Topic 3- Communication

Situation: A 74 year old Vietnamese woman with a 5 year history of Parkinson's disease, was referred to the Physiotherapy department at the Parkinson's Clinic for review of Parkinsons and for decreased mobility and falls. The patient attended the clinic with her son, who brought her in in a wheelchair. Patient C lives at home with her husband and son, who is the primary carer. Patient C does not speak much english but the son is able to translate. Currently, patient c only ambulates around the house (indoors and out). Her endurance is about 5-10 mins before she requires a rest. She uses a walking stick but requires a wheelchair for longer distances. She had a fall 3 months ago where she fell out of bed. This fall resulted in a Colles Fracture of her left arm. The fracture has healed and patient is still doing the hand therapy exercises prescribed to her by the hospital. She has been approved for a high-level package (for a nursing home) but the family do not intend to use it just yet but instead are just planning for the future. She is also currently waiting for a hospital bed to be delivered to assist with her bed transfers. She currently has difficulties with her balance, endurance, strength, bed mobility and transfers, sit to stand and car transfers. The son also reports freezing and difficulties turning in confined spaces.

Task: My role was to undertake a subjective and objective assessment of this patient to determine difficulties experienced and to treat them accordingly.

Action: Because patient C could not speak much english, I had to plan how I was going to tackle this task. I decided it was important that I only used simple words and short sentences with the patient. I was able to use the son to try and translate where necessary but I felt to really build up a rapport with the patient it would be best to try and get as much detail from her first and then let the son confirm or add information where required. It was also important that I used eye contact with this patient to let her know I was interested in what she had to say and to help her understand what I was asking. With my objective assessment it was important to also use very short, simple instructions. I reviewed her bed mobility, sit to stand, strength and balance but chose not to assess her walking in that session due to time, history of fatigue and because the patient had left her walking stick in the car and it would waste time in this session getting it. Therefore I informed the son and patient to bring the walking stick in next week so I could do the 20m walk test, the 6 minute walk test and timed up and go. For the remainder of the session I educated the son on possibly using a plastic bag to assist with car transfers, answered his questions (with the help of the physio) regarding the home care packages, and discussed the possibility of teaching him manual handling.

Result: I successfully completed the subjective assessment and the majority of the objective assessment. I was able to identify problems that the patient was having, including bed mobility, turning, balance, strength and endurance as well as freezing and bradykinesia. I explained my findings to the patient who understood and was happy to attend 1 on 1 physiotherapy.

Evaluation: I was very nervous before seeing this patient. I was unsure whether I would be better to talk directly to the son or to the patient. I decided to aim my questioning to the patient and just use the son as required for translating of the get more details. The patient did actually speak more english then I thought she would and therefore it was easier to engage with the patient. It was also easier to gage the patient's understanding of my questioning or instructions then I believed it would. I believe my strengths were that I used simple language and short sentences, used demonstrations where possible, maintained eye contact and involved the patient as much as possible. My weakness was that I got stuck a couple times with my questioning where I could not come up with another way of asking the same question when the patient could not understand and I could have further simplified some subjective questioning.

Strategies: The strategies I believe would assist to better my assessment of patients who speak little english include practicing simplifying questions and different ways of asking the same questions, for example in regards to festination and dyskinesia.