frontal lobe deficits

With only experience thus far in the main fields of musculo and cardio, my neuro placement specialising in head injury was something very different. Not only were there physical deficits but a variety of frontal lobe injuries. One patient in particular, (i was in charge of for a week while a physio was absent) had predominately behavioural problems. This young man required a companion 24/7 and constant attention.

Physiotherapy sessions with this man, consisted of a 1/2 hour basic exercise program for strength and balance as he had regained most high level function (walking and jogging). I was instructed to supervise and guide this mans exercise program every morning for that week. i can tell you now that i exhausted all of my persuasive powers and was mentally drained after each session. He would never initiate an exercise unless 1. instructed and 2. wanted to do the exercise. On my first day with this patient i took the 'lets be friends first' approach as he was similar to my age. This worked relatively well as the patient was compliant with all exercises, except for him putting his arm around me by the end of the session. I wasn't sure what to do in this situation, so i changed the exercise swiftly to something requiring both his ULs and nothing more was said

This situation didn't make me feel too confident in dealing with the situation if it were to arise again. At uni, we are made aware of frontal lobe issues that can occur however there was not much insight on how to deal with them. I was also unaware of what the patients behaviour variance was like and therefor not sure how he would react to me saying that his behaviour was unacceptable.

I discussed the situation with my supervisor as she said that what i did was perfectly fine and that every patient is different, requiring team consistency and trial and error. I was informed that this patient had lost the ability to determine a level of social appropriateness, for example he will talk about 10cm away from your face and put his arm around you. Together we derived some strategies to try the next day. A Strategy utilised by the other health professionals was consistently reminding the patient to shake hads instead of hugging as a component of re-teaching the patient appropriate social skills. Other strategies that were successfull included myself participating in the exercise and having a rewards system, whereby if he was compliant he got to go outside in the afternoon and play sport.

After this experience, i have learnt that discussing strategies that can be utilised by all staff work the best, as this reinforces consistency. Also that each patient needs an individual approach. The next day i employed these strategies which worked very well. In the future i will endevour to discuss ideas with other staff members and make our treatment meaningful to the patient.