One of my patients on my neuro placement was an extremely young patient who had suffered a stroke and required an emergency craniectomy. Because of her young age I expected to meet a patient who had abused her body with drugs and alcohol and who probably wouldn't have much family support in hospital. It was very refreshing to find a very pleasant woman with the support of her husband, mother and sisters from overseas. The support that she had from her family was something that I had not seen on my placement for anyone else on the ward. They were all very caring and trying to help the patient with her recovery.
Unfortunately that love became an unforeseen problem for me with her physio treatment sessions. As they all wanted to help so desperately, they would all want to come to the physio gym and watch her treatment and help out where they could. I was inexperienced enough to allow them to come for the first few sessions and I quickly became aware that although they were only trying to help, they were becoming more of a nuisance then anything during treatment. They were constantly asking questions and trying to help the patient during transfers and telling her to try harder, etc.
It took me a few sessions to realise that this in fact was not helping at all and I had to muster up the courage to ask the family if they could stop coming to the physio gym during her treatments. They actually took it a lot better then I expected and I just tried my hardest to explain to them that the patient would get a better treatment if it wasn't so crowded in the gym. I still allowed the husband to come as the patient seemed to be more comfortable with him around and he was able to get through to the patient better then me in some situations.
This was a steep learning curve for me as I would previously have had no problem at all allowing family and friends to watch our treatment sessions. Now I know for future that it is really not suitable to have more then one extra person involved in a patient's treatment and even then it can be too much sometimes. I think I will allow 1 person to watch and then decide from there if they should stay or not. Has anyone else had any circumstances like this one?
Wednesday, October 29, 2008
Bound for a Nursing Home
Recently on my neuro placement I had a patient who had suffered a massive stroke. As I was very inexperienced when I was given the patient, I expected to see significant gains in the patient over the course of the month that I was to treat him. However this was not the case and the patient remained completely dependent. After one month of treatment he still had absolutely no sitting balance and was unable to swallow. We spent countless treatment sessions trying to improve this sitting balance and left sided inattention that he displayed with little luck.
After a couple of weeks of treating the patient my thoughts began to change and I went from being very disappointed in the patient's progress to extremely excited whenever we noticed the slightest improvement. These improvements that we saw would be a tiny flicker of tone, a couple of clearly spoken words or a spontaneous turn of the patient's head to engage in an activity on the left.
It did become very clear that the patient would be eventually discharged to a nursing home as he was simply not showing enough improvement to warrant further rehabilitation. It became quite hard speaking to his family as they were always so excited about the patient's rehab and asking how long it would take for him to walk, etc. All we could do was constantly remind them that the patient was recovering a lot slower then we would expect and it would be a very long road to recovery if he ever got there.
I found it very hard to see the hope in his family's eyes slowly start to disappear over the month as mine had already done. In future I don't think I would approach the situation any differently however I would have the experience of dealing with such a patient and would not be so shocked if a patient didn't progress as I would expect. And I would just be as honest with family as i possibly could be.
After a couple of weeks of treating the patient my thoughts began to change and I went from being very disappointed in the patient's progress to extremely excited whenever we noticed the slightest improvement. These improvements that we saw would be a tiny flicker of tone, a couple of clearly spoken words or a spontaneous turn of the patient's head to engage in an activity on the left.
It did become very clear that the patient would be eventually discharged to a nursing home as he was simply not showing enough improvement to warrant further rehabilitation. It became quite hard speaking to his family as they were always so excited about the patient's rehab and asking how long it would take for him to walk, etc. All we could do was constantly remind them that the patient was recovering a lot slower then we would expect and it would be a very long road to recovery if he ever got there.
I found it very hard to see the hope in his family's eyes slowly start to disappear over the month as mine had already done. In future I don't think I would approach the situation any differently however I would have the experience of dealing with such a patient and would not be so shocked if a patient didn't progress as I would expect. And I would just be as honest with family as i possibly could be.
