Full Log
| YEAR 1 | 50HR |
| YEAR 2 | CLINIC 50HR / EXT 81.5 HR |
| YEAR 3 | CLINIC 155.5 hrs / EXT 26 HR |
| TOTAL | 364 HRS |
Excel Spreadsheet: Copy of Placment Hours 3rd year
Online Clinic – 23rd September 2020- 2hrs:
Online into clinic 2hrs –
I was very excited to start clinic and take on the practical side of our course, as I believed clinical practice was a weak area of mine. I was thrilled to hear clinic was still going forward through all the circumstances. The online introduction was very well laid out and instead of feeling nervous about all the new rules, the supervisors made us feel very clam and updated on procedures moving forward. We learn the new online consultation forms and didn’t move on till we were all happy with the full form, then going through the new COVID-19 screening, which was new to everyone, but went very smoothly. The Cliniko system was a lot easier to use that I previously thought, which was reassuring. The supervisors gave lots of detail and empathised the new situation we will be in and offered extra supports and reassurance. This made me feel a lot happier and less stressing towards the situation.
28th September 2020 – 3hrs:
Intro to clinic –
This was an exciting day, to fully go through all the practical side of clinic. We sat social distanced and went through the same powerpoint we did online, this was to refresh our memory, which was a good idea. We went through questions we had and then worked a case study together, which was also very helpful and was reassuring doing it along side the supervisors and gaining their knowledge of situations and any tips or tricks they may have. We then went through the COVID-19 PPE procedure, which was very new to all of us, but essential and not too hard to grasp. We then ended with a group discussion on the clinic and asked any further questions we had. I was a very good day and calmed a lot of us down, after worrying for months about clinic.
5th October 2020 – 3hrs:
The patient is a known pt, previously attended clinic 1 year ago. Pt is 1yr post stoke, previously had right side balancing issues, muscle weakness and lack of fall prevention knowledge. Pt was referred to have a face to face session, due to internet issues, communication and observation issues. This will ensure adequate treatment is given to the Pt.
Prior to online consultation, past notes on the pt were read up and Cliniko was set up on my laptop. My supervisor reassured me of the patient and the system, which further improved my nerves before the consultation. Microphone issues caused a five minute delay within the consultation, which made me feel uneasy, flustered, unorganised and unprofessional. Resolving the issue made me feel slightly calmer, but still feeling embarrassed and flustered. This then continued to show through the chat, questions, tests and communication were unorganised and felt I talked a lot of jargon. Communication began to improve, gaining a good connection before the next appointment. Further improvements could have been made from the online consultation, such as more in depth questions and ordering the questions in a better way. Now I have more knowledge and experience with the pt and background, I feel more confident to ask the right questions, tests and give the best rehabilitation program. Further research on the area will be taken out prior to the appointment and through future appointments.
After my pt, I continued to write up my cliniko notes. This proved slightly difficult due to the order I asked the patient questions, with the slight technical issues at the beginning, I felt flustered and lost my train of thought. I managed to gather the information needed and complete the subjective and objective form. Further information can be gathered from the Pt next week, to ensure all areas / details I need to know are on cliniko for the best pt outcome. Although I felt disheartened with my first clients, we managed to have a good conversation and gather all the information needed. This then made me feel confident that even though situations don’t always go to plan, you can still have a good consultation with patients. Talking to the supervisors also helped me feel more confident hearing how their experiences have been during the changed circumstances. Further research has been done to understand further mechanics / gait training for post stroke pt – giving me more in-depth tests, observations and treatment methods for the pt next appointment.
Some papers i have enjoyed reading: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196659/
Balance Tests Let Seniors Know if They Are at Risk for Falls
https://www.sciencedirect.com/science/article/pii/S0003999310008014
19th October 2020 2hrs-
Pt came into clinic for a follow up appointment, after virtual consultation 2/7. Further introduction, sx and ox were asked before practical session started. Pt mentioned falling a day / two prior to the face to face session, but was feeling well enough to attend clinic. Lbx had decreased, but left leg still “feeling weak” losing mobility and strength during day to day activities. Pt was looking forward to using the gym again, and remembered the equipment well.
Face to face session in the gym made me feel a lot more confident and excited. I believe this is a strong area for me, previously personal training a post stoke pt, face to face session to build a better connection with the pt, body language and communication on exercises / reasoning behind them and the gym environment, which I have previously worked in. Although the pt was not at the same stage as my past client, I managed to regress / give differential options for exercises and ways to get on and off of equipment, this further improved my confidence and connection with the client. Within exercise breaks, ensuring I ask clinical measures and keeping general conversation with my pt. The client seemed happy and confident using the equipment, weight and reps which were set; but was also being open about how he is feeling prior, during and after exercises. I thoroughly enjoyed the session and felt the pt gained a lot, as well as myself gaining a more detailed understanding on the pts ability. I will continue to do further reading to ensure I do not miss any important factors in my pt progression, as well as warning signs the pt my present prior, during or after training. My aim is not to tire my pt out, so he is fatigued / burnt out for the rest of the day or next, all clients will present different, so I believe it is important to know the signals or signs, but my also keeping a good relationship / communication with my client.
26th OCT 2020 – 1500-1600
Mike Supervisor
Experience – My pt had extra sessions through reading week, which I assisted with my supervisor. The session was in the clinic and consisted of balance, mobility, neurological, proprioception, resisted drills and body weight movements. Research has shown the positive outcomes for post stroke patients by taking part in exercise, these include physical and psychosocial effects (Han, P et al., 2017). This experience was not new to me, but was a huge insight into small and basic drills I would have missed with my pt, of which can make a big impact into their improved way of living and progressions. I gained a lot of knowledge from my supervisor on tips and tricks to overcome obstacles that a pt my present, but ways they can still preform exercises. This was very interesting to learn and experience, I also put some tips I have learn from working as a personal trainer into the session; suggesting to the pt to re centre himself after standing, turning or doing exercise by acknowledging corners of the room or objects that are stationary in the room. The patient has commented on the tip saying it is very helpful and working well for him, this filled me with confidence and proud I could help with even the smallest but important aspects.
Reflection – I mostly watched, praised and assisted while my supervisor placed and chose exercises. I definitely could have put more input into the plan, however I was taking a step back to learn and watch how others demonstrate and engage with the pt. I feel the input I did mention helped build a stronger relationship between myself and the patient. I was feeling very proud of the client and excited of what’s to come with the following appointments!
Action – This session has showed me ways to improve my programming and teaching techniques for this particular pt and others. I began to think out of the box on simple exercises / drills to do, which will help improve my clients day to day task. Starting basic will end up building a solid foundation for progressions.
Han, P., Zhang, W., Kang, L., Ma, Y., Fu, L., Jia, L., Yu, H., Chen, X., Hou, L., Wang, L., Yu, X., Kohzuki, M., & Guo, Q. (2017). Clinical Evidence of Exercise Benefits for Stroke. Advances in experimental medicine and biology, 1000, 131–151. https://doi.org/10.1007/978-981-10-4304-8_9
29th OCT 2020
Alex Supervisor
Experience – Follow up pt attended clinic to go through a fall prevention class led by Alex, I assisted in the class to learn how to lead it, progressions and regressions and teaching points for the best outcome for the pt. I am familiar in taking fitness or stretching classes, however this class had a structure that has research to support the order, in which to deliver to pts. This was very interesting to learn and take part in, also learning a lot of tips on communication and how to demonstrate / move the pt safely around a chair / room. I enjoyed the class and the pt seemed to too, which was great to see. I also found it good taking part myself, so I understand what pt will be going through / potentially feeling.
Reflection – I really enjoyed this class, and definitely learnt a lot on teaching ways and demonstrations. I had my doubts before we started, and still do to some extent. It great the class can be adapted to different levels, however it is packed with all the right exercises- however I feel like client need to focus longer on a couple than a packed hour of 10 minutes of each. On another scope, some pts will work well with little time and different exercises within the hour. I believe it is a great idea, but should also be judged on the different pt stages, to ensure they are getting the right personal treatment. I would, however, like to learn more about the class and find more of the research behind the routine / order. The class is great by mixing standing and sitting exercises together and regressions and progressions to different individuals, without going too far out of the way for them.
