Building Engagement in Physiotherapy – a practical example

I talk a lot about getting creative with exercise and some of the time it takes the form of adapting use of equipment or supporting understanding of it’s use. Then there are days when it’s about making stuff up on the spot to build engagement.

Yesterday was one such day…

A young lady with a Moderate Learning Disability (LD) is in the gym, she has poor balance, lower limb weakness and low bone density. She is a really fun character to work with but is easily distracted and she rarely engages with things for more than a few seconds. She responds really well to banter around who is cheekier, her or me.

I open by passing comment on her rather smashing pink, sparkly, FLASHING trainers that she got for Christmas. I add that I’m amazed she managed to get presents despite being on the naughty list.  This gets the response of a smile and tongue out. I ask if she would give them to me and, as she removes one to show me they are rechargeable (I know!!!) I pinch one and say I’m keeping it as it will fit me (it’s a size 5, I’m a size 12). After some back and forth we agree that if I hold the shoe out in the air and she can put her foot in it and put it in on without using her hands (they are slip ons) she can have it back. She is on her back on the plinth and I’m holding it around 5 inches in the air.

She lifts up her leg and manages to get her foot back into the shoe. I make a huge show of my disappointment at not being able to keep it. At this point she is removing her other shoe to repeat the process as she thought it was hilarious…and now we have some who is performing straight leg raises and loving it! I can move the shoes higher, lower, out to the side and each time she is working really hard to get to it whilst simultaneously removing her other shoe to go again.

After several minutes of this we move on to another exercise but already have someone who is engaged in the session and engaged with movement and exercise. Needless to say she smashes the session.

This is a small real world example of how you build engagement with an individual.

  • Will it work with everyone with a Learning Disability? Definitely not.
  • Will it work again with the same person next session? Perhaps it will, but it might not.

LD physio colleagues have to think on their feet & be this creative with EVERY person they see in order to get the best from the individual. It’s not always glamorous, it doesn’t always work, but building engagement is a staple of our area of work.

I am seeing more and more about adapting your communication style to suit the individual in wider practice. There is so much that physio staff could be learn from looking at how LD physios undertake a metamorphosis for each and every person they see.

For us:

  • This IS every day
  • This IS NOT an extraordinary example
  • This is how we work and fight for the best for each and every person we work with

and that was just to get a straight leg raise.