Capitalizing on the Continuum: Module 1 – Learning Mantras

Explore the concept of learning mantras with Steve Kerschke, PT and Brad Dexter PT, DPT of Kintinu Telerehab. Find out how these six key components, or “mantras”, are an essential part of any learning journey.

Speakers: Steve Kerschke, PT and Brad Dexter, DPT

 

Video Transcription

Introduction

Brad Dexter PT, DPT [00:12]:

Welcome. I’m Brad Dexter. I’m a Physical Therapist with Kintinu Telerehab.

Steve Kerschke, PT [00:17]:

Steve Kerschke, Director with Kintinu Rehab, and we’re both on the QLI side too, so it’s nice to represent both organizations.

Brad Dexter PT, DPT [00:25]:

Absolutely. And today, we’re going through a module that covers our learning mantras. This is something that’s really near and dear to our heart because everything that we do, not just from a therapy aspect, but also in work and life, I think there’s key components of learning. So we’ve kind of put this together within QLI, within Kintinu Telerehab with the intent that it’s not only for us to use to coach other people therapeutically, but also to be coached and shaped by in our own lives too.

Steve Kerschke, PT [00:58]:

Well, yeah. And even in our own lives, you and I are our coaches of our kids and even our family, friends, whatever it may be, so hopefully whoever’s listening to this can take away some nuggets for application into whatever it is that they see learning as being a big part of whatever they do. It could be fitness. It could be work. It could be lots of different opportunities I think for application, which is really what I think is exciting to us. It’s not just about the therapy world, even though we probably are going to use decent amount of examples of that.

Brad Dexter PT, DPT [01:32]:

Yeah, absolutely.

Steve Kerschke, PT [01:34]:

Great. Well, as Brad mentioned, we have broken down learning into what we call six components. We’ll call them mantras, a few interchangeable words here, but we’ve looked at it from three different ways… Excuse me, six different ways. And with that, we’re going to go through all six today, and we’ll expand a little bit more into what do all these look like and… Oh my gosh, it’s not working. I don’t know why that’s… There we go.

Brad Dexter PT, DPT [02:11]:

So just pick up where you were or you can kind of say the line over and then…

Steve Kerschke, PT [02:18]:

I don’t know why it’s not doing it. Oh, there we go.

Brad Dexter PT, DPT [02:21]:

Okay. So maybe go back where it’s zoomed in here. Yep.

Steve Kerschke, PT [02:25]:

So I would start with you kicked it over to me and I basically jumped into the mantras, right?

Brad Dexter PT, DPT [02:31]:

Mm-hmm.

Steve Kerschke, PT [02:32]:

Not the application of beyond rehab. We can leave that. We’re good?

Brad Dexter PT, DPT [02:40]:

Yep, we’re good on that.

Steve Kerschke, PT [02:41]:

Hold on. Let me make sure it’s going to work.

Brad Dexter PT, DPT [02:48]:

I mean, you had that part where you’re talking about… You said three components and you said, excuse me, six. I mean, you could probably start there.

Steve Kerschke, PT [02:53]:

Start there, right?

Brad Dexter PT, DPT [02:54]:

Yep.

What Are Learning Mantras?

Steve Kerschke, PT [02:58]:

All right, so we are going to dive into these six components of learning, which we’ll talk a little bit about it in terms of components, mantras, whatever they may be, but we’ve put together the important ones. It’s not necessarily meant to be all inclusive, but as you start to dig into this, you can see that different concepts of learning and skill building hopefully fall underneath the components that we have found to be helpful. We’ve also spent a decent amount of time with the names of the mantras, so hopefully they are something that is memorable. You can see we put some icons with it that sometimes they need some explanations, especially that motivate with meaning one, that little fancy heart in there is sometimes hard to see, but hopefully this comes with some visuals and a few different aspects that make them memorable and something that can be applied more broadly.

Around that center component, one thing that’s really, really important is that these mantras are not linear. We don’t believe that learning is linear, and we know that there are different mantras at different periods of time that are going to be important, and we might draw upon them as coaches or as learners, depending on the situation. But for the sake of today, we’re going to start with two that we often jump into and two that we find if they’re missed the other four oftentimes can be a bit challenging. So if it’s okay, Brad, I’ll go with motivate with meaning…

Brad Dexter PT, DPT [02:58]:

Go for it.

Steve Kerschke, PT [04:28]:

… and identify the interferences. And I know you have your favorites after that.

