The pt was a 4 yr old girl that had just had botox injections for her CP.
Thoughts and feelings?
Really enjoyed the experience. She came in with her mum and twin brother, and it was fun getting them all involved in this little girls rehab. At first i she was a little unsure of having me there but it didn't take too long before she was talking to and drawing with me and playing games whilst the physio did her stretches.
How you think you performed?
Pretty good considering that at first the girl was pretty hesitant to have me there.
What changes would you make?
Not be so hesitant to myself at the start, I didn't have the guts to sing nursery rhymes so thats something that I probablly need to work on in the future. I think because this was the first experience working with kids that it made it difficult.
Overall thoughts?
As the session progressed I think i was getting better and better at working with the kids.
Strategies to incorporate?
Practice nursery rhymes, think of heaps of fun games kids would like.
I would like to ask my supervisor more about botox injections.
Friday, October 31, 2008
Week 3 Day 3
Thoughts and feelings?
Had some difficulty with treatment with this pt and applying the techniques we learned in class, where we learn a glide in neutral, and applying it at EOR.
How do you think you performed?
Didn't to as well as i would have liked with this pt, it took me a while to decide on my Rx plan and so i felt i was creating uncertainty in the pt. I was able to get feedback from him and by talking to him i think i was able to establish some rapport. ( the fact that he knew i was just learning helped too)
What changes would you make?
Try not to have long pauses between treatment choices. From now on if there is a point where I'm still thinking about what i should do next, I'm just going to perform passive physiologicals or something whilst I'm thinking. This way the pt seems to think your still treating and doesn't lower their confidence in you as a therapist.
Overall thoughts?
Good learning experience.
Strategies you could incorporate?
Need to work on EOR mobilisations and have the confidence to give it a go.
Had some difficulty with treatment with this pt and applying the techniques we learned in class, where we learn a glide in neutral, and applying it at EOR.
How do you think you performed?
Didn't to as well as i would have liked with this pt, it took me a while to decide on my Rx plan and so i felt i was creating uncertainty in the pt. I was able to get feedback from him and by talking to him i think i was able to establish some rapport. ( the fact that he knew i was just learning helped too)
What changes would you make?
Try not to have long pauses between treatment choices. From now on if there is a point where I'm still thinking about what i should do next, I'm just going to perform passive physiologicals or something whilst I'm thinking. This way the pt seems to think your still treating and doesn't lower their confidence in you as a therapist.
Overall thoughts?
Good learning experience.
Strategies you could incorporate?
Need to work on EOR mobilisations and have the confidence to give it a go.
Week 3 Day 2
This pt presented with bilateral medial knee pain just proximal to the femoral attachment of the MCL.
Thoughts and feelings?
The pt wanted to know every detail about what we were doing and why we were doing it, needless to say I felt a little intimidated. She struggled to understand that what goes on at the hip can influence what goes on at the knee What made it even more difficult was the fact that coming into physio she thought that she may require a knee reconstruction.
How you performed?
Overall my subjective was reasonably good, i found out when her knee pain started, when it started to get worse and what changes were happening in her lifestyle at the time that could have exacerbated her symptoms. I should have found out more about what set off her initial knee pain 2 yrs ago.
What changes would you make?
Ask about initial onset, how old she was at the time (as PFL pain often happens to females in their late teens) and were there any changes in her lifestyle at the time.
Overall thoughts?
Not too bad. Subjective improving becoming more structured. The presentation was quite complex though and although i could understand the nature f the dysfunction and why she was getting her knee pain, the source of symptoms was difficult to diagnose due to the location of the reported pain.
What strategies could you incorporate?
Revise anatomy, practice subjective focusing on the ordering of my questions.
I would like to ask my supervisor about the likely source of symptoms.
Thoughts and feelings?
The pt wanted to know every detail about what we were doing and why we were doing it, needless to say I felt a little intimidated. She struggled to understand that what goes on at the hip can influence what goes on at the knee What made it even more difficult was the fact that coming into physio she thought that she may require a knee reconstruction.
How you performed?
Overall my subjective was reasonably good, i found out when her knee pain started, when it started to get worse and what changes were happening in her lifestyle at the time that could have exacerbated her symptoms. I should have found out more about what set off her initial knee pain 2 yrs ago.
What changes would you make?
Ask about initial onset, how old she was at the time (as PFL pain often happens to females in their late teens) and were there any changes in her lifestyle at the time.
Overall thoughts?
