Working on Rehab Again
It's been a while since I've had the opportunity to treat patients on our rehab unit. Usually I do evaluations. Someone else does the treatments. Today I actually did some rehab treatments. Not evaluations but 60 minutes of treatment in which I could work on whatever I wanted. What a nice change of pace.
Usually my day is filled with stroke evaluations. Some days I have treatments but my treatments are limited by time constraints and the acute setting. The rest of my patients are in the ICU. It doesn't matter whether those are evaluations or treatments. They aren't able to do very much with me.
While I was working, I realized how differently I was setting up my treatments now. I've spent a lot of time studying and attending courses. I think I can explain neuroplasticity in my sleep. Everything I set up followed the guidelines of neuroplasticity: repetition, challenge, functional and meaningful to the patient. Everything involved multiple body parts, even standing.
I always put my patients on their feet. Research is showing the best way to activate the legs is to have them weight bear. Leaning heavily on the parallel bars or an RW is actually defeating the purpose of standing. I set the parallel bars so they could be used for support but not weight bearing. Everything was done in front of the mirror. The last course I attended stressed the importance of visual feedback for motor learning so I tried using the mirror more. It worked.
The hardest thing for me was remembering that patients have to rest. When I work in the acute setting I don't worry about that too much. Just about the time I wear someone out, it's time to move on to the next one anyway. Sixty minutes is a lot of time before moving on to the next one. I didn't really know what to do with myself while we rested. My patients were perfectly fine with sitting still.
I also noticed how much the other therapists took for granted compared to me. Since I'm usually the first PT to work with my stroke patients I do a lot of teaching. By the time they reach rehab they've moved on to other things. I still caught myself explaining everything and setting things up like it was our first attempt.
The best part of my day was being able to work and sit down at the same time. That's a luxury I usually don't have.