Hi everyone, hope you enjoyed your break!
I am currently on my neurology prac at the Shenton park neuro out-pt department and have come across a difficult pt, Mrs W. This pt is a 71 year old woman who was diagnosed with spastic paraparisis in 1991.As a result of this disease the pt has experienced a progressive loss of strength in both LL (most muscles 2/5) and also suffers an increase in tone and decrease in length of bilateral h/strings, hip adductors and plantar-flexors. Consequently the pt requires mod/max assistance for all transfers and bed mobility. The pt mobilizes using a WC and will ambulate very short distances (from bedroom to bathroom) using a four-wheeled walker. Mrs W attends physiotherapy two times a week for 1.5hrs each session.
The problem I am having with this pt is that she is suffering from depression and has a very disheartened attitude towards her physiotherapy treatment. Mrs W believes that there is no point in performing strengthening exercises as she just continues to get weaker. I have tried to convince Mrs W that the exercises are of benefit and that she shouldn’t give up however I do not want to come across as being patronizing. I acknowledge the fact that this pt has been living with this progressively debilitating disease for a long time and can understand that after many attempts at improving her function (she has been attending physio at the NOPD for over a yr) she has not seen much in the way of benefits. Mrs W does appreciate the LL stretches provided during the physio treatment sessions however I get the impression that she doesn’t see the point of many of the other exercises due to her lack of motivation. After speaking to my supervisor I have learnt that Mrs W has just commenced psychological treatment, which I think will be beneficial and will hopefully help with her depression. I think that it is important to base the treatment session around the goals of the pt however I also understand that I do have to push Mrs W to increase her level of independence. Does anyone have any suggestions/techniques to achieve this? Would love to hear your thoughts!
1 comment:
Hmmm tough one. Sounds like you are doing well with this patient (reassurance, letting her know how the exercises will benefit her...). The only other things I could suggest might be a chart/diary for her to record her exercises on to see her improvements, even if small, in strength and so on? Maybe a flyer on exercise or a reading written by an expert might help inspire her? Whilst you can provide all the information in the world, sometimes I think that it has to be the patient's conscious decision to get motivated though,and you can only do so much to so keep at it with the gentle reinforcement and motivation and remember to keep in touch with the multi-disciplinary team esp the psych's :)
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