On tuesday my supivisor asked me to do an obkective assessment of a patient with shoulder pain. i knew just a breif run down of his subjective history, wich my supivisor informed me of, however otherwise the patient was new to me. I was pretty nervous about this as this was the 1st objective assessment i had done.
i had only 5 min to perform th eassessment and i wasn't clear as to weather my supivisor wanted me to perform all the possible objective assessments for the shoulded including joint integrity tests etc.
The assessment didn't go to well. I felt it was pretty disorganised and " here-there-and-ëverywhere". I think my supivisor aggreed!.
My supivisor advised me that i should be more systematic in my assessmnet and just assess what seems to be the problem; unique to each individual.
Generally my supivisor said that in objective assesment's we generally always perform
AROM
PROM ( physiological and accessories; unique to the individuals problem)
Muscle tests
Joint integrity tests ( if applicable)
I think next time i will have to take more time to anallyse what is being presented to me; and think about what ""tools"" of assessment i have in my knowlage bank; to stress and test the situation presented to me.
Wednesday, October 29, 2008
Sunday, October 26, 2008
WEEK2 POST 3
Sunday night and i'm just getting my third post up!.
A patient who had been attending Marmion Physio Clinic for a while; came in for her treatment on thursday. The lady had a history of incorrect patellofemoral tracking and pain as a result; in addition to this she also has arthritis of the joint; enhancing the pain issue.
My supivisor had already come up with a plan, but asked me to perform the treatment.
I was a bit nervous about treating this patient with my supivisor standing so close; however i tried not to show this!.
I performed a AP glide to her tibial tuberosity and a medial glide to her patella; she then had a session of interferential therapy. My supivisor reasoned that this would aid in reduction of pain, and an increase in ROM and would encourage the healing process.
During treatment my supivisor had to adjust the placement of my hands in the AP glide, making sure that the direction of glide was in the plane of the joint line, next time i will have to be concious that the placement of my hands can direct the direction to which the force/glide is moving.
In addition to this the application of interferential theraputic elctrodes was also different to what we had been taught at university. usually we have just been taught to "surround the joint" with the electrodes, however my supivisor showed me that one of the electrodes was to be placed on the patella; and the other one furthur up on the thigh/quadriceps muscle.
My supivisor told me that the reasoning behind placing the electrodes in the unusual place was to direct the current to the patella/superficial area instead of through the joint space.
I think i performed this treatment well.
A patient who had been attending Marmion Physio Clinic for a while; came in for her treatment on thursday. The lady had a history of incorrect patellofemoral tracking and pain as a result; in addition to this she also has arthritis of the joint; enhancing the pain issue.
My supivisor had already come up with a plan, but asked me to perform the treatment.
I was a bit nervous about treating this patient with my supivisor standing so close; however i tried not to show this!.
I performed a AP glide to her tibial tuberosity and a medial glide to her patella; she then had a session of interferential therapy. My supivisor reasoned that this would aid in reduction of pain, and an increase in ROM and would encourage the healing process.
During treatment my supivisor had to adjust the placement of my hands in the AP glide, making sure that the direction of glide was in the plane of the joint line, next time i will have to be concious that the placement of my hands can direct the direction to which the force/glide is moving.
In addition to this the application of interferential theraputic elctrodes was also different to what we had been taught at university. usually we have just been taught to "surround the joint" with the electrodes, however my supivisor showed me that one of the electrodes was to be placed on the patella; and the other one furthur up on the thigh/quadriceps muscle.
My supivisor told me that the reasoning behind placing the electrodes in the unusual place was to direct the current to the patella/superficial area instead of through the joint space.
I think i performed this treatment well.
Thursday, October 23, 2008
WEEK 2 POST 2
Well it was another gruling couple of days :P. But ill just talk about one incident that occurred in that time.
