“Easy. You may feel your muscles stretching a bit, but it’s okay. I’ll take care of that.” The patient’s upper arm was held up in one hand, the wrist cupped by all five fingers of the other, so that her glenohumeral joint could be rotated gently in rhythm, as it was now, overseen by a pair of eyes full of focus and care behind the silver rim of spectacles. In the Rehabilitation Department of Peking Union Medical College Hospital, on the 7th floor of its outpatient building, Ms. Yang was receiving physical therapy for her left shoulder, which could not be elevated to the level for radiotherapy after breast cancer surgery. Her therapist was a man named Chen Ang.
Chen has been working in the PUMCH Rehabilitation Department for a decade, providing professional rehabilitation services for a wide range of physical malfunctions and building close relationships with many of his patients like Ms. Yang.
Not a Massage Therapist
One of China’s early rehabilitation undergraduates, Chen studied at Capital Medical University and graduated in 2011. In his sophomore year, he began to work as an intern at Beijing Bo’ai Hospital, China Rehabilitation Research Center, and then moved on to PUMCH after graduation, pursuing his Master’s degree with Chen Lixia, director of the Rehabilitation Department. As her earliest disciple, Chen could be said to have had a “head start”.
Back then, the study of rehabilitation in Chinese universities had a shorter history than other areas of academic interest. When Chen was admitted to Capital Medical University, there was only one class for the entire enrollment of the year – less than 50 students. In his junior internship, the hospital facilities were far from enough to meet the needs. Chen’s days revolved around one diagnosis and treatment bed and several sets of rehabilitation equipment to help different patients. In times when there was only a dim public awareness of health, the term “rehabilitation therapist” was not well known. Chen would be addressed by other titles such as “masseur” or “massage therapist”. The young and aspiring man was uncomfortable at first. He felt that what he was doing was not understood, but as he saw the patient’s improvement from being helpless to confident, bedridden to slowly turning over, sitting up and even to standing without any support, a sense of accomplishment washed away whatever discomfort had been caused by all the misunderstandings. “For many patients, rehabilitation may take up to six months, and it takes everyday exercise. They are more like friends to me than patients.”
Repeating over and over what is normal to healthy people may not be as easy as it seems. Rehabilitation is a long-term process. If you don’t pay attention to details, it may not only be ineffective, but detrimental to the patient. Therefore, “rigor”, “detail” and “patience” have become the principles that Chen must hold at work. The most fundamental technique is the maneuver of the glenohumeral joint that requires applying the right amount of force to the shoulder, “Straighten out your elbow, relax your body, easy on your wrist”. Chen would repeat these key points hundreds of times a day. And he was very strict in guiding patients to do these every time, with little deviation allowed. “The way I see it, rehabilitation is like a ‘sculpturing process’. The more careful you are when carving those lines, the more vivid your final work will turn out to be. When each action is done properly with the right muscles involved, you will see a real difference at the end of the day. For patients who come to work on their legs, I will also consider the toes and the body in general, instead of just looking at the affected area. The strength or weakness of the toes can greatly affect the gait. “ Chen’s almost paranoid rigor has brought remarkable changes to his patients, winning more of their respect and recognition. check this out
Beyond hospitals
Rehabilitation medicine aims at eliminating and alleviating physical dysfunctions, losses, or deficiencies. It is the “lubricating oil” across medical divisions in hospitals. Other hospital departments may save lives whereas the rehabilitation department works to improve lives. Take people who had strokes for example. They might be resuscitated through some form of surgery, but they might also be left with various physical or cognitive disabilities which, if untended to, might render them dependent. One of the goals of rehabilitation is to help patients recover their abilities to live on their own as soon as possible, taking the burden off of their families.
Chen usually helps nearly 3,000 patients on an annual basis. As he worked with more patients, he found problems. Many patients who had done well in his hands were found to have a lot of regression during check-ups six months later. Some patients could walk independently in the rehabilitation room, but when they were discharged, they became home-bound again. This problem arose as not enough rehabilitation resources were made available, a clear gap between hospitals, families and communities. When they returned home, patients and disabled people lost access to the correct and effective rehabilitation exercises that they did back in the hospital. “The quality and durability of rehabilitation largely hinges on work outside the hospital.”
To solve this problem, Chen began to engage with his classmates and colleagues in supporting communities, nursing homes and special education centers in 2014, and providing free rehabilitation training and guidance for patients in need and community medical workers. He taught the affected families, community workers, and volunteers how to use daily objects as tools. “An empty plastic water bottle can be used as a prop for grip training. As the grip becomes stronger, empty cans can be used instead. The things we use in everyday life may be good rehab apparatus.”
