Dr. Sara Laxe and Dr. Dani Martí: "We help patients recover the maximum functional capacity possible, to return to a normal life or adapt to a new normality”

Sara Laxe: The rehabilitation doctor carries out a comprehensive assessment, a view of the whole set of functional deficits a person may have, at all levels; cognitive, language, communication and motor, and what implications this has on their life. We are like family doctors, but for patients with disabilities.  Each case is different and requires a different approach. For example, if we see a patient who has difficulties with walking, we will probably contact physiotherapy.

Dani Martí: The aim of the physiotherapist is for the patient to maintain or recover the maximum functional capacity as quickly as possible, to return to a normal life or one that is as similar as possible to the one they had before, and they do this through physical means, manual and instrumental techniques, and therapeutic physical exercise.  And if this functionality cannot be recovered, along with other specialists such as occupational therapists, speech therapists, social workers, psychologists, we look for ways of readapting the patient's life. We try to provide a more personalized service, which is adapted to the individual’s needs, and ensure that these are covered. This can make a difference in the evolution of the patient.

Dani Martí: There has been a change of model.  Before, physiotherapists depended on each institute and there was little communication between them. They were like small hospitals with their own group of physiotherapists.  The idea is that everything that can be involved in rehabilitation should form part of this service, in the same team and with a single manager, but always maintaining specific areas of knowledge.  In the past, I would see a patient in the ICU, then they would be transferred to a ward and I’d lose track of them. We didn’t know whether there would be physiotherapists to treat them. And later, the patient would maybe come to the hospital as an outpatient, but there was no connection.  Now, by all working as a group, we can communicate and transfer information better, agree on the approach and ensure the “continuum of care” for the same patient wherever they are in the hospital.

Sara Laxe: The hospital management saw the need to try to standardize a situation that was very sectorized, and start a project based on teamwork. We have started to carry out clinical sessions in which the physiotherapists participate, and where people discuss how the project is going, the changes that have been made and those that people want to make.

Dani Martí: Normally, what happens is that we think about rehabilitation once the disease process or a surgical operation has already had physical or functional consequences, and we try to reverse them.  An ideal situation would be to think of ourselves as “habilitation” professionals, before, during or after the process or operation, adjusting the type of work, dose and intensity to each situation.  A clear example of this is pre-habilitation before surgery.

Dani Martí: It is a programme led by the anaesthesia service, which filters patients who may be candidates. The aim is to prepare them before surgery through nutritional guidelines, psychological support and physical exercise. It is in this last block that the rehabilitation service comes in, through intensive aerobic and strength training to improve the capacity for effort and muscle strength, with the idea of reducing complications after the operation.

Sara Laxe: We start with fragile patients, in whom we know that surgery will decrease their functions, and may prolong their hospital stay.  Between the time that the patient is diagnosed and the operation, 3-4 weeks usually pass, during which time pre-habilitation is carried out.

Dani Martí: We currently have rehabilitation specialists, physiotherapists and speech therapists, but we are working to expand the team with occupational therapists, social workers, psychologists and neuropsychologists. We all add up. We have been working intensely for a year, together, and now we are starting to see some results.  For example, since I have been coordinator, communication between the physiotherapists from different areas of knowledge has improved for resolving doubts about how to approach a patient, and the physiotherapists from the different ICUs have formed a highly motivated team that reaches a consensus on the approach to critical patients in the hospital, including other professionals such as the team of speech therapists.

Sara Laxe: As professionals, we will have our own vision that has to combine with each individual’s circumstances. A person with family support, an adapted home and living in Barcelona is not the same as a person living on their own on a fifth floor without a lift.  The patient and their environment have to be assessed. In the case of the latter, support is required from social workers, occupational therapists, etc.

Sara Laxe: The information should be given to people when they are ready to receive it.  "The doctor-patient encounter must be rigorous, and it is very important because the cure or improvement will depend on this to a great extent. We are speaking about emotions. You can’t just give out information quickly in a corridor… You also have to assess how ready this person is to receive it.  We tell them that we must find a time to sit down and talk.  In this way, you are telling the person that they should be prepared.

Sara Laxe: Throughout our training, we adapt and understand that we are there to help the patients, to ensure their lives are as good as possible.  This doesn’t mean that sometimes there are patients and cases that you take home with you, and that in certain life circumstances it can affect you.

Dani Martí: I think it's impossible not to take it home, and you are never fully prepared.  You live with it. In my case, I have spent almost 20 years just looking after patients in the ICU, where we have often experienced very critical situations and seen people die.  I like the adrenaline and I wouldn't be a physiotherapist if I weren’t in the ICU, because I love it, but at the same time it marks you forever. In an ICU, you see the worst and most unexpected, and in my case it means that I am always in a state of alert.  It’s a matter of managing this all well.  It helps you to avoid living in parallel to reality, to be more aware.  

Sara Laxe: When a patient is happy and thanks you. For me, it’s like winning the lottery, especially when a person has serious functional problems, and even so, they see you have helped them.

Dani Martí: As an ICU physiotherapist, seeing how patients improve with my assistance, despite not being able to verbalize it. As a coordinator, seeing that our team is becoming consolidated and how its potential is growing in the hospital.

Sara Laxe: I always wanted to be a doctor. I studied medicine and had to choose a speciality, but I wasn’t sure which one.  What I did know is that I liked the global assessment of patients and one of the specialties that allowed me to do this was family medicine. At the same time, I liked being in the hospital, the energy you feel there, and rehabilitation medicine offered me this option.

Dani Martí: I wanted to do medicine and wanted to be an A&E doctor, even a disaster doctor, but for personal reasons I could not see myself studying for so many years. Also, I was doing a lot of sport at that time and it was linked to physiotherapy.  When I went to France, I did not know that critical care physiotherapy existed, but when I got there they put me in an ICU and it was the combination of both things. I was a physiotherapist in a constantly changing environment. I found that adrenaline that motivated me.