I thoroughly enjoyed this placement. I have loved living away from home and being independent in that sense. Getting to the hospital was easy and only a short drive from my home.
In the morning I ran the ward so a lot of my patients in the ward consisted of mobility patients and cardio respiratory patients. While in the afternoon I saw outpatients. This meant I got a great range of exposure in the cardio respiratory, gerontology, musculoskeletal and even neurology sectors of physiotherapy. I even saw a lot of women’s health patients. Firstly acutely in the hospital, after they had birthed their child and then 6 weeks after their birth for ongoing problems in the outpatient sector. I was glad to be involved with the women’s health patients, as I had not had a rotation with women’s health before.
I did learn very early on that prioritising your patient list is essential. As there was only one physiotherapist allocated to the ward patients (in the morning from 8am- 12pm) it was imperative to have good time management skills. By the end of the placement I was running the ward independently. This was a great experience.
I was initially expecting a lot of the conditions to be very different from the conditions down in Perth but I found that
I even got to do some home visits with the occupational therapist. The home visits were very surprising. I was able to see how the aboriginal people lived and the great difference between the European/Australian culture and the indigenous culture. I found some of the people lived bellow the poverty line, however they seemed content in their lifestyle. It was very enlightening and refreshing to be exposed to their way of life.
I loved working with the aboriginal people, I initially found it quiet difficult to relate with them but after establishing a rapport with the patients I was able to converse with them quiet naturally.
In the outpatient sector I found that the indigenous people did tend to be tardy, sometimes turning up to the clinic half an hour after their treatment session. Other times they would just turn up on a given day and expect to be treated. It was difficult in some senses because the person needed treatment, so I found myself sometimes working my schedule around so I could see the patient when they presented. I also did find that the indigenous people didn’t tend to do their exercises, so usually I would give them 1 or 2 exercises that I would stress were very important and then tried to kept them as simple as I could.
I have learnt so much from this placment, and i am thrilled that i have had the opportunity to work closley with the aboriginal people.
Sunday, July 25, 2010
Week 5
Situation
On the final week of my placement, a patient was referred to me from a doctor in the emergency department at Broome health campus. My patient was a 23 year old man that had a suspected tear of his anterior talo-fibular ligament . He did the accident 1 day ago while jumping off a truck, he rolled his right ankle inwards. At the time of the injury there was no crack but he immediately felt pain in the ankle and he could not walk on it. This man had an x-ray performed of his right foot, on the day the ankle was injured, the x-ray revealed no broken bones.
He told me that he had broken his fibula 5 years ago on the left and had sprained both his ankles multiple times.
He drives trucks on a farm and is anxious about when he can return to work.
I performed a subjective and objective assessment. On the objective assessment I found he was very tender around the lateral aspect of the malleolus and the ankle itself was grossly swollen. His active range of motion was also limited in all directions. He also couldn’t walk on the ankle at all. He was mobilising with auxiliary crutches.
Task
My task was to treat this man for his suspected tear of the anterior talo-fibular ligament.
Action
I talked to this man about his injury, showed him where the ligament was on a diagram and then told him his expected healing time. I then performed ultrasound on this man for 5 minutes. I then educated him about the swelling management; icing the ankle for 15 minute time slots, elevating it on pillows, and resting it. I also gave him some tubi-grip to help with compression. I then taped the ankle up using sports tape.
Result
I ended up giving this man a 35 minute treatment session where I gave him acute management techniques for his expected tear of the anterior talo-fibular ligament.
Evaluation
I think that I explained the condition to this man well and gave him a good explanation of his expected recovery time. I think I also performed the ultrasound well ( using acute settings) and gave him good swelling management techniques.
I don’t think my taping was good at all. I think i had far too many crinkles in the tape. I also think some of the pieces of tape were too short, to provide adequate support while other pieces of tape were too tight on his foot, especially when he stood up, he said it felt very tight across his forefoot. I had to reapply the ‘heel-locks’, many times because I don’t think I positioned the tape in the right place, I defiantly need more practice at this strapping technique.
Strategies
I thought of some strategies to help me the next time I came across an ankle that needed taping.
- Make sure the ankle is in neutral (planter-grade) or even with the toes pointing a little upwards (dorsiflexion) before I begin taping.
- I think I could gain a lot of practice from taping other people’s feet. I will try to use the taping techniques on my friends and family.
- In the initial stages of an ankle strain, compression is the objective, so in these stages I must apply tape liberally over the ankle using techniques such as stirrups, and bilateral heels locks etc. with the objective of using the tape to reduce the swelling.
- After a lot of the gross swelling has gone down, supporting the ankle is imperative, and preventing it from re-injuring in vulnerable directions. So in an inversion injury applying the tape to prevent inversion would be the best course of action, in the sub-acute stages.
