Last week on my neuro prac a very interesting incident occured with a pt on the ward. She was not my pt, but i had helped on several occasions as she was 2x max assist for transfers and i was called in as a 3rd helper for head control during transfers or additional support. Her HPC was a severe (R) sided haemorrhage that had caused a significant midline shift. She had a trache and was requiring regular suctioning due to having copious amounts of secretions. She was unable to communicate or respond to commands, and blinking for yes/no Q's was being trialled.
On one occasion last week, I entered the room expecting to see another physio student to liase with about plans for the afternoon. When i entered, the pt immediately turned her head and fixed her gaze on me. This was surprising in itself as the pt normally had no fixed gaze, if her eyes would open at all. I then asked how she was feeling, and she replied with not bad by mouthing the words and moving her (R) hand in a so/so motion. She also gave me a smile when i said she was looking much better.
We saw the pt again a few days ago and she was very talkative and moving her (R) side well, with some activation of her (L) UL and LL. We asked her if she remembered much and if she knew how far she had come. She replied saying she could not remember much of the early days, but from the week before she heard and understood everything, but was unable to respond in any way, and was getting very frustrated. She had made such and amazing and spontaneous recovery, in addition to the communication, requiring 1x min A for sitting compared with 2xmax.
This made me think of a few things. I didnt realise the turn around someone can have following an insult to the brain, where i was under the impression it would be a much more gradual process, especially after the acute stage (She had been in hospital for over 3 weeks). It also demonstrates the importance of physio and other therapy in these early days, even if a pt is very dependent and their outlook is not good, you just never know. Also, even though the pt is unable to communicate or respond in any way, they may still understand and this must be respected by always letting the pt know wat is going on and encouragement ++. I think this is really critical, even at the time if you think you mite be talking to yourself. This was a real eye opening experience and really illustrates the importance of all the care she received to aid her recovery.
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That's really interesting steve. Its nice to hear stories like the one you just told and to always remember there's hope. Im on a placement at the moment where most people on the ward are intubated and i always feel a bit silly talking to an unresponsive patient but i know if i was in their situation i would want to be talked to as well, so it is definitely an eye opener hearing first hand about your patient who understood everything but could not respond.
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