OK...then make her fall....then have her get up...show her how to get up if she can't....she needs to know she can recover from a balance disturbance or fall and that she will be OK....
Yes, you are right about fears....funny how some things I was not fearful of before I am (i.e. jumping from bridges into rivers :) David A. Lehman, PhD, PT Associate Professor Tennessee State University Department of Physical Therapy 3500 John A. Merritt Blvd. Nashville, TN 37209 615-963-5946 [EMAIL PROTECTED] This email and any files transmitted with it may contain confidential information and is intended solely for use by the individual to whom it is addressed. If you receive this correspondence in error, please notify the sender and delete the email from your system. Do not disclose its contents with others. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Friday, September 07, 2007 1:37 PM To: Lehman, David Subject: Re: [OTlist] Overcoming Fear During Mobility Hello David: The really interesting part is that the patient has never lost her balance to the point that I've had to catch her. She has always been able to regain control with only minimal input. Actually, the can does provide assistance, in fact I am trying to get her to decrease her WB through the cane. She can walk remarkable well wihtout the cane, but that is not a long term goal. I don't believe this is a motor learnnig issue. I believe it's a fear-based reaction. Think of someone learning to walk a tightrope. There must be balance (no pun intended) between perceived abilities and fear. Overestimating ability is not good and being overly fearful is equally not good. With continuing practice, ability and fear should reciprocate from each other, shouldn't they. But what if the person's continued training does not yield decreasing fear. Some people will never get over their fear, right? ----- Original Message ----- From: Lehman, David <[EMAIL PROTECTED]> Sent: Friday, September 07, 2007 To: [email protected] <[email protected]> Subj: [OTlist] Overcoming Fear During Mobility LD> Maybe she just needs to hold on to something since she does not use LD> walker correctly, is she using cane correctly? It sounds like the cane LD> is not really providing any assistance (i.e. removing weight bearing). LD> I say continue to work without a device....actually, maybe do what the LD> other respondent said and hold onto a hand...but, what I would do is LD> cause her to lose balance, incorporate obstacles, disruptions, and also LD> have her do secondary tasks while walking (i.e. count backwards by LD> 7's)...anyways, when she loses her balance, don't hold her up with the LD> hand she is holding, but, actually, give way...make her recover LD> herself... LD> Motor learning my friend....practice and challenges. LD> Nice to connect with you! LD> peace LD> David A. Lehman, PhD, PT LD> Associate Professor LD> Tennessee State University LD> Department of Physical Therapy LD> 3500 John A. Merritt Blvd. LD> Nashville, TN 37209 LD> 615-963-5946 LD> [EMAIL PROTECTED] LD> LD> This email and any files transmitted with it may contain confidential LD> information and is intended solely for use by the individual to whom it LD> is addressed. If you receive this correspondence in error, please notify LD> the sender and delete the email from your system. Do not disclose its LD> contents with others. LD> LD> -----Original Message----- LD> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On LD> Behalf Of Ron Carson LD> Sent: Friday, September 07, 2007 1:08 PM LD> To: Lehman, David LD> Subject: Re: [OTlist] Overcoming Fear During Mobility LD> Hello David: LD> Nice hearing from you. One of the reason we tried the cane is in fact LD> because the walker is too cumbersome and complex in the house. The cane LD> is much simpler for her. Interestingly, I've instructed that the care LD> giver is too work with the patient on safe use WITH the cane. I am LD> working on the patient not using any AD. It is not our goal that the LD> patient walk without an AD, but I believe that non-AD training will LD> greatly improve her safety and stability with the AD. She has LD> demonstrated correct sequencing and proper use of the cane so she knows LD> how to use it. LD> Honestly, this is a very complex situation. She really wants to use the LD> cane, she has demonstrated that she is physically and cognitively able LD> to use the cane but she is afraid. I believer that her fear is LD> disproportion to her abilities and desires. I am not downplaying her LD> fear, it's real, but the fear is preventing her success. She has fallen LD> and she is at risk to fall, but her fear increases her risk. Does that LD> make sense. LD> I have suggested to her that despite her stated desire of being LD> independent with a cane, the reality appears that she may be best served LD> with a walker. But a walker is not a panacea because she uses LD> it LD> incorrectly (i.e. climbing over the wheels, etc) LD> ----- Original Message ----- LD> From: Lehman, David <[EMAIL PROTECTED]> LD> Sent: Friday, September 07, 2007 LD> To: [email protected] <[email protected]> LD> Subj: [OTlist] Overcoming Fear During Mobility LD>> I agree with you Ron...we only overcome our fears by attempting the LD> task LD>> and succeeding. As for balance control, the same holds true and LD> also LD>> one must "fall" to learn how to regain balance control.....so, maybe LD> use LD>> a "secure" environment (i.e. things to grab on or mats to fall on, LD> and LD>> give challenges while she walks with cane (i.e. changing positions, LD>> shoving her, people walking in front of her, etc)...also, maybe she LD> will LD>> do better without a cane - maybe the cane just adds more complexity LD> to LD>> the task LD>> David A. Lehman, PhD, PT LD>> Associate Professor LD>> Tennessee State University LD>> Department of Physical Therapy LD>> 3500 John A. Merritt Blvd. LD>> Nashville, TN 37209 LD>> 615-963-5946 LD>> [EMAIL PROTECTED] LD>> LD> -- LD> Options? LD> www.otnow.com/mailman/options/otlist_otnow.com LD> Archive? LD> www.mail-archive.com/[email protected] LD> ************************************************************************ LD> ************** LD> Enroll in Boston University's post-professional Master of Science for LD> OTs Online. Gain the skills and credentials to propel your career. LD> www.otdegree.com/otn LD> ************************************************************************ LD> ************** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ************************************************************************ ************** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ************************************************************************ ************** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ************************************************************************************** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **************************************************************************************
