My left mid-to-upper back was bugging me and so I saw a back specialist. I had a CT done and then I had an MRI. The MRI experience was one I do not want to repeat (I was immobilized in a metal tube and I had to listen to Celine Dion songs — no joke!), but I did get information about my back and a diagnosis.
Mild bulging thoracic discs. Who knows what that means (it could be a result of normal aging or a result of chronic bad posture), but I was referred for physical therapy and I participated in a PT evaluation last week.
The PT assessed lots of different components of my range of motion and strength. I was intrigued by the entire process and I kept an eye on what he sporadically typed into the computer. In the end, I had strength and range of motion deficits that matched my diagnosis.
When he assessed the mobility of my neck, he typed in WFL.
- WFL, or Within Functional Limits, means that a person’s ability is outside of the normal range, but it is sufficient for activities of daily living.
- WNL, or Within Normal Limits, refers to a person’s ability to do something compared to same age peers’ ability is the same or in a range of the normal ability of that skill.
The PT is not working on my neck because WFL means I’m able to use my neck adequately to meet my needs. I won’t be winning any contests of neck mobility or flexibility, but that’s okay. I had other deficits that were in the impaired range and that is why I’m receiving physical therapy.
But participating in the physical therapy evaluation process made me reflect about my philosophical approach to speech therapy.
I’ve always been of the mindset of getting my students to “functional” and I’ve been less concerned about getting them to “normal.” I love working with needy students who lack foundational, functional skills. I guess those are my favorite group! My least favorite group of students are ones that have skills in the functional range, but are struggling to achieve skills in the average or normal range. Oftentimes these are students I inherited from a different therapist. Progress in speech therapy can be slower for these students and, potentially, some students will never reach the average range. But you know what? That’s okay, as long as they have functional skills.
Also, while assessing students I’ve written statements to the effect of “grossly within the normal range,” when students had skills in the functional range. There is a difference and I’m going to be clearer in my report writing.
I think my PT evaluation has helped me codify how I view my approach to therapy: “functional” is more important than “normal.” What do you think? Leave a comment below. Thanks for reading!
I couldn’t agree more with your thoughts here. I often think the functional part is missed by those outside of the field (by teachers and/or parents) because there is so much focus on making the student the same as peers. Achieving WFL is amazing but isn’t always treated that way, in my opinion. It’s interesting to compare the ideas behind both WFL and WNL. Thanks for the post!
A very interesting distinction, and food for thought! Thanks for sharing!
Great thoughts, Sarah. I, too, have always loved working with those more severely impacted kids. Because I do some consulting and evaluations for an agency that runs group homes, I’m often writing that someone’s skills are “functional” for their daily living, but these are folks far from “normal” limits.
And while Celine Dion might not be my favorite, all I ever get to hear in those darned MRI machines is a lot of clunking and banging! I’m jealous.