Not too bad. Subjective improving becoming more structured. The presentation was quite complex though and although i could understand the nature f the dysfunction and why she was getting her knee pain, the source of symptoms was difficult to diagnose due to the location of the reported pain.
What strategies could you incorporate?
Revise anatomy, practice subjective focusing on the ordering of my questions.
I would like to ask my supervisor about the likely source of symptoms.
Thursday, October 23, 2008
Week 2 Day 3
Thoughts and feelings?
Enjoyed working with this pt, he was a teenage guy with a subacute inversion sprain so it was a chance to become create with my exercise prescription.
How do you think u performed with this pt?
I think i did reasonably well overall. I was able to come up with a few good X's and my mobilisations were pretty good. My taping needs improvement and I still to get more creative with my exercise prescription.
What changes would you make?
Perform the taping technique better.
What are your overall thoughts and feelings?
Need to develop a greater pool of exercises to choose from, work on my taping technique and continue to work on my manual handling particular when there is a restriction and you have to work in end range plantar flexion.
What strategies can you incorporate?
Practice taping and manual handling.
I would like to ask my supervisor for more ideas for exercises for balance, proprioception and power for a patient of similar limitations.
Enjoyed working with this pt, he was a teenage guy with a subacute inversion sprain so it was a chance to become create with my exercise prescription.
How do you think u performed with this pt?
I think i did reasonably well overall. I was able to come up with a few good X's and my mobilisations were pretty good. My taping needs improvement and I still to get more creative with my exercise prescription.
What changes would you make?
Perform the taping technique better.
What are your overall thoughts and feelings?
Need to develop a greater pool of exercises to choose from, work on my taping technique and continue to work on my manual handling particular when there is a restriction and you have to work in end range plantar flexion.
What strategies can you incorporate?
Practice taping and manual handling.
I would like to ask my supervisor for more ideas for exercises for balance, proprioception and power for a patient of similar limitations.
Wednesday, October 22, 2008
Week 2 Day 2
Thoughts and feelings?
Starting to get the hang of taking a subjective. Felt that I was able to get the details I needed to give my self an idea of what was happening prior to getting into the objective. This plus the fact that the pt was suffering a shoulder injury and we have just covered it in class meant that I felt pretty comfortable throughout the session.
How do you think you performed with the pt?
This is probably best Ive done with a pt to date. I was able to rule out possible source of symptoms with my subjective and objective until there was only a few possibilities that it could be. Still need to work on my objective, in that I had limited it down to the posterior capsule or infraspinatus as the source of symptoms put I didn't perform the isometric tests in the appropriate range to confirm infraspinatus as the issue.
What changes would you make?
When a pt complains of pain in a particular range it is important to tests the structures in that range I made the mistake of testing external rotation in neutral and even though I got a positive test I would have got a stronger positive had I tested it in 90 degrees abduction.
Overall thoughts and feelings?
Can feel myself improving and feel like I'm start to the hang of differential diagnosis.
What strategies can I implement?
Take the time to think about the mechanism of injury and what that would tend to injure, have a handful of the possible source of symptoms and then structure the objective so that it rules out those that aren't and a diagnosis can be made.
I would like to ask my supervisor more on the structure of the menisci in the knee and how they can cause locking.
Starting to get the hang of taking a subjective. Felt that I was able to get the details I needed to give my self an idea of what was happening prior to getting into the objective. This plus the fact that the pt was suffering a shoulder injury and we have just covered it in class meant that I felt pretty comfortable throughout the session.
How do you think you performed with the pt?
This is probably best Ive done with a pt to date. I was able to rule out possible source of symptoms with my subjective and objective until there was only a few possibilities that it could be. Still need to work on my objective, in that I had limited it down to the posterior capsule or infraspinatus as the source of symptoms put I didn't perform the isometric tests in the appropriate range to confirm infraspinatus as the issue.
What changes would you make?
When a pt complains of pain in a particular range it is important to tests the structures in that range I made the mistake of testing external rotation in neutral and even though I got a positive test I would have got a stronger positive had I tested it in 90 degrees abduction.
Overall thoughts and feelings?
Can feel myself improving and feel like I'm start to the hang of differential diagnosis.
What strategies can I implement?
Take the time to think about the mechanism of injury and what that would tend to injure, have a handful of the possible source of symptoms and then structure the objective so that it rules out those that aren't and a diagnosis can be made.
I would like to ask my supervisor more on the structure of the menisci in the knee and how they can cause locking.
