Week 4.1 Entry

At this stage of our placement we are predominantly seeing patients who we have seen before and their treatment revolves mainly around applying similar treatment techniques as previously or modifying them if the desired results aren’t being achieved. Assessing the benefits of the exercises prescribed and progressing these is also important since we will hopefully be discharging a lot of our patients and we need them to be able to continue improving/maintaining their situation.

All of our patients today were making headway with their recovery and the decision had to be made whether we were to progress with treatment/exercises dependent on our latest assessment. With some of them it had gotten to a point where they were coming along great but they simply had to increase their strength and the only way to do this was to keep the same exercise but increase the resistance. Not very exciting for the patient but therabands can only take you so far. This is problem for those that find trouble weight bearing for example but need a high resistance for their HEP. Very few patients will have any kind of exercise equipment at home. We have needed to become a bit inventive on occasion to keep the patient interested and also progress the exercise.

One of our patients is working through a VMO/ leg strengthening exercise program and is almost pain free and able to walk up stairs which he had trouble with before. We moved his exercises to weight bearing and far more functional than the previously used theraband. He enquired about possibly being given the all clear and sent on his way. Since this was the first week which we had seen a significant improvement in his condition and we were only getting onto some tougher exercises today we decided that we needed to see the results from this latest exercise prescription and then reassess. Of course we want to see him head off in a better state but not too soon since we think that it is vital he is aware that his situation needs to be maintained and exercises need to continue well after we have stopped seeing him. Otherwise he will simply be back in a few months complaining of the same problem.

This made me aware of how important it is to have a discharge plan even in an outpatients setting. The proposal at the start of our placement was to formulate a plan to discharge the majority of our patients by the end of our 5 week stint. Some of them will be fine to discharge with exercises to continue their improvements whilst others will need to be handed over to the other physiotherapists which will require detailed handover notes and short & long term goals. This will be an important part of life in the physio world so the sooner I get the hang of it the easier it will be when the real world is reached in 2yrs.