Multiple Facets

Earlier this year I completed my Neuro placement at a hospital that required that I see patients on a variety of different wards as the Hospital did not have a designated neuro ward. One of the areas I worked was a rehab ward for elderly patients, which incorporated functional and balance retraining, as well as inpatient rehab for elderly neuro patients/
On the rehab ward one of my patients was an elderly man who had suffered from a brainstem lesion 3 weeks prior to me seeing him. He had previously been fully independent living at home with his partner, but now as a result of his stroke he had significantly impaired function down one side and as a result his mobility and function was impaired considerably.

As I stated above, this patient was 3 weeks post CVA when I first saw him, and he had recovered to the point that he was able to get from lying in bed to standing with some assistance, and ambulate short distances using a pulpit frame. From talking to the patient he was very impressed with his recovery so far as it was the first time he had been able to stand since admitting to hospital, and as a result was very compliant to future physiotherapy.
However, as my time at the hospital came to an end (he was still an inpatient when my rotation at the facility had ceased) his enthusiasm for treatment began to wane despite what I and the other team members considered to be significant improvement (he had become Independent in most self care, bed mobility and ambulating with a WZF). He repeatedly complained of tiredness or feeling unwell during treatment sessions and chose to cease treatment early, and this was reported by other team members (OT, speech, nursing staff). When asked if anything was wrong, or if he was happy with the treatment he was receiving he always stated he was. However at the next family meeting, his partner reported that the patient had stated to her he was unhappy because he had not recovered enough to be able to eat a normal diet and instead was still on thickened fluids. This in turn was causing the patient to become distressed as he felt embarrassed that his diet was regulated and that for him, thickened fluids 'reminded him of how sick he was'.

Towards the end of my final week there the patient was cleared by Speech Pathology to start on a normal diet, and changes in the patients demeanor were noticed with the return of his enthusiasm. While he would still have a large amount of therapy ahead of him, his prospect for recovery would be a lot higher if he applied himself to all aspects of therapy, especially as he was only 8 weeks post CVA.
This patients changes in behavior showed to me the multi faceted nature of patients. This may be due to a lack of clinical experience on my part, but I would not have immediately made a connection between a patients recovery with Speech Path and their behavior while in Physio rehab. While it is easy to understand and assume that a patients mood will have a huge effect on their response to treatment, I needed to think a step further to see why there are these changes in behavior.
I thought this was a good lesson to be taught and at only a few weeks into 4th year I think the timing was perfect. While in theory I was aware of the many different factors in a patients rehab, to actually see this and how important it is on an actual patient has put me in good stead for my upcoming placements. As a result I now liaise more closely with other allied health members to determine what stage patients are at , so I can have somewhat of an understanding of factors that may be affecting patient behavior.