Cerebellar impairment following alcoholism

On my rural placement I was treating an alcoholic patient with moderate cerebellar impairment. I have realised that rehabilitating a patient with a cerebellar impairment is challenging in itself and is even more challenging when the patient is an alcoholic.

The patient was relatively young, early 50s and was admitted to hospital for frequent falls due to impaired balance, ataxia and peripheral sensory loss. This patient denied that they drank too much and was keen to get home as soon as they were ‘better’. It was obvious that this patient also had some cognitive deficits, with their denial of their drinking problem and also memory loss and they were also in alcohol withdrawal.

I had come up with a treatment plan, for his ataxia and impaired balance, but found it very difficult to implement due to these cognitive impairments. During the treatment sessions the patient was very agitated and verbally aggressive, and I became quite impatient with him and each time I went back to my supervisor and told him that the patient was not cooperating and that I felt I was not getting anywhere with them. My supervisor joined me for the next treatment session and managed to actually get an effective treatment session out of the patient.

I realised after watching my supervisor treat the patient were I was going wrong. My supervisor’s demeanour was sympathetic to the patient and my supervisor also attempted to make everyday conversation. I realised that I did not, I was in fact just telling the patient what to do and not building repoire. The next time I was due to treat this patient I read his notes and there was a new social worker entry, highlighting the events that had lead to the patient’s drinking problem. These events were extremely sad and I immediately realised I was judging this patient for being an alcoholic. When I went to treat the patient I changed my demeanour to being sympathetic, to explaining what and why they were receiving physio and during treatment I spoke to the patient about thing other then the treatment session and we even managed to have a laugh together.

This experience has taught me that I still have preconceived stereotypes that I need to deal with, and how much these can actually effect patient progress. I have learnt to leave my preconceived judgements out of my treatment sessions and have learnt how to build repoire with a type of patient that I have never had the experience to do so with. This will make me a better physio as I can be confident that I can help different types of patients even if I may not support or accept their personal decisions.