WEEK 1
S-In the afternoons we work in the neurological inpatients gym. Here we mainly see stroke and brain injury patients in their last month or so of rehab before discharge. Patients on the ward make appointments with the physios here and can spend up to three hours in the gym! It is a real team orientated environment. All the physios work in one large room asking each other for help when required. (i.e.: if they’re having difficultly pinpointing the patient’s impairments or need extra assistance walking a patient.)
I was to see a new patient on my very first day. Ms A has multiple sclerosis and was admitted to Shenton Park that morning experiencing her 2nd relapse since her diagnosis (2003). She became aware of her condition deteriorating as she could no longer transfer with a slide board independently; she felt her balance was too poor. Ms A is fiercely independent and her ability to transfer is thus very important.
T-My task was to make the initial assessment of Ms A. Seeing as Ms A experiences most of her fatigue in the afternoon, we decided to just complete an assessment that day. We felt it may be too exhausting to include treatment in the one session as well.
A-I completed a thorough subjective examination whilst Ms A was in her chair. I tried to elicit as much information as possible about her condition, so that our objective examination could be specific from the outset to minimise her fatigue levels. While she was still in her chair we quickly ran thorough cranial nerves and sensation. We then transferred her onto the plinth to assess her motor status and tone. I quickly realised that muscle testing muscle testing was not clear-cut with Ms A. She had almost no movement in her lower limbs and I didn’t want to overly fatigue her by getting her in and out of numerous ‘gravity eliminated’ positions. I found the best way to elicit movement was to perform active assisted LL movements and document as such. It showed me the importance of palpating the muscle whilst moving it so I could feel for any muscle flickers. After these assessments Ms A came into sitting for a postural and balance assessment. She was not safe to be sitting unassisted and I noticed that her trunk was very ataxic. Because of this I decided to test her coordination looking for signs of potential new cerebellar involvement.
R- From this assessment I produced a concise impairment list, and thankfully I didn’t tire my patient out too much. She did in fact have positive results on cerebellar testing, including a new (3 week old) intention tremor. These findings will cause us to go down a different treatment path, focussing more on core stability and target type training.
E- I felt that my assessment went well. It was very important to be well organised as Ms A said asthenia really hinders her ability to participate in any kind of therapy. I thought that my subjective examination really helped to direct me to what was important, namely her new found LL worsening weakness and balance issues. I didn’t spend too much time on other aspects, such as cranial nerves as I had already asked about visual and swallowing difficulties etc. I also thought I did well in not making her moving around too much, as that is something I am usually terrible at! I’m always asking patients to sit down, stand up and sit down again!
The problem list that I came up with was reflective of her impairments but probably not prioritised well enough. I needed to remember that Ms A came in wanting to fix a specific problem, her transfers. So number one on our list should be to work on her core stability and practice transfers, and things like spasticity and LL weakness should be lower priorities. This is something I think I should do more every time I see a patient. I need to remember why they are here, what they want to achieve, and look more globally at the person.
S- The main strategy I used was preparation! Knowing that she fatigues easily meant I needed to be really well organised, focussed and specific. Before I saw the patient I wrote down what was essential to find out in my subjective examination. From here I worked out was most important to assess and tried to put that at the start of our objective examination. I also thought hard about testing positions and what would flow best. I think being well prepared was really the most important thing in making this a successful assessment.
Saturday, March 27, 2010
Sunday, March 21, 2010
INITIAL ENTRY (NEURO)
Tomorrow I start my Neuro placement at the Well-Tel Centre (part of Shenton Park Hospital). From what I can gather, it is a place that provides accommodation for people undergoing rehab or other services, but do not necessarily need to be admitted as an inpatient, in a ward environment. This will mean that the patients have much more independence and are in a less acute phase of their illness/recovery. For me, I think this means that the patients will be well versed in self care and will require more high level rehabilitation.
NATURE
I found it quite difficult to find much information on the Centre, but speaking to students who went previously confirmed my above ideas. The Centre is almost like a 'halfway house' for those who don't really need to be in hospital. Thus, PT sessions can be much more intensive, up to an hour of one on one work. As the patients are no longer acute, I think I will need to be prepared for 'later stage' training, ie: the final stages of motor recovery/high level balance work/coordination and power etc, all those things that make up a more 'normal' movement (as opposed to initial periods of flaccidity immediately following stroke for example.)
