On my rural prac one of my patients was an 8 year old boy who had fractured his SOF 2/12 ago and hadn't had any physiotherapy yet, not even a few exercises. He also suffered from mild developmental delay which meant he was extremely shy, never made eye contact with me and spoke in grunts. He would sit in the room with his head hung as low as he could get it, playing and fidgeting with anything in sight.
I realised quite soon that I wouldn't be able to do any mobilisations because he wouldn't let me touch his knee. I tried to rely on the father to help me get some information about his pain levels but his father just yelled at him and the son wasn't very compliant with what he said. I wasn't able to simply ask the patient to bend and straighten his knee because he wouldn't do anything I asked. I hadn't done any paeds pracs and this was my first patient of his age I had ever had to treat.
I was about to go and get my supervisor for some help but decided to have one last attempt first. I asked him to hit my hand with his foot, then asked him if he could make his foot hit the bed. Then I took him next door to the gym and got him riding the bike to try and determine how much knee flexion he was getting. By turning everything into a game he began to engage and we were able to come up with some exercises which he found fun.
This experience opened my eyes about some of the difficulties of this area of physio. You have to change so much about your communication when you're talking to children and turn it into terms they understand and care about. Next time I have a young patient I'll tailor my conversation to what they're interested and try to turn abstract concepts like 'knee flexion' into a game or something they can understand.
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2 comments:
Thats so true about having to turn everything into a game!! sounds like you came up with some really good ideas to relate to this patient! I had a similar experience with my 1st prac of the year which was in peads. I also found it hard to think up a relevant and 'exciting' game on the spot, and it took me a good few days to get into the mindset of being innovative! I also found it hard to determine with kids if they are in real pain or if they have behavioural problems, and knowing when to move on to the next activity if the current one wasnt working. It is a real art dealing with kids!!
Some ideas I learnt as a result of my placement included putting talcum powder on the floor and getting the child to draw shapes, write their name ect.. and emphasise which part you want to move the most (ankle, knee ect), blowing bubbles is good and get the child to chase them, or hit them with their foot from lying, hitting around balloons with feet/hands, and using equipments like trikes/bikes, like you did! Bottom line = distraction is good, and they will move if they are not focused on the painful area! and you can do your Ax throughout the game without them knowing.
I also learnt I had to use my voice better and emphasise the part of the activity I wanted the child to do, as well as to keep things simple and not talk too much!!
Hope the rest of your prac goes well and Im sure thinking of games will get easier!!
I personally find it really difficult to work with kids as a physio for that reason! Good work on figuring out creative ways to get the result you needed. I think that lateral thinking is really important in physio, and you may need that skill for some other situation other than paeds. For example, in situations with poor communication due to poor English, functional tasks such as "kick" to get extension may be better understood then "straighten your knee". If you learned another language, would "bring your knee to your chest" be something you would choose to learn? that is when demonstration and lateral thinking comes into play. And speaking of play, sounds like Alli has some great ideas and it sounds like you have it sorted as well. I might pinch some of those games too!!
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