Week 3- entry 2

Today i went to see patient d again after having little success with his balance and strengthening training on monday. His pain management was discussed at the team meeting with the doctor and it was decided he was allowed to have panadol but nothing else due to his renal failure. I discused this with him this morning and returned to see him later after pain meds had been taken. He also mention to me that he had tingling in his fingertips and feets. I asked him some questions about diabetes and also wondered whether his lumber fusion could have to do with it. I spoke to my supervisor and she suggested that he speak to his doctor.

I then took him in a wheelchair to the gym where i concentrated on his strength. He was much more motivated today and his back pain wasnt bothering him as much so it i managed to work him harder than last time which made both him and i very happy. I then got him to walk back to his room to work on his endurance. I was happy with my treatment today as i believe i worked within his pain limits but managed to challenge him. I will keep aiming to increase the amount i can do with him to keep things interesting, challenging and worthwhile

Week 3- number1

Today i worked with patient d who has a series of pulmonary problems, a fused lumbar spine and pins in his arm. He complains often about the pain in his lower back. He has good sitting balance but very poor standing balance and decreased strength and range of motion. I worked with him on monday but found i couldnt get through both balance and strength work in the one session as his back pain limits him so i did just strength yesterday and balance today. I got him in the parallel bars and tried to get him to do so static and dynamic exercises but he really struggled. I think his balance would be ok if he didnt have his back pain as i think he feels he need to lean on bars or his frame to take the weight off his back and therefore decrease the pain. I believe if his pain could be managed better we would have more luck with his strengthening and balance as well as increasing how far he can walk. I have discussed this with my supervisor and pain management will be brought up at the next team meeting.



I wasn't that happy with the treatment session as he wasnt able to do as much as i expected and i tried to modify my treatment but dont think i did as good a job as i could. For the next session i will try strengthing again and decrease the amount i was trying to get him to do.

Week 2- entry 3

Today i began an assessment on a new client. She has a L Colles Fracture post fall and fractures of R navicular, medial and lateral cuneiforms. She has other conditions such as hypothyroidism, pagets disease, OP, tracheostomy and COPD just to list a few.



She weakness on her L UL and LLs and general decreased range of motion. She wears glasses and a hearing aid and is often SOB. She ambulates about 200m with a pulpit frame. I am yet to finish her assessment as i it tired her out. So i will assess her sensation, proprioception, balance and gait on monday. I was happy with my assessment and the prioritising of my assessment (as in it was the end of the day and she had done a lot of walking during the day and so was fairly exhausted so i did things like her range of motion in sitting which was the position i found her in then lying, leaving the more tiresome assessments for monday morning).

Week 2- entry 2 23/10

Today i assessed a new client that as arrived from Fremantle Hospital. He was admitted to hospital with dehydration, nausea and dizziness, pulmonary oedema and other problems including pins in his L UL following a fracture. I assessed his mobility, gait, ROM, strength, sensation, balance and enquired about pain and respiratory status. I discovered that he had decreased standing balance both static and dynamic, decreased range of motion and strength of his L UL and his LLs and could walk about 50m. He also complained of back pain due to a fusion of his lumbar spine. he also had a change in sensation as i progressed towards his ankle when i did the light touch test. He was co-operative with my assessment and appeared motivated to exercise and improve. I then developed an care program for him which included a range of strengthening and range of motion exercises, walking and balance exercises. I will begin working through the program with him tomorrow. I was happy with my assessment and feel that i am improving on my assessment skills from week 1 especially in terms of doing everything i need in lying then sitting then standing to avoid getting the patient up and down in different positions all the time.

I was also lucky enough to sit in on a family meeting for one of the clients and his wife. The discharge coordinator, the physio, the social working and community intergration coordinator were all present. The meeting addressed the progress of the client, his needs and his wifes needs/concerns regarding his hopeful return back home in approximately 6 weeks. I was good to get an idea of the things that need to be addressed in order to discharge a patient back home. I plan to ask my supervisor tomorrow if it would be possible for Lillie and I to go with the OT on the home visit for this client to assess the home and look at possible equipment to help ease the client at home. This would help us learn about the possible equipment we could suggest in the future when we are looking at discharging a patient.

Wed week 2- 22/10

Today i continued to work with patient B who had a right ankle arthrodesis. I was lucky enough to also have a look at her scan to observe the oedema and screws after surgery. Exercises the patient B included upper limb strengthening exercises for maintenence (including arm raises, overhead press and bicep curls using 1kg weights) and lower limb strengthening exercises of the good leg (in sitting: knee extension and straight leg raise, in the parallel bars: hip abduction and flexion. We also worked on patient B's balance in the parallel bars by getting her to practice hopping and standing on one leg (as she is NWB on her R leg whilst the plaster is on).

