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

A 69-year-old retired secretary has a history of TIA 11 years ago. During the pandemic period, her daughter and granddaughter moved to another city because her grandchild was enrolled in university, so he has been living alone in her duplex house in Istanbul for the last 4 years. He has a history of falling while living alone, and his physical activity has decreased due to his fear of falling again. 

PART 1- The physical therapist (PT) and the patient’s daughter (D) meet in the office before the examination: (Starts by sitting down) 

PT: Hello, welcome Ms. D, how are you? I see that you have come for your father (says while looking at the computer). What is the topic? 

D: Hello, thank you. Yes, I wanted to come for my father, I am worried about him because he has been living alone for 4 years. He had a transient ischemic attack in 2013 and is fine. His condition was fine and he continued to work. He goes to routine doctor check-ups. Then he retired in 2020. My daughter entered university the same year and we moved. 

PT: (Nodding head, listening). You said that his condition is good, but what are your father’s complaints? 

D: We are far away and he usually does not talk about his complaints because he does not want us to be upset, but we feel that he is lonely and depressed. His sociability decreased due to reasons such as his retirement, the pandemic and the death of his peers. He doesn’t go out much, even the grocery shopping is done by the boy from the apartment (the woman’s mood is down). 

PT: I understand (Looks at the papers in her hand and the computer). When I examined the doctor’s reports, there is no pathological condition as you stated. However, I agree with your concerns. Physical inactivity, social isolation and loss of motivation can lead to serious problems. Appropriate physiotherapy evaluations and exercise approaches are important in order to prevent these problems during the healthy aging process. 

D: (The patient smiles, relaxes, feels that he is in safe hands). So what path do we follow now? 

PT: First, we will meet with your father and complete the evaluations. Afterwards, I will teach your father some exercises. (PT stands up) 

D: (stands up) Thank you very much. (shakes PT’s hand). 

PT: (Smiling) You’re welcome. 

PART 2- Physiotherapist (PT) and elderly (E) interview: 

E: (He walks through the door) 

PT: (Does gait analysis, general inspection) 

E: (shakes PT’s hand) Hello dear PT (shyly). 

PT: Hello Mr. Y. How are you? What are your complaints? 

E: I’m fine actually (thoughtful looks), I’m fine. 

PT: (Says motivatingly) You certainly look very good, you are healthy. Do you use any medications or supplements you take? 

E: Yes, I have blood pressure medication. I also had an illness 10-11 years ago, and I use blood thinners. I also take a gastroprotector in the morning. 

PT: (nods, takes notes) Okay. So how do you spend your days? What physical activities do you do daily? 

E: (thinks) Hmm.. Actually, every day is the same, I wake up, eat something, I’m usually at home.. (pauses) like this. 

PT: So can you estimate your daily step count? (Verbally questions physical activity level) Do you go out and take a walk? Going to the market and/or bakery, going to the park? 

E: I don’t go out much. I fell down the stairs once at home, a long time ago, and I’m a little afraid that I might fall outside, too. 

PT: (taking notes) First of all, I can say that there is nothing to be afraid of. We can beat this together. If you excuse me, I need to give you some physiotherapy evaluations. 

E: It’s okay. 

PART 3- Evaluation scene of the elderly (E) and the physiotherapist (PT): 

PT: First, we need to identify the source of your fear of falling. In this regard, our first evaluation will be joint range of motion. Could you please take off your shoes and lie down? (shows the stretcher) 

E: Sure. (takes off his shoes and lies on his back) 

….. 

1-Shoulder girdle and hip joint range of motion is evaluated. It is noted. 

PT: Secondly, I will evaluate gross muscle strength. Could you sit towards the end of the stretcher, please? 

E: (sits) 

….. 

1-Quadriceps femoris, hamstrings, gastrocnemius, tibialis anterior manual muscle testing is performed. It is noted. 

PT: Finally, I need to evaluate balance. Do you stand with your feet shoulder-width apart? 

E: (does)  

….. 

PT: Now can you stand in the same position with your eyes closed? 

E: (the elder is worried in this situation) I feel insecure. 

PT: (suggestively influence) Please trust me, you can open your eyes if you feel like you are going to fall. I will stand behind you and support you. 

E: Thank you, I can try to do it. 

…. 

E: (slightly unbalanced but does not fall). 

PT: (takes notes). 

PART 4- The elderly (E) and the physiotherapist (PT) talk about the evaluation: 

PT: Mr. E, we have completed your evaluations. I think that the main factor underlying your fear of falling and causing you to restrict your physical activity is your loss of balance. But there is nothing to afraid, because loss of balance is a situation we naturally encounter during the healthy aging process. Your joint movements are also very successful. I can say that your muscle strength is average, but we can improve it with exercises. 

E: Thank you very much, Ms. PT. What kind of process awaits me now? 

PT: We will prevent your fear of falling by improving your balance with a few balance exercises. I will also suggest an exercise to both increase your general muscle strength and improve your balance. I will follow up at regular intervals to record your progress. If you want, we can show you the exercises. 

E: (patient’s face smiles) Super… 

PART 5- Exercises of the elderly (E) and the physiotherapist (PT): 

PT: Our first exercise is the sit to stand exercise. Our primary goal with this exercise is to improve your balance. We will also increase your overall muscle strength. Please sit on the chair, cross your hands in front of your chest like this. (PT shows arm crossing over himself.) 

E: (does) 

… 

PT: Now let’s move to the chair. Take a step where you are, pulling your knees towards your stomach. Like this… (shows PT) 

E: Like military steps. I can do this easily (Patient laughs and then does the exercise) 

… 

PT: Perform the Romberg Test with eyes open, keeping time. In the future, we aim to increase this time, then reduce the support surface, and at the last level, do this exercise with eyes closed. For the Romberg test position, I want you to stay in the position with your feet shoulder-width apart as long as you can, as in your first assessment. 

E: (does) 

PT: That’s all our exercises for now. Until your next meeting, please do your exercises regularly, 10 repetitions 3 times a day. 

E: (nods) OK. (shakes hands) See you, ma’am. 

PT: See you, all the best.