Week 3: October 29, 2008
Not the best day today. Had a good morning, where I was in the pool, part of the amputee team meeting, then had to go put a few patients prostheses on before the ward round, but I did not enjoy the afternoon and I can’t really pinpoint why – it just wasn’t good!
In the afternoon, I was assigned an indigenous Australian woman, who was in the gym for the first time, because she had just come to the hospital. The patient has recently had a below knee amputation, hence her presentation in the amputee gym. My supervisor told me to perform an initial assessment of the patient, which included an amputee rehabilitation assessment, LCI, strength and muscle tests and then left me on my lonesome. This pissed me off immensely, because not only was it basically the first time I had seen these sheets, but I was with a middle aged woman with poor eyesight, hearing problems and a lack of english and general communication skills. I got started on my assessment though and did the best I could.
About half way through, one of the senior amputee physios came over to lend a hand with the remainder of my assessment and we made an exercise program for the patient as well – the extra bit of guidance was fantastic. I know the things that I did were not very good, but under the circumstances I think I did a bloody good job, and yes, I will look for excuses. My thoughts at the time were that I might as well get on with it because there was no way I would get better without practice. I guess this also alerted me to the fact that I will not always be working in ideal circumstances and there is not a whole lot I can do about it!
To improve the process, I would have shown the patient the big map of WA earlier, so that she could point where she lived. This was a significant event in the process, because it gave the patient a chance to speak more about her normal setting, something she appreciated, which also allowed her to open up more.
This was a good learning experience.
Wednesday, October 29, 2008
Tuesday, October 28, 2008
Tuesday: October 28, 2008
Little incident worth noting today, with an above knee amputee patient that I had not been working with but with whom I have worked with previously and feel I have a pretty good relationship with. The male patient was on his way out of the amputee gym at the end of the morning session and made an effort to come and find me before he left.
He told me that he was going straight home and was not going to attend his afternoon session. When I quizzed him as to why he had made this decision, he told me he was having a bad day and also that he had been really down in the dumps since he last saw me on Thursday. The patient also informed me that it had hit him hard recently, that he did not have one of his legs anymore, but also that he was sure he was going to lose his other one. It was the fact that the patient was so upset and was considering giving up rehab goals that made me feel pretty uneasy, especially as he seemingly came to me for help, and I really didn’t know what to do. Luckily my supervisor and other senior physios were there to help me out with the patient. They basically said that he needed to revise his goals and let us know what he came up with so we could help him achieve them, but also that skipping gym was not going to get him anywhere. The patient took a pen and paper away with him, with the intention of making some new goals, but unfortunately he did not return after lunch. This was his decision and there was not much we could do about it, but an appointment with the clinical psych. has been made, so hopefully this gentleman will be back on track soon!
This incident was evidence of why I must consider patients as a ‘whole’ and not just be focused on things like muscle strength and standing balance. There really is much more going on than just the physical aspects, the emotional state is just as important. Not that I was ever really thinking like this, but it is a good reminder of the importance of not becoming one track minded.
Aside from this, I had my first attempt at stump bandaging on a patient and did a ripper of a job – top effort that! Night Night!
Ozzman out!
Little incident worth noting today, with an above knee amputee patient that I had not been working with but with whom I have worked with previously and feel I have a pretty good relationship with. The male patient was on his way out of the amputee gym at the end of the morning session and made an effort to come and find me before he left.
He told me that he was going straight home and was not going to attend his afternoon session. When I quizzed him as to why he had made this decision, he told me he was having a bad day and also that he had been really down in the dumps since he last saw me on Thursday. The patient also informed me that it had hit him hard recently, that he did not have one of his legs anymore, but also that he was sure he was going to lose his other one. It was the fact that the patient was so upset and was considering giving up rehab goals that made me feel pretty uneasy, especially as he seemingly came to me for help, and I really didn’t know what to do. Luckily my supervisor and other senior physios were there to help me out with the patient. They basically said that he needed to revise his goals and let us know what he came up with so we could help him achieve them, but also that skipping gym was not going to get him anywhere. The patient took a pen and paper away with him, with the intention of making some new goals, but unfortunately he did not return after lunch. This was his decision and there was not much we could do about it, but an appointment with the clinical psych. has been made, so hopefully this gentleman will be back on track soon!
