Thoughts and feelings on finishing the unit?
A bit of relief from a full on 5 weeks. I feel that I have learned a so much from my supervisor and other physios that I worked with and I think now I am more comfortable in my own ability in regards to assessing, treating and communicating with pts. In the last two weeks of the placement I found that i was getting better at working with people in general and I think this is more of an exposure thing. Kalgoorlie is a pretty laid back town and I really enjoyed getting to know people and have a laugh when working with them. It was great to get the chance to apply the skills I've learnt into a clinical situation. I was thrown straight into it and I've i have really benefited from the experience.
Most important feelings that you've learnt?
The importance of:
- A functional exam
- Performing a systematic objective
- Performing a subjective that is structured and knowing not only what to ask but why you are asking them
- Understanding conditions and how they present in the subjective and objective
- Adjusting treatment to better suit a persons needs, including manual therapy techniques that work at EOR rather than simply in neutral
- Having a pool of exercises to choose from
- Observation of posture and palpation
- Easing into tests to get a good idea of what structures are involved
Friday, November 14, 2008
Week 5 Day 3
Thoughts and feelings?
This was a good pt to see on my last day as she was a person that presented with medial elbow pain and pins and needles that extended down to the last three digiots of her hand. It was a chance to perform a thorough objective exam and use my clinical reasoning as to why she was getting symptoms. It turned out that this lady, as result of prolonged driving, had increased tone in her pec minor and scalenes which resulted in ulnar nerve irritation and medial elbow pain. I enjoyed seeing the pattern to her symptoms unfold and being able to treat this lady so that she had no pain by the end of the Rx session with our asterisk, neurodynamic test.
How do you think you managed?
I think I did quite well. When it came to treating the lower cervical/upper thoracic spine, I was a bit unsure of what passive accessories we should perform to open up the IVF however once I had talked it through I was able to understand the reasoning behind each PAM. It was great to get such a positive effect from treatment.
What changes would you make?
Just remembering to retest your asterisk sign after each treatment method. I thinkl after the first technique I decided to retest using grip strength however I then realised that her neurodynamic test for the ulnar nerve was more of a asterisk sign.
What strategies could you incorporate?
Take the time to think about which is the best test to re-test post Rx.
Overall thoughts?
Quite pleased with how we performed the assessment and treatment. It was systematic which made it easier clinically reason as to why this pt was getting her symptoms.
I would like to ask the physio what are the usual points where nerve irritaion in the thoracic outlet can occur.
This was a good pt to see on my last day as she was a person that presented with medial elbow pain and pins and needles that extended down to the last three digiots of her hand. It was a chance to perform a thorough objective exam and use my clinical reasoning as to why she was getting symptoms. It turned out that this lady, as result of prolonged driving, had increased tone in her pec minor and scalenes which resulted in ulnar nerve irritation and medial elbow pain. I enjoyed seeing the pattern to her symptoms unfold and being able to treat this lady so that she had no pain by the end of the Rx session with our asterisk, neurodynamic test.
How do you think you managed?
I think I did quite well. When it came to treating the lower cervical/upper thoracic spine, I was a bit unsure of what passive accessories we should perform to open up the IVF however once I had talked it through I was able to understand the reasoning behind each PAM. It was great to get such a positive effect from treatment.
What changes would you make?
Just remembering to retest your asterisk sign after each treatment method. I thinkl after the first technique I decided to retest using grip strength however I then realised that her neurodynamic test for the ulnar nerve was more of a asterisk sign.
What strategies could you incorporate?
Take the time to think about which is the best test to re-test post Rx.
Overall thoughts?
Quite pleased with how we performed the assessment and treatment. It was systematic which made it easier clinically reason as to why this pt was getting her symptoms.
I would like to ask the physio what are the usual points where nerve irritaion in the thoracic outlet can occur.
Tuesday, November 11, 2008
Week 5 Day 2
This pt had a bilateral maleoli fracture and tension fracture of the superior fibula as a result of a hockey injury several months ago. At this stage of his rehab we are aiming to improve function particularly working on improving calf and glut strength to improve the overall shck absorbing capacity of the lower limb. Swelling of the ankle is still a concern so it is a matter of trying to improve function whilst minimising the effusion.
Thoughts and feelings?
I enjoy working with this pt as hes good bloke whom is keen to do well with is rehab and believes what you are doing will benefit him. When the pt you are dealing with is easy to talk to it makes it a hell of a lot easier to assess and treat as you tend to thrie of their ethusiasm and gain confidence in your assessment and treatment.
How do you think you performed?
I was able to perform a good functional assessment and was happy to see their were signs of improvement from the my last treatment session. My manual therapy seemed to produce the desired effects and i was able to progress to his exercises to suit his short term goals. One of the physios suggested that i could take an objective measure of his swelling rather than merely obseve so in future swelling can be accurately monitored. Overall i think i performed well with this pt.
