Situation
On the first week of my placement on the 23/06/10 I was asked to perform a subjective and objective assessment on a 22 year old woman of aboriginal decent. This woman had given birth to a baby girl the day before on the 22/06/10. This was the first baby she had birthed, she had previously miscarried one other child. The baby was 2.956kg but otherwise healthy , the woman had a long second stage of labour ( 1 hour) and she sustained a 3rd degree tear to her perineum, the birthing process was a difficult one and the doctor decided to use forceps to aid in the delivery process. She was resting in bed when I arrived in her room and the baby was asleep in the cot/cubicle.
This was my first practical where I had been exposed to women’s health physiotherapy. I was very unsure about how this session would go.
Task
I was asked to perform a subjective and objective assessment on this 22 year old woman and then proceeded to treat the women with my supervisor.
Action
I went into the room, introduced myself and first began questioning the young aboriginal girl. I asked her about her pain levels, if she was doing anything about her tear, her urine leakage, any back pain she was having, what her usual level of activity was before and during the pregnancy, I also asked her if she had heard about pelvic floor muscles and did she know what pelvic floor exercises were.
I then performed an objective assessment, I then measured her diastases and had a look at her abdominal tone, I also noted her posture during the assessment and how she was breathing. I also noted her level of contraction of transverse abdominus when I taught her a pelvic floor muscle contraction. It would have been good to see her perineum to note the level of tissue injury (I did read in the notes that it was a 3rd degree tear) but she was uncomfortable with this, so we did not perform this part of the assessment.
Result
I performed the subjective and objective assessment and from this accurately found out her problem list so I could develop a treatment plan for this young mother.
Evaluation
I think that the session went poorly I don’t think the young girl trusted me; she seemed very reserved and didn’t really want to talk to me about certain symptoms she was experiencing, for example it took a lot of questioning to find out she was having urine leakage. It took me a very long time to describe the pelvic floor and the reasons for the symptoms she was having. The whole assessment went for 25minuites. It was even difficult to assess her diastases between the rectus abdomens muscles, because she was reluctant to participate in the assessment session.
I think there were only a few strengths with my session. I think I got all the questions out that I needed to ask her. I think I also accurately found out her problems;
1) weak pelvic floor muscles, 2) a large diastisis 3) poor abdominal tone 4) a 3rd degree tear in the perineum.
Strategies
I was thinking of how I could improve next session if I was faced with another young aboriginal mother. I came up with a list of strategies that would help with the subjective and objective part of my session:
1. When dealing with aboriginal people who sometimes don’t have a good grasp of the English language, use simplified descriptions of what is occurring and it’s also helpful to use analogies so they better understand the problem.
2. Ask direct questions; sometimes even explaining why you need to ask them a certain question. ( i.e. if you have to ask if they have had any leakage of urine?; I would explaining to her that “this will tell me if you may have a pelvic floor weakness”.)
3. Keep the questioning as short as possible, often only asking impertinent questions as they can loose attention easily and can get very agitated with all the questioning.
4. Use diagrams and pictures when explaining muscles like the pelvic floor as they are easier explained in a diagram.
5. Try to find a common ground with aboriginal people i.e. develop a report with them so they gain a certain amount of trust in you, and you don’t appear as threatening to them. This also makes it easier when progressing to the treatment phase.
6. When assessing someone who is sitting down if you are standing, always lower yourself to their level or sit lower than them so you don’t seem domineering.
Saturday, June 26, 2010
Sunday, June 20, 2010
Initial Entry- Broome Health Campus
On my fourth rotation I have been placed at Broome Hospital Health Campus. I am really excited about this placement. It is a lot different than all my other placements which were situated in Perth. After the 5 weeks though I think I will be looking forward to coming home again.
I am living in a house which is only a 5 minute drive from Broome Health campus so getting to the hospital will not be a big issue, unlike my other placements which have been sometimes an hour away. I start each day at 8am and finish at 4pm.
From reading the reports on the internet and from talking to another student, I expect to be involved in a wide range of physiotherapy sectors. I expect to see cardiorespiratory, neurology and post-operative patients. In addition to this I will also be involved in women’s health physiotherapy; I am excited about this as I haven’t had a placement that covers women’s health as yet, I will need to pull out my notes from women’s health in third year. I am not sure wether I will be involved in the outpatients sector as well. But overall im glad that I will be involved in such a broad range of physiotherapy sectors as I think it will help me consolidate all my knowledge from previous placements.
As this is a regional sort of hospital, there are only a few physiotherapists that cover the whole hospital, so I expect that there may be a large caseload. I think I will need to learn how to prioritise my patient list so that I can see all the patients that urgently need treatment.
I assume that a lot of my patients will be indigenous patients. I have heard it is sometimes very difficult to establish good treatment with these people. Firstly because of their differences to Westerners with respect to time. Aboriginal people will often attend physiotherapy sessions a lot later than their allotted time; this can be very difficult when you are working on a timed schedule. Secondly I have heard that they often do not complete their exercises; as this is often an impertinent part of physiotherapy, it could be very challenging to treat the indigenous people.
