Week 4 Day 18 Entry 2

One of the pts I saw today has a history of depression, lack of motivation, and is often non-compliant to Rx suggestions. The pt suffers from frequent falls mainly due to his increased tone (and subsequent abnormal biomechanics of his LL), gait disturbance, and impulsivity. In order to help reduce the number of falls, prevent further injuries, and improve the pt's gait pattern, it was necessary to prescribe a narrow WZF. Previously the pt has already trialled a 4ww, but refused to use it (without reason or explanation). After requesting that the pt trial the WZF at home, the pt presented today with reports of reducing his falls over the wk. Nevertheless the pt had fallen twice when he had refused to use the frame in confined and difficult places around the house. Today's treatment involved problem solving with the pt how he could perform his normal tasks around the house whilst still using the frame to provide balance support. The pt's problem areas were the kitchen, bathroom, and bedroom due to the small size and large amount of obstacles and furniture. I wrote out a handout detailing how the pt could position his frame and perform his activities whilst remaining safe and supported. Although this education and discussion took up the majority of the Rx session, I still considered this treatment to be an efficient and effective intervention in an attempt to reduce his falls.

The instructions given to the pt were clear and concise, and the pt appeared to understand and comprehend the information. The pt agreed to try the strategies at home, as the pt did display some motivation to reduce the number of falls he is having. If the pt was still experiencing problems in the home, I would get a referral to the Pd OT for a home assessment. Other than assessing the pt's use of the frame I should have been able to incorporate some exercises into the time limits of the therapy session.

I felt comfortable and confident giving the pt these strategies for the home, as I had discussed some of these strategies with my supervisor with a previous pt. I would have changed my approach by reviewing some more of his HEP within the session, if time permitted.

In the future I would attempt to improve my time management with explanations and discussions. I think it would also be necessary to explain the importance of this education and explanation to the pt as part of their Rx process.

Overall today went well, I was able to see a range of pt's and was involved in either taking the entire Rx session independently or a component of the Rx.

I am continuing to read up on the Guidelines to Treating and Assessing Pd patients, as well as researching and writing my presentation topic.