Treatment Strategies/Techniques

On my current neurology placement, I had a stroke patient with left hemiplegia who was not responding well to exercises involving weight shifting to his affected side in standing. The patient would either do it incorrectly or pushing really hard with his good leg refusing to move and reported fear of falling and I was aware of “pusher syndrome” in this patient. In order to make him feel safer, I had the patient stood next to a high plinth and I stood on the other side, holding around his pelvis with both of my hands helping him to weight shift to his affected side but it did not work. I then changed my position to the front sitting on a stool with my hands around his pelvis with a high plinth at the patient’s back hoping to make him feel safer but the patient was still not doing what I wanted him to do.

I became frustrated at myself because 20 minutes of the treatment session wasted on trying to get this patient to weight shift. I then seek help from my supervisor. My supervisor treated him exactly how I did, however managed to get him to weight shift with only few attempts. I immediately realized the difference between our treatments was that my supervisor provided really good & strong grips, with short & precise commands and the patient trusted him more and therefore responded better. And the next time when I saw this patient, I reassured the patient that I will not let him fall, and made him feel more supported (to trust me more) by performing the exercises in parallel bars with me sitting in front and a chair behind him. I also tried not to explain too much what I wanted him to do and relied more on my hands (strong grips) and legs to give the patient input to move the way I wanted him to move, and the patient responded much better.