S-my collegues and i were assigned a 72 y.o. F, with a diagnosis of infected glands, dec. blood pressure ,ARF ( acutre renal failure), a R CVA 3 y. ago and a series of recent falls around the house. She presented with very swollen odetimus LL, the L knee bruised and even more swollen than the R ( this was due to a recent fall). She had a considerable reduction in all ROM of her LL and subsequent reduction in her balnce due to the swelling.
T- We decided to adress the, swollen limbs as she has dec. ROM in her LL and hence her balance was also very poor.
A- As a result we used , lymph massage, elevation icing and compression with tubigrip.
R- the result was terrible!. The tubigrip had pushed the swelling right up into her thighs, and although the compression bandage had retuned the shins back to a normal size, it had just directed the swelling into a higher another area, NOT the result we were hoping for.
E - Our supervising physiotherapist informed us that this was the wrong course of action as we as physio's cannot deal with this particular ladys swelling, as the CAUSE of the swelling could have been a number of things and it is best to leave this to the doctors field. She advised that we were better to look at strengthening type activities.
S-I have learnt that in a hospital situation you are faced with a patient who may have many problems going on at the same time, and as a physiotherapist you can only Rx those problems which relate to your field.
I have learnt that swelling in the LL can be attributed to heart failure, (AF or any pacemakers, as we have not completed our cardiorespiratory unit; we were not informed of this) , or ARF, incorrectly we assumed the oedema in the LL were attributed to an accumulation of lymph fluid.
Instead of following this form of Rx with this leady we decided to instead that adressing the following problems would be a better course of action:
Firstly treating the swelling in her L Knee that was actually created by the fall she had, using iceing every 20 min and elevation,
Secondly implementing a strengthenin programme, including exercises toadress weakness in her quadriceps and her glut. med
Thirdly looking at her transfers, teaching her new ways of transfering from chair- chair.
Lastly looking at her balance and implementing dynamic balance exercises. Also giving falls awareness and education.
Friday, July 31, 2009
Saturday, July 25, 2009
Placement 2-Hollywood Hospital-Initial Entry
I have been placed in the Gerentology/Neurology section for Hollywood Hospital.
I'am excitied about experiencing a different section of physiotherapy, and being activley involved in the assessment and treatment process. I do enjoy working with older people so im glad that i will get the opportunity to deal with some of the elderly and hopefully help them with their problems. I'll be there 5 days a week from 8 in the morning till 4 in the afternoon, i think i could be a bit exhausted after the first week!.
However, I am a bit worried about being thrown in the deep end, i have been told some students are given their first patients day one and simply told to ""go ahead and treat them"". I'am hoping to eventually get my own patients but i would like a bit of direction to begin with.
I'am slightly apprehensive about going on this placement, as i havent had any physiotherapy experience in a hospital setting before. My last placement was in a private practice, and was a musculoskeletal placement, wich i feel is a bit more straight forward than a neurology placement.
I don't think Neurology is my strongest section of phsyiotherapy, however I'm determined to give it my best shot.
Tonight could be a late night, doing some last minuite study of Alisons' Nero tutorials!!.
I'am excitied about experiencing a different section of physiotherapy, and being activley involved in the assessment and treatment process. I do enjoy working with older people so im glad that i will get the opportunity to deal with some of the elderly and hopefully help them with their problems. I'll be there 5 days a week from 8 in the morning till 4 in the afternoon, i think i could be a bit exhausted after the first week!.
However, I am a bit worried about being thrown in the deep end, i have been told some students are given their first patients day one and simply told to ""go ahead and treat them"". I'am hoping to eventually get my own patients but i would like a bit of direction to begin with.
I'am slightly apprehensive about going on this placement, as i havent had any physiotherapy experience in a hospital setting before. My last placement was in a private practice, and was a musculoskeletal placement, wich i feel is a bit more straight forward than a neurology placement.
I don't think Neurology is my strongest section of phsyiotherapy, however I'm determined to give it my best shot.
Tonight could be a late night, doing some last minuite study of Alisons' Nero tutorials!!.
