What do you do with the patient who doesn't listen???? Especially when it makes transfers unsafe!!! On my neuro prac we have a patient who has had frontal lobe damage and is extremely impulsive with all tasks. He is now restrained in his wheelchair as he has a tendency to leap out of his chair with no prior warning. One particular Rx session we had him in the gym and he wasn't particularly compliant. This session he wasn't restrained as the restraints were applied following these incidents. We were just getting ready to transfer him to a plinth and getting the area prepared. We instructed him to sit still till we were ready. Neither of us were prepared for what happened next. All of a sudden he was leaning forward and MOVING!!! We managed to support him half way through the transfer and help him on to the plinth. He's getting better at responding and now using the restraints makes it much easier to control him.
This situation presented us with a few issues to consider regarding patient communication and management. In terms of communication we now use very simple commands and keep repeating the same commands throughout the session and keep them constant over the weeks. He needs very clear direction and if you need his attention or need him to stop what he's doing yelling STOP works quite effectively. When treating this patient you can't treat the impairments because he gets confused and then does his own thing. We have to make the Rx functional. For example, part practice of a task doesn't work but if you say "stand up" and "walk" he is able to do it with assistance. It was quite a challenging experience and we needed the assistance of those with more clinical experience to deal with this patient. However, I think we handled the situation well and once we were aware of the patient's impulsiveness we were better able to manage the situation and direct the Rx sessions while still achieving the goals we set.
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3 comments:
Sounds like an interesting case. It's always interesting to find out different methods of dealing with patients.
That is such a tough issue, it's hard to treat someone when you're not sure if they're understanding you or going to do what you say. Its even more difficult when you have no experience in how to deal with these things. Some patients are just inclined go ahead with things before you are ready and its hard to know when to step in and be firm. I think you came to a good conclusion, unfortunately patients are never straightforward!
That sounds like quite a tough nut to crack. Its good to hear you have the situation under control and have adapted some simple strategies to manage this pt. I have seen pt's that think they are much more capable than they are, but having frontal lobe damage would certainly put a spin on spontaneous behaviour. Its great you approached physio's with more experience who have liklely been with a similar pt before to achieve the goals set for the pt. Sounds like you guys and the pt are learning a lot off eachother. Well done
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