Interview with Dr. Susan Roush of the University of Rhode Island
Dr. Susan Roush received her Bachelor’s degree in physical therapy from the Ohio State University in 1979. After obtaining a Master’s degree in Rehabilitation Services, she worked briefly as a Physical Therapy Instructor. This first academic position inspired Dr. Roush to pursue her PhD, which was in Measurement, Statistics and Design from the University of Washington.
Dr. Roush joined the University of Rhode Island’s Physical Therapy faculty in 1991 where her focus has been on Professional Issues (in both teaching and research), and disability-related topics. Her experiences have also included 5 years as Associate Dean of the College of Human Science and Services, and a 1-month term as Special Assistant to the Provost. Dr. Roush has participated in two sabbaticals including 6 months as a Visiting Scholar at the University College Dublin (Ireland) Center for Disability Studies, and as a Visiting Scholar at the University of South Australia (Adelaide) Physiotherapy Department. She is currently involved in grant work in conjunction with the Rhode Island Developmental Disabilities Council, and with the Craig H. Neilsen Foundation.
Note: You should consult with your doctor or physical therapist for recommendations on treatment. The views and opinions expressed in this article are those of Dr. Roush and do not necessarily reflect the official policy or position of OnlinePhysicalTherapyPrograms.com
How did you become interested in physical therapy?
Like so many physical therapists, I became acquainted with the profession through being a patient.
What are some of the challenges to getting those with disabilities the physical therapy care they need?
There are many reasons why those with disabilities may not be getting the physical therapy they need. A significant element is the unemployment rate for people with disabilities. It is much higher than for the general population and because health insurance is primarily provided through employers many people with disabilities lack health insurance- severely limiting their ability to access physical therapy services. Another factor is the surprising lack of physical accessibility in healthcare settings. Is there an accessible route from the parking lot to the building, are their electric door openers, is the reception desk at a height to accommodate people who use wheelchairs, are treatment tables accessible? Surprisingly, the answer is ‘no’ many times. In Rhode Island, kudos to the non-profit Accessible Healthcare RI for providing consumers with accessibility information on health centers, hospitals, and private practice (outpatient) settings via a searchable database.
Right now, some of your research is focusing on the incorporation of a social model of disability into the work of health care providers. What does this mean and why is it important?
There are several different models, or ways of thinking about, disability. Each has its advantages and disadvantages. Physical therapists function within the medical model in which disability is viewed as a problem that needs to be fixed or, at least, its effects need to be ameliorated. Indeed, physical therapy education is focused on helping students identify differences from normal (e.g. Good minus strength in the piriformis muscle) and then correcting those differences (targeted therapeutic exercise). One of the disadvantages of this model is the tendency to be paternalistic: the professional holds the specialized knowledge and knows what is best for the patient. Individuals with disabilities, however, often have difficulty with this model because of its paternalistic flavor, which can be demeaning, plus its lack of focus on function and what is important to them. The social model conceptualizes disability as existing because of society’s lack of broad enough supports to make life accessible to all. The disability is situated in society, not in the individual. Efforts to improve the lives of persons with disabilities focus on making the environment accessible and changing attitudes about what it means to have a disability. Why is this important? Many people with disabilities do not participate in physical therapy because of past demeaning experiences with health care professionals, even physical therapists. The incredible difference physical therapy can make in a person’s life may not happen as persons “throw the baby out with the bathwater.” That is a loss for the person, for the therapist, and for the profession.
What do professionals need to do to incorporate such a model?
The most important thing is to truly practice in a patient-centered way. That sounds easy, but in today’s fast paced treatment settings, it is often weakly practiced. Asking what the person wants from their physical therapy is paramount, and then following through with that as the guiding principle of all treatment is essential. I believe physical therapists should educate their patients as to what physical therapy can offer and then let them decide how they want to participate. Additionally, physical therapists should take every opportunity to advocate for policies that facilitate integrated, inclusive environments for people with disabilities. Compliance with the 1990 Americans With Disabilities Act is still spotty; When anyone sees inaccessibility they should speak up, especially physical therapists.
How can the field better support professionals who have disabilities themselves?
The biggest support would be a change in the attitudes of health care professionals where disabilities are not thought of as something that needs to be fixed. Physical therapists want to ‘fix things’- we are great problem solvers- but sometimes what we may perceive to be a problem isn’t a problem for the person. Understanding that disability is only one aspect of who that person is and not making the assumption that it only carries negativity is important.
What aspect of your research are you most proud of?
I’m proud of the article I wrote with Nancy Sharby advocating for more consideration of the social model of disability in physical therapy practice: Roush SE, Sharby N. Disability reconsidered: The paradox of physical therapy. Phys Ther. 2011; 91:1715-1727. There are not many voices in physical therapy advocating for consideration of the social model in our practice, and it was a privilege to share this perspective with the profession.
Do you have any advice for those starting a doctorate in physical therapy program?
You are entering a wonderful profession and you will be a practicing physical therapist before you know it! Physical therapists have enormous potential to better the lives of our patients. We also are in a place of significant privilege that calls for humility. I think Atul Gawanda offers astute suggestions on becoming the best health care profession you can in his amazing book, Better – A Surgeon’s Notes on Performance (Picador Publishing 2007). I think this book should be required reading for physical therapists and DPT students. His suggestions: 1) Ask an unscripted question, 2) don’t complain, 3) count something, 4) write something, and 5) change (pgs. 249-257).