Hi Everyone,
I am exriencing a difficult patient at the present who I feel slightly fustrated with. 2 weeks ago, an 80yo lady presented to me at the outpatient musculoskeletal department 9 weeks post greater tuberosity fracture and associated dislocation post-fall. The lady came in wearing a colar and cuff sling and bagan to tell me how much difficulty she has been having with her broken arm. She stated that she was told to do NOTHING with her arm until such time that she could begin attending physiotherapy sessions.
Once the physical assessment was under way it became very clear that this elderly lady had been very protective of her arm as extensive muscle guarding was present and extensive bruising still remained. The PROM measures I was taking were extremely limited and the lady began to get very irritated with me for moving her arm. After speaking to my supervisor who expressed her concern that PROM exercise had not even begun yet, I gave the lady some very light passive flexion and abduction exercise to complete for the following week. However, the following day, I recieved a phone call from the lady, telling me that I don't actually understand what has happened to her arm and that the exercises given were too difficult and not appropriate. She went furthur to say that she would no longer come to physiotherapy and would just wait until her arm healed by itself. I was very worried about her doing this, because as we all know, her arm will never get better by not using it, so I strongly suggested to the lady to return for another seesion and told her to cut her repititions in half until she saw me next. At the next appointment, I used heat to calm her down, gave her extensive education about the need to do exercises with her arm and used a slings to assist with increasing her PROM. As she is still very far off being introduced to active assisted exercises, I told her to continue with her PROM exercises at home.
My problem with this entire situation is that the lady is far behind in her rehab timeframe and I see no fast acceleration in the near future. Yes, she is quite elderly, she seems to have a low pain tolerance and she was given poor advice initially however now it is my responsibility to get her arm moving again. I feel that her trust in me is very important that perhaps she is not doing her exercise as she feels uncertain about whether I am doing the right thing for her. I also would like to give her some exercises that will encourage her to move her arm more (rather than the simple PROM exercise with the stick that I have already given her). If anyone has any good suggestions related to gaining trust and improving ROM post humeral fracture, please shed the light???!!!
Look forward to heariung back from someone,
Kate.
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1 comment:
Hi Kate
I agree that it can be very difficult to gain someone's trust when treating and to convince them that what you are trying to do is both safe and in their best interests! It does seem to be more prevalent in the elderly as well, perhaps because to them we must seem so very young? I am experiencing a similar problem on my gerontology prac attempting to do vestibular habituation exercises with a lady who is both very afraid of her dizziness adn falling and not particularly trusting of me! The things that you are doing - taking time to explain it all to her including the benefits, progressing only v. slowly etc - all sound like great ideas. Hopefully you will be able to fully gain her trust soon!
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