Pediatric Therapy Services

Photo by Kris Kathmann

For 20 years, Mankato physical therapist has been helping area children reach their developmental potential.

The three-year-old boy recovering from surgery watched Nancy Dobson demonstrate a sequence of activities for him—walking on a balance beam, stepping on and off a stool and crawling through a barrel. Then he said, “You got through there with your big butt, didn’t you, Nance?” Dobson, who is of average weight and size, replied, “Yes, and now it’s your turn.”

Dobson, founder and owner of Pediatric Therapy Services, Inc. in Mankato, said, “I could fill your ear with anecdotes, but I’ll just say it’s a privilege to be part of the children’s lives.” She gestured toward the array of patients’ photos on the wall above her desk. “What I like best about my work is the personal connection with children and their families.”

For Dobson, a Registered Physical Therapist (PT), this hands-on career was in her genes and on her mind from early days.

“Both of my parents were physical therapists,“ she explained. “I saw the joy my mom had in her job, working with special needs children in school systems. My father, now retired, worked as a PT at ISJ Hospital for over 30 years. My mother died while I was in PT school, but she knew I was following their example. Now my youngest son, Ben, is hoping to go into physical therapy.”

Dobson received her BS degree from College of St. Scholastica, Duluth, in 1980. She moved with her then-husband to Davenport, Iowa, where he had been offered his first job, and where she worked as a PT in a large hospital, treating a wide variety of patients. Two years later, when they were about to become parents, they returned to her hometown of Mankato.

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During Dobson’s focus on the births and parenting of five children (now all in their 20s), she stayed current with PT developments.

“I was able to keep my foot in the door by working part-time in a hospital, at several nursing homes, with several school districts, and with a few private patients,” she explained. “My friend Peggy Martin (Peggy Perendy at the time), who’s an Occupational Therapist, was working with Mankato schools. When we each had our last child (Peggy has three), we began brainstorming about opening a clinic just for children. A year later, in 1991, we did. Our mission statement is ‘to provide quality therapy to children in a kid-friendly environment while empowering caregivers to assist children in reaching their developmental potential.’”

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Pediatric Therapy Services, which opened in a one-room clinic on Teton Lane, is based on the proven premise that early intervention works and that therapy for children is different from therapy for adults. The partners met with SCORE representatives to develop a brochure and logo that carried the message of hope and progress. Two decades later, that logo still shows the silhouettes of four children: the first sitting, the second crawling, the third standing and the fourth walking. With brochure in hand, the partners called on physicians within a 90-mile radius. Even today, when word-of-mouth is the clinic’s best form of promotion, Dobson still contacts new health care practitioners with a “welcome basket.”

Although Martin left in 1996 to develop and direct the OT program at University of Wisconsin-La Crosse and now directs a similar program at the University of Minnesota, Minneapolis, their professional relationship has continued.

“We have one of Peggy’s students here doing an internship,” Dobson said. “And we’ve had other interns from her program. We also have interns (PT, OT and speech) from several schools, including Mayo Clinic.”

Dobson and her staff of 15 therapists (and four office personnel) provide a variety of therapy services to about 250 children. While she heads up the PT program, the staff includes other PTs, OTs and speech therapists.

“A lot has changed since we had five or six patients our first month, with only two therapists, no office staff, a shared desk, no computer, and our scheduling in a three-ring binder,” Dobson recalled. “I typed the insurance claim forms on a typewriter in my basement at home. Our first referral was from a doctor at Mayo Clinic, the second from Gillette Children’s Hospital in St. Paul.”

Pediatric Therapy Services moved to the lower level of a medical building (shared with Open Door Health Center) on Holly Lane in 2002. (Dobson is looking to move to another location where there are windows to let in sunlight.) The current site has six therapy rooms that offer a variety of equipment, including swings, balls, stairs, a small bench with steps, a ladder, a treadmill and bright-colored cushions that squeak when stepped upon. Dobson explained, “The cushions are great for teaching kids to jump or to learn how to shift weight from one leg to another, and they always bring a smile.”

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Pediatric Therapy Services offers free screening of gross and fine motor skills, as well as speech and language. Physicians refer many patients, while some families make inquiries and then get a referral. Dobson and her staff work in cooperation with each referring physician to develop long- and short-term goals and to plan steps needed to reach those goals.

“I value being able to provide support, looking at the child as a whole, rather than at the disability, and seeing progress,” Dobson said. “Sometimes progress is phenomenal. Sometimes it comes in small increments. We help the child and family develop tactics for progress. What we do here is only a small part of what we do for the child. Home programs are key. We help the family integrate therapy into their lives. Sometimes the big picture is overwhelming for them, so we ask ‘What one thing should we focus on intentionally?’ We try to let the parents be parents. We are the therapists.”

Much of the therapy is hands-on, helping the child’s body move through and learn new positions and movements. With a child who is reluctant, nervous or scared, the therapists “may go pretty soft during the first several sessions” and incorporate some treatment into a play activity. A child may sit on a disc swing and pick up beanbags from surrounding floor mats in a game called “animal rescue.” This exercise develops abdominal muscles and large muscle coordination.

“Working only with children, we strive to offer a team approach, looking at the whole child,” Dobson said. “We reinforce in a PT session what the child is learning in speech therapy by using a picture board in PT with non-verbal kids. In speech therapy, we reinforce the best sitting position. We help children with feeding disorders explore and process textures, such as textures in the mouth. We help children develop fine motor skills by grasping and manipulating small items. Children learn the activities of daily living, such as putting on socks, combing hair, brushing teeth. We implement the ‘nurtured heart approach,’ focusing on the child’s positive actions, and with praise.”