- Next time I will splaying the metatarsals wide before taping across the forefoot (using your fist on the planter surface of the ball of the patients foot) so that I don’t cause too much compression across the foot.
- I thought that I could measure the tape on the non-adhesive side before ripping it off. This way I will never have a piece of tape that is too short.
On the final week of my placement, a patient was referred to me from a doctor in the emergency department at Broome health campus. My patient was a 23 year old man that had a suspected tear of his anterior talo-fibular ligament . He did the accident 1 day ago while jumping off a truck, he rolled his right ankle inwards. At the time of the injury there was no crack but he immediately felt pain in the ankle and he could not walk on it. This man had an x-ray performed of his right foot, on the day the ankle was injured, the x-ray revealed no broken bones.
He told me that he had broken his fibula 5 years ago on the left and had sprained both his ankles multiple times.
He drives trucks on a farm and is anxious about when he can return to work.
I performed a subjective and objective assessment. On the objective assessment I found he was very tender around the lateral aspect of the malleolus and the ankle itself was grossly swollen. His active range of motion was also limited in all directions. He also couldn’t walk on the ankle at all. He was mobilising with auxiliary crutches.
Task
My task was to treat this man for his suspected tear of the anterior talo-fibular ligament.
Action
I talked to this man about his injury, showed him where the ligament was on a diagram and then told him his expected healing time. I then performed ultrasound on this man for 5 minutes. I then educated him about the swelling management; icing the ankle for 15 minute time slots, elevating it on pillows, and resting it. I also gave him some tubi-grip to help with compression. I then taped the ankle up using sports tape.
Result
I ended up giving this man a 35 minute treatment session where I gave him acute management techniques for his expected tear of the anterior talo-fibular ligament.
Evaluation
I think that I explained the condition to this man well and gave him a good explanation of his expected recovery time. I think I also performed the ultrasound well ( using acute settings) and gave him good swelling management techniques.
I don’t think my taping was good at all. I think i had far too many crinkles in the tape. I also think some of the pieces of tape were too short, to provide adequate support while other pieces of tape were too tight on his foot, especially when he stood up, he said it felt very tight across his forefoot. I had to reapply the ‘heel-locks’, many times because I don’t think I positioned the tape in the right place, I defiantly need more practice at this strapping technique.
Strategies
I thought of some strategies to help me the next time I came across an ankle that needed taping.
- Make sure the ankle is in neutral (planter-grade) or even with the toes pointing a little upwards (dorsiflexion) before I begin taping.
- I think I could gain a lot of practice from taping other people’s feet. I will try to use the taping techniques on my friends and family.
- In the initial stages of an ankle strain, compression is the objective, so in these stages I must apply tape liberally over the ankle using techniques such as stirrups, and bilateral heels locks etc. with the objective of using the tape to reduce the swelling.
- After a lot of the gross swelling has gone down, supporting the ankle is imperative, and preventing it from re-injuring in vulnerable directions. So in an inversion injury applying the tape to prevent inversion would be the best course of action, in the sub-acute stages.
- Next time I will splaying the metatarsals wide before taping across the forefoot (using your fist on the planter surface of the ball of the patients foot) so that I don’t cause too much compression across the foot.
- I thought that I could measure the tape on the non-adhesive side before ripping it off. This way I will never have a piece of tape that is too short.
Saturday, July 10, 2010
WEEK 3- 2nd Entry
Situation
In my third week of my placement I was given a referral for a 25year old male who had been referred by the occupational therapist in Broome Health Campus. The occupational therapist suspected tendonitis of the digiti minimi tendon in his left hand. He had been having a deep ache in his left hand for over 1 week. His past medical history included a previous fracture to his left scaphoid bone that was internally fixed 10 years ago, a left collar bone fracture over 5 years ago and gall stones which he has due to hav skin impedance and make it more difficult for the electronic treatment device to have the desired effect. e removed in two weeks.
His occupation was a pilot, and he was finding that he was experiencing increasing amounts of pain in his hand when he was flying the planes on longer journeys. I introduced myself and I asked him to come through to the treatment room with me and I performed a subjective and objective assessment. I found that he had pain at the end of range of pronation and wrist flexion, tenderness on palpation of his digiti minimi tendon and weakness on 5th finger extension when the left finger was compared to the right finger.
Task
I was asked to assess and treat this man with possible tendonitis of the digiti minimi tendon.
Action
In the treatment session I did the following;
- Firstly I performed deep tissue massage to his digiti minimi tendon with transverse tendon friction.
- I then performed ultrasound to his digiti minimi tendon.
- I advised him to wear his resting brace as much as possible during the next two weeks.
- I educated him about tendonitis, the pathology of the condition and its approximate healing time.
