Hi all,
I’m currently on my neuro placement treating TBI patients.
One of my patients (34yo, female) is (R) hemiplegic since she had bleeding and infarction in (L) frontal and parietal lobe about four months ago. She has been improving well since she was transferred to the ward for her rehab. Her main issues are increased tone and flexor synergy pattern in (R) UL& LL, decreased activation of trunk muscles, gluts and quads, short hip flexors and external rotators, etc. When I saw her three weeks ago, she had very poor her sitting and standing posture and reduced exercise endurance as she was exhausted after 1hr session. Also, she showed dominant (L) arm and leg use, for example she pulls herself forward with her (L) arm rather than by using weight shift and abdominal muscles and she uses (L) leg more than (R) when standing up. So I’ve been working on correcting her sitting posture, sit to stand, standing balance and she seems progressing well in physio.
I had an opportunity to observe her OT session this week. She was practicing independent dressing shirts and pants in W/C when I went down to see her. I was quite disappointed in her doing all things that I told her not to do such as pulling with (L) arm to come forward, lifting leg in a synergy pattern, leaning back in standing, etc.
I realised how important discussion and communication skills between the staff is so that the aim of PT and OT for her is in the same direction. For example, if she practices cooking in OT to improve her endurance in standing, we should focus on good standing posture and standing balance as well as her ability to do them with some distraction such as talking or UL movements. I was also curious about how to apply what she learns from physio session into her real life. She understands what she should do and should not do, however it doesn’t seem to work well in her daily activities. Does anyone have any ideas? It would be a great help, thank you in advanceJ
In Sun
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1 comment:
hey in sun, i too have realised the importance of a multi-disciplinary team effort. well, i think that perhaps if you could talk to the OT regarding her common compensatory patterns, the OT could also help look out for them and correct them as the OT session progresses? However, i think perhaps even though we're aiming for 'normal patterns' that a certain amount of leeway should be given so that the patient can still function/perform their ADLs?
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