FINAL ENTRY NEURO

Most of my assumptions about the Wel-Tell centre were correct. Well-Tel is a play on ho-tel, ie: a hotel for well people! It is there for those people who need an intensive burst of physiotherapy but are independent enough that they don't need to stay on the ward. Not only is this better for the patients, but it saves a whole heap of tax payer money!

Patient's were generally well versed in self care, and I found that my role was supervisory, but not the extent I had guessed. I did have to ensure patients could perform their exercise programs well enough that they could do it at home. However, it was also a great time to utilise treatments techniques that could not be done at home, things like the tilt table, hydrotherapy, hands on mobilisations and stretches and normal movement facilitation etc. So not only did I supervise, I was a hands on therapist! I was correct in saying that patients were no longer in an acute phase of rehab, but this did not necessarily mean that that they needed higher level training. Some patients did require this type of therapy as they had been admitted straight after an inpatient stay on the ward, ie: were in the final stages of motor recovery post stroke or GBS. Most of the patients however had degenerative or genetic conditions like MS or HSP (hereditary spastic paraparesis.) They did not require high level training, rather treatment to maintain or improve their current functional status.

The structure of the of the program was that patients came to the gym for 2 and half hours in the morning. Here they had one on one time with a physio, doing all those things they miss out on at home, and also work independently on their tailored programs. The rest of the day is for themselve. They can book in with the OT, speech therapist, social worker, podiatrist, attend hydrotherapy or even come back to the gym in the afternoon. It is a really well-rounded program that includes every aspect of the multi-disciplinary team!! And as I had thought, patients did make some really good friends and it was definitely a motivation to work. We were all in the gym together and it made for such a nice and supportive environment!

Aside from Wel-Tell, I was also assigned to the ward 2 gym, which sees neurological inpatients. Here I dealt with stroke patients in their acute phases of recovery. This meant my role was very hands on. I felt that my afternoon patients were much more dependent and my role was to facilitate and re-educate normal movement patterns. I felt that this gave me a really huge opportunity to see such a range of conditions throughout all phases of recovery!!

Concerns:
I did feel that I was a bit behind in my neuro, but I learnt so much! I really realised that it is all related to normal movement, and as the weeks went on I was able to more effectively not the deviations from normal and why. I may have been less confident initially, but with time it became much easier. Once you develop a rapport with the patient confidence really just comes. My supervisor did expect a lot of me, but only what was within my knowledge base. She didn't expect me to have a million different treatment techniques up my sleeve. She was aware that you only learn a few at uni and the rest comes with experience. And I did learn HEAPS of different techniques, but I think I would be still learning 20 years into a neuro career...the scope of what you can do is enormous.

I did enjoy my placement, but I also found it very confronting and overwhelming. I think experience is also needed in how to detach yourself emotionally (although I also think emotion is what can make you a great physio!) It was really hard and challenged me in more ways than I imagined. I'm not sure that it's the career path I'm cut out for, but it's an experience I'll definitely remember! I think if you can master neuro you can probably master most things...having a normal movement base is what most physio is about!!

My take home message: To be really honest I felt that neuro physio was initially quite subjective, everyone seems to do everything differently and you have different feedback coming from every angle!! (I'm also aware that it is less evidence based because it's unethical to withhold treatments from these patient groups.) But I've come to realise that it doesn't overly matter if everyone does things a different way. Nothing is really 'wrong' as such...as long as you're achieving your aim of normal movement an exercise is appropriate! You need to experiment with techniques and constantly monitor and progress. This drives home the importance of assessment. If you get your neuro impairment list 100%, you can work a treatment to suit your aim! Lastly, I wasn't expected to know everything there is to know about neuro, so don't be afraid to ask! I became aware of my own limitations and as such I knew when to ask for help and advice.