Effectiveness of Functional Training

Hi crew,

Well my first week on my neurology placement was something that I was looking forward to as I haven’t yet had the chance to work with patients with neurological disorders. Conversely my lack of exposure also meant that I had some anxiety during the first couple of days. My main concern was the way in which I would handle communicating with patients with perceptual deficits during assessment and treatment. And to reinforce my concerns, I was allocated a patient who had been on the ward for a few months with a demyelinating disease of unknown origin to the medical team.

The patient presented with decreased limits of stability bilaterally and required the assistance of two therapists for ambulation in addition to cognitive and behavioural disturbances. After assessing the patient’s postural control, my partner and I decided to focus on retraining sitting and standing dynamic balance. Our first goal was to improve the anterior pelvic tilt in sitting and back extension. Being the therapist behind the patient on the plinth, my responsibility was to keep the patient sitting with good posture. However I was not being very successful as the patient kept returning to a slumped position despite verbal instructions and my handling of the central key points in addition to the patient becoming distracted. I needed another strategy.

Then my partner suggested that we change our tack and use functional upper limb tasks to facilitate improve sitting posture. The suggestion was to have the patient reach for quoits in both directions slightly above shoulder height. This immediately had the desired result as the patient responded by sitting with improved thoracic extension and anterior pelvic tilt.

After the treatment session, we discussed the reasons why the patient responded well to the change from specific treatment strategies to a more functionally based treatment session. The evaluation concluded that the patient most likely did not understand the point of the treatment. The patient needed more relevance to the session than just sitting in an improved posture, which was provided by reaching for an object. The irrelevance of the initial strategy resulted in the patient becoming bored and disinterested to the stimuli we were providing. This was an important learning experience as I most likely knew that using functional tasks would be effective but I need to be reminded about this key treatment strategy.

Gareth