On my rural prac I’ve seen a variety of different patients. One lady I saw was in her early sixties and was approximately 10 days post back surgery. She presented to me on the ward, ambulating with a WZF and with a foot drop. She was an extremely difficult lady, continually complaining of pain even when on the highest dose pain killers she could have, and was convinced that if she worked on her muscle strength her foot drop would disappear, and her pain would be cured by a cortisone injection. She was given an AFO for her foot, which she refused to wear (it didn’t look pretty enough and didn’t fit into her shoes), and she continually tried to walk without her WZF.
The solution I came up with at the time was to educate and reinforce to the patient how important it was for her to use the AFO, and incorporated it into our sessions more. I managed to convince her to buy a pair of shoes that would fit the AFO and lo and behold, she realised the AFO worked! The other technique I used was for her to walk in the parallel bars, with me guarding close by, without her hands to see how steady she was without the WZF. On turning in the parallel bars her knee on the side of the foot drop kept collapsing on her and she began to see why she needed the WZF. It may have been a bit harsh, but in order to break through her denial and unrealistic expectations, I felt she needed to be shown her limitations, for her own safety.
Would you guys have done the same?
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3 comments:
I think you handled that well, I don't think you were being cruel really, but you showed her the extent of her ability and probably put things into perspective for her. I have a patient like this on my rural placement at the moment and she refuses to use her stick although she is a left hemiplegic and has terrible balance. I think I'll give the shock treatment a go!
I agree with your intervention. Sometimes it seems the only way to get through to people is by letting them fail (safely!). Your treatment from then on would have progressed as it should, like a partnership. Both parties being on the same track will always prove advantageous in terms of treatment duration and outcomes.
There is a fine line between showing a patient the truth gently and being cruel. I think you showed her the truth in a very professional manner, and I'm sure gained her trust at the same time. Well done.
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