On my previous placement, I was treating an 88yo man who was admitted 2weeks ago as he was not coping at home. 1 month previously to this he had suffered a (R) MCA stroke and had spent 1 week in hospital before discharging himself against medical advice. When he self discharged himself he was not able to ambulate and his (L) arm had no voluntary control. He was then re-admitted as he had had many falls (no injuries) and his wife could no longer look after him. When he was admitted the 2nd time he was ambulating with a walking stick (extremely unsafely) and had voluntary control in his shoulder and elbow (but mainly in synergies) and flaccid wrist and fingers on the (L) hand.
When I assessed him my main findings was he had global muscle weakness especially LL, poor static and dynamic balance, delayed and ineffective saving responses and no voluntary mvt in his (L) wrist and hand. He ambulated with a walking stick x1 mod A. I treated this patient x2/day, the morning session included balance exercises, strengthening and gait retraining and in the arvo we worked on UL and again gait retraining.
Improvements where slow (I did see some good improvements in his (L) UL - he was able to extend his wrist mid-inner range against gravity by 3 weeks) and the patient was not happy to be in hospital. He did enjoy physio session however and worked very hard in each session. By the end of the 3 week the patient hd had enough of hospital and self discharged himself again against medical advice. On discharge he was still a very high falls risk and still requires close S/B assistance when ambulating. His wife agreed to provide this assistance to him when at home but she was 85 yo and bearly 5 foot high!
We all educated the patient on the risk of going home but the patient had made up his mind. It is very hard to get through to a patient that we are really there for their best interest and to keep them safe. However I too would go stir crazy being in hospital for 3weeks +! In the future I am very sure I will come across many more patients like this man nd I believe all I can do is educate them on the risks and try to persude them to reconcider.
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I don't think you can do much more than that. If people have made up their mind to do something...chances are they probably will go ahead and do it, regardless of what anyone else says.
I think the major role of health professionals and medical staff is to educate the patient and provide a united front so the patient gets the message clearly and isn't presented with conflicting views.
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