CF patient treatment and compliance

Hi!

currently on a resp placement, and saw a paeds pt today (10 yrs old) with CF.
her home ACT include ACBT and use of the PEP mask, however i have concerns over her compliance with treatment, as today when i saw her (4pm) she had not yet used the PEP mask and had not perfomred any other ACT's. also, in previous physio notes, patient compliance with PEP was queried.

i have spoken to her about the importance of compliance with the technique. i think i am also going to give her a "PEP compliance diary" to fill in in order to monitor her compliance, what do people think of that??
has anyone any other ideas??

also, if anyone has any tips on how to make physio treatment for the under twelves in CF more exciting, i would REALLY appreciate it.

thanks a million

Hi ahah1313,

Compliance is a very tricky issue with Paediatric children and there is alot of research on it. It all basically comes back to making the therapy fun. Children are far more compliant if the therapy is fun.

I had a young boy who was notorious for non compliance and absolutely hated physiotherapists. Everyone warned me about him when I went to see him. So rather than do physio I spent the first session just finding out about him. I found out he liked biking. So in the next session I chased him around the hospital on my unicycle - and a beautiful friendship formed. Our therapy sessions from then on comprised a balance of fun and traditional exercises. We had alot of wheel chair races, and running races. We played badminton and basketball. And also had pushup competitions etc. At the end of each session we would run through a quick ACBT but i never used percussions because he hated them. Once I was confident we had a good relationship I spoke to him seriously about what it meant for him not to do his exercises and asked him about what he really wanted from life... funnily enough he'd just got a girlfriend and his view on life was more uplifted so he was far more interested in what i had to say about promoting his health. The nursing staff let me know that he did become more compliant with his exercises. To be fair I just told him that I didn't care how he cleared his chest as long as he did. So he would do things like bike rides and playing on a trampoline as his self treatment and finish off with a quick round of ACBT to get it out cause he knew thats what I wanted.

Things may be a bit different for girls. But a really awesome idea is to find out if your paeds department has a ps2/3 with an eyetoy or a nintendo Wii. Nintendo Wii is cool obviously and you can do things like Wii Fit and Wii Sports to get them moving. Eyetoy groove is a game that goes with the eyetoy and ps2 or ps3 - I bought it fo a girlfriend in university, and 2 of my physio classmates (her flatmates) ended up playing it so much they stopped going to the gym. Once you get to expert level (which doesn't take long) it makes you MOVE. It's an impressive workout.

I'm sure there are people out there with a thousand years of paeds experience. My experience is based on 1 rotation and only 3 CF children. But making it fun is the way to go.

The Compliance Diary isn't too bad of a idea, I'v heard of people making them sign contracts etc. Can you come up with a reward system to go with it? If they can show they'v been compliant for a week then get them a small gift - find out her interests.

Oh well, maybe theres something in there for you
Pudding

thanks so much for that answer!!v helpful!!!il check out the wii, she has a nintendo ds in her room so she is into the computer games!!goin to try the diary so il post how it goes for the info of other users

ahah

Yea - if shes into console gaming then find an activity based one.
I love the eyetoy groove game and other ones include the dancing based games as well.

Miss Puddling Bowl,
Your advice is brilliant based on just 3 CF's. Exercise exercise exercise. Children hate sitting still and the evidence is pointing us towards exercise. Who cares what really, so long as the child huffs puffs and coughs! PS2/3's are great and one way our CF's can enjoy sport without the embarrassment of coughing in front of their teammates which seems to be an issue with the girls I see aged 8 upwards.
If the non-compliance is surrounded around the PEP or if physio means PEP to this child (scary) then change her perception to physio is clearing the chest, however she wants. Form a plan, contact local sports places or investigate charities that may fund a PS3 for the hospital. They'll be lining up for physio.

Hey phunphysio.

Thank you for your kind words. I'm actually a male. The paeds patients I had were quite difficult so I suppose I learnt quick.

Thanks

Oh i do apologise Mr Pudding Bowl!
How sexist of me to think only a female could be this clever and like pudding so much as to name themselves after it! Sorry!
Your advise was great, maybe Paeds is your forte?
Merry Xmas

Haha, brilliant reply! I like your style.
Pudding has been a nickname of mine for over 10 years and doesn't have anything to do with food.
And yes, After my small paeds rotation I decided that is my true passion, and once I come back from my holiday over xmas and New Year I will endeavor to enter the field. Any advice would be appreciated. I understand I have very little paeds experience so to go into it full time is a big step.