Jane Brandenstein, PT

By Laurie Fronek | 8/14/07

Jane Brandenstein, BS, PT, is a specialist in rheumatology with the Centers for Rehab Services, a part of the University of Pittsburgh Medical Center, and a recognized expert on the role of physical therapy in the management of scleroderma. A member of the Association of Rheumatology Health Professionals (ARHP), she recently spoke with On Call's Laurie Fronek about her interest in scleroderma and about the advisability of physical therapists choosing a specialization.

Q. How did you get involved in working with scleroderma specifically?

A. I've been a therapist for 40 years. My third job was on the inpatient unit of a hospital with a clinical research unit that had a protocol for patients with scleroderma. At the end of the protocol, if the patients were in the hospital long enough, they had physical therapy and occupational therapy. So I saw a couple patients with scleroderma, and I just knew these people -- who at the time typically weren't sent for outpatient therapy -- really would benefit from rehab.

Scleroderma is an awful disease. It tends to hit women in their childbearing years and to affect their hands and face. "Scleroderma" means "skin tightening," but it really affects connective tissues in general. Their fingers tend to get really tight, almost like having on three pairs of rubber gloves. They can also get tightness in the face around the mouth and then not be able to open their mouth very far. Just as a way to understand, if you offered them a Big Mac, they wouldn't be able to get their mouth over it.

We started talking with the rheumatologist, who had been doing research on these patients since the 1950s, and we thought if we can get them stretching, maybe they don't have to get as tight, maybe they don't have to get as weak. I had had an interest in rheumatology since I graduated, because my first job was in a hospital that saw lots of people with arthritis. But it was the experience of actually working with patients that kick-started my interest in scleroderma.

Q. Is it important for physical therapists to specialize?

A. Over the years, our profession has gone back and forth. There have been times when we were all taught to be generalists: Every therapist ought to be able to do everything. If you work in an outlying area at a clinic that sees 12 to 15 patients a day, you really need to be able to work with anybody who walks in your door. Even though I'm at a center associated with a university and specialize in rheumatology, I still need to be able to treat any patient. On the other hand, there were times when PTs were urged to be specialists. The thinking is that patients would feel better if they see a therapist who specializes in their particular problem area -- the neck, for example, or the knee.

Q. That's interesting. So the philosophy has shifted back and forth over the years?

A. Yes. Here at the University of Pittsburgh, for example, they encourage students to do clinical work in a lot of different settings. But some students, by their third year -- their third year is a full-time internship -- have developed a specific interest. For instance, they might be especially interested in working with women's health issues and want to learn how to manage pelvic pain and pregnancy and lymphedema and those kinds of things that a lot of people don't even know physical therapists do. Some might want to work in sports. Some people say, "I really like working in the hospital," but some don't like it. A lot of them will develop an inpatient/outpatient bias. Some will like home care. That, I think, is the best part of our profession, that you can choose what you want to do. And you may move from one area to another over your career.

Q. How can students or working therapists pursue a particular interest?

A. If students have an identified interest, they should try to set up one of their clinical rotations in that specialty, especially early on when they're in the clinic maybe 10 to 12 hours a week, to see if that's what they really like before they narrow themselves completely. The same thing can be done on a formal or informal basis when you're out in the working world. If a physical therapist was interested in scleroderma, for example, they could call me up and say, "Hey, Jane, could I hang out with you for a day?" I have had people do that -- come and work with me for a day to see what I do and how I do it.

There are also graduate programs in physical therapy, where you can specialize. You could also do it by taking weekend continuing-education courses or setting up an internship where you spend two to three hours a week with a therapist whose specialty you want to learn.

Q. So you can set up your own internship?

A. Oh sure.

Q. Are there areas in which you think we need more therapists to specialize?

A. Looking at the population getting older, I would think there's need for more, good long-term-care rehab, therapists who are interested in things like stroke or Parkinson's. It's not my area of focus, but somebody needs to do it -- because I might need them!

Laurie Fronek is a freelance writer who lives in Seattle and a regular contributor to On Call. She has done the interviews for On Call for the past nine years.