Monday, October 27, 2008
Unsafe Patient
On my neuro placement I was treating a patient who had had a stroke. She had not been badly affected however she suffered from diplopia and verticality issues. Therefore my treatment was focused primarily on treating the patient's verticality issues. This improved fairly quickly and soon the patient was able to walk with stand by assistance. However she still very definitely needed that stand by assistance as she would periodically stumble to the right. To add to her problems she also displayed quite marked perceptual deficits.
From the allied health point of view this lady was going to need quite intense rehab over a prolonged period of time as she was very young and still working in management. However, after about a week in hospital I got news that the doctors were looking at discharging her to her home in the coming days. I was completely shocked about this and had multiple conversations with other allied health team members only to find that they were in total aggreance with myself. I was told that all I could do was write clearly in the notes that the patient was not safe for discharge and explain why. So i did this every day in capitals but it did not make a difference. The resident and registrar both noted our inputs but the consultant still wanted to discharge the patient.
I couldn't believe it and asked if I should talk directly to the doctor but my supervisors laughed and said it would not help at all and that I would just get my head bitten off. I don't understand why some doctors are so stubborn and will not take advice from the allied health team. This patient was clearly not safe and would probably be re-admitted with a fall. Not to mention there was no way she could work in management again.
I think if i was a qualified physio I would have approached the doctor but as I was only a student i felt it was not my place to make such calls. What would you have done?
From the allied health point of view this lady was going to need quite intense rehab over a prolonged period of time as she was very young and still working in management. However, after about a week in hospital I got news that the doctors were looking at discharging her to her home in the coming days. I was completely shocked about this and had multiple conversations with other allied health team members only to find that they were in total aggreance with myself. I was told that all I could do was write clearly in the notes that the patient was not safe for discharge and explain why. So i did this every day in capitals but it did not make a difference. The resident and registrar both noted our inputs but the consultant still wanted to discharge the patient.
I couldn't believe it and asked if I should talk directly to the doctor but my supervisors laughed and said it would not help at all and that I would just get my head bitten off. I don't understand why some doctors are so stubborn and will not take advice from the allied health team. This patient was clearly not safe and would probably be re-admitted with a fall. Not to mention there was no way she could work in management again.
I think if i was a qualified physio I would have approached the doctor but as I was only a student i felt it was not my place to make such calls. What would you have done?
Long Term Patient
Recently I was on a neuro based placement and was asked to continue the care of a patient who was recently admitted to hospital. From reading the notes I realised that the patient had been previously independent in all areas of life and still drove her car. She also seemed to be part of quite a wealthy family. On assessing the patient it became very obvious that she was going to be a 'handful' over the coming month. Although she realised she was no longer independent, she believed she would get better on her own. To add to the situation, this lady lost focus very easily and loved to talk bout anything at all, no matter what relevance it had.
Obviously I did my best to explain the necessity of physio as well as other medical help but this lady still felt she only required rest to get better. Over the month I was treating her we had some very interesting times and I found to get the best outcomes I had to become more of a friend then a physio and barter with her to complete her physio sessions. I often found myself giving her choices and rewarding her if she chose the harder option. It ended up being quite an interesting challenge to gain her compliance twice a day but it was something that i found myself looking forward to.
I approached it almost as a competition and I believe it allowed me to perform some effective form of treatment each day rather then very little if i had let her get her own way. After a few days it became very easy for me to tell whether she was just bluffing to get out of physio or whether she was in fact, not up for it at the time. I don't believe I would have been able to sense this if i had just taken a standard approach to the patient.
This approach would obviously not work for everyone but if I had a similar type of patient in a similar sort of setting again I would use the same techniques.
Obviously I did my best to explain the necessity of physio as well as other medical help but this lady still felt she only required rest to get better. Over the month I was treating her we had some very interesting times and I found to get the best outcomes I had to become more of a friend then a physio and barter with her to complete her physio sessions. I often found myself giving her choices and rewarding her if she chose the harder option. It ended up being quite an interesting challenge to gain her compliance twice a day but it was something that i found myself looking forward to.
