stroke

hey guys,
Hope everyone is enjoying their new pracs. I had a stroke patient and he was being absolutely incompliant where me and my supervisor were constantly being pushed away and being aphasic, he was making hand signals telling us to bugger off the whole time. I ignored his behaviour and went on being quite firm forcing the session in the end and being aphasic and weak, the patient had no choice but to follow my commands and did what was told and finished the session successfully (although more effort required). In the end we did find out the reason behind his repulsiveness from his sister where we were told that he dislikes being close to Asians. In my case, it didn't really bother me as I still managed to get his initial sessions done and did not have to see him again as I embark on my new country prac. However, would anyone have done any differently to what I did or would you have handballed it to someone else?

Robin in Geraldton

priorities...

Hey guys,

Had my final Ax at PMH with a little ex-prem baby on O2. He is now nine months corrected age and has barely left hospital since November last year, hence he has three huge volumes of notes! I had a really busy morning on my final day as I had to see three pt's as well as finish two HEPs for two other pt's whom I obviously wasn't going to see again. Knowing I had my final Ax that afternoon, but also assuming I would be given time to look over the notes (as I had not seen him before) I prioritised my other duties over preparing for my Ax. In the twenty minutes or so I had to prepare for the pt I did my best to familiarise myself but ended up having only a sketchy idea of this baby's medical history (due to the massive past medical history). In my handover I gave all the relevent info but got drilled on not having a good understanding of the pt's history and medical plan. I was also told that I should have prioritised preparing for my Ax over my other work and should have asked my facility supervisor for more time...or shortened my lunch break in order to allow myself time to prepare thoroughly.

I guess had I known the history of this bub was so extensive I would have allowed myself more time, but in the same way I felt like the other work was just as important and I felt like I was organising my time effectively. I also find it difficult to tell one supervisor I can't finish my work so that I can prepare for my other supervisor, as I am obviously being assessed by them both.

I know it is improtant to prepare adequately before seeing a pt, but at the same time in reality time limits everything and usually having a quick look at the notes is all you can fit in. Sometimes it just feels like prac is a constant contradiction!!

Honours and staying focussed!

After almost 2 years of working on my honours project (The impact of generation y in the physiotherapy workforce) i am beginning to find it difficult to keep drafting my article. I think this is because now I have been dealing with the topic for so long that it's almost too close to me now and it's hard to step back and see if what I'm writing makes sense anymore. To me, it all makes sense of course! I have sent a draft to a couple of friends to give it a fresh pair of eyes, however I was wondering if anyone had any hints to keep me fresh for just one more month whilst I finish it off! (and yes I have been taking lots of breaks... to master my winter surfing skills hehe)
Cheers! Amanda

Depressed Patients

Hi Everyone!

Working on a stroke ward it is inevitable that you will come across a depressed patient. I have had patients who start crying and can not stop or are so depressed that they say very nasty things about themselves or their situation. I am aware that it is often more complicated with a stroke or peripheral disorder patient than simply being bubbly and positive to ease a negative/ sad attitude. However, in such situations does anyone have an uplifting quote or good phase to use to get the patient motivated/ happier? Looking for any ideas really, thanks

Communication

Hi all!!!
I was previously on my neuro prac at SCGH in G66. For my final Ax I had a R hemi pt who was aphasic and a pusher. These two qualities combined made it quite difficult to be in control of the session. I tend to have a "teaching approach" to many patients. An aim to educate the patient (purpose of a given exercise/benefits of correcting posture etc) to encourage ownership of their treatment and if possible work towards treating themselves independently. So the difficulty in this senario was in correcting the paitents movement; gait, STS when she had no idea what I was trying to help her achieve and why. She was pushing a lot and refusing my manual guidance.
Has anyone got some tricks up their sleeve for such a situation? I know reaching or dual tasking with the pushing arm or fixing the pushing leg in a good position is very important, but anything else?
Ta

China prep

hey guys, how exciting another prac is over! For my rural prac I am going to china to work with kids with cerebral palsy which I am really looking forward too! We have a lot of preparation to do before we go so will be spending the next few weeks trying to learn some mandarin and refresh my knowledge of cerebral palsy. Just wondering if anyone could suggest some good books or resources about assessment and treatment techniques to help me with my study. Ive had a look through my old neuro notes but dont have a lot of info! Thanks guys, enjoy the week off!

