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Toni Talks about PT Today

Physical Impairment Doesn’t Equal Impaired Cognition

Published September 16, 2009 11:48 AM by Toni Patt
Last Saturday, one of my patients complained to me about the nurses. He was frustrated that he was being spoken to like a child. His words to me were "I'm not stupid." The man isn't stupid, but on initial presentation he could give that appearance. He uses a w/c for mobility.  He is mildly dysarthric and speaks slowly as a result.  He has left facial droop and a flaccid left arm he keeps propped on his lap tray. His appearance is deceiving. As soon as you speak to him, it is obvious he is fully alert and oriented. I speak slowly to him to compensate for age-related hearing loss, not stroke related confusion.

His complaint isn't unique. I've heard it from other patients. I suspect many people with physical impairments have the same complaint. For some reason, people equate physical impairment with cognitive impairment even though there is no direct relationship. One can be present without the other. People also equate cognitive impairment with aging. Decreased cognition is associated with aging, but not every older adult is cognitively impaired. 

Using baby talk with a cognitively intact adult is wrong. Period. So is assuming someone is cognitively impaired based solely on physical appearance. Had the nurses taken a few minutes to speak with my patient instead of speaking to him they would have realized their mistake.  It might be easier to do that but that isn't respectful of the patient. 

I would attribute this to working on a neuro unit where many of the patients are cognitively impaired.  That might be part of it, but I hear the same thing on medical and orthopedic floors.  That assumption can't be made based on appearance alone. Nor should someone talk at a patient because it is quicker or easier. 

PTs spend more time with our patients than almost any other discipline. We get to know them and they get to know us. A PT is willing to take the time to talk to someone before making judgments about cognitive impairment. I greet every patient as though they have no cognitive impairments even when I suspect they do. To me it's a matter of respect.  If a patient is cognitively impaired, I adapt accordingly. No matter how severe the physical deficits are the patient is still a person who should be treated with dignity. That means speaking to the patient and not at the patient.


Good post.  

I have one addition.  You said, "Using baby talk with a cognitively intact adult is wrong. Period."  

I would add:

Using baby talk with a cognitively imparied adult is wrong.  Period.

anonymous September 17, 2009 6:11 PM

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