I approached it almost as a competition and I believe it allowed me to perform some effective form of treatment each day rather then very little if i had let her get her own way. After a few days it became very easy for me to tell whether she was just bluffing to get out of physio or whether she was in fact, not up for it at the time. I don't believe I would have been able to sense this if i had just taken a standard approach to the patient.
This approach would obviously not work for everyone but if I had a similar type of patient in a similar sort of setting again I would use the same techniques.
Monday, October 20, 2008
Beckons the Dragon - Part 4
I worked with a five year old boy suffering from spastic hemiplegic cerebral palsy. He was a boy with a dense left hemiplegia. Both his left upper and lower limbs were in a flexor pattern and had increase tone when I tried to extend them.
He has only been in the Centre for about six months. The staff reported that when he first came in, he did not speak a single word, kept wetting his pants because he did not know how to say he needed the toilet, had no voluntary control of his left upper and lower limbs and even has an incidence of epilepsy and was foaming at his mouth. The staff thought they may have pushed him over his limit and overworked him. This is something that they do with all their children to help them reach their full capabilities.
When I learnt about all this that was happening, I felt worried for the children. The staff at the Centre work the children really hard. When stretching, they tend to stretch past normal range! They sometimes stretch the knee into hyperextension and the elbow into hyperextension. This was a sight that sent shivers down my spine. These poor children, most who could not express themselves, were not able to say if they were in pain. The staff also made the children stand for extended times in wooden standing frames. While in these frames, the children had lower limb splints on. They were then strapped at the ankles and knees, to the standing frame. This promoted knee hyperextension and was again another scene that required change! Finally, the children also had upper limb splints on and were made to remain in a 4-point kneeling position for at least 30mins. Support was given at the shoulders but some of these children did not even have the strength to maintain the weight of their body. If not careful, the children’s shoulders may sublux. Again, these poor children were not able to express themselves. The children sometimes cry and the staff took crying as a form of disobedience, and punished them further by extending the therapy time.
All the children in this room, regardless of their diagnosis, went through the same schedule daily. Even if a child had low tone, the staff would still be stretching them, and stretching pass neutral! This was something that was unacceptable back home. I noted all these down and during our handover session in the final week, told the staff that they should be careful with the exercises that they prescribe to the children. I even demonstrated the different exercises and stretching to show them where they should have their hands placed to give maximum support and how far they should go when stretching (never to go beyond neutral!!!).
These are just a few of the unacceptable practices I saw while on placement in Shanghai, China. What would you have done different to me if you were on the same placement?
He has only been in the Centre for about six months. The staff reported that when he first came in, he did not speak a single word, kept wetting his pants because he did not know how to say he needed the toilet, had no voluntary control of his left upper and lower limbs and even has an incidence of epilepsy and was foaming at his mouth. The staff thought they may have pushed him over his limit and overworked him. This is something that they do with all their children to help them reach their full capabilities.
When I learnt about all this that was happening, I felt worried for the children. The staff at the Centre work the children really hard. When stretching, they tend to stretch past normal range! They sometimes stretch the knee into hyperextension and the elbow into hyperextension. This was a sight that sent shivers down my spine. These poor children, most who could not express themselves, were not able to say if they were in pain. The staff also made the children stand for extended times in wooden standing frames. While in these frames, the children had lower limb splints on. They were then strapped at the ankles and knees, to the standing frame. This promoted knee hyperextension and was again another scene that required change! Finally, the children also had upper limb splints on and were made to remain in a 4-point kneeling position for at least 30mins. Support was given at the shoulders but some of these children did not even have the strength to maintain the weight of their body. If not careful, the children’s shoulders may sublux. Again, these poor children were not able to express themselves. The children sometimes cry and the staff took crying as a form of disobedience, and punished them further by extending the therapy time.
