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One Class, One Day: SAR Doctoral Students Get Physical

In lab class, budding therapists practice on MS, stroke patients

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Class by class, lecture by lecture, question asked by question answered, an education is built. This is one of a series of visits to one class, on one day, in search of those building blocks at BU.

As doctoral candidates in physical therapy, students in Sargent College’s Neurological Systems II have studied anatomy, but until this second-year lab course, the only humans they’ve worked on have been each other. So it is with a certain timidity that a group of the students begin asking volunteer Peter Banhazl, 57, of Wayland, Mass., about his multiple sclerosis.

A gentle, six-foot-tall bear of a man, Banhazl smiles and waits for the students, all women, to pipe up. Section instructor Alissa Leonard (SAR’04,’09) folds her arms and surveys the group. Based on Banhazl’s responses, they must surmise the specific nature of his MS—which can take several forms—and work with him hands-on to assess how he might benefit from physical therapy.

Several beats pass before the questions come.

“Peter, what was the first episode that made you think something was wrong?”

“It was around 1982,” says Banhazl, who knows the drill well after four years working with a succession of students. “My wife, Terrie, and I went skiing, and I got an earache and couldn’t stand up. I kept falling,” he says, gesturing across the room to his wife, Terrie Banhazl (SAR’77), who has a degree in occupational therapy. “A few weeks later I was playing racquetball at the club, where I was the second best player, and Reuben Finkelstein, who was way down in the ranking, beat me. I was concerned. I went to a hospital—this was in California—but that was before MRIs, and a CT scan didn’t show anything.”

Another student asks if Banhazl’s decline has been steady.

“Over years, not days and months, it stayed with me that I had something wrong,” he answers, “but it was so minor over time. I was almost like a crazy person. I was 30, I was in shape, and yet I knew there was something. And they couldn’t find anything.”

“And what year was…”

“The Reuben Finkelstein incident?”

After the laughter subsides, Banhazl describes finally being diagnosed with MS in 1987, when an MRI at Newton Wellesley Hospital revealed little dots on his brain that were the telltale “multiple scars” that characterize multiple sclerosis. But there were no medications at the time. (Today, several drugs are available to help treat the disease.) “There was literally nothing for them to do, just wait and watch you disintegrate,” Banhazl says.

Known around Sargent simply as Neuro, the class for PT students in BU’s three-year doctoral (DPT) program is taught by Lisa Brown, a clinical assistant professor of physical therapy. In the lab, Brown’s class of 47 students splits into two groups, each working with a volunteer. The yearlong course is broken into a fall sequence, when students work with stroke victims, and a spring session, when they work with people with traumatic brain injuries, spinal cord injuries, cerebral palsy, Parkinson’s disease, and MS sufferers like Banhazl. With hints from the instructor and Banhazl himself, the group concludes, correctly, that Banhazl suffers from a form and stage of the disease known as secondary progressive MS.

“Bringing patients into the classroom is nothing but a positive experience for everyone involved,” says Brown. “It not only gives students an opportunity to interact with patients in a safe, supported environment, it enhances the curriculum” by giving students a chance “to see, hear, and feel the concepts they’ve learned about in class that week.” And when patient (in both senses of the word) volunteers like Banhazl are not only allowed, but encouraged, to provide feedback and guidance, the experience gains a dimension that wouldn’t exist in a clinical setting. Interacting with actual patients is “a huge advantage, as opposed to just practicing on each other all day,” says class member Tamara Duncalf (SAR’12).

MS affects people differently, so right off the bat the students can’t assume anything about Banhazl’s condition. A so-called autoimmune disease like arthritis, MS is caused when the body’s own immune system goes on the attack, targeting the fatty sheaths encasing the nerve cells that make up the brain and spinal cord—the central nervous system.

Brown’s students are entering physical therapy at a time when an aging population means their skills will be in great demand. “In the case of someone like Peter, PT can help with his daily function,” says Duncalf. “We’re not waiting for him to get better, but we can help him manage his day-to-day life.”

There is no cure for MS, whose range of symptoms includes weakness, tremors, tingling, numbness, loss of balance, vision impairment, and even paralysis. But physical therapy can help, and even reverse, some of the later symptoms of the disease with exercises to strengthen muscles, improve balance and coordination, increase mobility, and ease pain. Physical therapists are themselves teachers; after several sessions they might send patients home with a program they can do on their own.

“I’ll usually prod them to ask important questions,” says Banhazl. “I help them diagnose me. They just studied the subject in class, and now have a real person to study.” He will give the students a verbal nudge if he feels they’re missing something. The caliber of the students is an inspiration, he says, calling them “the brightest of the bright. They’re so smart and focused. It’s comforting.”

“Something I really like about him is he is completely honest,” says Sara Grandall (SAR’12), another class member. “He makes us brainstorm and also gives us a sense of what he’s really willing to do in therapy.” (Banhazl admits that his stationary bike has become the proverbial coatrack.) Duncalf describes him as “super-helpful—he knows when to answer questions and when to hold back, and he is willing to have students practice on him over and over again. He seems completely comfortable.”

After the students finish interviewing Banhazl, they line up to observe him as he walks, runway-style and without his cane, halfway across the gymnasium-sized room. His weaker arm bent at the elbow, fist against his chest, Banhazl is wobbly, but advances briskly. This gait analysis lets the budding physical therapists assess whether he is at risk of falling, and which problem areas are impeding his balance. After the walk, Banhazl sits at the edge of an examining table for the stretching, prodding, and general manhandling that tests his flexibility, strength, and range of motion, all of which have been affected by MS in varying degrees. The proceedings also test his good nature, which is unwavering. When it’s over, two students bend down to gently help Banhazl into his socks and shoes.

“Physical therapists beat the crap out of people with MS,” says Banhazl, who willingly submits to all manner of prodding, including students bending his legs as if he were a rag doll to test his mobility. “That’s their job,” he says. “They can’t fix it, so they look for ways to make your life better by making your body stronger and looser.”

“I think Peter is really inspiring,” says Duncalf. “There are two ways you can go with an MS diagnosis. You can sit and feel sorry for yourself, or you can do whatever you can to help yourself.”

One way Banhazl is helping himself, the students say, is by giving back. “It gives him a little more purpose,” Duncalf says.

Susan Seligson can be reached at sueselig@bu.edu.

2 Comments

2 Comments on One Class, One Day: SAR Doctoral Students Get Physical

  • Anonymous on 03.28.2011 at 7:41 am

    It’s DPT students, not PhD students.

  • Anonymous on 03.28.2011 at 10:10 am

    Good work PT Department!

    I’ve been a patient-guest at a handful of medical schools and I can say with absolute certainty that the professors in this course did a great job of facilitating the interaction between the students and the guest. Very often that doesn’t happen and it turns into a really awkward, often negative experience for the guest. Cheers to you for doing it well!!

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