Interviewer - Any tips for a physio to engage/motivate someone with SCI in a wheelchair to participate in rehab?
Pete - Yes. Remember every patient will respond differently to a certain approach. Some won’t want to play ball, others will. One thing that’s universal is emotional engagement. No one wants to be treated as a ‘case’, which is the old-fashioned approach. You have to treat people as humanly as possible whilst still following a pragmatic path. Getting off on the right foot with a patient is important.
What I believe you’ll find is all SCI patients are emotionally wounded in the early stages, and it’s a good idea to acknowledge it. The patients are probably in the midst of the worst experience of their lives, and if you arrive with a checklist and a restless demeanour, you’re less likely to have a pliant client. Making a connection with your patient is the best possible start, and you can do that by making eye-contact with them and asking how they are. Their state of mind in relation to their health probably takes up a huge amount of space in their thoughts, and I think acknowledging their suffering is not only a considerate thing to do, it’s expected, consciously or otherwise.
I was occasionally looked after by a male nurse on the SIU when I was in rehab; he had tough standards and high expectations. I bumped into him a number of years later when I was back at the hospital and he asked how I’d been. I told him I’d struggled at times, and he said very earnestly, “why wouldn’t you?”. The bastard brought tears to my eyes. Although he hadn’t been so philosophical on our very first encounter when he was a younger man, this empathetic gesture made me feel less isolated, more accepting, and appreciative of how far I’d come, as well as appreciative of his support.
However, sympathy has a limited value in a world of progress. Once you’ve dealt with the elephant in the room, encourage things evolve along the right timeline. You could go in and act like Jim Carey on amphetamines from the outset, and some people may respond warmly to a physio with a comical demeanour, but I suggest you tread lightly at first and save the energetic approach for when you know what sort of patient you’re dealing with.
One thing I learnt early on as a patient is that trying to take in the enormity of everything involved is like trying to scale a mountain at a glance. No one looks at Mt. Everest for the first time and says ‘Piece of piss’. Even for the paralysed, the old adage is true: The only way to get anywhere is one step at a time. Progressing in small but persistent steps will probably be good for the patient’s confidence if they’re timid. If they’re a paraplegic, you’ve got more to work with, and you can perhaps go in more towards the deep end. When things are shit for me, I fall back on a reductive perspective. I just focus on one objective at a time: Waking up, get my legs off the edge of the bed, sit upright, let my hypotension recover, etc.
As far as dealing with patients goes, a valuable mantra to remember is: It doesn’t have to be fun to be fun. Anything you can make a game out of in terms of exercises will lift the mood and help the time pass. ‘Fun’ can quickly become a seemingly unreachable pastime, or a place you’re no longer allowed to be, in the shadow of an SCI. It’s good to oppose that.
If you’re dealing with a high-level quad who needs to work on their breathing, get them timing their inhalations, recording their breaths with a spirometer, competing with an egg timer - whatever. If it’s someone with more function, blow up a balloon and get them to knock it back and forth with you whilst they’re in bed or in a chair or a standing frame. It’ll be a fitting counterbalance to the elephant of seriousness you acknowledged on first acquaintance.
One of the tougher challenges for a practitioner might be remaining personable with the patient without taking whatever comes back at you personally. I’ve seen and experienced these relationships becoming acrimonious and it’s not easy to recover from. It’ll be in your best interest to treat upsets with total pragmatism. If they begin ranting in general, treat it like a moment of performance art. If a patient has a go at you verbally, you have to be bulletproof-cool. You’re dealing with people who have been reduced to a raw state, and it’ll benefit you to be forgiving from the outset – Forgiving of yourself as well as forgiving of them. You’re not the cause of their upset.
Remember that humour is often a good was to defuse a situation. Humans are stubborn and you’re probably not going to change anyone’s behaviour by meeting them head on. But you might get them to drop their defences by making the fuckers laugh.