I am hoping to get exposed to the aboriginal culture while on this placement. I hope by the end of this placement I have a greater understanding of the aboriginal lifestyle and their culture, back in Perth I think I have become a bit ignorant of their way of life and traditions.
I am living in a house which is only a 5 minute drive from Broome Health campus so getting to the hospital will not be a big issue, unlike my other placements which have been sometimes an hour away. I start each day at 8am and finish at 4pm.
From reading the reports on the internet and from talking to another student, I expect to be involved in a wide range of physiotherapy sectors. I expect to see cardiorespiratory, neurology and post-operative patients. In addition to this I will also be involved in women’s health physiotherapy; I am excited about this as I haven’t had a placement that covers women’s health as yet, I will need to pull out my notes from women’s health in third year. I am not sure wether I will be involved in the outpatients sector as well. But overall im glad that I will be involved in such a broad range of physiotherapy sectors as I think it will help me consolidate all my knowledge from previous placements.
As this is a regional sort of hospital, there are only a few physiotherapists that cover the whole hospital, so I expect that there may be a large caseload. I think I will need to learn how to prioritise my patient list so that I can see all the patients that urgently need treatment.
I assume that a lot of my patients will be indigenous patients. I have heard it is sometimes very difficult to establish good treatment with these people. Firstly because of their differences to Westerners with respect to time. Aboriginal people will often attend physiotherapy sessions a lot later than their allotted time; this can be very difficult when you are working on a timed schedule. Secondly I have heard that they often do not complete their exercises; as this is often an impertinent part of physiotherapy, it could be very challenging to treat the indigenous people.
I am hoping to get exposed to the aboriginal culture while on this placement. I hope by the end of this placement I have a greater understanding of the aboriginal lifestyle and their culture, back in Perth I think I have become a bit ignorant of their way of life and traditions.
Sunday, June 13, 2010
FINAL ENTRY
I really enjoyed this placement. I really enjoyed being in the outpatients sector. It was good to be able to speak to people that weren’t sick, and it was nice to be dealing with people whose whole purpose for coming into hospital was for physiotherapy treatment. They seemed a lot more receptive than some of the inpatients I have dealt with in my other placements.
I did get to see acute surgical patients ( that had come from a total knee replacement or an ACL reconstruction,) right through to the chronic back pain patients.
I did get a lot of patients that were post-operative, however there were a number of patients that came in with undiagnosed conditions, with referrals from doctors saying “longstanding pain in the knee””. I was very pleased to have patients like this because it tested my diagnostic skills.
I found I got exposure to a very wide range of patients I even got to see a few neurological patients, I had one lady with ulna nerve damage and another with carpal tunnel syndrome, I also had a lady with neural compromise, it was really interesting to see her symptoms.
There was also a large age range in the patients I saw, I saw a girl who has 13 and I also saw a lady that was 88. It was great to be able to have such a large range because I could work on my communication skills; it was challenging trying to relate to the younger patient and then quickly change my tactics to be able to relate to the elderly lady.
I got to see surgery 3 times while at Swan Districts Hospital, it was an incredible experience, I was able to witness an ACL reconstruction and a knee and shoulder arthroscopy. I think I’m able to have a better appreciation for what a patient has gone through after witnessing surgery like that.
Getting to Swan Districts took along time, especially in the mornings, sometimes in peak hour it would take up to 1hour and a half; I usually seemed to leave the hospital just before the peak hour rush home, so it took a lot less time to come home.
I really did enjoy this placement, I learnt a lot while on this placement and I think I can defiantly take those new skills with me into the future.
I did get to see acute surgical patients ( that had come from a total knee replacement or an ACL reconstruction,) right through to the chronic back pain patients.
I did get a lot of patients that were post-operative, however there were a number of patients that came in with undiagnosed conditions, with referrals from doctors saying “longstanding pain in the knee””. I was very pleased to have patients like this because it tested my diagnostic skills.
I found I got exposure to a very wide range of patients I even got to see a few neurological patients, I had one lady with ulna nerve damage and another with carpal tunnel syndrome, I also had a lady with neural compromise, it was really interesting to see her symptoms.
There was also a large age range in the patients I saw, I saw a girl who has 13 and I also saw a lady that was 88. It was great to be able to have such a large range because I could work on my communication skills; it was challenging trying to relate to the younger patient and then quickly change my tactics to be able to relate to the elderly lady.
I got to see surgery 3 times while at Swan Districts Hospital, it was an incredible experience, I was able to witness an ACL reconstruction and a knee and shoulder arthroscopy. I think I’m able to have a better appreciation for what a patient has gone through after witnessing surgery like that.
Getting to Swan Districts took along time, especially in the mornings, sometimes in peak hour it would take up to 1hour and a half; I usually seemed to leave the hospital just before the peak hour rush home, so it took a lot less time to come home.
I really did enjoy this placement, I learnt a lot while on this placement and I think I can defiantly take those new skills with me into the future.