This incident was evidence of why I must consider patients as a ‘whole’ and not just be focused on things like muscle strength and standing balance. There really is much more going on than just the physical aspects, the emotional state is just as important. Not that I was ever really thinking like this, but it is a good reminder of the importance of not becoming one track minded.
Aside from this, I had my first attempt at stump bandaging on a patient and did a ripper of a job – top effort that! Night Night!
Ozzman out!
Monday, October 27, 2008
Week 3: October 27 2008
Had a male patient this afternoon who had not been to the amputee gym for a few months, because he had been in hospital for various reasons and he has spent very little time in his prosthesis in this time, and consequently has not been doing much walking. So with a supervisor’s nod of approval, we set out to do a set of outcome measures to see where this gentleman was at. He did surprisingly well!
After a slow lap of the gym with a 2 wheeled zimmer frame, I explained the procedure of a 6 min walk test to the patient and asked whether he thought he could deal with that kind of test. The response was an honest “No.” I thought this was a fair enough call and didn’t want to force him straight into that test, however I decided we might as well just start walking around the gym and still record distance and time. We ended up walking for over 3 mins with a wheelchair following close behind. This rest lasted less than 90 secs and we were off again, and the patient walked for another 3 mins. So because I was clever enough to check the clock at 6 mins and also check the distance counter wheel thingamabob, I ended up getting a measure for my 6 min walk test after all,! Even if there was a decent break in the middle.
After another break, I got the patient to do a 10 metre walk test and then a timed up and go. Turned out that even though the 6 min test covered a significantly smaller distance than the previous recording, both the 6mwt and TUG test were improved performances, as compared to previous recordings. I wish I could do that after months of inactivity!
Mainly regarding the 6min test, I thought that it would be pretty hard for an older person to perform this test after a long period of bed rest. My clinical reasoning was based around the thought that it would be a tough test to do in the patient’s condition, but that I might as well get as much out of taking him for a walk as I could, so why not take measurements and recordings while I did it. I feel my communication with the patient about this test was where it needed to be. I first enquired how the patient felt about the test and then acted from the response and told him my intention to perform a modified version of the same test, which he thought was a good idea. I think I did pretty bloody well with this patient, but I’m sure there were things I could improve on. My plan is to work definitely on walking practice and balance related tasks but also to build up some upper limb strength, as the patient reported pain and weakness in the back of the arm while walking with the 2 WZF and also with the 4 wheeled walker.
Pretty good day, I spent time at Royal Perth’s Wellington Street campus in the morning and then back at my normal setting at the Shenton Street campus in the afternoon, so that broke the day up a little, which was good. There’s will be a few new patients over the next week, so that will be very interesting. Looking forward to it!
Ozzman out!
Had a male patient this afternoon who had not been to the amputee gym for a few months, because he had been in hospital for various reasons and he has spent very little time in his prosthesis in this time, and consequently has not been doing much walking. So with a supervisor’s nod of approval, we set out to do a set of outcome measures to see where this gentleman was at. He did surprisingly well!
After a slow lap of the gym with a 2 wheeled zimmer frame, I explained the procedure of a 6 min walk test to the patient and asked whether he thought he could deal with that kind of test. The response was an honest “No.” I thought this was a fair enough call and didn’t want to force him straight into that test, however I decided we might as well just start walking around the gym and still record distance and time. We ended up walking for over 3 mins with a wheelchair following close behind. This rest lasted less than 90 secs and we were off again, and the patient walked for another 3 mins. So because I was clever enough to check the clock at 6 mins and also check the distance counter wheel thingamabob, I ended up getting a measure for my 6 min walk test after all,! Even if there was a decent break in the middle.
After another break, I got the patient to do a 10 metre walk test and then a timed up and go. Turned out that even though the 6 min test covered a significantly smaller distance than the previous recording, both the 6mwt and TUG test were improved performances, as compared to previous recordings. I wish I could do that after months of inactivity!
