S- My patient was referred to women's health outpatients clinic for lower back and buttocks pain, she was 38 weeks gestation and spoke little english however her husband was present to translate.
T- My task was to assess this woman and devise strategies for management of her pain. I only had 30mins due to a double booking.
A- The subjective assessment took longer than I had anticipated due to the language barrier. With the objective assessment I was only able to assess her back and buttock in sidelying and sitting positions due to the woman being 38 weeks gestation. I found that changing positions caused her pain and discomfort.
R- Eventually I was able to determine that the pain was coming from an overactive piriformis muscle in her left buttock. However this was after tedious subjective questioning and extensive objective assessment. Due to my lack of planning my patient had to keep moving around on the plinth so I could achieve the appropriate position for assessment.
E- On reflection I found it difficult to communicate with the patient due to the language barrier particularly when searching for the pain objectively. I also felt that the sequence of my objective assessment was not efficient as I had to get the patient to move into different positions continously which caused them some discomfort and possibly could have exacerbated their pain.
S- I think with practise my communication through an interpreter will improve but I will endeavor to simplify my questions and instructions to make it as clear as possible to translate to the patient. Also by taking a minute before I begin my objective to organise my assessment so that I can achieve all my tests in one position and then change will help with the efficiency of my assessment and also make it more comfortable for my patient.
Sunday, March 28, 2010
Sunday, March 21, 2010
Initial Entry (round two 4th year prac)
My second practical placement for this year is at Osborne Park Hospital in the Women's Health area. In terms of structure I think the placement will consist of a mixture of inpatient and outpatient clients both individually and in an exercise class setting. I think that the morning will be spent on the ward assessing and managing inpatients, and in the afternoon I will have student outpatient appointments and an exercise class on some days. I think the majority of my patients will have incontinence issues and the rest will be antenatal and postnatal.
I think in the first few days I will be shadowing my supervisor to learn the expectations and protocols of a women's health physiotherapist. I hope that by the end of the week I will have my own case load which I can manage independently. I understand as a student in the women's health area that there will be things that I won't be able to do such as internal examination so I hope that I will have the opportunity to observe this instead. I predict that I will be able to observe a birth at some stage aswell.
I expect that my role as an educator is a vital part of women's health physiotherapy. Therefore my ability to translate my knowledge into layman's terms will be essential. I am concerned whether the depth of my theoretical knowledge is adequate as I am unsure of the expectations of me as a women's health student. I am also concerned of my ability to put this knowledge to practical use as we only spent half of a semester practicing and I have since not put it to use. Lastly and although petty I am concerned about getting along with my supervisor, unfortunately I have heard from past students that she is very intimidating and intense. I worry that I will be intimidated and constantly nervous under her supervision which will affect my performance. However I am not to going presume anything and that the opinions are completely subjective, I will also have a tutor for support if there is are conflicts. Overall though I am excited to start this placement as I really enjoyed the unit at university and now have a unique opportunity to gain hands on experience in the area.
I think in the first few days I will be shadowing my supervisor to learn the expectations and protocols of a women's health physiotherapist. I hope that by the end of the week I will have my own case load which I can manage independently. I understand as a student in the women's health area that there will be things that I won't be able to do such as internal examination so I hope that I will have the opportunity to observe this instead. I predict that I will be able to observe a birth at some stage aswell.
I expect that my role as an educator is a vital part of women's health physiotherapy. Therefore my ability to translate my knowledge into layman's terms will be essential. I am concerned whether the depth of my theoretical knowledge is adequate as I am unsure of the expectations of me as a women's health student. I am also concerned of my ability to put this knowledge to practical use as we only spent half of a semester practicing and I have since not put it to use. Lastly and although petty I am concerned about getting along with my supervisor, unfortunately I have heard from past students that she is very intimidating and intense. I worry that I will be intimidated and constantly nervous under her supervision which will affect my performance. However I am not to going presume anything and that the opinions are completely subjective, I will also have a tutor for support if there is are conflicts. Overall though I am excited to start this placement as I really enjoyed the unit at university and now have a unique opportunity to gain hands on experience in the area.
Friday, March 12, 2010
Final Post
On review, my initial expectations of the placment structure and my role within this were met. By the end of the 5 weeks I was managing a moderate caseload and conducting independent inpatient and outpatient appointments- I very much enjoyed the independence and ability to devise rehabilitation programs for my patients. I found that my theorectical knowledge was one of my strengths and that I had more trouble with the practical analysis of a patient. I've come to realise that this will only improve with practice and observing real patients. I thoroughly enjoyed having an inpatient and outpatient caseload mostly due to the fact I was exposed to both the acute and chronic stroke population. I would have liked to have had experience with other neurological conditions however due to the nature of the ward and outpatient refferals this was not applicable.
