Last week i had a pt who was deaf, semi blind and suffered from dementia. What i am asking of you is if you have had a difficult pt to communicate with, how have you got around this issue. What me and my supervisor tried was a lot of hands on techniques, all we need to do with the pt was to get him up and walking. The pt was very impulsive so we had to place a hand on his chest to notify him when we needed him to stay still and not move forwards. To stop him from standing up we had to place a hand on his shoulder. We stood right in front of the pt and used a lot of eye contact when we were explaining what we wanted the pt to do. Even with all this we still found it extremely difficult and more time consuming. We managed to get the pt to the shower and had to call it a day. So for next time i was hoping for some more ideas to try and make the session more effective and less time consuming.
Dickie
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2 comments:
Hi Dickie, sounds like youre handling this one pretty well by using as much hands on facilitation as possible! i can only suggest (and this depends on just how much vision he has) that often imitation can be useful, which is something ive tried with non-english speaking pts when theres no translator around. Are there ever friends or family present when you see him? He might respond better and be less impulsive if theres someone familiar there, and family members/carers often have great suggestions for you about how they get his assistance with showering etc. Other than that you might have to be prepared for a fairly long session each time you see him, which might be easier to plan around now that you know his situation better. Em
Hi Dickie, this seem like a quite a complex problem. I wonder what sort of background does this patient come from (i.e. nursing home, home with spouse etc). And what was the reason that he got admitted to your service.
A lot of time we get so bogged down with "I HAVE to do some 'treatment'", that we have forgotten maybe the treatment is in getting the patient to the shower.
I agree with what em suggested about having someone familiar there. As I have found from my experience with elderly in general (demetia or no dementia) that they LOVE routine, and see the same therapist/nurse/carer. And also that morning is a better time to do therapy as their dementia symptoms tend to deteriorate in the afternoon.
If it is impossible to get the family members etc to involved during the session, maybe the KISS principle is the best strategy. I.e. if u feel STS is the most important thing for him to learn, then do the same thing everyday, same words used, same routine used, keep descriptive words to minimum. be consistent with what u won't allow and what u will allow him to do (i.e. remember the rat experiment about behaviour training in psychology?).after u feel he has learned your rules and the STS, then u can then add on a new task for him to learn.
i hope what i have suggested is relevant to your patient.
Chin.
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