Mainly regarding the 6min test, I thought that it would be pretty hard for an older person to perform this test after a long period of bed rest. My clinical reasoning was based around the thought that it would be a tough test to do in the patient’s condition, but that I might as well get as much out of taking him for a walk as I could, so why not take measurements and recordings while I did it. I feel my communication with the patient about this test was where it needed to be. I first enquired how the patient felt about the test and then acted from the response and told him my intention to perform a modified version of the same test, which he thought was a good idea. I think I did pretty bloody well with this patient, but I’m sure there were things I could improve on. My plan is to work definitely on walking practice and balance related tasks but also to build up some upper limb strength, as the patient reported pain and weakness in the back of the arm while walking with the 2 WZF and also with the 4 wheeled walker.
Pretty good day, I spent time at Royal Perth’s Wellington Street campus in the morning and then back at my normal setting at the Shenton Street campus in the afternoon, so that broke the day up a little, which was good. There’s will be a few new patients over the next week, so that will be very interesting. Looking forward to it!
Ozzman out!
Friday, October 24, 2008
Week 1: October 24, 2008
Had a patient yesterday, who had an above knee amputation and had become very weak and deconditioned from general lack of activity. About 45mins into the session, the pain from a poor prosthesis fit was starting to become too much and so I decided that instead of walking laps of the gym, it would be more appropriate to do some other exercises to keep the patient off the prosthetic leg as much as possible. So we began to do some resisted hip extension on the prosthesis side, using some theraband. I quickly realized this was too hard for the patient, who was using large amounts of trunk flexion to facilitate the movement, so I switched to an easier grade of theraband and still no good. So I ditched the theraband and took the patient into the parallel bars to see if we could get it sorted. But the patient still insisted on flexing the trunk to achieve the hip extension. After 30mins of instructions, prompts and holding the patient upright I said to the gentleman in no uncertain terms “imagine u have big pole stuck right up your backside and into your back and all you can do is swing your leg backwards.” I knew the patient would not take any offense to this instruction, so I felt ok in giving it, and amazingly, I got some perfectly performed isolated hip extension immediately after this instruction!
The patient told me it was the best descriptive instruction I’d given all day, because it told him exactly what he should be doing. The significance to me, was that it illustrated the importance of finding an explanation that the patient can understand and relate to, because if they don’t understand what you want them to do, how are they going to do it? So yes, a lengthy experience trying to get someone to correctly extend the hip, but a worthwhile one.
I think my clinical reasoning was pretty good in this instance, in terms of going from hard to easy theraband and then to no resistance to achieve the extension. I also feel I thought enough about the course of the conversation with the patient prior to making the comment, so that it wouldn’t be deemed as an inappropriate one by the patient. Personally I think my initial communication was pretty good, but from the course of events it wouldn’t seem so! But definitely, though effective communication I was in the end able to achieve the desired result. Next time I will assess how well the patient is performing the action and look to progress by doing the extension in prone to provide resistance from gravity and then introduce resistance in the form of theraband.
I felt comfortable and confident with this patient because I believe I got to know the patient. This was the 2nd or 3rd time I had been with the patient and I feel we had a good understanding going on. In the future I will endeavour, to make my explanations to all patients simple and understandable, with the hope that they can get the most out of what I am doing with them.
Had a patient yesterday, who had an above knee amputation and had become very weak and deconditioned from general lack of activity. About 45mins into the session, the pain from a poor prosthesis fit was starting to become too much and so I decided that instead of walking laps of the gym, it would be more appropriate to do some other exercises to keep the patient off the prosthetic leg as much as possible. So we began to do some resisted hip extension on the prosthesis side, using some theraband. I quickly realized this was too hard for the patient, who was using large amounts of trunk flexion to facilitate the movement, so I switched to an easier grade of theraband and still no good. So I ditched the theraband and took the patient into the parallel bars to see if we could get it sorted. But the patient still insisted on flexing the trunk to achieve the hip extension. After 30mins of instructions, prompts and holding the patient upright I said to the gentleman in no uncertain terms “imagine u have big pole stuck right up your backside and into your back and all you can do is swing your leg backwards.” I knew the patient would not take any offense to this instruction, so I felt ok in giving it, and amazingly, I got some perfectly performed isolated hip extension immediately after this instruction!
The patient told me it was the best descriptive instruction I’d given all day, because it told him exactly what he should be doing. The significance to me, was that it illustrated the importance of finding an explanation that the patient can understand and relate to, because if they don’t understand what you want them to do, how are they going to do it? So yes, a lengthy experience trying to get someone to correctly extend the hip, but a worthwhile one.
