Week Five Entry: Presentation

Situation: The majority of the patients that I have seen on this placement have low tone. One of the first patients that I saw was a 3 year old Down Syndrome child who was at the stage where she was pulling to stand and starting to cruise along furniture, however with her lower limbs in external rotation. I had a strong feeling that this was a compensatory mechanism for a lack of stability around the hip joint and so it got me thinking more about the anatomy around the hip joint. From seeing many other patients with a similar presentation it became apparent that a lot of the activity limitations that children with low tone display are the result of impairments around the hip and trunk. Discussing this with my supervisor we decided that for my 5-10 min presentation that I was to give in my final week, a functional anatomy review of the trunk and pelvis would be beneficial.

Task: Give a 5 -10 min presentation on the anatomy around the trunk and pelvis and discussing the implications it has for paediatric physiotherapy on the child with low tone.

Action: I started getting back into the books, reviewing the anatomy. I decided that two of the major impairments that were evident in this type of of client demographic were muscle weakness and instability. Furthermore I felt that focussing on muscle tissue would be appropriate as it was what we as physiotherapists good impact with our treatment. Whilst reviewing the hip joint I noticed that all the textbooks state that glut med is an internal rotator of the hip joint in practice we always treat glut med weakness with clams. Clams is an exercise based on abduction and external rotation of the hip joint, so appeared to contradict the literature. I contacted my musculoskeletal lecturer to confirm the actions of glut med and felt that his would be a good discussion point for the presentation. I then planned to discuss when each muscle group becomes active during a child's activities of their daily routine, completing the presentation with the common compensations that child will display for weakness and instability.

Result: My lecturer highlighted that glut med can be divided into anterior and posterior fibres. The anterior fibres are internal rotators and the posterior fibres are external rotators. It is these posterior fibres that become weak an effect a person's function, hence why we prescribe clams, as an exercise for glut med. This became a good discussion point during the presentation. I wasn't too sure how to structure how each muscle impacts on function. I could have identified each activity of a child's daily routine (e.g. crawling) and then list the muscles that contribute to the task but decided to group the muscles according to their common action (e.g. hip flexors) and then highlight when they are important to function. I felt that highlighting the common muscles that are impaired in a child with low tone and then the compensations that are observed as a result created healthy discussion between listeners.

Evaluation: I felt that my presentation went better than expected. Whilst reviewing the literature I was worried about how to structure the presentation. It appeared that there was a lot of information to cover within 10 mins and I felt that grouping the information together so that it was relevant and engaging was going to be quite a challenge. I was happy to hear some positive feedback from my supervisors as they felt I was able to turn a reasonably dry subject into an engaging discussion. My presentation did go overtime though. Overall I was pretty happy with how it went.

Strategies: Something I learned from this presentation is to always question what you read. I guess this is a strategy that I will continue to use throughout my career.