The uncooperative patient

I have just finished my neuro placement in the neurosurgery ward which is a locked ward with head injured pts. We were assigned 3 patients to see for 1 hour every day. One of my patients decided she didn’t need physio anymore and was very incompliant with physio. She would pretend she was asleep before I came around to get her each morning for physio and sometimes pretended to fall asleep during our treatment session. Initially I thought it was part of her condition but after liaising with the OT staff that performed a cognitive assessment on her I found out that she would deliberately do this to avoid things she didn’t like doing.

It was my job to get her to physio and give her 1 hr of treatment so I had to come up with ways to persuade her to come to physio. Initially I was frightened to try to make her do something she didn’t want to do, as she was unpredictable and had frontal lobe behaviours. I found out that she used to look after 40 horses at her riding school back home and that she was very keen to return to this lifestyle. In order to persuade her to come to physio I told her that she would need to do a lot of work with physio in order to be strong enough and have enough balance in order for her to be able to return to looking after that many horses. She responded to this well and came to physio.

During out physio treatment sessions she would get bored and distracted very quickly and would regularly walk off towards the door in the middle of an exercise or assessment. In order to overcome this problem I had to ensure she had a large variety of exercises to do in order to prevent her from getting bored and terminating her physio session prematurely.

I now feel much more confident in dealing with pts with frontal lobe behaviours and that I have developed my persuasion skills and that in the future when I am presented with an incompliant pt I will be able to apply the same principles to motivate them. In conclusion I have found it to be effective to use functional goals as motivation for non-compliant patients.