One of the advantages of providing in-home speech, voice, and swallowing treatment, is that I am able to work with patients in a naturalistic environment, and observe them performing their home practice. Since there is usually a spouse or other family member observing and commenting on treatment, their presence provides numerous teaching and counseling moments. An observation I have often shared with a spouse, is that "nagging" is not a good therapy technique.Yet, I remember times when I fell victim to this with my own dad. Times when I chastised him for not performing his physical therapy exercises, warning: "do you want to keep falling?" his not drinking enough water, "do you want to get a urinary tract infection?"etc.,etc..
I do believe that nagging usually arises out of our genuine love and caring for another person, along with our desire for them to improve from, or not succumb to some disease. But, the truth of the matter is, all of these tactics typically result in an increased feeling of helplessness and diminished self esteem in an individual, who is already grappling with the symptoms and functional changes imposed by the disease.
Physicians and therapists can also be guilty of employing some of these fear tactics, particularly when treatment recommendations are based on their agenda rather than patient driven goals. "How can I help you be successful in reaching your goals?" is a question we should be asking every visit. And if or when a patient responds with the statement: "I don't think this is doing much good," they have provided important feedback regarding their own beliefs about their illness or their abilities, as well as an opportunity for further probing and goals clarification.
In the face of a progressive neurogenic disease, patients may fail to see the benefit of adhereing to proposed treatments, particularly when the end result is not a cure, or even a significant improvement in function, but rather a delay in symptom progression .
So, if fear tactics and guilt are not effective strategies for helping others follow through with treatment recommendations, including home practice programs, what might help?
Research suggests that patients ( potentially all of us) must believe that the recommendations for specific actions or steps for dealing with symptoms of an illness or improving any level of functioning, will actually make a difference, and, that they ( the patient) have what it takes ( mentally, physically, and emotionally) to carry out those steps. Patients with cognitive decline and memory problems, require a very personalized approach along with the use of treatment tools which will allow them to have some measure of self reliance and success. Videotaping a patient's treatment sessions can be a great method of improving adherence to practice. Once downloaded to the patient's computer, the session's instructions with live coaching, remain available as often as the patient desires or requires. Video-taping also provides a a visual documentation of change and improvement. Seeing and hearing oneself sound better can be emotionally satisfying with increased feelings of personal satisfaction and pride serving as motivation to continue.
I do believe that nagging usually arises out of our genuine love and caring for another person, along with our desire for them to improve from, or not succumb to some disease. But, the truth of the matter is, all of these tactics typically result in an increased feeling of helplessness and diminished self esteem in an individual, who is already grappling with the symptoms and functional changes imposed by the disease.
Physicians and therapists can also be guilty of employing some of these fear tactics, particularly when treatment recommendations are based on their agenda rather than patient driven goals. "How can I help you be successful in reaching your goals?" is a question we should be asking every visit. And if or when a patient responds with the statement: "I don't think this is doing much good," they have provided important feedback regarding their own beliefs about their illness or their abilities, as well as an opportunity for further probing and goals clarification.
In the face of a progressive neurogenic disease, patients may fail to see the benefit of adhereing to proposed treatments, particularly when the end result is not a cure, or even a significant improvement in function, but rather a delay in symptom progression .
So, if fear tactics and guilt are not effective strategies for helping others follow through with treatment recommendations, including home practice programs, what might help?
Research suggests that patients ( potentially all of us) must believe that the recommendations for specific actions or steps for dealing with symptoms of an illness or improving any level of functioning, will actually make a difference, and, that they ( the patient) have what it takes ( mentally, physically, and emotionally) to carry out those steps. Patients with cognitive decline and memory problems, require a very personalized approach along with the use of treatment tools which will allow them to have some measure of self reliance and success. Videotaping a patient's treatment sessions can be a great method of improving adherence to practice. Once downloaded to the patient's computer, the session's instructions with live coaching, remain available as often as the patient desires or requires. Video-taping also provides a a visual documentation of change and improvement. Seeing and hearing oneself sound better can be emotionally satisfying with increased feelings of personal satisfaction and pride serving as motivation to continue.
No comments:
Post a Comment