The trooper

I am always amazed by the effect that an optimistic patient can have on their own outcomes. I have completed a neurology placement and am currently on an ortho inpatients placement. During these placements there have been several patients that have greatly impressed me with their optimism and ability to see positives when their situation appears bleak. I belive that it is incredibly beneficial for patients to have some level of optimism, as these patients generally achieve far better results than others who let their disabilities get to them.

There are two patients that spring to mind, who are perfect example of the trooper patient.
The first was a man who suffered from multiple sclerosis, who was treated by another student and myself. This man had very little power in his lower limbs, could not stand and struggled to maintain sitting balance when unsupported. Despite having this disability and knowing that it would only get worse this man had the most positive outlook on life. It would be totally understandable for someone in his position to sink into depression and become completely dependent on others, however this man was completely independent. He lived in a caravan with his wife in which they had done a lot of travelling, and as he was unable to walk my patient used to crawl around on the floor of the caravan. For transport outside of the caravan this man drove a gopher. When the other student working with him commented on some large cuts on the patients knee, he casually reported that he'd rolled his gopher that morning which "took a bit of bark off".

The other patient is a 67 year old lady who i have been treating at my ortho placement, who has just had a total replacement of her (R) femur and a revision of her (R) total knee replacemet. She also has recently had her (L) hip replaced. Prior to the replacement of her femur she had a "girdlestones" operation on her (R) hip, which i still don't fully understand but apparently it is an out of date operation where thay remove the head of the femur and just allow the shaft to float around in the hip joint. Doesn't sound too good, anyway before this lady had her total femur replacement the surgeons removed her femur and she had to live for a week with no femur in her (R) leg !!!! Can you imagine how difficult that would be. She then underwent an enormous operation where they put an entire prosthetic femur in her leg and revised her total knee replacement. Such an operation would knock about the most healthy of us let alone a 67 year old lady, yet this lady is one of the most calm and cheerful patients i have come across. When i first went to see this patient my supervisor warned me that she would be very slow progress and that we probably would struggle to stand her given her history (Hasn't been full weightbearing on her (R) leg for years) and her operation. When we visited her we found her to be in a great mood although feeling slightly ill. She calmly vomited into a bag and then told us that she would be happy to try to stand. As we got ready to stand her i noticed that she had the most deformed feet i've seen and i remember wondering how she was going to be able to stand on them.Any way we stood and walked her with a pulpit frame, asfter which my tutor informed me that this lady should not be able to walk after what she has been through.
Three days after my initial visit the patient had progressed to being able to walk independently and safely with elbow crutches. I put her success down to her optimism and her willingness to try to improve despite everything that was against her. I have seen other patients that are youngerand stronger but have had less than positive attitudes and have progressed slower.

From my experiences with these patients i've learnt how how much a persons rehabilitation potential depends on their attitude towards life. As a physio I thinks its important to recognise patients who are more likely to allow their situation to get the better of them, and to try to steer them away from the type of thinking that suggests that they have no control over their outcome.