All the children in this room, regardless of their diagnosis, went through the same schedule daily. Even if a child had low tone, the staff would still be stretching them, and stretching pass neutral! This was something that was unacceptable back home. I noted all these down and during our handover session in the final week, told the staff that they should be careful with the exercises that they prescribe to the children. I even demonstrated the different exercises and stretching to show them where they should have their hands placed to give maximum support and how far they should go when stretching (never to go beyond neutral!!!).
These are just a few of the unacceptable practices I saw while on placement in Shanghai, China. What would you have done different to me if you were on the same placement?
Beckons the Dragon - Part 3
The Director of the Centre requested that I perform some therapy with her son. I accepted her request and went to see her son today. The Director told me yesterday that he is a very unmotivated boy. I didn’t think too much of it until I saw him.
The Director's son was a typical 17-year-old teenager. When I asked him to do exercises with us, he came up with lots of excuses. I tried to teach him a more suitable way of coming down to the ground from sitting but he said it was easier for him to do it “his way”. “His way” was reaching out to the ground with both hands while seated on the plinth, and going straight into a 2-point kneel position on the mat. He did not go through the half-kneel position but used upper limb support to get himself down. Even when he got back up onto the plinth, he lifted himself with his upper limb strength. He could be doing this due to the fact that he really did not have the strength to get into a different position because his lower limb muscles were just too weak (MMT grade 1/5). The session did turn out to be good eventually but most of the time was spent talking to him and understanding what he wanted out of therapy.
I guess when interacting with teenagers, they do not always share the same vision as their parents. He kept saying that his Mum does not know what he wants and that he will wait to go to Perth next year to do therapy. He said that his Mum has tried many forms of therapy, including surgery, and all these therapies did not help at all. Instead, he has just gotten worse from the many surgeries that he went for. I tried to talk to him and explain that his Mum is doing the best she can for him, and that he has to help himself if he wants to get better. He cannot be passive and wait for therapy to come, but has to be proactive in doing therapy now so that when he goes to Perth next year, he would be able to get so much more out the therapy session there!
What else could be said to a rebellious teenager to get him to do his exercises? I guess, having lots of patience could be something to start with. Have anyone else experienced something like this before?
The Director's son was a typical 17-year-old teenager. When I asked him to do exercises with us, he came up with lots of excuses. I tried to teach him a more suitable way of coming down to the ground from sitting but he said it was easier for him to do it “his way”. “His way” was reaching out to the ground with both hands while seated on the plinth, and going straight into a 2-point kneel position on the mat. He did not go through the half-kneel position but used upper limb support to get himself down. Even when he got back up onto the plinth, he lifted himself with his upper limb strength. He could be doing this due to the fact that he really did not have the strength to get into a different position because his lower limb muscles were just too weak (MMT grade 1/5). The session did turn out to be good eventually but most of the time was spent talking to him and understanding what he wanted out of therapy.
I guess when interacting with teenagers, they do not always share the same vision as their parents. He kept saying that his Mum does not know what he wants and that he will wait to go to Perth next year to do therapy. He said that his Mum has tried many forms of therapy, including surgery, and all these therapies did not help at all. Instead, he has just gotten worse from the many surgeries that he went for. I tried to talk to him and explain that his Mum is doing the best she can for him, and that he has to help himself if he wants to get better. He cannot be passive and wait for therapy to come, but has to be proactive in doing therapy now so that when he goes to Perth next year, he would be able to get so much more out the therapy session there!
What else could be said to a rebellious teenager to get him to do his exercises? I guess, having lots of patience could be something to start with. Have anyone else experienced something like this before?
