PPIVMs and PAIVMs

Hi everyone,
I have just recently had my musculo placement and am now on my rural. I have been lucky to have had a pretty broad selection of patients, however i have been treating quite a few Cx, Tx and Lx problems. I was just wondering if everyone else finds that it takes a lot of practice to get PPIVM (and also PAIVM) findings completely accurate?! I found at first that although i was fairly accurate it was difficult to work out what levels had the worst restriction... all of us on the same prac had the same difficulty, so just seeing if anyone else has had their musculo and agrees! i think that it definately just takes practice with 'feeling' different necks and backs, and am now finding it easier on this placment as i have already had 5 weeks practice. When speaking to other physios, they say that unless you try and get your hands on as many necks as possible you may be second/third year out of uni and still be unsure with your assesment!
So we had all better get PPIVMing if wanting to work in musculo!

Stace

Good supervisors and tutors

Hi All

I have just finished a placement at SCGH - musculoskeletal outpatient (curtin clinic) and I must say, I agree with everyone else who have said it is by far the best placement ever. It made me stop to think why exactly everyone was thinking the same thing about the placement and it was quite clear that it was because of the supervisor/tutor who made the placement a fantastic experience.

No matter how easy or hard the placement is, the supervisor/tutor can turn the tables right around. Even if you struggle with the area of expertese, having a very supportive and encouraging as well as an understanding supervisor/tutor, the placement becomes highly enjoyable and the learning experience is phenomenal. Whereas, having a supervisor who puts a lot of pressure on you and expects the entire world from you, makes the placement very "unlikeable".

I have indeed come across placements and have heard from others of difficult supervisors/tutors who are very inconsistent and don't give the best support...if only they could be like the supervisor/tutor we had at SCGH musculooutpt, fourth year would perhaps not be so stressful in the end.

patience & education

I have just finished neuro prac in an outpatient setting where many pts arrive via voluntary transport. These drivers are generally very accomodating to different peoples needs, and many pts get along well with them. Ive noticed, however, that some (newer) drivers show strong frustration and a lack of patience with people who ambulate very slowly. I understand that the drivers are working to a schedule and always allow time for my pts to walk to the car at the end of the session. Several times ive had drivers try and force a pt into being wheelchaired out to the car (about 30m away) as its faster than waiting for them to walk the distance.
I explained that its really important the patients get the benefits of a longer walk, and how trying to rush someone with reduced mobility may be unsafe (and will just make them more anxious and slower). Two of the newer drivers said they thought it was better for the pt to be wheelchaired and werent aware that a longer walk was indeed a good thing.
I've since realised that often its simply a lask of understanding by people in the community that leads them to appear impatient towards people with disabilities. The driver i spoke to said he was greatful for my explanations and hoped he would learn more and be more understanding in his job. I think that if we take a little extra time to explain goals, limitations and treatments to family / friends / carers (where appropriate) it can be of great benefit to the patients.

Smokers

My supervisor made a very good point about smokers. Our first thought, even though a bad one, when we read in the notes smoker for 40+ years diagnosed with COPD is that, this is thier fault. My supervisor said that when these pts started smoking they had no idea of the consequences so you do feel sympathetic and this really changes your perspective of the pt. It is the young people who started smoking when the consequences were well known who have no excuse. These are the respiratory pts that we are going to see, so is our attitude going to change (less sympathetic) and will this affect our approach to treating them. I myself think that this is the case and our approach will change. The thought of them doing this damage to themselves will stay at the back of your mind and it will be harder to treat these pts to the best of your ability.

Androgen-deprievation therapy's side effects

Not too long ago, I had a patient who was being referred to me by a gerontology doctor for a Balance Assessment. This is patient has a PMHx of Depression, Prostate cancer and Breast Liposarcoma. He complained that he doesn't feel that his walking is as steady as pre-cancer. The initial assessment results showed that his manual muscle testing of lower limb as well as Berg was almost full score. So I assumed perhaps it has to do with depression and did not think too much about other possibilities.

During a follow-up session, he brought an article about the type of cnacer treatment which he received -- "androgen-deprievation therapy for prostate cancer patient." The article explained that this testosterone reducing therapy can cause side effects such as reduced muscle strength, reduced bone mass and increased body fat. This then made me becoming more aware of the side effects of this type of therapy.

I am glad that he brought my attention to the article. This has taught me to always investigate further with the type of co-mordity treatment which the patient is receiving and whether it has side effects towards physio related problems.

Bilat wrist pain

Hi all

another late post...had a patient with bilateral wrist pain due to prolonged typing/writing as she is a TEE student. On physical assessment, she was TOP over the anterior surfaces of the radiocarpal joint, no restriction in range, positive NTPT (median nerve test), no restriction on PPIVM assessment and on PAIVMs she was TOP as she couldn't quite take the pressure from the PAs of central and unilaterals so no real objective measure was taken from the PAIVMs. Her mom likes to join in the session as she doesn't quite pay attention during the physio session.

is this a case of the patient making an excuse to not clean her room or something or is it really an issue as I couldn't quite seem to gauge where the problem was coming from, taking into consideration that she was quite hypersensitive to the objective assessments and so the accuracy of the measures is questoinable.

Sexual Harrassment?

Hi all,

Sorry for the late entry.

I have a question mark in the title because I am not too sure if it was being considered as a sexual harrassment or not.

Situation 1 - I walked past a regular-visiting outpatient the other day. He was not my patient but we would bump into each other weekly, and would say "Hi" only. He commented: "Hm you smell very nice today". That comment stunned me a little. I was a bit slow at responding to that comment, but came up with "oh, i have just got back from the hydro pool". I am normally not very conservative but I feel he was being a "tad" too flirtatious. That comment was unneccesary and too personal/intimate (even if it's true that I smelt nice).

Situation 2 - I was treating an elderly lady, his son accompanied her to the session. I was trying to explain what she could wear to attend the hydro class. And he jokingly said "in birthday suit, and everyone goes there in birthday suit." "jennifer hawkins has a new bikini range coming out, maybe mom can wear that". I failed to get the joke, so I responded with a cold smirk and hoping he would get the hint and stop the 'joke' right there. I am not too sure if it is his usual way of conversation with his mother or with others.

I normally take the approach of not responding/reacting to those sort of comments on the first occassion and hopefully that will discourage such comments, so that if there is a follow-up appointment, at least the atmosphere will not be awkward. But I would either tell the person directly that I don't find it acceptable or inform my supervisor if that person is re-offending.

Am I being too sensitive towards the situations above?

Chin.