Action- I will be further reading up about the research behind the class and practicing what I preach. This will make sure I am fully confident in delivering exercises to pts, along with progressions and regressions. I still have not practiced the getting up exercise if a pt finds themselves on the floor – this will be very helpful for me to gage a better understanding as to muscle groups predominantly are used. I strongly believe in practice what you preach, for your own benefit, but mostly to give the best advice to pts.
To conclude, I still have doubts on the running of the fall prevention class; however I will be taking myself through the class and reading the back up research to help me gain a better understanding as to why the class is run as it is. I personally need to go through to truly trust and believe in the class; however, in no instance do I think the class is bad.
3Rd NOV 2020
Experience – Follow up appointment for pt, today was to continue to gain knowledge of where he is using coordination, balance, proprioception, strength, endurance and confidence. The following sessions have been a class with Alex and clinic work with Mike, I wanted to combine the sessions together and grasp where the pt is after having a couple of days off and to add in exercises I have used in the past. A fellow student assisted me through the pt session, which was good to gain a extra hand in performing some exercises, watching form and aid in case of a fall. The session went very well and the pt seemed to enjoy every exercise and agreed to following a more structures program. Myself and another student took exercises each so the pt had the experience of different people and techniques, I believe this worked very well for the pt. It went well, apart from a couple of techniques I forgot the techniques too. The pt left happy with the hard work he put in.
Reflection – The session was slightly unorganised, which is nothing but my own fault – I thought I could remember a lot of the techniques, however when it came to the exercises I was baffled, unable to communicate correctly or demonstrate exercises. This made me feel very guilty for my lack of organisation, however I stand by the session being appropriate for the pt. This session continued to give me an insight into the stage the pt is in, which has helped for his new program design. I will now ensure I practice each exercise I give and teach a fellow student prior to the pt to improve communication.
Action- I will continue to ensure I practice every exercise and ask friends if I could take them through the exercises too – this will furthermore help with my communication. I am going to read more research on training techniques and the reasonings behind the effects it has on the body or specifically post stroke pts.
9th Nov 2020
11am
Experience –
A gym based session with the pt today was to on specific training techniques, so adequate time is spent on these exercises each week. The session today will consisted of cardio, balance and upper body strength, the idea is to spend >20 minutes on each, to ensure the pt can fully utilise the time we have. Previous sessions showed the pt had good upper strength when using the resistance band, thus upper strength not being the main focus today. Cardio and balance were the targeted area to work on with the pt. Adaptions were made to ensure the pt wasn’t overloaded with exercise, which could cause injury or stress to pt and partner. The pt had a previous fall, 3/7 prior to this session, this was in clinic and left the client feeling “disheartened”. My aim was now to show the pt that one fall doesn’t mean regression and show the progress already made. Within the gym, I had two master student assisting me, starting with the cardio aiming for a HIIT (high intensity interval training). The pt completed the cardio round with adaptions to the chair exercise by using a raised curl stand to improve posture and gain room for certain exercises. After the cardio round, we skipped balance, due to the fatigue the pt was presenting. The upper body strength went well and seemed reasonably easy and enjoyable for the pt. Finishing with stretches and an overview of the session and Fridays plan, I believe this can help keep the pt in the loop on what to expect and relationship between myself and the pt.
Reflection – . I believe the way the new program design will ensure the pt will not be overloaded with too many exercises. In previous session the pt has gone through many techniques and I personally felt he didn’t gain the full benefit of the exercises with the time we had. Looking back on strong areas and weak of the pt can indicate which are of more priority at the time, this however will continue to change and as will the program – ensuring the program adapts around the pt progress/ regress. I can truly see the importance of keeping post stoke pt active through cardio based exercises, this is to prevent another stoke, keep fitness up and endurance for daily living activities. In the past I have grasped the pt can perform exercises better in the morning / early afternoon, than late afternoon; the patient has previously mentioned his sleeping pattern not being the best, which leads us to understand why performing exercises in the afternoon isn’t the best idea. Before each sessions communication is very importance to judge how the pt may be feeling / how they will take the program for them. The walk into clinic and the gym leaves time for me and the pt to speak without being in a clinical area. In this case, questions of daily activities, feelings and general conversation suggested the pt was slightly tired and feeling fatigued already. The session was further adapted after the cardio round, after noticing more unsteadiness and fatigue while the pt was standing. Missing out the balance exercises made no substantial different to the program, due to next week being more specific to balance. I believed it is better for the client to leave the clinic still having energy for his daily living. The upper body strength could have gone smoother, I believed I knew how to adapt an exercise to suit the pt, but when it came to it; I became flustered and confused on an alternative way around the situation. Thankfully a master student aided me and the pt into the best way to perform the exercise, the client seemed happy enough to try different ways, but still makes myself feel unprofessional.
Action- Learning from each session with my pt can build a bigger image in feelings, physically and emotionally without the pt having to tell me. I think this makes a practitioner able to adapt and see a different side of how the pt is responding to treatment; also to build a strong relationship with the pt. Progressions and regression are always noted in the case the pt is feeling tired or has more energy, I will continue to adapt my programs to fit around the needs of the pt and ensure I make appropriate decisions with the pt needs put first. The following sessions will continue to give me an insight into strengths and weaknesses to work on, even if step back occur. Further gait analysing will be researches to continue aid my knowledge on techniques and reasonings behind certain movements, along side cardio exercises to use for a pt unsteady on their feet.
9th NOV 2020
17:00 -18:00
Experience –
Due to current circumstances, patients are limited in the clinic for safety, which meant my last hour wasn’t filled. Thankfully a fellow student allowed me to assist with their pt. This pt has been to the client in previous years with OA. The pt found out about our facilities, especially the anti-gravity Treadmill- which he has been utilising. The pt suffers from hip and knee pain from OA, he use to run, but hasn’t been able to in the last 2 years due to the pain. Our first week of clinic we got taught how to use the anti-gravity Treadmill, and the benefits of it. Thankfully notes were written down for the pt previous settings. The Treadmill was easy to set up and the pt was very familiar with the feel. The session was aimed to get the pt into a progression from last week, using speeds, air % and incline. Videos of the clients running pattern were also taken once jogging started, this showed a close running gait; which leads us to further believe this could be aggravating his hip. Once showing the video to the pt while he was walking, the next jogging stage he adapted to bring his legs slightly wider apart, and “felt a lot more comfortable” in that position. Which was a good acknowledgment of a potential way to reduce hip pain. The patient increased speed and air % and felt no pain in joint, but some fatigue toward the end in his muscles.
Reflection – Prior to assisting with another student and patient, I will read all notes on the patient as I felt I asked him the same questions everyone else has beforehand, which I can understand would be slightly annoying; although the pt did not complain. Knowing more on the pt background could have helped me understand reasons for getting back into running and why now, along with a more detailed running program for the client to ensure it was consistent, which I believe it wasn’t. Further research on gait analysis would have also helped my practice, and helped the client to gain knowledge about his own running. Preparation massively let me down for this pt, which made me feel annoyed at myself, because I know im better than to let this happen. I believe I need to refresh my knowledge on a rang of areas to ensure I can offer a high standard of practice to any pt that I see. This would make me feel more confident in myself and work ethics to ensure the pt has the best outcome possible.
Action- Further reading on running gait analysis will enable me to give the pt a better understanding of the importance of running technique and prevention of injuries. Education for the pt by himself is also very important as the kinetic chain plays a huge role within running, and there is only so much you can do with the pt face to face; ensuring the pt is acknowledgeable while running/ exercising by themselves plays a significant role within progression and recovery. Any free time I have, I will be researching and practicing common injuries, equipment and best methods for the best outcomes with either clinic supervisors or fellow students. I believe these papers will cover all areas of the anti-gravity, anatomy, biomechanics and osteoarthritis, specifically, to the pt; which will ensure I can assist his follow up with a rang of new knowledge and other potential pts.
To conclude, I will ensure detailed preparation for the pt is undertaken, to give myself confidence and an effective session for the pt. I will also work on ways to further educate the pt to ensure progression in and out of the clinic is made. I have gained more information on the importance of exercise and joint motion for pts presenting with OA, especially using the anti-gravity treadmill; with physical and psychological improvements for the pt.