STRUCTURE
I have only been in outpatient and hospital settings, so as far as the structure of the Well-tel centre is concerned, I think I may be in for a whole new experience!! I imagine it will be similar to an outpatient setting, with patients seeing you at previously booked times, but then they can go back to their rooms! Similar to a hotel or boarding house! I am also curious to see if they run any group sessions. I think it would be a great way to exercise as patients there for a week or more would most likely make friends (if it's similar to a hotel environment?) -this could be a great motivation!!
ROLE
I also found out I will be dealing mostly with disorders like multiple sclerosis, acquired brain injuries, spinal cord injuries and potentially some amputees. I think my role as a student will be to perform one on one rehab sessions with these patients, involving more high level and independent activities. I think I will become more of a 'supervisor' and less of an 'assistant' as patients at this Centre are independent, and will need more supervision of programs to ensure they're doing it correctly at home. I think I will also become an educator. I can only imagine how difficult it would be to live with MS, and I think I will need to be on the ball with advice, encouragement and support. I think my role is also going to be to learn as much as I can. As I understand from Ali, there are many different ways to approach neuro rehab, and I am hoping to learn many new skills, as well as consolidate those I already have.
CONCERNS
I have SO many concerns about this placement! I feel like my past 2 placements were very MSK based, and thus I have a much better idea about the MSK subjective and objective assessments and treatment techniques. (Not to mention more confidence!) I also missed the first placement as I was doing my project. We were told that now supervisors are less lenient and expect more because it is placement number two...but I am behind. I literally haven't seen any patients since Collie last year! I don't know if I trust myself. Plus, I have my usual worry about not living up to my own expectations or those of my supervisors...but that is nothing new:)
But, if it's anything like my previous 2 placements, I will love every second of it!!
NATURE
I found it quite difficult to find much information on the Centre, but speaking to students who went previously confirmed my above ideas. The Centre is almost like a 'halfway house' for those who don't really need to be in hospital. Thus, PT sessions can be much more intensive, up to an hour of one on one work. As the patients are no longer acute, I think I will need to be prepared for 'later stage' training, ie: the final stages of motor recovery/high level balance work/coordination and power etc, all those things that make up a more 'normal' movement (as opposed to initial periods of flaccidity immediately following stroke for example.)
STRUCTURE
I have only been in outpatient and hospital settings, so as far as the structure of the Well-tel centre is concerned, I think I may be in for a whole new experience!! I imagine it will be similar to an outpatient setting, with patients seeing you at previously booked times, but then they can go back to their rooms! Similar to a hotel or boarding house! I am also curious to see if they run any group sessions. I think it would be a great way to exercise as patients there for a week or more would most likely make friends (if it's similar to a hotel environment?) -this could be a great motivation!!
ROLE
I also found out I will be dealing mostly with disorders like multiple sclerosis, acquired brain injuries, spinal cord injuries and potentially some amputees. I think my role as a student will be to perform one on one rehab sessions with these patients, involving more high level and independent activities. I think I will become more of a 'supervisor' and less of an 'assistant' as patients at this Centre are independent, and will need more supervision of programs to ensure they're doing it correctly at home. I think I will also become an educator. I can only imagine how difficult it would be to live with MS, and I think I will need to be on the ball with advice, encouragement and support. I think my role is also going to be to learn as much as I can. As I understand from Ali, there are many different ways to approach neuro rehab, and I am hoping to learn many new skills, as well as consolidate those I already have.
CONCERNS
I have SO many concerns about this placement! I feel like my past 2 placements were very MSK based, and thus I have a much better idea about the MSK subjective and objective assessments and treatment techniques. (Not to mention more confidence!) I also missed the first placement as I was doing my project. We were told that now supervisors are less lenient and expect more because it is placement number two...but I am behind. I literally haven't seen any patients since Collie last year! I don't know if I trust myself. Plus, I have my usual worry about not living up to my own expectations or those of my supervisors...but that is nothing new:)
But, if it's anything like my previous 2 placements, I will love every second of it!!
Friday, August 28, 2009
end of prac
I am so glad I got to go to Collie. I can’t express enough just how much fun I had. I could have never imagined myself working in the country, but now it definitely seems like a fantastic option. I think the reason that I loved it so much was because of the people, everyone at the hospital made me feel so welcome and part of their team, I couldn't have asked for more!
ISSUE ONE: I think I am mainly nervous about being away for so long and feeling like there will be less people to ask for help. I am also worried about our accommodation. Jess and I might be a bit lonely if we’re the only people there.
Not at all an issue! There were more people to ask and everyone was willing to stop and give you a hand! Also, the accommodation was great. There were quite a few other students there and I made a really great friend with an OT student from curtin. We might go back for a Collie road trip together!
ISSUE TWO: Diversity, small country town hospital and a small allied health team?
