Hi all,
I’ve finally completed my neuro placement last Friday and I was assessed on the new patient who I had two sessions with.
He had a ponto-cerebellar bleeding in 1989 and significantly deteriorated in Sep last year. His main issues are severe ataxia trunk and upper limb worse than lower limb, decreased tone in his UL&LL and poor righting/equilibrium reaction in both sitting and standing. Based on my assessment, I’ve started bed exercises including bridging, sit-ups, AI/RS in 4pt kneeling and arm/leg lift in 4pt kneeling. My plan was to improve sitting posture and balance prior to work on his standing balance and gait. After one and a half hours of exercises, he was totally worn out and was not able to continue the last exercise that I planned which was balancing in sitting on fit ball. Also, he told me that he would be on weekend leave in the afternoon, so he wanted to practice walking and stairs which was what he needed when he goes back home.
I realized that I should have discussed what patient’s priority is and integrated into what I think he needs to improve. I learned how important communication skills with patient are as well as between the staff which I posted about last week.
Hope everyone learned a lot during the placement and good luck with next one!
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Hi Insun,
Yes, I agree. I think that discusssing SMART goals with the patient is one of the most important aspects of physiotherapy, especially in neuro. Why?, because in my little experience with neuro I think it is often hard for the patient to grasp why they are doing the exercise/task and if you can relate it back to the functional goal that they (the patient) wants to achieve, then the patient is often more motivated and compliant.
With all my patients to date, one of the first things I did was to discuss what their goals were and what they hoped to achieve during the sessions. A good way to approach this is the participation restriction, activity limitation and impairment approach, for example a stroke patient of mine had the goal of wanting to iron clothes again. To achieve this goal the patient needed to be able to reach, grasp and manipulate clothes. Therefore her treatment for the next period will be focussed entirely on upper limb work. Hopefully she will make progress to achieving her goal.
Cheers
Nic
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