References:
Higginson, B. K. (2009). Methods of running gait analysis. Current sports medicine reports, 8(3), 136-141.
Dugan, S. A., & Bhat, K. P. (2005). Biomechanics and analysis of running gait. Physical Medicine and Rehabilitation Clinics, 16(3), 603-621.
Kawae, T., Mikami, Y., Fukuhara, K., Kimura, H., & Adachi, N. (2017). Anti-gravity treadmill can promote aerobic exercise for lower limb osteoarthritis patients. Journal of physical therapy science, 29(8), 1444-1448.
Liang, J., Lang, S., Zheng, Y., Wang, Y., Chen, H., Yang, J., … & Ou, H. (2019). The effect of anti-gravity treadmill training for knee osteoarthritis rehabilitation on joint pain, gait, and EMG: Case report. Medicine, 98(18).
13TH NOV 2020
11-12 (1HR)
Description Overview – A weekly follow up pt attended the clinic for a continued face to face session. The program 3 consisted of proprioception lower and upper body; which had the intensity regressed after noticing early fatigue in previous programs. We were in the clinic for the hour, with both supervisors popping in and out to check on myself and the pt. The program consisted of incline and eccentric sit to stand, jockeys with a different object under the pts singular foot, heel to toe rocking (using wall for support), standing upper clock taps, banded wall thrusts, different size and weight ball throw and catches. Two further exercises were not performed due to time, but demonstration them to the pt; for him to try at home, which he seemed more than happy to do.
The pt is making great progress, with him showing the clinic staff his improved gait, which he has to ‘force’ himself to do, but still extremely proud he is using his own initiative. The exercises were preformed well, with no wobbles or falls occurring. The pt showed lots of frustration at the beginning of the session, holding tension in his shoulders and demotivating himself; him attitude began to change through the session, and we were able to have a laugh.
Feelings – I was very pleased to hear the pt had been doing all the prescribed exercises and taken it upon himself to try improving him gait technique and had not had a fall or wobble since the last visit. The pt was very pleased with himself too, which is great to hear and see.
The beginning of the exercises stared well, but soon changed; this put the pt in a very frustrated and angry mood, which did not continue to help him with the exercise. I believe his head is stopping him, more than physical weakness. I decided to take two minutes to sit back, relax and have a normal conversation. This seemed to help the pt and relax them before the next exercises, the pt mentioned he knows it is ‘more in his head’ which opened up a conversation on cues or tips to try and relax and reassuring himself. The pt seemed to like this idea, which made me wonder what further research I can find for psychological adaptations, which could ensure I give me pt the full and correct advice. It made me feel very sad that the pt did not see the improvement that I am seeing, but then further motivated me to give this pt 110% and he gives it back each session. He is truly inspirational and strong individual.
Evaluation – I am overall happy with how the session planned out, but would like to gain more knowledge to help my pt psychologically with his emotions. I think this works hand in hand with rehabilitation, and something I should defiantly know more about. I know now, there will never be a day I know everything nor do everything right; and that learning and experimenting is the best way to gain more knowledge and practical skills.
Analysis – Frustration coping mechanism (To look further into)
Conclusion – To conclude from the session, the pt is learning new skills every visit, and he is also teaching me a lot and ensuring I keep my knowledge up in a broad area. I also have come to terms with not knowing everything, I will be wrong and I will be right, and it will take time and practical skills to continue to question my own methods, with giving rational for my actions and choices. This session has taught me to do further research into psychological coping methods.
16th NOV 2020
1530-1800 (2.5HRS)
Description Overview – The first hour of clinic the supervisors took us through a new paper they had found regarding Tendon neuro plastic training. Sitting down as a group to discuss the new research and how we can implicate it into our own pts. The next hour I had a virtual pt with lower back pain (LBP). The begging of the call we had some sound issues, but then resolved. Going through the policy’s, the pt didn’t know what had been ticked or not, due to partner booking appointment. I had to ask Mike to show me if the policy had been ticked and agreed, which it was. Going through the consultation form was slightly confusing due to the pt answering questions that were going to be answered later on the sheet, but all the information was gathered and placed into the correct sections. I stumbled on the next couple of observations, as noticing it’s a lot harder over video call than in person. I believed I asked and took out as much as I could over video call, it was suggested the pt came in for a F2F appointment to finish some movements and observations tat were unable to be performed.
Feelings – Discussing the paper as a group was very interesting and good we could all talk about each opinion or how we have managed injuries in our own pts. This made me feel more at ease on handing pt and taught me to see how other analyse information and deliver. During the virtual video call, I am still felling slightly uneasy with the process and need to work out a routine to follow through the consultation. I gave the pt education on changed he could make to his lifestyle and easing factors that could apply.
Evaluation – I found the virtual consultation slightly worrying, but know I gave all I could over the video call. After talking to my supervisor I remembered we are all in the same boat and no one is going to be perfect, we can only get so much information over video; which was why F2F appointments can still continue and this pt being a good example for the right next move.
Analysis – I am going to hopefully sit in on fellow students appointments to gain a better understanding on the process they follow for virtual pts. I think it is important to see different ways to process information, to then be able to deliver/ gather information for my own pts.
Conclusion – Overall, enjoyed learning in the spare hour of clinic to be able to discuss and hear of different comments / experiences. The virtual pt went overall well, with all the information noted down and a progress plan put in place for the next student; this also helped me evaluate what my next move would be, if I have the pt for a follow up. The same struggles are still occurring, which I will aim to gain further confidence on each clinic session.
20th NOV 2020
11-1200 (1HR)
Description Overview – Weekly pt arrived to the clinic for a F2F appointment, the pt has now been through all of his programs (1-4). The aim of today was attempting the anti-gravity treadmill (AGT) to improve walking gait, and to build upper body strength. Today could have gone either way, as I was unsure about getting the pt in to the shorts needed for the AGT and getting the pt onto the treadmill, due to big steps needed. Mentioning to the supervisors I may need some extra assistance, they agreed happily. The pt was excided to try something new, and didn’t seem phased by the tasks ahead of him. Starting off the pt was very uneasy, nervous, tense and jumpy; after mentioning he felt very unstable and wobbly. The pt was told at any time we can stop and move onto something else, but he wanted to pursue with trying different weight and speed. After a couple of cues to loosen grip, lower shoulders and reassurance; the pt seemed to feel more comfortable about the AGT and started to improve leg stride and foot lifts. The pt continued for a total of 11 minutes before fatigue of the right leg set in, he felt proud of himself for continuing and was confident about getting off the AGT. Walking into the clinic the pt seemed very confident and made extra effort to walk with his improved gait. We then sat down and begun upper body and grip exercises for the remainder of the time, the pt was familiar with the final exercises and we were able to have more fun with these to end the session.
Feelings – Seeing the fear and anxiousness within the pt face, filled me with guilt and sadness that I decided to put him on the AGT and that I am made him feel his worse feelings. However, with the pt opting to continue to speed up and aim for more time, made me realise I chose this exercise for a reason and although he wont be feeling his best now, he will soon gain lots of progression.
Seeing the determination after so much fear, made me feel extremely proud and lucky to be working with such a wonderful individual. Sometimes you have to be uncomfortable to become comfortable. Even getting off the AGT and walking to clinic with his improved walking gait showed us the strength and willingness to become better. We always have a laugh and a joke, which makes the session even more enjoyable. I am continuing to research ways to help my pt psychologically, which still have a lot to read up on.
Evaluation – Overall happy with how the session planned out, glad I was able to see the body language and signs the pt showed while feeling uncomfortable; this will be able to help me gage the feeling of the pt through exercises. I have learnt that it is important to get pts out of their comfort-zone, to a certain extent, to progress further and teach the body to be uncomfortable.
Analysis – Research for AGT and gait abilities for stroke patients showed promising results on improved walking mechanism; stating, early gait training for post stroke patients using the AGT was effective in improving balance, gait and postural stability; along with underwater walking training (Park and Chung., 2018). Due to current circumstances, underwater walking training will not be possible, however we are very lucky to have a AGT on site to use.