Motivate with Meaning

But let’s just start with motivate with meaning. And like I mentioned, this icon has a subtle heart to it, and that’s one of the things I use to remember this mantra. And really what we mean by this is there’s always a driving force behind learning, there’s always a driving force behind adopting a new skill. And at the end of the day, does someone have a sense of purpose and willingness to devote the energy and the effort that’s necessary to adopt a new skill? And I think Jill Gunther, a colleague of ours, really said that and that resonated with me. Does someone have the energy and the effort available and are they willing to commit that to adopting a new skill?

So before we start with getting into some of the tangible ways that we help people, we have to start with this one. And when it’s not in place, oftentimes we see people struggle and it’s usually the first thing that we go back to down the road, and I think there’s lots of different applications for this that we see in the therapy world and even in our own lives.

Brad Dexter PT, DPT [05:46]:

Well, even I think about in other modules we’ll even talk about this concept of transitioning ownership and autonomy to the individuals. They kind of go through the healthcare process through the continuum of care. It really starts with this. If you’re not tapping into the thing that’s really truly motivating them or giving them purpose, it’s really hard to hand off that ownership.

Steve Kerschke, PT [06:12]:

Well, and I think sometimes it’s really obvious and other times as providers or as coaches, we have to really dig, or even for ourselves, we have to really dig and ask a few questions and get underneath the surface a little bit to really understand why it is someone wants to do something or wants to learn something. And I think even as a clinicians, we talk about people want to, want to walk again. If you have a spinal cord injury, that’s one of the first things that we hear. But when we start asking why do they want to walk again, usually it’s tied to something deeper and something more intrinsically motivating to them that it’s not necessarily about the walking, but it’s about the thing that they get to do if they’re able to walk. So I would say we have to make sure that we don’t take things at face value and that we really dig and understand what is that intrinsically motivating component that may or may not be front and center right away, and I think that’s a big, big takeaway here too.

Brad Dexter PT, DPT [07:11]:

Yeah. I mean, just things are popping into my mind here and it’s not just about walking, but it might be about, hey, being able to go enjoy the birds chirping in the woods as I hike through them or being able to go outside and chase my kids around or take my dog for a walk or any number of those things.

Identify the Interferences

Steve Kerschke, PT [07:28]:

Absolutely. So this is our first one. We’ll move on to the next one, which is identify the interferences. And for us, what this really means is there’s usually some sort of barrier in place when it comes to taking on a new skill or learning something. And that could be an environmental barrier, it could be a physical disability, or it could be a skill issue, but usually there’s a factor or two, or sometimes multiple factors, that can potentially get in the way of moving forward. And first and foremost, we have to identify what those are and, if possible, start to eliminate them. So if there’s a few things that we can say like, “Hey, don’t worry about that component yet, and don’t worry about that other one. Yeah, this one we should appreciate,” but if we can eliminate some of these barriers, all of a sudden the opportunity for learning goes up.

And also if we can’t eliminate those barriers, there’s some things that we might do down the road to almost work around them and come in the back door on them. So I think these interferences, there’s many of them. And again, same with the motivate with meaning, we have to remember that an interference that may or may not be present today, tomorrow, or the next day could pop up and be more in the picture or it might simply go away for various reasons. So neither of these are static, as we mentioned. And keeping that in mind, and we always need to be checking in on the interferences and making sure that we have a clear understanding of what is and is not affecting someone’s performance.

Brad Dexter PT, DPT [09:05]:

Yeah. I was just thinking. I had a client that I was working with recently and got on a Zoom call with him and asked him about his home exercise program. Pretty typical thing for a physical therapist to do. He was having a hard time getting to the gym to do it. It was hard for him to make it there. It’s not that far away from his apartment. I could have taken that at face value and just said, “Well, hey, come on, do better, try harder, and it just didn’t work like that. So I dug a little bit and I was like, “Hey, what are the things that are stopping you from getting out?” We started talking through a few things and one of the interferences was it takes me 20 minutes to get my shoes on and it’s just not worth it to me. So we looked at a couple pairs of shoes that might be easier. He ended up buying a pair and he said… The next time I got on, he just said, “These were life changers.”

It doesn’t seem like something that complex, but taking the time to actually figure out what’s a barrier for you, what’s the interference here, and identifying that with him has led to him being more successful with a home exercise program.

