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Life of a PTA

The Art of Distraction

Published May 30, 2014 4:25 PM by Allison Young

I recently had a routine but painful dental procedure performed by my good-natured dentist. As I sat, gripping the armrests of the exam chair, the dentist attempted to distract me (in vain) with small talk about my family and the "crazy Spring weather we're having" -- as he proceeded to insert a sharp tool into my gum line.

His distraction techniques did not work on this patient, however. As I knew how uncomfortable I was about to become and the last thing I wanted to part take in at that moment was casual banter about the increased rainfall.

It's moments like these that help me reflect on my own ability to distract patients in moments of therapy-induced pain. Patients with ORIF procedures or hip and knee replacements maintain a steady, high level of pain for many days and sometimes weeks post op. Despite diligent pre-medication, therapy can seem like necessary torture at times.

My therapeutic style is brutal honesty with the patient. Before we do the first ankle pump, I like to give the "game plan" for the therapy session, so the patient knows there will be a beginning (bed exercises), middle (transfer training) and end (gait training -- then ice!). I find that if patients feel like they have some control over their therapy, they can persevere and complete the session.

Without a doubt, I also distract with conversation. Supine exercises and seated rest breaks between gait-training bouts are the perfect opportunity to engage patients on their favorite interests, whether it's family, job, sports or their dogs. I have many, many in-depth discussions about people's pets. I think patients feel more at ease when disclosing details of their lives that are most important to them, especially if it brings them comfort and pride when they're feeling the most vulnerable.

Personally I think ignoring or not recognizing someone's pain, whether in the role of clinician or patient, can strain the relationship and ultimately the outcome of the therapy session. I've found that learning how to finesse the art of distraction (and honesty) has had positive outcomes for my patients throughout the years. How do you "distract" patients through a tough therapy treatment?

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TKRs are very painful and post op rehab is not a joke. Pt has to get that knee flexion & extension back. I have my pt in supine, inform my pt that I will bend their knee to see how far it can go, ask my co-worker to take measurement with goniometer. I than ask my pt to perform a heel slide x2 on their own to see how much of AROM pt has, then I get  into position, by stabilizing the knee and hold by the ankle at max flexion of A ROM. Then I slightly extend the knee so pt can rest a bit while still maintaining position. I than start taking to my pt about something they like to talk about, I just let them talk by asking what job they used to do or still doing, kids, grand kids- something totally irrelevant to rehab. After I see pt got comfortable I inform the pt on the count of 3 I will bend their knee..... And I do it to the max a quck, controlled flexion, 100% of times pt is audible, then ICE. I have to be aggressive with TKR and my supervisors completlysupport me on that. I don't like to cause pain to my pts, it's just has to be done for them to get back to previous functional level. What do you think of my technique?

Ivan J., Inpatient Acute - PTA May 30, 2014 7:19 PM
New York NY

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