Teachable Moments and Coaching Your Patients
May 2018 Issue
All too often as I'm fitting first-time prosthesis users, patients mention that a physician told them that they would never walk again after their amputations and would be relegated to wheelchairs or crutches. Some people might see that as a challenge and find it motivating, but it can take all hope away from someone else. In my role with Ottobock's Cooperative Care Program, I participate in prosthetic fittings when our customers request help, and I usually work with the clinicians and patients at the facility for two or three days. My role, like all O&P clinicians, includes teaching, coaching, and encouraging prosthesis users, while also being realistic with them that mastering using prostheses will not be easy.
In fittings for first-time prosthesis users, I try to paint a picture of the fitting process, including casting, the work that will be done in the lab to modify the cast, the fitting of the check socket, and then putting all the parts together for the temporary prosthesis. Finally, I describe the fitting of the temporary prosthesis and the details of making the prosthesis work for them.
Once all the parts are put together, the lessons begin. I start by having patients with lower-limb prostheses stand in the parallel bars to check the length of the prosthesis and begin working on weight shifting. Ideally, the patient's physical therapist is there to assist with the gait training and learn about the components that the patient will be using to give a better understanding of what will be required during therapy sessions. With a well-fitting socket and the correct alignment, many patients can make all the parts work together with a little coaching from their clinicians and physical therapists.
For gait training at a high-level fitting, such as a hip disarticulation fitting, I first explain the movement required to take a step, then I guide the patient's socket through the proper motion as he or she takes a step. A lot of time is spent initially in the parallel bars; however, if the patient is comfortable using crutches, I will have him or her try a few steps with the crutches, so the patient is aware of what should be done at home when he or she gets to that point. I also try to get patients on stairs, and if they have a knee that will allow step-over-step descent on stairs we also work on that. For patients struggling with the basics of controlling the prosthesis, we spend more time on the early process of standing and weight shifting, until they are more comfortable using the prosthesis. At this point, it's important to provide a lot of positive feedback for small improvements as well as encouragement to keep up the good work. Once patients are comfortable standing and shifting to put all their weight into the prosthesis, learning to take a few steps and control the prosthesis usually progresses quickly.
Because I have such a short time with these patients, I try to allow them to experience as much as possible. This lets them see the potential if they stick with the hard work ahead. I try to provide good counseling at the beginning of the process and good coaching during the fitting process to give the patient the best opportunity for success. Ultimately, it is their motivation, determination, and a good support system at home and in therapy that will allow them to have long-term success, so painting a positive and realistic picture can be an important first step.
Byron Backus, CP/L, is a clinical specialist at Ottobock, Austin, Texas. He can be reached at email@example.com.