I'm currently on my neuro prac on an acute stroke ward. I recently treated a patient with (R) MCA. She was a (L) hemi with no movement in both (L) UL and LL. I've read her notes prior to seeing her. She is 73, lives alone and has minimal support with family. She has a PMH of HTN, OA, Depression, Renal Failure.
Upto seeing her, she was very quiet and shy at first. I proceeded to introduce myself and explaining the reason i was there. Still no reply. She actually turned away and realised she was clenching her fist. I continued with my session and asked her how she was feeling and that i was going to take her to the gym to do some physio. She mumbled out "good". I pushed her (in a W/C) to the gym where it was a quieter environment. It was just me and her. She slowly started to open up and spoke to me. However, her actions were still agitated and irritable. She had explained that she's had not much support from family and not have anyone visit her since her admission. She also shares that she has suffered from depression for a very long time and feels it's getting worse and worse. I further questioned her life prior to her stroke. It was a very monotonous and sedated lifestyle, she pretty much stayed home all day. It was very hard to treat her neurological symptoms, as she seemed very dis-interested in everything i was trying to do. I tried to explain everything i was doing to help her understand. But no matter what i was doing she really wasn't interested or trying to move her limbs.
I spoke to my supervisor afterwards and found out her depression is quite severe. She is on heavy medication and therapy with psychologist. My supervisor suggested trying to get her to open up, talking to her and understand her thoughts. She also said, sometimes they have good days and bad days, so it can be a luck of the draw thing.
I continued to treat the patient and slowly built up my rapport with her, i kept trying to ask her questions about her and really trying to understand her. And i think it helped. She now looks forward to our physio sessions and has shown good improvements on her stroke.
Initially reading her notes and her PMH, it had depression and i just skimmed over it. Because 5 out of 10 patients that you see have got depression in their PMH. And i've never realy had any problems (so far). However i have learnt you always have to keep it at the back at your mind and determine the severity of the depression. Because it could affect your physio Rx, like this one.
1 comment:
your comment about many patients having depression down in their PMH and my tendency now to gloss over it is so true! i was recently treating a stroke patient who also suffered from depression and her response in physio sessions was highly variable. i tended to try avoid talking about her problems and tried to keep her focused on the physio tasks. i had some success with the patient but after reading your post it made me think that maybe on her bad days i'd encouraged her to talk about what was bothering her, i might have got more results from the patient. thank you for offering another way to approach this problem.
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