Expectations Make a Difference
Last weekend I worked at another rehab facility. I've been there before and like going there. The staff is very nice and the patients have been challenging but not overly difficult. This time it was different. Included in my caseload was a stroke patient. Comparing what he did for me to what he'd done previously would be like comparing night and day.
He was a max-assist transfer that required two people and was unable to stand. I was able to transfer him by myself and progress him to standing with mod assist within an hour of treatment. I wish I could say the difference was my skill. While that might be a factor, it wasn't the cause. My expectations for the patient were different from those of his regular therapist. I'm used to working by myself. I rarely have help. Most of the patients I see on the stroke level are just as involved or worse than that patient. My expectation was that I could perform the treatment myself and I would progress his standing ability because that is what I normally do. It never occurred to me that I would need a second person. Nor did it cross my mind that I couldn't do it.
Help is readily available in that facility. The normal caseload is heavily orthopedic. Before the patient was evaluated, the expectation must have been that he would be difficult to mobilize and require two people. Because they expected him to be hard to move, he was. He didn't make much progress because no one thought he would. From what I read in the notes they were standing him but it was difficult and labor-intensive. In all fairness, a dense hemiplegic like this would be unusual for them.
I noticed something else. Prior to working in standing, I worked on the mat with him. I inhibited a flexion synergy of the trunk and flexor tone of the leg. I didn't even try to stand him until I was ready. From what I read in the notes they did supine exercises and went right to standing. That would have made him much more difficult to manage. If the leg flexor tone prevented weight-bearing, he would not have been able to stand. Seeing it might have been enough to make someone think standing was impossible.
Therapist expectations weren't the only limiting factor. So were the expectations on the therapist. Where I normally work, I'm expected to get patients up and mobilized as soon as possible. If I don't, I need an explanation. We're very aggressive. This facility is just the opposite. There was no pressure or expectation to mobilize anyone. Getting patients out of bed is as far as they go with that. Making sure the patient receives three hours of therapy is adequate. The conclusion is to give our patients a chance. Appearances can be deceiving. Instead of telling ourselves we can't do something, we need to be open to the possibilities. I got more out of the patient because I expected to get more.