CHANGE: The Most Difficult Word in Rehabilitation

Have you ever tried to get into ‘better shape’ and incorporate the word EXERCISE into your

day?

Have you ever tried to lose—or gain—a few pounds? And CHANGE your eating habits?

Or have you ever tried to limit the number of hours you watch TV or play games on your phone-and do something 'more productive’ with your time?

Over time, it is likely that we have all tried to get into a new routine or habit and make some

type of CHANGE to our lifestyle.

And, if we do not do anything about it, we may forget it for a while. accept the fact that we will

NOT change the situation right now-—and move on-—or perhaps try again at another point in time.

There is extensive literature on what is referred to as the TRANS-THEORETICAL MODEL OF CHANGE and the different steps or stages people need to progress through in order to make some type of CHANGE to their lifestyle.

An example, related to changing eating habits, to better control Type II Diabetes could be:

PRE-CONTEMPLATION: “What’s the big deal? So, I have a little Diabetes, I am a little

overweight and need to take medication”.

CONTEMPLATION: "Oh, you have Diabetes as well? Is that why you are only having one beer and not eating all your chips?”

PREPARATION: “ Well, maybe I should check out the information online about eating more

healthily when you have Diabetes—or perhaps it would be better for me to meet with a dietitian (I am somewhat confused about all this foodie information)."

ACTION: "Eating like this is not so bad. I think I will start walking around the block several

times a day as well.”

MAINTENANCE: “I am feeling better, but I know I may go back to my old ways. I will join this

group of people who also have Diabetes who are in my age group. Meeting with them weekly

will help us all as we take our walks and share ideas about food and frustration."

TERMINATION: ‘Yes, it has taken several months, but I now feel better, look better and am

finding this new routine enjoyable. My doctor told me that my recent blood studies have shown that I can reduce the amount of prescription medication I take. Maybe I won’t have to take any medication for Diabetes one day."

The process of CHANGE- TTM – is the work a person does to progress through the stages of CHANGE.

A person’s motivation to change becomes an action.

But what if something happens that forces you to CHANGE your routine- and the direction of

your life—IMMEDIATELY?

CHANGE is the most challenging word in the rehabilitation environment.

It does NOT follow the TTM Model exactly, since there is NO time to process and progress from one stage to the next. There are times when a change must be made immediately.

Health providers and exercise personnel can often see or know from experience what their

patients/clients need to do to recover or return to their daily activities.

As they observe and assess their new client, health providers may be thinking:

1. My new patient had a traumatic amputation because of an accident at work.

“The femur amputation is at a good distance from the hip. In time, my patient will be fitted with an above knee prosthesis (artificial leg), and he will be able to do almost all the things he did before the amputation’.

2. My patient has finally had her headaches diagnosed by a specialist.

“She has been properly worked up for her migraine diagnosis and is taking new medication. I

can teach her some relaxation exercises and mindfulness techniques that will help her with

better headache control”.

3. My patient has sustained a concussion when she hit her head against the steel

wall beam where she fell. She was dazed for a few minutes.

“The new concussion guidelines state that we should not limit ‘quiet time’ to more than 48-72

hours post injury, before encouraging the patient to re-engage in their regular activities. But this patient fell 8 months ago. We will have to take it slowly, one step at a time."

CHANGE- Our ability to modify our outlook on life and our ability to manage life with all its stressors (as well as the good stuff) is an individual process.

Some people can manage change better than others. People working in certain occupations may not have the same options to take time off work (especially if everyone depends on them!)

A sudden change can create significant problems with the people in our lives-—partners,

spouses’ children, friends, work colleagues. And there may be additional strain if there already were challenges with these relationships.

Yet another unseen challenge (especially since you often cannot see the physical or medical

problem) is the ability to ask for HELP-—not only from your health providers but also from family and friends.

These are challenges for many of us. We are quick to help others but being on the receiving

end can often be interpreted as being weak or unable to take care of ourselves and our families. (such a human condition, sigh!)

Caring health professionals and exercise providers will assess a person’s injuries or problems thoroughly while they are also learning (and listening) to what their new patient is feeling, thinking and experiencing.

Not everyone learns the same way. Not everyone has the ability or the opportunity to

implement a change to their lifestyle immediately.

Our homework will be to develop S.M.A.R.T. goals.

S specific

M measurable

A achievable

R realistic

T timely

The next BLOG on Don’t Go to the Ouch! will focus on goal setting.

A useful way of working on CHANGE, step by step, and for any reason.