Safety first

Hello everyone,

This week concluded pretty well except for with one client on my neuro prac. I have found it very tricky to motivate and have safe treatment sessions with this individual who suffered a (L) MCA stroke and who has a 2 Gowland of the leg and foot...some year and a bit down the track.
He/she had a very big (and in my humble opinion completely unrealistic) goal of walking without assistance this past weekend for a special occasion. None the less the plan, according to my super, was to give it a go. So we had worked on it for the whole month exclusively.
Part of the reason he is unmotivated is due to the meds he/she which make him/her very drowsy. His/her partner is very caring and also does alot of transfers for him/her and thus with his/her impairments and his/her reduced need to self transfer he/she is unable to get out of bed without assistance (moderate...sometimes near max!!). The picture just didn't make sense or safe to focus strictly upon gait in the light of his other activity limitations. But I can understand that having a real tangible goal can give someone a great deal of determination.
The problem is/ was two fold. First, the supervisors incredible manual handling skills were so developed that he could manage to actually get this person to walk quite well..moving quick enough to tap into some auto pilot mode. But I just am no where near there as a neuro PT yet and I felt much more comfortable and SAFE in the // bars- doing a part practice type approach. Second, the pt. really had no interest in my unrewarding style of gait retraining and simply would delay effort for those types of exercise until the super would show up to perform his seemingly magical work. This pt would literally take 5 minutes to sit to stand when I was alone with him/her and when the super was there he/she would nearly pop up. Grrrr.
So anyway, to me, the deal is that we are nearly PTs in the real world and I just feel that I have to be honest with myself about my current skill set and if I make the call that someone is, say at risk of a fall or some other dreadful outcome because there is too many variables for me to control then that is the way it is. For this reason I wrote up my transfer summary to reflect this. After all these clients attend these clinics knowing it is a student run show. The last thing we need is someone to fall because we are working outside of our abilities. Hope that all makes sense. I am enjoying all your posts and best of luck in the next prac. Matt