Physio sessions - duration

Life after stroke
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Greetings!

This might be a “How long is a piece of sthring” question, but I must ask it as I do require some pointers.

I am looking to get some private physio for my Mum as the NHS / her care plan does not thing it is appropriate or necessary. This is primarily down to her age (very senior citizen in her mid- 90s) and also the fact she has been “immobile” and not weight bearing since she had the stroke.

We are hoping that we can find out of there is any potential for her to become more mobile with help from a trained and “sympathetic” physiotherapist.

To that end, I have sourced a local physio who does home visits (an essential) and who has a neuro understanding and who can be “trusted” i.e. belongs to a recognised professional body. The physio is a member of the chartered institute of physiotherapists and he has worked as team lead in the very hospital Mum was cared for though her was not one of the physios we came across at the time.

My question is how long should the physio sessions be to be beneficial for Mum?
He is suggesting 1 hour sessions and 3 x a week.

To me that might be way too much for Mum and she should be ramped up, but he says they only do 1 hour sessions as anything less would not be beneficial.

Does you have a view on this, or have you any experience that you can share?

Being private, this does not come cheap and I don’t want to waste money and more importantly I don’t Mum to to be adversely affected by too much too soon.

We had an assessment session last week and he suggested some muscle relaxant but he said the GP would need to prescribe this.

Your comments/feedback most welcome.

Thank you in advance.

Namaste|
:pray:

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You will probably find your mother is very tired if she keeps going for an hour. She may refuse to cooperate. If there is extra time ask the physio to show you some exercises you can do with your mother. She will improve faster if she can exercise every day.

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3 x 1 hour sessions a week for maybe a month, is about the norm for physios for the initial treatment to keep on top of any progress made. Then it might taper down to once a week and eventually leading to maybe a once a month maintenance check, which is optional or until you yourself feel you don’t need anymore. If he’s genuinely certified then he won’t run the risk of ruining his credibility by fleecing you. But they are expensive, so are osteopaths too, if you haven’t got the money :frowning:

What he’s not going to do is flog a dead horse, so’s to speak. Again, he’s not going to risk his reputation and certifications! This is his livelihood, his bread and butter. So he will not want to do anything that might put mum’s health or life at risk. And the fact that he suggested muscle relaxant but defers to mums GP is a nice little touch. So do speak with mum’s doctor to make them aware of what happening :wink:

I’m a little confused by this sentence because it sounds as though you are saying mum should have more or longer sessions rather and less. Because “ramped up” usually means increased not decreased

Lorraine

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Your mum may find that very tiring initially but I think hour sessions are about normal. My NHS physio was initially an hr. I agree with @EmeraldEyes in relation to his reputation etc. You could always ask a different physio for their view too & see if it is similar that way you would know for sure that what he is advising is correct.

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Thank you @Janetb , @EmeraldEyes and @Mrs5K for your feedback.

Sorry about the confusing phrasing of the ramping up.

I was, perhaps rather ignorantly thinking that with Mum effectively having been immobile for the best part of six years, with most of her time lying in bed or sitting on her bottom and with significant muscle wastage, a 1 hour session might be too much to start with and with only one rest day in between. I was thinking of myself, when I used to start physical activity after a long lay off whereby I build up (hence ramp up) or a person training for a marathon might start with shorter distances and build up.

No matter, I think you have put my mind at ease and I have met the guy and he seems genuine enough. It’s just that when you have been {perceptively] let down so many times, and thinking the way I do, I can become a little doubting Thomas or cynic.

Also, I always come back to why they always say, “She is too old for this or that” and so if she is too old should we not start slowly and build up? Maybe I am jumping the gun here and they will start slowing but take an hour to do it.

No matter, we shall see. Monday is the first session and by Friday we will have a better understanding of where this may go.

In the back of my mind, I am worried as Janet says, she will put her foot down (as she has been known to do and which I now understand is likely to do with brain fatigue - so much to be thankful for for this forum and people like you :slight_smile: )and refuse to cooperate :slight_smile:

Watch this space for an update :slight_smile:

:pray:

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My question is, what is to be gained from this physio, for mum, for you or for the family?
What are you hoping will be gained? Apart from say, improving her circulation.
Mum is mid 90’s, has virtually no muscle, tissue thin skin and certainly no leg strength to speak of to learn to stand let alone walk. She is not going to want to be pushed and pulled about a lot. Mum will have to be handled with a great deal of care, the body, including the organs system, get frailer with age, limiting the body’s ability to respond to stress both physical and emotional.

I wouldn’t at all be surprised if mum refuses, I know my mum would have at that age, I know I will too…if I ever reach that age :sweat_smile:
So if she refuses, don’t push her on it, her mind and body know what they really don’t need/can’t cope with and she will soon let you know I’m sure. She is after all in her “Twilight time of life” whether you choose to accept that or not. So let physio do a session or two if mum will let him, then reassess.

Lorraine

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Hello Lorraine - Thank you for your thoughts and insight which is always much appreciated. I shall try to address your questions/concerns as best as I can. Here goes …

It is our intention to give the best quality of life she can get whilst remaining comfortable. According to the experts, she is in palliative care and that may well be the case, though that is not how we see it.

