viscous cycle

At university we are taught the gold standard. It has come to my attention that this may not always be possible. No matter how hard you try.

While treating a patient with an ABI resulting in dense left hemiplegia, for 2 sessions we attempted to improve this mans standing capacity. I was using the Gold standard technique of no shoes to enhance proprioception and everything. For this particular patient, his ability to stand was limited by immence localised pain and discomfort on the sole of both of his feet (pain meds had been administered). He would easily be able to stand longer if he had no pain. On assessment, dorsiflexion was slightly limited due to pain and a nodule was found on the sole of his left foot, which reproduced this mans pain when palpated. For 20 minutes i mobilised this patients feet with a variety of techniques which improved range but did not eliminate pain.

When standing this patient (x2 assist) post rx, he experienced pain immediately and was able to maintain for no longer than 1 minute.

It seemed that a viscous cycle had formed. this man had painful, tight feet due to prolonged recumbency and tone which prevent him from improving his standing capacity and therefore he remains off his feet.

Clutching at straws, i approached the medical team about re-assessing his pain control and in the mean time brainstormed. We trialed standing with his joggers on as the sole has arch support. This improved his standing capactity to ~5 minutes before limited by pain.

It is in these situations i feel that minor changes need to be made to break the viscious cycle. This prac has definately challenged my problem solving skills in a good way!