Use of reflective analysis to achieve exercise participation in a patient with severe cognitive impairment: a case report

ABSTRACT

As individuals decline cognitively physiotherapists’ attitudes become more negative. Evidence supports the use of experiential learning modules in a curriculum to improve student confidence and knowledge to treat individuals with cognitive disorders. Work stemming from Schon’s model of reflection suggests that “reflection-on-specific action” can facilitate clinical decision-making. The purpose of this case report is to describe the use of this model by students working with a patient with severe cognitive impairment. Under the supervision of a neurologic physiotherapist who was also a full-time faculty member in a physiotherapy program, the 74-year-old male with severe cognitive decline worked with two student physiotherapists (10 sessions over 5 weeks). The students reflected upon and journaled before, during, and after each session including every encounter, patient response, and activity. Four themes emerged: (1) capitalize on caregiver involvement and knowledge, (2) salient activities promote engagement, (3) intentional communication, and (4) flexibility throughout treatment. Improved exercise participation was noted as the themes were integrated to a greater degree each session. Cognitive deficits precluded performance for some measures, the 6-minute walk test yielded clinically significant results. The factors identified in this case may be beneficial to developing exercise programs for individuals with severe cognitive deficits to assist with maintaining functional mobility and decrease caregiver burden. This intentional reflective approach to practice may combat negative attitudes by providers and enhance effective communication and intervention implementation. The educational approach increased reflective behaviors demonstrated by students and will be useful to educators interested in facilitating professional development in students.