Continuing Education

My self directed placement I took part in dissecting the brachial plexus on a wet specimen, it was a fantastic experiance. More to the blogg point of view, the biggest thing i learn't from dissection is how much anatomical knowledge we have. It doesn't take much to remember that Real Therapists Drink Cold Beers. (roots, turnks, divisions, cords, branches), and without blowing out own trumpet we have a very good level of knowledge when it comes to anatomy. However, with a little bit of revision you can realise that there is alot more detail available out there on anatomy and knowledge that is relevant to practising physiotherapists.
I know we all graduate soon, just wanted to make the point that there is heaps more for us to learn.

international health

Returning from China and reflecting upon my experience it made me realise that our health system is so advanced compared to a coutrny like China. We are in actual fact very lucky to be able to be part of a system that prioritises health over the economy andf everything else. You do not realise till you go overseas and work that Australia is such a lucky country to live in. We have access to the public health system which has mostly recent technology and knowledge. Quality of life is such a priority here compared to overseas where theressuch limited access to modern rehab techniques and actual therapists. It opened my eyes to the systems in place overseass as well as the status of physiotherapists overseas.

how do you tell someone they need to reduce weight?

I had a few patients that were fairly overweight presenting with low back pain. After multiple sessions of treatment their low back pain improved signficantly so the focus of the treatment was on self manaagement and their HEP. The other issue as mentioned before was the excess weight they were carrying. I knew from my initial treatment with my patient that I would have to address this issue. The only problem was that it is a very difficult topic to bring up, and most perople that are overweight are sensitive to the issue. Discussing with my supervisor there were many methods you could use to approach the issue. The very direct way or mor subtley or almost not at all. I approached the topic and fpund that it wasnt that hard to bring it up. The next session however my patient made excuses for this that and the other for not exercising and not eating right. This then continued in the next session and unfortunately there was not much i could do as my placement drew to an end. So how effective was my cozxing and education I wonder? At least I know now how to approach patients with this issue but in terms of how long the impression will last is another matter.

unrealistic pt expectations

I had a pt on my rural placement who was referred to me by the OT student who told me that he was a bit of an angry man. He had a thalamic stroke 2years ago and functionally he is independent with ADLs, he was referred to physio because he was getting pain in his buttock when cycling on his static bike. When I saw him he gave me a long story about when he had his stroke and the current symptoms he experienced. He told me at the time of the stroke he was out in his shed and when he started feeling the symptoms of the stroke, which he didn’t know was a stroke at the time, he went to his car and tried to get in and struggled due to the weakness but managed to get himself in. He felt that the pain in his buttock was from when he was trying to get in his car he thought he injured his leg, he thought ‘a sinew had been detached’ and he wanted an x-ray to show whether or not this was true. He was not too happy with the treatment he got when he was in hospital and said no one would do an x-ray for him. After doing the whole S/E I did the O/E and he had no musculoskeletal problems causing the pain, his pain was on his ischial tuberosity which was why he thought he had a sinew detached. I told him there was no treatment I could do for him to relieve his pain but I could give him a home exercise strengthening program as he had slight decrease in strength. His reply to this was that he didn’t want an exercise program as he was happy with his static bike cycling he was doing. His expectations in coming to physio were for a referral for an x-ray. I told him that I couldn’t refer him for an x-ray and if he wanted an x-ray he had to go to his doctor to get a referral.
This case showed me that pt expectations of what we can do for them are sometimes unrealistic and there are times that there is no treatment that we can offer the pt to help their condition. Sometimes all we can do is give them education and advice.
In the future I will take note of pt expectations and beliefs and treat the pt as I see appropriate trying to get to their expectations while still being aware that some expectations may be out of our scope as physiotherapists and possibly unrealistic and therefore pt education may be the only management I can offer the pt.

independence vs safety

I treated an 83 y.o. lady who was admitted for rehab after having a cerebellar stroke. She is mildly affected by the condition and is independent with her ambulation with no aid. Prior to admission, she lives alone in her own home and is independent with all ADLs. I decided to assess how well her balance is and so I did a Berg Balance Scale on her. Her score was 44/56 and therefore is a falls risk. Without me even suggesting to her any walking aids, she said to me that she doesn't want to be walking with any frame or stick and wants to be on her feet for as long as she can. I have no worries about her ambulation indoors (as she is walking around the ward by herself) but I am worried about her outdoors mobility (with the uneven surfaces and environmental factors). Prior to her discharge, i talked to her about her outdoor mobility and how it is very different to indoors. I also did the dynamic balance assessment (external displacement) on her to show her that she couldn't save herself appropriately if she is nudged by someone in the shopping mall or on the streets. I also told her that she will have a risk of being hospitalised if she does have a fall. I know that she doesn't like the idea of walking aids so I gave her a brochure which includes a range of 4WW which she could use as an outdoor walking aid to improve her safety. I am not sure if she went to get one in the end but I know that I have done all that I could in terms of educating her regarding her safety outdoors. I have also referred her to day therapy for more rehab.

Realising what my learning style is...

On the first day of one of my placements we did a learning style questionnaire. I was somehwere between a theorist and a reflector. One thing that the questionnaire mentioned was that theorists/reflectors require ++preparation prior to doing something. I really thought about this and agreed that this was soemthing that would benefit me. From writing notes to planning out a treatment session, when i have a plan i seem to perform alot better with greater confidence and efficiency.

I applied this to my practical sessions durin this placement by making sure i had thought about a plan before attempting notes or treatments sessions. It worked well and my supervisor noted that my confidence was improved.

Later in my prac (when motivation stated to reduce) i wasnt preparing for my treatment sessions. I was just doing things on the spot and funnily enough my supervisor picked up on this and told me that i was not as efficient or confident as i had been previously.

I have learnt fromthis situation that my learning style is most definitely theorist/reflector and that preparation is essential for me to perform well.

Comfort care

On my neuro placement, i treated a 92 y.o. male with parietal subdural hematoma as a result of a fall. Prior to the fall he is independent with all ADLs and ambulates with a walking stick. When i first see him, he appears confused and weak in his lower and upper extremities. He couldn't communicate well with everyone and has developed dysphagia. He also has anosognosia. I worked on his sitting balance all week and did not achieve much. It was also hard for nurses to transfer him with the pulpit frame due to his weak legs and trunk muscles. He is not taking in adequate food or fluid. The doctors and the family agreed to provide him with 'comfort care' instead of active treatment which will include tube feeding. I wasn't too sure what 'comfort care' means in terms of physiotherapy. My supervisor then asked the doctors if they are happy for physiotherapy to continue just to make transfers easier on the nurses. They were happy for that and so i continued treating that patient just to improve his sitting balance and ability to sit to stand to make transfers easier. However, one evening, when the patient was placed on a high back chair, the patient was seen kneeling on the floor trying to get back on to the bed. I felt responsible for the event as I was the one who encouraged the nurses to sit the patient out on the chair for as long as he could tolerate. It didn't occur to me that the patient also has lack of insight of what he is able to do and what he needs to do to get back into bed (i.e. call the nurses to assist). Since then I have decided that he could only sit on a recliner chair and that there is not much purpose in keep working on his sitting balance when sitting and transferring him via pulpit frame will be unsafe for him and the nurses. He is also seen on a few occassions trying to climb out of his bed trying to go to the toilet, and he has rails put up on the sides of his bed since. The nurses have been transferring him with the hoist after the incident and is now waiting for a HLC nursing home.
I realised that when treating a patient, we have to be realistic on what a patient is capable of and progressing a patient who is cognitively impaired is sometimes inappropriate.