On neurology placement I treated an acute L. hemiplegic pt. On initial examination the pt was unable to maintain his airway and subsequently developed an aspiration pneumonia. The pt was completely flaccid on the L. side and had remained RIB since the stroke. I treated this pt for one whole week, seeing him twice daily as the pt was desaturating regularly.
A week passed and the pt’s condition had become stable, being fed with NGT and was able to cough up small amounts of secretions. It was at this time that the medical team requested that the pt not be seen for cardiorespiratory PT, a trial to see how the pt can mange his own chest. The plan for this pt was D/C to nursing home so the only thing holding him back was his respiratory problems.
At the time this confused and angered me as I felt the pt required PT input, as the pt had not progressed greatly since day 1 post stroke. I obliged and ceased treating this pt. The following week the pt to my surprise coped really well without PT managing his chest well, and subsequently discharged to a nursing home by the weeks end.
This above situation frustrated me at first but then I realised that this pt needed to be able to test themself without my input if he were able to be D/C and avoid long periods in hospital. This situation has resulted in me allowing pt to test things for themselves more often rather then giving them assistance. I have found that by allowing pt’s to attempt tasks such as getting out of bed for themselves they feel more independent and are able to make goals that impact on their lives. Also they find our help more valuable as we assist them through our treatment to achieve these goals, returning them to their previous level of function and leaving hospital.
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Good work Lennon, i definately think that if a patient is given more control of there rehab it goes a long way in increasing compliance and as well in terms of making goals it's much better that they know its something they can work towards which is there own goal and will be benificial for them in returning to there level of function
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