Bakers Cyst?

Hi all, eeek last week of prac again! Hope it's been a good one. I was just wondering if anyone had come across a patient with a Bakers' Cyst before. i have a lady with arthirits in a hydro class tomorrow who arrived on crutches 2weeks ago as she ruptured a bakers cyst. She states she is unable to bend her knee even in the pool. I am supposed to give her a home exercise program this week and am struggling.... I guess common sense would be some RICE (although subacute now?), strength for around the knee (quads and hammys?) and some lower limb stretches. Tried to have a look in some journals but there seems to be no evidence regarding the indications for physio in patients with this problem. Just would hate to flare her up more, given she is polyarthritic already. Cheers!

Thinking outside the box

Hey everyone,

I can't believe there's only one week left of this prac!

I'm on paeds prac and I'm treating a little 2 year old boy with a mild (R) side hemiplegia. His dad said that before the stroke he did not communicate vebally, but now he is more delayed due to the damage to his language centre. Currently he is making only a few sounds but nothing coherent, and he is being seen by the speech therapist. The difficulty I'm finding is trying to engage him in therapy when he doesn't speak. I mean it's hard enough to get a 2yo to participate in any activity for longer than 10seconds, but it's even harder when he doesn't seem to understand what I'm asking and doesn't respond to me. I try to plan the session beforehand, and then it feels like he ends up controlling it as he does whatever he pleases. One of the strategies I have been using, is getting dad to come to the sessions and join in on the games. I have also been demonstrating what I would like him to do and that has been a fairly effective method of improving participation. I guess sometimes I just feel like I'm observing what he can and can't do and not really treating, although I know that playing is a form of therapy.

Has anyone else been in a similar situation, and have any ideas on how I could be more effective in my treatment session? Cheers!

paper work!

Hey guys, still on my musculo outpts placement which I am suprisingly really enjoying! except for the fact that there is sooo much paperwork to be done. In the last week or so my pt load has increased dramatically partly because I am seeing pts in less time but also because the notre dame student who was here on prac aswell has just finished and therefore has transferred all of his pts to us! This means that aswell as trying to reschedule all my usual pts and new pts I also have to try to see most of his pts and there simply isnt enough time in the day! Next week I have pts booked back to back which is going to make it very difficult to complete any paperwork. We have been given friday afternoon off to wright out all of our transfer summarys and discharge letters etc, however my supervisor decided to book me in a pt after lunch without my knowing and as a result I am only going to have like an hour and a half to do all my paperwork :( Unfortunatley I think I am going to have to stay back on my afternoon off and try to get the majority of it done as I wont have much time on friday. I know this isnt the end of the world but I would really prefer to spend my thursday afternoon off doing something a bit more exciting than paperwork!

Spinal Pts

I’m currently on my ortho inpts prac and all the acute spinal injuries come to my ward (once they’re stable – not in ICU) before they go to the spinal unit at shents. Tomorrow I will be treating my first paraplegic (T12) whose spinal cord was completely severed in a work incident a few days ago.

He does not speak English and I will be doing a full neuro Ax on him every day for the next week (to monitor swelling around the cord, etc). It is standard protocol that the pts are not informed about their future function until 6 weeks post-injury to allow for any sensory/motor recovery so my pt will be unaware that he wont walk again.

I haven’t been in this situation before and am worried about what to say if he asks me or gets really upset when I ask him to move/feel something and he can’t…

Has anyone had a similar experience and would like to share some tips with me about how to handle this?

Nasty patients!!

Hey guys,
Sorry i'm so late with this post!!! I'm putting 2 up today coz i forgot last week!!

I’m on an ortho inpt prac at the moment and last week had to deal with an extremely difficult pt…
He was admitted with a tibial plateau fracture that had been immobilised with a Richard’s splint. His surgery was being delayed until some of his swelling had settled so the doctors asked for him to be RIB. While talking to the pt I found out he had been an inpt for multiple other lower limb fractures, was a heavy smoker and had been treated with antibiotics for the 3 weeks prior to his admission for a chest infection (? Pneumonia).