Tuesday, December 2, 2008
FINAL ENTRY
So Sorry Jodie and Jo!,
I really did enjoy my Clinical education unit/prac placement this year. I felt like i was for the first time exposed to what physiotherapy is in a practicle sence. Clincial education opened my eyes to see that sometimes what you learn in theory/uni is sometimes not usefull or apllicable to do in a practicle situation.
I felt i was exposed
- a whole range of treatment options for conditions, such as lateral epicondyladure, and post operation conditions.
- i also noted that sometimes the treatment not only changes in doses as the person improves but also that the treatment can change in modalities as the person progresses in their recovery.
- gym sessions
- hydrotherapy sessions
- new machines such as traction devices, and different types of ultrasound/interferential therapy machies.
- i learnt to use my bodyweight to my advantage when treating patients, which is sometimes very important as a girl.
- i also learnt more about objective examination and that basically anything you dont measure you wont know if it improves.
However i was a bit dissapointed with the lack of paticipation and involvment that i
in this particular private practice 60-80% of the patiets were spinal patients and i was a bit annoyed that i didn't get to see more perpipheral problems. The reason for this being that i havent as yet studied the spine, but have studied the perpiphery.
I really did enjoy my Clinical education unit/prac placement this year. I felt like i was for the first time exposed to what physiotherapy is in a practicle sence. Clincial education opened my eyes to see that sometimes what you learn in theory/uni is sometimes not usefull or apllicable to do in a practicle situation.
I felt i was exposed
- a whole range of treatment options for conditions, such as lateral epicondyladure, and post operation conditions.
- i also noted that sometimes the treatment not only changes in doses as the person improves but also that the treatment can change in modalities as the person progresses in their recovery.
- gym sessions
- hydrotherapy sessions
- new machines such as traction devices, and different types of ultrasound/interferential therapy machies.
- i learnt to use my bodyweight to my advantage when treating patients, which is sometimes very important as a girl.
- i also learnt more about objective examination and that basically anything you dont measure you wont know if it improves.
However i was a bit dissapointed with the lack of paticipation and involvment that i
in this particular private practice 60-80% of the patiets were spinal patients and i was a bit annoyed that i didn't get to see more perpipheral problems. The reason for this being that i havent as yet studied the spine, but have studied the perpiphery.
Friday, November 28, 2008
WEEK 5 POST 3
Well this is my final post, Sorry its taken so long Jodie and Jo, i didn't realise i hadn't completed it untill i checked my email!!!
Today i performed treatment on a 16 year old boy with extensor tendinopathy. He had limited range of movement in extension, although there was only pain on resisted extension with radial deviation, third finger extension and power grip, there was no pain with unresisted extension. My supivisor decided that we would perform, deep tissue massage with triggerpointing to ECRB and ED, dry needling * although it would have been cool to perform this, my supivisor took over there :P* interferential therapy and also that we would give him some home exercises to stretch out his extensor tendons and strengthen them with some excentric loading.
I performed DTM ( deep tissue massage) with triggerpointing to his extensor tendons , and i progressed it with placing the extensor tendons in a more lengthened position, ie with his wrist in a flexed position. I felt that after treatment although he seemed a little sore, he was able to gain more movement; my supivisor then decided that dry needling the tendons would also be benificial.
On application of the interferential modalitiesi found it difficult to place all the electrodes around his arm without allowing them to touch eachother!. as the forearm is quiet a small area, i later asked my supivisor who said that placing the channels furthur down the forearm is still acceptable as long as the current is still going through the muscles. I still believe that the treatment was successfull.
Teaching the boy the exercises was easy enough as he seemed co-operative and willing to learn. however weather he will do them or not is left to be seen!!!.
In addition to this; on my final day i went to the gym!. My supivisor took me to the gym to look at a patient that he was performing a shoulder rehabilitation for. it was really interesting to see the last stages of rehab; as most of the time while i was in this practice i would only see the initial acute stages, most people managed themselves after a while and it was interesting to look at the different exercises that were prescribed. most being shoulder external rotation, internal roatation abduction and scapular setting with loading sorts of exerecises.
anyway thanks for reading!
