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Christine Robenalt PT, MPT is a physical therapist who is leading the way for treating pediatric physical therapy patients by implementing integrative care. By working with children in an integrative and holistic manner, she can better address their current impairments while also reducing the likelihood of unnecessary disease developing later in their lives.
Christine is the author of the pediatric chapter in the Integrative and Lifestyle Medicine in Physical Therapy textbook, edited by Dr. Ginger Garner and Dr. Joe Tatta. The book provides critical tools and resources to improve a person’s health using Integrative and Lifestyle Medicine across a person’s life span.
With Integrative & Lifestyle Medicine, it can be difficult to know where to start. This is true for adults and children, alike. Often, Christine begins by working with the nervous system, through concepts like Polyvagal Theory. Her goal is to help her patients find a sense of safety, so that healing is finally possible.
Creating a sense of safety (and belonging) in the clinic is a critical first step to providing integrative care in pediatric physical therapy. But it doesn’t stop there, the kids and their families need to learn tools to maintain or recreate that sense of safety outside the confines of the physical therapy center.
By teaching integrative care in pediatrics, you can empower kids and their parents or caregivers to create and maintain their own sense of well-being. As they find more safety in their environment, they’ll have more opportunities to learn, grow, and heal.
In this interview, Christine and Dr. Garner cover several tools you can use with your next patient or yourself! Within moments, you’ll find more peace and calm regardless of the circumstances.
Listen to the podcast or watch the YouTube interview today.
For those of you that prefer video, watch this discussion around how to bring trauma-informed concepts into pediatric physical therapy practices. You’ll get amazing tips from Christine Robenalt, PT out of Denver, Colorado.
You can also check out her chapter, “Pediatrics” in the book, Integrative and Lifestyle Medicine in Physical Therapy.
Christine is a physical therapist, wife, and mother to three children. She mainly works with children, but also has a strong interest in nutrition, mental health and addressing pain management for all. Since 2013, she been a pioneer in the use of Telehealth to provide children in rural areas with physical therapy services.
She incorporates her practice, additional training in nutrition education into her pediatric sessions to help kids with constipation, pain and reflux. She holds an endorsement in Infant Mental Health as well as certificates in ACT for Chronic pain, 200 hr Yoga Teacher training and mindfulness. She values a multidisciplinary approach and actively works to build bridges between patients, providers and families. In efforts to better support all parents she hosts a podcast entitled, Sparkler Parents, where she discusses ways to create more present moment awareness with your children.
00:03 Dr. Ginger Garner: Hi everyone and welcome. I am here with Christine Robenalt and we are going to talk about pediatrics and integrative and lifestyle medicine. This is all about longevity across the lifespan. So I am really excited to be talking about pediatrics. One of many favorite topics that I have. So welcome, Christine.
Christine Robenalt:Thank you for having me, Ginger.
00:39 Dr. Ginger Garner: Yeah, I’m really glad that you’re here. I’ve been asking this question of many of the authors in the Integrative and Lifestyle Medicine in Physical Therapy text. So I’m just curious to know how you came to PT and how you particularly came to pediatrics, which is, I think, a really special area of physical therapy. And it would seem like you have a particular passion to go into peds. So tell me your story.
00:56 Christine Robenalt: For sure. So I think when I was in the third grade, my teacher had us line up because she was pregnant and would, she’d all have us give her back rubs in the during movies and stuff. And I recall, I don’t know if this is true, she asked me to come back twice.
So since the third grade, I have really wanted to do something with body work, but I also wanted to be a psychologist or a teacher or a nutritionist. And then I found physical therapy and I found out through the school, even though I didn’t know at the time that I get to be all of those things. And really, I love my job so much. I can’t imagine myself doing anything else. And it’s just been a real blessing for me to be able to have such an opportunity.
I didn’t start off in pediatrics. I knew I wanted to be in PEDS, but it was kind of hard. I graduated in 2001 and where I was living, you were pretty much at the children’s hospital or you weren’t. And that’s kind of hard to get in as a new grad.
So I went and did things in skilled nursing facilities. Then I became a contract therapist. And so I’ve worked in over 50 different facilities in Denver, which really allowed me to do a ton of things. My first experience with telehealth was at the VA and working in the schools and doing different things. Then I found pediatric home health and really fell in love with that. So I do think that my ability to be a jack of all trades for about 12 years was to my benefit.
