I have just started my neuro prac and was given a 73 year old pt to assess and treat who had bilateral foot drop. From the notes I gathered that this has been an ongoing condition for as long as both the patient and his family could remember. They simply said he has had it for what seems like forever and he simply deals with it during everyday life. Though the scary thing is this elderly man lives alone in a house and both he and his family report he has constant falls (sometimes up to 3 per day) that are due to him tripping over. They said this has been happening as long as they can remember but they seem to not worry about it.
This man has been admitted to hospital several times prior to this due to a more serious fall and throughout all the admissions there has never been a confirmed diagnosis of the cause of this bilateral foot drop. Treatment in previous admissions has included balance exercises, ambulation practice focusing on getting a high leg lift during swing phase. There has also been several attempts at moulding this man AFO's to prevent this foot drop but with no luck. The reason there has been no luck is that this mans compliance is extremely low! There has been several types of AFO's made specifically fitted for this man and all have been turned down.
The reasons that this man gives for not using them varies including too hard to don/doff, uncomfortable, annoying etc. Other PT's have tried all sorts of things to attempt to encourage more use of the AFO's including outlining the importance of them along with possible consequences if they arent worn, using the family to put across the above message and a few other things.
So during this admission they tried another sort of AFO and we taught the man how to don/doff them and even he admitted they were simply to put on/off so hopefully that has erased that problem and again have tried to push the message of how important they are in preventing him falling. At the moment while hes in hospital he seems to be pretty compliant with them saying there comfortable and he understand the importance of them and that he will use them but the PT reports that he says this every time he comes in and yet never uses them at home and she is convinced this is simply going to happen again.
Though now he has recovered from the fall and he has his AFOs and is walking well in hoispital it has come for him to be discharged. And although we wish for the best from all reports he is simply going to go home, not use them and continue having frequent falls. So i was wondering if anyone has experienced a similiar encounter and what strategies other than the standard ones they have used to try and get patients to maintain compliance when discharged.
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I think there is only so much you can do, a patient has to want to help themselves. I think this is difficult to grasp as a physio student as we tend to aim to fix and correct patient impairments and want to witness a positive outcome as a result. So all you can do is to treat the patient's impairments as per usual, address any patient concerns preventing compliance, be extremely encouraging, lots of education, organise follow-up physio, maybe a social worker involvement to discern why he isn't compliant or to set up services for the patient and also liaise back with the patient's GP. Pretty sure you would have covered all these aspects already so you just got to be content that you did all you could do for the patient, and self critique in order to let the experence help you with another non-compliant patient.
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