She has never objected to anything we have tried to do for that might take her out of her comfort zone except when she has been fatigued. This is something I concluded recently following chats on this forum about fatigue. Mum has on occasions refused to cooperate and we have respected it without knowing it was down to fatigue. I can say this with relative confidence since on other occasions she has happily cooperated in the same activity.

Despite her chronological age, her biological age is much younger. Her obs are normal to good e.g. blood sugars, BP, oxygen level, heart rate etc.

She sits comfortably in the RR chair for the best part of the day except when she is bothered by gas build up.

Her circulation is being helped by use of Revitive Medic which she happily tolerates for up to 30 minutes and again, when she shows signs of discomfort for whatever reason we stop the use of Revitive Medic.

Our approach has always been to do things as she would do herself if she could and for us her cooperation suggests she is happy with this. We know when she is not happy because she shouts the house down and we know when she wants something i.e. help she will call out and continue to call out until she gets the help she requires.

Put simply, we do not want to allow her to “vegetate” and if she can improve in any way with any help that is what we do. It’s such a shame it has taken us this long to get the [private] physio of the calibre we think she needs. The NHS / CHC has robbed her of many things including the physio - and I accept she is not alone in this, but she certainly has not had her “fair” share.

It might come across to some that we are the equivalent of “pushy parents” but we don’t believe this is the case. Just on that, it is not just me who makes executive decisions on Mum’s behalf though I am her Court of Protection appointed Deputy. I always consult with her, though of course I cannot categorically state she understands all that is put to her, and also with both my sisters. Also, Mum is under the watchful eye of the GP and the care agency and in case of signs of any safeguarding concerns the social services will jump straight in.

We and Mum have never accepted the “stereotypes” associated with age and despite all that has happened she is still incredibly mentally and physically strong. We will never give up because she will never give up.

In the event the physio concludes she is beyond help (which might well be the case as he will be “constrained/directed” by guidelines from the healthcare bodies) we shall have to respect that and do as best as we can which of course will make it harder as we do not have the training and equipment or indeed the time due to all other things that need doing.

70 was the new 40 for her, then it was
80 that was the new 40 for her and then by the act of [insert as per your beliefs]
89 was the new beginning for her or we might say 90 is her new 40.

Crazy? Maybe be, but to coin a phrase “We are not one out of the bottle!”

Namaste|
:pray:

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Do you know what mum’s most optimal time of day is?
For instance, about 12 to 7pm is my optimal time of day for my stroke side; that’s when it gives its best performance. Outside of those times, my fingers tense up a little and my foot drops when over tired. My brain is sluggish to wake up so prefers dealing with one task at a time and the same goes for the evening too. But then, everything is wide awake and raring to go at midnight again…go figure :sweat_smile: It’s no wonder I can never get to sleep much before 4am :smirking_face:

Lorraine

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Hey Lorraine - we find Mum’s optimum time for this type of activity is mid-late afternoon until about 9pm. There are other times, but find around 5pm is “peak performance” and so we asked for the physio to start at 5pm.

They very kindly agreed though they normally finish at 5:30pm.

:pray:

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And that was what I was getting at, then completely forgot to suggest it :laughing:
I blame it on being tired because we’ve been stripping wallpaper and tiles in the kitchen today, it’s having a complete renovation :grimacing:

Lorraine

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Hope the session today went well & you got what you expected from it.

@EmeraldEyes happy new kitchen.

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Physio starts at 5pm and we have reviewed our plan and revised expectations but only the timings have changed i.e short, medium and long term goals.

Three siblings had chat over weekend to see if there is a common consensus as to what might be best for Mum and what Mum would want if she was able to act on her own behalf.

There is no rush - it has taken us six years to get here and so another six or whatever it takes is what’s on the plan. Mum works to her own schedule, always has and always will.

@EmeraldEyes Lorraine - I don’t envy you stripping down wallpaper and tiles, though I believe it is meant to be therapeutic :slight_smile:

Not sure if I may have mentioned it, but one theory as to why Mum had the stroke is she got stressed out during the home improvements that took place in the year preceding her stroke. We started planning for her longer term needs by extending the house to get a new kitchen and walk-in washroom and convert living room into a bedroom for when she needed it. She was not happy!! She thought it was a waste of money as she was happily climbing the stairs to use the upstairs bathroom and her bedroom. It did not help the builders turned out to be “cowboys”.

Anyway what happened happened, we need to focus on what’s ahead.

Have a lovely evening.
:pray:

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I don’t know about being therapeutic in this heat, the sweat has been pouring off me all day :sweat_smile: Standing on counters, hunched over upper cabinets trying to scrape off wallpaper that must have been stuck on with Gorilla glue or No More Nails or something :face_with_raised_eyebrow: Anyway, it’s done now and ready for the demolition man to knock a wall down and then starts the plastering.

