Hey crew,
In December this year I had my Neurology placement. I was working on an acute neurology ward. One of my patients was a 64 year old female who had had a R MCA stroke. Her main impairments were left sided weakness and abnormal motor control patterns of her left arm and left leg. This lady was fairly dependent and initially required 2 x moderate assist to sit to stand and do any transfers. Our main goals for this patient was for her to achieve independence in sit to stand (with the assistance of a rail) as well as independent transfers such as w/c to bed such that she would be able to return home to live with her husband. The doctor gave us 2-3 weeks to try and achieve this goal as after this they wanted to transfer her to Osbourne Park for further rehab and then return home or a nursing home.
Initially in the first week of Rx with her we focused on muscle strength of her legs and core stability. After this week I found out that if she didn’t achieve close to independent status she would have to go to a nursing home. This upset me as you could tell she did not want to go to a nursing home and her husband did not want her to either- however, he would not of been able to cope at home unless she improved her status. This situation really motivated me to assist her in regaining her functional status. From this day, I changed my Rx ideas to focus on transfers from w/c to bed and back as well as sit to stand practice. Everyday I saw her twice and spent 45-60minutes with her- I found her to be a very challenging patient as she was very inconsistent with her progress. One day she would have a great session and do the tasks really well and then the subsequent day it felt like we were back to basics and where we had started. She also had some memory problems which affected the way she performed tasks as she would forget the sequence of movements to achieve the goals. On her bad days I felt very frustrated as I felt my treatment was being ineffective and I wasn’t progressing her- these days really tested my patience and motivation to her Rx. Personally, when I’m treating patients I like to see the patients progress and improve as this shows that I am being effective and helpful in the patients function. I guess with this patient I realized that you’re not always going to get fast results and patients will progress and then regress on their bad and good days. I think I thought that everyday I would see progress and then when this wasn’t the case and she was fairly inconsistent it opened my eyes to the rehabilitation in stroke and how it can take a long time for someone to regain function.
Overall though, in the 2-3 weeks I was treating the patient I learnt a lot from her and she made some good gains although not as significant as I had hoped as she still required lots of cueing for each task she performed. For me, this patient raised 2 issues; the first being that I realized that rehabilitation can take a long time and you’re not always going to get fast results however its still important to prosper on and keep trying to achieve improvements by using various Rx technqiues, the 2nd issue that it raised for me is how much rehab is necessary for patients to improve? As we are students we were able to see this patient 2 x per day however I doubt that we would have this opportunity in the clinical world with a full case load. It concerns me that if this patient had of received less Rx would she of been in an even worse functional status? I worry that when we get into working in the clinical setting we wont always have time to achieve all that we want to achieve with patients and we may have to settle for a reduced functional status of the patients.
Just let me know if any of you feel the same way as me in this situation. Thanks.
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Hey, i think definitely that every physiotherapist would encounter the same emotions as you. We all want the best for our patients and would get frustrated especially when they're not improving as much or as quickly as we know they can. (perhaps due to a lack of motivation?)
I suppose in an ideal world, we'd get to spend all the time we need with the patient to help them to achieve their goals. However, because most of the time we're unable to, i guess we've just to remember that the responsibility to 'recover' still lies with the patient. That said, we could definitely facilitate better functional outcomes with much education, motivation, home exercise programs and caregiver training, also remembering it's always a balance between what they want and what we think is the best for them.
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