Conclusion – Each session teaches me the importance of my role and the responsibility I have to ensure my pts can live their life to the full potential. The trust and determination the pt brings to each session makes all the ups and downs completely worth it. It truly opens my eyes into the effects a pt can leave on myself, which I’m sure can be presented the other way. I believe it is so important to bring a upbeat, happy but sensible head to each session, but to also educate pts. This will build a stronger relationship between practitioner and pt. I’m overall happy with the decisions I made, and thought the session when well physically and psychologically for the pt. I will continue research on the feelings post stroke pt may be feeling and ways to handle the emotions. I am continuing to work on my speech and how I present information to the pt, I feel I rush what I say and end up waffling, instead of giving clear a precise information. I learn to think before I speak and also listening to the supervisors on how they deliver information to students and pts.
Park, J. H., & Chung, Y. J. (2018). Comparison of aquatic treadmill and anti-gravity treadmill gait training to improve balance and gait abilities in stroke patients. The Journal of Korean Physical Therapy, 30(2), 67-72.
23RD NOVEMBER 2020 – 1HR
Description overview- Follow up pt arrived for a F2F gym appointment. The session today was cardio and endurance based, which is the first program we stared on. The pts mood seemed slightly different this session, which we further discussed once in the gym. The session aimed to improved biomechanical gait, by preforming specific exercises that are weak, but vital areas to further progress the pt; also looking into fall mechanism to aid if the client has a wobble of fall. The pt mentioned he had a wobble and landed on his arm, which was causing an aching feeling, along with his lower back feeling worse than Friday. The pt mentioned a complication with a family member over the weekend, which could explain the mood. Through the session the pt showed an improvement in mood. Walking gait with aid is being performed very well and feeling confident with his walking through the gym and to different equipment; however turning, from previous fall, has increased worry in the pt. Warm up was preferred on the cumber bike, with the back support due to the aching in the lower back. Exercises were performed very well throughout the session, seeing improvement in endurance and power though the lower limbs.
Feelings – I was saddened to hear the effect left by the complication, as this had an substantial impact on the pts mental and physical health. I am glad the pts mood began to lighten as we got into the session, we had a laugh and chatted about random topics; with the pt leaving in a much improved mood than when he arrived. This showed me the importance of exercise, not only for physical health, but mental health.
Conclusion – Thinking back to the beginning of the session compared to the end, showed how important exercise is for this pt. To physically build up strength and endurance, but also to build up mental health and endorphins. This can ensure the pt continues to associate the exercise for something they enjoy, rather than a task to do. Today showed me the importance of this, and something I will always aim to do for my patients.
23RD NOVEMBER 2020 – 3 HR
AMBER – A virtual appointment for a past Marjon student was to discuss the rehabilitation process through a full ACLR operation to return back to Football. The female athlete discussed the mechanism of injury, post injury treatment and operation preparation of the lower limbs strength, control and endurance to aid in an adequate recovery. A gracilis graft was being used for the ACL. Information on end feels, ROM, pain stim and strength was gathered prior to the Op, however data was not reliable over a virtual appointment, however it was appropriate collection for the moment. The reason for gathering data prior to the Op was to have outcome measures for the long term goals to ensure we either meet or progress when returning to play.
The next step was to design a early ACL programme by literature and specific protocols used. The main goals at the early stage were, PEACE and LOVE – reduce swelling, increase ROM on extension and flexion and beginning to normalise gait. Game Ready, muscle stim, crutch gait training and advice on life style factors were all to be used within the next day / week. The evidence below supported my choice in these methods in early ACLR.
The excitement and worry of the progress of this Pt was overwhelming, but also honouring. Although feeling overwhelmed with what, when, how- I began to read a range of journals and watch Youtube videos (By professional practitioners) on the process of ACLR, female athletes recovery, outcome measures, signs and symptoms and the importance of a symptomatic approach. The following journals helped me become more confident for the process of recovery for this athlete. Pre reading prior to the appointment would have assisted me on giving more detailed information to the Pt while on the virtual appointment, although information was send via email the same day on the action plan.
26th NOVEMBER 2020 – 1 HR
Pt attended clinic for a F2F follow up appointment 2 days post ACL reconstruction. The Pt was happy with how the surgery went and with the minimal swelling present. The aim of the session was to build a portfolio of the injury, interventions, the Pts feeling / worries towards the rehabilitation and give the pPt as much information and care as I can moving forward. We took note of thigh circumstance, and AROM. Using the game ready to control the swelling, extension lag and gait walking with crutches, we were able to gain a starting point for the process of recover.
I did extensive research to prepare for today’s session, however still felt slightly nervous I could worsen the injury. Overall excited to see the benefits of the exercises and the process of rehabilitation.
Extensive research will be needed throughout the rehabilitation, due to the type of injury, female and football being the end goal. This will ensure the appropriate treatment procedure during certain weeks occurs and reduces the changes of a re-injury.
To conclude, I was happy with how today went, now having a larger insight into the continued research and procedures needed for the best outcome. The pt was very happy with the session and felt confident within the clinic and myself to help her recovery.
27TH NOVEMEBER 2020 – 1.5hr
Description Overview- Pt come for a follow up appointment to have a back assessment and continue with post stroke rehabilitation. The back assessment was led by Alex and Mike, while I observed and wrote notes; it went very well and gave a good insight into the persistence of the pain / discomfort. It was great to see the supervisors relaying questions and tests without destinations, this is a target I would love to aim towards and be more confident within my testing of pt. The session continued to physical exercises with myself and supervisors popping back and forth. The session consisted of balance, gait and turning techniques, these are all aspects that the pt is currently most concerned about; due to turning being a mechanism of most of the pts falls. While aiding the pt, I noticed the feet weren’t being raises as much as forward walking, this leading to the foot coming into contact with the floor mid turn; further leading to a fall. Methods were put in place so the pt marches when turning, making a stronger conscious decision, while also keeping feet in line with body. This may lead to longer to turn, but will be worth reducing the fear of falling and becoming more independent. The pt enjoyed the new idea and thought it was a good decision, which made me feel confident within my method of turning technique. The balance and gait training my pt is familiar with, with a couple adaptations to ensure progression is always made.
I was relieved no further health conditions were found, and that I took the right procedures for the pt through training. I also felt very confident within my program and observations of the patients movements; as this further helped the pts coincidence.
I continue to learn that confidence within the Pt can improve / help progress physical movements.
To conclude I was extremely happy with today’s session and the effort put in by my pt. The pt left proud and happy with his progression, which leaves myself feeling also proud.
30th November 2020 – 5
Description overview: Pt came into clinic for a F2F follow up appointment. The aim of the session was strength, unilateral and bilateral work within the gym. The pt enjoys using the gym equipment, and feels the benefit of the exercises. It all went very well, and kept the endurance manageable so the pt can continue activities through the day without being tired.
Feelings- The pt seemed very comfortable in the gym, which was great to see – along with the determination to perform the exercises to the best of his ability.
Conclusion- The pt performed very well within the gym and enjoyed each exercise. The pt left feeling proud and motivated for the next coming sessions. The session went well, and I was happy with the exercises given. Moving forward, I need to make realistic timings for the programs, due to not being able to complete the full body workout within the hour.
SECOND PT-
Feelings- Pt attended clinic F2F appointment following ACL reconstruction 1/7 ago. The pt had been getting on well with HBE and ensuring proper aftercare. Measurements of the thigh were taken, along with angles of flexion and extension. The session went well, consisting of the game ready, passive heel slides, gait, ankle ROM and gravity assisted leg ext with quad contraction. The pt listened and took on board everything instructed to her and had a discussion on further information about her injury.
Evaluation- I found the session very interesting, but also gave me a lot of questions into the effects of the rehabilitation exercises. The Pt had worries of loss of sensation, which I was unable to confidently answer, within research I haven’t found a reason for the shin to be numb. My conclusion was due to the surgery and the structures having to have been cut through. My supervisors were able to assist me in answering / calming the worries of the numbness and explain to me, and demonstrate a good way to handle a situation like that. I continue to learn I am not expected to know everything, but it’s the courage to ask for assistance during the situation that will enable me to be a better practitioner and preformed the proper pt care.
Conclusion- Thinking back to the session, I’m glad I continue to ask questions still I gain full understanding about a situation, this helps be develop my knowledge, confidence and pt care. I enjoy my sessions with the Pt and learning a lot about hoe the client is psychologically handling the injury, this will ensure I can aid her in recovery not just physically, but mentally. I will continue to do further research on the female athlete recovery, alongside the menstrual cycle.
