This week on my prac on a neurosurgery ward, I’ve had to deal with a 30 yo male patient, SP, who is presenting with the late effects of an ABI which he sustained at age 3. He has lived a relatively normal life growing up in the country, attending mainstream schools, playing sport and working on his family’s farm. He now presents with an abnormal gait pattern due to impairments including decreased muscle length & muscle strength. He is also displaying signs of frontal lobe behaviour, which has become an issue over the last week.
During some of my one-on-one treatment sessions with SP, he made a few unsuitable comments. The comments were not aggressive or overly offensive, but between a female therapist and male patient, they were indeed inappropriate. My initial reaction was to ignore the comments and change the subject as if they hadn’t been said. Later when I was chatting with a senior physio about frontal lobe behaviour, she said that she had overheard a few of SP’s inappropriate comments to me. She told me that the patient was displaying frontal lobe signs with such comments and that it was not to be tolerated.
Soon after this conversation, I was seeing a 17 year old female patient, SB, in a joint treatment session with the same physio. The patient mentioned that SP had also made some inappropriate comments to her and that it made her feel uncomfortable. The senior physio then instructed me to inform the nurse in charge of the ward, which I did. SP has since not made any inappropriate comments towards myself, SB or any other staff or patients.
My initial approach to dealing with the matter was to simply ignore it, but I now understand that the comments were unacceptable and had to be dealt with immediately and professionally before the situation went any further. So I’m glad that the senior physio taught me the correct way of handling the issue and I will aim to apply what I’ve learnt, when dealing with other patients with frontal lobe behaviour.
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2 comments:
I have not yet had my neuro prac and have limited clinical experience with frontal lobe patients so I have a question. I wonder on the severity of his condition, my understanding of frontal lobe behaviours is that social inhibition is absent and therefore they cant control their comments. That is interesting that, after correction, he was able to control his comments... social inhibition? Does it depend on the severity of the injury as to the amount of control the patient has of the frontal lobe behaviours?
Yes, I agree it is curious that this patient was able to inhibit his inappropriate actions given his diagnosis of frontal lobe signs. However, I can update you on his behaviour in the few weeks since... For about the first week or so, his behaviour was suitable and our sessions were going well. Though, over the last week, he has resorted to some of his past behaviour, referring to me as 'babe' and making other inappropriate comments, even asking for my phone number so that we can 'catch up' in the future.. Of course I will not give him my phone number, if he asks again, I will tell him it would be inappropriate and unprofessional and that will be the end of it.
As for determining the extent to which a patient can control their frontal lobe behaviour, I'm sorry, I can't give a good answer..But hopefully with more exposure, we all will know one day!
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