Recently, I approached one of my patients for therapy participation and was quickly given a decline. Up to this point, the patient (who newly arrived to the skilled nursing facility a few days prior) had been agreeable to therapy. The refusal was quick and adamant, which included the following myriad of reasons: she was in pain, did not sleep the previous evening and felt she "overdid it in yesterday's session." Pain and fatigue are the most common reasons a person will not be enthusiastic at the prospect of daily gait training.
In further discussion with this particular patient, I found out she was also anxious with aide staff, feeling frustrated with her family and she was constipated. After hearing these additional details and educating on the importance of physical movement and healing, the patient really looked at me for the first time during the conversation and stated that she felt depressed.
Having been diagnosed with clinical depression more than once in my life, I take that statement with the weight it deserves. Depression can sneak into your life and steal all of the energy and motivation that you think you might possess. When you need physical activity the most, every fiber of your body resists. Depression in patients is common and comes as no surprise considering the increased stress and fatigue associated with hospitalization. By the time patients arrive to a SNF, they have already experienced major surgery or illness and most likely have been isolated from their home for quite a while. It's crucial that patients get out of bed and physically start moving at this point -- for their body and mind.
If I suspect depression or, as in this case, a patient verbally states the fact, I will alert the nursing staff and primary physical therapist. Once recognized, each department can address the depression before it can completely sabotage the patient's recovery.
Luckily, physical therapy plays a key component in overcoming or avoiding depression altogether. Armed with this knowledge, a successful therapy session becomes as important as an anti-depressive medication. Maybe even more effective.