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Toni Talks about PT Today

‘I Can't Wait Until I Can Walk Again'

Published August 20, 2013 4:44 PM by Toni Patt

Last Saturday, one of my patients at the SNF was a woman with left femoral neck and humeral shaft fractures. She'd undergone an ORIF to repair the hip and the arm was immobilized. She was NWB on both extremities. Like many of our patients, this was not a small woman. She was limited by bilateral knee arthritis and admitted she didn't walk much before she fell.

Her first words to me were, "I can't wait until I can walk again. I need to get home as soon as possible." I got her into her wheelchair with a slide board using one of my feet to prevent her from leaning on the left leg. I did most of the work. She couldn't have stood in the parallel bars even if I had let her weight-bear through her left leg. Nonetheless she believes she is going home in a week or two because she will then be ambulatory.

I hear those kinds of things all the time from my stroke patients. They have an excuse. Their cognition is impaired. Some right MCA stroke patients truly believe they have no deficits. With the exception of her one delusion, this woman was cognitively intact. I don't understand how she could think she'd be able to go home in a few weeks. I doubt she'll even be able to stand until her weight-bearing is increased.

Selective hearing only explains so much. Doctors aren't known for always explaining things clearly either. Even so, she must have slept through the conversation. She isn't alone in her delusion. I've had others say similar things when it was obvious walking wasn't going to happen anytime soon. I don't understand what part of the brain fails to make the connection. Sometimes the CNAs allow patients to do things they shouldn't because it makes the transfer easier, which might create a misconception. This woman couldn't do that if for no other reason than it would hurt too much.

Do people really lack that much insight into their limitations? How can someone who wasn't active before believe she is going to hop up and move along without effort? Remember we're not talking brain injuries here. This is similar to the patients I've had who complained that they walked into the hospital before the surgery, so why can't they walk now? I've had patients who were surprised they had pain after surgery. Does someone really have to spell it out for them?

I suspect this woman will figure it out after a few more therapy sessions. Or someone will get her to understand how long the recovery is going to be. I wonder if what I refer to as her delusion is really the normal response and I'm just jaded because I see this all the time. I wish someone would explain it to me.

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The other thing to point out, aside from the lack of MD education or knowledge of a realistic healing timeframe is the lack of insight.  This spans to therapists as well.  Some patients don't have the insight into the severity of deficits just as some therapists (or employees of any profession) don't have the insight as to how the are perceived by others.

Being able to receive feedback and acknowledge both physical (in the case of this patient)  and other character "weaknesses" is a skill some people just lack. That's where it becomes extremely important to provide enough feedback, delivered professionally, to patients and coworkers becomes a critical component of our profession.

Lisa Mueller August 22, 2013 9:55 PM

I agree with Jon's comments here.  Doctor's often don't do enough EDUCATING.  And in the acute setting I work in, nurses often don't have the time to do some serious EDUCATING.  So it often falls on other health care professionals to do the EDUCATING.  (Can you see a theme here?)  As PT's I think we are filled with more than enough knowledge to answer the "how long until I?" and "when will I be able to?"  I wrote about this in one of my blog posts too, why don't we, the PT's educate patients?  Are we afraid to step on people's toes?  Are we afraid we would be acting outside our practice acts?  I think if we were taught this information in school or continuing ed courses or even on the job, then we should be able to and allowed to educate our patient's as best we can.  And if doctors or nurses or other health care professionals feel we should not be doing this, then I think it falls on us, the PT's to educate the health care professionals about concerns we have and patient's/family's have about the lack of education we are seeing so hopefully these other health care professionals can educate their patients instead!

Great thoughts on this.  

Mike Kelley August 21, 2013 3:22 PM
Chicago IL

I run into this in outpatient as well. Especially after a shoulder surgery. NWB on the arm and "do not use it" doesn't seem to translate. I actually have to tell people all the time what that means. I have to go as far as to tell them not to wipe with that arm after using the toilet.

I think people don't get it, in outpatient and SNF, because most people have no idea how the human body heals, or how it ages. I think because this is like second nature to me, that I sometimes assume that it is to my patients as well.

I also tend to be very blunt these days. I'm only 5 years out of school, but already so tired, that sometimes I don't care how it sounds anymore. And frankly, some people need to frankness to get through their skulls to their brains.

I kind of went off on a tangent there. But basically, you aren't alone. I believe we all experience this to some degree.

Michelle Merritt August 20, 2013 10:09 PM

I've seen this numerous times over my new career as a Physical Therapist and it's hard to tell them that it's going to take quite awhile before they are walking again.  I listen to what they have to say and then let them know in a conversant way. Doctors don't do enough explaining so it's up to the other healthcare professionals to educate them on their condition and precautions etc.

I'll have to say I thought I was going to be able to walk normally without much pain after dislocating my L patella laterally after a skating accident in high school. Albeit I didn't know anything about physical therapy but I then became knowledgeable and knew how long it was going to take. Some of these people just don't know what it takes to be able to walk.

With a R CVA patient they will underestimate their issues and can be impulsive so they're difficult to deal with in that regard; it just takes constant reinforcement for those patients. L CVA's are scared sometimes to perform because of the thoughts of failure and those you have to encourage. I'm sure you already knew this. Anyways, I may not have answered your questions but I wanted to add some insight into this issue.  

Jon Yarbrough, Physical Therapist August 20, 2013 6:56 PM
Ormond Beach FL

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