Situation
On this occasion I was to implement a session to treat a 4yr old boy with spastic hemipelgia who had just undergone botulinum toxin injections on his right hamstrings, gastroc and biceps 3 days prior. I had previously assessed and treated this boy on 2 occasions with good compliance and success with the majority of the interventions. As with many children with similar conditions his gait pattern was impaired and the use of his right arm was affected which was to be the main focus of the sessions. The main reason his gait pattern was impaired was due to his limited dorsiflexion which was also to be a target of the intervention sessions.
Task
To carry out an intervention session to treat the patient’s main impairments and teach him the correct technique to walk and also throw. The session was also be used to educate the parents on what activities and exercises should be performed at home to consolidate what occurs during the physiotherapy sessions.
Action
A full program was planned to keep the child busy and interested in the interventions that were planned to target his impairments and improve his ability to function. His mother stated that his walking pattern had improved slightly despite only receiving the Botox treatment 3 days prior so a quick assessment of his ROM into dorsiflexion could be determined. It was found that his dorsiflexion had improved slightly well ahead of the anticipated time when changes are meant to occur. No formal assessment was made of his right arm but it was evident that his ROM had improved since his elbow extension when throwing was almost to full extension.
During the session the child became very disruptive and aggravated with every activity which made keeping the session on track very difficult. I was constantly attempting different techniques to motivate the child to complete the activities as planned. I had to involve the mother to try calming him but nothing would change the situation and we had to terminate the session early.
Result
The patient was very difficult to work with and get the required results out of him so the early termination of the session was necessary. I was able to educate the mother on the importance of stretching in terms of improving and maintaining his dorsiflexion since we did manage to complete some dorsiflexion stretching prior to his behavioural changes
Evaluation
The child became very difficult to deal with and I feel that I dealt with the situation as best I could by attempting to focus in on certain activities that he became interested in at different times such as stairs or the treadmill. Unfortunately this did not appear to work. I also gave the mother and child alone time to try and calm the situation for 5minutes but this did not appear to work either. Having the session over a shorter period of time and focusing in on only 3 different activities would have been of benefit as the initial exercises were completed well with good compliance.
Strategies
Involvement of the mother and also planning a shorter program by tackling the main areas could potentially have made the session more effective and maintained the child’s interest. Also focusing on the education of the parents since at home is where most of the improvements will be made on a daily basis. Understanding how the child will respond to different exercises by targeting his interests would also give each activity a much greater chance of succeeding.
Sunday, May 30, 2010
Sunday, May 16, 2010
Week 1 STARES - TCCP
Situation
On the 4th day of my placement I was to briefly assess and treat a 4 yr old boy with spastic hemiplegia on his right but also with a slightly affected left side. He had been in on several occasions previously and had been through two treatments of Botox and was due for a third in two weeks. The main issues the boy faced were an impaired gait pattern and decreased right upper limb function. The main issue from the parents point of view was his impaired upper limb function while from the health professional’s perspective his impaired gait was the major issue. The boy was very communicative and happy to be involved in the process and the parents were very supportive and understood the importance of sessions with the centre.
Task
To determine what the individual’s issues are by performing a musculoskeletal assessment, gait analysis and functional capacity assessment. During this session it was not intended to treat the patient as such but simply get an idea of what his current limitations are.
Action
As I have found to be important when attempting to assess and treat children is the development of rapport. Fortunately the child in this case warmed very quickly to us and he was very willing to be involved in the process. Initially I assessed his lower limb range of motion and tone. The main issues found were increased tone in his right leg with dorsiflexion and knee extension. He also had decreased standing balance on his right leg. His gait showed impaired right foot clearance, circumduction, inability to extend his knee and high guard with his upper limbs. His reaching ability was also impaired predominantly when reaching to the right.
Result
This highlighted to me that the main area to work on was strength in the patient’s right lower limb, his gait pattern and also his ability to use and function with his upper limbs.
Evaluation
I believe that I conducted the musculoskeletal assessments correctly but need to improve my ability to apply and determine exactly what each of the more functional tests are inferring. I need to know what to be looking for and how it all applies to the big picture.
Strategies
On the next occasion I will know exactly what I am going to do and to keep the patient involved bring in a an incentive of some form to give him a goal. Sticking at one task for a while then completely stopping it and moving on to another would also ensure the patient is able to focus further. With time being able to find ways to keep a child involved while still keeping on task from a physiotherapy point of view will be an important skill to fine tune.
