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