Could you please describe your patient's "movement disorder"?
Why assuming that it might be psychologicaly rather than cognitively
related?
Noemi
-----Original Message-----
From: mdne adams [mailto:[log in to unmask]]
Sent: 20 December 2000 22:35
To: [log in to unmask]
Subject: Re: School for Bravery
Chris, thanks for your reply,
You ask the six million dollar question here ! "What do you feel is
maintaining your client's movement disorder ?"
This patient is the subject of much debate in the mental health services and
medical health services as to the whys & wherefores of her movement disorder
and repeated attendance at Casualty with a variety of symptoms. She will not
acknowledge that there may be a psychological component to her difficulties,
which has effectively excluded her from direct dealings with Psychologists,
as she won't consent to this. She has a complex and traumatic social
history including divorce, time spent in a hostel, and recent rehousing in a
bungalow. The System has therefore inadvertantly supported her disability by
bailing her out of a miserable situation and she has mastered the art of
getting help and sympathy from family members, friends, neighbours and
anyone passing by using her movement disorder (and of course contact with
the Health services who unwittingly reinforce it all over again every time
she presents herself for reexamination, and the Benefits Agency who have
granted her lower rate Disabled Living Allowance) This has become a
well-entrenched habit and we are well aware that it will be very difficult,
if not impossible, to reach all the people that currently maintain her in
her illness behaviour.
This is why we're particularly keen to temporarily pluck her out of this
environment, help her to achieve a major change in her behaviour and most
importantly give her an acceptable, publicly understandable excuse and
reason for making a recovery - bravery through physical exercise. There have
already been several multidisciplinary meetings about her, and there are a
number of people available who are willing to encourage wellness behaviour
in the future - but this is probably too daunting to achieve without the
admission to a unit specialising in this sort of approach first.
So Chris, if you or anyone else knows of such a unit, or you have any other
ideas, please let me know. So far, my own involvement has been observation
of her movement disorder in her 3 different home environments over the last
year or so, and repeated offers from me to meet her at a local swimming pool
of her choice, which she hasn't yet taken me up on.
This is a challenge to all concerned - ideas very welcome
Nikki Adams [log in to unmask] <mailto:[log in to unmask]> Wakefield
----- Original Message -----
From: Chris Murphy <mailto:[log in to unmask]>
To: [log in to unmask] <mailto:[log in to unmask]>
Sent: Wednesday, December 20, 2000 12:26 AM
Subject: Re: School for Bravery
A quick question regarding your question. What do you feel is maintaining
your patients movement disorder. To change behaviour you need, as you point
out, not to reinforce the maintaining factor. The school of bravery
programme follows a behavioural model which the cognitive behavioural
programmes incorporate as this has been proven to be very successful.
However the question of what is maintaining your patients behaviour is
paramoiunt as this needs addressing initially and correct educzation of
partners and relatives can be very useful in treatment regimes.
Cheers
Chris
----- Original Message -----
From: mdne <mailto:[log in to unmask]> adams
To: [log in to unmask] <mailto:[log in to unmask]>
Sent: Monday, December 11, 2000 7:33 PM
Subject: School for Bravery
About 15 years ago in the UK there was a lot of interest in Joyce William's
"School for Bravery" programme, which was a method for changing "illness
behaviour" into "wellness behaviour". She did this at Doncaster Royal
Infirmary, and also ran courses on it that were attended by many PTs from
all over the UK - who then set up their own "School for Bravery" programmes.
I am really keen to find out if anyone is still running such a scheme, or
anything like it - I have already contacted Doncaster and they don't do it
any more. The illness behaviour that my client is exhibiting is a movement
disorder rather than chronic pain behaviour - what I think she needs is a
friendly group environment, where illness behaviour is totally ignored and
wellness behaviour lavishly praised.
Anywhere in the UK would be a possibility as I believe a strong case for
funding it could be made.
Here's hoping !
Nikki Adams Community Physical Disability Team Wakefield
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