My supivisor asked me to performa an initial "practice" subjective assessment of an elderly patient that had been comming in for treatment for the past 30 years. The process went well and my supivisor said that i gathered the correct information. However i think i needed to be more accurate and direct in my questioning. Asking questions that were a bit more closed so i could get a more direct and succinct answer from my patient.
Another point my supivisor advised is that i try to keep my patients on track when they begin to tell me information that is not necessary- I felt this was a bit difficult as i didn't want to appear rude to the patient- by cutting him off. My supivisor said that sometimes you have to be a bit blunt- for the sake of time; but you can put it in a nice way.
One of my supivisors gave me an acronym that he uses for subjective interviews. I think ill use it for future subjective interviews as it keeps me on track with my quesitoning. The acronym was
W- when
O- onset
C- constant/intermittant
S- superficial/deep
N- numbness/ pins and needles/tingling
O- other areas?
R- relationship/ referal
This Acronym will also hopefully make sure that i am thorough with my assesment and don't leave any important information out.
My supivisor asked me to performa an initial "practice" subjective assessment of an elderly patient that had been comming in for treatment for the past 30 years. The process went well and my supivisor said that i gathered the correct information. However i think i needed to be more accurate and direct in my questioning. Asking questions that were a bit more closed so i could get a more direct and succinct answer from my patient.
Another point my supivisor advised is that i try to keep my patients on track when they begin to tell me information that is not necessary- I felt this was a bit difficult as i didn't want to appear rude to the patient- by cutting him off. My supivisor said that sometimes you have to be a bit blunt- for the sake of time; but you can put it in a nice way.
One of my supivisors gave me an acronym that he uses for subjective interviews. I think ill use it for future subjective interviews as it keeps me on track with my quesitoning. The acronym was
W- when
O- onset
C- constant/intermittant
S- superficial/deep
N- numbness/ pins and needles/tingling
O- other areas?
R- relationship/ referal
This Acronym will also hopefully make sure that i am thorough with my assesment and don't leave any important information out.
Tuesday, October 21, 2008
WEEK 2 POST 1
Today a past patient came in with a total knee replacement. The woman had been in before, and had previously recieved treatment, from my supivisor. My supivisor asked me to perform an AP on her tibial tuberosity.
I wasn't patricularily anxious about this patient as i was being watched by my supivisor, and i was quiet familiar with these mobilisations as we have already performed these in our UL musculoskeletal unit.
We performed an AP on her tibial tuberoisty, and a medial glide to her patella to loosen up the ligamentus/ muscular structures ( surrounding the tibiofemoral joint)and improve her ROM. We then performed stretches to her quadriceps and gave her a session of interferential to deal with any pain she was feeling and also to improve the blood flow to the injury site.
During treatment; the woman complained of pain in her knee; i believe as my supivisor later told me that i was performing the AP with "a little to much enthusiasm" and possibly she could have felt pain on her bony prominance, from the constant pressure. He advised me next time to "move my hand placement but still glide in the same joint line plane; in order to spread out the pressure".
Otherwise i was generally happy with the way things progressed today! :).
For furuture cases I think i need to have another look at one of my anatomy books; it seems that particularily in musculoskeletal physiotherapy you need to know your surface anatomy VERY WELL!.
I wasn't patricularily anxious about this patient as i was being watched by my supivisor, and i was quiet familiar with these mobilisations as we have already performed these in our UL musculoskeletal unit.
We performed an AP on her tibial tuberoisty, and a medial glide to her patella to loosen up the ligamentus/ muscular structures ( surrounding the tibiofemoral joint)and improve her ROM. We then performed stretches to her quadriceps and gave her a session of interferential to deal with any pain she was feeling and also to improve the blood flow to the injury site.
During treatment; the woman complained of pain in her knee; i believe as my supivisor later told me that i was performing the AP with "a little to much enthusiasm" and possibly she could have felt pain on her bony prominance, from the constant pressure. He advised me next time to "move my hand placement but still glide in the same joint line plane; in order to spread out the pressure".
Otherwise i was generally happy with the way things progressed today! :).