And I really picked up, I knew it from the beginning, but I really got to see that physical therapy is physical therapy is physical therapy, no matter what setting I’m in. And all my adult training helped me out as a pediatric therapist. And if I were ever to go back into adults, I’d have a whole nother perspective now working at it developmentally. I don’t think I’ll be doing that, but if I ever needed to. Yeah. So that’s my story.
03:11 Dr. Ginger Garner: Oh, gosh. Well, that’s interesting because I didn’t know you weren’t in Peds to begin with. I want to share a little bit more with the audience. Sometimes I do this in the beginning, but for the listener, Christine is a PT, a wife, a mom of three. Yay to moms of three out there, three kids. I also am a mom of three. You do get to be a nutritionist, you do get to be a therapist, a teacher, to use psych-informed principles and trauma-informed principles in your care. Christine’s been a pioneer of telehealth and has been doing that for a very long time. How long did you say you’ve been doing telehealth with peds?
03:57 Christine Robenalt: Yeah, now about 10 years, so 2012, 2013.
04:02 Dr. Ginger Garner: Yeah, so way before the rest of us had to do telehealth in COVID. She incorporates a lot of nutrition into her pediatric care. She works with kids with constipation, pain, and reflux. She also has training in infant mental health, which is amazing, and A.C.T. for chronic pain, as well as in yoga. Obviously, Christine, you value a multidisciplinary approach, and that means building bridges with patients, providers, families. And there was another thing. You have a podcast too, right?
Christine Robenalt: I do.
Dr. Ginger Garner: Right? And a dog.
04:44 Christine Robenalt: Yeah, I’ve got my dog, my podcast. Yeah. Sparkler Parents is my podcast that I’m actively doing right now, like five to eight minute little snippets to try to create more present moment awareness as a parent, but as a therapist too, like, you know, if you hold a sparkler with your kid, you’re not going to like, give it to them and walk away, right?
So it’s not like you’re leaving them, but you’re also hopefully not holding it for them and you you’re letting that child have that experience and, and joining in with their delight and really being with them. And when that sparkler is done, it’s done. And so whether it’s a good experience or a bad experience, if you want to use those value-based words, you’re there in that moment with your child.
And that really is what I try to do as a pediatric therapist. And I try to put as much into the parents’ and the caregivers’ hands. I look at it more like I have a flashlight that I’m holding and, and it’s the parent and the child that are on that path. It’s not me at all.
05:53 Dr. Ginger Garner: Yeah, yeah. Like the guide on the side.
Christine Robenalt: Yeah, for sure. Versus the sage on the stage. Yeah.
06:01 Dr. Ginger Garner: So then. You mentioned the podcast, the nutrition, your integrative approach. What would you… It’s hard to say, like, what’s the thing in physical therapy that keeps you…coming back every day that, you know, makes you want to get out of bed in the morning. But what would that be?
06:23 Christine Robenalt: The relationships or the human experience. I think I didn’t know going into physical therapy just how much it would impact me, how much I have grown as a person, but all these tools and things I’ve acquired and learned, I first applied to myself. And I mean, yoga is a good example, but even thinking about the nutrition and lifestyle medicine, my father passed at 54, diabetic, 80 pack year smoker, stroke, two amputations.
Like I’ve seen the other side, I don’t want that for myself or my family. And so that really put me on the path of what can I do right now? And how important are these lifestyle, oh, it’s approved by the FDA. Oh, it’s, you know, everybody’s eating it and like, it must be okay. And without getting too political, like, maybe not. Maybe this isn’t actually okay for me and for my family and how I wanna feel.
And so when I started noticing things in myself and whether it’s nutrition or sleep or even just how my nervous system is running. So when I was younger, if you think I talk fast or loud right now, this is you know, slow. I had no awareness. I had no awareness of me talking so fast that people couldn’t understand me into college.