Today i performed treatment on a 16 year old boy with extensor tendinopathy. He had limited range of movement in extension, although there was only pain on resisted extension with radial deviation, third finger extension and power grip, there was no pain with unresisted extension. My supivisor decided that we would perform, deep tissue massage with triggerpointing to ECRB and ED, dry needling * although it would have been cool to perform this, my supivisor took over there :P* interferential therapy and also that we would give him some home exercises to stretch out his extensor tendons and strengthen them with some excentric loading.
I performed DTM ( deep tissue massage) with triggerpointing to his extensor tendons , and i progressed it with placing the extensor tendons in a more lengthened position, ie with his wrist in a flexed position. I felt that after treatment although he seemed a little sore, he was able to gain more movement; my supivisor then decided that dry needling the tendons would also be benificial.
On application of the interferential modalitiesi found it difficult to place all the electrodes around his arm without allowing them to touch eachother!. as the forearm is quiet a small area, i later asked my supivisor who said that placing the channels furthur down the forearm is still acceptable as long as the current is still going through the muscles. I still believe that the treatment was successfull.
Teaching the boy the exercises was easy enough as he seemed co-operative and willing to learn. however weather he will do them or not is left to be seen!!!.
In addition to this; on my final day i went to the gym!. My supivisor took me to the gym to look at a patient that he was performing a shoulder rehabilitation for. it was really interesting to see the last stages of rehab; as most of the time while i was in this practice i would only see the initial acute stages, most people managed themselves after a while and it was interesting to look at the different exercises that were prescribed. most being shoulder external rotation, internal roatation abduction and scapular setting with loading sorts of exerecises.
anyway thanks for reading!
Wednesday, November 12, 2008
WEEK 5 POST 2
Today i treated a young patient who had dislocated his patella 7/52 ago.
I had seen my supivisor treat this patient before; and was quiet confident that i could perform this treatment session on my own.
I applied a medial glide to the patella.I then performed DTM on the boys ITB, and lastly finished the treatment with a dose of interferential therapy, that was aimed at stimulating the VMO muscle. i then gave the boy a exercise that aimed at switching on VMO.
Reflecting on my performance (:) there you go Jo!) i think i performed well; i was confident that what i was doing was correct and i continued to ask the patient whether they were in pain, or they felt an ''adequate'' stretch. I probably think that my exercise i prescribed to the kid was maybee a bit to hard for his stage of rehab, so i asked my supivisor who had a look at the child and decided that yes maybee it was a bit difficult. My supivisor then showed me a more effective stregthening exercise for VMO at this stage of the boys rehab. I feel confident now that i could presctribe some good exercises for switching on VMO! :). Overall my supivisor said i did well and i feel as though compared to the begining of my placement i am alot more confident in treating patients.
I had seen my supivisor treat this patient before; and was quiet confident that i could perform this treatment session on my own.
I applied a medial glide to the patella.I then performed DTM on the boys ITB, and lastly finished the treatment with a dose of interferential therapy, that was aimed at stimulating the VMO muscle. i then gave the boy a exercise that aimed at switching on VMO.
Reflecting on my performance (:) there you go Jo!) i think i performed well; i was confident that what i was doing was correct and i continued to ask the patient whether they were in pain, or they felt an ''adequate'' stretch. I probably think that my exercise i prescribed to the kid was maybee a bit to hard for his stage of rehab, so i asked my supivisor who had a look at the child and decided that yes maybee it was a bit difficult. My supivisor then showed me a more effective stregthening exercise for VMO at this stage of the boys rehab. I feel confident now that i could presctribe some good exercises for switching on VMO! :). Overall my supivisor said i did well and i feel as though compared to the begining of my placement i am alot more confident in treating patients.
Monday, November 10, 2008
WEEK 5 POST 1
Today a client walked in with pain in his wrist/hand. From my supivisors subjective assessment i found that: He was a security guard who had been chasing a offender and had tripped, he had fallen onto an outstretched hand ( FOOSH). I also noted that pain was felt both sides of the hand and it was a constant pain that was felt about 20 min after he fell.
