Increasing patients motivation

A 56yo male presented to my neuro inpatients ward with a stroke to the basal ganglia. This patient had the stroke 2 months ago and was still in hospital receiving physiotherapy rehab. He had improved significantly in the first month according to the notes but now any improvements in gait were minimal.

During my time treating this patient, he told me that his major goal was to walk his daughter down the aisle of her wedding which was one month away. The patient’s present physical status warned me that this would be a huge deadline to meet as he required one assist to walk plus the aid of a 4 point walking stick. I explained to the patient that what he was asking was quite a huge challenge and that at best he should expected to walk down the aisle with his daughter helping him.

During the next week we focused mainly on improving the patients gait, this included 2 hourly sessions morning and afternoon to try to retrain the patients movement pattern. After one week of treating the patient this way I was aware that they were quiet and seemed to be withdrawn from the treatment session. I constantly asked the patient if they were ‘ok’ and they continually told me they were ‘fine’, yet their actions didn’t match what they were saying. After much thought on the inconsistencies of my patients behaviour I decided to talk to my supervisor and ask what they realistically thought this patient would achieve in terms of gait.

I then went to the patient and sat them down and explained how I noticed their attitude towards rehab had changed and how I wanted to reassure them that they were progressing. I had made a list of goals which he had achieved and ones which I thought were realistic with timeframes attached. He then told me that he didn’t feel he was progressing as much as other patients in the hospital. So I then explained how depending on the severity and the type of stroke people will improve at different rates. For this patient educating him on what was realistic and that all patients will progress differently, gave him the help he needed to continue with the rehab and not to give up.

AFTER THIS PLACEMENT I HAVE DECIDED THAT IT IS VERY IMPORTANT TO MATCH THE PHYSIOTHERAPISTS GOALS WITH THE PATIENTS GOALS, AS THIS INCREASES THEIR MOTIVATION TOWARDS REHAB. ALSO CONSTANTLY REMINDING THE PATIENT OF THEIR ACCOMPLISHMENTS DECREASES THE RISK OF THEM GETTING DEPRESSED FROM NOT IMPROVING.