Just Keep Moving
Recently, a coworker of mine introduced me to a quote by Albert Einstein and how appropriately it relates to our patients in the SNF setting: Life is like riding a bicycle. To keep your balance, you must keep moving.
For that matter, this quote can be applied to most patients in any PT gym, whether outpatient clinic or post-op acute in the hospital. Most of my patients are "out-of-balance" -- literally, in many cases as a result of inactivity. As we all know, sedentary lifestyle and poor diet choices are causing an epidemic of younger, diabetic patients with co-morbidities, who never exercised a day in their life.
As a result, many of my patients look at me like I have two heads when I remind them that physical therapy sessions are every day during their stay at the skilled nursing facility. And yes, they are expected to participate each and every day. These are, of course, extremely low-level patients and we begin their treatment with the most basic of exercise: supine in bed. As my patients, I educate them on the importance of exercise not just with building strength and joint ROM, but in the psychological benefits including reducing stress and depression.
With no surprises, I've had the "just keep moving" talk with more than one patient on my schedule who refused to get out of bed due to fatigue/pain/drowsiness/nausea. It's frustrating for us both. They're very ill and feel terrible and I know they won't start getting stronger until they get out of their bed. Unfortunately, sometimes this standoff doesn't get resolved and the primary therapist has to give it his best attempt, which can ultimately result in the patient being removed from therapy for non-compliance.
Once in a while though, I'll be given a patient who starts therapy so weak he can barely walk in the parallel bars. Even through the pain and fatigue, he participates in therapy every day and begins to progress. Whether limited by obesity or an amputation, he gives 100% effort and surprises even himself with his accomplishments. In turn, these patients inspire me to not give up when this job gets insanely stressful or even when I set a personal goal for myself.
Please share how you motivate your patients to "keep moving," whether in an inpatient or outpatient setting. Better yet, how do you keep moving? Because I'm always open to tips, bicycle or not. ;)