For furuture cases I think i need to have another look at one of my anatomy books; it seems that particularily in musculoskeletal physiotherapy you need to know your surface anatomy VERY WELL!.
Sunday, October 19, 2008
UPDATE
Sorry about the absent blogging! but i've had difficulty accessing a computer!.
My First Week at Marmion Physiotherapy clinic has been very tame. I'm mostly getting to know the patients and observing alot of treatment. At least 60% of the cases that are presented are back and neck problems, so its been a reall learning curve as spinal assessment and treatment are the components of 3rd year.
There was one situation where a gentlemen walked in with LBP. My supivisor assessed him as having a tight pirformis and trigger points in his glute max. I was asked to perform deep tissue massage. I was particularily a bit unconfortable as he was a male and this is quiet a private area, however i ignored my "unconfortableness" and began to converse with the patient. i made myslef hide the unconfortableness and tried to be as professional as possible. I found i even loosened up at the end of the treatment. In a way im glad i had this experience as i learnt that the more relaxed and professional i am, the more at ease my patient will feel; and this is necessary to a sucessfull treatment.
I found that in completing the treatment my patient had more pain relief and greater ROM in hip flexion and medial rotation.
My supivisor advised me to use my elbow next time in treatment as the olecranon is fantastic for applying pressure to knots etc. Next time i will use this technique alswell as it seemes to have a more effective result in 'direct' application of pressue to the problem area.
In the following weeks ill be doing alot of assessments/SOAPIERS and treatment with electrotherapy, massage and getting in the pool- teaching hydrotherapy classes etc.
P.s I promise to be more regular in my following weeks of blogging JO!.
My First Week at Marmion Physiotherapy clinic has been very tame. I'm mostly getting to know the patients and observing alot of treatment. At least 60% of the cases that are presented are back and neck problems, so its been a reall learning curve as spinal assessment and treatment are the components of 3rd year.
There was one situation where a gentlemen walked in with LBP. My supivisor assessed him as having a tight pirformis and trigger points in his glute max. I was asked to perform deep tissue massage. I was particularily a bit unconfortable as he was a male and this is quiet a private area, however i ignored my "unconfortableness" and began to converse with the patient. i made myslef hide the unconfortableness and tried to be as professional as possible. I found i even loosened up at the end of the treatment. In a way im glad i had this experience as i learnt that the more relaxed and professional i am, the more at ease my patient will feel; and this is necessary to a sucessfull treatment.
I found that in completing the treatment my patient had more pain relief and greater ROM in hip flexion and medial rotation.
My supivisor advised me to use my elbow next time in treatment as the olecranon is fantastic for applying pressure to knots etc. Next time i will use this technique alswell as it seemes to have a more effective result in 'direct' application of pressue to the problem area.
In the following weeks ill be doing alot of assessments/SOAPIERS and treatment with electrotherapy, massage and getting in the pool- teaching hydrotherapy classes etc.
P.s I promise to be more regular in my following weeks of blogging JO!.
Saturday, October 11, 2008
Initial Entry
I'm really looking forward to my musculoskeletal placement at Marminon Sports Clinic. Talking just recently to my supivisor; I get the impression that i will be really challenged and stretched at this place. this has got me a bit aprehensive but also very excited.
I am a little worried that im not going to remeber all of my anatomy that well; and im sure that there will be a few situations where im unsure of what is the cause of a certain problem, but im hoping they are in the minority!.
This is a private practice setting so the physios working in this clinical placement work closley with all types of HCP for referals etc. Examples of these HCP could be a doctor, a podiatrist, a OT etc.
I am a little worried that im not going to remeber all of my anatomy that well; and im sure that there will be a few situations where im unsure of what is the cause of a certain problem, but im hoping they are in the minority!.
This is a private practice setting so the physios working in this clinical placement work closley with all types of HCP for referals etc. Examples of these HCP could be a doctor, a podiatrist, a OT etc.
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