Reflection on a case with Mental Health Considerations

October 16, 2020

Since June, 2019 the team at Total Health Physio has been helping an NDIS participant who is dealing with significant physical and mental health challenges.

She currently lives in government housing and has daily in-home support from a carer. Through Physiotherapy, our role has been to support her in making positive lifestyle changes to contribute towards a safer, healthier and meaningful life.

In addition to having suffered a stroke at age 30, the client’s medical history includes:

  • Borderline personality disorder
  • Dissociative disorder
  • Scoliosis
  • Post-traumatic stress disorder
  • Alcohol-related brain damage

Total Health Physio is here to treat the community with love. No matter our client’s age, background, religion or current circumstances, we will always devote our trust, compassion and care to the fullest.

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Initial assessment

An initial assessment was undertaken to establish the client’s current capacity and gain an understanding of the pain she was experiencing.

This assessment was particularly important because the client had an NDIS Plan Review coming up. This meant there was an opportunity to review supports and ideally, help her obtain appropriate funding.

Her initial assessment included:

  • A sit to stand assessment
  • A pain scale assessment
  • Range of motion assessments
  • Discovery of existing pain management strategies (including medications)
  • Goal-setting for both long term and short term Physiotherapy goals.

The initial assessment revealed that the client was experiencing significant and debilitating pain that required her to take daily medications (such as Endone). She was often unable to get out of bed in the morning without waiting up to two hours for her pain to subside.

Short term goals

Within her overarching goal of living a healthier, more meaningful life, the client identified six additional short-term Physiotherapy-related goals.

  • Reduce back pain
  • Reduce bilateral knee pain
  • Reduce neck pain
  • Improve range of motion and upper body strength
  • Reduce excess weight
  • Increase standing and walking endurance

Reducing pain was a critical factor in improving her independence. When we started working together, the pain was a barrier to physical tasks such as housework or getting in and out of the car (which then impacts her ability to access the community).

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In our discussion, the client also identified a longer-term goal to launch her own florist business. She had already undertaken floristry training, but her health was impeding her ability to start the business. This was a meaningful goal that could contribute significantly to her financial independence.

At Total Health Physio, we support people holistically, through physical rehabilitation, we know this can help with people’s financial, emotional, spiritual and mental wellbeing, we’re here to deliver on that philosophy.

The importance of a support network

The client’s care is delivered by a team of experts. From Total Health Physio she receives Physiotherapy, Occupational Therapy & Exercise Physiology.

Her regular care also includes a Psychiatrist (and psychiatry hospital for admittance as needed), a support worker and her GP.

The client’s NDIS Support Coordinator also plays a central role in her care. Her Support Coordinator has a nursing degree as well as a background in mental health, meaning she is very well matched to this client’s needs. The role of the support coordinator is often critical to a participant’s experience as they can alleviate stress by managing the administration and payment components of dealing with multiple health carers, and ensure that the client is aware of and has access to the full range of services they need.

Total Health Physio recommends that many NDIS participants would benefit from having the right NDIS Support Coordinator. They are wonderful assets in our community.

Considerations

This client experiences significant fluctuations in her emotional state.

When working with her at home, our Physiotherapy sessions need to accommodate changes in her motivation and capacity for exercise.

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At each appointment, we listen to her and cater the session to her current mood and needs. Some days this may mean adjusting the planned program. We can do this in several ways, such as:

  • Providing manual therapy to release muscle tension rather than her usual exercise regime
  • Moderating the intensity of the strength exercises
  • Shortening the session to half an hour
  • Lowering the intensity of, or removing, the cardio workout component

While our primary goal is to reduce knee, back and neck pain, our role is also to educate the client on the benefits of regular exercise. Exercise has a role to play in mental health too, as it releases endorphins which assist with improving mood and mental state.

We do our best to help people in the long term. If we can develop a person’s love for exercise and movement, we can help them live their best lives.

Recommendations and interventions

Having established her baseline capability and goals, our Physiotherapist and Occupational Therapist made several significant recommendations.

It’s important for our clients to agree on proposed interventions before starting, as this is an aspect of patient-directed care.

These included:

  • Weekly Physiotherapy sessions while offering support and motivation
  • Home modifications including a bath hoist
  • Assistive equipment including a mobility scooter to facilitate engagement with the community

At Total Health Physio, we don’t just deliver the services. Each client is an individual, one we treat with Trust, Compassion & Care which is always needed when helping someone improve their mental health.

Outcomes and client feedback

Based on Total Health Physio’s recommendations, the client’s NDIS Plan Review resulted in a considerable increase in supports, which was a great outcome.

The client now has a significant budget for Physiotherapy, Occupational Therapy and Exercise Physiology. We know that the client has been very happy with the services that Total Health Physio has been providing.

It is always rewarding to play a role in helping someone to live a more meaningful life.

This client has faced extraordinary struggles in her life, and if we can contribute to improving her physical health in a way that flows onto positively impact her mental health, then that is something that is incredibly meaningful to us.

Please contact us if you know someone that may benefit from our services.