Tuesday, October 21, 2008
Week 2 Day 1
Thoughts and feelings?
Enjoyed working with this pt as he was young bloke that had dislocated his patella and undergone surgery a few months ago. It gave me a chance to try and come up with some good exercises that could help speed up recovery and draw on my own past experiences with physio and rehab.
How do you think you performed with this pt?
I probably needed to get more out of my physical examination. I was able to get some info on what muscles needed to be strengthened but if I had have used my palpation better, I would have worked out that some muscles were tight and needed releasing. Once I knew that ITB was tight I was able to release TFL proximally and improve the pts ER ROM.
What changes would you make to your approach?
Make sure I cover all aspects of the objective assessment. Look at not only strength but also muscle length.
What are your overall thoughts and feelings?
Still need to work on my objective, work through it step by step and make sure I cover all aspects.
What strategies could I use?
Think along the lines that if their is a change in the biomechanics of the joint, it could be due to overactivity of one group of muscles or under activity of another. If I can start to recognise these patterns it will help guide my objective assessment.
I would like to ask my supervisor more about patella tendon transfers.
Enjoyed working with this pt as he was young bloke that had dislocated his patella and undergone surgery a few months ago. It gave me a chance to try and come up with some good exercises that could help speed up recovery and draw on my own past experiences with physio and rehab.
How do you think you performed with this pt?
I probably needed to get more out of my physical examination. I was able to get some info on what muscles needed to be strengthened but if I had have used my palpation better, I would have worked out that some muscles were tight and needed releasing. Once I knew that ITB was tight I was able to release TFL proximally and improve the pts ER ROM.
What changes would you make to your approach?
Make sure I cover all aspects of the objective assessment. Look at not only strength but also muscle length.
What are your overall thoughts and feelings?
Still need to work on my objective, work through it step by step and make sure I cover all aspects.
What strategies could I use?
Think along the lines that if their is a change in the biomechanics of the joint, it could be due to overactivity of one group of muscles or under activity of another. If I can start to recognise these patterns it will help guide my objective assessment.
I would like to ask my supervisor more about patella tendon transfers.
Saturday, October 18, 2008
Week One Day 5
Thoughts and feelings?
My subjective and objective seems to be improving. Just need to work on putting the pieces of the puzzle together to make a provisional diagnosis.
How do you think you performed with this pt?
I ran through the objective and subjective in a structured manner and performed all the tests i needed to. My palpation skills seem to be ok although i need to work on hand positioning when applying treatment to get the best results.
The treatment saw improvements n the pts rom so overall it seemed to go well.
What changes would you make?
Im starting to find that if you do everything by the book you don't always find the asterisk sign you need even though your on the right track. The pt presented with pain with overhead activities however when assessing elevation she could get full rom. It wasn't until she internally rotated when elevating that she lacked active and passive range. I need to learn to modify the assessments that we are tought in class to suit the pt and their history.
Overall thoughts?
Becoming more comfortable wth pts and im finding this is helping my overall Rx sessions.
What strategies can I encorporate?
Work on observation skills and realating the objective to the subjective.
I would like to ask my supervisor about annulus fissuring
My subjective and objective seems to be improving. Just need to work on putting the pieces of the puzzle together to make a provisional diagnosis.
How do you think you performed with this pt?
I ran through the objective and subjective in a structured manner and performed all the tests i needed to. My palpation skills seem to be ok although i need to work on hand positioning when applying treatment to get the best results.
The treatment saw improvements n the pts rom so overall it seemed to go well.
What changes would you make?
Im starting to find that if you do everything by the book you don't always find the asterisk sign you need even though your on the right track. The pt presented with pain with overhead activities however when assessing elevation she could get full rom. It wasn't until she internally rotated when elevating that she lacked active and passive range. I need to learn to modify the assessments that we are tought in class to suit the pt and their history.
Overall thoughts?
Becoming more comfortable wth pts and im finding this is helping my overall Rx sessions.
What strategies can I encorporate?
Work on observation skills and realating the objective to the subjective.
I would like to ask my supervisor about annulus fissuring
Thursday, October 16, 2008
Week One Day Two
Pt presented with an inversion sprain of the R ankle
Thoughts and feelings?
Felt pretty confident with this pt because there was a definite event and a specific history. It made it easier to clinical reason and gave me idea of what was happening before I moved onto the objective Ax.
What did you do well and what do you need to improve?