Beckons the Dragon - Part 2
I felt I finally managed to make a difference today! I was working with a child suffering from CP in the Conductive Education room today. I felt she was a child that might have skipped a milestone and went straight onto walking. She seemed as though she never learnt to crawl as she was not able to coordinate the reciprocal movement of the upper and lower limbs when in 4-point kneeling position. As such, I decided to set up steps for her to climb up into a ball pit. This encouraged her to move her limbs reciprocally to facilitate crawling and climbing. I also taught her to stand through 2-point kneeling to half-kneeling and finally to standing. It took many attempts before she was able to do it properly.
Towards the end of the treatment, the child got really tired and started to cry! I tried to stop her from crying but to no avail. I had to let her go eventually and she started to crawl towards the center of the room where the other children were playing. She was attracted to the large fitball and wanted to play with it. Without prompting, she moved towards the ball and stood up in the way we taught her to! I was so happy as I felt that the treatment I just had with her was effective.
I was beginning to have more confidence in being able to help both the children and staff at the Centre, be it in terms of treatment, training or just being able to listen to them and offer suggestions to the issues they were facing. The successful therapy session with the child made my day!
Towards the end of the treatment, the child got really tired and started to cry! I tried to stop her from crying but to no avail. I had to let her go eventually and she started to crawl towards the center of the room where the other children were playing. She was attracted to the large fitball and wanted to play with it. Without prompting, she moved towards the ball and stood up in the way we taught her to! I was so happy as I felt that the treatment I just had with her was effective.
I was beginning to have more confidence in being able to help both the children and staff at the Centre, be it in terms of treatment, training or just being able to listen to them and offer suggestions to the issues they were facing. The successful therapy session with the child made my day!
Sunday, October 19, 2008
Beckons the Dragon - Part 1
Hey everyone, it's been sometime since my last post but here is the 1st part of my 4-part post on my PT Abroad placement in Shanghai! I worked with children suffering from cerebral palsy, autism, ADHD and Down Syndrome while I was there. It has been a wonderful experience and I definitely did not regret making that choice to go.
The Centre I worked at had three different rooms: the “Physical Therapy room”, the “Conductive Education room” and the “Sensory Integration room”. Each had different types of children and different equipment. Of the three room, the one that physio had most in common with was the Physical Therapy room.
In this room, I saw a range of children. Amongst the many children, there was one child that was positioned very poorly in the wheelchair. She had very high tone in both her upper limbs and lower limbs and it was very difficult to even try to extend her arm. Her hands were in the small space between the armrest and her trunk was rotated towards the right. Her hips were also internally rotated and it seemed to me she had windswept hips.
A reason why she was in such a bad position could be due to the size of the wheelchair? The wheelchair was too big for her and thus could not give her adequate support to keep her in an upright posture. The staff did try to put extra towels to support her trunk but I think not enough towels were used.
I also noticed that none of the staff were doing any therapy with her. She was just left to sit in the corner. As it was only my second day at the Centre, I felt I might not have seen the bigger picture. In a sense, I may have missed the parts where the staff did the passive movements and muscle stretches and any other therapy that they have lined up for her.
I had a whole plan drawn up for her. She requires vigorous therapy to prevent deterioration. What else could be done for her if there was not enough staff to carry out therapy for her? Afterall, I will only be there for four weeks, and when I leave who will help her? I feel for the children there and hope that things will start to get better for them.
The Centre I worked at had three different rooms: the “Physical Therapy room”, the “Conductive Education room” and the “Sensory Integration room”. Each had different types of children and different equipment. Of the three room, the one that physio had most in common with was the Physical Therapy room.
In this room, I saw a range of children. Amongst the many children, there was one child that was positioned very poorly in the wheelchair. She had very high tone in both her upper limbs and lower limbs and it was very difficult to even try to extend her arm. Her hands were in the small space between the armrest and her trunk was rotated towards the right. Her hips were also internally rotated and it seemed to me she had windswept hips.
A reason why she was in such a bad position could be due to the size of the wheelchair? The wheelchair was too big for her and thus could not give her adequate support to keep her in an upright posture. The staff did try to put extra towels to support her trunk but I think not enough towels were used.
