A plateau in rehabilitation can be caused by a multitude of factors, including ourselves, as rehabilitation therapists. Applying a stringent checking system will help us prevent plateaus in our patients, identify them early, and move past them quickly!
Plateaus can be a normal part of rehabilitation, but they can also be a sign that treatment needs to be changed, adjusted or optimised.
When our patients plateau
A plateau in recovery refers to a period where there is little or no improvement or change in the patient following a period where progress towards goals was evident. It can be easy to feel that ‘this is as good as it gets’ when we hit a plateau, especially for cases where we don’t know how much function we can realistically regain.
A plateau commonly occurs after the healing phase of the condition, but this does not mean that all healing or recovery is complete. Neurological damage and retraining can take an extended period of time, whether the damage is within the spinal cord or peripheral nerves, and whether one is retraining for normal or optimal motion patterns.
A plateau can often be seen when in-house rehabilitation starts to taper, and can be a sign of a home exercise plan that is lacking in one of a few areas.
The healing timelines
When we work outside of or against the healing timelines of specific tissues, we can cause a plateau through inhibiting instead of aiding the body in the process of healing.
We really need an in-depth knowledge of the healing timelines, and an understanding of how we can influence different tissues in different phases of healing. This is essential if we want to optimise instead of inhibit healing.
The physiological causes of plateau
You may remember our series on exercise physiology, in which we were reminded that our bodies adapt to the stresses placed on them – and that a lack of such stresses can lead to a plateau in improvement. To prevent the plateau, we need to continue increasing or changing the challenges of our rehabilitation programme, so that we’re always causing the body to adapt and improve towards our goals.
The opposite phenomenon can also apply; an overstressed body will also stop improving. We may see a plateau because we’re adding too much to the exercise programme too soon, or the owners are overdoing it, leading to fatigue. For optimal healing and recovery, we need to work with a gradual progression of exercise, based on the adaptations of the patient, together with regular periods of rest.
Learn more about the physiological responses and adaptations of the body in Exercise Physiology: Go beyond to prepare your patients for life.
An effective home exercise routine
One of the most important aspects of an effective rehabilitation programme is the work the owner does at home on an ongoing, daily basis. For a home exercise programme to be effective, it should
- be realistic for the owner to incorporate into their daily life
- be specific to the patient and their needs
- slowly progress over time so as to stress the body and cause the necessary adaptations
- be clear, concise and simple for owner and patient to execute successfully
It is important to send the owner home with simple, clear instructions that they can follow. With home exercise programme subscriptions like Canine Home Exercises or Equicantis, you can create customised, clear and professional home exercise programmes for your clients, including videos, photos and other descriptions, without spending an excessive amount of time creating them.
An effective home exercise programme may be the best way you can prevent or push through a plateau.
It is really easy to lose motivation when we’ve been working towards a specific rehabilitation goal for weeks or months, and suddenly we’re no longer seeing any improvements.
The first question to ask is whether the plateau is real or only perceived; to answer this, we need to keep track of our progress with regular re-evaluations and objective outcome measures. These can help us identify a plateau early and celebrate the successes we have made so far. Taking regular photos and videos is also a great way to remain motivated, as we can compare the current condition of our patient to what we saw earlier. The use of clinical metrology instruments can be a valuable way to measure progress, and can be incredibly motivating for the owner, since the system is based on owners’ own observations.
Is the plateau your fault?
An essential part of any rehabilitation plan is to establish clear goals for treatment. However, it can be easy to fall into the habit or routine of doing the same things over and over again, instead of continuously re-evaluating our course and focusing on the individual goals and progress of each patient.
Our clinical reasoning skills are essential in this process. We must have clear goals, then decide on the best course of action to achieve them, and then assess and reassess progress as we move toward those goals. After each assessment, we need to be prepared to adjust treatments and plans as needed to keep us on course.
If any step in that process is missing, we may cause our patients to plateau early, or even fail to reach the optimal function they are capable of achieving.
Goal-setting is the first step, and clinical reasoning is the next. We love to say that ‘we do not know what we do not know’; what I mean by this is that neither you nor I know if we could be achieving better results or doing things differently unless we continue to learn. Remaining effective as a Vetrehabber means continuously learning. This is why I occasionally compare myself and my methods to the methods of others, sometimes follow the clinical reasoning pathways of other therapists, attend lectures, conferences and workshops, and dedicate time to my ongoing education. This, for me, is the only way I know to continue serving my patients to the level that they deserve (and not just to the level that I am currently capable of).
Do you #neverstoplearning? If so, you’re in good company among the Onlinepethealth Vetrehabbers!
Do your patients plateau? Do you know how to motivate yourself and your owner through these periods? Do you know whether or not you are the cause of the plateau? Regular assessments should include assessment of ourselves, our skills, our mindsets and our motivation levels to ensure that we are solving instead of adding to the challenges our patients and their owners face.
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Onlinepethealth members can watch the following webinars to help with clinical reasoning, evaluation and more: