Muscle-Stim Heel Switch

Hi everyone,

This week i had the opportunity to use e-stim which i thought i'd never touch this whole year haha but it was great to revist the parameters etc...Anyhow, I have applied it to a patient with an incomplete tranverse myelitis at C5/6 and as a result, his main problems during gait are hip hitching of the (L) leg during swing due to mainly inadequate DF and KF. I firstly got the patient to stand on a wedge to prolong stretch (L) gastrocs before applying the e-stim. My aim was to stimulate the DF but not just the strengthen them while in sitting, but to apply it during gait...

The heel switch component of it was placed in the patient's shoe, and everytime there is pressure through the heel i.e. stance phase, the e-stim is off....however as soon as the pressure is off the heel switch (during pre-swing) the e-stim turns on and it activates the (L) DFs...to the patient's amazement he began walking with a near-normal gait pattern...his hip hitching dramatically reduced and his balance improved significantly.

The treatment obviously proved interseting, but to what extent will it have in terms of effect on the recovery of the strength of DF in a pt with tranverse myelitis, I am unsure of.. Anyone have any experience with the same?

Blogging about blogs

Hi guys,
I apologise for the lateness of my last blog and just wanted to actually blog about blogs! haha. I was wondering what everyone's thoughts were on how useful they have been and what they have got out of them? I feel they are extremely helpful to get other peoples perspective on how to handle difficult patients, supervisors and placements in general. I also find it really helpful when people share the positive stuff about what has worked for them. I do feel however that there are probably too many blogs that we are required to do and often find the quality of my posts dropping a little as I struggle to find things to talk about. All in all I feel the blogs are very helpful and perhaps with a little refinement in future years will be extremely effective in helping students to make the most of their placements!

Major Issues

Hi everyone. I have had a very difficult past few days of prac which is looking like it will result in an extra placement after the PCR. The placement has been quite messy with my supervisor often away but I felt it was going okay and I was at least passable. Things kind of exploded on Tuesday, and I discovered that there had been conversations going on about things occurring that they were not happy with. Had they bothered to ask me or anyone else involved in some of these issues it could have been explained and handled with next to no fuss. Instead it's suddenly a massive problem brought up half way through my last week.

An example included that one morning when my supervisor was not at work, she had organised for me to attend a few speech sessions. That morning the speechie came and spoke to me and said that because of the sensitive nature of two of the sessions it would be better if I didn't attend. I said that was fine, and went on with some reading and preparation (this was in the 2nd week). It was then brought to me by my CCT this Tuesday (still no one at the facility spoke to me about it) that they thought it was unprofessional that I had not turned up to scheduled speech sessions as arranged.

The other situations were similar to this involving miscommunication. In hind sight I acknowledge that some issues could have been prevented by extra communication on my part, but others couldn't.

I had the OT come and yell at me in a rather unprofessional manner, for things that hadn't been classified as requirements to me, stating she didn't "give a rats" what I had been doing that morning. This was in front of my supervisor. Had I been unsure I have have clarified myself, but as far as I was concerned I knew what was expected.

My main frustration with this situation is that on the Tuesday of my final week, this all came to the surface, when it had been being discussed behind my back the entire placement. It was not brought up at mid-placement Ax. As far as I was concerned they were "reasonably happy".

I recognise what my responsibilities were, but without the feedback..?

I am still attending my final two days, despite being told I will fail the FCT assessment, and am hoping to pass my final CCT one. If I have to do another placement I will do one, but without the appropriate feedback and support I'm not sure passing this one was ever a possibility.

If anyone has been in even a slightly similar situation I would really appreciate your input.
Thanks

Non english speaking...

Hi all,
Over the duration of my last placement, I have encountered numerous clients who are non english speaking/reading. There are a few ways to tackle this situation, although generally i feel that not all of the information i need to give them gets through correctly. The ward coordinator attempts to get an interpreter for one session, where all the medical staff are able to attend (midwife, physio, doctor) to discuss and explain things to the client. this doesnt always work out though, as often you are busy at the time the interpreter is available, or it is simply too busy with everyone wanting a turn to speak to the client. I have found that family members (mother or husband) are generally quite helpful if they are fluent in english, though you cant be sure everthing is being passed on accurately. The biggest help i have found is the information sheets/brochures which are written up in all different languages (ie. postnatal advice/pelvic floor exercises/bowel and bladder information), so long as there is the language you are looking for! i think these are a great idea, and i feel they should be available in all public and private hospitals. So always ask the physios/ward coordinator if these exist, as they will help you greatly! Does anyone else have any thoughts or experiences?

Change of approach

Just wanted to share something related to one of my previous posts about trying to get compliance out of a 5 year old. My last session with this client was really successful and I came up with a few reasons for this.
Firstly my supervisor was not in the room so I felt my confidence in myself and my abilities without looking over my shoulder.
Secondly, it was mainly a treatment whereas previous sessions had involved compulsory parts of assessment that I really had to push through to get a baseline.
Thirdly, I changed my style with her. Together we constructed an obstacle course, and I think this made her feel involved and allowed her to include things that she enjoyed and found easier. Consequently I could slip parts in that were more difficult and challenging for her. I had a lot of different ideas to work with that I could bounce back and forth to if she refused one activity. Due to her compliance the session was shorter and more effective and I ended up feeling quite good about it.
I know that there were a few factors that contributed to this session, but I choose to believe my adjustments and ideas were part of it!