And so understanding where my nervous system is, helps me better understand the little ones that I work with today, when it’s not quite making sense to the parent, they don’t understand why their child is that way, what’s wrong with them. And I’m here as an example to say that we can develop this awareness and this acceptance of all this sensory information coming in and being received from the inside teaches us. And we can only learn from it if we are present and calm. And then that’s when it starts making sense. And this is the same for the children that I work with, it’s the same for you and for me, for us as adults, but I think we take that for granted. And I really try to keep that in my present moment in my mind, that how important it is to slow down and to be aware of what’s happening.
09:01 Dr. Ginger Garner: That makes me think of…when I was looking in your chapter in the book, you’ve got a lot of great information in there.
Christine Robenalt: Thanks.
Dr. Ginger Garner: And yeah, and I wish I could show, you know, the audience. Yeah. It’s easier to show the cover. It’s harder to show them all the cool things, but I can open up, look at the cool graphics in here and in the Peds chapter. But when you were mentioning noticing your own slow, you know, slowing your own nervous system down and doing that for children as well, I know you have a couple of practices in the book chapter. I don’t know if one of those, or if you can just carry or take us through an exercise when you know a child comes in and you know, in terms of like the Vagus, the Ventral Vagus Circuit is there outside of that. And you need to start implementing these measures to calm the nervous system down. Is there something that you can take us through that we can just experience to do that?
10:00 Christine Robenalt: Sure, yeah, I think even just giving hugs. So you can start up at the top of your shoulders and push into your shoulders and keep that pressure, a pretty firm pressure as you slide all the way down to your elbows and then again, squeeze again and then all the way down to your wrist and give a little squeeze again and off your fingers, squeezing at the palms, off your fingertips. So that proprioceptive awareness, I mean, you could do that with a Exhale on your squeeze. Inhale again down. Exhale on your squeeze and off your hands.
Two things happen when we do breathing and proprioceptive input.
It shuts off the switch to your HPA axis. So if you are breathing and you have safety through your proprioceptive system, you’re not going to go into fight or flight. Or if you did, you’re going to be able to come back.
And so when I see a little one who is in distress, who has no idea how to regulate their body, they need to be co-regulated. That means that they need assistance to come back to a calm state. I can’t bring them to calm. All I can do is create an environment to invite that.
And that’s what I teach the parents and the caregivers that I work with as well. So a nice firm hug, modeling breathing, because our mirror neurons are always working. So if I’m modeling slow, calm breathing, that other little one’s gonna pick up on that. And so that would be really, you know, just those two simple things, model what you want to see and think about that safety of breath and proprioception.
12:07 Dr. Ginger Garner: Hmm, do you have a name for that one that you call that one regularly?
12:11 Christine Robenalt: I don’t have a name for that one. On my YouTube channel, I have one called Inchworm Fingers, and I don’t remember if I have that in the chapter or not. I will have to give a shout out to MNRI who taught me this by a different name, but I do that sensory neuromotor processing, I have all training in that as well. And so that really has helped me put some of these pieces together that I’ve learned in PT school, but didn’t necessarily have a good pathway of how to implement it. So this is another way to really get into that. And I do that all the time with my, I have for my yoga classes, I teach for the kids and adults, we do six breathing tools. That’s one of the six breathing tools that we learn very early on.
13:03 Dr. Ginger Garner: Okay. How long does it take to do the inchworm?
13:06 Christine Robenalt: Maybe a minute.
13:08 Dr. Ginger Garner: Okay.
13:10 Christine Robenalt: Yeah. Can you show us? Yeah, I can show you. So I like to start on the pinky finger and you’re going to take three fingers on one hand and kind of munch down the finger, inhaling to the base of your finger, and then maintaining the pressure as you pull off, exhale off.
You can release fast if you like. And again, inch down, breathing into the base of your finger fully and then exhaling off maintaining that pressure.
Yep, and you keep going. And just notice how your body is feeling. As you’re doing that, I’ll invite you to slow that exhale down. So as you exhale, slowly pull off that finger, maybe twice as long as you inhale.
And if you are still not feeling calm, you have another hand.
Dr. Ginger Garner: Haha… I love it.
