Monday, August 30, 2010

"You can't teach an old dog new tricks..." (Elise)

I have heard this saying many times before: “You can’t teach an old dog new tricks.” Often it was used in response to trying to ask an older adult to try a different method/technology to complete a task, such as using a remote control for the television or trying to make phone calls on a cellular phone. The saying suggests that an older person who has a technique for doing something may either find it too difficult to learn something new or is not interested in trying a different way. Research shows that this is quite false—the brain is capable of learning new things regardless of age (or even certain injuries) due to neuroplasticity, which is the brain’s ability to generate new pathways or re-distribute neurons (cells) to perform functional or cognitive tasks.

This quote came to mind this week as I worked with some of my patients on the pressure ulcer management service. Patients who have been injured for many years are very different in therapy from those with new injuries. You might think this is a pretty obvious statement. As a physical therapist, it’s been interesting for me to try to define my role with the new patient population I am working with. For the past 2 years, I have been working with individuals who sustained a spinal cord injury recently. In fact, very recently—anywhere from 2 weeks ago to a few months prior depending on the severity of the injury and the number of medical complications during their acute care stay. I was almost shocked this week when I interviewed some of my patients on the pressure ulcer management service. The three main people I worked with this week have been living with a spinal cord injury for between 25-40 years! That’s quite a change! When I spoke to my patients regarding equipment preferences, transfer techniques, and pressure relief methods, they were quick to inform me about their routine and hesitant to listen to my suggestions for alternatives.

I am learning a lot about maintaining patient-centered care and compromise. During a seating evaluation with one of my clients, we discussed the need for a new power wheelchair. His old chair was completely worn down due to his living environment: daily navigation of rugged, unpaved, and hilly terrain on his ranch. In no time, he stated the name, make, and model of the rear-wheel drive power wheelchair he wanted. This was a surprised to me! I was so accustomed to my clients with “newer” injuries choosing the mid-wheel drive power wheelchair design; the positives of these chairs (in my mind) seemed to completely outnumber those of a rear-wheel drive chair. For example: the smaller turning radius and better suspension provide a smooth and more accessible model. My client would not budge. He was comfortable in how the rear-wheel drive maneuvered, familiar with accessing home and community environments in it, and had no desire to order a chair that was completely new and different. It makes sense to me now, especially knowing he had been in the other chair for 11 years!

Even if his choice was not “justified”, a patient-centered therapist will always allow the patient to make the ultimate decision regarding their care. Certainly, we can provide education regarding other equipment options, access to trial equipment for demonstration, and even suggest a network of current equipment users to contact. It is important to remember that our clients are the ones who will be using the equipment every day and have an extensive knowledge of their own body and living environments. I am looking forward to learning many things from my new patients, as their “injury age” provides them with a certain wisdom that I could not possess. I am certain that information and experience I gain will only help me to better serve and work with individuals who sustain spinal cord injuries at all aspects of the acuity continuum (acute à chronic).

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