Vol. 24 Issue 20 Page 11
Movers & Shakers
Goals, Pain and Meaningful Activities
My back has issues. Some days it is more vocal than others. On rare occasions it has gotten so bent out of shape that I cannot stand erect and have to crawl. More typically it is a nuisance, lengthening the time required for ADL or requiring creative solutions.
Putting on socks or pants often requires an altered technique. Some days the pain is prohibitive; other days it just isn’t worth the effort.
Recently I decided to push through the pain and see how far I could get. At some point in the process I realized my primary focus had shifted from “pushing past the pain” to “accomplishing the task.” The pain’s intensity hadn’t decreased, but when I wasn’t focusing on the pain, it was less noticeable. This type of mind shift is subtle, but can help your clients reap big dividends.
Let’s take this concept into the clinic. Is the shoulder arc an activity of choice when working to improve a client’s upper extremity range of motion? What relevance does it have to a client’s everyday life? When the client reaches an uncomfortable position, he will think of the pain. You may say, “Freddie, reach just a bit further and you can make it to the other side.” Freddie will comply, but he’s likely thinking, “This hurts, I have to push past the pain.” The shoulder arc has no meaning to him aside from accomplishing a task his therapist has designed to improve function. In this example, Freddie’s focus is pushing past the pain.
Using activities that have functional relevance to the client help to shift his focus. Let’s say Freddie is an avid solitaire player. Place tape outlines for his cards in positions that achieve the desired range of motion. Use a bedside table to adjust it to the desired height. As Freddie reaches, stretching his shoulder, he will be focused on placing the cards on the desired stacks.
The end result still will be increased range of motion, but Freddie’s focus will be on accomplishing a desired task: winning solitaire. The result of achieving his new goal will be to meet your original goal (increase range of motion) but the pain will be less noticeable.
Do you design goals that cause your client to focus on completing meaningful functional activities? Or do you establish clinical goals that cause your client to focus on pushing past the pain?
It is possible to have a functional activity as a goal but still focus the patient on her pain. Consider a client who is in rehabilitation for adhesions and RSD, S/P shoulder replacement. Your stated goal is: “Will don shirt independently without an assistive device.” Indeed, that is an excellent functional goal. Now evaluate how you encourage your client. When she grimaces during the course of treatment, are your comments directed at completion of the functional activity or at pushing past the pain?
Our goal as therapists should be to achieve functional goals using activities that are meaningful to the client. The client’s focus should always be on completing a meaningful activity, never on pushing past the pain. Carefully chosen -encouragement can inhibit pain’s effect on performance, enhance a client’s motivation and promote independence. n
Jane Goude is a freelance writer in Lexington, SC, with 12 years of rehab and management experience. Column consultant Mitzie Derrick, OTR/L, is manager of occupational therapy and speech-language pathology at Spartanburg Regional Medical Center in Spartanburg, SC. You can reach them at firstname.lastname@example.org.