patients?
Having suffered an injury is very different than treating one. I do not even begin to compare my short lived orthopedic issue with some of the life-changing events that my patients face. However, it did give me insight into the effects that a physical restriction can place on your whole life whether it is impaired mobility, pain, or social and emotional challenges. I am taught daily by my patients to be positive and strive for quality of life.
What kind of difference does physical therapy make for patients? How long do you typically work with a patient?
I believe that physical therapy makes a big difference. It allows people to be as independent as possible. It may help them get better or be a means to slowing progression or helping to prevent changes that can occur with a progressive diagnosis. In Parkinson’s disease, research on the effects of properly prescribed exercise has shown 30% improvement (consistent with use of medication regimens). My time varies with each patient. I may consult with them for a one time visit. However, I usually see them for about 12 visits if I am following them at Lenox Baker and they are local or willing to return. At the ALS clinic, we see people for an evaluation and then every 3 months.
What’s one thing you wished more patients knew about physical therapy?
Physical Therapy has multiple areas of sub-specialty like neurology, orthopedics, and cardiology. Some therapist are good generalists but others truly specialize in their practice. The right physical therapist is important for your specific issue. We are not all the same.
Cates poses with her husband during a biking trip through Italy's Dolomite mountains.