One recent morning, at the clinic he co-owns in Salem, Oregon, Mike Studer, PT, MHS, turned his attention to his newest patient. The man was a retired nurse who had sustained a stroke more than 18 months earlier. His recovery to that point had fallen short of his expectations, and he'd come to the practice, Northwest Rehabilitation Associates, seeking a way to get back on track.

"He felt like he was a failure," Studer recalls. "He was heavily dependent on a cane for walking, and he was falling frequently. He was disappointed and ashamed about how impaired he still was."

There was a time, Studer says, when physical therapists (PTs) might have helped such a patient using what he calls a "top-down" approach. "It used to be 'therapist input equals patient output.' You'd ask patients to try to do something, then you'd give them constant feedback, using words or your hands, until they were able to do it." The problem with that strategy, Studer notes, is that patients may become dependent on that feedback. "Maybe they'd learn how to perform well in the clinic, but they might not be as functional once they left," he says.