Whilst on my neurology placement I encountered a patient who presented with a cerebellar bleed, as well he was displaying frontal lobe behaviours, was highly impulsive and quite a tall man which complicated matters a bit. The patient had also had a trache and as he was improving his trache was removed so he began to be able to communicate a bit more.
The first few occasions of treatment were really based upon transfers and basic functional exercises, this was progressing well but as the patient improved in terms of there function they became more impulsive, and it became harder to complete a full worthwhile treatment session which would address the goals I would set out at the start of each session.
Following a discussion with my supervisor they provided some tips on how to achieve these goals. The first tip was to make sure each time the patient did something for example supine to SOEOB that they would perform it in the correct manner and pattern and if they didn't to make them perform it again. The second was to try and keep the sessions short as the patient would tend to lose interest so perhaps two shorter session in the day would be more effective. A final tip that I was given was to. The final tip was to take a more of a controlled role in the session using verbal and tactile measures to make sure the patient was paying adequate attention and performing the correct task, and even if the patient became impulsive it would be easier to get them back on task.
THROUGH IMPLEMENTING THE ABOVE TIPS ALTHOUGH THE PATIENT WAS STILL DIFFICULT AT TIMES IT ALLOWED FOR THE SESSIONS TO BECOME MORE EFFECTIVE IN ADDRESSING THE IMPAIRMENTS, WHERE AS BEFORE A LOT OF THE TIME WAS SPENT ON JUST TRYING TO GET THE PATIENT TO PERFORM THE CORRECT TASK, NOW THE TREATMENT WAS BECOMING EASIER FOR ME AND ALSO MORE BENEFICIAL FOR THE PATIENT, AND SAFER FOR BOTH OF US.
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From my experience, i feel that it is really important that we stay in control of the situation so that we gain some form of patients compliance. It may seem harsh at times but we have to do what we have to do to see improvements. One other tip just to add to those is that sometimes, just take a few moments to talk to them and tell them that we are there to help them but they have to also try or just talk about something that interests them so that you build rapport with them to get them on site.
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