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Physiotherapy in Palliative Care
By India Gooderham

Working as a Physiotherapist in the UK I have cared for many patients at the end of their lives who were suffering from varying diseases including; end-stage chronic lung disease, various cancers, degenerative and acute neurological disease and patients with acute infections or following trauma in intensive care.

I worked for the NHS who offered Physiotherapy services in out–patient, in-patient and community settings.
My most recent work was with neurology patients in the community. Most of the patients suffered from neurological conditions such as Multiple Sclerosis, Stroke, Motor neurone disease and also patients with cancerous brain tumours. Due to my interest in palliative care I would see most of the palliative patients with brain tumours. The main reason I would be referred to see these patients would be due to deterioration in their mobility. Early Physiotherapy intervention and the ability to predict the likely progression of the patient’s illness and disability were of paramount importance, as although the NHS is an amazing service the provision of equipment and services is not always timely. It also means that the patient and the family are well-informed and prepared for the future. I found that treating patients in their own homes was more insightful and rewarding than hospital-based services, as the patient was often much more comfortable and relaxed and I could really offer advice that was appropriate and helpful in coping with the home environment in terms of the physical layout, working with other members of the family and assessing for other psychosocial factors.

Before I left my job to come to India I treated a gentleman with a brain tumour for about 6 weeks before he died. He lived with his wife who was caring for him full-time with some respite care from the local hospice team. His condition was very variable; on “good” days he was very mobile, alert and orientated and on “bad” days he was bed-bound and extremely confused. My main aim was to provide him and his wife with equipment and education so that they could cope with this variability. He was a very sweet man and when he was feeling good we would sit and have long conversations. He would tell me about his life and particularly about his passion for foreign food and his wish to travel to India. On “good” days he would enjoy doing some gentle chair-based exercises as he said it helped to “loosen” the stiffness in his muscles and joints, he also enjoyed classical music.
On “bad” days he lacked insight into his condition and his disability. He would suffer from severe left-sided weakness and left-sided neglect and he would attempt to walk but this was very unsafe. I taught him and his wife to use a wheel-chair, and also a walking frame for when the weakness was milder. I advised his wife of simple ways to communicate to help with his confused state.

In the early stages I re-arranged the furniture in the house to allow for more space to safely mobilise and taught his wife safe manual handling techniques to reduce risk of injury to both of them. In the later stages, when he became bed-bound I arranged for an electric hospital bed with a pressure-relieving mattress to be delivered so that he could be nursed in bed without the risk of pressure sores.
A very important part of my visits was supporting his wife, as she became very distressed with his confusion and lack of insight. I sat and listened to her and did my best to support her through this difficult time. I taught her how to give him foot and hand massage to help calm him when he became anxious and agitated.

We may be “physical” therapists but we are definitely moving towards a much more holistic approach to patient care. We are now assessing and treating patients according to their biological, social and psychological needs (biopsychosocial model). An understanding of the role and expertise of other members of our multi-disciplinary team (including doctors, nurses, dieticians, speech and language therapists, social workers, psychologists etc) is fundamental so that patients can receive optimal care from the appropriate specialists within the team.

In working with death and dying in the west I have became acutely aware of how taboo and dark this subject was. Death is not a topic that people generally liked to talk or even think about. How can one be prepared for death if we ignore it all our lives? I came to India to work for Ganga Prem Hospice to experience and immerse myself in a culture where death is accepted as a transition rather than an end. According to Vedic insights, birth and death are cyclical in nature. India has a culture that is deeply rooted in spirituality, with a strong connection to the soul rather than the body, a culture where the dress code at the funeral is white.

I feel privileged to have been welcomed to be part of such an inspirational charity. I hope that I can be of service and work together with other members of the team to achieve their honourable vision.

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