Psychophysiotherapy

I have a patient who has what is likely to be a conversion/somatic disorder (where she believes she has an encephalopathy but presents with clear CT head, MRI, etx). She has been unable to walk and relies on her mother to help transfer her. On Friday we took her to the parallel bars and without much input she walked about a dozen laps on her own! So yesterday I started working on some bridging, etc. with her and she walked 20 laps. Although slightly medico, my question is this….what are the overriding factors here, mind or body?

Frustration!

Hey guys, I trust everyone is enjoying their time back on pracs and I know ill be glad not to be blogging to myself!!

Im currently on a cardiotx surgery ward at charlies and I have been allocated a pt who had a stroke post-op, mainly because I just came of neuro. Anyway, because the pt originally came in for heart surgery and is on a cardio ward, his chest/lungs are the doctors/physio's/nurses main concern, but this does not in anyway help on his road to recovery from the stroke. If he was on a neuro ward he would be being seen twice daily for up to an hour each but on this ward, because he is for "rehab" and is no longer an acute chest, I can only offer him 30mins max. of my time. My supervisor stated b/c he was rehab, only 3 times a week. I feel so sorry for this pt, as it seems that he is just being sweeped under the rug. I understand that hospitals are at capacity and so so understaffed but it appears this is to the detrement of everyone. Unfortunately, rehab will not accept him until he is medically stable, meanwhile he deteriorates every day. It is just so sad to know how much I could do for the recovery of this pt yet due to time contraints and what appears the finer points of hospital legistics, my treatments are very incidental. Just wondering if anyone else has experienced the frustration of this situation, and whether us as a new generation of physio's are concerned about our hospital system and what we are going to do about it!!
Thanks for reading. Suanne

depressed pt

Hi everyone, hope you enjoyed your break!
I am currently on my neurology prac at the Shenton park neuro out-pt department and have come across a difficult pt, Mrs W. This pt is a 71 year old woman who was diagnosed with spastic paraparisis in 1991.As a result of this disease the pt has experienced a progressive loss of strength in both LL (most muscles 2/5) and also suffers an increase in tone and decrease in length of bilateral h/strings, hip adductors and plantar-flexors. Consequently the pt requires mod/max assistance for all transfers and bed mobility. The pt mobilizes using a WC and will ambulate very short distances (from bedroom to bathroom) using a four-wheeled walker. Mrs W attends physiotherapy two times a week for 1.5hrs each session.
The problem I am having with this pt is that she is suffering from depression and has a very disheartened attitude towards her physiotherapy treatment. Mrs W believes that there is no point in performing strengthening exercises as she just continues to get weaker. I have tried to convince Mrs W that the exercises are of benefit and that she shouldn’t give up however I do not want to come across as being patronizing. I acknowledge the fact that this pt has been living with this progressively debilitating disease for a long time and can understand that after many attempts at improving her function (she has been attending physio at the NOPD for over a yr) she has not seen much in the way of benefits. Mrs W does appreciate the LL stretches provided during the physio treatment sessions however I get the impression that she doesn’t see the point of many of the other exercises due to her lack of motivation. After speaking to my supervisor I have learnt that Mrs W has just commenced psychological treatment, which I think will be beneficial and will hopefully help with her depression. I think that it is important to base the treatment session around the goals of the pt however I also understand that I do have to push Mrs W to increase her level of independence. Does anyone have any suggestions/techniques to achieve this? Would love to hear your thoughts!

OUT OF the LOOP

Hey guys, Hope you are all doing well. I survived neuro...woo hoo! It was an amazing four weeks which i thoroughly enjoyed. My blog is about feeling "out of the loop", which i think we often feel as a student. Where do you stand, talk, does your opinion matter etc.? While on this prac. you receive your own patients, however you are not involved in any discussion about them for example in attending the team meetings. I found this very hard as it felt like you were "out of the loop." It was difficult to determine what the plan was for each of your patients and often information was not passed on to you as a student. To add to this the supervisor discussed with me that i needed to be more aware of the d/c plan and liasing with the allied health team. But how am I meant to know this when i am totally unaware of what is happening. It made for much more extra work and was very frustrating. On a previous prac. I attended the team meetings with my physio and therefore was well aware of the plan for each and could therefore treat accordingly. Just wondereing if anyone else out there is feeling a little bit "out of the loop" and any suggestions as to how to overcome this or is it just something to put up with as a student.

cardio

Currently in my cardio prac at the moment.... as you all know there are thousands and thousands of facts in cardio such as the 10 cardio problems, 10 systematic ways to look at an xray without missing anything, whipples and all other surgical approaches and what they are, the drugs and their side effects... etcetc to memorize and supervisors often expect you to dig out all these facts somewhere in our brains accumulated with info. of cardio as well as neuro and musculo.....
Does anyone have any good strategy to organize them in our heads so they are readily accesible when tested? I tried using acronyms but in the end I ended up remembering the acronyms but not what the letters stand for.....

Helping fellow students

One afternoon in the clinic, I was told by my supervisor to help a fellow student with putting one of his patients on a tilt-table. As I had more experience than the other student with tilt-tables, I did my best to help organise things and avoid any potential problems. When the student was out of the room getting a wedge, the supervisor told me to just be a passive assistant and let the other student take charge. This put me in an awkward situation when the student returned, as it seemed natural to me help someone in an area where I had more experience. Also, the other student was not aware of my role change but I was worried about offending the supervisor if I had informed the student about the conversation. In the end, the student got drilled by the supervisor for his performance, which made me feel a bit guilty and sorry for him.

