Sunday 11 November 2007
Bargaining
I am currently on my neuro prac and have come across a young adult with an intellectual disability and severe cerebellar ataxia due to an unkown cause. He experiences severe vertigo when turning his head and is very fearful of rolling in bed due to his dysmetria. He is also fearful of standing despite adequate support. My partner and I have been trying several strategies to help overcome his fear such as aligning ourselves in his field of vision and positioning ourselves in a front on position with transfers so that he feels safe, however he still feels very fearful of falling and this means that we are often only able to get a maximum treatment session of about 15-20minutes. We feel that he would show greater improvements if we could get more time out of him, but no matter how much we bargain with him he still constantly asks to be returned to his room. Has anyone faced a similar situation and have any useful strategies for gaining his trust in us as students and therefore hopefully leading to a more productive session?
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3 comments:
i often have to bargain with the kids on my prac- any chance your pt might like stickers?? Just kidding. Do you have a bobath plinth that you could wheel into the pts room? He may feel safer if he does Rx in his room that way...
We have a lady on my neuro prac who sounds similar, ahe's not my pt but I assit w transfers and she cries every time we roll her and gets so anxious it takes 3 or us to hold down her legs and roll her because her tone is so high. They always just try and explain to her..you've done it a million times, it won't hurt, we are all here etc For this lady speaking in a quiet soothing voice talking non stop and askig lots of questions so she has to answer and can't think about what is happening is probably what works best,but I can't say it makes heaps and heaps of difference. They do also use music, she often has her ipod on and that seems to calm her down quite well. But I don't know if that helps with your pt at all?
I have found that taking things in small steps seems to work. If you work together with the patients to set goals they are often more compliant. Try sitting down with him and explaining what you need to achieve andthat you will be there to support him. Ensure he knows that he has to stand up but you are willing to comprimise to set his own goals. So you will work at a pace set by us you to achieve these goals. Some treatment is better than none by the sounds of it.
He has lost all control over his life since becoming sick. Providing him some control over the treatment (obviously ensuring that you still reach your goals) may increase compliance.
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