Walking on the ward

Go through the slides to see each of the team members and view their discussion.

Slide 1

Introduction: Go through the slides to see each of the team members and view their discussion.

Slide 2

Alan’s key worker: Alan is keen to walk on the ward. He feels that he is more than capable, knows what he must do and that in order to progress he must practice more out with therapy. He feels that if he had a stick he could be more independent. He accepts there are potential risks both with walking on the ward and with the use of a walking aid but he is prepared to accept them. He finds sitting on the ward all day depressing and frustrating. Saying no may be detrimental to Alan’s mood, motivation and morale.

Slide 3

Nurse: The nurses in the ward are specialist stroke nurses and are capable and keen to facilitate Alan’s rehabilitation. Once shown staff would be able to provide additional therapy sessions in the ward. Self practice with staff other than therapists could also increase his confidence and ability to self manage his condition.

Slides 4 and 5

Therapist: Alan is walking in the gym with the guidance of a therapist, this is to prevent unwanted patterns of movement and ensure the optimum outcome from his rehabilitation. I feel that he is not ready to walk with supervision on the ward yet. A walking aid could be provided to facilitate his wish to walk on the ward but he would need supervision. I am concerned that the addition of an aid may be detrimental to his overall long term outcome by encouraging unwanted patterns of movement and compensations. Alan is also at risk of falling in the ward and this could have a negative impact on him.

Slide 6

Doctor: If we decide Alan is safe enough to walk on the ward with a stick and supervision then allowing him to do so may reduce his risk of secondary complications (DVT; contractures etc). We have to consider that he may decide to do it anyway and perhaps it is better to work with him so we can control the possible risks involved. As a team what is our decision should Alan walk on the ward?

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Q. Should Alan walk on the ward? What do you think the team should say? Yes or No.

Yes – For this to succeed the staff in the ward and Alan require to be provided with clear guidance and training. In order to walk on the ward at this stage he requires to be provided with a walking aid. Consideration should be given to continued use as this could be detrimental to his overall outcome. There has to be a clear method identified for monitoring his progress so that any negative issues or problems can be reported and addressed as soon as possible. By allowing Alan to walk on the ward he has to practice walking in a new environment, doing functionally relevant tasks and this could improve not only his walking but his motor recovery, balance and functional ability. There is a risk of falling but this risk can be managed on the ward by good team communication and training of and close supervision from staff during practice. Alan, following stroke, may be at a higher risk of falling this can be successfully managed but not completely removed. Alan may, however, get overconfident and start taking unnecessary risks.

No – Alan is an active partner in the rehabilitation process and has the right to make an informed choice about his treatment. By saying no you may have a detrimental affect on Alan’s mood and motivation. These psychological factors may have a negative impact on his overall outcome. If Alan is not to walk on the ward, at this stage, then this needs to be clearly explained to him and a time frame of when he will be walking on the ward identified. By waiting till his walking has improved you may reduce the risk of falls and the potential for Alan to sustain significant injury. Conversely Alan may get very frustrated and decide to walk without the appropriate supervision and assistance and be at more risk of falls. Although not evidence based by controlling his walking and preventing unwanted patterns of movement and compensatory strategies Alan may have a better long term outcome and develop less secondary complications (joint problems etc).

There is no right or wrong answer in this situation. Research would indicate that the length of therapy sessions are very short and that increased amount of practice of functionally relevant tasks, such as walking to the toilet, may improve Alan’s walking and his overall functional ability. After careful consideration the team has agreed that Alan can walk on the ward.