What could you change?
I have been advising him on how to reduce swelling e.g. ice, elevevation, compression etc. however if the swelling continues to be an issue on next review, it might be worthwhile trying to use some massage and EPA techniques.
What strategies should you incorporate?
Probably thinking whenever you see an impairment such as swelling, how you could objectively measure it so that you can more accurately reassess on review.
Overall how do you think you performed?
I think i performed well with this pt. I am seeing improvements in function each time I see him and i think he sees it too. Probably need to work on thinking of ways to objectively assess things like swelling or circulation so that it is easy for other physios to know whether it is improving or not if they were to assess.
I would like to ask the physio about pitting oedema.
Thoughts and feelings?
I enjoy working with this pt as hes good bloke whom is keen to do well with is rehab and believes what you are doing will benefit him. When the pt you are dealing with is easy to talk to it makes it a hell of a lot easier to assess and treat as you tend to thrie of their ethusiasm and gain confidence in your assessment and treatment.
How do you think you performed?
I was able to perform a good functional assessment and was happy to see their were signs of improvement from the my last treatment session. My manual therapy seemed to produce the desired effects and i was able to progress to his exercises to suit his short term goals. One of the physios suggested that i could take an objective measure of his swelling rather than merely obseve so in future swelling can be accurately monitored. Overall i think i performed well with this pt.
What could you change?
I have been advising him on how to reduce swelling e.g. ice, elevevation, compression etc. however if the swelling continues to be an issue on next review, it might be worthwhile trying to use some massage and EPA techniques.
What strategies should you incorporate?
Probably thinking whenever you see an impairment such as swelling, how you could objectively measure it so that you can more accurately reassess on review.
Overall how do you think you performed?
I think i performed well with this pt. I am seeing improvements in function each time I see him and i think he sees it too. Probably need to work on thinking of ways to objectively assess things like swelling or circulation so that it is easy for other physios to know whether it is improving or not if they were to assess.
I would like to ask the physio about pitting oedema.
Sunday, November 9, 2008
Week 5 Day 1
Thoughts and feelings?
Today we had to conduct some initial assessments for a new health promotion scheme at the Nickel Smelter. These assessments are general fitness, flexibility and strength screens designed to give the applicant a baseline measure on where they are at individually and what they need to improve on before their reassessment down the track. For me it was a great chance to practice my communication and clinical skills without having to clinically reason too much.
How do you think you performed?
Once I had done a couple of assessments I think I did really well. It was more or less just getting use to explaining each test and the reason behind them. I think my observation improved with each assessment as I became familiar with some common compensation strategies.
What would you change?
Make some corrections to some of the applicants postures when performing some of the tests.
Overall thoughts?
Reasonably well, just need to work on my explanations to pts and correcting their movements so the tests are more valid.
Strategies to incorporate?
Really work on my observation skills, this could be something that i focus on with my objective assessments and work on explaining to pts how to correct their faults.
I would like to ask my supervisor more about normative values for some of the tests in the assessment program.
Today we had to conduct some initial assessments for a new health promotion scheme at the Nickel Smelter. These assessments are general fitness, flexibility and strength screens designed to give the applicant a baseline measure on where they are at individually and what they need to improve on before their reassessment down the track. For me it was a great chance to practice my communication and clinical skills without having to clinically reason too much.
How do you think you performed?
Once I had done a couple of assessments I think I did really well. It was more or less just getting use to explaining each test and the reason behind them. I think my observation improved with each assessment as I became familiar with some common compensation strategies.
What would you change?
Make some corrections to some of the applicants postures when performing some of the tests.
Overall thoughts?
Reasonably well, just need to work on my explanations to pts and correcting their movements so the tests are more valid.
Strategies to incorporate?
Really work on my observation skills, this could be something that i focus on with my objective assessments and work on explaining to pts how to correct their faults.
I would like to ask my supervisor more about normative values for some of the tests in the assessment program.
Friday, November 7, 2008
Week 4 Patient 3
This patient had a history of R achilles tendonitis and plantar fascitis. His latest onset is not as severe as previous episodes and he was attending physio as more of a precaution and a means of prevention.
Thoughts and feelings?
I knew before i went into session that this guy was a triathlete so i knew in the subjective i should focus on external factors to his achilles pain aswell. I think i did a reasonably good job in the subjective and it made it easier that he knew what was going on and why he needed physio.
How do you think you performed?
I thought my manual therapy techniques were pretty good with this pt and probably needed to work on getting a asterisk sign. It made it difficult that this pt was a triathlete because he would get his pain on when running. Eventually we were able to reproduce his pain through repetitive dorsiflexion.
What changes would you make?