4th DECEMBER 2020 – 1HR
Description – Pt had a follow up F2F appointment continuing treatment for post stroke treatment. The Pt had recurring limitations in shoulder and lower back joints, which were being monitored and treated for on a weekly basis. HBE programme was going well for his balance, strengths and endurance, not causing any pain. The Pt has been enjoying new exercises to try and the challenge they pose. No falls, wobbles or trips occurred, which made the Pt feel confident. Pt aim is to improve walking and confidence, the session consisted of lower limb gait, proprioception and confidence for functional movements.
Feelings – I feel very humble and proud for the positive effect the clinic and HBE are having on the PT, physically and psychologically. I continue to be impressed on the motivation and determination my client has, but also shocked at the long term effects a stroke can have on an individual.
Analysis – After a stroke gait is majorly impacted, it has been highlighted to be a complex aspect of rehabilitation treatment. Aspects of motivation from practitioners, friends and family is associated with good rehabilitation for the Pt. (Physiopedia).
Conclusion – I believe the session met the long term goal of the Pt recovery and alongside the short term goal of improved walking, balance and confidence. The progression of the Pt has been amazing, however I have read research on the progression can be intermittent due to the motor control interruption from the stroke. Therefore, regressions and continued motivation and education to the Pt will help to support any regression that may occur.
7TH DECEMBER 2020 – 3 HR
Pt had a follow up F2F appointment continuing treatment for post stroke treatment. HBE programme was going well for his balance, strengths and endurance, not causing any pain. The Pt has been enjoying new exercises to try and the challenge they pose. No falls, wobbles or trips occurred, which made the Pt feel confident. Pt aim is to improve walking and confidence, the session consisted of lower limb gait, proprioception and confidence for functional movements.
I believe the progression of the Pt has been amazing, however I have read research on the progression can be intermittent due to the motor control interruption from the stroke. Therefore, regressions and continued motivation and education to the Pt will help to support any regression that may occur.
SECOND PT-
Descriptive Overview – Pt arrived for a follow up F2F appointment. The previous sessions have been going very well and the Pt seemed very happy with the service given. The aims for this session remained slightly the same, however with small progressions being made to ensure adequate adaptation was occurring. The main goals were to continue to small amount of swelling present, increase the ROM in flexion and extension, to improve gait and to reassure on the process and worries the Pt was having.
I found the psychological aspect of recovery to be a large contributor to the hesitation and worries through the rehabilitation process, due to different feelings, pain and sensations occurring. Which I believe if continued will negatively affect the process of the rehabilitation.
To conclude, the Pt was enjoying learning the process and the education of her injury; however psychological barriered were holding her back and proceeding to making the sessions we had more difficult to have a consistent flow of rehab. Further research was done to understand management of psychological worries post injury and how to aid athletes suffering. Alongside the next steps for the athletes rehab process. This majorly helped me to keep my anxiety down and ensure I was helping the Pt mentally and physically.
THIRD PT-
Descriptive Overview – Pt was booked in for a online triage after complaining of pain down the buttocks into the back of the leg. Having a general chat to begin with gave an insight into the cause / continued irritation of the injury, but also build a better relationship with my pt. After completed all the screening questions we figured out the cause / area of injury. The pt was advised to attend a F2F appointment to get further treatment.
Feelings- I felt confident talking to this pt about his injuries, due to extent research and practice on the symptoms.
Overall, the Pt seemed happy with the guidance and help advised. I informed the Pt of management techniques to help manage symptoms. The Pt was looking forward to being out of pain and being able to take part in daily activities again. The PT was advised to attend clinic to gain further details regarding treatment methods.
11TH JANUARY 2021 -1 HR (ARREN NO SHOW)
My first Pt did not show to his appointment, a phone call with the PT highlighted the Pt had been held up at work and has rebooked. Therefore I did further research into his complaint and designed a longer rehabilitation plan for the Pt if he meets the outcome measures. I performed the exercises and stretches myself to ensure I was confident on how to perform them and how they are feeling. To conclude I was happy with the final rehab design after having to adapt a couple of exercises / stretches to ensure they were specific for my Pt ability.
12TH JANUARY 2021 – 1 HR
Descriptive Overview – In the absent of F2F appointments, the virtual appointment consisted of general chat and follow up on HBE. The Pt has had three falls since last appointment, all falls occurred in the early morning and resulted in an ambulance, neighbours or builders next door to assist getting up off the floor. This majorly affected the Pt confidence, causing a fear of movement / daily living. Minor injuries were caused to the hip, shoulder and elbows. Doctors did not find any abnormal issues with the Pt and ruled out suffering another stroke.
The news of this Pt falling broke my heart, due to all the physical and mental progression we made. However, with further reading and discussions with my supervisors I began to understand the long term implications of a Stoke and how it can be very unpredictable. This helped me gage a better understanding, rather than blaming myself for not being effective enough. I have come to realise this will be a continued lesson for self-development, knowing that I am human and cant only assist so much and am not a miracle worker – there will be ups and there will be downs, but recognising these are key to keep focused.
To conclude, further research into how to support psychological aspect of a Pt I believe will play a very important role in the mental well-being. Alongside conversations to supervisors on their experiences with similar Pt is helping to pick up some key management tools.
Ref:
De Wit, L., Theuns, P., Dejaeger, E., Devos, S., Gantenbein, A. R., Kerckhofs, E., … & Putman, K. (2017). Long-term impact of stroke on patients’ health-related quality of life. Disability and rehabilitation, 39(14), 1435-1440.
28TH JANUARY 2021 – 1 HR
Due to the current COVID restrictions, a virtual appointment was put in place for this Pt. He is currently disheartened and feeling demotivated due to recent falls occurring over the lockdown. This is a big same due to all the psychological and physical progress made, however knowing it can be done once, so can be done again. The aim of today was to have a general chat to the Pt for reassurance and to keep in contact through the pandemic on his HBE program.
It is challenging, especially in the case of this Pt, to review his rehab via virtual calls, however he seems to be enjoying the general chat and showing us how he is doing online. This has also helped me to be able to adapt to different scenarios that might occur during the future.
To conclude, although the appointments are not the ideal for the Pt, I believe continuing contact and following up weekly with help the Pt mentally and physically due to the general conversation alongside progressions and HBE updates.
1ST FEBUARY 2021 – 2 HR
Pt 1 had a virtual appointment due to the pandemic. The weekly appointments are in place throughout the lockdown to ensure continued monitoring, physical progression and general conversation and well-being are continued. The Pt had some conditions that came up during the lockdown, which we advised to seek medical attention for and to keep us updated.
To conclude, the Pt is doing well and enjoying the weekly check ins. We believe this is helping with his mental well-being and motivation. It has helped me to adapt my skills to continue to give the highest standards of practice through a virtual process. Pt is enjoying the catch up and demonstrating his HBE back to use, which is showing a lot of engagement through the pandemic.
SECOND PT –
PT had a virtual appointment due to covid restrictions. The Pt was use to virtual technology so found it ideal in her lunch to book an appointment. The client seemed to be having difficulty with her shoulder, and when demonstrating the internet slowed down. Although information and guidance was given to the Pt, the interruption of the video call gave a unprofessional feel to the situation. Which I believed knocked me and made me loose my trail of thought.
Overall, the consultation gathered all te information needed and we were able to suggest the best advice for the pt to leave with. The new virtual ways are still difficult to get my head around, but I need to remember we are all human and these mistakes can throw us off point.
8TH FEBUARY 2021 – 1HR
Pt had a follow up virtual appointment. A general conversation and HBE check ups were discussed today. The weekly check ups help keep the Pt motivated and aid in his well-being to have a general conversation. Pt had been having a few set-backs, however was advised to continue to move when he can and stretch out more in the morning and after sitting for a long period of time.
To conclude, I am enjoying having weekly check ins with this Pt, however finding it difficult to stay imaginative and motivational without F2F approach. Although this is difficult, everyone is finding it challenging and we are all doing the best we can. The Pt is looking forward to getting back into clinic, which I think will really help him physically and mentally.
