Another crying moment

A very lovely patient that I worked with on my neuro prac had previously been in a coma and then had a stroke. She was severely deconditioned, the muscle wasting extreme but she was improving and had a great sense of humour. A very positive out look on life seemed to be shared with her family. So it was a surprise when at the end of a physiotherapy session she began to feel hot and sweaty, faint and teary. The tears came. She expressed such a despair and feeling of hopelessness that even my supervisor was moved to tears herself. It was such a emotionally difficult moment. But I learned some interesting things from it.

My supervisor explained to the patient how Bobath philosophy involves a link between movement and emotion. For example, when stressed people tend to hunch their shoulders and extend their neck. After doing movements such as we do in physiotherapy, the movements can stir up emotions which seem either abrupt or otherwise unexplainable. I'm not sure of the specific scientific indications for this, but I found it very interesting. Also, the dramatic change of health for this patient has been a long but for much of it a passive journey. When in the coma and when awaking but heavily dependent, she was in the midst of the busy hospital full care timetable, no time to process and fully understand what was happening to her. Now that she was being challenged physically to improve and trying to achieve things that were previously everyday activities, her limitations were really being put in her face. It was potentially the aftermath of all her painful and upseting experience coming out at the first opportunity.

I had never considered this pattern of emotional processing before. But when dealing with patients in similar situations, we do need to be aware of the fact that a)movement affects emotion, and b) not everybody processes things at the same rate or in the same way as we do. It was also a learning curve for me regarding how depressed patients can become, and with good reason, but also how we as physiotherapists can encourage positivity through our expert knowledge, our humanity and our time.