Week 5 entry 2

Patient B with a right ankle Arthodesis went to the orthopaedic clinic yesterday and is now able to weightbear as tolerated. So i fitted her with a wzf and got her up into standing after some oedema management. She was very confident in standing and we began walking to the parallel bars for walking practice. I re-educated on gaining heel strike and did some weight shift exercises with her however her gait and strength was suprising better than i expected. She then wanted to go for a walk and her managed to walk about 200 meters. I felt she was very confident and comfortable with the wzf and so i thought i might try her walking with a stick as she had walked with a walking stick previously. She walked quite awkardly with the stick putting little weight on the stick at all. I believe that with more practice she would walk quite well ith a stick but for the moment i have left the wzf for getting around and we will practice walking with the stick for the rest of the week.

Week 5 entry 1

Today i was asked to assist the physio with getting patient F into sitting and then seeing how she copes with the tilt table. Patient F had a stroke affecting the middle cerebral artery territory. Patient F has right side hemiplegia, expressive and receptive dysphagia and increase tone on the right side resulting in an flexion contracture. I began with getting my patient into sitting on the edge of the bed. This required the assistance of two people as we rolled her to one side and then pushed up through side lying to sitting. Patient F had difficulty in sitting as she had poor trunk control and tended to fall to the right. Based upon her sitting posture and stability we decided that it would be a better idea to use a tilt table to get the patient into the standing position. To transfer her from the regency chair to the tilt table we used 3 assist and a slide sheet. We then strapped her down, ensuring that the straps were not too tight. She managed to tilt up to about 60 degrees before she became a bit uncomfortable and distressed. We stood with her for a few miutes before lowering her back down and doing passive stretches of her Right shoulder, elbow, wrist and fingers and her right hip, knee and ankle. I found this hard to perform against the strong contracture however i felt like i was still stretching.

Week 4 entry 3

Today i worked with a lady who had a L NOF that had been managed with an ORIF. I worked through the treatment plan that was created by the physio which included general UL strenghtening with 0.5kg weights. She was quick to give up and say it was too hard, when she could clearly do them so with some education and encouragement i managed to get her to complete the number of reps i wanted, which i was happy with my effort. I also did ankle pumping and circles to maintain circulation and ROM. I then moved to her knee using a slide board. This patient had been using the CPM machine at Fremantle hospital where she left with 50 degrees knee flexion. After getting her to do some actice knee flexion on the slide board i managed to get her to to 60 degrees, which the the patient, physio and i were very happy with. I then got her in standing with her frame to do active hip flexion and abd. I then thought it would be a good idea to teach the patient how to self propel with the wheelchair. The patient was very happy to know that she now has more freedom to move around now that she could self propel. I was very pleased with this this treatment and my management of this patient.

Week 4- entry 2

Today i worked with patient b who had the Left Colles fracture and fractures of her right foot. Jackie was visiting Lillie and I today so i thought this patient would be good to work with. First we went through her hand therapy and it was observed that her hand was still quite swollen. Tubigrip has been used but massage has also been recommended and so i taught patient b how to do a self massage. I then got her to walk to the gym where i did some strengthening of her upper limbs and lower limbs. I also was about to start balance work but i realised that i had been working with her for more than 30 mins and the nursing staff were also chasing her to change her trache strap and give her a shower. I was happy with my interventions and rapport i have built with this patient and it was also good to have Jackie there to also give me some tips with the exercises like placing a ball between the knees during knee extension exercises and using PNF movements instead of just straight weights in different directions to make it functional. So i plan to try these out tomorrow.

Week 4 entry 1

Today I went on a home visit with patient D who has had a stroke 3 months ago and also has an arthrodesis of his L hip, limiting his range of hip flexion and L sided weakness. Currently he Patient D uses a bed rail to roll onto his side and swing his legs over the edge of the bed. He needed assistance for sit to stand as he cannot get his weight forward with his limited amount of L hip flexion. Patient D was ambulating with a 2 wzf about 100m before requiring a break. When walking with him i decided to stand on his left side, being his weak side and because he tends to leav to the right lifting the left side of the frame off the floor so by standing on the left side i can put pressure on his frame to avoid it toppling over. I also made sure that i was far enough behind him with my arm on his right pelvis so that i could stop him if he tilted off to the right. This was a far safer way of walking my patient and minimising the falls risk.

Patient D is due to be discharged in a few weeks to the community with his wife as the primary care giver. The Physio's and OT staff however are concerned about the patient's 'safe' ambulation in the house. We needed to assess whether a wheel chair would be needed in doors, whether the 2 wzf would fit in all of the rooms and whether the lounge chair was comfortable and safe to transfer into and out of. During the home assessment with the OT, it was discovered how narrow and small the house was and therefore how difficult would be to use a wheelchair inside for the limited amount of space. It was decided that a magnet to hold the door front door would be necessary as well as rails at the front door, the entry to the back room where there was a small step and in the toilet. The weather strip at the front door also needed to be removed and a transfer bench has been put in the shower.

Patient D has been using a tilt recline wheel chair for seating. This has enabled patient s to sit in less hip flexion, it is also optimal for pressure care and has long enough arm rests for the patient to push of during a sit to stand transfer. The wife informed us during our visit that the patient is inclined to spend most of his time in his lounge room chair. We assessed the chair for comfort, transfers and pressure care. The chair is too low for the patient as he will require too much assistance to go from sit to stand. The arm rests are also curved downwards at the front making it impossible for him to push down during the sit to stand transfer. Due to the L hip arthrodesis and limited hip flexion, patient s is also far better off in a seat that can tilt backwards to take the pressure of his lower back. After a discussion we decided that the best thing would be to consider getting him an electric chair to sit in when he is in the lounge. We called independent living center to organise an appointment so that we can ensure patient D gets the best possible seating for himself.

Week 3 entry 3

Today i worked with patient c who had the tracheostomy and L Colles fracture and R foot fractures. She returned from the orthopaedic clinic where they removed her airboot and POP so she is now able to weightbear. I worked on her hand exercises that fremantle hospital gave her as well as working on her strength and ambulation. She did extremely well in this session and so i would like up the sets of strength exercises on monday as i believe she could do more than the original number i gave her, as i used 10 x 1 each for all exercises to gauge her SOB and endurance, which it turns out is a bit better than i expected. I was happy with the exercises i gave her though as i believe they were relevant.