Christine Robenalt: And this is really a nice one to do. I wouldn’t recommend any of this when you’re driving because you need to attend to the road. But it’s nice because your hands are always with you. And so whether you’re doing it to yourself or you’re doing it to a child, you can just, you know, gently take their hand and do that as you’re talking to them. It’s not something that requires a lot of equipment. And people don’t even need to know that you’re doing it. So for me, I’ve helped people come down from panic attacks, adults actually, by asking them, may I see your hand? And I just model the breathing. And this has also been helpful for me if I’m feeling a little anxious or stressed, maybe after a patient, before a patient. So it’s been a very useful tool. And again, it’s combining proprioception, which is one of our senses to know where we are in space based off of the position of our joints. But more importantly, are we safe?
Because that, at the essence, is the point of our sensory system. It’s to tell us, am I okay or am I not okay? And I want 99.9% of my day to be okay.
15:24 Dr. Ginger Garner: That brings up an important point that integrates polyvagal theory into it. And in the work of Dr. Stephen Porges, he coined the phrase neuroception as a way to describe if our body is able to accurately detect risk or threat. And that’s essentially what we’re talking about is neuroception. Can we accurately decide, is it a threat or not? And one of the chief ways that, in addition to proprioception, in some of the literature is interoception, is when we’re practicing these things, as you know, is plugging into or asking how people feel, you know, how the child feels, how we feel as individuals while we’re moving our bodies through space, even if it is the inchworm or the hug. There’s one, there’s another exercise. It seems really similar, but mostly fluttering, the butterfly exercise, which is an EMDR, eye movement desensitization. And that reminds me of that particular exercise too, all about safety. But I think that this touches on such an important point that if we don’t have that, it doesn’t matter what the rest of the therapy would be. Right?
16:49 Christine Robenalt: This is very true, especially with my population. If I have children who have autism or children who have cerebral palsy, even, it doesn’t matter, whatever their challenge is, what I’ve found is most children have a very small window of tolerance. So if we’re gonna talk about other authors, Porges or I can’t think that Dan Siegel, Dr. Dan Siegel is talking about that window of tolerance. And if it’s so small that any little thing pushes them over the edge, pushes them outside of calm and alert, now we have no choice to be in fight, fight or freeze. And any of the things that I’m trying to do as a physical therapist are gonna be met with resistance. And so I used to just push through that. And sometimes you can, because sometimes the child just needs to have the experience again, and they’re like, oh, okay, that wasn’t that bad. But many times why I feel progress can be slower with children who have special needs is because we are going way past their window of tolerance. And as a therapist or a parent, we’re not recognizing that. We’re not recognizing that that child has been pushed over the edge and now no learning is being taken place. So we’re just wasting our time.
So my motto is to support and stretch. Support the child or the parent where they’re at and stretch them just a little bit beyond. But if I…throw them over the edge, I’ve got to start pretty much back from the beginning. And that’s okay. That’s okay. I learned something with that experience, but I know that I need to change the internal, external environment for the next time so that the child feels safe and more successful. And interoception is huge. I think as adults, we don’t have a very good idea of our interoceptive awareness and to expect that a two-year-old who is in development anyway is going to understand their big emotions right now. And the whole idea that everybody needs to behave and sit still is. Basically telling them no, your feelings and how you’re sensing right now doesn’t matter.
And I think we know as adults, when that happens to us as children, how we feel as adults, that we don’t feel valued, that we don’t feel heard, that we feel like we have to do it anyway. And then that sets up really bad habits. And so, yeah, the child might not feel okay right now, and that’s okay. And we have to be okay with them feeling angry or sad as long as they’re not hurting themselves or others, and to be able to co-regulate with them. That is…you know, as an adult, I need some co-regulation sometimes.
19:47 Dr. Ginger Garner: That’s a gift. I think of that as a gift. Yeah. To have that. For those of you, for our listeners, there’s, and I know you probably have this, I have this taped underneath the wall clock in the kitchen, because the kitchen is kind of the heart center of the house and with three kids and it’s all chaotic and they’re high schoolers and teenagers. Oh, it’s a scary time for adults when you have teenagers. But we have a feelings wheel. I put up a feelings wheel and you probably, you’re gonna whip it out right now, aren’t you?
20:10 Christine Robenalt: Yeah, I am. Yay. Here it is.
Dr. Ginger Garner: Lovely, I’d have to run down the hallway. Yay, that’s it. Yeah, and so if you don’t have that, that’s a really good tool. And they are printable online, they’re really easily accessible, but having a feelings wheel around, I think that that’s good for all of us. It’s not just about our kids too, but we can all benefit from it.
