The time for honesty?

Helena Cook, an independent neuro physio in south Wales, highlights an issue facing physios due to the ever-increasing pressures on services.

Comment from Helena Cook

‘The physio said I’d never walk again.’

‘The doctor said if I hadn’t got better in a year, then I never will.’

I have often heard clients quote these words and I don’t doubt the clinician stating them had all good intentions.

I fully understand there are some conditions and injuries we treat that have less than positive outcomes, and we, as health professions, have a duty to use our experience and knowledge to inform our clients of realistic outcome potential that help prepare and adjust to new lives.

Many medical professionals still talk in timescales for recovery following a brain injury; three months, six months, a year. Perhaps what is being referred to here is spontaneous recovery, the brain reorganising after an assault, and which will naturally slow after a period of time.

By definition, spontaneous means occurring from natural tendency, without planning or being forced. This reorganisation is going to happen regardless and, obviously, our physiotherapy role is to guide and direct the recovery towards normal pathways.

But once this natural response slows, is this the ‘plateau’ that is observed? And, more importantly, is this the time to reduce or stop our input?

If, at this time, the natural recovery of the CNS is starting to slow, then surely this is the most important time for therapeutic input to increase, not decrease. Creating challenges for the CNS to further change and adapt to, needing even more repetition and guidance to make further neuroplastic changes.

The NHS is unable to support rehabilitation indefinitely. 

But it is about being honest with our patients. 

Honest about what our service can provide, and honest about what they may be able to achieve if they have the opportunity to.

These two statements aren’t necessarily describing the same end point. 

As physiotherapists, we are hugely influential when it comes to what patients believe is achievable.

Don’t limit your patient’s goals or ambitions because of the limitations of the service you’re able to provide.

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