Video materials on improving communication with patients, cross-cultural aspect

VIDEO: INTERVIEW WITH ADOLESCENT WITH POSTURAL DEFECTS

An introverted, unconfident, and rebellious adolescent (14 years) who was ashamed of his/her appearance, bullied by his/her peers was brought to a physiotherapist by his/her family because of his/her hunchback. The physiotherapist is trying to ensure the adolescent’s participation in exercise therapy.

Part 1: Physiotherapist – Family interview

Physiotherapist (Pt): Hi, I’m Physiotherapist Aylin. I think you are here for Beren.

Mum: Yes, hello. I’m Beren’s mum Ayşe.

Pt: First of all, it’s nice to meet you. I’d like to get some information about Beren’s condition. You applied with a complaint of hunchback, isn’t that right?

Mum: Yes, we went to the doctor 2 weeks ago because of Beren’s back pain. We were aware that his/her posture was not very straight, but the doctor referred him/her to you, saying that his/her spine alignment was disturbed and that she/he needed to do exercises.

Pt: I understand. Posture disorder is a very common condition at this age and it can progress rapidly because they are still growing. For this reason, it is very important that we intervene early. Apart from the kyphosis problem, is there any other health problem that caused you to come here?

Mum: There is no health problem that we have noticed so far. But this hunchback is quite challenging for him/her.

Pt: I see. Also, what do you think about Beren’s emotional state, how are his/her social relations, what is his mood in general?

Mum: She/he has become very withdrawn lately. He/she is always in his/her room either on the computer or on his/her mobile phone. He/She doesn’t communicate with us much. We think he/she is being bullied by his peers. He/She has difficulty in expressing himself/herself. I think he/she is embarrassed especially because of his/her appearance. When we go shopping, he/she does not want to try on clothes, he/she prefers clothes that are much bigger than his/her size. All these seem to affect her/his self-confidence a lot.

Pt: I understand, you may be right that it is a difficult period. In order for Beren to overcome these difficulties, it will be important for us to focus on her/his emotional health in addition to improving her/his physical health. We may need to refer her/his to a specialist in this area. How do you feel about this?

Mum: Absolutely, I would want him/her to get all the help he/she can get. I am ready to do whatever it takes for him/her.

Pt: We can refer Beren to a psychological counsellor and guidance counsellor to get support in this regard. We can help her/his feel better by focusing on both her/his physical and emotional health.

Mum: Thank you very much.

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Part 2: Physiotherapist-Patient interview

Physiotherapist (Pt): Hello! I am Physiotherapist Aylin, can we meet, what is your name?

Adolescent (A): Hello… I am Beren.

Pt: Hello Beren, good to see you. I talked to your mother before you about your condition, she said you have difficulty standing upright and you have back pain, but I would like to hear from you. How are you feeling?

A: I’m not well, I don’t want to be here.

Pt: I understand that you came here at the insistence of your family, but I think I can help you, is there anything else bothering you besides the back pain?

A: I just… I feel like everyone excludes me, just because of this hunchback. Most of the time people make fun of me and I feel ashamed.

Pt: It is a very difficult situation for you, but I can say with confidence that we can solve the problem of the hump that brought you here. Physiotherapy and rehabilitation can affect not only your physical health but also your general well-being.

A: How can he help me?

Pt: First of all, we can correct your posture by doing hump-related exercises. Since you are still in the age of growth and development, I think we will get quick results. We will evaluate your posture and create a special exercise program for you to ensure muscle strength and flexibility. These exercises can have a positive impact not only on your physical appearance but also on your self-confidence.

A: So, can this make me feel better?

Pt: Yes, absolutely. As your confidence grows, other people’s perception of you may change. But the important thing is how you feel about yourself. What do you want? The most important thing is that you actively participate in the treatment and apply it in your daily life. For example, you need to reduce the time you spend in front of the screen.

A: Okay, I will try.

Pt: Great Beren! Once you have completed the assessments, we can start your exercises. Also, if you want, I can refer you to a psychological counselor and guidance specialist so that you can share your feelings in more detail and get support. I am sure she will help you to feel better.

A: Hmm, maybe that would be good.

Pt: I’m glad you agree, then we can move on to the assessment and exercise part.

