Saturday, February 9, 2008

When to stop pushing?

Hey guys…hope your first week of prac has been good.

I’ve just started my neuro clinic, working in an out patient’s department. I am enjoying it so far, but haven’t got to see too many patients yet. One patient I did work with briefly, while helping another student, left me questioning how much you should try to encourage and push your patients who don’t have a good attitude. This patient had had a stroke about 4 years ago and has been living at home, leading a normal life for a couple years now. About a month ago his GP recommended a 2 month period of physio to reinforce proper gait and normal movement. As this patient has been without physio for some time now, he had developed poor habits and compensatory patterns which we are trying to correct now. During his last session, the one which I was helping with, we were working on weight transfer to his affected side. While our supervisor was helping the patient was working really well and had a good attitude. As soon as he left, the patient became very aloof and was not trying hard at all. He made comments about these physio sessions being pointless because he just starts walking the way he had been as soon as he leaves. I proceeded to question whether he practices walking with better gait at home or does any of the exercises at home. He reported that he doesn’t and appeared to have no interest in improving his gait or movement patterns. He said he hasn’t noticed any difference in his movement since he started physio and is only going because his GP and wife want him to. This leads to my question, how much I should have pushed him to be compliant, practice walking, do his exercises, etc. If the patient already has a bad attitude, I feel too much pushing/encouragement may turn them off even more. What do you think would be the best way to handle a situation like this?

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