My supivisor asked me to do an objective assessment of the patients wrist pain... immediatly alarm bells were ringing and i was thinking a fracture.. the most common being of scaphoid, however he said his pain was on the oposite end to scaphoid, so i started thinking possibly a fracture to other carpal bones....
Immediatly the patient was TOP on his carpal bones. I asked him to do active flexion, extension in supination and pronation. He was very painful on all these movements. ulnar and radial deviation were non painfull.
I performed AP's of his carpal bones and found him stiff in the 2nd carpal row as well as between capitate and hamate. He told me that in particular this was a very painful movement and it was the pain he was experiencing.
My supivisor performed AP on his carpal bones as well as medial and lateral glides to his carpal rows ( my supivisor said it would be a good idea to perform them next time in the objective assessment as he found them a bit stiff..). we then placed interferential therapy on the hand and my supivisor wrote him out a referral for an x-ray.
I found it interesting that we still performed physiotherapy on the patient even though we suspected a fracture to hamate. But my physiotherapist replied that the patient had come for phsyiotherapy and doing some physio wouldn't harm the wrist anymore than it had already been damaged.
My supivisor asked me to do an objective assessment of the patients wrist pain... immediatly alarm bells were ringing and i was thinking a fracture.. the most common being of scaphoid, however he said his pain was on the oposite end to scaphoid, so i started thinking possibly a fracture to other carpal bones....
Immediatly the patient was TOP on his carpal bones. I asked him to do active flexion, extension in supination and pronation. He was very painful on all these movements. ulnar and radial deviation were non painfull.
I performed AP's of his carpal bones and found him stiff in the 2nd carpal row as well as between capitate and hamate. He told me that in particular this was a very painful movement and it was the pain he was experiencing.
My supivisor performed AP on his carpal bones as well as medial and lateral glides to his carpal rows ( my supivisor said it would be a good idea to perform them next time in the objective assessment as he found them a bit stiff..). we then placed interferential therapy on the hand and my supivisor wrote him out a referral for an x-ray.
I found it interesting that we still performed physiotherapy on the patient even though we suspected a fracture to hamate. But my physiotherapist replied that the patient had come for phsyiotherapy and doing some physio wouldn't harm the wrist anymore than it had already been damaged.
Thursday, November 6, 2008
WEEK4 POST 2
Today i did hydrotherapy. I was pretty confident that i would be okay if asked to perform/direct clients on what to do because i remeber doing hydro last year- and also remeber doing it for our clinical ed tute!!.
It went fine and most of the time i simply observed.
One particular patient had had a menisectomy, and also still currently had a bakers cyst at the back of her knee. I found it interesting that the physio leading the hydro session was able to do manual therapy on the patient in the water ( she did alot of accessory mobilisations on the knee cap and tibia, with also some massage). My supivisor said thatwater has many benifits for all types of problems; those including.
- provides a 'weightless' feeling for those patients that can not move under the forces of gravity.
- enables a traction force to be applied
- the warmth can create a soothing relaxation feeling to sore muscles.
- has a boyancy force direction ( that can aid in exercising certain muscles etc)
My supivisor said that hydrotherapy is especially important in people with longstanding chronic back pain. She said that there has been alot of research into chronic LBP and they have found that significant relief from pain can be found with traction forces produced during hydrotherapy.
It went fine and most of the time i simply observed.
One particular patient had had a menisectomy, and also still currently had a bakers cyst at the back of her knee. I found it interesting that the physio leading the hydro session was able to do manual therapy on the patient in the water ( she did alot of accessory mobilisations on the knee cap and tibia, with also some massage). My supivisor said thatwater has many benifits for all types of problems; those including.
- provides a 'weightless' feeling for those patients that can not move under the forces of gravity.
- enables a traction force to be applied
- the warmth can create a soothing relaxation feeling to sore muscles.
- has a boyancy force direction ( that can aid in exercising certain muscles etc)
My supivisor said that hydrotherapy is especially important in people with longstanding chronic back pain. She said that there has been alot of research into chronic LBP and they have found that significant relief from pain can be found with traction forces produced during hydrotherapy.
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