Work more on reproducing the pts pain.
Overall thoughts?
We were able to reduce his pain with repetitive dorsiflexion so i think overall he the Rx was successful. I think its important now that he has good self managemtn with his running and continue with the exercises prescribed to ensure he geyts the best results.
Strategies to incorporate?
Learn more about achilles tendinitis and how to best objectively measure a patients symptoms.
I would like to ask my supervisor how she treated him previously.
Thoughts and feelings?
I knew before i went into session that this guy was a triathlete so i knew in the subjective i should focus on external factors to his achilles pain aswell. I think i did a reasonably good job in the subjective and it made it easier that he knew what was going on and why he needed physio.
How do you think you performed?
I thought my manual therapy techniques were pretty good with this pt and probably needed to work on getting a asterisk sign. It made it difficult that this pt was a triathlete because he would get his pain on when running. Eventually we were able to reproduce his pain through repetitive dorsiflexion.
What changes would you make?
Work more on reproducing the pts pain.
Overall thoughts?
We were able to reduce his pain with repetitive dorsiflexion so i think overall he the Rx was successful. I think its important now that he has good self managemtn with his running and continue with the exercises prescribed to ensure he geyts the best results.
Strategies to incorporate?
Learn more about achilles tendinitis and how to best objectively measure a patients symptoms.
I would like to ask my supervisor how she treated him previously.
Week 4 Patient 2
This lady was the first patient that i saw on my placement and whom ive been treating ever since. She has progressed well and after my last treatment i had planned to discharge her.
Thoughts and feelings?
Ive enjoyed working with this lady and seeing the progress she has made. It was a great feeling to be able to discharge her because you realise that you've been able to help relieve her of the distress that her pain caused.
How do you think you performed with this patient?
Pretty well, ive seen her progress and this last session was more of a maintainance session and a chance to give her the right advice and eductation she needed to prevent neck pain in the future.
Overall thoughts?
Think i worked well with this patient, i enjoyed working with her and seeing the progress she made.
Strategies to incorporate?
Stay relaxed and maintain good communication with pts.
I would like to ask my supervisor more about handover notes.
Thoughts and feelings?
Ive enjoyed working with this lady and seeing the progress she has made. It was a great feeling to be able to discharge her because you realise that you've been able to help relieve her of the distress that her pain caused.
How do you think you performed with this patient?
Pretty well, ive seen her progress and this last session was more of a maintainance session and a chance to give her the right advice and eductation she needed to prevent neck pain in the future.
Overall thoughts?
Think i worked well with this patient, i enjoyed working with her and seeing the progress she made.
Strategies to incorporate?
Stay relaxed and maintain good communication with pts.
I would like to ask my supervisor more about handover notes.
Week 4 Patient 1
This pt presented with R shoulder pain and a feeling of restriction in his left shoulder. He had a previous rotator cuff injury to his left shoulder. The eventual diagnosis was slight impringement due to instability although the rotator cuff injury to his left had caused the shouders biomechanics to be altered.
Thoughts and feelings?
There was a stage in the subjective where i thought i was getting a bit lost because i was dealing with two seperate issues on each shoulder. I was able to pull it together though and focus on one shoulder at a time.
How do you think you performed?
I think early on in the subjective i wasn't doing to well, because the pt tended to talk about, something and then i search deeper into what he was talking about. I realised this wasn't the best way to get the info i needed so i decided to take a more systematic approach and follow the pro forma. My objective was reasonably good, because a he was getting multiple asterisk signs with both instability and impingement symptoms it made it difficult to process all the results.
What changes would you make?
Just focusing on one complaint at a time. Do the subjective for each seperately and then the objective for each seperately.
Overall thoughts?
Thought i did reasonably well. My objective for shoulder instability in particular could have been better. I should have performed more than one test to prove my diagnosis rather than just choosing one.
Strategies to incorporate?
Practice shoudler instability tests.
Thoughts and feelings?
There was a stage in the subjective where i thought i was getting a bit lost because i was dealing with two seperate issues on each shoulder. I was able to pull it together though and focus on one shoulder at a time.
How do you think you performed?
I think early on in the subjective i wasn't doing to well, because the pt tended to talk about, something and then i search deeper into what he was talking about. I realised this wasn't the best way to get the info i needed so i decided to take a more systematic approach and follow the pro forma. My objective was reasonably good, because a he was getting multiple asterisk signs with both instability and impingement symptoms it made it difficult to process all the results.
What changes would you make?
Just focusing on one complaint at a time. Do the subjective for each seperately and then the objective for each seperately.
Overall thoughts?
Thought i did reasonably well. My objective for shoulder instability in particular could have been better. I should have performed more than one test to prove my diagnosis rather than just choosing one.
Strategies to incorporate?
Practice shoudler instability tests.
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