Sunday, August 30, 2009
final entry
I really enjoyed my this rural placement. Initially I was nervous about being in the country however I thought it was a good experience. I learnt a lot about workers compensation issues and pilates! It has encouraged me to look into doing a course in pilates so hopefully I can eventually take classes! I was concerned about my time management and confidence while on prac. I found both improved over the course of the 5 weeks. Initially my supervisor gave me twenty minutes to do a subjective and objective on patients and I was taking just over ten minutes to get through the subjective! Towards the end of my time at the practice I was able to complete both in that time and do a much more thorough objective. I also felt my confidence improved as my educational skills and interaction with patients became easier and I was less nervous. I learnt a great deal about the musculoskeletal side of phsyiotherapy and now know a few extra tips and techniques that we do not get to cover at uni!
topic three- intervention
S- approximately 30 yr old female with RSI in her wrist. She had been having acupuncture and massage to treat it previously however was still experiencing pain on wrist extension especially when putting weight through her wrist/ and overpressure.
T-I was aiming to decrease her pain and 'free up' her movement
A- As I could not do acupuncture on the patient's forearm I decided to do mobilisation of her wrist joint and of the carpal bones instead in combination with massage of her wrist extensors. I also noted that she had not yet tried using anti-inflammatory cream to do self massage so I decided to use it for the treatment to assess if there would be a change in her pain in these muscles.
R- the patients wrist extension was pain free even with overpressure after treatment! She also reported her wrist felt less stiff.
E/S- There was a good repsonse from using the anti-inflammatory cream and the patient was happy with her movement after the mobilisations. I was happy thatI chose to do the mobilisations and encourage the use of the cream. I think it was good that I tried to use a combination of things to improve her outcome. However I was unsure about doing the mobilisations at first as they caused pain initially which then eased.
T-I was aiming to decrease her pain and 'free up' her movement
A- As I could not do acupuncture on the patient's forearm I decided to do mobilisation of her wrist joint and of the carpal bones instead in combination with massage of her wrist extensors. I also noted that she had not yet tried using anti-inflammatory cream to do self massage so I decided to use it for the treatment to assess if there would be a change in her pain in these muscles.
R- the patients wrist extension was pain free even with overpressure after treatment! She also reported her wrist felt less stiff.
E/S- There was a good repsonse from using the anti-inflammatory cream and the patient was happy with her movement after the mobilisations. I was happy thatI chose to do the mobilisations and encourage the use of the cream. I think it was good that I tried to use a combination of things to improve her outcome. However I was unsure about doing the mobilisations at first as they caused pain initially which then eased.
Sunday, August 16, 2009
wk 3 post- assessment/ evidence based practice
S-approximately 40 year old female. Presented with neck pain and LBP with symptoms in her left leg extending down to her foot (P & N, etc). She also complained of altered sensation in her left upper limb.
T-I did a very thorough subjective assessment to rule out any red flags and followed with an objective to assess whether her symptoms in her arm were related to her neck pain. Aim was to treat both neck and back pain in that session.
A-I spoke to my supervisor before continuing as I found after the assessment she had almost 4 or 5 red flags, possibly indicating cancer or a neurological source. I did not end up treating the patient however my supervisor did some treatment. We referred the patient to the doctor to be assessed.
R/E-As mentioned previously I did not treat the patient but in telling my supervisor what I had found the patient can be cleared of anything more serious and we can continue to treat her without needed to take any precautions, etc . I think it was good that I picked up that something may not have been quite right. My weakness was that I tried to write a referral letter and it could have been summarized a lot better.
S- I think I could practice writing referral letters so I can communicate better with other health professionals.
T-I did a very thorough subjective assessment to rule out any red flags and followed with an objective to assess whether her symptoms in her arm were related to her neck pain. Aim was to treat both neck and back pain in that session.
A-I spoke to my supervisor before continuing as I found after the assessment she had almost 4 or 5 red flags, possibly indicating cancer or a neurological source. I did not end up treating the patient however my supervisor did some treatment. We referred the patient to the doctor to be assessed.
R/E-As mentioned previously I did not treat the patient but in telling my supervisor what I had found the patient can be cleared of anything more serious and we can continue to treat her without needed to take any precautions, etc . I think it was good that I picked up that something may not have been quite right. My weakness was that I tried to write a referral letter and it could have been summarized a lot better.
S- I think I could practice writing referral letters so I can communicate better with other health professionals.
Sunday, August 2, 2009
Topic One (Intervention/communication)
S- approx. 55 yr old man had a TKR 3/52 ago, undergoing a rehab programme
T- I was asked to go through some exercises with him to improve his range of knee flexion. I had to give him feedback on his exercises that he had already been given and teach him a few progressions. I also needed to measure his knee flexion ROM before and after his exercises.
A- Exercises aimed and strengthening his quads/hams. strength and improving range and flexibility around knee. I observed his gait on the treadmill and encouraged him to concentrate on heel strike,etc and educated him about the correct posture during gait to optimise the his biomechanics especially at his knee.
R-The patient reported that his knee felt less stiff after the session and also said he felt a difference at his knee/in his legs when I corrected some of his exercise techniques. As a result he ended up working the correct muscles optimally and his exercises became more challenging. His knee ROM had improved.
E- strengths: constructive, clear feedback, gait analysis. weaknesses: I had some difficulty with adapting a few exercises when some caused discomfort and so probably could have given him more effective exercises
S- I went and asked the physio about some modifications to some exercises and looked up some more exercise ideas
T- I was asked to go through some exercises with him to improve his range of knee flexion. I had to give him feedback on his exercises that he had already been given and teach him a few progressions. I also needed to measure his knee flexion ROM before and after his exercises.
A- Exercises aimed and strengthening his quads/hams. strength and improving range and flexibility around knee. I observed his gait on the treadmill and encouraged him to concentrate on heel strike,etc and educated him about the correct posture during gait to optimise the his biomechanics especially at his knee.
R-The patient reported that his knee felt less stiff after the session and also said he felt a difference at his knee/in his legs when I corrected some of his exercise techniques. As a result he ended up working the correct muscles optimally and his exercises became more challenging. His knee ROM had improved.
E- strengths: constructive, clear feedback, gait analysis. weaknesses: I had some difficulty with adapting a few exercises when some caused discomfort and so probably could have given him more effective exercises
S- I went and asked the physio about some modifications to some exercises and looked up some more exercise ideas
Saturday, July 25, 2009
Initial entry
I am really looking forward to this placement especially as it is a private practice and in the musculoskeletal field- I am sure there will be lots of opportunities to ask questions and I will come across a range of presentations. It will be a good refresher of all the tests, etc we have learnt thus far. I also think it will be a good time to improve on my assessment skills, treatment techniques, time management and my confidence. I am concerned about all!! I'm a little nervous about how many patients I'll be expected to see in a day due my time management skills! I am looking forward to doing some clinical pilates as I have had some experience with it so may possibly be running a small class as well as prescribing home exercise programmes. I might be doing some work site reports which I think will be beneficial as it is a part of being a physio most of us are not familiar with. I'm nervous about the placement as I'm not sure exactly what to expect and also due to the fact that I'm on a rural placement.
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