Monday, March 5, 2007
Last One
Well 2nd placement down and PCR on the way. What I learned on the last week of last placement is that now that we are at a basic level we can relax and just learn. What I mean is, there so much pressure to meet that level required that is almost not enjoyable. Now that we are at a basic level we can know that our treatment is good enough to be independent but we can work on improving the little things. When discussing with my supervisor on the last week about my final Ax patient she said relax, just go and do it and then learn from the feedback. She also said there is always going to be something to learn whatever level we are at. It was comforting to put it in perspective and realise we don't have to know it all now. So I hope this is helpful. My thoughts are that we shouldn't expect to be able to know and do everything fantastic straight away. Do your best and learn from those who have been doing it longer. Good luck for the PCR.
Interesting Case
Hi guys,
Well, here we are on our last blog, and our last clinic.
My last week was an interesting one, where I was given one more new patient to see.
He is middle aged aboringinal man who sufferred a bilateral cerebellar infarct 3/12 ago, and has just been admitted with a R MCA. He is dysarthric, and is not accustomed to our lifestyle and therefore feels very apprehensive regarding what we want to do with him.
The learning experience for me is that, at uni, we learn the treatment for different infarcts, not a combination of them.
this man is extremely ataxic in his R UL, R LL, and trunk. To add to this he has L hemiparesis, with very little movement in his L UL and L LL (gowland 2 and 3 respectively).
His sitting balance requires close S/V when he uses his R UL for support, and a 1 mod A with no UL support, as he is very ataxic through his trunk.
Now, this is where your comments/ideas will help. I have decided to address his ataxia issues (trunk and R UL) prior to addressing his hemiparesis primarily. My reasoning is this: I feel that without a decent stable base to move from, he will not be able to move properly. I have given him some bed exercises regarding his L limbs to assist in rehab, but have focused primarily on his sitting balance and ataxic imparments.
I could go on and on about this patient, as i did find his case and culture background very interesting, and unfortunately I will not get to continue with his rehab.
He was progressing well, and we had started standing balance ex with him.
Good luck for the PCR's guys, we all will be FINE!
Well, here we are on our last blog, and our last clinic.
My last week was an interesting one, where I was given one more new patient to see.
He is middle aged aboringinal man who sufferred a bilateral cerebellar infarct 3/12 ago, and has just been admitted with a R MCA. He is dysarthric, and is not accustomed to our lifestyle and therefore feels very apprehensive regarding what we want to do with him.
The learning experience for me is that, at uni, we learn the treatment for different infarcts, not a combination of them.
this man is extremely ataxic in his R UL, R LL, and trunk. To add to this he has L hemiparesis, with very little movement in his L UL and L LL (gowland 2 and 3 respectively).
His sitting balance requires close S/V when he uses his R UL for support, and a 1 mod A with no UL support, as he is very ataxic through his trunk.
Now, this is where your comments/ideas will help. I have decided to address his ataxia issues (trunk and R UL) prior to addressing his hemiparesis primarily. My reasoning is this: I feel that without a decent stable base to move from, he will not be able to move properly. I have given him some bed exercises regarding his L limbs to assist in rehab, but have focused primarily on his sitting balance and ataxic imparments.
I could go on and on about this patient, as i did find his case and culture background very interesting, and unfortunately I will not get to continue with his rehab.
He was progressing well, and we had started standing balance ex with him.
Good luck for the PCR's guys, we all will be FINE!
Sunday, March 4, 2007
Last Blog!
Well another prac over ...and I almost forgot to do my last blog! In looking over the last few weeks I can't believe how much I have learnt in Musculo...although I wouldn't have minded another 4 weeks to consolidate further with our brilliant supervisor dropping pearls of wisdom at our feet!
Anyway, something I wanted to comment on was how attempts at motivating a few of my patients I mentioned previously did actually work... as they all were reviewed last week. It was exciting to see that 3/4 patients had really taken on board what I had told them and had clearly being doing their exercises etc by the progress they had made. This was very encouraging to me and emphasized the point that if you do take the time and energy to clearly explain the anatomy/healing process/strengthening process/advantages from sticking to the rehab programme (a good lecture!) it does make a difference, and patients do improve. Using models etc and the "worst and best case"scenario is very useful! Something I shall definitely take into my clinical practice in the future.
So good luck to all of you in the PCR and it has been a pleasure blogging with all of you!!!
Anyway, something I wanted to comment on was how attempts at motivating a few of my patients I mentioned previously did actually work... as they all were reviewed last week. It was exciting to see that 3/4 patients had really taken on board what I had told them and had clearly being doing their exercises etc by the progress they had made. This was very encouraging to me and emphasized the point that if you do take the time and energy to clearly explain the anatomy/healing process/strengthening process/advantages from sticking to the rehab programme (a good lecture!) it does make a difference, and patients do improve. Using models etc and the "worst and best case"scenario is very useful! Something I shall definitely take into my clinical practice in the future.
So good luck to all of you in the PCR and it has been a pleasure blogging with all of you!!!
