Home > Physical Therapy Academic/Professional Guidelines .:

• Initial evaluation
  
  This is a time when a lot of information needs to be communicated and you are not yet used to the communication style of your patient. Use the strategies you find successful in daily life. Therapists work with patients several times a week. This is the time to set up successful communication strategies that will last for the entire duration of a patient’s time in physical therapy. Some tips:
  
  * As you introduce yourself, let your patient know that you have a hearing loss but you can work together as a team for successful communication. This should not be a long conversation. It can be a mere two sentences. Remember, the focus is on the patient not you.
  
  * “Good morning Mrs. Smith. My name is Miss Jones. I look forward to working with you. I a deaf and would appreciate it if you face me when you wish to talk to me. I am sure we will communicate just fine. Now tell me a bit about why you are here…”
  
  * If you use an FM system, simply hand the patient the microphone (or show them how to clip it to their lapel) with a brief explanation. Often this then becomes second nature to the patient and they will ask for the mike before they start a therapy session.
  * If you use a sign language interpreter, explain their role to the patient. They are in the room to facilitate communication, not to act as a PT aide.
  * Make this first session positive. Give the patient confidence that you can help them feel and function better. Often the fact that we need to give our patients our full attention to communicate is seen as a positive thing. It is not uncommon for patients to tell therapists that have a hearing loss that they are the best listeners they know!
  * Multiple people/multiple conversations during the initial evaluation
  
  * If a family member is present, simply ask that one person talk at a time so information is relayed accurately.
  
  * Treatment sessions: This is often when patients will be in a variety of positions. Use strategies that worked for you in the initial evaluation. Accommodations to provide safe, quality patient care are relatively simple but require teamwork. You may need to occasionally remind the patient that you can not understand them if you are writing or they are facing away from you. This may be an individual’s first experience working with someone with a hearing loss. Patience and a sense of humor goes a long way in building a therapeutic relationship.
  
  * If the patient is lying on their stomach or on their side and facing away, set up a simple communication system. “Pound the table if this is hurts and I will ease up on the stretching.” “Give me a thumbs up if this feels fine and a thumbs down if it is tender.” “point to where it hurts” If you use an FM system, you can ask an aide to help with communication. The aide can wear the FM mike and pass on the patient’s verbal comments.
  * If you are walking next to a patient and they need physical assistance for safety and stability, you may be able to use an FM system or speechreading from the side to communicate. If that is not possible, you may need to stop occasionally and speak to the patient when they are seated and you can face them. Since the patient's hands may be holding onto a walker, crutches, parallel bars or a cane, set up simple head or body movements for safety, so the patient can let you know if they need to sit down.
  * You may need to change your position to facilitate communication. If the patient can walk unassisted and you are observing their gait pattern, you can walk backwards to facilitate communication. You can kneel in front of the patient or even get on the floor and look up so you can see a patient’s face.
  * Learn to use your powers of observation to read body language. You may be especially sensitive to vibrations. Use these skills to enhance your palpatory skills and you can be ahead of the game. You may be better in these areas than you hearing counterparts. Use these skills to their advantage!
  * You need to give a safety switch and a bell to patients on electrical stimulation modalities or hot packs. Check on your patients frequently and ask the aides or other therapists to let you know if the patient rings a bell or sets off the safety switch.
  * If you are working with a patient in a gym, other patients may be on a bike nearby. Remember that these can be noisy. Watch you patient for facial expressions that let you know that you need to raise your voice volume.
  * Your patient may be willing to write down their symptoms, especially if they have had a long weekend with varied activities and responses.
  * Your patient may be interested in learning a few signs. This can be both fun and helpful for communication.

* Pediatrics

* Working with young children is often done in the guise of play. You may be on the floor with your patients. Watch their body language and feel for changes in body tone to assess treatment effectiveness.

• Use the above strategies to communicate with your patients’ parents.

* ICU

* Learn the visual aspects of alarm systems on various IV pumps and monitors. Check these monitors every few minutes, reminding yourself with a vibrating timer if needed.
* If a patient has a very weak or no voice, you may find your speechreading skills invaluable.