I also noticed that none of the staff were doing any therapy with her. She was just left to sit in the corner. As it was only my second day at the Centre, I felt I might not have seen the bigger picture. In a sense, I may have missed the parts where the staff did the passive movements and muscle stretches and any other therapy that they have lined up for her.
I had a whole plan drawn up for her. She requires vigorous therapy to prevent deterioration. What else could be done for her if there was not enough staff to carry out therapy for her? Afterall, I will only be there for four weeks, and when I leave who will help her? I feel for the children there and hope that things will start to get better for them.
Saturday, October 11, 2008
Serotonin Syndrome
Hi everyone, hope your pracs are going well- one to go til we’re physios!
On my rural prac I’ve had the opportunity to watch my supervisor treat patients in ICU. One patient caught my attention as he had been admitted with a condition I’d never seen before. It’s called Serotonin Syndrome, and I thought it was an interesting condition so I thought I’d share what I’ve learnt.
Serotonin Syndrome is an adverse drug reaction that can happen after therapeutic or recreational drug use, and usually involves an interaction between two or more drugs. It’s not a spontaneous reaction; it’s the result of excessive serotonergic activity in the CNS and peripheral serotonin receptors. The most common kinds of drugs which, if combined or used in excess, cause this are anti-depressants, opioids, CNS stimulants, psychedelic drugs (e.g. LSD) and some herbs (like St John’s Wort and Gingko Biloba). Clinical presentations of serotonin syndrome can range from mild to potentially fatal. Milder symptoms can consist of tachycardia, profuse sweating, myoclonus, hypertension, hyperthermia and hyper-responsive reflexes. Severe symptoms include the previous symptoms as well as agitated delirium, muscle rigidity, metabolic acidosis, rhabdomyolysis (muscle breakdown) and renal failure. Most symptoms tend to resolve within 24-72 hours.
In the patient I’ve seen, he had taken a combination of ecstasy, dexamphetamines, cannabis and alcohol. He was also taking three different prescription anti-depressants and anti-psychotics. He has been sedated and intubated in ICU for 11 days, far longer than the 3 days that it should last. His muscles exhibit leadpipe rigidity on muscle testing and he is constantly sweating, even under sedation. He is 24 years old, and there is a possibility that he has suffered brain damage from this condition.
It is an extremely sad situation. It has made me realise that many people don’t know or understand the consequences of mixing medications, and how dangerous it can be.
On my rural prac I’ve had the opportunity to watch my supervisor treat patients in ICU. One patient caught my attention as he had been admitted with a condition I’d never seen before. It’s called Serotonin Syndrome, and I thought it was an interesting condition so I thought I’d share what I’ve learnt.
Serotonin Syndrome is an adverse drug reaction that can happen after therapeutic or recreational drug use, and usually involves an interaction between two or more drugs. It’s not a spontaneous reaction; it’s the result of excessive serotonergic activity in the CNS and peripheral serotonin receptors. The most common kinds of drugs which, if combined or used in excess, cause this are anti-depressants, opioids, CNS stimulants, psychedelic drugs (e.g. LSD) and some herbs (like St John’s Wort and Gingko Biloba). Clinical presentations of serotonin syndrome can range from mild to potentially fatal. Milder symptoms can consist of tachycardia, profuse sweating, myoclonus, hypertension, hyperthermia and hyper-responsive reflexes. Severe symptoms include the previous symptoms as well as agitated delirium, muscle rigidity, metabolic acidosis, rhabdomyolysis (muscle breakdown) and renal failure. Most symptoms tend to resolve within 24-72 hours.
In the patient I’ve seen, he had taken a combination of ecstasy, dexamphetamines, cannabis and alcohol. He was also taking three different prescription anti-depressants and anti-psychotics. He has been sedated and intubated in ICU for 11 days, far longer than the 3 days that it should last. His muscles exhibit leadpipe rigidity on muscle testing and he is constantly sweating, even under sedation. He is 24 years old, and there is a possibility that he has suffered brain damage from this condition.
