Practice - Facing Disfigurement

Looking ‘normal’ means more than we may expect, Diana Hughes tells Janet Wright

What does a physio do when a patient is too wounded psychologically to care about physical recovery?

It was a dilemma that Diana Hughes, of Newport, Gwent, encountered soon after graduation.

‘As a junior, I would begin a rotation wanting to learn as much as I could about which muscles were attached where, what muscles and function had been lost and what we could work on to improve overall strength, fitness and independent life,’ says Ms Hughes, now a band 5 physio.

‘But on vascular surgery rotation, I treated a lot of amputee patients who would lie in their beds and say:

“What do you know? You don’t understand what I’m going through”.’

Despite the holistic elements of her university course, she didn’t know how to respond. It wasn’t just about the disability, says Ms Hughes, who is now on acute medical respiratory rotation in Morriston Hospital, Swansea.

When she tried to motivate patients to regain all the mobility they could, some would say: ‘How can I go out and walk again when I look like this?’

She realised their sense of disfigurement was hindering their recovery.

And it wasn’t only amputees who found it hard to deal with the sight of their changed body, she discovered.

The same happens with other injuries that affect people’s appearance.

Burns are the most obvious example. But many other injuries can leave damage that the patient finds disfiguring.

What she learnt made Ms Hughes eager to promote psychological training for physios, and a keen supporter of disfigurement charities Changing Faces and the Katie Piper Foundation.

She recommends courses run by Changing Faces, to help healthcare professionals understand and support people with disfigurements.

Patients may get some psychological support, says Ms Hughes, but she encourages physios to find out more about the role they can play.

‘We need to provide psychological support throughout all aspects of a patient’s care - from beginning to end,’ she says.

‘The psychologist isn’t there all day every day, or when we’re trying to get someone to do face exercises if they have been burnt, or leg exercises if they are an amputee.’

Although physiotherapy training does emphasise a holistic approach, Ms Hughes would like to see more specific training in the factors that cause depression or resistance to rehabilitation.

‘All juniors going on to a rotation such as amputee rehab, intensive therapy unit or burns should be trained to cope with patients who have been through this kind of trauma as it surely will demotivate them when it comes to rehab,’ she says.

‘Some hospitals and universities do this, but it needs to be happening everywhere.

‘Courses like those run by Changing Faces can improve our communication with patients who may feel unmotivated or even threatened by the work we’re asking them to do, and this can aid their overall recovery,’ she says.

And backing her words with action, she’s off to train for the mountain-climbing Three Peaks Challenge, to raise funds for the Katie Piper Foundation. See page 47 for details on sponsoring Ms Hughes and colleagues in the Three Peaks event. fl

Janet Wright

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