Interview with Kendra Gagnon, PT, Phd - March 2015

The following is not original material. This interview is reproduced with permission from Cinema, a former Twitter personality & blogger who left the social media world years ago. The reproduction is intended to preserve & share Cinema's insightful interviews.

I have always been intimidated by Pediatric Physical Therapy. It takes a unique skill-set and perspective to become an effective Pediatric PT; also, it takes a special person to practice in this field and then step into the academic domain of Pediatric PT. Kendra Gagnon is one of those special individuals. Although she still practices on a limited basis, Kendra spends most of her time as an Associate Professor for the DPT program at Rockhurst University in Kansas City, MO. In addition to her blog, she also has a fantastic series of videos on her Youtube Channel that I heartily recommend you check out.

She also has a passion for tech & social media integrated into Physical Therapy clinically and academically. Enjoy the interview!

So, what did you have for breakfast today?

Pears, sausage, and blueberry pancakes. I am not a morning person at all, but – lucky for me – my husband is an early riser and cooks a hot breakfast for me and our three boys every morning!

Back in PT school I was recommended to spend an afternoon with a Pediatric Physical Therapist. It’s a whole other world that takes unique skill sets of communication that I was completely lacking. What led you into the world of Pediatric PT?

I’ve wanted to work with children for as long as I can remember, but I didn’t want to be a teacher (which is a bit ironic since I’m now a professor…). And I was always interested in health care but didn’t want to be a doctor. So I thought I was going to be a speech therapist when I started University of Missouri. My first semester, I took an Introduction to Health Professions course. During one of the class sessions, a physical therapist came to talk to us and he happened to share his experience in pediatrics. I didn’t know much about physical therapy, and I had no idea that there were physical therapists that worked with children with developmental disabilities. After his talk, I did a little research, did a couple of pediatric PT observations, and I was totally hooked!

What concepts from the world of Pediatrics do you think translate well into PT for grown-ups?

There are a couple of things I think we pediatric therapists do really well. First, we are really good at looking at context and participation. We don’t really care if a child can climb the “stairs to nowhere” in the PT clinic. Can they get up the stairs to their bedroom to get ready to go to sleep at night? Can they safely get on and off the school bus? Those are the things that we hone in on.
I also think we are really good at teaming with other professionals and even working on sneaking other professional’s goals and activities into our sessions. For example, if I know a child I’m working with is learning to sign the words for different colors with her speech therapist, I’m going to incorporate that into my PT session as well. I’m not sure that concepts like natural environments, participation, and transdisciplinary teams are unique to pediatric PT, but I don’t see them as much in other specialty areas. I think pediatric PTs were sort of forced to embrace these ideas since so many of us practice in schools and early intervention settings, where we are required by law to provide educationally-relevant, family-centered services in natural environments. But I really think it makes us better at making a real difference in our clients’ daily lives. I would really like to see PTs who work with adults embrace some of these ideas as well.

Tell us about your transition into teaching. How did you end up spending much of your time in Physical Therapy Education?

After I had been practicing about 5 years, I knew I wanted to advance my career; do something more. My degree was an MPT, so I saw two paths to advance my education and credentials: get a transitional DPT and a PCS, or get a PhD (or EdD or similar). I really enjoyed being a CI and thought I would be good at teaching PT students, and I frequently got feedback from others that I was a “natural teacher.” There was an opening in the PT program at the University of Kansas Medical Center, so I sent in a CV and met with the Chair of the PT Department at the University of Kansas Medical Center, Lisa Stehno-Bittel. I didn’t get the job…I didn’t even get an interview. I was SOOOOO not qualified. But I hit it off with Lisa and she encouraged me to apply to their PhD program and start teaching in their Department at a Graduate Teaching Assistant. That grew into a faculty position, and the rest is history.

There’s a rumor that you required mandatory Twitter participation for your students in the past. Why do you feel so strongly about engaging on Twitter?