Subjective was pretty good, objective still needs work and particularly need to work on my structure.
The plan would be to try and get the ankle moving ASAP to reduce stiffness and get the pt wt bearing and doing some light stretches (since it was in the sub-acute phase and most of the pain and swelling had eased.
Changes would you make?
Work the objective from observation and palpation through active movements and special tests in the appropriate order and formulate my diagnosis from there.
What are your overall thoughts of the day?
My confidence is slowly getting better which is helping to improve my subjective assessment. The more pts I see, the better I'll get. My objective assessment seems to be the part I need most work on and I found that there were times that I wasn't moving through the assessment how I would of like if I had sat down and thought about it.
What strategies can I incorporate?
Sit down and watch another physio do their objectve assessment and learn to prioritise my assessment.
What question would i ask my supervisor?
How you perform the Mulligan treatment for the ankle and what it involves.
Thoughts and feelings?
Felt pretty confident with this pt because there was a definite event and a specific history. It made it easier to clinical reason and gave me idea of what was happening before I moved onto the objective Ax.
What did you do well and what do you need to improve?
Subjective was pretty good, objective still needs work and particularly need to work on my structure.
The plan would be to try and get the ankle moving ASAP to reduce stiffness and get the pt wt bearing and doing some light stretches (since it was in the sub-acute phase and most of the pain and swelling had eased.
Changes would you make?
Work the objective from observation and palpation through active movements and special tests in the appropriate order and formulate my diagnosis from there.
What are your overall thoughts of the day?
My confidence is slowly getting better which is helping to improve my subjective assessment. The more pts I see, the better I'll get. My objective assessment seems to be the part I need most work on and I found that there were times that I wasn't moving through the assessment how I would of like if I had sat down and thought about it.
What strategies can I incorporate?
Sit down and watch another physio do their objectve assessment and learn to prioritise my assessment.
What question would i ask my supervisor?
How you perform the Mulligan treatment for the ankle and what it involves.
Wednesday, October 15, 2008
Week One Day 1
Thoughts and feelings?
Was asked to take a subjective Hx for this pt. Was a little nervous as it was only the second history I had taken but a was more excited to get the opportunity to redeem myself after the first one!
How do you think you performed with the pt?
Communication with the pt was pretty good. I was able to get enough information from the subjective and objective to formulate an idea on what was going on, although my documenting skills need improving.
The main goal for the pt was to clear of any serious damage and reduce pain and hence the follow up Rx will only be warranted if pain persists and the pt feels he needs another Rx session.
What changes would I make?
I would document a better body chart and work on my observation skills. Found it quite difficult to actively listen to the pt whilst writing, so thats a skill i need to practice.
Overall thoughts and feelings of the day?
I learnt a lot. Got thrown into it straight away which was good and have enjoyed working with the pts and putting the skills we learn in class into practice.
What strategies can you incorporate for improving your performance in this clinical unit?
Practice Hx taking, relax a bit and think through the clinical reasoning side of things more systematically.
Would like to ask my supervisor more about shorthand documentation
Was asked to take a subjective Hx for this pt. Was a little nervous as it was only the second history I had taken but a was more excited to get the opportunity to redeem myself after the first one!
How do you think you performed with the pt?
Communication with the pt was pretty good. I was able to get enough information from the subjective and objective to formulate an idea on what was going on, although my documenting skills need improving.
The main goal for the pt was to clear of any serious damage and reduce pain and hence the follow up Rx will only be warranted if pain persists and the pt feels he needs another Rx session.
What changes would I make?
I would document a better body chart and work on my observation skills. Found it quite difficult to actively listen to the pt whilst writing, so thats a skill i need to practice.
Overall thoughts and feelings of the day?
I learnt a lot. Got thrown into it straight away which was good and have enjoyed working with the pts and putting the skills we learn in class into practice.
What strategies can you incorporate for improving your performance in this clinical unit?
Practice Hx taking, relax a bit and think through the clinical reasoning side of things more systematically.
Would like to ask my supervisor more about shorthand documentation
Saturday, October 11, 2008
Initial thoughts and feelings on the upcoming prac
Looking forward to prac tomorrow. Just starting to settle in to my new home for the next five weeks and really I just want to get started so I know whats expected of me and how the place runs. At the moment I'm a little nervous, particularly because of the standards the person prior to me has set but I'm expecting to learn a lot from the experience and am excited about the idea of working with real patients with real concerns. Good luck to everyone!
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