I think my clinical reasoning was pretty good in this instance, in terms of going from hard to easy theraband and then to no resistance to achieve the extension. I also feel I thought enough about the course of the conversation with the patient prior to making the comment, so that it wouldn’t be deemed as an inappropriate one by the patient. Personally I think my initial communication was pretty good, but from the course of events it wouldn’t seem so! But definitely, though effective communication I was in the end able to achieve the desired result. Next time I will assess how well the patient is performing the action and look to progress by doing the extension in prone to provide resistance from gravity and then introduce resistance in the form of theraband.
I felt comfortable and confident with this patient because I believe I got to know the patient. This was the 2nd or 3rd time I had been with the patient and I feel we had a good understanding going on. In the future I will endeavour, to make my explanations to all patients simple and understandable, with the hope that they can get the most out of what I am doing with them.
Tuesday, October 21, 2008
Week 2: October 21, 2008
Today just seemed like a really long day… Really, really long… But I got through :)
First thing this morning I had a young male patient with an above knee amputation and today was his second day with his prosthesis. My supervisor helped him to get the prosthesis on, gave me the very brief instructions “get him doing some stepping exercises” and then left me alone. The only problem with this was the fact that I hadn’t previously done any work with someone at such an early stage in their rehab, so I didn’t know what I theoretically could and could not do for my exercises and in all honesty, this both annoyed me that I was put in this situation but also had me thrown back a little. I was worried I would start at an inappropriately high level and it was only the patient’s age and known upper limb strength that gave me the confidence to proceed.
I started in the parallel bars with some step ups onto a block, and some heel placement exercises (‘squashing a cockroach’) and the patient was incredibly keen to start walking, so I let him and he looked pretty good. My supervisor came back and said that it was good I was getting him to walk, at which point I was feeling pretty good about myself! But then it came! “So did he do this, this, this and this, how did he look doing this and how many of these did he do?” and I realized things weren’t so great! My supervisor explained that it was ok in this instance to have skipped over a few things because the patient was young, fit and already quite safe, but otherwise I should have progressed slower. I also needed to pay more attention to what I was observing and then think about what could be done to change any faults, so look at quality of the exercise and not just the fact the movements we being performed. But I’ll definitely know for next time!
Today just seemed like a really long day… Really, really long… But I got through :)
First thing this morning I had a young male patient with an above knee amputation and today was his second day with his prosthesis. My supervisor helped him to get the prosthesis on, gave me the very brief instructions “get him doing some stepping exercises” and then left me alone. The only problem with this was the fact that I hadn’t previously done any work with someone at such an early stage in their rehab, so I didn’t know what I theoretically could and could not do for my exercises and in all honesty, this both annoyed me that I was put in this situation but also had me thrown back a little. I was worried I would start at an inappropriately high level and it was only the patient’s age and known upper limb strength that gave me the confidence to proceed.
I started in the parallel bars with some step ups onto a block, and some heel placement exercises (‘squashing a cockroach’) and the patient was incredibly keen to start walking, so I let him and he looked pretty good. My supervisor came back and said that it was good I was getting him to walk, at which point I was feeling pretty good about myself! But then it came! “So did he do this, this, this and this, how did he look doing this and how many of these did he do?” and I realized things weren’t so great! My supervisor explained that it was ok in this instance to have skipped over a few things because the patient was young, fit and already quite safe, but otherwise I should have progressed slower. I also needed to pay more attention to what I was observing and then think about what could be done to change any faults, so look at quality of the exercise and not just the fact the movements we being performed. But I’ll definitely know for next time!
Monday, October 20, 2008
Week 2: October 20 2008
This afternoon in the physio gym, I was working with an elderly male outpatient with a below knee amputation. I felt we had a very worthwhile session and I know he did too. It was a little different to other patients I’ve had in the past, mainly because there was a lot of ‘friendly disagreement’ going on. By this I mean, I would make a suggestion and the response would be a laughing “no,” followed by a smile, or a cheeky comment such as “why didn’t you tell me that?” when one of the other physios were chatting to him. This was fine and it didn’t upset me, but it was hard to ascertain exactly what was being said to me at times, which was a little off-putting. However, at the end of the session he was very grateful for the effort I had put in with him and the results he achieved, he also apologized for being, what he termed as ‘cheeky’ and said he was looking forward to Wednesday, when he is in next.