The rumors are true! I have run a couple of courses with students where I required participation in online discussions via Twitter. I actually have a case study on this coming out in the Journal of Allied Health next month – you can check it out if you want more details about what I’ve done. I’m not sure I feel strongly about engaging in Twitter specifically, but I do feel strongly that today’s health care providers need to learn to navigate social media in a professional capacity. In DPT education, we teach students about professional interactions in person, on the phone, via email… But we largely ignore the fact that almost every single student, health care provider, patient, and potential patient uses social media in some capacity. Our students need to think about what they will do if a patient asks to “friend” them, a colleague shares identifiable health information in a tweet, or a patient comes to them with a blog post they found through “Googling.” Twitter is a nice platform for synchronous and asynchronous discussion, and doesn’t feel quite as personal or intrusive to ask students to use Twitter as it might to ask to connect with them on Facebook. On Twitter, students can access information, build a network of professionals with similar interests, and practice public professional interactions and scholarship. Even if they never use Twitter again after the class, I hope the activity forces them to think about professionalism and social media and provides an understanding of the opportunities and drawbacks of using social media for professional purposes. I co-authored a Perspective in PTJ on this topic with Carla Sabus and have written about it on my blog.

Let’s say you suddenly found yourself in a position to develop a new DPT Program. How would it be different than what is presently available? And, why would you make those changes?

Oh boy. That’s a big, fat, loaded question. I recently gave a talk on the future of DPT education, and I asked that same question…”If you could take DPT education apart and put it back together again, what would it look like?” Getting a DPT takes a long time and is really expensive. Programs keep growing, and placing all of those students in clinical internships is increasingly challenging. It seems like there is agreement that the current model isn’t sustainable, but it’s harder to find anyone who has a solution or who is actually willing to do anything about it. I think technology might be the real game-changer. Even 5-10 years ago, it was hard to imagine a way to deliver PT education that didn’t require butts in seats for X amount of hours. And even when online learning began to take off, it was largely asynchronous and dehumanized. Instructors simply posted slides, readings, and quizzes on a learning management system and ran a few discussion boards. And this type of learning was really limited to those who had the resources for a computer and internet access. The rise of high-speed internet, mobile devices, and WiFi has brought the possibilities of “anytime, anywhere learning” to almost everyone and gives instructors the opportunity to use video to create and share more engaging learning materials and provide synchronous, real-time learning and interaction. With all that in mind, I think an ideal DPT program would be shorter than 3 years and would be delivered via a hybrid model (online and in person) to allow more flexibility for learners. I’m also really intrigued by the idea of competency-based learning, where progression through the program is based on successful completion of its components rather than a set amount if time. The program would have to stay within current accreditation standards, but I would like to see fewer, longer internships and more authentic experiences integrated early into the curriculum. A two-year DPT program followed by a one-year residency seems like a win-win to me – students spend less time and money on the degree and there is less burden on clinicians to take students for internships. Students get more mentored clinical practice and potential employers have a pipeline of residents-in-training who then become residency-trained therapists. I am really excited to be part of a team associated with Evidence in Motion that is currently trying to get a 2-year DPT model like this off the ground. Stay tuned!

Pediatric PT has weaved through a few different philosophies & theories over the last couple decades. What are the stand-out themes that come to mind?

No one likes to talk about theory…it’s not very sexy. But I kind of geek out about it. A big influence in pediatric physical therapy over the last couple of decades is Dynamical Systems Theory. We used to think that the central nervous system was the primary driver of motor development, and that’s really the premise that traditional NDT is based on (integrating reflexes, normalizing tone, etc). But the emergence of Dynamical Systems Theory in the mid-1990s sort of broadened our view of development. Now we know that, while the brain is a very important component in motor development, there are other systems that are equally important. We began to understand that, when we see a movement “abnormality,” it isn’t the result of a deficit so much as it is the best solution the child can come up when all their body systems work together to complete a task in a given environment. And, maybe more importantly, we became more aware of the influence of the environment on the child. This has given rise to a more task-oriented approach to providing therapy services. So I think pediatric physical therapy practice has become a lot less about simply treating neurological deficits and more about supporting the child’s strengths, providing interventions to address impairments, and modifying the environment to set the child up for success.

