Can you believe it - only two weeks to go!
Currently on my neuro placement, I had to do a telephone handover yesterday to another hospital as one of my patients was being transferred. She was a 31 year old with right hemiplegia, LL gowland 5 of leg and foot, UL stage 2 arm stage 1 hand. Aphasic but able to verbalise yes, no, good, bad, ok.
When this placement started my patient was walking independently, bed mobility was independent - able to roll to the left and to the right by herself. When I handed over this information, the physio more or less yelled at me questioning why I was letting her roll to both sides, this should never be allowed and gave me stern warning to never let this happen with another patient ever again. This patient has just begun to move in a flexor synergy (UL) but has a significant increase in tone of the right finger flexors. When I told the physio this she blamed me for this increase in tone "because you let her use these faulty movement patterns...this wouldn't have happened otherwise...you have managed this patient poorly."
This converstaion left me quite confused. If I stopped this lady from rolling to both sides, is this not taking away some of her independence??? Don't we want our patients to have as much independence as possible? When I assessed her rolling to the left, though she found it slightly difficult, she was still able to do it with no assistance. Is it right to stop her doing this? Secondly, I thought the increase in tone was becuase she was recovering? How are we supposed to stop this from occuring at all?
Though this lady is sadly no longer my patient, if I have made a huge mistake with her i'd like to stop if from happening again with anyone else. Can anyone share the light?
Fan
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2 comments:
Hi Fan, my understanding is that you don't want to encourage them to roll onto their affected side especially if they have a low Gowland, a painful and/or subluxed shoulder. However at the same time we need to assess mobility so just saying that a patient is able to roll both directions can be very helpful in creating and impression of the patients functional ability. Increasing tone in a flaccid arm is a good sign as it indicates an improvement in gowland score. If the arm is flaccid there is no voluntary mvt. If it has tone there is some movement or it can be facilitated. It is certainly not a bad treatment for a patient to go from flaccid to tone.
Maybe the physio was concerned about decreased range in the finger joints d/t increased tone. Either way from what you've said I'm not seeing a huge mistake. Ask your supervisor about this if only so you don't keep stressing about this.
Hope you have a good final 2 weeks.
Anna
Hey Fan,
For 1 thing it sounds like the physio you were talking to could have handled it much more professionally, maybe asking what you'd had been doing as treatment, and if they didn't agree with it then explain their way of thinking, rather than acting like they did, when they clearly haven't ever seen you treating this patient.
Secondly, neuro confuses me alot because i think it is a very subjective field. 10 different physio's could see the same patient, come up with 10 different problem lists, and do 10 different treatments, yet if they can all be justified then they're all right. I found this part very difficult on my neuro placement as receiving feedback from 5 or 6 physio's about the same patient gave me a number of different points of view.
I assessed my patients rolling to both sides, they're going to have to do it eventually, I think the important part of this is giving them prompts on how to do it properly i.e. looking after their arm when they're rolling. Ideally we want our patients to adopt as normal a movement pattern as possible, but somewhere the line has to be drawn and we need to consoder function as more important than normal movement.
It sounds like you've done nothing wrong to me Fan, and the main issue here is a physio who clearly has no communication skills and wants everything done their way. So I'd just pass it off as that, accept that you treated your patient as well as you could have (after all we're being supervised, I'm sure your supervisor would have said something if you'd been making glaring mistakes), and move on and keep doing a great job on your future patients :-)
Hope this helps Fan,
James
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