panic in sitting

[hrhk]

Hi,Iam just comming across a peculiar syndrome where the elderly patient is very comfortable in bed, but the moment we attempt to get him out of bed he has panic attacks, even if we manage to get him out into a chair he doesnt even last for 2 minutes, he tends to extend his knees & slide down from chair and totally destabilses himself,Iam not sure if its is decorticate rigidity as i was taught decorticate rigidity would be quite sustained whereas this patient has this episode only when we attempt him to get out of bed.
Thanks in advance

[Judith Mollet]

A little more information about the patient could get you more answers!
1. Diagnosis? Brain damage? Dementia?
2. Capable of conversation? Understanding of the situation? Medication?
3. Aim of Physiotherapy? Is it just to get him out of bed in a chair and leave him there? Could the aim be changed?
4. Preparatory exercises with participation in bed prior to sitting if possible on the edge of the bed. Can he turn over? Can he sit on the edge or does he hyperextend there already ? Does he "Push"? What are active movements like in bed? Hypertonus? Hypotonus? Stiffness? Pain?(we are back to diagnosis and assessment)
5. Think of neuro basics whether Bobath or whatever. Start on a appropriate participation level that is possible without panic. Without a proper assessment, we can't treat effectively. Advice online is rather difficult anyway.
6.And on a slightly weird note: Lying "very comfortable in bed" was he? Thinking of all the geriatric patients I forced out of bed to walk when a young physio, I decided in a weird way that I, as a geriatric someday would probably say "no way" if forced out of bed when I didn't want to and didn't see the point in it. Of course it's good to be mobilised and up. But one can mobilize and do physio in short suitable stages with intermediate goals as well. Even if the NHS policy dictates otherwise!
Wish you luck
Ancient Physio. Still getting up by herself.

[hrhk]

thanks for the contribution ,no diagnosis has been made , I made a conclusion that it could be postural tremors,thepatient extends his knee in such a force that ,we r unable to use an encore as he ends up with laceration in his shin.
still looking for answers.
thanks

[alophysio]

Hi,

Perhaps the patient really does have a psych disorder really is getting a panic attack when sitting?? Maybe he wants to stay in bed !!

Ocham's Razor - All things being equal, the simplest solution is often the best [a paraphrase].

Ask for a pysch review would be my advice based on the amount of information i have thus far!

Cheers

[hrhk]

sorry for the delay,An MRI showed small vessel disease?

[alophysio]

hi - an MRI of what?? Brain?

Thanks

[jonathan_PTRP]

before referring him to the physiotherapist, there should have a certain diagnosis.. refer to the doctor..

[msk101]

OK, well it's a (very) long shot but here goes...

Has there been any consideration given to this being an orthostatic type reaction? the otolith organs stimulate the autonomic nervous system to upregulate when we go from lying to sitting to help prevent our blood pressure going through the floor (by activating postural muscles). If the sensors aren't working properly through neurological dysfunction - the small vessel disease - then the movement from lying to sitting might (and this is a hazy theory at best) trigger an overzealous response and instigating a strong extension reflex. - do the patients arms extend and neck extend at the same time as the leg extension?

perhaps try sitting the patient in increments by raising the bed head 10 degrees... guage the response, then the next day try 20 degrees and see... etc etc. you might find a happy place part way to get the patient accustomed to for a while before going all the way to full sitting.... or perhaps try leaving the patient lying but lift head forwards (up off the bed if their neck allows sufficient movement) and see if the same "panic" response is elicited with the body remaining essentially flat but head upright.

Other option is perhaps to see if it's a sensory organisation issue and see if the same response occurs while the patient's eyes are closed/covered so they receive less sensory input which may confuse the brain less....????

That's the extent of my guesswork for today!

msk101

[neuromuscular]

Originally Posted by hrhk

Hi,Iam just comming across a peculiar syndrome where the elderly patient is very comfortable in bed, but the moment we attempt to get him out of bed he has panic attacks, even if we manage to get him out into a chair he doesnt even last for 2 minutes, he tends to extend his knees & slide down from chair and totally destabilses himself,Iam not sure if its is decorticate rigidity as i was taught decorticate rigidity would be quite sustained whereas this patient has this episode only when we attempt him to get out of bed.
Thanks in advance

Dearhrhk,

While the assessment and diagnoasis by a qualified medical practitioner is very much a necsessity, the only person I had with a painic attack was one who landed on the deep rotators of the pelvis. He would get sudden panic attacks. treatment of the mscles relieved it. I do not know why, but after other assesment if nothing works it is worth considering.

Neuromuscular.