A lot of things are definitely changing, but I’m sure that many are for the best. I recently heard the chairwoman of the Spanish Geriatrics Society say that there is nothing more different from an 80-year-old gentleman that an 80-year-old gentleman. And age alone, while certainly a criterion, is not enough to evaluate patients.
Every human being is unique, and evaluating their functional capacity –that is, not only what the elderly do, but how they do it– can be a more useful tool when making treatment decisions.
I couldn’t agree more. But I would also apply it to patients with neurological disorders. There is nothing more different from one stoke patient than another stroke patient, nor from one MS patient than another MS patient. From one child with ICP than another child with ICP. Scientific evidence has sought in earnest to establish prognostic factors that help us distribute otherwise limited resources, and establish treatment tools. However, in clinical practice, we constantly see how difficult it is to predict how patients will evolve, or at least a great many of them. Because, as we say on the streets, every patient is a world unto him or herself.
Every patient is different. There are many factors that influence the functional recovery capability of each of them. Some of those factors are related to the genetic makeup of each one; others with their previous aptitudes; still others with the nature of the injury itself or the expression of the injury in the patient; and others will be related to the treatment they receive. The Spanish Rehabilitation Society stated that the treatment for a stroke patient must start quickly. It must be provided by a multidiscipline team, it must be intensive, and its duration must be determined by achieving the stipulated objectives. And this is where we’ve got a lot of work to do.
Those of us who face our patients each day know that all of our training and our clinical experience will help us design more effective treatments, but we must adapt it to each specific patient as a unique and unrepeatable individual, capable of advancing and improving. Understanding their goals and respecting their pace. And we are also aware of the need to update our knowledge constantly, because we know that the patient’s quality of life depends on that.
Those of us who also design training for other professionals like us are challenged with attempting to complete all aspects of training. Updating existing scientific evidence and promoting scientific output, establishing synergies between different approaches, being specific in the treatment of certain patients: acute, chronic, with ataxia, with problems in their upper limbs, with alterations in their sensitivity, with walking difficulties, with neuropsychological problems… in order to guarantee that the professionals continue to ensure that no patient, regardless of their characteristics or their expectations, is left behind in their evolution and can continue to advance.
Cecilia Estrada Barranco
Directora del Curso de Experto en Fisioterapia Neurológica