WEEK 5
Situation
On the last week of my placement; the 09/06/10 I was given a referral for a 22 year old female. She had been referred for right sided knee pain, the onset was 2 months ago and it seemed to come on gradually. She revealed she had most of her pain while sitting for extended periods or going up stairs.
She had come into her physiotherapy appointment with her x-rays of her right knee; they revealed a very lateral sitting patella.
Her past medical history included a transposition of her left patella in July 2009, a fracture to her left talus in 2005 and multiple bilateral sprained ankles. She lived at home with her parents and was completing her university degree. She was also a very active basketball player, but since the onset of her pain, has had to rest from the sport, she was very keen to return to it.
The referring doctor suggested that she had patello-femoral pain, but the girl wished try conservative treatment (physiotherapy) before considering surgery again, even though her left operation had been very successful.
Task
My Supervisor asked me to assess and treat this girl with possible right sided patello-femoral knee pain.
Action
I performed a subjective assessment and then did a quick observation of her patella, I then assessed her active range of motion, and I performed special tests such as McConnell’s, Patella apprehension and Clark’s tests.
Result
These tests confirmed to me that this girl had patello-femoral pain. The assessment gave me a good indicators to which i could measure the effectiveness of my treatment.
Evaluation
I think there were some positive points to my objective assessment, I think I assessed most of the impertinent indicators of patellofemoral pain, such as pain scores, position of the patella, active range of motion for knee flexion, and special tests such as Clark’s and Patella Apprehension.
However I don’t think my objective assessment was fluid, I think I jumped all over the place, and it didn’t run smoothly. I think I also missed a few assessments such as muscle length ( in this case ITB length) and muscle strength ( of the hip) and I didn’t perform a quick test such as a squat.
When performing an objective assessment session I need to be more systematic in the way I go about assessing a patients impairments.This will not only make the session run smoother, it will also clearly indicate to me the astricts signs, so I can correctly measure their improvement, if there is any.
Strategies
I think if I followed a step-by step assessment plan it would be easier to identify the astricts signs and I will from these signs be able to show an adequate improvement in the patients condition. I think I should write the following steps on paper before beginning an assessment to jog my memory of what order I carry the session out and it will help me not to miss any of the assessments.
Observations (position of the patella, pronating feet etc.)
Quick tests ( Squat, pain score for that )
Active Range of Motion
Passive Range of Motion
Neurological integrity/dynamics ( if indicated)
Muscle length and strength tests.
Special Tests ( in this case Clark’s test, patella apprehension test, and McConnels test)
On the last week of my placement; the 09/06/10 I was given a referral for a 22 year old female. She had been referred for right sided knee pain, the onset was 2 months ago and it seemed to come on gradually. She revealed she had most of her pain while sitting for extended periods or going up stairs.
She had come into her physiotherapy appointment with her x-rays of her right knee; they revealed a very lateral sitting patella.
Her past medical history included a transposition of her left patella in July 2009, a fracture to her left talus in 2005 and multiple bilateral sprained ankles. She lived at home with her parents and was completing her university degree. She was also a very active basketball player, but since the onset of her pain, has had to rest from the sport, she was very keen to return to it.
The referring doctor suggested that she had patello-femoral pain, but the girl wished try conservative treatment (physiotherapy) before considering surgery again, even though her left operation had been very successful.
Task
My Supervisor asked me to assess and treat this girl with possible right sided patello-femoral knee pain.
Action
I performed a subjective assessment and then did a quick observation of her patella, I then assessed her active range of motion, and I performed special tests such as McConnell’s, Patella apprehension and Clark’s tests.
Result
These tests confirmed to me that this girl had patello-femoral pain. The assessment gave me a good indicators to which i could measure the effectiveness of my treatment.
Evaluation
I think there were some positive points to my objective assessment, I think I assessed most of the impertinent indicators of patellofemoral pain, such as pain scores, position of the patella, active range of motion for knee flexion, and special tests such as Clark’s and Patella Apprehension.
However I don’t think my objective assessment was fluid, I think I jumped all over the place, and it didn’t run smoothly. I think I also missed a few assessments such as muscle length ( in this case ITB length) and muscle strength ( of the hip) and I didn’t perform a quick test such as a squat.
When performing an objective assessment session I need to be more systematic in the way I go about assessing a patients impairments.This will not only make the session run smoother, it will also clearly indicate to me the astricts signs, so I can correctly measure their improvement, if there is any.
Strategies
I think if I followed a step-by step assessment plan it would be easier to identify the astricts signs and I will from these signs be able to show an adequate improvement in the patients condition. I think I should write the following steps on paper before beginning an assessment to jog my memory of what order I carry the session out and it will help me not to miss any of the assessments.
Observations (position of the patella, pronating feet etc.)
Quick tests ( Squat, pain score for that )
Active Range of Motion
Passive Range of Motion
Neurological integrity/dynamics ( if indicated)
Muscle length and strength tests.
Special Tests ( in this case Clark’s test, patella apprehension test, and McConnels test)
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