The Power of Encouragement/Motivation

Hey there friends and colleagues, hope you’ve all had a friendly and inviting first week of clinic. I’m currently at Charlies in neurology with 3 other lovely people. One thing that has become particularly evident to me over the last week is the incredibly important role of encouragement and movitation in dealing and communicating successfully with patients in this area. I understand that this is necessary with patients in all areas but for many of the patients on my ward, their worlds have been totally turned upside down and they have gone from active, independent individuals looking after others, to completely dependent on people for their most basic needs. As you can image (although, I’m not sure we fully can unless you’ve experienced it), this is very depressing and degrading and many patients lose hope. One of my patients was a very independent and active lady before her stroke in December, and now she cannot stand independently, her speech is dysarthric and she is at the mercy of others for all her ADL’s. In working with her she is often expressing that there’s no point in trying and that she doesn’t care anymore which poses an additional challenge to her rehab. I have been amazed at the difference some genuine encouragement and positive reinforcement has made with her. You can see in her face the flicker of hope when you say how well she’s doing and she asks, “Really?” The role of motivator cannot be underestimated when working with patients, and I guess in general the degree of impairment tends to correlate with the level of encouragement/motivation needed to an extent. So go for it guys!!

DOMS

After week one on my neuro prac I have found myself in a world of hurt! I find myself as a fairly fit individual but recently am struggling with very sore muscles and aching joints! My musculo prac had nothing on this one where acute stoke patients, big and small, require a MAX effort to attain any position. It has always been warned that one needs to be somewhat strong to work as a physio.

What I have found is there is huge spectrum of hand placements, transfers and tricks of the trade to ‘safely’ move and treat these sorts of patients. I share a larger, max assist patient with one other individual on my clinic. It is very difficult to feel safe with the patient when all my muscles begin to shake and I start to sweat profusely. I have found it very beneficial to get tutored on the ‘field’ way of handling patients in this situation though I am still uncertain as to my comfort level with theses patients.

Our curriculum has done a good job of giving us a ‘base’ to start from. The difference is, practicing on each other is very different from the real thing and modifications are needed to really get the desired effect!! Currently we have utilised tutorials by our clinical supervisors to demonstrate facilitation, transfers, reeducation etc. as is done in practice. Techniques become quite modified and there are noted changes with those clinicians with years of experience. I still feel the need to become more confident to ‘modify the mold’ of what I was taught and what is used. I guess it comes down to what works for you as an individual but I do want to assure my patient is safe! Has anyone else found that tweaking some of the lessons learned has helped or hindered confidence with transferring/treating a patient?

Hi all. Hope everyone enjoyed their holidays. It is weird to not see all of you every day :)

I'm doing Neuro Outpatients at Shenton Park. So far it is really good. It is a student run clinic and we each have a list of patients that we have taken over from the last set of students in December.

So far everything is running smoothly. My most challenging aspect so far is dealing with a patient that speaks virtually no english. She is a left hemi that needs both gait retraining and upper limb function retraining. I find that I have to use my hands more than my mouth and I need to have very concise instructions, if any (if you know me then you know that it is really hard for me not to be chatty). The hardest part is giving her a HEP because I cannot seem to get her to understand what I want her to do and how many times. I can get her to do what I want if I guide her, but not by herself. She is content to let me move her appendages, but cannot repeat the actions on her own. I finally got her to lift her toes for IC, but not she is almost lunging instead of striding. Any thoughts?

Hi everyone!. At the moment I am on a neuro placement at RPH Shenton Park in the out-patients department. Patients come in to us after they have been discharged from the ward on a twice weekly basis. "Reflecting" back on our whole studies in neuro, we have been taught how to do various assessments ie tone, cerebellar, cranial nerves etc but I am now having trouble putting these into perspective in an outpatient setting. When a patient is in the ward, you are seeing them daily and testing absolutely everything you can think of progressively throughout their stay in hospital ie you test everything. In an outpatient setting, patients have all recovered to some extent (enough to be discharged) and all come in with a wide variety of issues. Consequently, I had absolutely no idea which assessments were necessary and which were an absolute waste of time ie I had no idea where to start when a new patient arrived! Was I supposed to test vision? Was I supposed to test cranial nerves? Did I need to check sensation? Our supervisor knows each patient as she has treated each one previously on the ward so can pick her assessment up from where she left off. She states in an outpatient setting she never checks sensation, or perceptual deficits as the main goal is to improve motor function. Apparantly it is not time efficient to test everything. Hmm. I saw no other way to resolve this problem then simply to ask? Our supervisor gave us the answers (which was lucky as this is our assessment). I feel I know how to do things, but not necessarily when to do things in an outpatients setting. Reflecting back on our studies, perhaps it would have benefited me now if I had clarified which assessments were relevant in an outpatient setting, other than motor function.

jitter bugs

I always get the jitters when I see patients for the first time.

And this is because I get anxious about focusing too much on the assessment and the whole procedure that I forget to look at the big picture. Is this known as focusing on the trees and forgetting the forest? Hmm.

One good example is when I was assessing a patient with multiple sclerosis (MS), I followed the assessment form and thought that I had assessed enough and analysed it well. But when my supervisor came and saw the patient move from a position of supine to crook lying, she immediately saw something that I had completely missed out. My patient had a very subtle trunk ataxia. She went on to explain that some MS patients may seem to have no/little ataxia because they fixate the movement through the global muscles. In addition, if we work on getting them to stop the fixation, the ataxia will become more apparent and as a result, patients may think we are doing them more harm than good. Contrary to popular belief, enabling them to stop the fixation will allow us to work on their postural muscles and thus, improve their ambulation.

Being a student with no experience in neurology, I feel it is important we analyse our assessments (therefore we do a SOAPIER) and get the supervisor to go through it (important to do at least one) so from there, we know if we are on the right track and can build up on our skills.

I think it all boils down to how well individual observation skills are (that’s why we are students and trying to get more experience to train it). Apart from observing patients movements and analysing it, knowing common movement patterns are pertinent too.

Is there any other way to improve observation skills?

Learning Styles

I’m interested to know how different people prefer learning whilst on their placements. I have been on placements which have involved the majority of my learning and practice solo and have also been grouped with other students. At present I am part of a wonderful group of 4 people which I believe is enriching my learning experience. Working with a fellow classmate enables us to bounce ideas off each other and fill in each others learning gaps. Even if we are working with separate patients but are in the same work space (i.e. the physio gym) we are able to confer briefly if questions arise or ideas need clarification. Personally I am happy to help others where I can and in turn am grateful to receive help in my time of need. I think both styles of learning have there place, but perhaps initially being paired together gives me more confidence and sets me up to handle things individually as time on placement progresses…..what do you guys think??

Powers of observation

Hi guys!

Hope you have all had a fantastic break and are ready to take on the final few months.

I am currently in Cardiothoracics at SCGH. While treating a patient today, I was in need of an extra chair. There were no spare chairs in the room, and I had noticed chairs in the corridor that the patients used to rest on during their walks. I hurried out of the room and grabbed a high back chair by the arms pulled up. To my dismay the chair stayed where it was and I was left holding the arms - the chair was tied to the wall!

Hmm, seems I need to work on those powers of observation. Ok, my next blog promises to be more clinical but I learnt to pay more attention to the environment that I work in.

Mike