Hey guys….just a reminder I’m doing my neuro placement in an out patients department. I have an elderly patient who has hereditary spastic paresis and has been having quite a bit of trouble in the last few weeks. She has been noticing a decline in her functional abilities over the past 12 months due to progressively diminishing strength and increasing tone, particularly in her lower limbs. She has remained independent with her mobility, using a manual wheel chair while at home and doing all transfers and bed mobility on her own. However, these tasks are getting more and more difficult as she gets weaker. Her husband has been helping with her ADL’s (dressing, personal care, etc.), but is quite frail and has been told he should no longer assist.

During our session today she requested to be taught a slide board transfer to allow continued independence with more ease. Unfortunately, she was not strong enough to maneuver the slide board on her own to get it under her bottom and most likely would not be able to move her body across the slide board on her own.

Following this attempt I suggested that we continue to work on the strength of her legs to maintain the strength that she has. She then became quite upset and began crying, saying that she has been told that for the last year and has just continued to decline. She is becoming very frustrated and losing hope.

In response to this I suggested we try a different slide board to see if she would have more luck, as she did not want to hear that we should just keep working on strength. We managed to use this new slide board, but with my assistance. We have decided to practice with the slide board a little bit each session to see if she can become more independent. She was happy with this, but remained quite down during the session.

The reality of her condition is that she will continue to deteriorate; there is not much that can be done to avoid this. My question is how can I discuss this reality with her in a sensitive manner, as I am sure it will come up again. She know the prognosis of her condition, but is having a hard time accepting how quickly her decline has been over the last year.