Week 5 Day 21 Entry 1

During Monday's visit to SCGH, I assisted with an OT/PT Rx session of a 74yo man. This pt had recently been discharged from OPH following a medication trial, in an attempt to find a balance between increasing the pt's mobility & avoiding confusion/compromising cognition. After this trial the pt and his family elected to be non-medicated for his Pd mobility disorder in favour of being cognitively alert. The pt described that medication caused significant confusion, and disorientation. This pt presented in the clinic today as a particularly alert, friendly, and witty man. Even from my initial contact with the man, it became more obvious to me why someone would choose to be virtually immobile if it meant that their personality, mood, and behaviour remained unaltered.

The aim of the PT/OT Rx was to try to optimise his function and modify ADL to maintain or increase his quality of life. This has become even more pertinent since the pt has come off all Pd medications.

From a PT perspective, this man's Rx involved practising STS and walking in the parallel bars. Although this does not sound an extensive Rx program, it was about the extent of the pt's mobility limits. For the pt to stand from his w/c and walk down the 4m parallel bars it took close to 10mins. It was then necessary to instruct and prompt the pt with many cues to allow turning. The pt then required rest due to fatigue (but no SOB was reported). I then challenged the pt to walk to the end of the parallel bars, where we collected his 4ww and with 1xA the pt was able to walk over to a chair about 2.5m from the bars. This was then the limit not only of the pts exercise endurance and mobility capacity but also the end of the 45minute Rx session.

I think I managed this client well as I was able to identify his limits. I was also able to identify and modify an exercise appropriately to help with the pt's decreased unilateral trunk strength. When working with this pt a great degree of patience was required due to the extreme slowness of the pt's mvmt, and I think I handled this challenge well. This pts main problem was akinesia or excessive inhibitory output from the basal ganglia which causes cessation of mvmt, so I provided appropriate cues such as saying to take big steps, count, or visualise stepping over a line/log.

One area that could have improved was controlling the pt's descent into the chair. The pt tended to flop into the chair, and did not have the ability/strategies to control this mvmt. I think I should have either assisted the pt into sitting or provided more input on how to control getting from standing to sitting before allowing the pt to perform this independently.

I felt confident and comfortable in this Rx session as I was not the only therapist present. I was working with the OT in attempt to assess and modify the pt's mobility as a MDT.

From this session I have learnt that it is very important to recognise a pt's limitations and how then to modify what you think would be an ideal Rx to the ability of the pt. So far this week has gone well, yet I hope to fulfil my supervisor's expectations when it comes to the final assessment on Friday.