Intervention

STARES 2:

Situation – A 54 year old man was transfer to Peel Health Campus following a craniotomy and partial evacuation of a terminal tumour. The patient has no past medical history other than that of the tumour occupying part of his right side of his brain. Pt previously was independent with all activities and lives at home with his wife. Currently presents in bed supine, left upper limb and lower limb are completely flaccid with notable left inattention, patient also shows sign of pusher syndrome. Patient is non ambulant and requires hoist transfers to get from bed to a fall out chair. Pt is not classed as rehabilitation due to his poor prognosis and therefore the aim is to get patient to be able to sit in a wheelchair so he can go home. I saw this patient in the previous week where we aimed our treatment at positioning for comfort and facilitation of the left limbs.

Task – Pt was seen to help improve sitting balance and sitting posture. To do this successful we would need to take the patient down the physio gym where we can use the plinths and mirrors to aid his upright posture and to reduce the pushing.

Action – Treatment session initially required 3 assist to slide sheet patient from the fallout chair (which becomes nearly flat) to plinth to ensure safety of patient and to help control patients left side especially the leg. 3 Assist was then required to move patient from supine to sitting on the edge of the bed. Once in sitting I sat behind him to give him the support he needed and my supervisor sat in front and slightly to the left to support the left leg. To begin the patient was significantly leaning to left and we used a mirror to assist with the upright position we wanted him in. To facilitate upright position we prompted the arch the lower back and push the chest out using key points on the sternum and on the lower back- paying particular attention the left side which lacks muscle bulk, activation and control. We used reaching upwards and to the right to facilitate weight shift forwards and to the right. The patient fatigued quickly after a few attempts so the session need to be ended. We slide sheet transferred him back onto the fallout chair and repositioned him and returned him to the ward.

Result – the result of this treatment was that it was successful but shorter than I had anticipated. However the main aim of our treatment session was to get the patient into sitting and just begin to work on it. Also knowing that things do take alot of time to improve I think the treatment session was successful in getting the patient to understand weight shift and the idea of sitting upright.

Evaluation – Overall I think that my treatment was thorough and I now know that everything you plan before going into seeing a patient doesn’t always happen and you need to be able to think quickly and make a decision about what to do next if what you planned for some reason can’t be done. I know know the patient’s limits and this will help me to plan my treatment session better for the next treatment.

Strategies – I think the main thing I can do is go back to the books and the evidence to find out what are the best treatment strategies for further on down the track to help make the treatment sessions more interesting and keep the patient wanting to improve. I also think watching the ways my supervisor places her hands on the patients and how he reacts to it will be very useful in learning successful hands on techniques that not only work on paper but on patients too.