week 5 post- intervention (treatment planning)

S: My supervisor has discussed with me the importance of making treatments functional and relevant to a patient's goals and daily lives (the importance of this has also been stressed to us at university!). That day I saw a 15 year old boy with limb girdle muscular dystrophy and was asked to conduct a full assessment. Taking on board what my supervisor had said, I made an effort to find out his goals and functional abilities in my assessment so that I had a clear idea of where to direct my treatment ideas. Once I had done the subjective assessment , I found that he enjoyed doing sailing at school once a week as he found it challenging and that he noticed he had difficulty walking up inclines and stairs as he tended to lean forward and walk on his toes. He was very physically active (often cycled to friends' houses and walked to school, etc). His goals were to maintain his strength and fitness; slow the progression of the disease as well as be able to walk up inclines/hills with less difficulty. Objectively, some of my findings were that he had reduced dynamic balance (with higher level tasks) and when squatting. He fatigued quickly after doing squats and bridges. His calves were very tight as he had reduced ankle dorsiflexion range. In general, hisupper limb strength and range was slightly lower than what is proposed as 'normal'. He also toe walked when ascending/descending stairs which made it slightly harder for him to balance.
T: My task was to plan a short treatment programme for him that was functional and directly linked his goals while at the same time being achievable and realistic for him.
A: I developed a treatment program with the above findings in mind. In forming the programme, I did a bit of research into sailing to find out what gross movements were involved in the sport. I found that (depending on a person's role on the boat), sailing requires upper limb strength for pulling the sails, good dynamic balance for maintaining balance on a moving boat, squatting and leaning out of the side of the boat. These requirements I found were what the patient had had some difficulty performing in my objective assessment. Therefore, based on this information; my other findings and his goals, my treatment plan consisted of the following (complete plan not written here): Squats (double leg and single leg/double leg while catching a ball/ standing on foam, etc), balancing on a wobble board and other high level balance activities, calf stretches, bridging (to maintain his hip extension strength), light resistance exercises with theraband for his upper limbs and more. These exercises I felt targeted things which he struggled with and would aid him in being able to continue with sailing as well as prevent deterioration in his balance, strength, fitness and joint range. If these deteriorated, his functional abilities would reduce to an extent.
In terms of his cardiovascular fitness, he was doing an appropriate level of physical activity already so I did not suggest many new ideas to target this apart from swimming (which would also be good for his joint range and maintaing strength). I noted down to encourage him to continue living an active and healthy lifestyle so that he could continue with his ADL's and sailing and prolong his ambulation. In planning this intervention, I also made a note to educate the patient that due to the disease process, with physiotherapy we can only maintain his strength and that there would not be a significant training effect on the muscles so his strength would not necessarily increase by too much. The importance was ensuring he could continue doing activities he enjoys and optimise his functional ability as the disease progresses. I also made a note that we did not want to over work (or overstretch) his muscles due to the disease processa and that stretching his calves will help him toe walk less however it is likely he will continue to toe walk once again due to the inevitable disease progression but we can work on his balance, hip extension strength and on preventing further tigthening of his calves.
R: I explained my treatment plan to my supervisor. He thought that it was good in the way that it addressed the patient's goals and was very functional while at the same time achieved some aims of physiotherapy which would be typical for a patient with limb girdle muscular dystrophy. These include preventing contractures (with stretching and weight bearing), optimising function and ability to participate in activities with peers and so on. I got the opportunity to trial a few of the exercises from the programme and explain why I chose certain exercises to the patient before finishing my placement. The patient was happy with his exercises that were trialed and others that were suggested and felt that they were relevant to his goals.
E: I felt that I did a good job in making my intervention functional and patient specific while also ensuring I had goals of physiotherapy in mind and that these were being achieved simulatenously. It was important and satisfying that the patient was happy with my proposed treament program. I think I could have enquired more about what aspects in regards to sailing the patient found challenging and specifically what his role is on the boat to make the treatment even more relevant to him and his needs. I completely forgot to investigate further into this in the subjective!
S: I think I could practice being a better investigator in my subjective so that I can make sure my treatment is as relevant to the patient as possible and so that I am not making any assumptions about what the patient needs to do. This will help maximise the patient's satisfaction with the treatment they are receiving and also be more beneficial to them from a physiotherapy perspective.