The driving each day is exhausting! I’m feeling less tired at the end of today than I did the past 2 days though – maybe getting used to full days at work! Yesterday we learned about stats and how we have to enter them into the computer each day. Our supervisor seemed surprised that we hadn’t been shown how to do this at uni. We now enter them in at the end of each day – but it is such a hassle! We also went back and filled in the first day. Each day has to add up to 7 hours, 45 mins, which is hard when we only see a couple of clients. We fill up the rest of the time with admin kind of stuff and study. I have been going over the history taking and need to remember to ask about the social history. When I took the history from our second client today I did remember, and found out a bit about her living arrangements and job. Part of my job today was look after a baby of one of the other physio’s clients. She was such a heavy baby!! So I walked around with her for about half an hour while her mother received treatment. I was glad to be helpful but could have thought of a few better things to be doing! The mum was very appreciative though and I really didn’t mind.
We were called into a session of another physio to see a patella alta. I hadn’t heard of this before but it is where the patella sits very high up. It looked quite unusual and I’m not sure how I would treat it if I came across it. Perhaps taping? Or surgery? It was quite interesting. I plan to look up some more info on it. It’s great how the physios call us into their sessions if they have an interesting client – we are getting to see quite a few different and unusual things.
The following is about a client we saw today. I feel as if we are getting much better with the history taking process and the objective examination. Matt and I have been taking it in turns – one of us does the subjective and the other does the objective, then we switch for the next client. It seems to be working well and allows us to be a little more independent even though we are working together with clients.
1. We had a client come in today with OA in her knees. As we had already seen a client with OA I felt a little more confident. I did more research on OA last night and felt I knew a little more about the treatments for it. On assessment however we found more problems. The client suffers from shoulder pain and has had some elbow pain. This is common to see as arthritis generally affects the larger joints. The ROM of her knees, particular the right, was very limited and there was a great deal of pain. Her muscle strength was generally decreased.
I felt as if the objective assessment went well, however we missed a dew things we should have assessed. Our supervisor pointed these out and we went back and assessed them.
We decided to only look at the knees to start with and deal with the shoulder in another session. It was hard to understand her with the strong accent and she talked a lot. She insisted on telling us a lot of irrelevant things in great detail. I had to cut her off occasionally so I could ask important questions. She also insisted on showing us demonstrations of how she cuts up chicken and gets up off the floor. We gave her some exercises for her to do at home.
I just get the feeling that no matter what we manage to fix for her there will always be something wrong.
2. There was one particular thing we did not do well. The client insisted about 3 or 4 times on showing us how she gets up from the floor. We kept saying no, we would like to look at her walking on stairs, but she was adamant. Sooo…we said ok we’d take a look so she tries to get down on the floor and gets into a low squat before just tipping back and falling onto her bottom. She looked like it hurt a bit! Then she couldn’t get up. We instructed her to get into 4 point kneeling and to get up from that position, then she nearly hit her head on the plinth. It’s a good thing nothing bad actually happened – it came close! Next time we will just say no and if she insists on showing us something we will ask her to explain how she does it before letting her try!!
3. I felt quite comfortable with this client, except for having trouble understanding her. I seem to have a problem understanding people with accents and I feel bad when I keep asking them what they said. I was quite confident as I knew what treatment we should give her.
4. I would definitely not let her demo anything without explaining it properly first!! Maybe also cut her off a bit more and ask more questions to keep her on track.
5. One strategy would be directing the conversation in the history talking. This was our first client who really talked too much about irrelevant things. We can show we are listening but when they start rambling and go off track we should immediately steer the conversation back to their reason for being there. Otherwise the history taking just takes too long!
6. Overall today I thought things went well and we are definitely improving. I still forget little things in the history taking but nothing as major as I was before. I feel a lot more comfortable in dealing with the clients now.
7. I will do a little research on patella alta (and also patella baja).
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