Putting it all together

Hey guys,

Hope you all went great in your previous placement, and best of luck for the final one.

On my recent placement in neuro inpatients i got a good understanding of how the treatments we do with our patients influence the final outcome, and in the end how they all come together and things seem to fall in place to acheive what we're trying to do.

I know that sounds a bit vague, so I'll give you the example that made me think this.

My patient is a man who had a left MCA infarct around 7 months ago, and is due for discharge in about a month. It was difficult to assess my treatments from his perspective as he was quite dysphasic and it was very difficult to gauge his responses, he would basically just do what i asked him to, down to the letter, and trust that i knew what i was doing. I found that while this was a little overwhelming at first, it really gave me a chance to have some faith in myself, and trust in myself that my treatments and techniques would help him reach the goals he was aiming for.

The focus of his last month of inpatient rehab was on his walking, getting him safe and independent. In my assessment i noticed he was retracting his pelvis during gait, particularly right stance, and decided that the main reason for this was his lack of posterior pelvic tilt during stance. Using this assessment i focused my attention on facilitating his pelvic tilt, first in sitting, then progressing to standing. He was very good at both of these positions, and i could tell he had obviously been taught this before, but he was still unable to PPT during gait. So once I had him doing it in standing, i progressed him to stride stance, and attempted PPT in this position, which proved much more difficult, but eventually he seemed to get the hang of it. From there i worked on his weight transfer from his back leg (left) onto his front foot (right), with emphasis on acheiving PPT prior to weight transfer. While he seemed to grasp this concept well, i was still skeptical on whether my hour or so that I'd spent on teaching him this would actually have an impact on his gait. At the conclusion of the session we attempted to put it all together and walk back to his room, as we did at the end of every session, and lo and behold everything just seemed to fall into place and it was his best walk to date. True, the next day he was retracting again, but now he knew what i wanted from him in the treatment session it was much faster to facilitate him into PPT and to work on other aspects of his gait with the aim to acheive independence.

What I'm getting at in the extremely long winded blog, is that we do know our stuff, we can indentify the impairments that need to be addressed in order to acheive our aim, and if we go into a session with some sort of plan, follow it through, and you'll see results. Obviously it's important to continually re-assess and evaluate our treatment, and adjust if necessary, but make sure you always give it a go first and i think you'll find more often than not that you've got it right.

Anyway, it was exciting to see all the things that I'd been working on with my patient finally fall into place and work how I'd visualised it in my head, and I thought I'd tell you all about it :-)

James