Shifting Gears: Working Through Client Resistance

During the seating & mobility evaluation, a client’s emotional state may not receive the same attention as asymmetrical postures or pressure management, but it’s just as critical to functional outcomes. How clients feel about their mobility equipment can determine how well they use it — or whether they use it at all.

Lois Brown, MPT/ATP, faced this challenge with a female client who had a brain aneurysm with hemiplegia, severe extensor spasticity and a frozen shoulder: “She came to my office in a scooter and demanded an exact replacement of what she had. She knew what was best for her, and who was I — someone that did not even know her — to make a recommendation?”

In this column, Brown discusses why such clients act as they do, and how she worked with this particular client to create a solution that was clinically and emotionally satisfying.

Why Clients Resist Our Recommendations

Clients who are resistant to making a transition to new equipment may be facing a plethora of issues.
It may be related to their condition. For example, they may have difficulty with “new learning” as a secondary sequela of a neurologic diagnosis.

They simply may be intimidated by new technology. We are creatures of habit, and once we feel comfortable with something, it is easier to stay with what we know.
Fear of insurance denial can also be a factor. They may feel that they are asking for a device that is too “high end” and think they may not qualify. They don’t want to take the risk of being denied.
Of course, there is also the stigma that comes along with moving into higher-end products or using more advanced technologies. Clients are dealing both their self-images and the perception of others and fear that they will look “more disabled” if they make the switch.

Overcoming Emotional Obstacles
To ease clients’ fears, you need to take a customer service approach. You need to build a relationship and establish a good rapport in order to gain their trust. You accomplish this by listening and probing to understand where they are in their recovery process and by restating and paraphrasing what they are telling you so they know you are listening. Use empathy statements to validate their feelings and work toward resolution by making a “consultative service suggestion.” By listening to your clients and acknowledging what they are feeling, you gain their trust.

The other important piece is understanding the emotional component that comes along with offering additional medical equipment. Many times we forget how much clients have lost already in their journey to “recover.” They may have lost their ability to be independent. It is imperative to understand where the frustration, anger and yelling stems from and not to personalize it or let it affect your approach. Try to maintain a calm, low voice in order to positively affect the situation.

A Happy Ending

This client presented herself as angry and somewhat abusive in her communication style. She was pointing her fingers, yelling and resisting a reciprocal conversation.

Because of her insistence at wanting the scooter, we trialed a new scooter first, hoping she might recognize her own limitations and safety issues with this device. While she stated she was having difficulty with her ADLs within the home, she insisted on only the scooter. Her trial created concern over her safety due to risk of injury to her lower extremities, which were outstretched over the base due to severe extensor spasticity. She also exhibited decreased control of the tiller to the point where she was banging the scooter and her legs into the wall.

She outwardly denied any issue and had poor awareness of the risk for injury.
When she refused to try the mid-wheel-drive power chair, we told her, “I hear that you feel the scooter is the best option for you. But what I also heard you say is that there are still things that you are unable to do with this equipment and that you require additional help from others to accomplish your daily activities.

“I want you to know there are other options that will offer you more independence and will provide increased safety for you, and I want you to know that there is sufficient medical justification to support coverage for this device.”

After lengthy, difficult discussions, she mentioned wanting to cook again and that she really couldn’t use the scooter within parts of her home. When the focus of our conversation was her goals, she finally agreed to try the power chair, which would give her better positioning, control and access to her environment… with that, she changed her mind.

From there, she agreed this would be more helpful to her and wanted us to move forward with trying to get it approved.  Success!

This article originally appeared in the March 2008 issue of Mobility Management.

About the Author

Lois Brown, MPT, ATP, is the rehab clinical education specialist for Invacare Corp., Elyria, Ohio. She is a frequent presenter on seating & mobility topics at industry events.

In Support of Upper-Extremity Positioning