15TH FEBUARY 2021 – 1 HR
Pt had a follow up virtual appointment. A general conversation and HBE check-ups were discussed today, the Pt was pleased as he received his first COVID vaccine. The weekly check-ups help keep the Pt motivated and aid in his well-being to have a general conversation. The Pt recently inquired into help to fit ramps around his house so he is able to limit the amount of stairs he has to go up and down, however the company were unable to adapt the house for ramps. This disheartened the Pt, due to the continued worry of tripping when leaving the house. The Pt is enjoying and continuing with his HBE but has had a few set-backs, however was advised to continue to move when he can and stretch out more in the morning and after sitting for a long period of time.
To conclude, I am enjoying having weekly check ins with this Pt, however finding it difficult to stay imaginative and motivational without F2F approach. Although this is difficult, everyone is finding it challenging and we are all doing the best we can. The Pt is looking forward to getting back into clinic, which I think will really help him physically and mentally.
17TH FEBUARY 2021 – 1 HR
The supervisors had a group chat with us to give time for questions or any worries we may have in the clinic. It was very interesting hearing other students comments, as they all were on the same line. The clinic is amazing and the help from the supervisors is outstanding. We are all very happy and just touched on areas we aren’t so comfortable in, which is the next action plan to work on.
22ND FEBUARY 2021- 1 HR
Descriptive Overview – Pt had a virtual appointment. The Pt has mentioned his mood is low and feeling “fed up” of the whole situation. Pt is now unable and not confident enough to continue to use his walking stick, so is now a four wheel walking frame. Although this may seem as a progress, it much more important that the Pt feels safe and confident walking around and daily living. HBE are becoming limited due to the client feeling more fatigue and tried during the day, but the Pt has been advised to continue to move, stretch throughout the day and given more life style advice to try. It is very difficult to help the Pt the way he needs, but the clinic will be opening soon which I hope is going to help with his mental and physical mood. Therefore I am going to continue reading on psychological helpers and having discussions with supervisors that have dealt with Pts like mine.
To conclude, my Pts low mood makes me feel awful and saddened that I can not help him in the way my profession is “meant to”. However, having more discussions with my supervisors I have slowly realised this Pt will need continued assistance / rehab throughout his life and due to his condition will have progressions and regressions, but the best methods for my role is to give the best support and aid I can to help him live a happy life. Further research on psychology of Pts and post stroke effects will further help me gain a better understanding on the changing status of my Pt.
11TH MARCH 2021 – 1 HR
Pt had a follow up F2F appointment. A general conversation and HBE check-ups were discussed today, before heading into the gym or an upper body strength session. The Pt was feeling motivated and happy to be back in the gym. The session went very well and seemed to improve the Pt mood even more. Upper body is a weak area for the Pt and often causes worry when he falls, therefore the importance for these gym sessions.
To conclude, I am enjoying the Pt back in the cliic and gym, which is refreshing for myself and him. Overall regression has occurred, however we built it up before and we can do it again. Slow and steady steps for my Pt for a long term improvement.
15TH MARCH 2021 – 1HR
Pt had a follow up F2F appointment. A general conversation before starting our rehab. The Pt enjoying the talking part of the session and I believe it is a big part of rehabilitation, especially for this Pt who will most likely be a long term client. The session went well and my Pt mood and motivation began to pick up straight away.
To conclude, I am enjoying having more appointments with my Pt and seeing the small progressions he is making. Although his mood is slightly up and down at this moment, which I have discussed with my supervisors on the best way around the situation.
17TH MARCH 2021 – 6 (LBP wife talked)
Pt wife spoke on behalf of husband that is suffering from a bad back, the online triage was slightly difficult due to not speaking to the actual Pt. However he was a returning Pt with lots of notes, and is wife also knowing a lot about him and his medical background. I believe the appointment went well, even under different circumstances which has also taught me how to adapt my normal routine to suit the Pt on the call. The call was quicker than normal, due to being unable to do any ROM.
SECOND PT – SIT IN
For the second Pt, I sat in on a fellow students call. The pt was complaining of a shoulder injury which was effecting their job and daily living. It was interesting to see the different techniques and communication methods used by the other student, which I will be implicating within my consultations. I stepped in every now and again for tests and exercise ideas, which the Pt seemed to be motivated and excited for. The call went well overall and a RC strength focus programme was designed by both of us to sent to the Pt, alongside finalising the written notes.
NEXT HR-
The next our of so entailed fellow students performing exercises to go onto the social media page and Youtube. I helped film a couple and took part in a couple also. This was a good way of communicating the teaching points of how to do an exercise, alongside keeping the videos in house for our Pt, so they can recognise and know that is the exercise prescribed.
18TH MARCH 2021 – 1HR
Follow up pt arrived for a F2F gym appointment. The session today was cardio and endurance based, which is the first program we stared on. The pts mood seemed slightly different this session, which we further discussed once in the gym. The session aimed to improved biomechanical gait, by preforming specific exercises that are weak, but vital areas to further progress the pt; also looking into fall mechanism to aid if the client has a wobble of fall. The pt mentioned he had a wobble and landed on his arm, which was causing an aching feeling, along with his lower back feeling worse than Friday. The pt mentioned a complication with a family member over the weekend, which could explain the mood. Through the session the pt showed an improvement in mood. Walking gait with aid is being performed very well and feeling confident with his walking through the gym and to different equipment; however turning, from previous fall, has increased worry in the pt. Warm up was preferred on the cumber bike, with the back support due to the aching in the lower back. Exercises were performed very well throughout the session, seeing improvement in endurance and power though the lower limbs.
19TH MARCH 2021 – 1 AMBER
Pt is a follow up F2F appointment following a ACLR 16 weeks ago. Due to the current pandemic causing a nation lockdown, F2F appointments had to be put on pause. The Pt has also seen a physio to get some extra information while Marjon is close, however the physio seemed happy with the rehab plan by Marjon. The Pt is feeling very good and very impressed with her progression and movement, she has started prepping for running, but been advised to hold off running for the time being. Pt is noticing a lot of fatigue in the injured limb, which is understandable. Pt is looking forward to the next phase of rehab including strength, proprioception and neuromuscular techniques – this phase is falling more into her profession as a S&C coach.
I’m happy with the outcome measures and progression the PT is making, especially during a lockdown. I have however, taken her phase of rehab back a couple of weeks due to not being able to use the adequate resources needed to ensure no re-injury and proper strength and mobility.
To conclude, the Pt has been regressed for her “typical” phase of rehab, to ensure we are meeting the prior outcome measures to ensure she is ready for the next stage. I am happy with the progress and how the Pt in engaging. Research will never stop with this Pts injury, which is refreshing to learn lots about the injury, especially after different trials for different sports and types of athletes.
22ND MARCH 2021 – 1HR
Pt arrived for a follow up F2F appointment, the main focus of today was balance and co-ordination. The Pt arrived in a good mood and was ecited to get started. The exercise skills were very well preformed today, almost seeming as if his regressions were weeks ago – however I continue to remember things can change week on week and to ensure the pt feels proud day on day, not to compare. A laugh and a general chat always happens through the rehab, as it is a important technique to continue to build the trust and relationship. But also to slightly make exercises harder when the Pt is talking, thinking or laughing.
Overall, a good and jolly session. The Pt left pleased with the session and was motivated to bring the same energy next week.
24TH MARCH 2021 – 6
Pt came in for a follow up F2F appointment. Pt was complaining of a recent hip and groin pain. Therefore the session plan was changed to go onto the anti-gravity treadmill and perform some walking and exercises within the treadmill. The Pt get nervous but motivated to stay on the treadmill, and once started normally enjoys it more. The treadmill worked well for taking the pressure of the Pt joints to perform some exercises, which were interesting to note compared to his last use on the treadmill. Overall the session went smoothly and the Pt enjoyed the treadmill. The pain had subsided, however HBE have been adapted to support the hip more and maintain no pain.
The next hour was discussing with next hour was discussing with my supervisor her experiences with the same ty supervisor her experiences with the same type of Pt in the past and methods for certain tips, tricks or alternatives. The discussion was very eye opening and taught me a lot about my job role and the long term realistic aim for the Pt. We also put together a new plan for his next visit, due to being unable to adapt core exercises enough for my pt to perform comfortably.
