Week 1: October 24, 2008

Had a patient yesterday, who had an above knee amputation and had become very weak and deconditioned from general lack of activity. About 45mins into the session, the pain from a poor prosthesis fit was starting to become too much and so I decided that instead of walking laps of the gym, it would be more appropriate to do some other exercises to keep the patient off the prosthetic leg as much as possible. So we began to do some resisted hip extension on the prosthesis side, using some theraband. I quickly realized this was too hard for the patient, who was using large amounts of trunk flexion to facilitate the movement, so I switched to an easier grade of theraband and still no good. So I ditched the theraband and took the patient into the parallel bars to see if we could get it sorted. But the patient still insisted on flexing the trunk to achieve the hip extension. After 30mins of instructions, prompts and holding the patient upright I said to the gentleman in no uncertain terms “imagine u have big pole stuck right up your backside and into your back and all you can do is swing your leg backwards.” I knew the patient would not take any offense to this instruction, so I felt ok in giving it, and amazingly, I got some perfectly performed isolated hip extension immediately after this instruction!

The patient told me it was the best descriptive instruction I’d given all day, because it told him exactly what he should be doing. The significance to me, was that it illustrated the importance of finding an explanation that the patient can understand and relate to, because if they don’t understand what you want them to do, how are they going to do it? So yes, a lengthy experience trying to get someone to correctly extend the hip, but a worthwhile one.

I think my clinical reasoning was pretty good in this instance, in terms of going from hard to easy theraband and then to no resistance to achieve the extension. I also feel I thought enough about the course of the conversation with the patient prior to making the comment, so that it wouldn’t be deemed as an inappropriate one by the patient. Personally I think my initial communication was pretty good, but from the course of events it wouldn’t seem so! But definitely, though effective communication I was in the end able to achieve the desired result. Next time I will assess how well the patient is performing the action and look to progress by doing the extension in prone to provide resistance from gravity and then introduce resistance in the form of theraband.

I felt comfortable and confident with this patient because I believe I got to know the patient. This was the 2nd or 3rd time I had been with the patient and I feel we had a good understanding going on. In the future I will endeavour, to make my explanations to all patients simple and understandable, with the hope that they can get the most out of what I am doing with them.