Difficult patient

by Ah Cheng
(Johor, Malaysia)

Question: I'm currently handling a patient who is very passive and non-compliant to exercises prescribed. Even on my supervision, repeated verbal and visual clues, patient showed little or no effort as if giving up. Caregiver reported that he is fully dependent and situation is even tougher with family members (which he will at least listen to therapist's command a bit)

Prolonged time, condition gradually becomes worse due to immobility and lead to secondary complications such as DVT, extremities swelling and severe muscle atrophy.

Any suggestions on what I can do? I feel sad and helpless seeing patient like this.

Answer: Stroke can cause changes in the brain that effect motivation. I would suggest talking to the doctor and see if there are any medications that can help with decreasing apathy and improving motivation. I would also suggest bringing in a neuro psychologist or neuro psychiatrist to visit with the patient, and they may have medication recommendations as well. Another way to address the problem is to try and identify anything that motivates the patient and incorporate that into therapy. If you can find something that really interests the patient, the patient will be more likely to participate. Make sure the patient is setting the goal, and that you are addressing the patient's needs. As therapists, we often focus on what we think needs to be addressed, but if the patient isn't interested, then it won't work. You have to know what interests the patient.