20:46 Christine Robenalt: 100%. My oldest turns 15 next month. And so yes.
20:54 Dr. Ginger Garner: Oh my goodness. My middle one just got his driver’s permit today.
20:59 Christine Robenalt: Congratulations!
21:00 Dr. Ginger Garner: I’ve already been through one getting it. This is the second one, so it was a little less angsty, but it’s interesting. Every step is interesting. So yes, world, there’s a new driver out there today. If you’re in North Carolina, particularly Greensboro. You’ve been fairly warned.
So, you know, with the challenges that face parents and, you know, our teenagers and learning, I think one of the things that’s on the edge of everyone’s mind, I know it is, and you’ve probably gotten this question a lot, is during COVID, there’s a lot of challenges. There’s a lot of challenges for our PTs out there learning. There’s a lot of challenges for our children who missed, basically, mine missed about two years of that developmental process that they just sat in their room and my youngest one would, you know, cry and turn his camera off and he didn’t like learning online. So what are you seeing as some of those challenges in your pediatric kids and population right now?
22:12 Christine Robenalt: I think one of the challenges that most likely is a direct result of COVID and that shut down is a decreased tolerance for interpersonal relationships. So that’s one of our senses, to have an interpersonal sense, how safe I feel with you. And believe it or not, even via video visit, even via telehealth, I can get a sense of how safe I feel with you. And if I feel safe with you, I’m gonna be able to be open and explore and play, and things are gonna feel easy. If I’m feeling anxious or nervous right now, even if you’re the safest person in the world, my perception is that, no, I better not say anything, or I might not be able to look at you. I feel uncomfortable, and I don’t like that uncomfortableness. And I think because there’s been potentially less exposure to talking to other people, to seeing other people’s faces and mouths, and all the nonverbal expressions, that we may have more catch up to do in that area.
But the cool thing about our brain, and I know you know this, we are neuroplastic. So we did have two years of a significant decrease in that information of those experiences, but that doesn’t mean that it’s over. That doesn’t mean that we can’t create new pathways. Thankfully we can, or we wouldn’t have jobs.
And so now it’s about supporting that child, that child who is nervous when I come into the space. I could keep pushing, I could keep sitting right next to him and hand over hand everything, or I could notice, he shows me a lot more things if I step back. He shows me a lot more things, he works with his parent better if I actually go on the other side of the couch. Okay, that’s all right, let me see what you know. And then when he starts to be more curious about me when he comes over and notices my ring or notices my watch, that’s an invitation for me to reciprocate. And so paying attention to those things is really important. Paying attention to those nonverbal cues, when somebody is starting to feel stressed out, what things do they do? Do they bite on their fingernails? Do they chew on their shirt? Do they turn away from you? And taking into those signs, those aren’t behaviors because the child’s trying to be naughty or bad or not listen. They’re doing the best they can with the resources they have right then.
And resiliency, we talk about resiliency as if it’s something I can go buy in the store. Resiliency can only be there if you’ve built it up there. Brene Brown talks about it in a social sense of putting marbles in your jar. And then when something goes wrong, you end up taking a whole handful out. Well, we don’t have any marbles left in our jar. Our resiliency levels have been depleted for many people. And so there’s nothing left and there’s this fatigue and there’s this like, oh, I don’t wanna deal with anything. Well, we do need to find those small moments to be grateful for and to be shared connection with people so we can start building up that jar of marbles again and feel like we have a capacity to come back after a challenge. That’s really to grow that capacity to come back.
25:44 Dr. Ginger Garner: Hmm. You said something really important that as an autism parent, one of my sons are, was diagnosed years and years ago and he’s in high school now and doing well. But one of the things that I had to work on with his school system in third grade was the things that they do that are coping, right? And because you mentioned not acting out, that it is essentially their method of coping, which is one of the things that I love to focus on now in, you know, in my work in physical therapy, which is outbursts, making noises in class, spontaneous sound.