On the 4th day of my placement I was to briefly assess and treat a 4 yr old boy with spastic hemiplegia on his right but also with a slightly affected left side. He had been in on several occasions previously and had been through two treatments of Botox and was due for a third in two weeks. The main issues the boy faced were an impaired gait pattern and decreased right upper limb function. The main issue from the parents point of view was his impaired upper limb function while from the health professional’s perspective his impaired gait was the major issue. The boy was very communicative and happy to be involved in the process and the parents were very supportive and understood the importance of sessions with the centre.
Task
To determine what the individual’s issues are by performing a musculoskeletal assessment, gait analysis and functional capacity assessment. During this session it was not intended to treat the patient as such but simply get an idea of what his current limitations are.
Action
As I have found to be important when attempting to assess and treat children is the development of rapport. Fortunately the child in this case warmed very quickly to us and he was very willing to be involved in the process. Initially I assessed his lower limb range of motion and tone. The main issues found were increased tone in his right leg with dorsiflexion and knee extension. He also had decreased standing balance on his right leg. His gait showed impaired right foot clearance, circumduction, inability to extend his knee and high guard with his upper limbs. His reaching ability was also impaired predominantly when reaching to the right.
Result
This highlighted to me that the main area to work on was strength in the patient’s right lower limb, his gait pattern and also his ability to use and function with his upper limbs.
Evaluation
I believe that I conducted the musculoskeletal assessments correctly but need to improve my ability to apply and determine exactly what each of the more functional tests are inferring. I need to know what to be looking for and how it all applies to the big picture.
Strategies
On the next occasion I will know exactly what I am going to do and to keep the patient involved bring in a an incentive of some form to give him a goal. Sticking at one task for a while then completely stopping it and moving on to another would also ensure the patient is able to focus further. With time being able to find ways to keep a child involved while still keeping on task from a physiotherapy point of view will be an important skill to fine tune.
Sunday, May 9, 2010
Initial Entry - Rotation 3: TCCP
My third placement for the year will at The Centre for Cerebral Palsy. I am looking forward to becoming involved in a facility and program that helps individuals who can potentially have very significant impairments and functional limitations. I have been involved in the centre previously during 4P and took great satisfaction from helping and also being involved with people who work there who have a real passion for improving the lives of the patients.
I am expecting to be involved with the planning and implementation of individualized programs for each patient after thorough examination of their deficits and impairments. I have not been exposed to the specific nature of an examination for someone with cerebral palsy but expect that it is very similar to the standard musculoskeletal examination but with the addition of testing an individuals tone and level of spasticity.
As I found previously hydrotherapy is a large component of many of the patient’s programs and I envisage some time in the hydrotherapy pool will be involved. Onsite sessions may be at a patient’s school or education facility or possibly in their home environment. The exact nature of the treatment is not very clear to me at this stage but from lecture material I would think a lot of stretching, strengthening and conditioning work will be involved.
Due to the specialized nature of the Cerebral Palsy centre I believe that I will be observing and assisting my supervisor during the early stages but as time passes become more independent and involved in the entire of process of assessment through to implementation of a long term plan to maintain and potentially improve an individuals situation. I hope that there will be some elements of continuing education and exposure to some of the more difficult patient scenarios.
From previous reports I have found that it can be a very rewarding placement being involved in an aspect of physiotherapy that is not often considered by many following graduation. As with most placements there is a certain amount of nervousness but I expect this to dissipate rapidly as I become more and more involved.
I am expecting to be involved with the planning and implementation of individualized programs for each patient after thorough examination of their deficits and impairments. I have not been exposed to the specific nature of an examination for someone with cerebral palsy but expect that it is very similar to the standard musculoskeletal examination but with the addition of testing an individuals tone and level of spasticity.
As I found previously hydrotherapy is a large component of many of the patient’s programs and I envisage some time in the hydrotherapy pool will be involved. Onsite sessions may be at a patient’s school or education facility or possibly in their home environment. The exact nature of the treatment is not very clear to me at this stage but from lecture material I would think a lot of stretching, strengthening and conditioning work will be involved.
Due to the specialized nature of the Cerebral Palsy centre I believe that I will be observing and assisting my supervisor during the early stages but as time passes become more independent and involved in the entire of process of assessment through to implementation of a long term plan to maintain and potentially improve an individuals situation. I hope that there will be some elements of continuing education and exposure to some of the more difficult patient scenarios.
From previous reports I have found that it can be a very rewarding placement being involved in an aspect of physiotherapy that is not often considered by many following graduation. As with most placements there is a certain amount of nervousness but I expect this to dissipate rapidly as I become more and more involved.
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