While an inpt he had been transferring himself to a wheelchair so he could go outside and smoke (at least 8 times a day)…

I explained my role to him, showed his some bed ex’s, attempted some deep breathing ex’s and cough/huff and explained that moving around/transferring would increase his swelling and that was the only thing delaying his surgery and that the doctors would like him to RIB. He was quite angry with me… “You’re the first person that has told me that, no one else said anything and your just the stupid physio so what would you know!!”

He nastily told me he knew all the bed ex’s and not to waste his time. He refused to cough or huff due to pain in his knee and I thought his pain may be the reason for his aggression.

I went and asked the RMO to come and chat to my pt, and suggested he may need some more pain relief as he appeared to be in quite severe pain (probably exacerbated by his excessive mvt!!) – I went with the RMO to chat to our pt and I was not the only person the pt was angry with… The doctor explained to him that they would like him to RIB to decrease the swelling and he offered him some immediate release pain relief (the pain team were coming to R/V him later that day and we’d explained that to him)… The pt refused pain meds and asked to be left alone (not in those words, a lot more expletives were used)!!!

I feel as though I did the right thing by getting the RMO to come and talk to the pt and offer him pain relief but he was a very angry man!!

What would u guys have done in this situation or do you have any suggestions of how I could have handled it better…
Thanks
xox

Working with the health care team as a student

Hi All,
I am on a neuro inpatients placement. What I have sometimes struggled with during this prac is working with a senior OT.
After speaking to the senior PT I discovered that I was right in feeling the vibe that the head OT sometimes does not approve of the way in which PT progresses patients. This OT is lovely and great at her job, very committed to the patients. However, sometimes it is hard to rationalise certain decisions that are made by the PT team.
For example, taking away a lateral support she had fitted and replacing it with a lumbar role and a towel under affected side. This decision was made as the patient had good sitting balance, activation of trunk muscles. The patient could realign himself although does fatigue.
To explain this as a decision that would help the patient if left for about 30mins was very difficult!!!! Instead of thinking in terms of getting the pt to active muscles they could control she wanted the support there for constant good alignment.
She was... well angry really... as the patient did sit with the head more to the affected side, therefore she confirmed as not ready for the progression due to poor BALANCE and alignment...
Any pointers of how to speak to other members of the health care team in such situations? I did ask my supervisor and she was happy about our decision to remove the extra support...
Thanks :-)

Stress cycle

Hey guys,

This is probably something we have all had to face on prac...getting the right balance with your supervisor. I often don't feel like prac is about physio skills as much as it is about knowing how to relate with your supervisor and understanding expectations. Don't get me wrong my supervisor is lovely, but here is my dilemma, I want to look good in front of my supervisor so I don't like to ask for help, however because of this she assumes I know exactly what I am doing...then when she watches me I tend to freak out and 'fumble' my way through it and then we are both left feeling a little unsatisfied with my performance! Does anyone know what I mean? It's so annoying because it feels like the more I try, the more stressed I get and then the more likely I'll do something to stuff up.

Does anyone have any helpful ideas on how to manage stress when they are in this kind of situation? One thing I am learning is to put less pressure on myself...we can't expect to be perfect when this is the first time we are treating for example a child who has just had a stroke, and I'm learning that it's OK to ask questions!

PPIVMs & PAIVMs

Currently on my musculoskeletal prac, I'm having a lot of trouble assessing joint mobility/stiffness. During PPIVMs and PAIVMs along the spine, changes are very subtle, especially when the entire spine is equally stiff. I don't have a wealth of experience with these assessments so I have no idea of "normal" segmental moblity. I try to form an opinion on what I've felt, then my supervisor comes along and has a feel for herself, and usually has totally different opinions from me.

I've come to a conclusion that accurate PPIVM and PAIVM assessment not only takes time and experience to develop, you also require an accurate and consistent teacher to teach and check every finding you have made. The 4 weeks I have in this prac seem very insufficient. I just wonder how possible it is to have this sort of guidance if we are new grads working in a private clinic. Did you guys find that you had a grasp of it by the end of your placements?