a silver lining to every cloud
Well hallo my fellow physios to very soon be
My experience this week relates to a 29yr old lady with a 14yr Hx of MS. She is a delightful pt to work with and constantly amazes me with her positive attitude towards life. In the last 18/12 her ms has progressed significantly and she is now mobilising with a MWC. Her primary impairments are very low tone in her trunk, high tone in her LL's bilaterally (esp in the plantarflexors) and she has very poor activation of glutes, lower abs and LL muscles which makes gait very difficult; and to top it all off she is very ataxic. I approached working her with the attitude that i would just try and slow the inevitable but making improvements would be impossible. However, in collaboration with her we came up with several Rx strategies that have actually made several significant improvements in her Fx. Firstly i sent her down to Actimed to buy a duradisk, which she has been sitting on ~ 4-6hr daily whilst doing balance exercises. Secondly we decided to break her gait practice right down and work on basics in stride stance and only move to whole practice once she had mastered each component part. As a result of this, and most importantly her committment to her HEP, she is now able to amb into the toilet independantly and take care of all her basic hygiene needs, something she feels very excited and proud of. I have learnt so much from working with this young lady, i will never approach people with progressive diseases with such a negative attitude again. The other thing i learnt is that by listening to the pt you can learn alot about how best to approach their Rx.
The Manipulator
posted by the manipulator @ 9:40 AM
2 Comments:
Hi Jez,
It's great to hear that you were able to make such a difference in your patient!! It is very hard to have a positive attitude when it comes to progressive diseases because you always have that idea in the back of your mind that they are going to get worse. But you just have to remember that even the things you do that seem so small and insignificant, make such a big difference to the patient. And i also agree with listening to your patient, especially in a neuro outpatient setting, because these people have been dealing with thier conditions for many years, they know what works for them and what doesn't. So by listening to them you can make your Rx session so much more effective.
You are doing a great job manipulator and good to see that you are enjoying your neuro prac so much. I have also found that specific goal setting with your patient (especially MS patients)works the best and gives them the responsibility and ownership of the Rx sessions which motivates them. We then just need to provide encouragement and good sequencing of Rx sessions so they can achieve their goals.
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