29TH MARCH 2021 – 6HR
The first hour of clinic the supervisors took us through a new paper they had found regarding shoulder training techniques. Sitting down as a group to discuss the new research and how we can implicate it into our own pts. The next hour I had a virtual pt with lower back pain (LBP). Going through the policy’s, the pt didn’t know what had been ticked or not, due to partner booking appointment. I had to ask Mike to show me if the policy had been ticked and agreed, which it was. Going through the consultation form was slightly confusing due to the pt answering questions that were going to be answered later on the sheet, but all the information was gathered and placed into the correct sections. I stumbled on the next couple of observations, as noticing it’s a lot harder over video call than in person. I believed I asked and took out as much as I could over video call, it was suggested the pt came in for a F2F appointment to finish some movements and observations that were unable to be performed.
NEXT-
Sitting in a fellow students F2F knee appointment. This was a returning Pt and known before to the student. I took the Pt through ROM and trials for the exercise prescription. This PTs injury seemed very difficult at the presents, but after speaking our thoughts to the supervisor, she helped us break it down into little section to make it clearer. This was very helpful for us to focus on the main areas, but to also remember the surrounding structures that may also be affected. A further plan was designed and sent to the Pt, who seemed very happy with his time spent in clinic and was looking forward to the exercises.
31ST MARCH 2021 – 6
Descriptive Overview – Pt had a follow up F2F appointment 4 months post ACLR. Pt has been engaging well with her rehab exercises and was excited to be on the football astro to perform her rehab and be surrounded by her fellow team mates. No complaints about the injured knee, which was a good sign. Has been enjoying sea swimming, ensuring she follows the advice given by myself on kicking techniques to use. Pt has stared a new job so has had an physical increase in her lifestyle, which can lead to a slight adaption to rehab exercises and a diary for her injury knee / rehab to asses feelings, actions and timings. This will be to ensure the injury is not being overloaded, even by standing more – adequate sleep, stress and nutrition all play a role within the recovery.
Feelings- I am happy with the process and where we both are in the rehab plan, however my studies are becoming more intense and communication with the Pt is reducing. However, the Pt is very understanding as she was a student a year prior to myself and the phases of rehab are starting to be more toward her profession.
Conclusion- To conclude, although communication is not as regular as I would like, I am happy with the knowledge and progression the Pt is making and if she has any extra questions she knows to message myself for advice.
After my client I did research for the next phases of her rehab, with evidence and video based methods. This gave me an idea of progressions to be made and what the next step may took like, but also the risk it carries.
1ST APRIL 2021 – 2 (Ken and Mark (shoulder))
Pt follow up appointment. Pt recently had a couple of bad falls which knocked his confidence massively. Today we had a longer chat and stripped back the physical aspect to begin fresh. I believe this was a good idea for the pt physically and mentally. Being able to perform easier exercises and focus on them being better than on past harder exercises which the pt will not be able to do. The overall mood of the session started low but built up once we started moving. Another chat with myself, pt, wife and supervisors were had to have a catch up and to reiterate the next plan for the Pt.
A discussion was had with my supervisors on the next steps and methods they found to be useful. This was great to have a follow up with them and get a understanding of how to manage the situation for the next couple of weeks.
SECOND PT
First year rehab student has a vitual appointment due to shoulder issues and pain down into little finger. The call went well and managed to gather lots of information on the Pt and his condition. At first the signs and symptoms seemed very scary, however going deeper into the form, began to realise not to jump to conclusions. The pt was able to perform certain ROM exercises which helped build a better picture, but will advised to have a F2F appointment to re assess the injury and ROM.
14TH APRIL 2021 – 6
My morning entailed with no clients, therefore I went back through my notes and aimed to improve my abbreviations and overall writing style of the form to ensure all information is displayed clearly and accurately. This will also help me get int a better routine when writing notes for clients while doing the appointment. Also speaking to my supervisor to discuss methods that work best for him to read and understand.
A follow up F2F appointment came in. The appointment was in the private studio while the gym was busy with the public. This enabled myself and the client to move around freely and with minimal trip hazards. The beginning of the session was having a long chat and catching up on some recent events the pt had been through. Then a focus on all over body was for today, due to mentioning he hadn’t moved much recently. This way he could get all his body moving in a safe, effecting and monitored way to ensure safety and company while performing new exercises. The Pt seemed happy with the session and managed to walk away without feeling too fatigue, this was a good sign. It also motivated the Pt to why he does enjoy exercise and moving, although getting stuck in bad mind sets of not wanting to do them.
20TH APRIL 2021 – 3 (Running Clinic/ CPD)
The supervisors took us through a running clinic CPD. Running is not a strong point of mine, but I really enjoyed the learning outcomes, group discussions and new ideas that could be put into play with all athletes. This session helped to be critical of my reasonings and ideas, alongside being able to discuss different ideas with my fellow students. Over all a very good session, engaging and enlightening.
21st APRIL 2021 – 6 (Ken and John (hamstring))
28th April 2021 – 6 –
A follow up F2F appointment. The appointment was in the private studio while the gym was busy with the public. This enabled myself and the client to move around freely and with minimal trip hazards. The beginning of the session was having a chat and catching up. The focus today was lower coordination, due to still suffering with some lower back pain form falling asleep in a sun chair. This way he could get all his body moving in a safe, effecting and monitored way to ensure safety while performing exercises. The Pt seemed happy with the session and managed to walk away without feeling too fatigue and easing of the LBP, this was a good sign. It also motivated the Pt to why he does enjoy moving and reminded him not to fall asleep in chairs.
A new Pt arrived at the clinic, although meant to be online. This threw me off my process of this Pt, which normally means a jumpy consultation. However, I managed to get the information I wanted, but the PT injury did not suit the signs and symptoms together with injury type. Due to the pain still, it was difficult to pinpoint the structure damaged, as he was able to perform many exercises and ROM very well. After having a discussion with my supervisor, we designed a plan for the Pt to begin so he reduced the potential for scar tissue to produce.
After the appointment, a more detailed discussion was made with my supervisor to discuss my thoughts and opinions and then put it all together. This methods helps me keep my trail of thoughts in the right order and think clearly.
14th May 2021 – 4
Due to not appointments apart from one, my morning was researching psychological and physical function impacts of a stroke. The research was in aid of my long term Pt suffering from a post stroke. The research was to help me gain a wider knowledge set for the management, treatment and key areas to look out for in post stroke Pt. The research differed groups of long-term physical disability (LTPD) and non-LTPD. Evidence demonstrated that the two groups did not differ in depression and anxiety, however did differ in pain interference, fatigue and physical function. This research was very interesting to read in relation to the impact of stoke, LTPD and aging, which gives me a insight into the difference and management of Pt already living with LTPD.
Discussions with my supervisor also helped me gain a understanding to the neurological aspect, in relation to my Pt. It helps me to hear it from someone that has experienced this situation and can give his own opinion or management on the situation.
REF: Lincoln, N. B., Kneebone, I. I., Macniven, J. A., & Morris, R. C. (2011). Psychological management of stroke. Hoboken, NJ: John Wiley & Sons.
Pt had a F2F appointment. The Pt seemed in an upbeat mood, has seen the fall clinic specialists which he has been waiting for a while. The first half of the appointment was having a in-depth conversation about general life, HBE, any aches or pains and overall well-being. Due to the past couple of months / weeks I thought it was an appropriate fit to take longer to have a conversation and catch up on anything we have missed, the Pt was very grateful for this and said “it is all part of the therapy”. I’m glad he recognised the importance and also glad his mood had improved. Recently reading a paper by (BLA*) highlighted the neuro and psychological impact of stoke Pts, thus reminding me to not overthink my approaches. My Pt was feeling off-balance today, so had the choice to pick from four past programmes to do today (has previously been through all programmes more than once). I believe this helped to ensure the client was comfortable to perform exercises he knew his body could handle. Progressions were made by myself when recognising a consistent performance, the Pt was asked if he was comfortable progressing; which he was more than happy to, ensuring he kept up the hard work and was very enthusiastic.
To conclude, I was overall happy with the session and my Pts mood. He is finally getting answers to conditions that were out of our scope. Although physically not performing the best, the motivation and enthusiasm to each session and HBE is incredible and it having an impact on his over all well-being. Further research on neurological and psychological post stoke will be researched so I gain a wide range of detailed evidence.