Good Guidance with a Full-Time Curtin Clinical Supervisor
For the past four weeks, I was having my musculoskeletal clinics and in a facility with a full-time Curtin clinical tutor,
For the first three weeks, I had to consult my supervisor after both subjective and objective assessment and to work out my treatment plan verbally with her. I found it very tedious and time consuming. This was especially so when I had to join the queue together with five other students. I started to appreciate this form of teaching when I assessed and treated my own patients.
During the last week (where the final assessments were held), I was allowed to assess and treat my own patients (seeking guidance only if I would put my patient in ‘danger’). I found it so much easier to consolidate all the asterisks findings and coming up with the correct diagnosis and classification. I think this was partly due to having more hands on experience with patients and also due to the teaching process in the facility. Having to verbalise my subjective findings, objective assessment plan and findings for every new patient had allowed me to consolidate all the asterisks findings mentally and treat the patient there and then.
It was definitely frustrating in the beginning but I hope future batches of students will appreciate it eventually and enjoy the clinics!!!
For the first three weeks, I had to consult my supervisor after both subjective and objective assessment and to work out my treatment plan verbally with her. I found it very tedious and time consuming. This was especially so when I had to join the queue together with five other students. I started to appreciate this form of teaching when I assessed and treated my own patients.
During the last week (where the final assessments were held), I was allowed to assess and treat my own patients (seeking guidance only if I would put my patient in ‘danger’). I found it so much easier to consolidate all the asterisks findings and coming up with the correct diagnosis and classification. I think this was partly due to having more hands on experience with patients and also due to the teaching process in the facility. Having to verbalise my subjective findings, objective assessment plan and findings for every new patient had allowed me to consolidate all the asterisks findings mentally and treat the patient there and then.
It was definitely frustrating in the beginning but I hope future batches of students will appreciate it eventually and enjoy the clinics!!!
Just taking that few more minutes
Sometimes we are get familiar with certain things that we do that we become complacent. Anybody feel the same way too?
One morning, I had a day 1 post radical prostatectomy patient to see. I have seen a couple of those pts, so I had the mindset of the same routine things that I usually do. So as usual, I did the relevant subjective & objective Ax, then went on to treatment. I educated him on importance of early mobilization, upright positioning, DB ex’s & supported cough. The pt was well enough to get out of bed, and ambulated a short distance. Thereafter, I got him to SOOB for a while. He then started to feel cold & clammy, and got a bit sick. Then after a min or so, he said he was better & he could manage SOOB. So, I thought..good, he is feeling a bit better & he says he wants to try SOOB..and I decided to let him stay in the chair. As I was walking out of the room, I felt uneasy about the while thing, decided to take his BP to see for sure if I had made the right decision. Gosh, his BP was 80/55, far from his usual of 110/60. Back to bed it was for him and I also explained the reason to him. Though SOOB was important for him, compromising with his low BP was not exactly what I wanted. I am so glad I took his BP to justify my decision and not have it based only on the pt subjectively, especially on the last week of placement.
Congrats everyone for completing this placement! Good luck for the coming PCR!
One morning, I had a day 1 post radical prostatectomy patient to see. I have seen a couple of those pts, so I had the mindset of the same routine things that I usually do. So as usual, I did the relevant subjective & objective Ax, then went on to treatment. I educated him on importance of early mobilization, upright positioning, DB ex’s & supported cough. The pt was well enough to get out of bed, and ambulated a short distance. Thereafter, I got him to SOOB for a while. He then started to feel cold & clammy, and got a bit sick. Then after a min or so, he said he was better & he could manage SOOB. So, I thought..good, he is feeling a bit better & he says he wants to try SOOB..and I decided to let him stay in the chair. As I was walking out of the room, I felt uneasy about the while thing, decided to take his BP to see for sure if I had made the right decision. Gosh, his BP was 80/55, far from his usual of 110/60. Back to bed it was for him and I also explained the reason to him. Though SOOB was important for him, compromising with his low BP was not exactly what I wanted. I am so glad I took his BP to justify my decision and not have it based only on the pt subjectively, especially on the last week of placement.
Congrats everyone for completing this placement! Good luck for the coming PCR!
Saturday, March 3, 2007
Final blog - Musculo
Well, so that's that then! This musculo placement was fantastic. I only wish we had more time to sponge off our supervisor who was an absolute fountain of knowledge and who was able to make things so simplistic and easy to understand! While my experience with the vertebral column remains limited, I sure did see a range of post-surgical pts - some with fantastic results and some the result of surgery gone wrong or poor self-management.
An interesting pt for my final Ax - young boy #tib/fib and metatarsals 1-4. 3/12 later foot barely moving and resting in an extremely disfigured inverted position. Was managed by 3 diff medical teams. Has been told that is a "normal" resting posture for the foot. Somebody might want to clarify with that individual his understanding of normal foot posture. So this brought about a bit of noise with the rest of the physios in the area...... Do you a) slightly overlook the fact that the resting position of the left foot looks nothing like the right b) see how Rx goes for sometime to see if muscle activation and ROM can restore some normal positioning or c) tell the parents to go to a private hospital and try and have the foot reconfigured. Well, we went with b) but with the intention of suggesting c) after a bit of intensive Rx showing limited success. Anyone with any other suggestions?
