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Journey of a DPT Student

Changing Goals

Published April 14, 2014 5:05 PM by Lauren Rosso

With one week left until graduation, I had my most challenging patient-care conversation since starting PT school. One of my current patients, whom I happened to work with in inpatient rehabilitation during my previous clinical rotation, is a very complex case. He suffered an anoxic brain injury that unfortunately was complicated by a transfemoral amputation with a very short residual limb. On top of that, his hospital course was protracted and he has a lot of other secondary complications as a result.

The conversation I'm referencing had to do with adaptive equipment and options for wheeled mobility. The family's initial goals were to progress to the point where prosthetic training could be considered. Despite multiple setbacks we made some great functional gains during therapy, but unfortunately not related to standing balance. Faced with the reality that the most appropriate form of wheeled mobility needed to be addressed, I sat down with the family to discuss the available options.

This was the first time that the family was told directly their son would require a wheelchair for functional community negotiation. Prior to this point, prosthetic training was such a focus that I think we lost track of long-term decision making. I take the blame for this. In hindsight if I had voiced my recommendations, I would have told them that a wheelchair would likely be required. We trialed manual propulsion, but my clinical recommendation was power from a functionality standpoint. In the end, I think the family felt like we went from talking about prosthetics directly to powered mobility. I can understand why they were upset, and I wish I had handled the situation more effectively.

I had long conversations with my coworkers about how I could have changed and improved this entire situation, and the common thread was that early transparent communication is key. Even when it's difficult to say and may not directly align with the family's perception, opening those doors at the start results in a better and less upsetting experience for everyone involved. Lesson learned.

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