I did see a much more diverse range of things! I had cardio, peads, neuro, WH, ortho and MSK patients….a bit of everything! It made a FANTASTIC earning experience, I feel like I have seen so much. I also got to look after he ward and see people in an acute setting which was great! The hospital was a lot quieter though than my previous, but it meant you could put more time into patient preparation and care, so it wasn’t the downfall I expected!
The allied health team was huge, and very inclusive. You could ask anyone for help and there were constant inter-departmental referrals.
All in all, best prac ever!
ISSUE ONE: I think I am mainly nervous about being away for so long and feeling like there will be less people to ask for help. I am also worried about our accommodation. Jess and I might be a bit lonely if we’re the only people there.
Not at all an issue! There were more people to ask and everyone was willing to stop and give you a hand! Also, the accommodation was great. There were quite a few other students there and I made a really great friend with an OT student from curtin. We might go back for a Collie road trip together!
ISSUE TWO: Diversity, small country town hospital and a small allied health team?
I did see a much more diverse range of things! I had cardio, peads, neuro, WH, ortho and MSK patients….a bit of everything! It made a FANTASTIC earning experience, I feel like I have seen so much. I also got to look after he ward and see people in an acute setting which was great! The hospital was a lot quieter though than my previous, but it meant you could put more time into patient preparation and care, so it wasn’t the downfall I expected!
The allied health team was huge, and very inclusive. You could ask anyone for help and there were constant inter-departmental referrals.
All in all, best prac ever!
week 5 STARES
COMMUNICATION
S- My patient, A young girl who had previously fractured her ankle and then suffered from RSD, came in to see me with recurrent ankle pain. She came in with her mother and they had SUCH a bizarre relationship. The mum answered every question for her daughter and kept cutting in. For example, when I asked her the intensity of the pain the girl answered only a 3, but then her mother cut in and said its definitely more like a 9. Then mother then continued to rattle off every disease under the sun that her daughter had, including rheumatoid arthritis which was causing the ankle pain.
T- My task was to assess the girls ankle and provide treatment as required. However, all of the mum's information was making me think that she just wanted a sick child for attention and I felt it was a bit of a red flag for Münchhausen's. We sent the girl home with a program and booked her in for 3 days later. My supervisor then rang the specialist at PMH and sure enough the mother has been flagged for potential Münchhausen's (but non harmful) and her dependency on PMH was noted. Our task then became to really utilise our communication skills to try and explain this to the family.
A- I asked my supervisor to come in with me as I didn't want to say the wrong thing and make it worse for the child. We then chose to speak only to the daughter so that the mum could not butt in as much. We explained that she did not have a disease process in her ankles, but that she has some hypermobilty, which is completely normal. We emphasized that she should not be having days off school and that she can play sport (originally her mum was even letting her walk far) We talked about her ankles for about half an hour, and hopefully it helped to drive home to her that there was nothing wrong!
R- I think that my education and communication skills were to the point as the daughter was responding to questions on her own rather than looking to her mum. She was glad to hear that she was normal! I showed her my knees just to prove that having some hypermobiity doesn't make you abnormal!
E- I was really glad that I asked my supervisor to come in with me. I think I did a good job but sometimes I'm not quite strong enough in my convictions and I think the mother could have bullied me into changing what I said. My supervisor is reviewing her once a week to ensure she is doing everything that a normal 13 year old should be doing!
S- The main strategies I used were communication and education, which is definitely what the family needs the most. Also, her dad (a totally normal guy) will bring her n next time under the guise of also having to review his knee...getting her away from her mum will also be the key!
S- My patient, A young girl who had previously fractured her ankle and then suffered from RSD, came in to see me with recurrent ankle pain. She came in with her mother and they had SUCH a bizarre relationship. The mum answered every question for her daughter and kept cutting in. For example, when I asked her the intensity of the pain the girl answered only a 3, but then her mother cut in and said its definitely more like a 9. Then mother then continued to rattle off every disease under the sun that her daughter had, including rheumatoid arthritis which was causing the ankle pain.
T- My task was to assess the girls ankle and provide treatment as required. However, all of the mum's information was making me think that she just wanted a sick child for attention and I felt it was a bit of a red flag for Münchhausen's. We sent the girl home with a program and booked her in for 3 days later. My supervisor then rang the specialist at PMH and sure enough the mother has been flagged for potential Münchhausen's (but non harmful) and her dependency on PMH was noted. Our task then became to really utilise our communication skills to try and explain this to the family.