Patient B is a retired nurse and an interesting lady to talk to. She is fairly independent and relatively strong. She also understands the importance of exercise for recovery which means she willingly participates in therapy. I enjoy working with her.

Day 5 of Prac 17/10/08

Today i was asked to assess patient a's balance using the Berg balance scale and work through the patients exercise program. I felt comfortable and confident using the Berg Balance scale and so was quite comfortable to use this outcome measure. Patient A was admitted to Carinya with a stroke. He was fairly good and independent ambulation however he sometime struggles with foot clearance of his right foot (especially when walking outdoors), endurance (he can walk about 10mins outside) and he struggles with function of his right arm and hand which rests suported in a sling when not exercising.

I explained to patient A what i planned to do with him that day but it made easy by the fact he had had a berg balance test performed whilst he was in hospital and he has a fairly sound communication and understanding (only sometimes finding that he can't say/explain what he is thinking or what he wants to say). Patient A's Berg Balance results had improved from 46/56 to 51/56, which was good to see. Patient A should be ready for discharge soon.

I then proceeded to do his exercise program with him. He has done the program for a while so he knows what the exercise is and how to do it once prompted. The exercise program consisted of LL strengthening exercises as well and upper limb exercises where i tried to encourage movement of his right upper limb, especially his wrist and fingers where he had little AROM.
I then did some complex standing balance exercises in the parallels as well working on patient A's stepping and weight shift to assist with his gait.

I was happy with my work with patient A, however i think he is beginning to find some of the exercises orginally prescribed as too easy (however others are still complicated), so i would like to review his program and maybe give his some new exercises as well as incorporating some functional tasks to challenge him a bit more.

Day 4 of prac- entry 2 16/10/08

Today i had to run an exercise class with Lillie. This was the second time we have run one however we have help out on the previous 2 days. We had 9 people including ourselves in the class which was a nice size to handle. We felt completely comfortable even though we were unsupervised as we had watched to classes on previous days and had practiced running classes at uni.



We began with a Warm up which included marching in sitting, stretches, ankle and wrist circles, head stretches etc. . Then we did upper limb ROM exercises in sitting with each client holding onto a stick. The stick actually seemed to encourage them to more their joints more whilst they aimed to do things like trying to reach the roof with their stick. We then did some Lower limb exercises also in sitting such as knee extension and Straight leg raise. Then we moved on to coordination where Lillie did a few movements and then had to copy such as touch knees, touch shoulders, touch head.

Before we ended we played a game of coits where each person had a ring that they had to try and get on the pole in the middle. This was great fun- they really enjoyed this. It encouraged throwing (therefore arm movement) and judgement and coordination to get the ring on the pole.

We finished up with some deep breathing and stretches to cool down.

All in all this was a great class. It was nice to hear from the supervisor later on in the day that clients that being reporting to her how much the enjoyed the class that we ran. I would be more than happy to run another one.

Weekly Entry 1 14/10/08

1. Lillie and i were asked to go and assess a client. I felt comfortable in this situation as we had discussed the assessment sheet with the supervisor prior to performing the assessment. The assessment included the clients functional independence, balance, range of motion, muscle strength/ control and tone, sensation, and gait.
The patient had fractured her tibial plateau in july and was still to be NWB. Lillie and i decided it would be inappropriate to assess her standing balance, as she was only to WB as tolerated in transfers only.

For our first assessment i believe we communicated appropriately however we could have planned the order of our assessment slightly better. We then had to go away and plan a treament program for her now and when she is able to WB. We are yet to discuss our plan with the supervisor.

2. I think we handled to patient well. We completed our assessment and i believe we made fair good clinical reasoning decisions about what should and should not be assessed (however, we now understand that gait probably didn't need to be assessed at this point). As mentioned above- prior planning of the order and joints/muscles we were going to assess may have saved some time. We were able to pick her main problems and create a treatment plan aimed at improving these problems and work towards her goal of being able to WB (and therefore ambulate) so she could go back to the hostel.

3. I felt fairly confident doing this assessment but as it was our first patient on our own i was still a little nervous.

4. I would plan my assessment ahead of time in future to save time whislt with the client

5. From watching our supervisor i have learnt more about communication with patients which will come in handy with future patients

6. Had a fantastic day. Much better than i expected and i am really looking forward to going back tomorrow!

Initial Entry 10/10/08

I am excited yet nervous about going on prac. I am looking forward to developing my understanding and skills in the gerontology area and meeting new people. I just hope i'm not excepted to know too much!!! hehe

I see the physiotherapist working with other staff members such as nursing staff and OT's to create a safe environment, providing excellent treatment that will improve the patients quality of life, health and mobily. I think the Physio in this seeting would be working with other physio's to conduct balance assessments, cardio assessments, falls assessments etc and create exercise programs accordingly. They will also work with other staff members to assess mobility and aids and ensure no presure sores develop.