Spontaneous sound is also vagal toning. So if they’re creating spontaneous sound, inappropriate in the classroom, doesn’t work when you’re trying to teach, but it’s their coping mechanism. And so working on them with a productive, you know, way to do that. So, um, shirt chewing, you mentioned that when we went through lots of clothing during those years. What are some of the other ways because I think this messaging is not just for parents with children on the spectrum or, you know, any of the populations that you would see, but I think it’s for everyone. What are some of the other ways that you see children and or parents coping that may not be necessarily productive, but that are you know, moving in that direction of trying to do their best.
27:22 Christine Robenalt: For sure, well, first of all, I’ll say it is the same for all people, children, adults, older people, because it’s the same nervous system. It might be dysfunctioning differently, but it’s the same nervous system. So these pathways that need to be developed. One of my first books that I read that talked about this was David Eagleman’s book, Incognito. And he talks about the rival parties in our brain. And prior to reading that book, I felt this, but I didn’t have words to put on that. So I’m dyslexic and ADHD, and I had some medical trauma during my births that I didn’t acknowledge for 10 years. And so during that time I would have outbursts, I would have inability, I stuttered for an entire year.
So my nervous system completely was destroyed. And I thought I was going crazy. And it was really hard for me to reconcile as a 30-something-year-old person with three children, what is wrong with me? And when I started meditation and when I started yoga, and when I started kind of tuning in to how I was feeling and this neural sensory motor reflex integration, all of those things started feeling so much more connected.
And so I come to my clients, I come to anyone and say that this isn’t easy. And one of the nice things, one of the things I really appreciate about yoga is being okay with things as they are not trying to change it and and trying to accept all of the sensory information and recognizing am I safe right now and using that that deep perception of am I okay that neuroception am I okay and having tools either from within myself or support from around me that’s going to add to me feeling okay and me moving toward the person I want to be so an example alcohol cigarettes even coffee to an extent would be coping mechanisms but they’re moving you further away from who you want to be.
And as I do my mentorship and trainings with the therapists who start with the company I work with, we talk a lot about this. I talk very little about what to do as a physical therapist. We spend most of our time in this space about creating connections with people and noticing where people are disconnected and we can’t judge or assume, but being able to pay attention to when people are okay and when people are looking for a way out or shutting down or having a behavior that we would assume like, why are you that way? What’s wrong with you? Like nothing’s wrong with that person. We have been through a lot. Everybody has been through a lot. If you even go back through ancestral trauma, vicarious trauma, like these are real things.
My grandmother, her mother, was institutionalized. She grew up without a mom. My mom went to an orphanage for two years because my grandfather died and my mom, my grandmother was a mom of five and she couldn’t do it. So my mother, I love my mother but she didn’t have the capacity within her to mother me. And so now I am like, okay, that’s the past, but yet this is my experience. And now I have to take this experience, what I know today and move forward. So I think my message is to be open, be accepting, be curious and try not to judge people for what they’re doing, saying, or not doing.
And be curious, ask questions. Reflective questions don’t come easy. It takes a lot of practice. First person I suggest you asking reflective questions to is yourself. Get really good about asking yourself questions, and whether that’s journaling or talking to yourself in the mirror. All those practices help you feel more comfortable with being uncomfortable.
31:51 Dr. Ginger Garner: And that’s a very important point to like stop and sit with because if we aren’t taught that as children, that everything is going to be okay all the time because you often get, and we call that toxic positivity now, like everything’s going to be fine, everything’s going to work out. You’re fine, don’t cry, get up, it’s fine. Lots of ‘it’s fine’ messaging, but then we become adults and we find out, hey, that’s not going to work out. That’s actually not going to be okay. And we have to learn to sit with what is sometimes deeply uncomfortable, mildly uncomfortable, annoying, frustrating, tedious, all of those things. And to refer back to Brene Brown’s marble jar, if we don’t have our marbles together in our jar, things aren’t going to go well.
So I think that one of the big messages, and I’ve got a follow-up question I can’t wait to ask about this, but I think one of the big take-homes for our time together today is whether you’re dealing with children or adults, or…your patients or children or adults, or you’re just dealing with your own stuff, is to be willing to sit and not try to change anything. Identify how you’re feeling. Whip out that feelings wheel. Identify how you’re feeling and turn down the gain on judgment and just sit with it..
33:32 Christine Robenalt: Yes. I can’t say much better than that.
