Q&A with Louie Carder: Insights on the AVH Team Advantage

Aspen Valley Hospital has expanded its rehabilitation services significantly over the last decade, from just a handful of therapists to 28 on staff today. As the department has grown, so have the types and complexity of services offered to the community.

Rehabilitation Services Director Louie Carder says there are three different types of therapists on staff including 22 physical therapists, four occupational therapists and two speech therapists. The expanded team is able to collaborate in areas such as pediatric, vestibular, pelvic health and traumatic brain injury rehabilitation that require multiple specialties.

Carder, who joined the Hospital in 2015, has overseen much of the growth. The Hospital now offers the most extensive level of service in the region, ensuring people get the best treatment available to help them return to their daily lives as soon as possible. Below, he answers questions about each specialty and how they work together to meet the rehab challenges of each patient.

To start, what exactly is occupational therapy?

Louie Carder: That is a great question because occupational therapy is broad, but very specific at the same time. Occupational therapy is really anything from the waist up that may need care and treatment, whether those are physical, developmental or cognitive challenges. We treat everything underneath that umbrella, depending on the needs of each patient.

Why does a patient see an occupational therapist?

Carder: Our occupational therapists may see patients who are admitted to the hospital as well as outpatients who have a referral from their physician.

I’ll give you a few examples. If you think about someone who has just come out of surgery and may not have any use of their hand, they need help to develop and employ strategies to avoid using it while it heals. How do you get dressed? When are you allowed to start strengthening? We work to help you regain the use of that hand as soon as possible. We start just with basic motions and then help them return to full function.

With a brain injury, a concussion for instance, we treat the cognitive challenges that are associated with a brain injury. It’s a team effort that includes other therapists to help people overcome the problems they’re experiencing.

Share a little bit about the team at the Hospital.

Carder: Five or six years ago, we only had one occupational therapist at the Hospital, and now we have four. We have two certified hand therapists—the only two in Aspen. It’s an amazing team of therapists with many years of experience. They’ve really done an incredible job of expanding the program so we can meet the needs of each patient.

Everyone thinks they know what physical therapists do. Is there more to it than people realize?

Carder: There is a general stereotype that physical therapists only provide exercises for people. Actually, there’s much more to it. We perform an evaluation initially to assess your strength, your range of motion, your pain, your functional ability and your goals so that we can actually determine the best treatment to get you back to doing the activities you want to do.

So yes, exercises are a part of the process, but we determine which exercises are going to reduce your pain and which exercises are going to increase your strength. Those exercises are created from the information gained during the evaluation. Our therapists will establish a plan with the patient to best fit the individual they are working with, providing exercises and manual therapy when required.

Are sports-related injuries the reason most people seek treatment? Are there other types of patients you treat regularly?

Carder: Many of our patients come in due to sport injuries or conditions that develop because of their sports-related activities. Beyond that, we have a pediatric program, a brain injury program, vestibular program and a pelvic health program. Pediatric patients may have orthopedic issues or developmental disorders. When treating a brain injury, such as a concussion, our therapists help people overcome balance and vestibular issues from the physical therapy side, cognitive and oculomotor issues on the occupational therapy side, and cognitive issues from the speech therapy side. Our pelvic health program can help someone who may be experiencing incontinence issues.

How do physical therapy and occupational therapy overlap?

Carder: One of the things we do extremely well as a team is communicate. One example is our inpatient team of occupational and physical therapists. They attend rounds every morning and discuss all the patients who are currently admitted, what the plan is for each patient on any given day.

Once a patient is discharged there may be an outpatient referral for both physical and occupational therapy. They may have an arm injury or leg injury and need to continue seeing both. Our therapists continue to coordinate on treatment.

Are their particular strengths in the physical therapy department you’d like to highlight?

Carder: We have total of 22 full time physical therapists at the Hospital and our satellite offices. It’s a very close group with great leaders within the department, who help us maintain the latest evidence-based practices. We meet regularly to discuss what’s new. What things are we doing? What things should we be doing?

Great, let’s move to speech therapy. Does your speech therapy team provide adult and pediatric services? If so, how are they different?

Carder: We have two speech therapists working at the Hospital. One specializes in pediatrics, although she also works with adults. Our other speech therapist will see adults and her specialization is oral oncology rehab. Our therapists are able to handle a wide variety of diagnoses and speech-related conditions.

What are the different conditions speech therapists treat?

Carder: People may have difficulty speaking after surgery or because of treatment. They may have a speech impediment, like a lisp. They could have trouble talking due to a brain injury or some other cognitive challenge.

There’s also the swallowing component of speech therapy. Some people may not be able to completely swallow their food, so we use imaging and other techniques to perform a swallow evaluation. The imaging allows us to see why they are unable to completely swallow their food and chew it appropriately. Our speech therapist then develops a plan to help their patients chew and swallow foods of all consistencies.

Can you give us an example?

Carder: Someone who has had throat cancer and chemotherapy may have had to change their diet completely because they can no longer swallow, or they have a fear of swallowing whole foods, or a fear of choking. The speech therapist and the treatment plan are integral for that person getting back to a normal diet.

Is speech therapy a regular part of treatment for people who experience brain injuries?

Carder: Absolutely. This is where the speech, occupational, and physical therapy work very well together, as part of our brain injury team. All three areas are important in treating cognitive challenges from traumatic brain injury, and helping people return to their normal life activities.

The department’s latest addition is a vestibular therapist. How does that add to the services you already provide?

Carder: We recently hired an experienced vestibular therapist, who is already an integral part of our Traumatic Brain Injury team.

A vestibular therapist is a physical therapist whose specialty is the inner ear apparatus, which plays a critical role with balance and motion. Vestibular therapy focuses on alleviating conditions such as vertigo and dizziness, eyesight challenges and imbalance, all of which can lead people to fall and injure themselves further.

So, your vestibular therapist coordinates with other therapists in treating concussions and other brain injuries?

Carder: Brain injuries require comprehensive treatment. It’s where physical, occupational and speech therapy overlap and complement each other.

Brain injuries don’t always present the same way physical injuries do. When you break a bone or hurt yourself, you can see and feel it. With a brain injury, someone may not even know they are injured. Our team of therapists can bring their experience in physical, occupational and speech therapy to help identify a brain injury and come up with a treatment plan as soon as it’s diagnosed. It is important to begin treatment as soon as possible.

What are some of the more obvious symptoms of a brain injury?

Carder: There are some symptoms that can help an individual recognize they need treatment. For instance, you may have headaches, light sensitivity, or noise sensitivity, or you may have trouble with your balance. But it may be harder to make a connection if you are facing certain cognitive challenges that make it hard to focus on the things you need to do to do your work, take care of your kids, take care of yourself and live your life. If you hit your head and have a concussion, it’s important to see a doctor initially, who may then refer to our team.

If you would like to schedule an appointment or talk to someone at Rehabilitation Services, call 970.544.1177. A doctor’s referral is not necessary.

Click to learn more about Aspen Valley Hospital’s Rehabilitation Services.