No more Mr. Nice Guy

I have a patient on my prac who has an interesting condition which was originally treated as a benign paroxymal positinal vertigo, but has had persistent vertigo, dizziness and nausea upon almost any movement of her head. She is able to reduce symptoms by sitting still. A balance assessment was performed and she scored very poorly and most exercises were ceased due to her dizziness. Her ambulation is severly impaired by her condition and she reports that she has incidences where she has to grab onto the nearest bit of furniture or her husband to prevent her from falling on a daily basis. I think it is only a matter of time before she has a fall.

Treatment to date has focused on trying to give her accomadation and substitution strategies, giving her exercises where she provokes her symptoms in a controlled setting to try and give her body some desensitisation to it, and hopefully this will cause her to be able to deal with it better when she is in a everyday situation. She is very compliant and motivated to try and improve her condition, however has reported that the exercises have had little effect.

I have spoken to my supervisor and we both agree that the exercises are probably not going to change her condition all that much and think it is more important now to begin to focus on her safety. However my supervisor advised me that the patient is not very keen when walking frames are brought up. I was cautious in how i approached it trying to reason with the patient that her walkin is not very safe and that she should consider using some sort of aid. She was positive with this idea when a walking stick was brought up, but as she does have a problematic side and reports she loses balance to both directions i suggested a 4 wheeled walker was going to be a much safer option. As soon as i mentioned this she went rather quiet and did not seem happy at all. I left the topic at this time and went on with some other aspects of her treatment.

It is hard as it is obvious that the patient does not like the idea and people sometimes have psychological issues regarding using a frame as it makes them feel like they are gettin worse or older. I do not want to push the issue on her because i could see her not wanting to come to physio anymore, but i also think that this is the best option for her safety. My next plan is to try and show her that she is safer with the walker by tryin to get her to use it while we repeat a dynamic gait index test or a timed up and go. I think if i am able to get her to try these things with the walker she may realise how much easier it is, but as i said before if she does not want to try it i dont want to push the issue so much that she does not return. Tough gig.