I am currently on my neurology placement and am treating a gentleman who had a (R) MCA stroke 12 months ago. He is progressing very well and his treatment is mainly consisting of high level balance. This man is very motivated to do his exercises and during treatment he will try and push himself to get the very best from the session. The only problem is that he thinks that we are not giving him hard enough exercises and has been taking exercises off the Internet and performing them at home. We have explained that it is not safe for him to do all the exercises at home because he is at home by himself and his balance and diminished eye sight is a risk factor. Even though he said he understood this, he is still pushing himself, modifying his home exercises to make them 'harder'.
Although it is very good that he is so motivated, this would have contributed to his progress, it makes me quite nervous to give him any exercises to do at home. He tends to do at home what was done with him at physiotherapy, so I have to make sure to reiterate that it is not safe to perform independently. It probably happened because he had seen such an improvement since his stroke and contributed it to the physiotherapy intervention, so he has assumed by doing more exercises it will make him better quicker.
I know I have done all I can but I still feel like there should be something I can do to prevent him from falling or hurting himself at home. Next time I will see him, I will try and review his exercises and try see if I can modify them so both him and me are satisfied! If anyone has any approaches to this situation please let me know!
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2 comments:
Sounds like a tricky one. Perhaps setting a significant amount of time during the session to self managment and home exercises may be the way to go. Educating clearly on the purpose of each exercise and reviewing the exercises (and progressing them if indicated) at each session may help. Also, if possible, educating his family may help with saftey.
I also found it pretty tough to educate R MCA's. I reasoned with a few of them over and over again, but it was really hard to change their thoughts on certain things. Bit like beating my head against the wall actually. I guess all we can do is try. and if that doesnt work take a different approach. Not sure what approach would be best with this guy though.
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