Motivation

Every physical therapist motivates his/her patients differently. For some, they need to be pushed aggressively. I, however, am not one of those people. Aggression does not motivate me. It doesn't help me, but makes me want to give up instead.

Today was the worst PT session ever. Up until today, all my therapists have been great. They are extremely knowledgeable and helpful. They are also very encouraging. They help me feel confident, while they challenge me. My main physical therapist is Jess, a PT student. She's here doing her clinical rotation. Because she is a student, she has to be overseen by one of the other physical therapists that work here full-time. My main physical therapist is Laura, but Laura is on vacation, so Jen is covering for her. I don't like Jen as much as I like the other physical therapists. She is knowledgeable like all the other therapists; however, she is also very abrasive. I've been working really hard. When I first came here, I was unable to stand up. I couldn't stand up at the parallel bars or even just with the walker. I essentially had to have someone hold me up or support me at all times. Then we started using the standing frame and I was gradually able to stand for longer periods of time. As my legs got stronger, I was able to stand using the walker for short periods of time; however, I was still unable to walk at all. So they put me in the LiteGait. The LiteGait is a machine that is similar to the standing frame in that it supports you while you do the work of walking. It helps you build up the muscles needed for walking unassisted, but provides support through this process so that you don't fall. To use the LiteGait, you must first get into this harness. It kind of reminds me of the canvas slings they use when a whale becomes beached so they can throw it back into the ocean. They had me lay on the table so that they could strap me into this contraption. When you are all fastened in, it is like the harness for para sailing. They then use the controller to bring you to a standing position. You hold onto handles in front of you for balance. As the machine moves forward, you are forced to walk, step-by-step. The nice thing is that with the harness, it is impossible to fall. They can change the amount of help the machine gives. It can hold you up nearly completely, the machine doing all the work, or they can decrease it so that essentially you are doing all the supporting and walking, holding your own body up. This prepares you for being able to walk with the walker.

Well, I was making progress. I didn't really need the standing frame anymore. We had tried the LiteGait a few times, and now they wanted me to try walking a few steps. I was extremely nervous. When you first practice walking with the walker, the have one therapist with you, with one hand on the gait belt. The gait belt is a thick belt that you wear so that if you begin to fall, they can support you. Another therapist follows with a wheelchair behind you so that if you do begin to fall, become unsteady, or get really tired, the wheelchair is right behind you.

When I first began to walk, I was very unsteady, but I was determined to do well. One of the things that I noticed was that my foot/leg was doing something weird. It kept shaking back and forth, almost as if I was continuously rolling my ankle. It would roll to the side and I'd work to straighten it. Then it would do the same thing. It was so frustrating. I couldn't seem to get it to work properly. My brain kept telling it what to do, but the muscles wouldn't respond normally. It took extra effort to make it work and control this weird movement. Walking, just by itself, takes up a lot of energy and this made it more so. I was so unbelievably frustrated at not being able to make it just walk normally. On top of that, this movement hurt. It was like having uncontrollable muscle spasms which can be extremely painful. To make things even worse, neither Jen nor Jess seemed to notice that my foot wasn't working properly.

I'd stand up with the walker, and almost immediately my foot would start the twitching. I'd go several feet and then be so exhausted and in so much pain and needing to sit, Jen would say, "No! You can't sit." It was very derogatory and said in a tone that suggested that I wasn't trying and just faking weakness because I didn't want to work or just making excuses. Now I'm a perfectionist, I work hard at everything I do. I always give at least 100% most times 110%. I never take the easy way out, and always push myself to the end. The next time I walked was similar. I walked, trying to work through the spasming and the pain. When I couldn't go any further, Jen was like, "Come on Melissa, you can do it. NO, don't sit. Oh Melissa...." Just that was hard enough, but then she said, "next time, I should leave the chair behind so you can't stop." All of this badgering was taking a toll on me. I was working so hard and from the way she made it seem as if I wasn't trying at all. I was trying to work through the pain and frustration of my foot not cooperating. As we stated the next trial, the pain started to get to me. Jen continued to badger me, and I was unable to go very far, only a couple feet As she continued to tell me that I could do more and that I wasn't really working, that I needed to just trust myself, I began to cry. I didn't want anyone to see me cry. I felt so ashamed. I WAS trying even if she didn't think so. As I stood for one more time, I couldn't get my foot to behave at all. I hurt, I was tired, I was in pain, I was frustrated, and I was crying. As she pushed me saying that she wouldn't let me sit until I'd reached a certain point and that I wasn't trying, that I could do better than this, I started really crying. Each step I took hurt immensely. I was at this point sobbing. I couldn't catch my breath because I was walking, and I was crying. The physical pain, however, was nothing compared to the emotional pain. I wanted to just give up right then and there. Sit down and say, you're right. I can't do this, I'm not going to do this; I give up. Finally Jess seeing just how upset I was got me to sit. When she brought me back to my room, she told me how proud she was at how hard I had worked and how much progress I'd made.

I understand that each therapist has different ways to motivate their patients. For Jen, that is badgering them. The idea is that by saying they aren't tying and they can do more will make them want to prove they are trying and cause them to push harder and do more. I don't work that way. For me, it caused me to shut down completely. I want to sit down and say "you don't think I'm trying. Fine, I won't." The emotional pain not feeling like you are trying your best but that it isn't understood or appreciated can be the worst and just makes you want to give up.

It is interesting to see how different therapists motivate. Jess motivates through encouraging me, and this works better for me. She will say, "come on, you can do it. Just a little bit further. You're almost there. Keep going." She would then say how great I did. We'd make goals and then see if I could surpass them. While practicing standing, she'd distract me so my focus was on something else. I did better with this when I'd be standing, we'd set a goal of how many minutes I could stand for. She'd have the timer, but it would be pointed so that I couldn't see it. she would then talk to me about redecorating the gym area. When I started to get tired, I'd ask if I was at the goal yet so I could sit. She'd say "almost. Just a little bit more." So I'd stand longer, figuring if I was close and it was only a little bit more, I could stick it out. Again, I'd ask, "Am I there yet?" and get the same response. "Almost. Just a little bit more" Finally I'd be too tired and have to sit down. When she'd tell me how long I'd stood for, it was well over our goal. She was sneaky in this way, but it worked.

I left so upset after that incident with Jen that I almost didn't want to do PT the next day. I wanted to refuse and not put myself through that again. It must have been discussed because though Jen still oversaw Jess and her work with me, she wasn't an active participant. She was in the room, but working on something else across the room, and for this I was grateful. In reality she had no right to be that way. Motivating patients that way may help some, but I am definitely not one of those people. I do better with encouragement. To do things in that way makes me feel like a failure then I do give up and quit. She didn't know how hard I was working. n truth, only I could know that. I was trying. I was giving 110%. I was pushing through pain to work harder and do better. I wanted people to be proud of me, and the work I was doing.