It is an extremely sad situation. It has made me realise that many people don’t know or understand the consequences of mixing medications, and how dangerous it can be.
Friday, October 3, 2008
Suitability for physio
Recently I was on my musculoskeletal placement and had a 26 yr old female English patient referred to me from her GP for low back pain. On assessment, I found that she had developped this back pain insidiously about a month after the birth of her first baby. Her husband works full time and she is a stay-at-home mum. They have been in Perth for six months. There were no significant findings on objective assessment which could fully explain her LBP. It also did not follow a pattern of conpression or stretch and her posture was reasonable.
On initial session, I educated her about posture and the lasting effects of pregnancy on the body (relaxin, decrease muscle tone) as well as the importance of strengthening TA and pelvic floor to support her lower back. I went through basic TA retraining with her and also good lifting techniques and positions for changing, bathing baby.
After seeing this patient, I spoke to my supervisor as something just didn’t seem to add up. I discussed my findings and session with him as I felt that perhaps there was something else going on as I didn’t have enough assessment findings to explain it. My supervisor suggested that I investigate further at the next session. On the next session she presented with similar low back pain as well as pain up into her thoracic spine. I also found out that she is not coping well at home with her husband working. She doesn’t have family in Perth and doesn’t have many friends here as she moved recently.
I asked if she had sought any help or support to which she replied that she wasn’t aware it was avaliable. (I had talked to my supervisor the previous week about the nature of her chronic pain and the potential for something such as PND to perhaps be contributing or causing her problem. My supervisor agreed it was a possibility and to talk to her about it next time.) I explained that I had recently also been on a womens health placement and that it is not uncommon for women to feel overwhelmed with a new baby, I also explained PND and asked if she had heard of it. She said that her sister had it with her second baby. After talking to my supervisor we decided to refer her back to her doctor for an assessment and I wrote a letter to him explaining the assessment and findings and querying another cause of the chronic pain.Two weeks later, I recieved another letter from her doctor explaining that she had been diagnosed with mild PND and reffered on. This made me realise how important it is to keep in mind that some patients may not be fully appropriate for physiotherapy even though sometimes it seems like they are. I suppose it is always been in the back of my mind, but after this patient, I was certainly more aware!
On initial session, I educated her about posture and the lasting effects of pregnancy on the body (relaxin, decrease muscle tone) as well as the importance of strengthening TA and pelvic floor to support her lower back. I went through basic TA retraining with her and also good lifting techniques and positions for changing, bathing baby.
After seeing this patient, I spoke to my supervisor as something just didn’t seem to add up. I discussed my findings and session with him as I felt that perhaps there was something else going on as I didn’t have enough assessment findings to explain it. My supervisor suggested that I investigate further at the next session. On the next session she presented with similar low back pain as well as pain up into her thoracic spine. I also found out that she is not coping well at home with her husband working. She doesn’t have family in Perth and doesn’t have many friends here as she moved recently.
I asked if she had sought any help or support to which she replied that she wasn’t aware it was avaliable. (I had talked to my supervisor the previous week about the nature of her chronic pain and the potential for something such as PND to perhaps be contributing or causing her problem. My supervisor agreed it was a possibility and to talk to her about it next time.) I explained that I had recently also been on a womens health placement and that it is not uncommon for women to feel overwhelmed with a new baby, I also explained PND and asked if she had heard of it. She said that her sister had it with her second baby. After talking to my supervisor we decided to refer her back to her doctor for an assessment and I wrote a letter to him explaining the assessment and findings and querying another cause of the chronic pain.Two weeks later, I recieved another letter from her doctor explaining that she had been diagnosed with mild PND and reffered on. This made me realise how important it is to keep in mind that some patients may not be fully appropriate for physiotherapy even though sometimes it seems like they are. I suppose it is always been in the back of my mind, but after this patient, I was certainly more aware!
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