There was one particular incident that sticks in my mind though. We were doing a standing balance exercise with his prosthesis on, an exercise we named ‘Hanging out the washing,’ which involved picking up loose theraband from an above head height on a climbing wall and placing it onto a nearby table and then doing the reverse. The purpose of the exercise was to reach outside the bodies base of support and I progressed this by increasing the distance of the table from the patient. I did this while the patient was sitting down to rest and informed him that I want him to stand in the same position, but still place the theraband onto the table, which was now further away. Instead he just moved closer to the table… and I let him keep going. When this happened I thought that, this would be ok for now and I will just change it next time. When I thought about it later I realized that I had not actually progressed the exercise at all and was quite annoyed at myself for not having done so.
I think that I will need to be firmer with policing what I have said in the future to try and achieve the best results for my patients and not let them take the easy/slack option. I feel that my plan for the exercise was adequate and appropriate, I just needed to make sure it was performed in the manor that I intended. If I do this activity again, I will put markings on the floor to provide visual cues for foot placement for the patient. Less specifically, I have learnt that I should stick to my guns while taking a patient through an exercise, with the hope that they will reap the desired rewards from whatever they are doing.
This afternoon in the physio gym, I was working with an elderly male outpatient with a below knee amputation. I felt we had a very worthwhile session and I know he did too. It was a little different to other patients I’ve had in the past, mainly because there was a lot of ‘friendly disagreement’ going on. By this I mean, I would make a suggestion and the response would be a laughing “no,” followed by a smile, or a cheeky comment such as “why didn’t you tell me that?” when one of the other physios were chatting to him. This was fine and it didn’t upset me, but it was hard to ascertain exactly what was being said to me at times, which was a little off-putting. However, at the end of the session he was very grateful for the effort I had put in with him and the results he achieved, he also apologized for being, what he termed as ‘cheeky’ and said he was looking forward to Wednesday, when he is in next.
There was one particular incident that sticks in my mind though. We were doing a standing balance exercise with his prosthesis on, an exercise we named ‘Hanging out the washing,’ which involved picking up loose theraband from an above head height on a climbing wall and placing it onto a nearby table and then doing the reverse. The purpose of the exercise was to reach outside the bodies base of support and I progressed this by increasing the distance of the table from the patient. I did this while the patient was sitting down to rest and informed him that I want him to stand in the same position, but still place the theraband onto the table, which was now further away. Instead he just moved closer to the table… and I let him keep going. When this happened I thought that, this would be ok for now and I will just change it next time. When I thought about it later I realized that I had not actually progressed the exercise at all and was quite annoyed at myself for not having done so.
I think that I will need to be firmer with policing what I have said in the future to try and achieve the best results for my patients and not let them take the easy/slack option. I feel that my plan for the exercise was adequate and appropriate, I just needed to make sure it was performed in the manor that I intended. If I do this activity again, I will put markings on the floor to provide visual cues for foot placement for the patient. Less specifically, I have learnt that I should stick to my guns while taking a patient through an exercise, with the hope that they will reap the desired rewards from whatever they are doing.
Friday, October 17, 2008
Week 1: October 17 2008
Just before I left the physio office last night my supervisor told me that I would be required to give a patient handover (for a patient I’d never met…) to my clinical tutor at the start of my session with her today. So I left for the night, pretty buggered as usual, but not too worried about my little handover that would take place the next day.
I immediately began studying the patient’s notes when I got to the hospital this morning and with some points from the 224 tutorial on patient handovers I was all set to give my handover in an hour. I started in the amputee gym where I thought the notes would be physio specific and more what I was after, the only problem was that there were 3 admissions into the notes for the patient’s 4 week stay, they weren’t great and the most recent was 2 weeks ago. I FREAKED OUT! I thought I was doomed for my handover. However, I found a nice summary of the patient’s medical history which was a good starter. Then I raced up to the ward to look at the ward notes and there was still very little for physio. PANIC! I figured I might as well read the notes that were there (mainly nurse, OT and social worker) to find out a little more about the patient. When I finished I had 5 mins to go…
I got back to the gym for the assessment and was reading what I had written down. My supervisor came by and asked if everything was ok and I explained I was having some trouble. I told her…
1. There’s hardly any physio notes for this patient
2. I don’t understand a fair portion of the notes
3. I can’t read the handwriting in the notes!
First thing she told me was ‘Relax!’ Then she said that everyone has the last 2 probs, mainly because people have different abbreviations, but also because medical talk can be tough. Then she told me why there were no physio notes. The patient had been too medically unstable to attend gym, so he had only been a few times, hence the lack of notes! We had a laugh and she explained that this would not be a handover with large physio content, simply because very little physio had been done.