Activating Dorsiflexors

We have just learnt a technique from one of the senior neuro physios to activate dorsiflexors where dorsiflexion activation is a deficit. It involves applying pressure/compression between the fourth and fifth metatarsal space of the foot and this would elicit toes extension and some dorsiflexion. I've put this to the test to two of my patients (MS and BG-stroke) and they were amazed at the reflex that was elicited from the pressure applied. However the effect on the actual active-dorsiflexion in gait is yet to be observed but I am positive that this technique would prove helpful!

Final prac...

Hi everyone,
Hope the last placement of the year is going ok, not too long to go now! i just wanted to write about the differences i have found between my first placement of the year and this one...
I have found that all of the physiotherapists i am working with treat me as one of them rather than as a student, and they often make comments 'well your more a real physio now than a student' (it may just be a good placement with nice people!) and i feel that this is because we are so close to finishing. i definately have been given more responsibilities, and am left to do a couple of wards a day on my own, and even take outpatient appointments on my own (womens health). i find this really enjoyable (others hate the sink or swim scenario) as it definately makes me work harder, manage my time more efficiently and learn a lot more.
has anyone else found this on with the last few placements, or do you still feel as though a lot of the supervisors still treat you as though you are on your first placement ever?!!

personal experiences

I was seeing an elderly patient on my last prac and had just positioned her out of bed and were going though some deep exercises etc. A relatively new doctor to the area came over and began to look at her nursing notes sitting on the table at the end of the bed. The patient starting to get very agitated and scared saying she didn't like that doctor and he was not to come near her etc. The doctor hadn't even said anything to the patient before she was begging me not to leave her alone with the doctor and was crying/shaking etc. I had to reassure the patient over and over with help of the nurse, that the doctor was here to help her and he would do no harm. It took around half an hour to settle the patient before she would allow the doctor to see her. The patient revealed later it was the doctor's appearance/nationality that had caused her outbursts, which i found strange and a bit difficult to comphrehend but it did alert me to the that a lot of elderly people have had personal experiences in the past that affect how they interact with people today.

students and health professionals

Hi all,
just wanted to share an experience i had with a nurse during my last prac. I had gone into the room where the nurse was and began my assessment. I was auscultating and making sure i respected the privacy of the patient (she was female). The nurse suddenly interrupted me and began to lecture me on how i was being inappropriate and rude as i hadn't shut the blinds whilst examining. I had made sure the patient was covered the entire time throughout my assessment and explained this to the nurse but she continued to disagree and lecture me in a quite condescending manner. In the end, I did what she said. I felt as a student, she was very intolerant to me. I mentioned what happened to my supervisor and she agreed with me, but did think it was just easier to comply with the nurse. I'm sure everyone has had a similar experience with some other health professional but any suggestions on how we can change this 'student' status? and how others perceive students?

Tough one!

Hi guys,
sorry for the late post. Just with regards to a patient I saw on my cardio placement. He was post aortic valve replacement and was progressing along fine the first few days post op. After the first few days though, he started to plateau, his main problem was dyspnoea, but he was also having dizzy spells and getting sort of a tingly feeling in his hand when he was really short of breath. His ex tol was decreased and Sp02 was dropping when amb'ing. The doctors t/f'd him to Bentley for more rehab before he went home and myself and my supervisor told them several time that there was something not right about his presentation and we couldn't quite figure it out. In the end he came back to the ward and after many more tests they discovered a phrenic nerve palsy! Obviously as a student it is not my role so much to be pushing my point to the doctors but i was just wondering as a professional how much would you make your point to the doctors before giving up? Especially if your not sure what the actual problem is??

Communication with parents

I have found it difficult on my paediatric placement sometimes, to be taken seriously by the parents of the clients I see. Particularly with infants I occasionally get the impression that they think I am too young and inexperienced to know what I'm talking about (which isn't too far from the truth sometimes). Some are quite happy to be seen by a student but then speak directly to the supervisor rather than me. I try to sound confident and talk to them about ideas to help their child at home, but my supervisor will always jump in with something more relevant or effective. I'm trying to power through but I feel because of the set up I'm not being given a chance to show what I know.

Positive Support Reaction and Sit to Stand

Hi Everyone...half way there!!

Although my prac is outpatient neuro, a couple of us have had the opportunity to go down to Ward 2 which is a ward dedicated to intensive neuro rehab for inpatients. A common presentation for some stroke patients is the positive support reaction where the unaffected side is over-active and when weight is transfered to the unaffected side (e.g. in standing) the unaffected lower limb would push away towards the affected side. As part of the sit to stand retraining, the physios make the patient follow a specific pattern that causes the patient to transfer the weight to the affected side and stand through the affected side.

This technique seemed very effective to ensure patients are able to sit to stand and not have a positive support reaction from the unaffected side, however my question is, does this technique not lead to a poor pattern of movement down the line?

thanks for any input