Sunday, November 24, 2013

Motivating Adult Patients a Reflective Approach.




Have any of you moved before? If so, you know how hectic life can be during and after the move! So after a crazy couple of weeks of moving we finally have the Internet and I have my cozy office set up.

As I sip on a nice cup of tea this evening I find myself reflecting on some of my adult patients that I have been so fortunate to work with lately. Most of these patients have sustained traumatic brain injuries and/or a stroke. When an event like this occurs it can leave the patient with significant cognitive-linguistic deficits.

Often times these patients that I see will reflect upon what used to be. “I used to be able to read an entire book.” “I could go to the grocery store without a shopping list.” Etc.. This reflection is normal and can help drive treatment but when a patient becomes stuck or fixated in the world of “what used to be” then making gains in treatment can be challenging.

Though I have never experienced a traumatic brain injury or a stroke I do understand what it is like to be in the “what used to be” world. When I was in graduate school I played golf for Missouri State University. It was so easy to get stuck in the mindset of “why can’t I hit this pitching wedge…last week I was able to…maybe if I hold the club this way…no more club head speed, less club head speed…I used to be able to make that put.” I was lucky because my coach, Coach Kevin Kane, was able to recognize when I would get stuck. He would tell me to “get out of your own way.” Mentally I had to stop thinking about what I did but what I was going to do and what I was going to accomplish. Sometimes we have to help our patients get out of their own way.

When I identify a patient that is in the land of “what used to be” or they are “in their own way” and they can’t get out of it, I will have them do a simple exercise. I will have them make a list of the accomplishments they are proud of. This list can be long term or short term. I know it seems strange to have them reflect on the past but there is a method to my madness… After they make this I have them write what they now want to accomplish and what they will be proud to accomplish. Just because a patient has had a stroke or a traumatic brain injury does not mean that there past accomplishments are worthless or gone. They can still be proud of a past award, raising their children, writing a book or being a great grandmother or grandfather. It’s time to harness that feeling of pride and accomplishment and move it into treatment. It’s time to talk about the work that they put into previous accomplishments and how that same work ethic they possess is going to help them now. With every single patient that I have done this with, I have seen a fire light inside of him or her and then gains in treatment.  This exercise is not only good for the patient but it has also been tremendously helpful for the treatment plan that I formulate for the patient. You may find that your current treatment plan is not reflective of what the patient wants to see the most gains in, you may find more functional day to day cognitive-linguistic skills that the patient would immediately gain from.

Have you tried something like this with your patients before? Have you seen positive gains? Do you have any other methods that help keep your adults motivated? Do you have a patient that may benefit from this technique? Please share!  

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