Dr. Ashley Schilling has special interests in adaptive equipment used to promote development across domains, serving children from early infancy through the transition to adulthood.
Dr. Ashley Schilling is bringing pediatric care to the bike lanes.
As the Sharon Vanderbilt Professor of Physical Therapy in the University of Tennessee at Chattanooga Department of Physical Therapy, Schilling is researching pediatric movement.
As a board-certified pediatric physical therapy specialist, she combined her passion for pediatric care with cycling to help identify appropriate adaptive cycling equipment for children with neuromuscular disabilities.
Her research examines movement, something she has “always been interested in.”
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Why did you pursue a career in physical therapy?
“I always knew I wanted to do something medical. My grandmother was a nurse and I grew up on my grandparents’ family farm. So I saw a lot of medical care, not for humans, but for animals. I knew I wanted to be involved in that, so I majored in biology in undergrad, thinking I might go to medical school, and I got a job at a hospital as a nursing assistant. The physicians I worked for said, ‘If we had to choose it all over again, we’re not sure we would go to medical school, maybe something a little bit different because we’re not getting to spend the time with our patients that we would really like to and you seem to be the type of person that really wants to build relationships with folks.’
“They picked up on something that I’m grateful for because they were absolutely right. I got to go into the athletic training room at Iowa State University and watch a physical therapist work with a collegiate basketball player over a couple of different sessions. He spent time educating her on what happened to her knee structurally and what the surgical procedure looked like, and he pulled out a model. He walked her through everything, what had been done, and where she was going to rehab to get back to what she loved most: playing basketball. Through that interaction, I said, ‘I want to do that.’ I want to build a relationship. I want to have the knowledge to be able to support somebody to do what they want to do in terms of movement.”
How do you develop those relationships?
“I teach the pediatric content here and like to tell my students, you’re not treating just the child; you’re treating their family. The relationship isn’t just me and the kiddo. It’s me, the kiddo, and whoever the caregivers are, whether that’s mom and dad, grandparents, aunts, uncles or foster parents.
“It’s child-centered, but it is also really important that we build it with a family because I get to spend between 45 minutes and an hour, sometimes once, if I’m lucky, twice a week with a child and their family. That’s not when the changes happen. The changes we want to see, improvements in motor skills, strength, coordination and activity, happen at home and in the community.”
What research are you currently working on?
“I just published this summer an article on using an IMU, which is an inertial measurement unit. It literally looks like a little matchbook that has a gyroscope and an accelerometer in it. Those are just big, fancy words for measuring movement. So measuring movement in terms of how fast something is rotating around a certain axis or how fast it is moving in a certain plane. With that device, I wanted to see whether it would be sensitive to changes in children’s postural control.
“In the future, we’re looking to do similar work, but with kids with neuromuscular disabilities because hopefully then it will be sensitive enough to pick up on the changes that we see in our kids with neurodevelopmental issues. We are lucky here at UTC in the physical therapy department because this summer we upgraded our system; now we can do it without markers. It’s called a markerless system, and it really reduces the burden of placing markers in very specific places.
“We’re trying to connect all of these dots so that clinicians can figure out what level of support they or I need to provide to this child so they can functionally use their hands and maybe even their eyes to be able to look around the room. If you don’t have good trunk control, it’s really hard to rotate your head, look around, or even make eye contact with your caregiver so you can have some social moments.”
Students in Dr. Ashley Schilling’s class helped construct adaptive equipment.
How important is collaboration to this process?
“We have a new initiative that started this summer through the Biomechatronics in Healthcare Initiative. Working with Dr. Erkan Kaplanoglu is amazing and he’s so collaborative. The IMU study with the motion capture—I recently got a grant through this initiative to work with engineering students and potentially computer science students.
“That’s the really cool part about being on a campus like UTC. We’re not trying to work in silos. We’re trying to help one another. Whenever I read that somebody else is doing something on campus, I’m like, ‘Ooh, I should ask them about X, Y, Z.’ I encourage students to think about that too.
How has collaboration like that helped in other areas of research?
“I am a cyclist, and 16 years ago, in 2010, I got roped into assisting with starting a nonprofit in Nashville when I worked at Vanderbilt with another pediatric PT to get children with disabilities adaptive bikes.
“I fell in love with it. It became an absolute passion of mine. I volunteered with that nonprofit for many years and developed a continuing education program for physical therapists to help them choose the best frame for the potential rider in front of them.
“It’s not how you would normally set up somebody on a typical bike because there’s a whole line of how do you get perfectly fit on your bike if you’re a cyclist. It is different because the biomechanical principles change if you have weakness or a contracture.
“I have, for many years, used clinical reasoning to set riders up a particular way. I have to say every time I teach this class, I have no evidence. I have no quantitative empirical evidence to stand up here to tell you that this is how you should do it. I have only my clinical experience. When I finally got the opportunity to do that quantitative empirical research, I wrote a grant, and now we have adaptive bikes here. We’re working in the motion lab, and I have a group of DPT second-year students working with me. We are going to see if what I’ve been teaching all these years from a clinical experience lens works.
“The whole idea is not a perfect bike fit, but instead it’s the bike fit that allows that rider to ride the furthest, the fastest, the longest alongside their brothers, their sisters, their cousins, their neighbors and have fun. As a therapist, I see that type of intervention as something the kids don’t think of as therapy at all. It is a bike. They’re just out here to have a great time with their friends. If I can help them be as independent as possible by making sure that seat position is correct the first time, then I’ve done a good job in terms of getting them that access to their community that they need, deserve and want.”
What advice would you give to students interested in physical therapy?
“Observe, go find a clinic, and it doesn’t necessarily have to be the population you’re interested in. I didn’t get to observe pediatrics. I was with the student-athlete population at the collegiate level when I was like, ‘Yeah, I like this. I like this a lot. You’re going to need a strong foundation in the sciences in terms of anatomy, physiology and kinesiology, but you will also get more of that in PT school.
“Make sure that you take time as an undergraduate to learn about things that you’re passionate about that might marry well with what you want to do someday and support you as a whole, holistic thinking human. It’s really important to remember that the people that come into our clinic, the kids that come into our clinic, they’re not just the prescription or the diagnosis on the prescription. They’re a whole human who wants to do other things outside of there, and so are you. So get a really well-rounded education.
“And ask questions, come see us in the PT department. If students on campus are interested, our program coordinator, Dr. Rebecca Littleton, is amazing. She runs our admissions process. She handles everybody who’s got a question or wants to go on a tour. She rolls out the red carpet. We love to see our UTC student undergrads in here checking it out.”
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UTC Department of Physical Therapy