- I also informed him about taking anti-inflammatory medication (such as Neurophen) and its role in helping decrease the pain in tendonitis.
Result
The result was I effectively treated this man for 40 minutes, identifying his astrics signs and using the mentioned methods to address his problem list.
Evaluation
I think the treatment session went ok, I did identify that this man was in his acute phase of tendonitis, and I effectively treated the pathology and addressed his pain management.
However, I think I should have progressed this man earlier on, I think I should have given him strengthening exercises ( eccentric) within a pain free range as he was young and only mildly irritable. Originally I was going to give him the strengthening exercises on his next visit, however on reflection I think it would have been more effective to give them earlier on.I think I should have though about what order I performed my treatment in; before I administered it. I think I should have performed my education first, then my ultrasound, then my deep tissue massage with transverse tendon frictions. This would have made the treatment session flow better, in addition it would have prevented the problem of increased skin impedance with the electronic device (due to the cream used in the massage).
Strategies
I think I could defiantly improve my treatment of this individual next time if I took into consideration the following points;
- Always check how effective my treatment has been by assessing the astricks signs after one repetition of treatment. This makes me more aware if my treatment was effective and what part of my combination of treatment yielded the most results/progress.
- Use diagrams to help explain to the patient how the intervention/ treatment can be effective
- Start progressing the individual early on in the intervention; even if treating an acute problem sometimes its appropriate to give them exercises earlier on (depending on their irritability level). Don’t wait for the next treatment session to start progressing them.
- If using ultrasound and also massaging, consider using the ultrasound or electrical device first in the treatment session. The reason for this being that having things like oil or cream on the skin can add to skin impedance and make it more difficult for the electronic treatment device to have the desired effect.
In my third week of my placement I was given a referral for a 25year old male who had been referred by the occupational therapist in Broome Health Campus. The occupational therapist suspected tendonitis of the digiti minimi tendon in his left hand. He had been having a deep ache in his left hand for over 1 week. His past medical history included a previous fracture to his left scaphoid bone that was internally fixed 10 years ago, a left collar bone fracture over 5 years ago and gall stones which he has due to hav skin impedance and make it more difficult for the electronic treatment device to have the desired effect. e removed in two weeks.
His occupation was a pilot, and he was finding that he was experiencing increasing amounts of pain in his hand when he was flying the planes on longer journeys. I introduced myself and I asked him to come through to the treatment room with me and I performed a subjective and objective assessment. I found that he had pain at the end of range of pronation and wrist flexion, tenderness on palpation of his digiti minimi tendon and weakness on 5th finger extension when the left finger was compared to the right finger.
Task
I was asked to assess and treat this man with possible tendonitis of the digiti minimi tendon.
Action
In the treatment session I did the following;
- Firstly I performed deep tissue massage to his digiti minimi tendon with transverse tendon friction.
- I then performed ultrasound to his digiti minimi tendon.
- I advised him to wear his resting brace as much as possible during the next two weeks.
- I educated him about tendonitis, the pathology of the condition and its approximate healing time.
- I also informed him about taking anti-inflammatory medication (such as Neurophen) and its role in helping decrease the pain in tendonitis.
Result
The result was I effectively treated this man for 40 minutes, identifying his astrics signs and using the mentioned methods to address his problem list.
Evaluation
I think the treatment session went ok, I did identify that this man was in his acute phase of tendonitis, and I effectively treated the pathology and addressed his pain management.
However, I think I should have progressed this man earlier on, I think I should have given him strengthening exercises ( eccentric) within a pain free range as he was young and only mildly irritable. Originally I was going to give him the strengthening exercises on his next visit, however on reflection I think it would have been more effective to give them earlier on.I think I should have though about what order I performed my treatment in; before I administered it. I think I should have performed my education first, then my ultrasound, then my deep tissue massage with transverse tendon frictions. This would have made the treatment session flow better, in addition it would have prevented the problem of increased skin impedance with the electronic device (due to the cream used in the massage).
Strategies
I think I could defiantly improve my treatment of this individual next time if I took into consideration the following points;
- Always check how effective my treatment has been by assessing the astricks signs after one repetition of treatment. This makes me more aware if my treatment was effective and what part of my combination of treatment yielded the most results/progress.
- Use diagrams to help explain to the patient how the intervention/ treatment can be effective
- Start progressing the individual early on in the intervention; even if treating an acute problem sometimes its appropriate to give them exercises earlier on (depending on their irritability level). Don’t wait for the next treatment session to start progressing them.
- If using ultrasound and also massaging, consider using the ultrasound or electrical device first in the treatment session. The reason for this being that having things like oil or cream on the skin can add to skin impedance and make it more difficult for the electronic treatment device to have the desired effect.
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