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.
Saturday, June 26, 2010
1st Entry- WEEK 1
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.
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.
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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