Awesome Attitude!

There are people in this world who just attack life in such an amazing way. As a Physical Therapist I am especially impressed with people who face their physical challenges with courage, determination – a willingness to do whatever is asked of them because they see an end that even I can’t visualize. This is an amazing man. Please watch his video.

Posture and Risk of Aspiration.

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I have a patient that recently received instruction from a Speech Therapist after failing her swallow study.  She had been aspirating and he instructed her to look down toward her navel when she swallows.  I thought about this as I assessed what changes occurred as she did this.  It appeared to me that the cervical extension occurring to “level the eyes” as a result of the increased thoracic kyphosis was the problem. By having her look down toward her navel he was essentially getting her cervical region to a neutral position.  I took a photo of her from the side and showed her the degree to which her neck was tilting back.  It as apparent that this amount of extension would be equivalent to sitting with a straight spine and tilting the head back to look at the ceiling.  I think I would have difficulty swallowing correctly with my head tilted back as well.

Every year there are many elderly that die of Aspiration Induced Pneumonia.  Physical Therapists should be keenly aware of the postural changes that could be playing a part in this occurrence and should work to train patients and caregivers in proper positioning and posture to avoid this problem.

Smell – alarms to help promote appetite

I have several patients that need to eat more and without the desire for food, they aren’t motivated to cook.  This means a loss of weight that is not healthy.  I have seen alarm clocks that wake you with the smell of bacon.  I would like to see “appetite trigger alarms” that would begin to fill the room with the odor of cooking food so that my patients with this problem would be prompted to seek meals.

Sense and Sensibilities

I took a class a long while back called “Power Communication for Women”.  It was an interesting class that talked about body language, taking up space at a table to establish power, keeping yourself over the eye level of others when speaking and other interesting and effective strategies.  I recognize that if these approaches work in business then there must be similar strategies for working with my patients, most of whom are elderly.  These are the things I have found to be most consistent.

1.  It is important to establish a respect for the patient’s home space.  This is done by calling and being prompt for appointments, avoiding “just walking in the house” without an invitation, acknowledging the pets and the part they play in the patient’s life, consideration for cleaning shoes when going in the home and leaving items where they were placed prior to your intervention.

2.  It is best to introduce yourself by getting down to the floor in front of them.  It is preferable of course to not sit on the floor as you may carry germs/ contaminants from home to home but getting to a lower level improves the patient’s ability to see your face.  Many of the elderly have a hard time hearing and seeing your lips helps them to comprehend what you are saying.  Saying things louder does not always improve comprehension.

3.  Respect the patient’s right to privacy but ask if they wish for you to speak with a family member or friend about their condition.

4.  Follow through with the things you say you are going to do.

5.  Explain why you are doing the exercises you are doing.  People are more likely to follow through if they understand the reason for the instruction.

6.  Avoid “disappearing” from their lives without a call or note.  There are times when a patient leaves care because they go to the hospital or they stop the services.  A note to them will give closure and leave things in a good light.  You will be welcomed back in the future if you left in good standing.

7.  Show the patient that you are washing your hands and cleaning the equipment.  Patients appreciate that you are working to protect them from germs coming from other people’s homes.

8.  Leave with grace.  Many people have poor vision.  Putting things back “exactly” where you find them, will show a sensitivity to this.  Always leave assistive devices in reach.  Offer to turn their tv back on or reset the volume.

9.  If you know they love a certain show on tv, try to avoid that time for your visit.

Small acts of kindness in Home Care

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There are opportunities in home care to make big differences in peoples’ lives with small acts. Today I saw a patient that was anxious because the sound on his television had stopped working. Anxiety has an effect on health and I saw this as something I needed to address.

The use of DVRs, sound bars, and satellite receivers has complicated television reception and it is not uncommon for these types of things to happen. When calling a cable / satellite provider, it inevitably requires trying some things with the equipment that our patients can’t do. They usually can’t get down behind the equipment. They can’t see to handle the bundle of cords that fall behind the set.   If they have to have a technician visit, it costs money that they may not be able to afford.

I was able to trouble-shoot through the situation while he watched with trepidation that I might “make it worse”. In the end, I was able to get the sound back on and it was wonderful to see the relief on his face.   Crisis averted! Solving his problem made my patient more comfortable addressing the exercises and tasks on my agenda for the day.

Medical Crowd Sourcing – a place to find people with inventive minds in medicine.

I love to find new sites.  There is a crowd sourcing site for medical related services and inventions.  It is called medstartr.com.

Please take a look at this invention.  It will communicate with a Smart Phone and inform the physician that the patient is developing significant swelling in the lower extremities.  This is an important sign of Congestive Heart Failure and can lead to earlier treatment and reduced need of more emergent care.

http://medstartr.com/projects/430-edema-sock