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BONUS VIDEO: INTERVIEW WITH SCOLIOSIS PATIENT

24-year-old Ms. Cansu, who was found to have scoliosis in her chest X-ray, has been modelling since her childhood and attaches great importance to her appearance. As a result of being diagnosed with scoliosis, she consulted a physician with the concern of losing her profession. The physician thinks that scoliosis develops in adolescence and the diagnosis is too late. As a result of the evaluations, it was determined that she had 15 degrees C type scoliosis, and she was referred to a physiotherapist for exercise therapy.

PART 1- A scene enters in which the physiotherapist (Pt) and the patient (P) meet:

Pt: Hello there, welcome.

P: Hello physiotherapist (anxious and tense expression)

Pt: Have a seat, how are you, what are your complaints?

P: Thank you. I was diagnosed with scoliosis as a result of a radiograph I had taken last weeks. I have never heard of this disease before and I searched on the internet. I have seen very bad examples, am I going to become like this too? I am a good model, my appearance is very important to me, my profession is my everything… Is there no remedy for this?

Pt: First of all, calm down, not everything you see on the internet reflects the truth. There is no disease, there is a patient. Let’s examine your examinations and make your evaluations, then we will schedule a treatment plan, there is no need to be afraid, of course it is not unsolvable, there are many treatment approaches used for scoliosis. Do you have any complaints, pain, etc.?

P: From time to time, I experience back and lower back pain, but I think this is due to my long working hours. Especially when I use high heels during the shoot, my pain gets worse. While looking at the photos after the last underwear shoot, I noticed that one of my shoulders was lower. Could this be related to scoliosis?

Pt: Hmm… yes probably, when you use a backpack or wear a bra with straps, do you have a one-sided shoulder drop?

H: Oh yes, is that why? (surprised facial expression)

Pt: I also talked to your doctor and he gave information about your X-rays and now we will proceed to the evaluation.

……

PART 2- Patient (P) and physiotherapist (Pt) enter the evaluation scene:

Pt: Firstly, I would like to evaluate your posture in front of the mirror. If possible, could you take off your clothes, leaving your underwear on?

P: Is that really necessary? (worried)

Pt: It is necessary to evaluate your bone structures properly, yes, there is nothing to worry about, this is a routine evaluation.

P: OK, he will be prepared.

…..

1-Pt analyses posture in front of the mirror. It looks at shoulder-hip levels, proc.spinosus, waist lines and leg length.

2- Adams Forward Test, the patient leans forwards.

3- Scoliometer is used.

……..

PART 3- Patient (P) and physiotherapist (Pt) enter the conversation scene:

Pt: There are inequalities in shoulder heights and leg length. Muscles on the concave side of scoliosis are constricted and I think you have pain due to these. Scoliosis treatment includes orthosis-corset use, exercise approaches and surgery. Together with your doctor, we have decided that exercise therapy and modifications to daily life will be sufficient for you. Thus, we aim to stop the progression of the curvature and relieve your complaints.

P: Thank you. You relieved me, I’ve been so stressed for days, at least I know what to do.

……

PART 4- Patient (P) and physiotherapist (Pt) enter the treatment scene:

Pt: Ms. Cansu, there are different treatment approaches such as SEAS and Schroth in scoliosis. As a Schroth therapist, I will create your exercise programme with this approach. Is there anything you want to ask before starting the exercises?

P: Will I get better when I do these exercises? Will 3 months be enough? My work life is very busy and I may not always be able to do it.

Pt: Ms. Cansu, your complaints will decrease, but remember that you will always have scoliosis. First of all, we need to accept this. It is necessary to adapt these exercises and lifestyle changes to your daily life rather than treatment for a certain period. These are not challenging exercises; you need to gain these habits in order to keep your curvature under control and to continue your profession. 

P: So I have to learn to live with scoliosis.

Pt: Yes, we will do our best for your spine health, I am sure you will benefit. In addition, it may be good for you to consult a psychiatrist/psychologist to manage the process well. I understand that your appearance is very important to you in terms of your profession, and I think it would be useful to get professional support for your concerns.

P: Thank you for your understanding, let’s learn these exercises.

…..

1- Respiratory exercise.

2- Cat-cow 3- On hands and knees, cross-arm leg extension