What do you think are the biggest challenges in Physical Therapy today? And, how might they be tackled?

Perhaps it’s my bias since I sort of “live” in the academic world, but I think DPT education is probably the biggest challenge facing our profession right now. And it’s not just about physical therapy – really the entire higher education system in the US is in crisis. Suffice to say that there are going to need to be big, broad, painful disruptions in education before we can even make a dent.

You were very active with the Kansas Physical Therapy Association. What were your biggest take-aways from this experience?

I have been involved in the Kansas Physical Therapy Association (as the Standard & Practice Committee Chair and a Delegate) and the Section on Pediatrics (I am currently the Communications Committee Chair). When people ask me about the benefits of APTA membership, I immediately start talking about the value of State and Section involvement. I have learned so much about the APTA and PT practice in general through my involvement. And, more importantly, I have met a lot of great physical therapists and have formed some great relationships and collaborations.

Favorite books and/or authors?

I’m a big Malcolm Gladwell fan… The Tipping PointBlink, and Outliers were all great reads.
Of Mice and Men is probably my favorite classic.

Let’s fantasize. Imagine a world 5 years from now that closely integrates technology and Physical Therapy. What types of tech do you imagine influencing and integrating with PT? And, what impact could this tech have on our profession?

There are so many exciting advances in health care technology, but I’m sort of obsessed with telehealth right now, both as a health care provider and as a patient. I am really interested in the idea of a “Virtual Visit” and initiatives such as “Flip the Clinic.” As a pediatric PT who has spent part of her career driving long distances to visit children in rural, underserved areas, I could really see the value in being able to video conference with a family, teacher, or caregiver to provide movement and mobility strategies for their child. And as a mother myself, I would LOVE to be able to videoconference with my kids’ doctor so he could just take a look at that rash without me loading everyone up and driving 25 minutes to his office to see him. I think this intersects with health tracking & wearables. If I’m hypertensive and wear a fitness device that notices my blood pressure is elevated, it could “ping” my doctor who could then contact me to set up an appointment, adjust my medications, etc. And perhaps my wearable device could even offer anticipatory guidance to suggest a restaurant for lunch with healthy options or guide me to the nearest fresh food market. To me, there is so much amazing potential there. These are complex issues with lots of legal, ethical, and financial pieces to consider. But none of the barriers seem insurmountable to me and I am excited to see how telehealth and health tracking come together to improve health care and outcomes.

Life is an adventure. Tell us about one of your most memorable adventures.

About 5 years ago, my husband and I took a 9-day trip to Italy. My husband’s family is Sicilian, so we decided to spend a night in Camporeale, the little village (pop. 2000-ish) where his great-grandparents lived before they came to the United States. Our rental car didn’t have GPS and we weren’t able to get any signal on our mobile phones, so we got lost on the way. We eventually found a nice old man in a grocery store who helped us find our way, learned that the owner of the Bed & Breakfast where we were staying and my husband were probably long lost cousins, and ended up spending the evening being served a 10-course Sicilian meal (and lots of Italian liqueur!) at a local family restaurant that opened up after hours just to feed the two Americans who had rolled into town. I don’t think they often had tourists there. We had an amazing two days in a little town where literally no one spoke English but were as warm and welcoming as anywhere I’ve ever been.

Thanks for sharing your insights and experiences! I admire the deep involvement you have with our profession, as well your commitment to the Pediatric domain of Physical Therapy and the integration of tech & social media into the classroom. All the best!

Connect with Kendra via twitter: @KendraPedPT

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