Modification and priorities of treatment….

The weeks are flying by... not long to go now. I hope everyone is enjoying their placements.

I am currently on my neuro placement and I must admit it is the most physically and mentally challenging so far. It is certainly time to dust of all those cranial nerve, cerebellar and cortical examination assessments.

I would like to share with you my encounter with one patient in particular who confronted by practical neuro skills. This patient sustained a cerebellar infarct two weeks or so ago. My problem is that the majority of my patients not only present with the impairments associated with their current admission but also at least three additional co-morbidities. This not only challenges my repertoire of skills and techniques but confronts and often opposes the methods we have learnt in neuro.

For example the patient above, presented with typical cerebellar impairments i.e.; nystagmus, dizziness, decreased hearing, feeling light headed and leaning to the left. Sounds relatively straight forward right? Let’s add his PMHx; a (R) rotator cuff repair where his shoulder could not passively move past 90 degrees and a (L) THR which causes him a lot of pain and cramping. So if we all think back to our neuro labs, I theoretically want to have him weight shift to the right, with an appropriate arm reach to improve alignment and correct his posture. This was not going to happen. I had to quickly adjust my treatment plan so that I could be more effective in prioritising his impairments.

At first this wasn’t easy and I didn’t feel like I was doing a very good job at treating him. My hands didn’t seem to feel right and his impairments made him very difficult to treat. I felt quite frustrated and thought I should be doing a much better job than I was. It took me a couple of days to realise, after talking to a few other newer staff on my ward that I shouldn’t feel like I should be an expert yet, I’m far from that!! At the moment we do only have very basic skills, our hands are still adjusting and feeling their way around and our repertoire of techniques are very simple. It takes years of practice to achieve a high level in any area. Sometimes there is not specific way to handle patients and it’s just a case of moving your hands around until you achieve the desired result.

So my thought is, for all of us who do feel slightly incompetent with certain techniques at the moment don’t!! Even though our supervisors make it look so easy, we can’t expect to be experts straight away (even though we want to).

Heidi