Anyway, after all that, my tutor ended up just asking for a ‘brief’ handover because we were running short on time, so I got pretty worked up for no reason. I guess what I learnt and the main point of this entry is that by stressing, you don’t achieve anything and I found this out the hard way. This incident also reminded me, that as with many things, the solution to a problem is often a very simple one and often the first thing you think of, but obviously this is not always the case. (“so now he’s a philosophiser”)
Good day, good week, did many things and saw even more! I can’t believe how tired I am!
Just before I left the physio office last night my supervisor told me that I would be required to give a patient handover (for a patient I’d never met…) to my clinical tutor at the start of my session with her today. So I left for the night, pretty buggered as usual, but not too worried about my little handover that would take place the next day.
I immediately began studying the patient’s notes when I got to the hospital this morning and with some points from the 224 tutorial on patient handovers I was all set to give my handover in an hour. I started in the amputee gym where I thought the notes would be physio specific and more what I was after, the only problem was that there were 3 admissions into the notes for the patient’s 4 week stay, they weren’t great and the most recent was 2 weeks ago. I FREAKED OUT! I thought I was doomed for my handover. However, I found a nice summary of the patient’s medical history which was a good starter. Then I raced up to the ward to look at the ward notes and there was still very little for physio. PANIC! I figured I might as well read the notes that were there (mainly nurse, OT and social worker) to find out a little more about the patient. When I finished I had 5 mins to go…
I got back to the gym for the assessment and was reading what I had written down. My supervisor came by and asked if everything was ok and I explained I was having some trouble. I told her…
1. There’s hardly any physio notes for this patient
2. I don’t understand a fair portion of the notes
3. I can’t read the handwriting in the notes!
First thing she told me was ‘Relax!’ Then she said that everyone has the last 2 probs, mainly because people have different abbreviations, but also because medical talk can be tough. Then she told me why there were no physio notes. The patient had been too medically unstable to attend gym, so he had only been a few times, hence the lack of notes! We had a laugh and she explained that this would not be a handover with large physio content, simply because very little physio had been done.
Anyway, after all that, my tutor ended up just asking for a ‘brief’ handover because we were running short on time, so I got pretty worked up for no reason. I guess what I learnt and the main point of this entry is that by stressing, you don’t achieve anything and I found this out the hard way. This incident also reminded me, that as with many things, the solution to a problem is often a very simple one and often the first thing you think of, but obviously this is not always the case. (“so now he’s a philosophiser”)
Good day, good week, did many things and saw even more! I can’t believe how tired I am!
Thursday, October 16, 2008
Week 1: October 16 2008
Firstly, I’d like to say I think I’ve been pretty lucky because yesterday I sat in on an amputee team meeting with the whole MDP (inc physio, doc, OT, psych, nurse, pharmacologist, prosthetist etc) and I got chocolate cake! And today there was a sausage sizzle for hospital staff so I got a couple of dogs in buns, a few cokes and an icecream! JOY!
Today was very interesting and I saw many things, however there was one patient of significance that springs to mind. The patient was an elderly male who had a trans-tibial amputation nearly a year ago, but due to complications, including wound healing problems, he only received an interim prosthesis less than a month ago. Consequently, the patient was essentially immobile and stuck in either a sitting or lying position for the best part of a year – resulting in dec strength and inc stiffness. Despite this, great progress had been made since getting the prosthesis and the patient was very enthusiastic to have a big exercise session.
My thoughts were that the pt would be very deconditioned, which would definitely affect exercise quantity and rate, but enthusiasm gave me great confidence to push hard! I started objectively with TUG and 6 min walk tests and although different gait aids were used to previous tests, there was significant improvement in both. I then did some standing balance (w/o aid) and progressed by standing on a large foam cushion to simulate uneven ground. My supervisor suggested looking from side to side and up/down, which I incorporated in the exercise when I felt it was appropriate. I felt we were doing really well and practice produced obvious improvement in this activity, as well as other standing balance exercises performed after. But when pain, stiffness and fatigue levels began to climb, I decided to call it a day with this patient.