Steve Kerschke, PT [10:19]:

Yeah. Great therapeutic example. So another example that maybe a bit more tangible is with my son, Charlie. My son Charlie wears glasses. And as a parent outside looking in, I can see all of the reasons why I think Charlie should ditch the glasses for contacts. So in that case, the motivate with meaning for me is convenience and he plays sports, so then he doesn’t have to mess around with those. And we’ve been trying to get Charlie to ditch the glasses for some time now. I guess you can probably imagine where we’re at with that based on how I’m telling the story is Charlie’s still wearing glasses, and I think it goes back to, one, motivate with meaning. He’s basically like that, “I have no desire first, first of all, to get rid of my glasses,” and so that in and of itself is an interference. I haven’t checked the motivation box with him, but some of the other interferences are he’s a little bit sensitive to the eyes and there’s a few other factors around whether or not it is actually more convenient for him.

So until I started digging in on motivate with meeting and identifying some of those interferences, we’re never going to get him to adopt this idea of ditching the contacts and… or ditching the glasses and going for the contacts, so a more practical example maybe.

Brad Dexter PT, DPT [11:37]:

Yeah. Well, I’m still sporting the glasses too.

Steve Kerschke, PT [11:40]:

Yeah. I know, I see that. You’re not helping. Every time I talk to someone about it, they’re like, “Oh well, no big deal.”

Brad Dexter PT, DPT [11:43]:

Oh, I tried contacts once upon a time and just couldn’t touch my eye.

Steve Kerschke, PT [11:49]:

Well, he’s there, so that’s a definite interference.

Brad Dexter PT, DPT [11:51]:

Yeah. I feel him.

Steve Kerschke, PT [11:52]:

Where do you want to go next?

Step Outside the Comfort Zone

Brad Dexter PT, DPT [11:53]:

Let’s go over to step outside the comfort zone. So to me, I often think about this in terms of intensity. I usually have this like visual in my mind of walking along the edge of a cliff. And if you’re on the edge of the cliff, you’re safe, you can kind of enjoy the view. But if you fall over the edge of the cliff, it’s like failure. On the other side of things, if you’re too far from the edge of the cliff, you can’t really like take in the sites. You can’t kind of feel the energy. You’re not outside of the proverbial comfort zone. So like when we’re training on something from a PT aspect, we got to kind of walk this line. We can’t be over in the comfort zone. We also don’t want to be over in the failure side of things. We’ve got to be right on this edge of the cliff, just outside of that comfort zone to actually get some amount of change.

I also think about that in terms of my own life. So I’ve done a lot of like DIY projects. I was just telling you recently there are a lot of things that I do that I feel a little bit insecure about because I just don’t quite know what I’m doing, and I’m definitely not in my comfort zone. I also take a lot of steps to make sure that I am not going over the edge of the cliff, to make sure that I’m not failing. I watch a lot of videos. I consult people. I’m trying to learn, and I’ve gained a lot of skills just through taking on a new project, something that’s different, it’s outside of my comfort zone, and learning there. If I hadn’t done that, I might still be afraid of taking those steps, and I obviously wouldn’t know what to do either, but it’s given me some tiling skills and some different woodworking skills that…

Steve Kerschke, PT [13:44]:

Well, you’ve alluded to several other mantras, which we can definitely come back to.

Brad Dexter PT, DPT [13:48]:

For sure.

Steve Kerschke, PT [13:48]:

When I think of comfort zone, and you alluded to this too, is the kind of the feeling that you get when you’re there. It’s not too easy and it’s definitely not too hard, it’s kind of just right and it’s a little bit almost invigorating to a degree and it keeps your attention and it keeps you engaged. So you can see on our slide here, we have this idea that we don’t want people to be bored, but we don’t want them to be frustrated to the point where they just give up. And sometimes, finding that level of intensity or the level of complexity of a task is a bit try of trial and error. We don’t always know. Sometimes we’re going to overshoot or sometimes we’re going to undershoot it, but if we find the right degree of intensity or difficulty, we’re going to get some level of engagement.

But as a result, we should also get some growth and learning. So back to this like dynamic non-linear component is that it takes us all the way back to a different spot where we have to redo and up the ante and find a different quote, unquote, “step outside your comfort zone limit.” So that’s kind of the fun part too.

