I am having fortnightly visits from an NHS physio since my discharge in October. She is pleasant and efficient, knows the private physio I am seeing and is not at all phased by the arrangement. However, yesterday she said something that really rattled me. She asked what my “aims and objectives” were. This, to me, is corporate-speak. I am damaged from the stroke, it’s no use me having ‘aims and objectives’ because I am limited by how well my brain is going to heal, which is an unknown. It’s the sort of speech one gets from the ‘team’ scenario, and the hospital psychotherapist sessions, which I stopped agreeing to as I found them demoralising and belittling. It seems a pity that a very good physio, as she is, should think I or any of us has any control over what the outcome of our stroke will be. Might seem trivial to someone able-bodied, but we stroke victims need all the morale support we can get. Our recovery isn’t a choice.
@Dexster and anyone else who cares to read this.
Stroke compels one to deal with,
isolation, one can be isolated in a crowded room,
restriction, even though you have been given unlimited choices,
misunderstanding, where prejudice muddies the water,
difficulty, when something everyone knows or understands just isn’t so any more.
When everything is turned on its head yet no-one realises you are in this topsy-turvy world, then, you have big problems.
Until all of humanity has had a stroke things will probably remain this way but we have each other and can recognise all this.
We must share our experience of the world and find ways to move forward, to improve our lot, be better integrated and to more fully be ourselves.
These are only a few words, they don’t say it all, but they are the beginning of a conversation that might help us find that way forward.
keep on keepin on
I was also asked what my goals were. I think this is do they know what you are hoping to achieve & they can make a plan to help you get there.
They don’t have to be large goals but for me having something to aim for helped keep me motivated with my recovery & was a great thing to “celebrate” when it was achieved.
@Bobbi Thanks for the great inspiring words.
My day job is working on clinical audit software including the Sentinel Stroke National Audit Program, so I have a small amount of insight into why these words might have been used. The point of these clinical audits is to improve treatment, which leads to clinical guidelines that are used by clinicians when we are treated, rehabilitated, etc. The guidelines for stroke are here - I’ve linked to the rehabilitation section there, but anyone with an interest can get at the whole document from there.
If you skim through you’ll find corporate terminology like goals and objectives all over the place. It’s likely that the wording has carried from here, through training and into the physio’s daily vocabulary. It is very corporate and feels quite impersonal, but I can understand why it happens. The bit that seems to have been missed, though, is this:
People with stroke should be actively involved in their rehabilitation through:
having their feelings, wishes and expectations for recovery understood and acknowledged;
participating in the process of goal setting unless they choose not to, or are unable to because of the severity of their cognitive or linguistic impairments;
being given help to understand the process of goal setting, and to define and articulate their personal goals.
In short, if you don’t want to set goals, aims or objectives that is your prerogative, and there is no stigma attached. You always have a choice.
We all have aims and objectives in life and nowhere more in stroke recovery. But there are also stroke survivors who couldn’t care less and are quite happy to have everyone wait on hand foot for them. And then there those who have very specific targets they want to reach such as charity walks to raise awareness or whatever. Some people just want to recover enough mobility to be able to fend for themselves and not have to rely so much on family. And then there are those want to be able to get back to their work or any other job they can manage.
So what your physio asked is reasonable though maybe it could have been worded differently. But her objective for asking may determine how she forward with your physio. For instance there may be additional/different exercises she might be able to recommend to help you reach those goals. Just remember, she not a mind reader 
Aside from all that, what annoys you today may not tomorrow. You might even wonder why it annoyed. Speaking from my own experience, I put it down to brain fatigue. It’s my brain throwing a toddler tantrum because its over tired. I usually say nothing and have a quiet relaxing even. Come next day I wonder what that was all about 
Lorraine
I can see I didn’t get my meaning across properly, for which I apologise. My contention is that it is considered that I should be working towards the “goals, aims and objectives” so well expressed - thank you - by those of you good enough to reply. My point is that I have no control over my illness, so dumping the responsibility for my recovery on ‘goals and objectives’ that I have set for myself is disingenuous. All the goals and objectives in the world won’t help me get better - my recovery is in the lap of the gods, as my illness was. What I want is an irrelevance. What happens is not my choice, any more than what happened was. Therefore the implication that my recovery is in the power of ‘aims and objectives’ is as irrelevant as my eye colour. It should not decide my treatment, which ought to be geared towards building the best recovery my body can allow., I don’t see that setting ‘aims and objectives’ for my recovery is any more than stupid, as whatever I want or would like to be/have depends on my body and brain, and their ability to heal.
