Flexibility

Oops it appears I am one blog short for P2 so here it is:
I was treating a very interesting Parksinson's patient on my neuro prac who elected to admit herself to hospital for a review of her Parksinson's medications. The patient was very much affected by the "on-off" phenomena associated with her medications, and was experiencing more frequent "offs" and unpredictable "offs". During her "off" times, before the medication kicked in she had marked bradykinesia, occasional freezing, slow shuffling gait and dystonia in her left foot. The patient told me that when she is at home (she lives alone), she tends to not be able to do very much during her "off" times- and mostly chooses to sit and do nothing and wait until she comes "on" again.

During her time in hospital, she was trialling a 2 hourly medication schedule- most of the time it took about 30 mins for her medication to really kick in, and started to fade just prior to her next dose- however this was not always the case. Being busy with other patients, I was not always able to see her during her "on" times and would often see her when she was quite "off". I think seeing a patient when they are at their best and at their worst is important- as it was during her "off" times when she had the most difficulty with her mobility. In the beginning I would plan out a treatment session and try and implement my plan regardless of how on/off she was. I soon realised this was not ideal- when "off" certain exercises exacerbated her dystonia and bradykinesia, whereas other more rhythmic exercises like simple walking would actually assist her to come "on".

So for the remainder of my time treating the patient, I was extremely flexible with my treatment sessions. I would hand a lot of the control and choices over to the patient, as ultimately, she was the one who knew what was most beneficial for her at any stage. Sometimes when she was very off, we would just walk laps around the ward until she started coming on, then I would throw in some simple exercises and variations along the way as we walked. When she was on, I could do quite a lot more with her, including trunk rotation exercises, fit ball exercises, etc.

I guess the point of this blog was just to highlight that with some patients, careful planning is very important but with other patients, all the planning in the world won't help! We need to be prepared to be very flexible and have a variety of options up our sleeve, depending on the state of the patient. I think handing many of the choices over to the patient also helped her gain a sense of control over her situation.