Topic 3 - Communication

SITUATION
82 yr old man was admitted to SCGH with a R MCA 1/7 ago. He is Vietnamese, speaking minimal English and is now dysphasic from the stroke which made it very hard to communicate with the patient to conduct an accurate subjective and objective assessment. His wife was present for the majority of the Rx sessions, but unfortunately she speaks less English then he does so translation was not possible. He had a son that was available to come in to translate for 1 Rx session, however he was not present during the initial assessment and because of his dysphasia, they also had trouble understanding what he was trying to communicate. So when Rxing the patient we had to adopt numerous strategies to communicate with the patient and look for signs of pain etc that he would be trying to express to us. He had a very dense L side hemi, and was a grade 3 pusher, with L hemianopia and dysphasia, and continuously drowsy and therefore didn't participate well in Rx.

TASK
To complete an objective assessment on the patient and do an appropriate Rx session to treat what was found in the objective assessment.

ACTION
In the patient notes there was a detailed subjective and objective assessment done from the admitting Dr, so I had some idea of what to expect to find when I went to see him. I introduced myself and then began to ask how he was etc. but when I wasn't getting responses from him, I went straight into my objective assessment. I began with ROM and tried to ask him using simple words to actively move his limbs. For something I thought to be very simple, it turned out to be a long winded task. Words were not working so therefore I had to use demonstration and one worded commands such as 'lift'. After looking at active ROM and ms power, passive ROM and tone were a lot easier to assess. We then tried to get him up to sitting using more non-verbal communication then verbal, with no luck we had to use 2maxA to sit him up, then try to get him to realign and stop pushing, which again was done via non-verbal language of pointing between shoulders and one worded sentences like 'straight' and 'up tall'.

RESULTS
Unfortunately I was unable to complete a more physio based subjective assessment in that inital assessment, as there was no one there to translate. My objective assessment also lacked important neurological assessment measures such as ms power and sensation as we were unable to tell whether it was because of not understanding or deficit in the area. This is best portrayed in when we were trying to decide if he had inattention or lack of sensation, as we were applying tactile input to his arm, but he wouldn't acknowledge it. However, we were able to being treatment of his pushing and core control. From this assessment we were also able to realise how dense his L hemi was, and realise that he would require 2A and to time sessions when someone was around to be able to translate.

EVALUATION
A big down fall of not being able to communicate properly with the patient was it meant that a lot of time was wasted trying to get him to complete the tasks, which in the setting i was in, you were not able to spend an hour assessing a patient, cause you have other patients you have to see. I found after trial and error that one worded senstences, hand gestures and demonstrations worked the best to get the patient to participate in the assessment. Also consulting the wife in one worded sentences or demonstrating to her for simple tasks so she could try to translate worked well to get the patient to participate in the assessment. I found that i adapted well to the situation, being able to realise when a certain approach wasn't working i was able to continue until i found an approach that gave me the best participation out of my patient. However i think i did spend to long trying to get a response out of my patient on some areas especially active movement. This left me with minimal time to get through the rest of the assessment in an appropriate time frame.

STRATEGIES
It would have been much better if one of his sons had been at the initial assessment so that we could have reliable translation and therefore conducted a more efficient assessment. I also need to work on a more efficient assessment layout to make everything run more smoother for the patient along with my work finding ability, especially when finding the right word to get the movement you require is important. This was good experience as communication and rapport are central to working with patients, especially when their communication is poor and i need to practice my communication skills. I also think that my communication skills will improve with more practice.