I recently completed my Neurology placement in an outpatient setting. While there, I treated a patient over the 5 weeks (twice per week for 90 minutes per session), who was being discharged after having attended the Outpatient Clinic for over a year and a half. She was quite a young stroke patient, with a young family and an extremely supportive husband (who attended every session with her and assisted her with her home exercise program (HEP) which she diligently performed daily.)
On her second last session I started some discharge measurements, at which time she started to become quite upset. She revealed that she felt she was being discharged from the Clinic because she was no longer making any improvements. Her discharge measures actually showed that she had made significant improvements in her gait and balance throughout her admission.
I reassured her that her improvements were continuing because of her commitment to her HEP, not purely due to the 90 minutes, twice a week physiotherapy she was receiving- and that if she continues with her program, there was no reason she shouldn’t continue on this path. We also discussed that although her stroke would leave her with some residual, irreversible deficits, that her commitment to her rehabilitation would ensure she would be able to optimize her function.
On her last session, the patient again became upset about her discharge. I reassured her that in 3 months time she would have a review at the Clinic, and that in the mean time she was more than welcome to call with any concerns or queries she had.
It seemed that the patient had become dependent on Physiotherapy sessions almost as a way of life, and as an absolutely essential part of her week. This situation made me think that patients need to be reminded that their neurological illness (in this case her stroke) shouldn’t be the thing that defines them- that they still have a life to live above and beyond their condition, and above and beyond Physiotherapy.
While we are able to provide some extremely valuable “hands on” physical treatment techniques, I think we need to put more of an emphasis on the patient’s self management and independence with their home program, so they don’t build a reliance on clinical services (especially towards a patient’s discharge within a long term setting, when their condition is lifelong.)
Renae
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That is so true about how much patients can depend on physio, and how they often think that it is only what we do that fixes them. On the prac I am on now, right from the start the patients are asked to set their own goals, so that they take ownership of their condition and dont depend on the physio to do their exercises. And I think that the more you encourage patients and make them realise that all the work they are doing at home is also aiding them in their recovery, the more confidence they will have in themselves to manage without us. So physio also involves lots of talking and education, not just `hands on stuff`, as I have come to realise.
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