Has anyone been in a similar situation, or would have handled the situation otherwise?

Thinking outside the BOX!

hey guys. Hope you are all well. I have been on neuro prac for the past four weeks and i wanted to share one particular experience with you. A patient that I was treating who had recently suffered a stroke also presented with marked kyphoscoliosis. She described that it was an effort to breath but that she had be accustomed to it has it was a long term issue. Initially, we were a bit skeptical about how much we could "touch" her spine but after we discussed it with our supervisor she gave us the all clear. We performed some central key point tx extension techniques over the next few days and remarkably the patient said that her breathing had become less effortful. The best part of it was however, that objectively we had made a difference too! Sats rose from 84-88% RA to 94-96% RA. WOW!!!!! It was so rewarding to see your treatment make a difference. It was also very rewarding knowing that we had thought outside the "stroke" box and were able to make a difference to the patients QOL! Just wondering if anyone else has had this experience and been able to use our knowledge to treat outside the area your currently treating in!

Time management for writing SOAPIER

During my outpatient neuro prac, patient appointments were booked back-to-back and patients were expected to be treated for the full 90 minutes. This left no time for me to write up a SOAPIER at the end of each treatment session. After the last patient had finished, there were 30 minutes left for cleaning up the treatment area and writing notes. Given that I saw 4 patients a day, it was really insufficient! The clinic had a rule that notes were to be written within the same week, and I found myself staying back on Friday afternoons (we had half day off on Friday) to catch up with my notes.

Writing notes at the end of the day and week affected the accuracy of my notes. I would get muddled up about the reps/sets or evaluation of each patient’s treatment and sometimes memory lapses were filled with guesswork. To cope with this, I tried carrying a notebook around with me so that I could jot down the treatment details. As I was bringing the notebook home, I had to be careful not to breach any confidentiality issues by using patient initials.

I wonder if I have a short-term memory problem, or if anyone else has had difficulty in this aspect. Any tips to improve the system or the way I could work would be much appreciated too!

Acute vs Rehab

HI guys, Im currently on an acute stroke ward and just thought Id raise the question of the different settings we can work in. Im loving the acute ward for the majority of reasons but there is one thing in particular which is getting to me. Its so great to see the progress your patient's make from one day to the next. Its really rewarding and well at least some part of it could be becasue of your treatment. Its amazing but then they get d/c somewhere else to rehab and thats the end of them. You never get to see what thier final outocme is, whether they got to walk again or eat using a regular knife and fork. I find this really hard to move from one patient to the next and just forget about them. As a learning expierence I feel we need to see both ends of the spectrum, i.e. what the presentation of the pt is actuely and various rx techniques but then what the pt can achieve for themselves before being d/c'd home and the rx techinicques you used to get them there. Does anyone else feel the same on their ward? Maybe I just become too attached. Or could someone shed some light on the rehab side of stroke? Thanks Suanne

Treating progressive neurological disorders

One of my patients on my previous placement was an elderly lady with progressive spastic paraparesis of unknown cause. She was at the stage where she could only walk 20m with a 4WW and she had difficulty performing transfers. Treatment was based around maintenance of current function for as long as possible. The patient was extremely unmotivated as physiotherapy could not cure her and instead caused pain. She gave up easily during exercises, complaining that she “could not do any more” and that they were “difficult for her”. She had low exercise tolerance and complained that she was tired after treatment.

We were taught in uni that we are, on top of being clinicians, largely motivators for our patients. For this patient, however, I did not want to cause more pain and grief during treatment, so I dropped the role as a motivator and just let her do only as much exercise as she wished. The aim of physio from my point of view was just to keep her moving as much as she could to condition her muscles and maximise function.

It was just disappointing for me to know that there was very little I could do for the patient, given her condition. It is easy and rewarding to encourage patients during treatment, telling them that the exercises they were doing were good for them and would help them get better. In this instance, whether exercise was beneficial or detrimental was debatable.

I wonder if anyone else would have approached the situation differently or have had experience with similar situations?

NEURO

Hey guys, I think this might be a blog to myself but ill give it ago anyway!

Im currently doing my neuro prac at SCGH and wow is it nothing like I expected. NO matter how much you study don't expect to be prepared. Im on the acute stroke ward and astounded at the wide range of ages that are currently on the ward. Aswell as the wide variety of presentations a stroke may have. I don't think when learning about stroke I truely understood the true meaning or many meanings of the word. For example there are pts two days post "stroke" who are able to balance SLS on affected side for 15sec and then at the other end of the scale there are pts three weels post "stroke" who are fully dependant with very little active movement present. It also has become apparent that changes/ recovery can happen overnight, something I never really thought happened. My reflection therefore is how could I have been better prepared for this placement. I studied and read over my notes but nothing I did really helped me. Does the information we aquire at uni become obsolete until we are able to see for ourselves a "real" example of a stroke patient. Has anyone else found this one their placements that no matter how much "written" study and preparation they have done, it all appears different when out in the "real" world of physiotherapy.

Not sure if anyone else is on a placement atm, so hope you are enjoying your holidays!
Suanne xo