Ok so i explained to you last time, what my normal day looks like. Besides looking after inpatients on the orthopaedic ward, ie acute cases, I also see outpatients, which only come in for their appointments. They are usually not acute anymore, sub- acute or chronic. I got orthopaedic cases like kids that came out of casts or had some sort of pains after playing sports etc. So these patients usually required a thorough assessent in order to find the source of their problem rather than just treating them post-OP for mobility. So two totally different things.
Once you diagnosed them and decided they would benefit from physio, I arrange appointments with them and treat them as well. Very often I do hydroptherapy with them cos the pool seems to have magic effect on kids and their pain. Its just such a great environment to do physiotherapy in. The water and its properties is like a gym full of equpiment: buyoancy, resistance, compression, heat, assisted movement when creating a strudel, massage .... and then we have so many cool toys as well, so its always really good fun.
Then, if I am not effective or if I think there is something else going on, I can refer them on: I had one girl who was sooo hypersensitive after her cast, I diagnosed her with CRPS (chronic regional pain syndrome) which is a syndrome, where the brain and its neural connections to the affected site "gets confused" about signals so light touch is perceived as pain. Usually its when u had major traume so the brain wants to protect the tissue, like a broken ankle, but in fact, no one knows why exactly that happens, the site is healed, no damage but the brain still wants to protect so even just touching the skin makes these sort of kids jump thru the roof because light touch is perceived as nociception ie pain signals. Really bad condition and really hard to treat cos u cant touch them. You actually have to remodel your brain and convince that the body is healed and touching or just moving is NOT painful.
So first I had to explain that complex condtion to the girl and the partents, which was already hard, but then make them understand that Tracey has to push through that pain cos the more she doesnt use that foot, the stiffer and the weaker it gets and the more it will hurt to get it back to normal again. So, I have to desensitize her, kinda hard cos they in sooo much pain but I did one session with her and got an "excellent with gold star" from my educator cos I have handled her and the situation so well. Anyway, my point was, I had to refer her on to the pain management team. I also came to the appointment with her and the doctors asked me all that questions and really acknowledged me and what I have been doing and what my plan was for her. Felt little proud as the little student with the two big doctors =)
OR another girl which huuuuge social issues at home (abuse etc which I read in chart from the child protection services) stopped bending her knee, so she is majorly tight and stiff and cant walk so I tried to do hydro for 3 weeks with her, only got better tiny little bit, most of the time we jsut talked and she told me all that stuff about her "fucked up" (excuse my french, but thats how it is) family and she really enjoyed coming to physio and when i told her that i have to send her back to the orthopaedic team she got bit scared "can i come back to physio again tho?" and i told her it depends on what the doctors find out because i dont feel i am effective enough to justify the treatment. And there u go, I got her to bend the knee, walk up stairs in pool and do all sorts of stuff, got rid of her crutches (MAJOR IMPROVEMENT-yay) and I got her knee to 70° degrees knee bent. So I have to see whether physio is the right thing and sometimes you are jsut a friend who gives you attention, which is the case with her I think, so psychosomatic issues rather than actual physical impairment. Once I thought that was the case, I jsut pushed her heaps further altho she told me it was painful but she was just not consistent enough with her pain patterns and intensities and it all didnt match up so I took that risk and went through the pain with her and tadaaa, she can walk again. Thank god =)
Ok i have to go to work, brain numbing waitressing, no need to think and lots of opportunities to chat to my friends and the guests, I love that, always have a good chat and loads of good food- I LIKE.
Week four tomorrow, then one more week and I finish my 3rd placement. OH MY GOSH!
I miss you all at the moment. Been to a few family & friends things and got majorly jealous!! kinda imagined how nice it would be to be able to just come over and have dinner with my fam or go for coffee and stuff :( bugger! we'll talk soon tho, ok?! Kisses to my beloved friends and especially family =)
Once you diagnosed them and decided they would benefit from physio, I arrange appointments with them and treat them as well. Very often I do hydroptherapy with them cos the pool seems to have magic effect on kids and their pain. Its just such a great environment to do physiotherapy in. The water and its properties is like a gym full of equpiment: buyoancy, resistance, compression, heat, assisted movement when creating a strudel, massage .... and then we have so many cool toys as well, so its always really good fun.
Then, if I am not effective or if I think there is something else going on, I can refer them on: I had one girl who was sooo hypersensitive after her cast, I diagnosed her with CRPS (chronic regional pain syndrome) which is a syndrome, where the brain and its neural connections to the affected site "gets confused" about signals so light touch is perceived as pain. Usually its when u had major traume so the brain wants to protect the tissue, like a broken ankle, but in fact, no one knows why exactly that happens, the site is healed, no damage but the brain still wants to protect so even just touching the skin makes these sort of kids jump thru the roof because light touch is perceived as nociception ie pain signals. Really bad condition and really hard to treat cos u cant touch them. You actually have to remodel your brain and convince that the body is healed and touching or just moving is NOT painful.
So first I had to explain that complex condtion to the girl and the partents, which was already hard, but then make them understand that Tracey has to push through that pain cos the more she doesnt use that foot, the stiffer and the weaker it gets and the more it will hurt to get it back to normal again. So, I have to desensitize her, kinda hard cos they in sooo much pain but I did one session with her and got an "excellent with gold star" from my educator cos I have handled her and the situation so well. Anyway, my point was, I had to refer her on to the pain management team. I also came to the appointment with her and the doctors asked me all that questions and really acknowledged me and what I have been doing and what my plan was for her. Felt little proud as the little student with the two big doctors =)
OR another girl which huuuuge social issues at home (abuse etc which I read in chart from the child protection services) stopped bending her knee, so she is majorly tight and stiff and cant walk so I tried to do hydro for 3 weeks with her, only got better tiny little bit, most of the time we jsut talked and she told me all that stuff about her "fucked up" (excuse my french, but thats how it is) family and she really enjoyed coming to physio and when i told her that i have to send her back to the orthopaedic team she got bit scared "can i come back to physio again tho?" and i told her it depends on what the doctors find out because i dont feel i am effective enough to justify the treatment. And there u go, I got her to bend the knee, walk up stairs in pool and do all sorts of stuff, got rid of her crutches (MAJOR IMPROVEMENT-yay) and I got her knee to 70° degrees knee bent. So I have to see whether physio is the right thing and sometimes you are jsut a friend who gives you attention, which is the case with her I think, so psychosomatic issues rather than actual physical impairment. Once I thought that was the case, I jsut pushed her heaps further altho she told me it was painful but she was just not consistent enough with her pain patterns and intensities and it all didnt match up so I took that risk and went through the pain with her and tadaaa, she can walk again. Thank god =)
Ok i have to go to work, brain numbing waitressing, no need to think and lots of opportunities to chat to my friends and the guests, I love that, always have a good chat and loads of good food- I LIKE.
Week four tomorrow, then one more week and I finish my 3rd placement. OH MY GOSH!
I miss you all at the moment. Been to a few family & friends things and got majorly jealous!! kinda imagined how nice it would be to be able to just come over and have dinner with my fam or go for coffee and stuff :( bugger! we'll talk soon tho, ok?! Kisses to my beloved friends and especially family =)
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