A- I asked my supervisor to come in with me as I didn't want to say the wrong thing and make it worse for the child. We then chose to speak only to the daughter so that the mum could not butt in as much. We explained that she did not have a disease process in her ankles, but that she has some hypermobilty, which is completely normal. We emphasized that she should not be having days off school and that she can play sport (originally her mum was even letting her walk far) We talked about her ankles for about half an hour, and hopefully it helped to drive home to her that there was nothing wrong!
R- I think that my education and communication skills were to the point as the daughter was responding to questions on her own rather than looking to her mum. She was glad to hear that she was normal! I showed her my knees just to prove that having some hypermobiity doesn't make you abnormal!
E- I was really glad that I asked my supervisor to come in with me. I think I did a good job but sometimes I'm not quite strong enough in my convictions and I think the mother could have bullied me into changing what I said. My supervisor is reviewing her once a week to ensure she is doing everything that a normal 13 year old should be doing!
S- The main strategies I used were communication and education, which is definitely what the family needs the most. Also, her dad (a totally normal guy) will bring her n next time under the guise of also having to review his knee...getting her away from her mum will also be the key!
week 3 STARES
week 3 STARES
S- In week 2 I saw my first patient by myself. The patient had been diagnosed with a shoulder impingement and biceps tendinitis. She has also been to the physio here for a number of other problems however and has numerous pain issues. She attends a class run by the physio department during which she sits out most of the exercises due to pain. She came to our appointment wearing a sling and was displaying her illness very obviously.
T- I had to perform an assessment and treatment to best help this patient, keeping in mind her pain issues and trying not to feed into them any further.
A- I performed a thorough assessment. A few things that I noted were that her active shoulder range on assessment was no further than 120º yet she could take off her jumper using full shoulder ROM. She also had very poor posture and didn’t understand her diagnosis or what it meant in terms of her pain. As such, I really focussed on education. I made sure she understood the mechanism of her pain and how poor posture affects her shoulder and really is the solution to her pain. I also discouraged her wearing of the sling but suggested she ice her shoulder to help with inflammation. I then gave her an exercise program focussing on improving her posture and strengthening her rotator cuff.
R- The patient was really happy with the explanation of her pain and felt that knowing the problem gave her more control of the issues. She performed the exercises well and was happy to continue them at home. I also saw her at the exercise class a week later and she said her pain had reduced and that she was constantly correcting her posture.
E- I was happy with how our session went. I was especially happy with my explanation as I feel that her interpretation and lack of understanding was having the most impact on her pain and her ADL’s. (As wearing the sling meant she couldn’t do too much). I think though that I need to get into a much better routine during the assessment, as I had my patient moving from sitting, to supine to prone…etc and it was a bit all over the place. She also had some trouble moving on and off the plinth so it really didn’t help! Next time I see her (or any other patient) I am going to organise my tests into those categories before I start so I am more confident and prepared.
S- The strategies I used were education and postural re-education. I was happy with how I used these and my confidence in the education process.
S- In week 2 I saw my first patient by myself. The patient had been diagnosed with a shoulder impingement and biceps tendinitis. She has also been to the physio here for a number of other problems however and has numerous pain issues. She attends a class run by the physio department during which she sits out most of the exercises due to pain. She came to our appointment wearing a sling and was displaying her illness very obviously.
T- I had to perform an assessment and treatment to best help this patient, keeping in mind her pain issues and trying not to feed into them any further.
A- I performed a thorough assessment. A few things that I noted were that her active shoulder range on assessment was no further than 120º yet she could take off her jumper using full shoulder ROM. She also had very poor posture and didn’t understand her diagnosis or what it meant in terms of her pain. As such, I really focussed on education. I made sure she understood the mechanism of her pain and how poor posture affects her shoulder and really is the solution to her pain. I also discouraged her wearing of the sling but suggested she ice her shoulder to help with inflammation. I then gave her an exercise program focussing on improving her posture and strengthening her rotator cuff.
R- The patient was really happy with the explanation of her pain and felt that knowing the problem gave her more control of the issues. She performed the exercises well and was happy to continue them at home. I also saw her at the exercise class a week later and she said her pain had reduced and that she was constantly correcting her posture.
E- I was happy with how our session went. I was especially happy with my explanation as I feel that her interpretation and lack of understanding was having the most impact on her pain and her ADL’s. (As wearing the sling meant she couldn’t do too much). I think though that I need to get into a much better routine during the assessment, as I had my patient moving from sitting, to supine to prone…etc and it was a bit all over the place. She also had some trouble moving on and off the plinth so it really didn’t help! Next time I see her (or any other patient) I am going to organise my tests into those categories before I start so I am more confident and prepared.