I am fascinated by this discussion and would like to explore more if participants will allow.
Unless I have misunderstood, words said by a physio has rattled Dexster. You are receiving PT from two PTs, one private and one from the NHS. Both are working in harmony and you were happy until the “words” were spoken. I would like to ask @Dexster one question.
How rattled would you be if it was the Private Physio had said the something?
So instead of the NHS physio, the private physio says
Are you still rattled?
My aim after stroke is to probably miss and my objective is to object to it.
There are teo categories of goals and objectives, short term and long term. I wonder if having some very simple short term goals like ‘listening to music I like x days a week’ or ‘getting some natural light every day eg sitting by window or whatever, might both satisfy their box- ticking, which I suspect this may be, and also give you something to look back on after a while after some time has elapsed. You could say its too soon and the wrong time of year to be thinking in terms of long term goals. I am sure both are true. You may want to set more goals at a future time if you feel you are improving your capability or developing or even modifying your plans for the future. They may be trying to help but it sounds as if their methods are a bit clumsy.
I don’t think you should let this bother you. They will be asking you what you would like to get out of the sessions. To a certain extent you do have to have aspirations. They are what keeps you exercising. Your recovery depends on you and the amount of time and effort you put in.
I wanted to walk normally again and be able to use my hand normally. The physio can then focus their efforts on helping you achieve this with the correct exercises. I partially managed to achieve my aims with exercise, so had some control.
I would much rather they say this than what one fairly senior physio said to me, “let’s face it, you’ll probably never get movement in that hand”! Thanks a bunch!
Keep going. Improvement is like wading uphill through custard most of the time, but keep going. You will get somewhere (even if it isn’t the somewhere you wanted) and set yourself small goals to work towards.
I would have been equally rattled if the private phyio had used those words because the implication is that I have control over my illness and recovery. And it should be clear that I don’t. Yes I can do the exercises - and I do - and I can hold the mindset - and I do - but I have no control over how the brain/body interface heals, so setting goals/targets/objectives is a waste of emotional energy - something we stroke victims don’t have much of so need to nurture. Yes it’s just words, but words are important. I don’t need to be set up for failure if I can’t reach a ‘target’.
My thanks to all of you who took the time and trouble to answer.
Thank you for your message. I think that it is great having good physiotherapy input and I have made progress from my stroke in August 2023 largely thanks to physiotherapy and I have really appreciated all the advice and exercises received from my local Community stroke team. My greatest aim throughout has been to be able to walk again and I have usually told my physios that this is my goal - that and if possible to take part in a 5 k Park Run. Your message struck a note in my mind because I have noticed that access to nhs physiotherapy seems to depend on them identifying goals and working towards them, so perhaps identifying goals and aims is more for their own purposes rather than yours. I strongly suspect that when working with a stroke survivor, nhs physios need a goal or aim to work towards, almost to justify their own continuance with your case. I guess, of course, resources are limited, so if they cannot justify a reason, plan or purpose to be working with you then they may be directed elsewhere by their own management. So perhaps asking for goals and aims may be more about their own performance management systems than what is the best for you. This is just a personal hunch based on my experience but I have experienced some brilliant and motivating NHS physios and I definitely see physiotherapy as the best help for mobility and spasticity problems. I absolutely agree that words matter and if they make us feel uncomfortable then we need to explain and ask for alternatives and also ask about what the impact of identifying goals where the outcome may be unclear.
THANK YOU that makes a LOT of sense.
Hi Carol - Thank you so much for the well thought out response to help clarify this.
Excellent - thank you.