I think I managed the patient pretty well. I allowed him to set some of his own goals along the way (eg. Time spent standing w/o assist), which were achieved, but I felt I was providing good motivational support for this patient. My instructions weren’t perfect for the 6mwt, in that I told the patient he could rest during the test if required, which happened with 45secs to go, but then the patient didn’t walk again. The patient said he would have kept going had he known he only had that much time to go – so I will review my technique for giving instructions for future testing. I am definitely looking forward to seeing improvement in this patient over the next month. I expect to see better results in the 2 tests from today and in standing balance ability, which I will continue to progress and with the patient’s good compliance with the home exercise program, there is a good chance this will occur.
I felt both comfortable and confident with this patient, especially because he was so keen to do whatever I suggested and tried his hardest to respond to any comments I made.
From this patient, I have found the importance of stressing at the patient clearly understands all instructions and aspects of objective tests and of exercises/activities, because this enables the patient to get the most out of their physio sessions.
Overall, today was great! I feel I understand my placement a little better and plans for the next few weeks were explained to me, which was good. The supervisor also provided some good feedback on how I was going today, which was really encouraging!
Fingers crossed for an outpatient who works at Maccas who brings in double quarter pounders 2moz!!! :D
Firstly, I’d like to say I think I’ve been pretty lucky because yesterday I sat in on an amputee team meeting with the whole MDP (inc physio, doc, OT, psych, nurse, pharmacologist, prosthetist etc) and I got chocolate cake! And today there was a sausage sizzle for hospital staff so I got a couple of dogs in buns, a few cokes and an icecream! JOY!
Today was very interesting and I saw many things, however there was one patient of significance that springs to mind. The patient was an elderly male who had a trans-tibial amputation nearly a year ago, but due to complications, including wound healing problems, he only received an interim prosthesis less than a month ago. Consequently, the patient was essentially immobile and stuck in either a sitting or lying position for the best part of a year – resulting in dec strength and inc stiffness. Despite this, great progress had been made since getting the prosthesis and the patient was very enthusiastic to have a big exercise session.
My thoughts were that the pt would be very deconditioned, which would definitely affect exercise quantity and rate, but enthusiasm gave me great confidence to push hard! I started objectively with TUG and 6 min walk tests and although different gait aids were used to previous tests, there was significant improvement in both. I then did some standing balance (w/o aid) and progressed by standing on a large foam cushion to simulate uneven ground. My supervisor suggested looking from side to side and up/down, which I incorporated in the exercise when I felt it was appropriate. I felt we were doing really well and practice produced obvious improvement in this activity, as well as other standing balance exercises performed after. But when pain, stiffness and fatigue levels began to climb, I decided to call it a day with this patient.
I think I managed the patient pretty well. I allowed him to set some of his own goals along the way (eg. Time spent standing w/o assist), which were achieved, but I felt I was providing good motivational support for this patient. My instructions weren’t perfect for the 6mwt, in that I told the patient he could rest during the test if required, which happened with 45secs to go, but then the patient didn’t walk again. The patient said he would have kept going had he known he only had that much time to go – so I will review my technique for giving instructions for future testing. I am definitely looking forward to seeing improvement in this patient over the next month. I expect to see better results in the 2 tests from today and in standing balance ability, which I will continue to progress and with the patient’s good compliance with the home exercise program, there is a good chance this will occur.
I felt both comfortable and confident with this patient, especially because he was so keen to do whatever I suggested and tried his hardest to respond to any comments I made.
From this patient, I have found the importance of stressing at the patient clearly understands all instructions and aspects of objective tests and of exercises/activities, because this enables the patient to get the most out of their physio sessions.
Overall, today was great! I feel I understand my placement a little better and plans for the next few weeks were explained to me, which was good. The supervisor also provided some good feedback on how I was going today, which was really encouraging!
Fingers crossed for an outpatient who works at Maccas who brings in double quarter pounders 2moz!!! :D
Tuesday, October 14, 2008
Week 1:
My first 2 days on placement have been very full on. I have been busy the whole time and very tired at the end of the day! One significant aspect today was a particular patient I was with.
