This week, within the five hour timetabled clinical session I saw two different clients and completed the appropriate notes and follow up emails.
My first client had been into clinic previously and explained how he had been experiencing dizziness. This prompted me to go away and find out what special questions I need to ask him next time to ensure nothing was missed. While I was researching, I came across the term vertebrobasilar insufficiency (VBI) which is a condition characterised by ischemia (poor blood flow) to the posterior portion of the brain, specifically the vertebrobasilar circulation (Lima et al., 2017). This clinical syndrome can be assessed while checking for an symptoms of dizziness, diplopia (blurred vision), dysarthria (swallowing problems), dysarthria (problems speaking) and drop attacks (Alnaami, Siddiqui & Saqqur, 2012). Other symptoms to check for are nystagmus (involuntary movement of the eyes), nausea, neurological symptoms, light headiness, disorientation, disturbance in the ears, pallor, tremors or sweating and fascial paraesthesia / anaesthesia. The treatment of VBI ranges from conservative measures to minimise head movement to surgical procedures designed to limit head rotation or to decompress and free the vertebral artery at the point of compression (Alnaami, Siddiqui & Saqqur, 2012).
What Went Well
I was confident when performing mobilisations on the costoverterbal joints and rib angle, as the client felt less stiff once the treatment was complete. This made me happy. I also asked my new client about lifestyle factors as her back problem appears to be psychosocial related pain due to her stress, sleep pattern, diet and exercise routine.
|Areas for Improvement||Action Plan|
|Update myself on the guidelines for rehabilitation after lumbar spinal fusion surgery||Search up the guidelines and implement the appropriate action into my client’s session|
|Revise what different end feels can indicate at a joint||Create a table on the different end feels with a description of each|
Closing the Loop
Since writing this reflection, I have reviewed the guidelines and my client continues to progress. I have also began revising for my final clinical exam which includes the end feels at joints.
Alnaami, I., Siddiqui, M., & Saqqur, M. (2012). The diagnosis of vertebrobasilar insufficiency using transcranial Doppler ultrasound. Case Reports in Medicine, 2012, 1-3.
Lima Neto, A. C., Bittar, R., Gattas, G. S., Bor-Seng-Shu, E., Oliveira, M. D. L., Monsanto, R. D. C., & Bittar, L. F. (2017). Pathophysiology and diagnosis of vertebrobasilar insufficiency: a review of the literature. International Archives of Otorhinolaryngology, 21(3), 302-307.