Sounds like the man has given up on life. Perhaps he has no goals
because he has no expectations of getting "better". Perhaps you can
show him the way on a few self generated goals, and then watch out the
flood gate of goals may come open. Sad that the prior OTs only focused
on UE ROM. Sounds like a waste of time. I usually use this concept to
continue neuromotor training: If a patient has no movement in the
flaccid arm (absolutely no movement) in a reasonable amount of time,
then I train the patient and family on keeping the arm comfortable. I
then move on to more reasonable and achievable goals.
Chris Nahrwold MS, OTR
-----Original Message-----
From: Ron Carson <[email protected]>
To: [email protected]
Sent: Sat, Jul 4, 2009 2:16 pm
Subject: [OTlist] A Vision For Patients?
Do you ever sit back and envision a new life for your patients? Do you
imagine how patients' lives can be after therapy is done? While fishing
today, a patient I just evaluated crossed my mind and I wondered how I
could improve the quality of his life. How I could make a life for this
person. I developed a "vision" of how this many might live his life.
BUT, this is my vision, not his. In the two meetings I've had with the
patient, he's not verbalized any goals or passions.
This middle aged man experienced a stroke about 12 years earlier. It
left him severely impaired. He is essentially dependent for all
self-care. He is unable to unable to do almost anything for himself. The
man has received countless hours of therapy since his stroke. Based on
reports from caregivers, past OT's have focused on ROM for the patient's
UE.
At my last appointment, I asked the patient "what are your goals?",
"what do you want to do with your life?" The caregiver, who has been
with the patient 5x/week for 1 year, stated that no therapist had ever
asked the patient what HIS goals were. If true, that's a pretty sad
statement about the OT's who came before me. But that's another message.
I am seeing this man 5x/week and I want to get inside his brain and help
him figure out how he wants the rest of his life to play out. I'm sure
he wishes that this "nightmare" would just end, but the sad reality is
that he will probably spend the rest of his life in a wheelchair. I told
him that there was nothing "I" could do to make a substantial
improvement in his physical condition. I told him that my job is
teaching people how to take care of themselves and be productive. At the
moment, self care is out of question, but productivity has lots of
possibility.
But, I want to get this thing right. I want to ensure that I am on the
same page as the patient. What if the patient has no goals? What if he
just doesn't care and has given up? What if he has no vision for his
life? Can one person give another person a vision? Can I "show" this man
that his life may never be the way it was, but that it can be better
than right now? Help me find a vision for this man!!
Thanks,
Ron
~~~
Ron Carson MHS, OT
www.OTnow.com
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