Walking Aids in Neuro

Hi All,
I learnt something this week that seems really obvious now but wasn’t at the time. One of my patients had a right MCA stroke about two months ago and for a variety of reasons, my supervisor and I thought that it was best for her to use a stick in her right hand during ambulation and transfers. Over the first three weeks of my placement, the patient had marked tone in her left UL, especially in the wrist and finger flexors, but also in the biceps, pecs and lats. I had been doing a lot of work trying to reduce this tone, but did not feel like I was making a lot of difference. Then my patient was offered a place on a Bobath course being run at the hospital. At this course she was treated by an extremely skilled Neuro Physio from the UK as well as other Physio’s who have spent years specialising in Neuro PT. When I saw her after the week long course, the tone in her arm was significantly reduced and they had told her to stop using the stick for walking and transfers. What I hadn’t realised but makes sense now, is that when using the stick in her R UL, she was getting carryover into the left UL and the tone in that arm was being encouraged. Now she is managing transfers without the stick, although I haven’t had the opportunity to see her gait yet, and the tone in the UL is much better. While we still may have to get her using the stick so that she can be discharged safely within a given timeframe, I found this a really interesting learning experience. When I first heard that she was managing without the stick and that the people on the course had managed in five days to achieve what I hadn’t been able to in three weeks, I lost a bit of confidence in my Physio skills. But then I realised that these people were specialists who have been working in Neuro for years and that I have only had four weeks of clinical Neuro experience, so I shouldn’t be so hard on myself. I have realised though that when providing aids to Neuro patients you really need to consider what compensations or other problems they might cause.
Mel