Hi guys
Today I was treating an elderly patient on the neurology ward that I had seen all last week, where she had been fairly mobile and I had walked 80m with her at the max. I knew that she had had a bad wkend with neurological episodes of unresponsiveness and so I was prepared for a decline. However, when I saw her today she was a changed woman, she moved with such a slowness of movement with really slow initiation and could not follow commands properly. I kept downgrading my planned treatment session in my head until I would have been happy if we just did a lap of the bed with her WZF then let her lay back down again. However, just past the foot of the bed as we were walking to the other side she froze and could not take the next step with her right foot that she needed. It looked really similar to when I have seen Parkinsons patients freeze in doorways, although she does not suffer from Parkinsons (her condition is rarer and more complex than this). I spent 5 min with her in the one spot, trying counting, prompts and tactile facilitation, with her getting more fatigued from the prolonged standing. A chair was only1.5m away but I had justified that it had taken her so much effort to stand from SOEB that if I moved the chair to behind her and let her sit I might not get her up again easily! Plus I didnt want to move from a guarding position to grab it. Luckily another physio walked past at that point, so I asked her to help and we tried one person weight shifting with another person trying to move the right leg to help her take the step to get her going again. However, the patient felt unsteady and began to cry, saying that she thought she was going to fall. The other physio decided that she would guard the patient whilst I grabbed the chair, we put it behind her and let her sit down, then we (big no-no I know!) dragged/lifted the chair with the lady in it to the side of the bed where she could sit in it and relax.
The things I learnt were that it can really be great to ask for help, especially from a more experienced physio, and also that it is often a better idea to let the patient rest instead of continuuing to try to push and push the same thing and distress the patient.
However I also wondered, does anyone else have any clever tricks for a neurological patient who has just seemed to 'freeze' to help get them moving again (taking into consideration frail elderly w a WZF)?
Thanks
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1 comment:
Hi Mel,
I am seeing a few patients who also present with Parkinsonism traits, and they have a rare neurological disease known as Multiple Systems Atrophy (MSA) - is it the same as your patient? Well done using counting, prompting and tactile input! Mental imagery also works really well for one of my patients, but I'm not sure how much you can get out of a frail acutely unwell patient-"cognitively".
Mark
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