The therapist may work with a baby to teach him to hold up his head so he can see what’s around him. With an older child, one who has cerebral palsy for example, the therapist works on teaching the child how to safely go up and down stairs while carrying something. An adolescent who is unable to walk is taught to propel an electric wheelchair to the bed or toilet.

“There’s such a diversity in the kids who come here,” Dobson said. “The reason could be evident, such as wearing braces or being in a wheelchair, but sometimes it’s not so evident. Some patients may have global disabilities, needing PT, OT and speech therapy, while others may have only one area of need. We also serve children with autism who may or may not have physical disabilities.”

Dobson divides her time about equally between administrative work and physical therapy. She usually has four 45-minutes sessions with patients daily, which she termed the “best part of my day.” One day a week she provides school-based therapy in small school districts within 50 miles, including the Minnesota State Academies for the Deaf and Blind in Faribault, where she often works alongside an interpreter.
Other staff members work outside the clinic, as well. One speech therapist goes into daycare centers to do a story time. (It’s part of her job description.) She helps daycare providers incorporate language skill development into activities.

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During two decades of service to children, Dobson has seen changes in the healthcare field that she finds of concern. “Healthcare costs have risen, and therapy coverage has decreased,” she said. “The concept of managed care came along around the year 2000 and there’s more paperwork now. We continually devise systems to measure and document a child’s progress. We know it’s important to be able to document progress and to show insurance companies the positive results from our therapy.”

When a family’s medical insurance runs out or isn’t available, a child may qualify for state medical assistance. There are a limited number of lifetime (not yearly) visits. After the limit is reached, a therapist may submit documentation about the patient’s progress, and the state may or may not authorize more treatments, based on the level of progress.

“So you can try again,” Dobson said. “We’re making a difference, one child at a time. As an employer and taxpayer, I do support being a good steward of tax dollars, but I know there’s a window of opportunity when we can have the most impact on a child, on any child.”

Dobson puts her money where her mouth is. She explained, “There are families that have financial or insurance limitations, but the child would benefit from more frequent therapy. If they have no insurance, we have a sliding fee scale. We try to work with each family financially for the child’s benefit.”

Although Pediatric Therapy Services patients are the best “advertisement,” Dobson recently engaged a marketing consultant to increase awareness of “who we are and what we do.”

“I’m sure there are some families not aware that early identification of a disability is important,” Dobson said. “Early intervention works. If it’s not your child, perhaps it’s your grandchild, a niece or a neighbor child. We get success stories every day, whenever a child is first able to change positions or take a first step, or learns to communicate.”

Dobson recalled a 10-month-old boy who could only lie on his back or remain in a sitting position when he came to her clinic. “He could not get in or out of the sitting position, and he couldn’t roll or crawl,” she said. “Less than three months later, he’s crawling on his hands and knees, even on stairs, and pulls himself up to a standing position by holding on to furniture. He soon should be walking.”

A preschooler who had sustained significant head injuries in a car accident came to Dobson after being in a coma for a month and undergoing initial therapy in a hospital. “She could walk with a walker, but was so wobbly, and her speech was limited and difficult to understand,” Dobson said. “Within a few months, she stepped away from her walker, holding her teddy bear. She eventually became a long-distance runner and quite the conversationalist. She had a lot of therapy; we were just part of the picture. I recently went to her graduation party. It’s awesome to see how far she has come. It’s one of the reasons I love what I do.”

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“There is no cure for some conditions, but it’s not depressing,” Dobson said. “Yes, there are moments when I’m sad, when a child needs another surgery and I see the family struggling. But those moments are far outweighed by the times we see progress. If something doesn’t work, we revise it and try something else. When children are engaged in a fun activity, they relax, and their bodies move more readily.”

While gazing at the photos adorning the wall above her desk, Dobson choked up and dabbed at her eyes, saying, “I’ve done this long enough that I’ve gone to some graduation parties. I also have been to funerals, which is never easy. I know those families’ lives have been forever changed, first by having a child with a disability, then by the child’s death.”

Dobson’s connection to patients goes in both directions. Recently she encountered a man who had been her mother’s patient when he was an elementary school student and whom her father also had treated. She smiled while saying, “We chatted about his memories of my family.”

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Dobson’s Memberships

• American Physical Therapy Association, Pediatric Section.
• Coordinator, Mankato Area Children in Need (a nonprofit group that provides families with equipment for therapy); organizes annual golf tournament fundraiser.
• Former board member, The Miracle League.
• Greater Mankato Growth.

Just Nancy

• Childhood: The youngest of four children, I graduated from Mankato West High School.
• Favorite subjects: I liked the sciences. It’s interesting and intriguing how the body works.
• Least favorites: To be honest, I loved school, but college physics was challenging.
• First jobs: Working in the Junior Department of Brett’s Department Store, I spent most of my paychecks in the store. I also did waitressing. I developed and used people skills in both jobs.
• Family: I have five grown children, one grandchild and one on the way. My second husband, Joe Meixl, came with eight children and seven grandchildren.
• Recreation: I still have two sons at St. Olaf and love to attend their games. I enjoy reading, boating on the Mississippi, kayaking and bicycling with my husband.
• Most valued intangible: My faith. That’s at the core. The longer I’m here, the more I see the clinic as a form of ministry. If I can be used that way, I value that.
• What else might you do: I’ve done physical therapy work on two mission trips to Panama and hope to do more.
• Words that describe you: I would hope they would be kind, compassionate, caring and making a difference.

THE ESSENTIALS: Pediatric Therapy Services, Inc.

• Founded: 1991
• Phone: 507-388-5437
• Address:
  309 Holly Lane
  Mankato, MN 56001 (MAP)
• Web: kidtherapy.com