Wednesday, January 06, 2016

Don't Believe the Hype -OR- Have You Been Lowballed? -OR- Clinician Fulfilled Prophecy

Peter G. Levine
Stronger After Stroke
Thursday, December 24, 2015

Bottom line: 
What the therapist predicted: very little
What the survivor achieved: a lot

Let me tell you about a stroke survivor I worked with a year or so ago. I'll call him "Joe."

I was working in a skilled nursing facility. I heard about Joe a couple of days before I met him. The front office had informed the therapies (OT, PT, Speech) that a new survivor was to be admitted from the hospital to our facility. The physical therapist that was to do Joe's admitting evaluation told me that Joe would be added to my caseload.

The next day I read the PT evaluation and it was pretty shocking. One thing stuck out: The "long-term goals" that were laid out by the evaluating therapist was on thing: "bed mobility."

There it was. The best that Joe was expected to do was to be able to roll around in his bed. He wouldn't be able to stand. And walking was beyond belief.

The day Joe was to have his first treatment I went to the nurses station to read his chart before I met him. Nursing facilities often have a cluster of patients in wheelchairs right around the nurses station. It's where all the action is.

As I begin to read Joe's chart I asked one of the nurses to point Joe out to me. She pointed to a gent in a wheelchair. That couldn't be him. If he could not get around the bed, how did nurses get him in a wheelchair?  "That's him. He came in yesterday."

This was the guy who's long-term goals were "bed mobility."

That day he took his first step. Two weeks later he was lapping the facility several times, without an AFO, and beginning to walk outside. Yes, we were both a "hot mess" by the end of treatments, but it was fun. Joe would get called out by staff  "Amazing! Keep going Joe! Lookin' good!" In fact, some of the folks with dementia thought it was some sort of conga line so by the end of our walk we'd have a parade!

P.S: There may be several reasons for the physical therapist lowballing expectations. Maybe Joe was exhausted by the experience of being transferred from hospital to skilled nursing. Maybe his meds had changed. Maybe he was admitted so late that by the time the therapist got there he was asleep and the therapist had to wake him and he was very tired.

Or maybe:
Some clinicians are so concerned with deficits that they miss potential.

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