One of my patients on my previous placement was an elderly lady with progressive spastic paraparesis of unknown cause. She was at the stage where she could only walk 20m with a 4WW and she had difficulty performing transfers. Treatment was based around maintenance of current function for as long as possible. The patient was extremely unmotivated as physiotherapy could not cure her and instead caused pain. She gave up easily during exercises, complaining that she “could not do any more” and that they were “difficult for her”. She had low exercise tolerance and complained that she was tired after treatment.
We were taught in uni that we are, on top of being clinicians, largely motivators for our patients. For this patient, however, I did not want to cause more pain and grief during treatment, so I dropped the role as a motivator and just let her do only as much exercise as she wished. The aim of physio from my point of view was just to keep her moving as much as she could to condition her muscles and maximise function.
It was just disappointing for me to know that there was very little I could do for the patient, given her condition. It is easy and rewarding to encourage patients during treatment, telling them that the exercises they were doing were good for them and would help them get better. In this instance, whether exercise was beneficial or detrimental was debatable.
I wonder if anyone else would have approached the situation differently or have had experience with similar situations?
1 comment:
Hey Steve I understand what your saying. Knowing that when you say this will be beneficial is much more motivating when its actually true. I guess there has to be a fine balance between what the patient can tolerate but also what you know they should do. I keep being told that even as a student physio we know alot more than the general population. And I think im coming to realise this, finally. I think the only thing you can do in this kind of situation is use your clinical judgement while also showing some compassion. Maybe you could alternate the treatment sessions between one active one and one so called "passive" one. Otherwise i don't think anyone will ever say that words of encouragement ever go to deaf ears.
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