Thursday, December 24, 2015

Don't believe the hype -OR- Have you been lowballed? -OR- Clinician fulfilled prophecy

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 "Sam."

I was working in a skilled nursing facility. The physical therapist (PT) did Sam's evaluation.  The PT then told me Sam would be added to my caseload. 

I read the PT evaluation and it was pretty shocking. One thing stuck out: The "long-term goals" were one thing: "bed mobility." 

There it was. The best that Sam 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 Sam 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 began to read Sam's chart I asked one of the nurses to point Sam out to me. She pointed to a gent in a wheelchair. "That couldn't be him"- I thought. If he could not get around the bed, how did nurses get him in a wheelchair?  The nurse: "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. Sam would get called out by staff "Amazing! Keep going Sam! 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 Sam 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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