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Reframing Programme Development – The Three Lenses of Rehab

Thank you for joining me for the first week of Knowledge Nibbles. I am really excited to be able to connect with you weekly in a more personal way than on social media.  

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This week I want to share a little tip with you about how I reframe rehabilitation when I am developing a programme.  I like to look at the plan from different perspectives to ensure that I don’t miss anything out.  To help me with this, I use a way of thinking which I call the three lenses of rehabilitation planning. The three lenses of rehabilitation planning that I use are: 

The Realist Lens
The Optimist Lens
The Executor Lens

Think: Just stop here for a moment and consider your current system of creating a rehabilitation plan.  I suspect that you have protocols to work from or even templates. But as we all know too well, templates are great for guidance but you will always need to change something. It never goes to plan and we need to re-evaluate along the way. 

When it comes to more complex cases it can be really challenging to know what direction to take with exercise prescription. What system do you follow for creating a plan?  Can you find it/write it down?  Do you even have one? 

Let me explain how I use this in practice

Step 1 - Pick up the realist lens

Firstly, with any new case I pick up my realist lens (it’s actually a sticky note but you get the gist!). I want to gain a clear perspective of exactly where we are today and I record it in a way I can measure.

Think: Stop here to have a think about your realist lens. Does the process you use allow you to gain a realistic picture of exactly what the situation is? Does it consider patient history and owner ability and commitment? Do you record this in a way you can measure?

As well as using this lens for the first consultation you can pick it up again at any time you need to take a step back and re-evaluate. The most common mistake I see our advanced rehab students make when they are trying to get to grips with this is a lack of sufficient re-evaluation. I see too many therapists ploughing on with their original plan when just a slight change in trajectory could have made all the difference to the patient.

Step 2 - Pick up the optimist lens

Now that I know exactly where we are, I need to clarify where we want to get to. Here, I pick up the optimist lens and look forward to the outcome that I want. Be optimistic here and try to identify the best case scenario. While we always need to be real with the owner, it is important that we stay optimistic to drive the results and keep the owner motivated.

You can use the optimist lens for short and long term goals. After the initial consultation (or during, depending on time) I will take a few moments to clarify and record the optimistic long term goals. Before each subsequent appointment I will take a moment to read the long term goals to remind myself of the direction we are heading. It is very important to keep these goals visible throughout the rehabilitation process.

The other way I use this lens on a weekly basis (or at each appointment) is to set the short term goals. These are the goals that I would like the patient to meet by the next appointment. I clarify where we are now, in step 1 and then I clarify where we want to be next week in step 2.

Think: You don’t need to fill out the whole plan step by step at this point but does your system include crystal clear clarification of the long term goals? Are they written down and do you refer to them at each appointment?

Step 3 - Pick up the realist lens again

Now you know exactly where you are (realistically) and exactly where you want to get to (optimistically) then you need to consider the gap. Take a realistic view of the gap between where your patient is now and where you want them to be. How big is it? For example, if you have a dog that can’t stand up unaided and you want them to return to climbing a flight of steps to their front door, then that is a big gap. But if you had a horse that is fully fit and jumping but is rolling poles due to poor proprioception of the left hind then this is a relatively small gap. Not every programme takes the same amount of time and effort and it is important to know what is ahead of you before you start to take action.

Step 4 - Pick up the executor lens

The steps above provide me with a very clear roadmap. I often see people jumping straight in to prescribing exercises without carrying out step 1,2 and 3. However, without a clear picture of where you are, where you want to get to and how big the gap is between the two, you are just throwing spaghetti at the wall and hoping some of it sticks!

So, now I have my current and planned destination clearly written down, I need to actually do something to move from A to B. This is where I plan and execute the exercise prescription. While looking through the optimist lens during stage 2, I have identified my weekly goal/s so now I just have to plan the exercises for this week and execute them (or see that the owner does).

Why is this important?

A goal without a plan is just a dream. I see a lot of practitioners struggling with rehabilitation plans and not really knowing what to do or how to get started. We all need to take a moment to sit down and plan when we get a new case. A little bit of time upfront will save you time later in the plan and will keep you on the right trajectory.

If you are not intentional about filtering your view through these different perspectives and you try to look through all three lenses at the same time, you will not be able to see clearly. Being deliberate about swapping lenses can really help with clarity at each step.

Action:

If you already have a system for how you plan your rehab programmes, then just run it through these lenses and check that it allows you to view the case from each perspective. Most systems that I review will have a broken link somewhere and could be tweaked and improved.
If you don’t yet have a system then create one. Use this framework to get you started and then make it your own along the way.
If you are not yet developing rehab plans but you want to start, then use this framework to get you going. Start with a very simple plan and then keep picking up that realist lens to revisit and revise.

Good luck! Let me know how you get on:)

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