A Matter of Perspective
I went to a CEU course last week about motor control. One of the key points of the presentation was the influence of perception on movement. For example, a patient will move in response to the perceived environment. Therefore, if the patient perceives the environment to be unstable, the patient will move in a manner prevent falling. This will happen even if the patient is actually standing on a stable surface with support.
That got me to thinking. Perception influences therapists as much as it influences patients. I work on a rehab unit. The therapists have the perception that our patients are there to get three hours of therapy aimed at improving function. We know the therapy can be difficult and tiring. Because of our original perception about the patient, we believe this is acceptable to the patients. Our treatment plans and goals are based on these perceptions and expectations.
Today I evaluated a patient who didn't want to work with therapy. He agreed he was on a rehab unit and was there for therapy. Among other things, he was upset that all three disciplines came to see him in one day. He thought it was too much. He adamantly refused his afternoon treatments stating he would "do something" tomorrow.
He told me he didn't think he would have to do so much. He thought he could get better by lying around. He didn't understand why three different people came to see him. He also thought he should be able to work at his own pace on what he wanted to do. His idea of therapy was getting into a chair for a little while, then returning to bed.
It's pretty obvious where the perceptual problem is with that patient. His response to me was based on what he perceived therapy/rehab to be. When the truth was explained to him he agreed to participate, but wasn't happy. It wouldn't surprise me to see him make little progress. He doesn't strike me as someone willing to work for anything.
This is a glaring example of something that probably happens more than we think. I expect neuro patients to have problems with perception physically and plan treatments accordingly. What I don't do is factor in other perceptions that might influence therapy. A patient who perceives his or herself to be weak will expect to be treated as if that is the case. A person who has been treated as an outpatient will expect rehab to be similar and vice versa. Patients who are in pain often perceive the pain as a limiting factor. The same is true of fatigue, nausea and just about any other reason patients refuse therapy. When I look at things from this angle I can see why patients refuse therapy to watch a favorite TV show. It might not be that they think therapy is unimportant. It might be that they don't perceive therapy as more important. They don't have the perception that time is valuable and accommodating a TV show (or anything else) might not be possible.
Having this light bulb go off for me has made me aware of the need to fully explain how the unit works. When I run into someone who doesn't want to do something I will ask specifically why. If it's a matter of perception (RWs are for old people, etc) I can try to address it. I feel like I have a whole awareness of how patients experience the world. The class was well worth the time and money. Not only did I learn new treatment techniques, I also gained a new context for working with patients.