tone trouble

I’ve had trouble progressing a pt I’ve been treating over the past 3/52’s on my neuro placement because due to other complications this pt had a number of days that he could not stand up and weight bear. His tone in his (L) leg has increased and his ankle joint has also stiffened up as his foot has been in a bad position for the majority of the day. Therefore despite our best efforts doing foot mobilisations pre-treatment we cannot get this pt to weight bear through a flat foot on the (L). He also has parkinsons disease and therefore also has trouble straightening up to get his COM over his BOS. As we were struggling to get weightbearing through the (L) foot when doing STS and struggling to get his weight forward we couldn’t progress to ambulation. We decided at the beginning of last week to try the standing frame as this would help him get his weight forward and hopefully the weight through the foot would break the tone and the heel would drop to the floor for even weightbearing (L) and (R). We tried this the first two days but as soon as he tried to weight bear the tone kicked in even more and his foot inverted and plantar flexed and there was clonus through his whole (L) leg and he cannot get his heel to the ground and as a result his weight was over to the (R). We then decided to take it back a step further and try the tilt table with the thinking that as its more passive the leg can relax easier and the foot would remain in a better position and get some weight through it to once again try break the tone. With doing two treatment sessions per day it has got easier and the foot is getting into a better position each time and the foot is feeling better during the mobilisations but soon after moving up into a weightbearing position the tone starts kicking in and the foot slowly starts moving into the inverted and plantarflexed position and we have yet to get his heel to touch the floor fully even though in sitting and supine when doing the mobilisations we can get the foot into a neutral position. It is a very frustrating thing to deal with both for us as physios as we aren’t able to progress the pt, as well as for the pt as he is trying so hard and doesn’t seem to be improving much. This situation has taught me that sometimes as other complications interfere with treatment and pts decline in functional ability as a result that we may have to go back to treatment techniques that the pt should have past a long time ago and start close to the beginning before moving forward and once again progressing towards pre-admission status. It’s also shown that many factors can result in the pts inability to STS effectively and these all have to be worked on individually at times before the pt is able to put it altogether and complete the functional task. It has also highlighted the importance that daily treatment has in the acute setting and how easily tone can increase if the pt is unable to get out of bed or his chair and weight bear for a few days.