Increasing confidence - exercises?

[Maes Seren]

Hi, I was hoping someone could give me a hand in thinking of things I can do with my patient who has decreased confidence. He's currently walking with hand assistance of one, but is usually independent. I've been trying to encourage a few extra steps each time in encouraging his independence with me alongside, however this is proving difficult! Said patient also has moderate learning difficulties.

I have access to limited gadgets, as he's an inpatient, we have long wards to walk up, I have tried using a stick with him but without success.

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[nataliemelfa]

Hi, I was hoping someone could give me a hand in thinking of things I can do with my patient who has decreased confidence. He's currently walking with hand assistance of one, but is usually independent. I've been trying to encourage a few extra steps each time in encouraging his independence with me alongside, however this is proving difficult! Said patient also has moderate learning difficulties.

I have access to limited gadgets, as he's an inpatient, we have long wards to walk up, I have tried using a stick with him but without success.

I had a similar patient. We practised walking daily in parallel bars, so that his anxiety would lessen due to the presence of the bars. We encouraged him to walk at first holding onto both bars, then one, then none. His confidence quickly improved and soon he was able to walk independently with a stick.

Always worth a go if you have access to parallel bars, if not, you could always try two sticks, and then progression onto one?

Hope this helps

[Maes Seren]

Thanks, we don't have any parallel bars unfortunately. And to scupper your sticks plan, I tried him with one stick but due to his learning difficulties, he didn't understand how they were used and I ended up doing the placement of the stick for him and even through repetition of that, he just wouldn't grasp it.

On the ward, there is a hand rail, however charts are often hung on there so not a brilliant area to practice holding on to. :/

[nataliemelfa]

Thanks, we don't have any parallel bars unfortunately. And to scupper your sticks plan, I tried him with one stick but due to his learning difficulties, he didn't understand how they were used and I ended up doing the placement of the stick for him and even through repetition of that, he just wouldn't grasp it.

On the ward, there is a hand rail, however charts are often hung on there so not a brilliant area to practice holding on to. :/

I found with learning difficulties that sometimes a tri-wheeler/wheeled frame is useful initially- as long as you don't think he will be dependant on it? I work in learning difficulties and find you really have to tailor the treatment to include things they are interested in and understand- as they are not always understanding of why their confidence is decreased. If you have someone that works with you, have them control the frame in the front and ask him to walk initially with assistance of one- letting him know that the frame is there but he must try not to grasp it- sometimes making it a competition works (1 point for every step taken without holding on, and -1 point for grabbing the frame for example- or just counting how long he can go without holding it on) with lots of very positive encouragement.

This will be a good one once you crack it!

[Fyzzio]

Hi,
just another thought.
As with every other patient, but especially in the area of learning difficulties, it is repetitive practice which will lead to success. Increasing confidence for walking is not an area that should be specifically targeted by a Physio, but the whole team.
I don't know how often you see the patient and for long he can actually walk, but I would suggest for him to practice walking (max. tolerated distance) in the pattern and with the aids that you have perscribed for at least 4 times per day [this is not evidence based; but practical]. Now, your job is to find ways to put this into action. Discuss it with the team like Nurses, OTs, etc. (to ensure that everyone e.g. gives only 1 hand support), use Therapy or Nurse aids, instruct family, ...
It is very difficult to challenge patients with learning difficulties. So, as said above, you use the support they feel comfortable with and then gradually reduce over time. In Physio, you could break down walking into the specific steps and then practice those single tasks by reducing the amount of support or adding other physical or vestibular tasks. E.g. patient might be able to stand independently, therefore practice catching throwing a ball, pass a flanel around body and under knees, roll a Swiss ball forwards and backwards, move a glass of water from chair to higher ground, progress to kicking, etc..

Good luck,
Fyzzio