Brad Dexter PT, DPT [14:59]:

Yeah, absolutely. Again, I’m coming back to the therapy side of things too, but if we’re not pushing people outside their comfort zone, how do you get better? There’s a very simple physiological concept of the body responding to the stresses that are placed on it and you see that from like a baby growing into a child. So as they start rolling over or crawling, they strengthen bones and muscles to get to a point where they can walk and run around and jump and hop. We do the same thing if you’re strength, training or training for a marathon, the body’s going to respond to the stresses that are placed on it. And unless you get outside of a comfort zone, it’s not going to get better, so to say.

Tie it to the Task

Steve Kerschke, PT [15:40]:

Yeah, absolutely. Well, you’ve kind of alluded to what I think is another… a good mantra and that’s tie it to the task. Talk a little bit more about how maybe that ties into your approach as a therapist and maybe even with your DIY projects. I think you’ve already brought this concept in without actually talking about it.

Brad Dexter PT, DPT [16:00]:

Yeah. So to go back to something we were talking about earlier, if someone wants to learn how to walk again, ultimately we’ve got to walk to work on that. There are lots of components that go into walking like, hey, you got to be strong enough. You’ve got to have the balance, maybe some amount of sensation and coordination to make that happen, and it’s good to work on those things. We need to break a complex task down into smaller pieces that are tangible and that we can actually work on and get better at, ultimately to get better at walking. But unless we’re tying it to the task and walking, we can’t actually get better at that thing and so we have to find ways to do that by offloading weight or putting a person in an environment that they’re going to be successful actually walking.

DIY project wise, for me, I can watch videos all day long. I can talk to people about how to lay tile, how to put backer board up in your shower or how to waterproof it, but unless I actually get my hands on and do that thing, I can’t really learn. Right. So I maybe could tell someone all the steps, but I don’t actually know.

Steve Kerschke, PT [17:14]:

Well, the other thing that I think about is the environment is not something that we can simulate. Let’s take walking. We can walk all day in a controlled environment in our clinic or in someone’s home, but we can’t always mimic what it’s like to go walking at a busy concert or in the grocery store or when there’s distractions and there’s other factors, uneven surfaces, that are unpredictable. When we don’t train people to navigate those things, there’s always going to be a gap in their performance. And as coaches or trainers or therapists, we have to understand that unless we actually see them in that actual environment, there’s a gap in what we think they may be able to do. We can make some assumptions about that and oftentimes we can get pretty close, but there’s still going to be some things that we miss. The other thing that I think about is your DIY project. Let’s say you’re taking out some of your existing wall for that backer. You don’t know what’s behind that wall.

Brad Dexter PT, DPT [18:19]:

No.

Steve Kerschke, PT [18:19]:

And as an inexperienced DIY construction person…

Brad Dexter PT, DPT [18:22]:

Been there.

Steve Kerschke, PT [18:23]:

… you don’t know how to navigate that. Assuming that it’s perfect, great, right down the middle, good to go, but it doesn’t usually happen that way. And because you’re inexperienced, that could trip you up and it could affect your performance or your effectiveness in completing that task.

Brad Dexter PT, DPT [18:40]:

Yeah. You talk about, I’ve been thinking about this a lot lately because you’re coaching baseball, and I’ve just been listening to you talk about coaching the kids. And you can have them go out and throw to one another to work on their arm strength and their accuracy, you can take them to the cage, and you can hit, but unless you put them in like specific game like situations, they’re not going to know what to do when the game comes around. So balls hit to the short stop and you got to run around first base, what do you do with that? Balls hit the center field and you have runners on first and third, where do you go? Who’s the cutoff man? You have to teach all of those specific scenarios, and I really think that translates into tie it to a task [crosstalk 00:19:23].

Steve Kerschke, PT [19:22]:

Yeah. I think the other thing that I found hard is how do you teach it, and then also get the repetition? Because the components of breaking it down allow us lots of repetition and efficiency, but it takes away the spontaneity, and I think that’s really… The great coaches and the great teams and trainers find a way to balance that and figure out the secret sauce to incorporating that into training.

Support for Success

Brad Dexter PT, DPT [19:50]:

I feel like that’s a really good transition to having the right amount of support for success.