So, how did it go for your mum today? You’re not all in the dog house now are you :sweat_smile:

The home improvements could have stressed her out, when you get to a certain age, you don’t care for too much change, it can be disruptive. Life is short in old age, you don’t want time wasted by having it turned upside down for any length of time.
To simplify that statement, every time I washed my hands today I wasted time hunting for the kitchen towel, which is no longer in the home where it used to always hang and instinctively I’ll go there first. Old habits die hard :wink:

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Lorraine

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@Mrs5K and @EmeraldEyes - An update on the first physio session.

I am delighted to report that it was everything we could have hoped for and possibly more if that is possible.

We had concerns with it being a hot day that Mum may not be up for it. In the past when we did this sort of thing and which may have lasted anything from 5 - 15 minutes, we always said that Mum had just done the equivalent of running a marathon which she probably did.

She had been allowed to rest during the so she was ready for the session which took place at 5pm. We have found Mum is most alert and receptive between 3 pm and 9 pm and so for third parties such as physios we try to get them booked in a very narrow window between 3 and 5.

The physio arrived and we prepared Mum and re-introduced her to the Physio. Then it was over to the physio and Mum. The session started with warm-up stretches etc. and Mum was responding to the instructions and participating in the session and gave out the occasional “ouch” to indicate that hurts. Again, no pain no gain mantra was repeated though in this session it was never the intention to push her through the pain barrier.

Anyway, the physio worked her way through the plan, working both paralysed and non-paralysed limbs. I left the session to try and give Mum less of a distraction and so my sister stayed with the physio to observe, learn and to advocate as needed though Mum didn’t seem to have problems communicating with the physio.

The physio was a nice young lady, relaxed manner, spoke Mum’s mother tongue as well as English and so all bases were covered.

Post session, we had a chat and the physio was very pleased and surprised how well Mum responded and how fit/strong/flexible she was all things considered. That was music to our ears when the physio said that.

Mum showed no signs of fatigue or unwilling to participate and the hour went by so quick.
Her cheeks were glowing and she was happy.

Bonus:
We have been giving her water by mouth for over a month now in our attempt to “normalise” her as much as we can.
With the physio over, boy was she ready for that drink :slight_smile: :partying_face:
She enjoyed that drink so much!
She sat there, cool as a cucumber as she slurped her way through the drink.
What a Trooper she is :slight_smile:

So for us that just about the most satisfactory outcome we could have wished for.

We kept an eye on her for the rest of the evening and throughout the night and absolutely no signs of distress or aches and pains or anything.
Today she has been resting and is super relaxed and still no signs of aches and pains.

I think we’ll have more of the same if you don’t mind.

Thank you both for your support and encouragement.

Namaste|
:pray:

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Just wanted to say how great it is to read this @ManjiB. I’m really pleased the physio has gone so well for your mum :slight_smile:

Anna

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Thanks Anna - I appreciate that.

I/We are truly grateful (Anna and Lorraine will know) for the Stroke Association and this forum. In the early days of caring for Mum we were always underwater and struggling to breathe. Then one day out of the blue or so it seems - to this day I don’t know how the contact was made, but a lady from the Stroke Association visited us at home.

She came with a huge package of information including communication aids etc. and she sat with us and went through everything you could possible wish to know. I think there was some link with the hospital stroke ward or at least she knew Mum’s stroke consultant and this potentially gave us a hotline to the consultant. Anyway, she left us with all this and said we would receive this support for 6 months or a year (I forget as it was so long ago) and we could contact her anytime. I think she then handed over to another colleague who used to follow up once a month or so.

They were both incredibly supportive and helped us get through some very difficult times in the first year post stroke.

For a long time we just carried on and then I signed up for the Forum but was a casual user coming in once in a while to see if I can get any help on specifics. And then late last year, I became a more frequent visitor and now I can’t seem to keep away even though it is actually bad for me to spend as much time on here as I do.

Finally, thanks for not black balling me following a few comments from newbies who didn’t quite appreciate my weird sense of humour or style of communication or simply “poking my nose in where it don’t belong”. It’s nice I am at least on the same wavelength or plane as most of the members here.

Thank you all once again.

ManjiB.

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It’s great to hear you had some good support, those early days after a stroke can be extremely difficult to navigate without the right support and I’m pleased you’re getting a lot out of the Online Community too :slight_smile:

Anna

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That sounds like a very successful session. So pleased it went so well & that your mum seemed to lap it up. Beware of fatigue hitting in the next couple of days as it sometimes takes a while to impact. But definitely sounds like all went really well and that your mum is up for more sessions.

And i bet she did enjoy that drink of water afterwards.

So pleased for you all.

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I too had the support of someone from the Stroke Association after my stroke. The hospital referred me although I didn’t know i had been referred at the time. They were great and helped me loads with questiona I had, providing info & being a conduit between me & the consultant. Took the pressure off me a bit at a time when I needed no more pressure. They also pointed me in the direction of this forum for which I am very grateful. I still get so muxh out of it but like you probably spend too much time here :grin:

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Hey Ann - As the day draws to a close I can confirm Mum has shown no signs of ill effects from her physio session yesterday. Despite the heat, she has managed to stay cool and relaxed all day. We will be freshening her up and tucking her in for the night and then it’s day two tomorrow!