17th May 2021 – 1
A virtual appointment with a new Pt, which is a family friend. The Pt had had some difficulties recently and had then injured her wrist and shoulder. The accident came at a bad time, and recovery was not what she hopped for. Being unable to perform daily tasks without losing grip, strength and lots of pain. After a detailed talk, the best idea was to make an appointment for the Pt to re assess the injuries and start a solution so she is able to live her life pain free and able to perform daily living tasks. I was difficult to hear the effect of a bad recovery can have on an elderly person, but she seems motivated to start her rehab journey and I am excited to help her along the way.
19.05.21 – 6
A weekly follow up pt attended the clinic for a continued face to face session. The program 3 consisted of proprioception lower and upper body; which had the intensity regressed after noticing early fatigue in previous programs. We were in the clinic for the hour, with both supervisors popping in and out to check on myself and the pt. The program consisted of incline and eccentric sit to stand, jockeys with a different object under the pts singular foot, heel to toe rocking (using wall for support), standing upper clock taps, banded wall thrusts, different size and weight ball throw and catches. Two further exercises were not performed due to time, but demonstration them to the pt; for him to try at home, which he seemed more than happy to do.
The pt is making great progress, with him showing the clinic staff his improved gait, which he has to ‘force’ himself to do, but still extremely proud he is using his own initiative. The exercises were performed well, with no wobbles or falls occurring. I was very pleased to hear the pt had been doing all the prescribed exercises and taken it upon himself to try improving him gait technique and had not had a fall or wobble since the last visit. The pt was very pleased with himself too, which is great to hear and see.
22.05.21 – 6
Weekly pt arrived to the clinic for a F2F appointment. The aim of today was attempting the anti-gravity treadmill (AGT) again to improve walking gait, and confidence on the machine. My Pt is more comfortable to go on the AGT than before, due to better recognition of the ‘feel’ for the movements on the machine. The Pt performed everything very well and with lots of confidence. The session went well overall and the Pt didn’t feel too fatigued post session.
My next appointment was virtual, with a new Pt complaining of shoulder pain post nerve move operation. The Pt had had some difficulties recently and had then injured her chest / shoulder at the gym. The Pt is unable to perform her normal weights in the gym and on the occasion continues to get “numbness” in her operated forearm. The Pt was advised to have a face to face visit, to re asses symptoms and to design a plan of action to aid the Pt. The Pt seemed very grateful for the advice given and was looking forward to getting the symptoms managed.
26.05.21 – 1
Follow up pt arrived for a F2F gym appointment. The session today was cardio and endurance based, which is the first program we stared on. The pts mood seemed slightly different this session, which we further discussed once in the gym. The session aimed to improved biomechanical gait, by preforming specific exercises that are weak, but vital areas to further progress the pt; also looking into fall mechanism to aid if the client has a wobble of fall. The pt mentioned he had a wobble and landed on his arm, which was causing an aching feeling, along with his lower back feeling worse than Friday. Thinking back to the beginning of the session compared to the end, showed how important exercise is for this pt. To physically build up strength and endurance, but also to build up mental health and endorphins. This can ensure the pt continues to associate the exercise for something they enjoy, rather than a task to do. Today showed me the importance of this, and something I will always aim to do for my patients.
7.06.21- 6
Pt come for a follow up appointment to have a back assessment and continue with post stroke rehabilitation. The back assessment was led by Alex and Mike, while I observed and wrote notes; it went very well and gave a good insight into the persistence of the pain / discomfort. It was great to see the supervisors relaying questions and tests without destinations, this is a target I would love to aim towards and be more confident within my testing of pt. The session continued to physical exercises with myself and supervisors popping back and forth. The session consisted of balance, gait and turning techniques, these are all aspects that the pt is currently most concerned about; due to turning being a mechanism of most of the pts falls. While aiding the pt, I noticed the feet weren’t being raises as much as forward walking, this leading to the foot coming into contact with the floor mid turn; leading to a fall.
The next hour entailed fellow students performing exercises to go onto the social media page and Youtube. I helped film a couple and took part in a couple also. This was a good way of communicating the teaching points of how to do an exercise, alongside keeping the videos in house for our Pt, so they can recognise and know that is the exercise prescribed.
8.06.21 – 5
My morning started with no clients, therefore I went back through my notes and aimed to improve my abbreviations and overall writing style of the form to ensure all information is displayed clearly and accurately. This will also help me get into a better routine when writing notes for clients while doing the appointment. Also speaking to my supervisor to discuss methods that work best for him to read and understand Pt notes.
A Pt attended the online clinic service reporting of a bad back, the online went well with the Pt. However he was a returning Pt with lots of notes. I believe the appointment went well, even under different circumstances. Over this period of online consultations, I have found the process to be easier and am able to utilise the time wisely. The Pt seemed happy with the service and was looking forward to the face to face appointment.
14.06.21- 6
Pt arrived for a follow up F2F appointment, the main focus of today was balance and co-ordination. The Pt arrived in a good mood and was excited to get started. The exercise skills were very well preformed today, almost seeming as if his regressions were weeks ago – however I continue to remember things can change week on week and to ensure the pt feels proud day on day, not to compare. A laugh and a general chat always happens through the rehab, as it is an important technique to continue to build the trust and relationship. But also to slightly make exercises harder when the Pt is talking, thinking or laughing.
Overall, a good and fun session. The Pt left pleased with the session and was motivated to bring the same energy next week.
17.06.21 -5
Pt had a follow up F2F appointment continuing treatment for post stroke treatment. The Pt had recurring limitations in shoulder and lower back joints, which were being monitored and treated for on a weekly basis, these were beginning to improve in ROM and P. HBE programme was going well and causing no pain. The Pt has been enjoying new exercises to try and the challenge they pose. No falls, wobbles or trips occurred, which made the Pt feel confident. Pt aim is to improve walking and confidence, the session consisted of lower limb gait, proprioception and confidence for functional movements.
Second Pt came in for a follow up F2F appointment. Pt was complaining of a ongoing hip and groin pain. Therefore the session plan was changed to go onto the anti-gravity treadmill and perform some walking and exercises within the treadmill. The Pt still gets slightly nervous but motivated to stay on the treadmill. The treadmill worked well for taking the pressure of the Pt joints to perform some exercises, which were interesting to note compared to his last use on the treadmill. Overall the session went smoothly and the Pt enjoyed the treadmill. The pain had subsided, however HBE have been adapted to support the hip more and maintain no pain.
21.06.21 -6
Pt was booked in for an online triage after complaining of pain down the buttocks into the back of the leg. Having a general chat to begin with gave an insight into the cause / continued irritation of the injury, but also build a better relationship with my pt. After completed all the screening questions we figured out the cause / area of injury. The pt was advised to attend a F2F appointment to get further treatment. Overall, the Pt seemed happy with the guidance and help advised. I informed the Pt of management techniques to help manage symptoms. The Pt was looking forward to being out of pain and being able to take part in daily activities again. The PT was advised to attend clinic to gain further details regarding treatment methods.
For the second Pt, I sat in on a fellow students call. The pt was complaining of a shoulder injury which was effecting their job and daily living. It was interesting to see the different techniques and communication methods used by the other student, which I will be implicating within my consultations. I stepped in every now and again for tests and exercise ideas, which the Pt seemed to be motivated and excited for. The call went well overall and a RC strength focus programme was designed by both of us to sent to the Pt, alongside finalising the written notes.
22.06.21 – 6
The next hour was discussing with next hour was discussing with my supervisor her experiences with the same ty supervisor her experiences with the same type of Pt in the past and methods for certain tips, tricks or alternatives. The discussion was very eye opening and taught me a lot about my job role and the long term realistic aim for the Pt. We also put together a new plan for his next visit, due to being unable to adapt core exercises enough for my pt to perform comfortably.
Sitting in a fellow students F2F knee appointment. This was a returning Pt and known before to the student. I took the Pt through ROM and trials for the exercise prescription. This PTs injury seemed very difficult at the presents, but after speaking our thoughts to the supervisor, she helped us break it down into little section to make it clearer. This was very helpful for us to focus on the main areas, but to also remember the surrounding structures that may also be affected. A further plan was designed and sent to the Pt, who seemed very happy with his time spent in clinic and was looking forward to the exercises.