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Toni Talks about PT Today

Because the Family Wants It

Published January 10, 2012 4:37 PM by Toni Patt

Because the family wants it isn't a reason to order physical therapy. Because it would make the family feel better isn't something that requires skilled intervention either. Last weekend I ran into a nurse who disagreed with me about this. I performed the evaluation and signed off. I have nothing to offer an unstable C3 quad whose family is independent with ROM exercises and nursing gets out of bed daily.

The majority of families would like their loved ones to get therapy. Therapy is beneficial. Seeing their family member getting up and moving around implies the patient is getting better. The opposite is true when the patient doesn't get therapy. The sense of getting better isn't there. That doesn't mean everyone should be getting therapy.

Not all patients are appropriate for therapy. I run into this a lot in the NICU. Some patients just aren't awake enough to participate. I check on them every few days. I monitor ROM and positioning. I teach ROM exercises to families. I don't see them daily for PROM and out of bed in a neuro chair. Those aren't skilled services. Every so often I get orders to do something more because the family doesn't think the patient is getting enough therapy.

Last weekend a family member followed me around the floor while I walked other patients. Her husband wasn't on the caseload because he was unresponsive. I guess she thought staring at me would get him seen. A few days previously, I spent 30 minutes explaining to a daughter that unless her dad woke up and participated in therapy there wasn't much we could do. She insisted dad was just sleeping and would wake up if we let him walk.

This is something that irks me to no end. I understand how the family feels. But I shouldn't have to be the bad guy. At least once a week I have to explain to someone that it isn't safe to walk patients who aren't awake. And no, standing them up won't wake them up no matter how stubborn they were before the stroke.


Rque (hope I got the name right)

Sorry to take so long to respond.  I've been torn between computer issues and a horse show.  

I learned much of what I know from watching other therapists. No matter what you know, someone else can always teach you something.  Some of my best treatments have come from watching others.  

Continuing education courses are another good resource.  The APTA has one on neurology.  It's somewhat general but will point you in the right direction.  Motivations and Cross Country also have some neuro stuff.  I've taken courses from both and found them to be thorough and well done.

There are only a few texts that might help you. I've listed them by author and title.  That should be enough to find them on the web.

Neuroanatomy through clinical cases  by Hal Blumenfeld

Motor Learning: translating research into clinical practice by AnneShumway-Cook and Marjorie Woollacott

Neurological Rehabilitation by Darcy Umphred

I have one other suggestion.  Make friends with your neuro docs.  I spent the last 2 years "badgering" our fellows with questions.  The attendings have also been very helpful.  A couple of them have gone out of their way to help me.

Hope this helps.


Toni January 18, 2012 6:01 PM

Are the other disciplines on the NICU supporting you in this area or they dumping needy family members on you as a way of not dealing with it themselves?

I remember working on a cardiac ICU many years ago. When the docs would re-order therapy for someone unable to participate, I would simply document there was no change in the patient's condition and is still unsuitable for rehab and discharge the patient again.

You need some allies to get this message home to families. It is too tough a task to do on your own and unfair of others to dump it on you.

Dean Metz January 11, 2012 12:42 PM

hi toni! i dont know how else to reach you but thru this comment box. do u have any books u would recommend for inpatient neuro rehab? i would greatly appreciate it. i have enjoyed your posts!!! keep 'em coming.

rque zon January 11, 2012 12:06 PM

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