First Client...

1. We had a client referred for pain and OA in his ankles. This was our first client. When I read it was OA I was a bit worried as I wasn't really sure what to do for OA treatment. Matt took the subjective history.

On assessment we found a significant decrease in DF and an increase in swelling around the ankles (we measured using a tape measure). There was also a decrease in other movements
at the ankle, but the limited DF was tge primary concern as it was enough to limit his walking ability (on one ankle he was -2 degrees, and you need 10 degrees DF to walk properly).


The limitation of DF could be due to a number of things - we clinically reasoned that it was due to a tight gastorcs and increase in swelling (and there was enough swelling to limit movement). It was also due to the OA in joints.

Our treatment consisted of passive accessories in an AP direction to improve DF. We reassessed after treatment and there was an improvement in DF. We tried to teach him a stretch against the wall for gastrocs but it was difficult due to the DF limitation. We gave him another stretching exercise to do at home (stretching sitting down using a towel around the foot to pull it into DF).

The treatment had an effect and increased DF so I feel as if we were effective. Next time we should work on the pain and swelling as well. I'm not convinced he will do the stretching at gomr so we will need to follow ip on that next time we see him, which will be next week.


2. I think as this was out first pateint I was very nervous and forgot a few things for the assessment. We eyeballed his ROM then had to go back and use a goniometer (which we should have done to start with!) The client was very patient and cooperative.



3. I was very nervous to start wth going into the examination with the client. As we started I realized it was ok and I relaxed a bit. Our supervisor didn't prompt us at all, but waited to go through stuff with us after we had finished.


4. I could probably get through the objective assessment (measure ROM etc) alot quicker than what I did.


5. I should plan the objective assesment as much as I can before I start so I don't forget things and have to go back later and do them - it just wastes time.


6. Overall I am feeling confident and pleased with how we handled the client and what we have done so far. As we go along I'm feeling more relaxed and confident. Our supervisor is supportive and helpful - he doesn't have a go at us if we do something wrong or forget something, but rather gives constructive criticism. He is busy with his own clients so we are being given a chance to be more independent.


7. Read up on OA and find out more about treatments and current ideas - journal articles...