Steve Kerschke, PT [19:55]:

Absolutely. So the other thing that we talk a lot about is, and we’ve talked about it to different degrees even within our discussion today, is there’s different levels of support that can be provided and it can be external support in the terms of a coach or a mentor or a therapist, and then there’s internal support in terms of how do we self-evaluate and self-analyze our performance or project what our performance is on the front end and then see what it looks like on the back end. So it can be internal or external. And we talk about it in terms of providing just the right amount of support, especially on the external side. Then on the internal side, do you do it at the right time and can you do it in a way that it doesn’t get in the way of your performance and get in your own head so to speak?

But at the end of the day, the amount of support that is available or that is provided can start to offset some of those other aspects of learning that we’ve already talked about. So when there’s lots of interferences in place, if we bump up the support, sometimes we can start to hack that system in a way that they’re not as big of an issue. Or when the complexity is a bit higher or we’ve introduced some different challenges that we know are going to start to create some learning opportunities, if we jump up our support a little bit and make it at the right time and in the right amount, we can help people work through that, facilitate learning, and get on the other side of it. So this I think is one of the heavy hitters that you and I talk a lot about, and it can be used at different times and in different ways.

Brad Dexter PT, DPT [21:25]:

I mean, on a more large scale spectrum, you think about healthcare. We work in the catastrophic injury world and so there’s kind of different levels that people go through, ICU, acute rehab, post acute, outpatient, and each one of those has a different level of support, and it changes over time. And ultimately when people get back to a community setting, that support looks a lot different as well.

Steve Kerschke, PT [21:56]:

Well, and I think where people sometimes get tripped up is they just assume that when you work through that continuum, that the support should go away, and the reality is that’s not real life.

Brad Dexter PT, DPT [21:56]:

Absolutely.

Steve Kerschke, PT [22:06]:

You and I have coaches and trainers in various parts of our life, whether it’s golf or whether it’s business coaching or whatever, so we all benefit from support, it just is all relative. So I think in healthcare, we have to think about it that way, just because someone works through the continuum doesn’t mean that the support should just be shut off and there’s ways to go around it to make sure that people maintain some level of maintenance or progress and that we also keep costs in check. But I think there’s a shift that needs to happen to account for that. All right. Let’s get to our last one. I’ll let you take this one.

Repeat, Repeat, Repeat

Brad Dexter PT, DPT [22:43]:

Yeah. So last one is power of repetition really. Repeat, repeat, repeat. Just going back to the comment you made about baseball, it’s hard to like take people through situational drills, but then it’s even more difficult to get the repetition that you need in those circumstances. DIY project. Hey, if I just do tiling one time, hey, I’m getting a lot of repetition within that time, but if I don’t do it for another five years, I’m probably going to have to look a lot of that stuff up again, consult people over again. So in order to kind of get things ingrained, we have to repeat them over and over and over again. So using that example of walking for the spinal cord injured patient, it’s not just one session of walking with them and expecting that they’re going to take that away and be fine with it, it’s repeating that movement over and over and over and over and over tens of thousands of times to get it down.

Steve Kerschke, PT [23:49]:

Yeah. I think the other thing that I hear you talk about is how do you help these individuals envision what repetition looks like functionally because everyone has different interferences or distractions or even priorities within their life that can be a constant tug away from maybe that goal of walking, so how do we provide some formal and structured opportunity for repetition with the right amount of support? But outside of that, how do we help someone envision how to get the right amount of repetition within the flow of their day so that it doesn’t feel like extra work and it doesn’t feel like they have to carve out 30 to 60 minutes to get that workout in? Instead, how do we help them really be creative with capitalizing on things that are more just organically happening within their day, and I think that’s, that’s a really important aspect of this.

Brad Dexter PT, DPT [24:43]:

Yeah. Well, we’ll touch a lot on just the power of habit when it comes to this. How do you create these small habits that just integrate therapy into your life on a regular basis?

Steve Kerschke, PT [24:53]:

We want to make it easy.

Brad Dexter PT, DPT [24:54]:

Right. Right.

Conclusion

Steve Kerschke, PT [24:55]:

Well, Brad, we are at the end here and have touched on all six components, and I think where the magic of this all happens is how you use them and where each one fits in at various times and paying close attention to which one do I have to work on here and which one do I need to start to think about or address, and sometimes go back to, and what does that learning journey look like? And as someone progresses and then maybe they level out, we get to do it all over again. So this is a really fun topic and I’m glad we were able to talk a little bit about it today.

Brad Dexter PT, DPT [25:30]:

Absolutely. Hopefully you guys can enjoy this and apply it for yourselves, and look out for more of our modules coming.

The Continuum of Care