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Negotiating With Your Patients
You would think that a patient would do anything in their power to return to their prior functional level. Unfortunately, this is not always true. For patients who were in the hospital for an extended period of time, they usually return home extremely deconditioned, with low self-confidence, feeling hopeless. They may receive Home Care Physical Therapy 2-3 times a week with the therapist establishing a Home Exercise Program to be performed on the days the therapist is not there. However, in my experience, when discussing rehabilitation with these patients, they want to get better but are non-compliant with their exercise program. I admit, some of the exercises become monotonous after a while. I have come to the realization that I must choose my battles, and negotiate in order to "win the war." If a patient is not performing the exercises on his 'non-PT days,' then I try to find something that they will do...something less complex than a list of exercises. For these deconditioned patients, I found that walking is a an all-around conditioning exercise that they are not so resistant to. Because many of them are deconditioned, I usually recommend short frequent walks in their home. Many of them spend a great deal of time on the couch watching TV. Because of this, I recommend getting up and walking a lap around the house whenever a commercial comes on. When their show returns, they can go back to their seat to watch it. They will repeat these short frequent walks every time a series of commercials comes on. You would be amazed at how much exercise this is. This is one way to get your patient to increase the volume of activity without being so resistant to it.
