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!