33:37 Dr. Ginger Garner: The research is there, you know, we could get all nerdy and geeky and talk about how suppressing feelings and emotions make them worse. It makes rumination worse. It makes addictive behaviors worse. It makes what we’re trying to avoid, it makes us go to the things that we’re trying to avoid. So until we learn to sit with it, it’s gonna keep coming back and getting us.
34:02 Christine Robenalt: Because there are messages. There are messages in our physical body and our psychological body. They’re like big billboards. And when I do talk with the children who have the ability to understand that, I have a girl who has cerebral palsy, she’s 13 right now with a lot of back pain. And yeah, she has a difficult time feeling where her body is in space, but then her body is letting her know that with this pain. And I said, I don’t want you to have pain, but I want you to understand that that pain is communicating something to you. What do you think it might be telling you?
And even yesterday I was asking her, we were doing transitioning from double leg squat to a single leg squat. And I said, now, if you have pain when you’re doing this exercise, what do you think that means? And she said, I’m probably working too hard. I said, that’s great. I said, what should you do? She said, I should go back to the double leg squat. I said, that’s amazing. Thank you so much for thinking about that. And I’m so happy to hear that you didn’t say that you’re just gonna stop, but you’re going to think about how am I feeling? What can I change? And I thought that was great for her to have that ability to understand and to reflect. And even if it’s just with me right now, we’re still building up that awareness of her body and what her body is telling her as opposed to pain is bad, get rid of it. So, thank you.
35:25 Dr. Ginger Garner: So, yeah, that’s a beautiful example of what our theme of what we’re talking about of psychologically informed physical therapy, that we’re working with these individuals, these people on mental health skills so that they can improve their physical health, you know. It’s everything that we weren’t talking about when I know you and I went to a PT school probably in a similar time, 25 years ago, this is my 25th year as a PT. And it was all about fix it after it’s broken. And it was such a deeply. It was a deep time of a kind of the profession being uninformed about its capacity and own power, because I wanted classes on prevention and wellness and health promotion and they didn’t exist.
And now we’re able to talk about things. Now we have a book. You know, I love it. Multiple books. We have So many ways to discuss this with our with our patients, with our clients, with our family, with our community. It is inspiring for me. And so I think this is a great opportunity.
With that in mind, the question I was trying to get to just a moment ago, but then our conversation took a lovely turn. I want to come back full circle, because now we’re into an expanded place of understanding and say, okay,
You’ve given us some awesome practices. And I don’t use that word lightly, because awe is also helps with vagal tone to something that’s bigger than yourself, or seeing something that’s beautiful. And I think that’s what those mindfulness practices are, they open up our capacity to feel awe to feel something beautiful. And so you’ve given us these awe-some practices to do. Is there anything else that you would like to extract from your chapter that if you had to say, oh, this is one point, you know, what is it about your chapter?
37:42 Christine Robenalt: Yeah. Okay, this is, I hope this comes across well. The first thing is to invite what you want to see. So whatever it is, ask for it. If the person or yourself is unwilling or unable to do what was asked, you need to take a step back and observe what might be there. Is the person able to do what was asked? They are. Is the person wanting to do what was asked? And whether or not that’s true or not, I think we have a few things to kind of look at. And the way I break it down, I think it’s four steps.
The first thing is to try to increase the fun and the motivation and the novelty about it. Can they achieve it then? If so, then awesome, the person can do it. And now that you give them a reason to do it, they do it. If that’s not good enough, then decrease the degrees of difficulty, make it easier, make it more simple. Can they do it then? If yes, then awesome. Then a physical therapist, we know what to do with that. We just keep making it a little bit harder. But maybe they can’t do that either. So then we have to take a look at the sensory systems, which one of those sensory systems is not making sense. And maybe it’s more than one. So take away, turn down the lights, turn down the sound, ask somebody to leave the room. Does the behavior change then? I failed my last clinical in PT school because I could not get along with my CI and I felt so nervous that I could not show her what I knew. And she said, you’re not entry level. She said, go do it again, all eight weeks. So go.
39:38 Dr. Ginger Garner: Oh my.