S- The strategies I used were education and postural re-education. I was happy with how I used these and my confidence in the education process.
Saturday, August 1, 2009
week 1
One week down of my placement! It’s been going really well, but I don’t feel as though I have much to report on as I have only been observing the 4th year student and my supervisor rather than getting my own hands on opportunities, that’s not to say I haven’t learnt anything though, or had fun. Also, I'm finding it's A LOT quieter in the country as opposed to perth!!! Next week I have been able to book in patients so that will be more challenging. I have 3 post natal referrals which I’m especially looking forward to as we haven’t had that much practical exposure yet, I don’t know if I should be nervous or excited!
S- A ‘no falls’ class for clients referred with balance issues. The class focuses on stretching, strengthening, lots of balance work, mobility and multitasking.
T- Take the class (which I had never seen only once before) while my supervisor worked one on one with an elderly gentleman who needed quite a lot of extra help.
A- I took the class and we ran through some gentle arm weights, leg strengthening and balance work. We also did some walking while bouncing the ball to encourage multi-tasking.
R-The class worked well and enjoyed the exercises I gave them.
E-I think that I did a good job in that I was confident and enthusiastic, but next time I think I could definitely branch out a bit more. I stayed on the same track that my supervisor follows but I think I could spice up the program with some of my own ideas.
S- I’m going to go and have a look through some of our past notes/lectures and find some new and exciting exercises that the class can do. Especially some new balance work.
S- A ‘no falls’ class for clients referred with balance issues. The class focuses on stretching, strengthening, lots of balance work, mobility and multitasking.
T- Take the class (which I had never seen only once before) while my supervisor worked one on one with an elderly gentleman who needed quite a lot of extra help.
A- I took the class and we ran through some gentle arm weights, leg strengthening and balance work. We also did some walking while bouncing the ball to encourage multi-tasking.
R-The class worked well and enjoyed the exercises I gave them.
E-I think that I did a good job in that I was confident and enthusiastic, but next time I think I could definitely branch out a bit more. I stayed on the same track that my supervisor follows but I think I could spice up the program with some of my own ideas.
S- I’m going to go and have a look through some of our past notes/lectures and find some new and exciting exercises that the class can do. Especially some new balance work.
pre placement post
COLLIE!
I am feeling very nervous, and excited, about heading to Collie tomorrow. I just arrived home from Melbourne and am now packing a truck load of things to take down for 5 weeks; I didn’t leave myself much organising time! I am bound to forget something!
I think I am mainly nervous about being away for so long and feeling like there will be less people to ask for help. I am also worried about our accommodation. Jess and I might be a bit lonely if we’re the only people there.
Heading down to Collie I am expecting to see a much more diverse range of things than I did at Bentley. My supervisor deals with everything, from paeds, WH, musculo and lymphodaema, so I need to be much more prepared and ready for anything. I am also expecting the hospital to be much quieter than my previous placement. I think the structure will be much the same, with the physio's seeing out patient referrals, but I also know that the physio takes care of patients on the ward as well. I think my role as a student may expand. There's only one physio working in the hospital so her role and jobs may include things not necessarily under the umbrella of physio. I'm not too sure if there is a large allied health team, I'll guess I'll just have to wait and see.
Mostly though, I can’t wait! I am so excited to see a bit more of the South West and be challenged with things that I might not get to deal with in Perth.
(Note: I did leave something in Perth, probably the most important thing, my wallet!!)
I am feeling very nervous, and excited, about heading to Collie tomorrow. I just arrived home from Melbourne and am now packing a truck load of things to take down for 5 weeks; I didn’t leave myself much organising time! I am bound to forget something!
I think I am mainly nervous about being away for so long and feeling like there will be less people to ask for help. I am also worried about our accommodation. Jess and I might be a bit lonely if we’re the only people there.
Heading down to Collie I am expecting to see a much more diverse range of things than I did at Bentley. My supervisor deals with everything, from paeds, WH, musculo and lymphodaema, so I need to be much more prepared and ready for anything. I am also expecting the hospital to be much quieter than my previous placement. I think the structure will be much the same, with the physio's seeing out patient referrals, but I also know that the physio takes care of patients on the ward as well. I think my role as a student may expand. There's only one physio working in the hospital so her role and jobs may include things not necessarily under the umbrella of physio. I'm not too sure if there is a large allied health team, I'll guess I'll just have to wait and see.
Mostly though, I can’t wait! I am so excited to see a bit more of the South West and be challenged with things that I might not get to deal with in Perth.
(Note: I did leave something in Perth, probably the most important thing, my wallet!!)
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