FINAL ENTRY

I really really enjoyed this placement!.
In my initial entry i was really worried and stressed about the responsibility of having my own patients, however this was a really big learning experience for me, we wern't just thrown into the deep end but they slowley eased us into having our own patients.

I also said in the initial entry that i was apprehensive about this being a neuro placement. Although we did see some neuro patients, we were always accompanied with a supervisor, so this wasn't as stressfull as i thought it would be. All my single patients were gerentology based.

I found each day i went to this placement i learnt so many new things. we contributed to team meatings, we discharged patients, we referred patients on. We saw a complete variety of patients aswell ranging from THR, to occipital strokes, temporal strokes, COPD patients, neurological compramise patients... the list was really broad. At times i was really stressed about my case load and often left late however i felt as though i was learning so much. i liked this placement alot better than my last!.

THIRD ENTRY- WEEK 5

S-i was asked to Ax and Rx a83 y.o F patient who had come in with a broken femur fixed with a femoral nail 2 weeks ago. She had a past medical history of parkinsons disease and hypertension. She had broken her hip when she fell over at a resturant.

T- my supervisor asked me to continue on with the Ax and Rx.

A-I began assessing her with the subjective questions and then the objective movements, i was however very wary about her ORIF , and restricted some of the Ax and Rx movements as i didn't want my patient to dislocate.

R-as a result i didn't get my patient to complete all the exercises necessary for hip rehabilitation.

E- i dont think this session went well with the patient. However she was very gracefull and next time i saw her i made amendments, ajusting her Rx programme and her exercises.

S-I think next time i am faced with a patient who has had replacement surgury or an ORIF put in i will read up on my orthopedics restrictions and be clear about what surgury requires restrictions. i learnt very quickly that ORIFS do not have any restrictions on them!. My supervisor mentioned that i need to take into consideration her other problems as well, in this case it was parkinsons disease. If her PD wasn't being effectivley managed with medication, then this could be the reason she is having the falls.

S-

SECOND ENTRY- WEEK 3

S- On placement, I was assigned one particular patient that had had a TKR. He was 84 y.o and had severe dementia. At times he appeared agitated and aggressive. Previous to admission this patient was independent in his ADL’s and living alone. He had the operation 2/52 ago and was admitted to the rehabilitation unit I was working in because he didn’t achieve the required degrees of knee flexion in order to be discharged.
T- I assessed this patient and begun treating him. He had approximately 52 degress of knee flexion, the hospital required at least 70 degrees of knee flexion for discharge. I knew from the orthopaedic handover that this patient was very distressed about using a pulley system to encourage knee flexion, and had the potential to get abusive.
A- I began increasing his knee flexion using Active Assisted movements. I used a sideboard with a towel under it so he could control the amount of knee flexion that was occurring himself. I then attached him to a CPM machine in the time he wasn’t at physio. I avoided completely the use of the pulley system. He seemed to like the systems I was using, however when the CPM machine pushed him a bit too far he called me some abusive names!.
R- the result wasn’t the best ;I did end up increasing his knee flexion to 59 degrees, however over the weekend my patient discharged himself. I suspect my patient would have had to have a MUA, because his knee would no longer be functional with the amount of knee flexion he had.
E-I though my methods of dealing with this patient were good considering his mental state. I think I have learnt from this situation that you have to be able to tailor your treatment to your patient and their needs. I would have loved to use all the pulleys and active assisted towel exercises for a patient with such poor knee flexion ROM however, his lack of understanding and mental state prevented me from allowing these treatments.
S-Maybe next time I should focus a lot more of my treatment time on education for the patient so they have a greater understanding of how the treatment can help their condition. Maybe next time I would try to get the family or loved ones to reason with a patient who had such a poor mental state. This could have prevented the patient from discharging himself.

FIRST ENTRY- WEEK1

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.

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!!.

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.

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!