39:39 Christine Robenalt: So interpersonal sense is legit. Yeah. Anyway, and then if so all those things you can’t you did the reward you made it simpler all those things don’t work. Go with what the person does with ease, even if it’s the opposite of what you want. Challenge them where they find it to be easy. And then once they feel that intrinsic drive, once they feel that success, then you can start to come back to what you want. And then repeat and always act out of love, and compassion, and empathy, never with trying to be more powerful than somebody, never with what’s wrong with you, come from a place of love and repeat and repeat and repeat.
40:30 Dr. Ginger Garner: And that is a lesson for our whole lives. It really is. I think that’s a beautiful way to finish up our time. Because that can be, you could just rewind that, everybody listening, just rewind it. And then apply it. If you’re a therapist, that’s great. Apply it to therapy. But then apply it to your relationships. Apply it to your work. Apply it to yourself. Approaching yourself with compassion and love. Because I think one of the biggest challenges that we face today in PT is burnout. We have crippling student loans. We have lowering rates of reimbursement. We have salaries and wages that are stagnant. We have benefits that are flagging. We have people wondering, should I stay in PT? Should I even go into PT? What should I do? So I think that if we extend ourselves, that self-compassion, that self-compassion
And then step back and decide what one little step do I need to take next to do the next right thing then our world might seem a little bit more…
negotiable and navigable. And that little jar, that little jar of marbles looks better.
41:51 Christine Robenalt: Yeah, absolutely. 100%. So that is in the book chapter. So if you read the book, you’ll get it in writing.
41:58 Dr. Ginger Garner: Fantastic, fantastic. I’ve been asking all the authors this question everyone that have been interviewing as well.
42:07 Dr. Ginger Garner: If you had to pick a song that represents physical therapy, what would it be?
42:14 Christine Robenalt: I think it is, I rewritten it down. It’s like never give up, or no, I’m sorry. It only makes you stronger. If it doesn’t kill you, it makes you stronger. And I listened to that song again, and I know it’s talking about a relationship like with a significant other or whatever, but thinking about, if it doesn’t pull you completely under, if it doesn’t take away your last breath, what are we gonna learn from this? How are we gonna come back stronger and better? And if you don’t have those marbles in your jar, you don’t have that resource within yourself, don’t be afraid to ask and look for resources around you that move you forward. So if that’s that song, that’s what it takes, makes me think about physical therapy, whether you come with an injury or a disease, a congenital condition.
If you’re still here, if you’re still breathing with me, then what can we learn and how can we respond and move forward and get whatever help you need? Yeah, I mean, your body does what it needs to do in the moment for survival. And there are times in your life if you are in a dangerous situation that you need to survive.
But…the rest of the day, the majority of the time for most people, we don’t need to be in that heightened sense of awareness. And so that is just kind of what I, as a physical therapist, I want to help people understand what their nervous system is telling them and to interpret that. And that’s what I hope I do.
43:57 Dr. Ginger Garner: Yeah, and to be able to guide them to what their system is capable of.
Christine Robenalt: Oh, for sure. Right?
Dr. Ginger Garner: Is to understanding where they came from and where they’re going. So I think everybody go out and listen to Kelly Clarkson’s Stronger. Put it on your Apple iTunes or Spotify or whatever you’re listening to. And I hope this interview has been, it’s been a blessing to me. I hope it’s been a blessing to you. I think that speaking with pediatric therapists, OTs, PTs, all the therapists out there are some of my absolute favorite people in the whole world. So thank you, Christine, for this time. I really appreciate it.
44:36 Christine Robenalt: Very welcome, my pleasure.
44:41 Dr. Ginger Garner: Oh, one more question. Yeah. Um, where can people find you, uh, website wise, if you’re on Instagram, Facebook, whatever that might be.
44:51 Christine Robenalt: I think the easiest place and the most present place I am is on my YouTube channel, Sweet Pea Pediatric Wellness. And I have a lot of public facing videos that you can share with your patients and your friends. In the book, there’s a lot of links to those videos. So that would be probably the best place for you to go. Apart from that, I’m trying to get into some more blogging spaces. We’ll see, and Sparkler Parents is also a great place to find me on YouTube, Spotify. So I hope to continue recording those episodes.
45:27 Dr. Ginger Garner: All right. Sparkler Parents on podcast and Sweet Pea Pediatric Wellness on YouTube. All right. Thank you, Christine.
Christine Robenalt: Thanks.
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