Hi all,
I’ve been at a Neuro Physio Outpatients clinic for 2 weeks now and I’m starting to question why we see some of the patients that come in.
I have this one patient in particular who has had a R MCA stroke just under a year ago which has affected both his upper and lower limbs. He has a real problem with high tone, which is made worse upon any sort of effort or even thinking about doing something. He is a lovely guy and I really enjoy working with him but I don’t seem to be getting anywhere. I’ve seen him four times now, and each time he comes in I spend over half an hour with him doing techniques to reduce his tone to maximize the movement in his limbs. We then do half an hour of upper limb retraining, with the last half an hour spent on gait retraining.
This guy does really well when I’m there and he tries really hard to do what I ask him to and make corrections to his movements, especially his walking, but as soon as he leaves he goes back to the old way. I watch him walk out of the gym and he leaves exactly the same way that I saw him walk in.
I’ve raised this issue with my supervisor and he said that ultimately a person will do what is easier for them, and that is to use compensatory strategies. For a person who’s had a stroke, the more they use these strategies, the harder they are to change.
While patients are inpatients on a rehab ward, they are receiving physio for a few hours everyday. Their rehab is quite intensive and good gains are made. As soon as they leave the hospital and become outpatients, we only see them for a max of 3 hours per week, which in my experience with this patient is not enough. Its not like this with all patients I’ve seen, but for him 3 hours isn’t enough to do any good. Most of his problems come from the fact that he has such high tone with any activity and that’s something that a physio can’t do much about in the long term. I just wonder, for someone like this, if the pt is the same every time he comes into the gym, and nothing much changes by the time he walks out, is treatment worthwhile or is it better to spend time with someone else that we can have an effect on?
Tara
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1 comment:
Hi Tara,
I definitely think treatment should continue for as long as possible. Imagine if he received no physiotherapy at all, his tone would become even worse. Eventually he would have contractures in both his upper and lower limbs and be unable to walk and function at the level his does at the moment or have any form of independence.
It must be quite difficult treating him and to feel as though you are getting no where but you must think about the benefits your treatments are giving him. At the very least you are delaying further disability and maintaining function for him at his current level.
As you said 3 hours of treatment a week probably isn’t enough and in the ideal world you would probably like to provide that amount of treatment everyday. So in the 3 hours you have with him it is still very important that he gets the most beneficial treatment as possible; even though you might not be able to implement everything you want with him.
Maybe to help direct your treatment and make it clearer in your own mind as to what you are trying to achieve you could ask him what his goals are from physiotherapy. By doing this it can help you establish goals both short and long term that you can both work towards. Just a couple of suggestions, I hope that they could help.
Cheers
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