Cognitive deficit, part II

This blog refers to the same patient as in "Cognitive Impairment, Part I".

Another issue I faced with the stroke patient with cognitive impariments was managing his wife's attendance and contribution to treatment sessions. I had taken note of the fact that social work had reported in the notes that the patient's wife had been particularly distressed by her husband's current condition. I felt it would be nice for her to feel included in the treatment sessions to see the tasks he was performing well with and also to see the areas in which he was improving. She was appreciative of the invitation to attend the physio sessions and it became part of her daily routine to join us.

This did not pose too much of a problem to begin with. When I started to attempt to get my patient to perform more abstract tasks such as weight shift, however, his wife would want to try to explain the task to her husband when he wasn't responding to my instructions. Although occasionally her instructions did gain a better response than mine, for the most part this became a big distraction for my patient and caused more confusion.

Eventually, during a treatment session with my patient I had to explain to his wife that it was taking all of his concentration to maintain focus on me and what I am asking him to do, and that although sometimes her explanations helped it then took some time to get his concentration back to me. She seemed a little hurt by this to begin with but I spoke to her once I had finished treatment and she said she understood and thought it was very reasonable.

In the future, if such a situation arose I would rectify the issue as soon as it became an issue, rather than waiting until the middle of a treatment session which is already a rather stressful situation. Or otherwise mention it to begin with when inviting the family member to the physio session.