The Memory Unit OT

We’ve talked at length about promoting increased independence with mobility, even on the Memory Unit. But what about those patients that really rely on the wheelchair, like more than they should? What about those patients that are safe to ambulate throughout the facility or their home, but they just refuse?

Now I want to make sure we get on the same page before we go much further.

The patients I’m referring to are the ones that, for safety reasons, can no longer use a wheelchair. Meaning, a patient who has a cognitive impairment, prefers the wheelchair, but doesn’t have the means to remain in the facility for the long-term and has a home with stairs or narrow spaces that cannot be modified.

I’ve encountered exactly this in my own practice several times. We have clients who admit to the skilled unit with the plan to return to a group home or other community-style residence. These homes typically run as non-profits and the people who own and operate them traditionally do not have the financial resources to make modifications like ramps or stairlifts or wider doorways.

In this sort of scenario, it is actually harmful to the patient’s overall care to avoid progressing from a wheelchair to an ambulation device. And this can be a really tough place to be in as a therapist. It might seem like you’re being too tough, you’re forcing someone to do what they don’t want to do, you’re pushing your own therapy agenda onto a patient. All of the things we never want to do or be viewed as doing.

The First Step is to Educate and Advocate.

Get your staff and care partners on board as much as possible. Ensure that the entire interdisciplinary team understands where the patient will be discharging home to and why they need to make progress in order to discharge home safely. Incorporate the nursing staff into your sessions to collaboratively find and implement strategies and cue techniques that maximize success without distressing the patient.

Get the Patient’s Family and/or Other Care Partners Involved as much as Possible.

Have frequent meetings to discuss progress and further areas for improvement. Keep reminders of the home environment frequent. Encourage family members to encourage your patient. Don’t go at it alone. Get the team involved.

Integrate your Patient into Group Activities that Require a lot of Standing and/or Walking.

You could group treat with some of your other patients, perform your individual sessions in the therapy gym while other therapist are treating, or integrate your sessions into established groups within the facility. The point being, you’re integrating your patient into a setting where they can see other patients and residents perform standing activity. Peer support and exposure can often promote increased participation.

Make the Progression from Wheelchair to Walker something to be Celebrated.

Have a little graduation celebration. Give them a certificate. Decorate the new device. Create a positive emotional response around this change.

I’d love to hear about ways you’ve encouraged an upgraded status when a resident just doesn’t see or understand their own potential! Tell me everything, because I’m always learning too!

source for featured image: https://depositphotos.com/stock-photos/wheelchair.html