I have been treating a young girl recently and an issue concerning how hard to push young children has come to mind. This girl has a history of avoiding physio but at other times she really enjoys getting out of bed and into the gym. I have a feeling that she has learnt what to say to get out of physio, for example expressing sickness or headaches…or she might be telling the truth.
It is difficult when she has been genuinely ill and hasn’t been out of bed with me for 3 or 4 days. When I go to get her out of bed after that time; she often says she isn’t up for physio, or just flatly refuses. I don’t want to be the bad guy making her get up when she just cant and lose her trust before I have had time to earn it. But at the same time I don’t want be neglectful, or have her thinking she can just get out of it when she wants. It is easy to be more demanding of adults, but with children and this child in particular, it has been difficult to gauge just how much I should push them.
I discussed this issue with my supervisor. She confirmed that this girl does sometimes manage to “pull the wool over your eyes”. It was also suggested that it is OK to be a bit more generous with children, in terms of letting them have time off – which is fair enough. This child also has a medical condition which makes her very sick at times, so that needs to be taken into account when she says she doesn’t want to do physio.
One technique which did work with her was making a deal that if I let her stay in bed one day, when I came back tomorrow she had to get up. It worked pretty well too, I got her out of bed for a good ½ hour session and she didn’t seem to kick up much of a fuss. Ball skills have also seemed to work with her.
From what I have learnt through this experience and from my supervisor, it will come down to making a judgment call using whatever information is available and in particular, observing how she is behaving to help determine how far I push her. This should allow me to be better informed for issues like this with other children which, no doubt, will come up. Also, any suggestions of ball-based games that can be played in a descent sized individual room would be nice so I can add to my repertoire.
4 comments:
During my prac at SCGH I had similar issues trying to exercise a teenage CF patient. She would come in to the ward a couple of times a year for a course of antibiotics and was well known to the ward staff. This patient was also known to be difficult to get execising she did not want to use any fitness equipment or the gym and wold regularly refuse treatment with a range of excuses. After treating her for a few days I worked out some techniques to increase compliance which included having a reason for the walk ie going and seeing what food they had at the canteen (which also happened to be up a few flights of stairs) and going outside to see how cold it was. Also I foudn that she was more likely to walk up the stairs if you told her she only had to do 2 flights even though most of the time she would end up doing all 5 anyway once she got going. Lastly I did start bringing a ball in for treatment as there was nothing fun to do around the hospital. We played hand ball in the room and made up games to play in the stairway (opps the ball fell down the stairs, better get it). NOt only did this make te exercising fun it would put her in a better mood to later do the boring exercise. Also balloons are good as you play with them as much as you want in a room without the risk of breaking anything.
From my previous experience, I had a patient who knew she had to do the exercise but also knew how to create tons of reasons not to participate. Because she had been doing exercises most of her life and it won't never stop as she grows.
I am sure these children get really tired of doing exercises over and over again due to their conditions. As your supervisor has mentioned, it is sometimes good for them to have time off and have fun without any physio input behind. At the same time, we as physios need to give them Rx as well, so we got to have creativities in our intervention. It is always good to have some activities which children would love to do and activities we focus in physio point of view in the session. It is also fun for them to have combined games; eg. gross motor, fine motor, visuospatial stimulation, sensory integration.
As you said ball games and balloons as Kellie mentioned are good activities for them and fun. Trampoline with a ball or bubbles is also good one as well.
These are really difficult situations. Gaining compliance in kids who know the system (and how to manipulate it at times) is difficult. I know I found treating teenagers with CF quite a challenge.
I'm not sure what the limitations are in your facilities, but I'm wondering whether a Wii might be a good investment??
What do you think and would you feel confident in suggesting that as a potential purchase at your facility?
Trudi
thanks for the comments guys.
From what Trudi suggested - the facility is pretty well off and have a multitude of different things - but a lot of them I dont think this pt would be interested in. I would love to be able to use a Wii for motivation (and for my fun too!!) I believe they have one there but I remember at orientation they said no-one knows how to use it or set it up I think. Definately worth more investigation, I will do that!
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