In 2016, Chen spent his holidays studying community and senior rehabilitation practices in Tokyo. He learned that prior to discharge from a rehabilitation center or hospital, local professional and technical workers would visit the individual’s home and offer suggestions on improving accessibility to facilities and making things easier. They would also provide guidance and help both physically and psychologically. This was done not only in the hope that the individual can live independently, but also to help with the return of social interactions. “Good rehabilitation is not only to restore the patient’s lost or damaged physical functions, but also to cultivate their confidence in social interactions.”
To this end, Chen also learned counseling. Strict as he might be as a rehab therapist, he is all attentive and supportive to the patient’s frame of mind. “In their rehabilitation sessions, patients and disabled people may spend more time with me than with their families. It is an enduring process, both physically and psychologically, and I want to help them overcome obstacles and get out of trouble as much as I can.”
Community-based rehabilitation
As an intern, Chen had provided physical therapy for children with cerebral palsy. And he still remembers a young patient by the name of Kang Kang, a cute little boy with fair skin and soft curly hair, who worked very hard to follow Chen Ang’s instructions step by step in each session. In one of the sessions, Kang Kang suddenly burst into tears and, when asked, said that he was bullied by someone at school due to his uncoordinated movements. Though effective, the sensory integration approach usually involves repeated, one-on-one therapist-based practices, with the absence of playmates the same age. Once back at school and in social activities, the child tends to get nervous and intimidated. “Many children affected by cerebral palsy physically, not mentally, like Kang Kang, may end up quitting school or resorting to day care centers just because they feel unworthy or rejected by other children.”
In this process, Chen constantly changed the way he did things at work. From the literature, he learned that the per capita cost of institutional rehabilitation in other countries approximated 100 US dollars, achieving as small as a 20% coverage, whereas community-based rehabilitation only cost 9 dollars per capita, with an astounding 80% coverage. He was determined to promote community-based rehabilitation. “Rehabilitation resources in China have always been limited given the huge number of patients in need. At this point, it is very difficult to offer hospital rehab services with a focus on life-oriented and self-care tasks. We need to find breakthroughs elsewhere.”
In 2017, as part of the PUMCH Talent Training Program, Chen studied children’s rehabilitation and recreational therapy in Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA. This experience, along with his own at work, led to his design of nearly 100 games and activities which are easy to use, effective and fun in home settings, without the need to rely on professional help or complicated apparatus. check this out
These simple rehab activities gave Chen and his partners a new direction in helping people with disabilities. Chen learned that there are nearly 500 “Activity Centers” in Beijing, offering a wide range of public services to address the needs of local disabled communities. He decided to start from there. While working with the “ Activity Centers”, Chen designed a little game that involved pinning buttons on cloth boards to represent subway stations. “Taking buttons out of the box can help the patient improve the flexibility of their fingers, recognize the names of subway stations, and train memory and cognition. When they learn the map, remember the names of the stations and feel a sense of accomplishment, they will want to go out into the real world and try it for themselves. For patients who suffer from strokes or other disabilities, such little games can boost several levels of function at the same time, at a cost of only a few yuan.” In addition, it is also supplemented by a social system. After completing one round, you get one token and then go on to play other rehab games. When you have up to 10 tokens, you can get a free rehabilitation treatment on weekends. “This kind of rehabilitation treatment is provided by our volunteers free of charge. This way, the patient will be motivated to interact more.”
Chen and his partners have been doing this for seven years. The original two-person operation has become a 100-strong team, serving nearly 300 disabled people on a daily basis. “As the numbers of elderly and disabled people are going up, so are the needs for rehabilitation. The government is paying more and more attention to the development of rehabilitation medicine. It is a joy to be part of it, to use what I have learned, and to find my place in society.”
Chen Ang:
He was born in Beijing in 1989 and works as the Chief Therapist at the Peking Union Medical College Hospital. He is a national certified Grade II counselor who has won the honorary titles of “Beijing Youth Model 2019” and “Expert-nominated News Personality for Helping the Disabled 2020”.
Picture: The 81 Rehabilitation Center in Chengdu, China, as part of Health China Plan 2030 promoted by the State Council. Rehabilitation medicine has gained more attention over the years with social development. (photo by Zhang Ximeng)
This story is part of a series of articles published as an exclusive editorial exchange between China Press for People with Disabilities & Spring Breeze and ABILITY Magazine
Translation provide by Jing (Jenny) Hu
This story is part of a series of articles published as an exclusive editorial exchange between China Press for People with Disabilities & Spring Breeze and ABILITY Magazine