The patient has a trans-femoral amputation and has recently had a fall, but is otherwise quite healthy. I had been working with the patient for a lot of today, but pain in the residual limb was beginning to cause problems and thus limiting exercise options. Mirror box therapy was eventually decided upon. The patient had been introduced to this treatment, but did not really think much of it as a treatment method, which initially made me a little uncertain, especially as I don’t consider myself an expert with this form of treatment. I began the process and with the assistance of my supervisor, explained to the patient the rationale behind the treatment and why we were performing it. At one point during the exercise, the patient became very quiet and looked a little upset (different from the usual loud and talkative nature) and I informed at this stage that it was not uncommon to become emotional during the treatment, which was appreciated by the patient. The patient then looked at me and began to explain the process they went through when losing their leg and that seeing 2 entire legs was comforting, but did stir many thoughts and emotions. After some more time, the patient explained how they would be more inclined to use the mirror box in the future and was very grateful for my help in the process, which was a very comforting gesture.
I feel I managed the day and the situation pretty well. I felt I was able to engage well with the patient and able to convey my knowledge and information effectively. If I was doing the treatment again I would progress to whole leg movements quicker, rather than just toe and ankle movements which I began with, because it was the whole leg movements that seemed to produce the biggest response.
As silly as it sounds, I felt much more comfortable and confident when my supervisor was not with me, I don’t know if this was because I felt under pressure but I definitely want to reduce this problem so that I can show my supervisor that I have got the goods!
Today was a very busy day, I attended a meeting with a PT, OT and nurse to discuss patient progress and changes of a number patients and do some FIM and FAM documents. A lot of time was spent in the gym with my TFA patient and I got to write their SOIER in the patient notes -
Saturday, October 11, 2008
Initial Entry
October 12, 2008
Right now my head is filled with a whole mess of thoughts and feelings and to even begin to interpret it, is a challenge in itself; however I guess the nerves and excitement is something everyone is going through around about now.
I’m going to Royal Perth Hospital and this alone is quite scary because I have not spent much time in hospitals in the past, which I suppose is actually a good thing. After reading some information about my placement I expect that a lot of it will be about rehabilitation based, which should be very interesting. I also believe the number of patients I come into contact with will not be as many as some other placements. I’m definitely looking forward to putting all the knowledge I have acquired thus far into action, although having said this, I do worry that I don’t know some areas as well as I think or probably should do. I am also looking forward to interacting with patients and other people around the place, as this was one aspect I really enjoyed when completing my 4P hours.
As I mentioned, I am a little concerned that when the time comes, my knowledge in some areas may be lacking, but I am definitely excited and looking forward to the experience over the 5 weeks.
At Shenton Park, I see the physiotherapist working alongside a range of health care professionals to ensure that the patient is cared for in the best possible fashion and that the rehabilitation process can be as quick and easy as it can be under the circumstances. I believe that one of the main roles of the physiotherapist in this situation will be for gait re-education and then to work with others to achieve adequate pain management.
Right now my head is filled with a whole mess of thoughts and feelings and to even begin to interpret it, is a challenge in itself; however I guess the nerves and excitement is something everyone is going through around about now.
I’m going to Royal Perth Hospital and this alone is quite scary because I have not spent much time in hospitals in the past, which I suppose is actually a good thing. After reading some information about my placement I expect that a lot of it will be about rehabilitation based, which should be very interesting. I also believe the number of patients I come into contact with will not be as many as some other placements. I’m definitely looking forward to putting all the knowledge I have acquired thus far into action, although having said this, I do worry that I don’t know some areas as well as I think or probably should do. I am also looking forward to interacting with patients and other people around the place, as this was one aspect I really enjoyed when completing my 4P hours.
As I mentioned, I am a little concerned that when the time comes, my knowledge in some areas may be lacking, but I am definitely excited and looking forward to the experience over the 5 weeks.
At Shenton Park, I see the physiotherapist working alongside a range of health care professionals to ensure that the patient is cared for in the best possible fashion and that the rehabilitation process can be as quick and easy as it can be under the circumstances. I believe that one of the main roles of the physiotherapist in this situation will be for gait re-education and then to work with others to achieve adequate pain management.
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