So, I walked out of my first physical therapy session with exercise instructions in hand:
a, two standing balance routines,
b, one head turning/visual fixation routine, and
c, one head turning/side-lying routine.
All of these exercises are aimed at reducing my inner ear problem with its positional vertigo.
To have any effect, these routines need to be carried out at least once and preferably twice a day. The routines themselves will make me dizzy, somewhat nauseous, and headache-y. But the long-term effect (I’m told) is to habituate my body to these movement-triggers; ultimately I won’t become dizzy and nauseous because of head positions and visual stimuli.
a. I’m supposed to stand in a corner for the standing balance routines so I have something to block me if I start to fall. I try out the corner of the kitchen counter and then the corner in the upstairs hallway. Both spaces work for the exercises, so I end up using them both.
b. For the visual/head turning exercise, I cast about for some way to display this 3-inch card with a large ‘X’ on it and settle on paper-clipping it to the kitchen calendar. In that location, I can stand directly across from it, with my back against the door jamb, and do my head-turning and visual focusing exercise.
c. The side-lying exercise provides more of a challenge. I try sitting on the side of the bed upstairs, turning my head to a 45 degree angle, and lying down sideways. The bed location works fairly well, but doesn’t feel like it gives me quite enough support and is a little high. After a couple days I try the sofa downstairs in the living room; the sofa is firm, has a small pillow on each end for me to put my head on when side-lying, and is more accessible during my daily life. So I settle on the sofa.
The next question is when to do the exercises. The side-lying exercise is the one that makes me dizzy and headache-y, so I tend to do that just before going to bed for the night. For this exercise, I decide once-a-day is the best I can do for now. The other exercises I can do off and on throughout the day as they are easier to fit into my usual routine.
Today, I’m thinking back to what I was experiencing as I worked to fit an exercise routine into my daily life. My own experiences raised the question for me: “What do clients — who leave occupational therapy with instructions for new exercise routines, new adaptive equipment and new ways to carry out their daily occupations — experience as they learn the new routines and fit them into their everyday lives at home?” How much do we help clients think this through, and how open are we to compromises and modifications in how and where and when they fit these changes into their days? And do we get and give feedback on what they have figured out the next time they come to therapy?
Has anyone done research on the phenomenology of embedding new therapeutic regimens and equipment into one’s life? Wouldn’t new understandings of this phenomenon help get rid of that over-used, ill-gotten term “non-compliance?”