appropriate actions

Hello all,

I have had a good week on prac as I hope you all have. This blog entry is, once again, regarding my pt w the degenerative disorder I had originally described as Progressive Supra-nuclear Palsy...he instead has been Dx w Multi- Systems Atrophy (which presents in similar ways to Parkinsons...reduced initiation of mvmt and forward flexed posture for starters). The pt attended just once this week and had, in the time since last week, noticeably reduced saving responses and balance difficulties. He stated at the commencement of our session that he had really noticed a change this week.
I largely worked on bed mobility, getting off the floor, gait and anything Fx that I could think of to be pro-active. He was significantly more stressed and exhausted with this exercises. I also got some TUG tests going as they appear to be a staple in patients who are on trials of L-dopa...which he is now maxed out on.
Half way thru our 1.5 hr session he quickly moved from our obstacle course back onto the plinth. He said he was very tired. I noticed he had urinary incontinence, his shorts were soiled. He was trying to hide his embarrassment and stated that he was too tired to carry on with the session. I initially pretended not to notice the issue and said that would of course be fine but first I would like to chat with my supervisor quickly before the pt was to leave.
I wanted to know if I should, in confidence, ask the pt if he would let me assist him in finding a solution to this incident and thereby not have to walk thru the hospital ashamed. Perhaps I thought if we got to the change room he might be able to dab them dry while we waited for his transport to arrive?? The supervisor and I agreed that the most important thing was for him to leave w some sense control over his situation and not flee the session with a really bad experience.
When I tried to gently tried to bridge this option with the pt he clearly was is such a state of distress that he didn't even acknowledge my suggestion and practically ran out of the gym. On the way out he quickly blurted that he would not likely be back next week due to a holiday planned down south. Then I tried to stay with him and ensure he was safe and his transport would know where he was. He insisted he was fine and essentially was just not accepting my help. I verbally directed him the men's room. He has a mobile phone and said that he was ok to connect with his ride.
Sorry for the long story here but it was just a rough moment for all parties. Anyway I spoke again w the supervisor and suggested that we follow up w the pt next week via the phone but perhaps re-evaluate how his case will be managed...namely the pt being seen primarily by a staff PT (because I felt that this pt responded better to my senior with all his experience and that way any extra embarrassment I had caused the pt he would not have to re-visit). So yeah lots of lessons learned of which the greatest might be to know when to ask for your senior to step in....That is all. MFJ