Anyway, thought I would give a pt example as I hadn't done so in some time. All in all I do feel much more comfortable in Ax and Rx in these 3 domains now. I am able to realize much more now the areas I really do need to expand my knowledge base (and boy is it extensive!!....yikes) in some more and those areas I really am interested in expanding it to! I think that all three pracs have been so very useful in consolidating the knowledge we have acquired at Uni. And not just consolidating, I guess I mean fitting all the pieces together so that it actually makes sense - not just trying to memorize it verbatum for exams! I am also quite excited to get out there and get working and be able to take more courses that I am interested in! So, with that in mind, fingers crossed - PCR be gentle! Good luck all.
An interesting pt for my final Ax - young boy #tib/fib and metatarsals 1-4. 3/12 later foot barely moving and resting in an extremely disfigured inverted position. Was managed by 3 diff medical teams. Has been told that is a "normal" resting posture for the foot. Somebody might want to clarify with that individual his understanding of normal foot posture. So this brought about a bit of noise with the rest of the physios in the area...... Do you a) slightly overlook the fact that the resting position of the left foot looks nothing like the right b) see how Rx goes for sometime to see if muscle activation and ROM can restore some normal positioning or c) tell the parents to go to a private hospital and try and have the foot reconfigured. Well, we went with b) but with the intention of suggesting c) after a bit of intensive Rx showing limited success. Anyone with any other suggestions?
Anyway, thought I would give a pt example as I hadn't done so in some time. All in all I do feel much more comfortable in Ax and Rx in these 3 domains now. I am able to realize much more now the areas I really do need to expand my knowledge base (and boy is it extensive!!....yikes) in some more and those areas I really am interested in expanding it to! I think that all three pracs have been so very useful in consolidating the knowledge we have acquired at Uni. And not just consolidating, I guess I mean fitting all the pieces together so that it actually makes sense - not just trying to memorize it verbatum for exams! I am also quite excited to get out there and get working and be able to take more courses that I am interested in! So, with that in mind, fingers crossed - PCR be gentle! Good luck all.
Friday, March 2, 2007
The chronic pain patient
Hi everyone,
congrats on getting through another placement. I Just wanted to briefly discuss a patient who presented in the clinic with LBP. She was diagnosed with a chronic hypomobility disorder L4/5 5/S1 and had been receiving physio treatment for several weeks. On the day I treated her, she reported pain scores of 9&10/10 for all Lx ROM. Paivms were even worse… every segment I touched whether it be central or unilateral appeared to reproduce the pain. I quickly realised that pain was not going to be a very useful outcome measure, but what was I to do for treatment? Objectively there appeared to be reasonable segmental movement occurring at Lx segmental levels with mild hypomobility bilaterally at L4/5 5/S1. After discussion with my supervisor it was decided that the most effective treatment for this patient at this stage did not include manual techniques, rather education and a graduated exercise program focused on improving functional tasks. I am told that in recent studies of chronic pain patients, providing education about the chronic pain cycle alone has been shown on MRI to have an effect in reducing pain. I thought that was pretty interesting….I am yet to read the literature myself, but I thought i may as well give it a go. In this case, the education combined with a low intensity gym program of 3 minutes on the bike and treadmill and some core stability work in functional positions had a better effect than the previous sessions of manual treatments. There is still a long way to go in completely resolving her pain, but she appears to be content with the knowledge of what has caused this pain response and what SHE needs to do to improve it.
Good luck everyone for the PCR and thanks for all the comments and suggestions over the past few weeks.
congrats on getting through another placement. I Just wanted to briefly discuss a patient who presented in the clinic with LBP. She was diagnosed with a chronic hypomobility disorder L4/5 5/S1 and had been receiving physio treatment for several weeks. On the day I treated her, she reported pain scores of 9&10/10 for all Lx ROM. Paivms were even worse… every segment I touched whether it be central or unilateral appeared to reproduce the pain. I quickly realised that pain was not going to be a very useful outcome measure, but what was I to do for treatment? Objectively there appeared to be reasonable segmental movement occurring at Lx segmental levels with mild hypomobility bilaterally at L4/5 5/S1. After discussion with my supervisor it was decided that the most effective treatment for this patient at this stage did not include manual techniques, rather education and a graduated exercise program focused on improving functional tasks. I am told that in recent studies of chronic pain patients, providing education about the chronic pain cycle alone has been shown on MRI to have an effect in reducing pain. I thought that was pretty interesting….I am yet to read the literature myself, but I thought i may as well give it a go. In this case, the education combined with a low intensity gym program of 3 minutes on the bike and treadmill and some core stability work in functional positions had a better effect than the previous sessions of manual treatments. There is still a long way to go in completely resolving her pain, but she appears to be content with the knowledge of what has caused this pain response and what SHE needs to do to improve it.
Good luck everyone for the PCR and thanks for all the comments and suggestions over the past few weeks.
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