Week 5 - monday

I have been treating a patient which is a high falls risk and was previous to his hospital admission. He is another NOF patient. This patient has in particular has poor balance. His performance also fluctuates, in particular when he returns from dialysis, which he attends 3 times a week. He is very shaky and uncoordinated. Initially we have bee aiming our treatment at mobilising the patient safely but he fails to negotiate turns and corners safely. I also definitely think he has some cognitive problems because he needs to be prompted every time he is walked.
It will be simple to rehab this patient to his premorbid state but i think it will be very challenging to be able to send his home knowing that he is 'safe'! I think this is a massive challenge for the physio because while all the other parts of the medical team are happy to D/C a patient except for the physio because he has poor balance/ambulation which cannot really be effectively improved in the hospital environment anyway and he is possibly degrading due to excessive bed rest. Atleast at home he has social aspects to his life and will get up move around and be confident. Something that comes to mind for me is hip protectors atleast this way if he falls he will be protected to some degree, but they are very expensive and a doubt that this patient would comply to wearing them.
Meanwhile D/C is underway i have be assigned to carry out his balance and mobility training. The main techniques i have decided to use include balancing with eyes closed, balancing on foam mat, UL reaching and Functional ambulation with obstacles, figure 8's, outdoors etc. I think this is a excellent plan as it addresses all the components of balance and is not to time consuming. What i have had problems with is deciding on is an appropriate balance objective measure. Most of the balance Ax we have learnt are far to advanced such as bergs, step, Sharpened rhombergs. I decided on the TUG and Standard rhombergs which were decent objective measures and should allow me to track his progress.
Looking back on the treatment i could have used a more difficult task with UL reaching such as a heavy weight instead of TV remote (even though this is fairly functional). I would like to look into other objective measures which might be useful such as 360turn or FR test.
I feel fairly confident with managing this situation and have found it very informative being involved in the DC planning for this patient.