As predicted the patient's rehabilitation was conducted from a multidisciplinary approach where I found myself constantly liasing with other team members to ensure an efficient yet safe discharge. It was evident that a patient's rehab is multifaceted and requires the co-operation of many professions to ensure that the patient has the maximum potential to recover. I was pleasantly surprised to see that physiotherapists played a very important and pivotal role in deeming a patient safe for discharge once they were medically stable. Often in the ward meetings the medical consultants would look for our opinion first in terms of discharge planning and what timeframe is predicted before the patient is safe to go home. Overall, I found that physiotherapy has high integrity within the neurological rehabilitation setting and that our role in preparing patient's to be safely discharged home and aiding them in returning to better function is pivotal in the multidisciplinary team.
As predicted the patient's rehabilitation was conducted from a multidisciplinary approach where I found myself constantly liasing with other team members to ensure an efficient yet safe discharge. It was evident that a patient's rehab is multifaceted and requires the co-operation of many professions to ensure that the patient has the maximum potential to recover. I was pleasantly surprised to see that physiotherapists played a very important and pivotal role in deeming a patient safe for discharge once they were medically stable. Often in the ward meetings the medical consultants would look for our opinion first in terms of discharge planning and what timeframe is predicted before the patient is safe to go home. Overall, I found that physiotherapy has high integrity within the neurological rehabilitation setting and that our role in preparing patient's to be safely discharged home and aiding them in returning to better function is pivotal in the multidisciplinary team.
Thursday, March 11, 2010
Topic 3: evidence based practice and intervention
Situation: My patient was referred to outpatient's clinic for impaired mobility and dynamic mobility due to stroke in 2000. The patient's goals were to improve efficacy of functional mobility ie. rolling, supine to sit, sit to stand, and able to get off the floor if falls over. Pt was found to have learned non-use on the L) side as the L) UL was functional however the pt did not percieve it to be part of themselves nor believe they could functionally use it.
Task: My task was to devise a program to achieve the patient's goals and also address the learned non-use on the L) as I believed it was greatly impacting their functional mobility.
Action: I researched constraint induced movement therapy in correlation with learned non-use to find evidence on the benefits and limitations for the treatment approach. I found that my patient was a good candidate as they were reasonably high functioning in the L) UL and was also a chronic stroke patient in which the majority of the studies were conducted on. I applied the principles of the CIMT approach such as forced use of the L) UL in functional activities-rolling, supine to sit, assisting with STS, putting shoes on and weight bearing activities through the L) UL to prove to the patient that their arm could indeed be used functionally.
Result: I found my actions to be successful because by the end of the session the patient was using the L) uL consistently in functional activities particularly during STS. The patient was very interested in the CIMT and the research behind it so went home to follow it up. The pt also began to recognise the functionality of their L) UL during WB exercises and was suprised to find that it could support weight and also aid with mobility thus changing their attitude towards their L) UL.
Evaluation: Overall I believe my intervention was beneficial for the patient and indirectly targeted their goals. I think my strength was being able to adapt the principles of CIMT to my patient so it was relevant and beneficial in obtaining their goals. I think my weakness was that I wasn't strict enough with the protocol, for instance the patient tended to use the R) UL after continous failed attempts with the L) and I occasionally would allow him to do so. I think for this treatment approach to be more effective I need to be vigilant with the forced use concept and strongly discourage compensatory use of the R)UL during the treatment session.
Strategies: A strategy I could use to avoid this would be to place the R) UL into a restrictive device to completely discourage use such as a sling or rigid mitt. Also by explaining to the patient the importance of not compensating with the R) UL may engrain the principles better and encourage better performance at home aswell.
Task: My task was to devise a program to achieve the patient's goals and also address the learned non-use on the L) as I believed it was greatly impacting their functional mobility.
Action: I researched constraint induced movement therapy in correlation with learned non-use to find evidence on the benefits and limitations for the treatment approach. I found that my patient was a good candidate as they were reasonably high functioning in the L) UL and was also a chronic stroke patient in which the majority of the studies were conducted on. I applied the principles of the CIMT approach such as forced use of the L) UL in functional activities-rolling, supine to sit, assisting with STS, putting shoes on and weight bearing activities through the L) UL to prove to the patient that their arm could indeed be used functionally.
Result: I found my actions to be successful because by the end of the session the patient was using the L) uL consistently in functional activities particularly during STS. The patient was very interested in the CIMT and the research behind it so went home to follow it up. The pt also began to recognise the functionality of their L) UL during WB exercises and was suprised to find that it could support weight and also aid with mobility thus changing their attitude towards their L) UL.
Evaluation: Overall I believe my intervention was beneficial for the patient and indirectly targeted their goals. I think my strength was being able to adapt the principles of CIMT to my patient so it was relevant and beneficial in obtaining their goals. I think my weakness was that I wasn't strict enough with the protocol, for instance the patient tended to use the R) UL after continous failed attempts with the L) and I occasionally would allow him to do so. I think for this treatment approach to be more effective I need to be vigilant with the forced use concept and strongly discourage compensatory use of the R)UL during the treatment session.
Strategies: A strategy I could use to avoid this would be to place the R) UL into a restrictive device to completely discourage use such as a sling or rigid mitt. Also by explaining to the patient the importance of not compensating with the R) UL may engrain the principles better and encourage better performance at home aswell.
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