Y3S1W9: Ding

The 2nd and 3rd year physio students were once again involved in promoting the School of Physiotherapy during the Health Science First Year information evening, and the secondary school open day. I gave up two hours on Tuesday to get amongst the high school students whom were buzzing around looking at their career options. A common concern for many students was the common year, HSFY where they are lumped with medicine, dentistry, pharmacy and medical laboratory science hopefuls. The idea that they had to battle for their place was put to ease when we told them that the entry criteria was now 'should they meet the minimum requirements of a B- average, AND only select physiotherapy as their preferred professional programme then they will almost certainly be guaranteed a place in the professional programme'. So with that worry now abolished, they were then concerned about achieving grades in papers they really had not prepared for at high school such as chemistry or physics. Unfortunately that's something they will have to really study hard to ensure they pass with a good grade. Fortunately, all that first year health science study will be worth it, for they will be on track to becoming physiotherapists!! 

I participated in a Masters student's research project at the School of Physiotherapy on Wednesday morning. The data collection was undertaken in the biomechanics lab with a movement tracking system (UV, 3D-motion analysis) and advanced EMG setup. Researchers are generally more than happy to give you an insight as to how the equipment works, or to use it to showcase how your own body works. I got to see my shoulder muscles activation patterns with shoulder movement - the changes in EMG with movement reflect the dynamic role of each muscle group with specific movements (agonists/antagonists/stabilisers/neutralisers).... and as there was a lot of muscles measured, it was quite entertaining. It is an experience not to pass up, should you have an opportunity to participate in or conduct your own research using these devices. On this occasion the researchers were comparing a practitioner applied mobilisation with movement (MWM) technique of the glenohumeral joint with a self-mobilisation technique. I wish them well over the next few months as they analyse the data.

Biomechanics Lab, School of Physio.

 The setup: EMG and 3D Motion Analysis

 

Self-mobilisation with movement

 Physiotherapist applied mobilisation with movement

On Wednesday night we had our terms test for pathology. It was a 120 MCQ exam. The exam questions were played on a powerpoint show, with one minute per question before "Ding" the next slide/question was shown. There were plenty of images (histology, gross anatomy, tables and graphs) with arrows pointing, H&S stains highlighting, letters denoting and people with conditions displaying etc. "Ding". One minute per question was easily manageable (it was MCQ after all), however two hours of sitting there (most of which we were day dreaming or wishing for the previous slide to be replayed) was a struggle. "Ding". We had a joke before the exam about finishing early, knowing full well that if they did then they obviously had not seen all the questions (but the answer is always 'B' anyway, right??!). "Ding". In momentary discussions after the exam finished, I found that the general consensus was that the test wasn't as bad as we all had earlier perceived... yet, we were pleased to have been scared in to studying hard before hand. "Ding". Thank goodness for the "ding" after each slide changed, as this sound brought us back on task... but we're now very tied of hearing "DING!!" There was a lab group BYO (or in the case of our lab group, it was a flat pizza night) immediately following the exam for combined 2nd and 3rd year groups.

MSK is slowly bringing everything we have learnt together. The lab was split 50:50 between practical and theory. We started with clearing tests for the shoulder, thoracic and cervical regions. This fine-tuned our manual handling skills. There was a joke about "soft end feel" with horizontal flexion with overpressure for the shoulder joint on females... obviously that's something to avoid at all times! The second half was followed by a case study. We were tasked with coming up with a few hypotheses of the underlying structures at fault based on the subjective assessment. After stating our hypotheses, we had to explain what we would do in the objective test. Often our specific orthopaedic tests are based on functional limitations and reproduction of symptoms in the clearing tests. We were then given the objective assessment for the case and had to describe which structures were at fault and how we knew this. It feels like we're almost practitioners!

Our physical agents lab was about safely and effectively using ultrasound. There were a few machines (of varying ages) that we had to be confident using (once you've used one, you've used them all.... sort of). There are a few different ways to apply ultrasound e.g. through water, gel, balloons - so long as there was a contact medium. Apparently the ultrasound head is fairly easy to brake (and quite expensive). Our lab books also listed condoms as a good contact medium... but I wonder how well that would go in real clinical situations. Ultrasound is reported to be a useful therapeutic modality, and it is easy to use. There are a few parameters we need to think about: depth of penetration (1MHz vs 3MHz), duration of treatment, intensity (W/cm2) and whether it is continuous or pulsed (and the ratio of the pulse).

The week ended with an infections prevention and control lab. We were reminded about the 'five moments of hand hygiene', personal protective equipment (gowns/gloves/shields/masks) and protocols for people with or suspected to have a viral illness. There were a few 'what should you do in this situation' case studies and then we all practised putting on and safely removing the personal protective equipment... yes there is an order to removing the gear so as to contain any bacteria or virus that may have been sneezed on you, rubbed on you, or virus passed onto you by exposure to vomit. We didn't get to see an Ebola suit (although I'm sure the DHB will have one somewhere). When we were all dressed up, there was a suggestion that we should all run through the main street yelling "it got out!!" - that would be entertaining (and have many unintended consequences).

Vodafone was giving free passes to the rugby on Friday!! These opportunities don't come around too often. In the end the Highlanders were too strong for the Sharks, beating them 48-15!

With pathology terms test done, we can focus on other things... some productive, others for pure entertainment. If you're into a quiet evening reading physio blogs - here are a few worth browsing over. (I'm linking them here to save bookmarking them elsewhere):

• The Awesome Physical Therapist: http://theawesomept.com/ 
• CinemaSays: https://cinemasays.wordpress.com/
• Physiological: http://physiologicalpt.com/
• The Sports Physio: https://thesportsphysio.wordpress.com/
• PT Brain Trust: https://ptbraintrust.wordpress.com/
• Pain Science: https://www.painscience.com/
• Science-based Medicine: https://www.sciencebasedmedicine.org/
• Forward Thinking PT: http://forwardthinkingpt.com/
• Keith's Korner: https://keithpkorner.wordpress.com/ 
• The Manual Therapist: http://www.themanualtherapist.com/
• Human AntiGravity Suit: http://humanantigravitysuit.blogspot.co.nz/
• PT Think Tank: http://ptthinktank.com/
• Critical Physio: http://criticalphysio.me/  
• Physiohead: https://physiohead.wordpress.com/ 
• PhysioTalk: http://physiotalk.co.uk/ 
• Raynersmale: http://www.raynersmale.com/

Y3S1W8: Exposed

Pulpit Rock, Silverpeaks, Dunedin.

We had another great week of classes followed by an ANZAC remembrance weekend. The Silverpeaks is a tramping area on Dunedin's doorstep - I took a few hours off to walk to Pulpit Rock (en-route to Jubilee Hut). Having pondered the involvement of physiotherapists in historic conflicts (in this sub-alpine, exposed but beautiful landscape - thankfully there were no guns fired), I scouted the internet and found this great article by AUT University's Dave Nicholls: http://criticalphysio.me/2015/04/20/physiotherapy-at-gallipoli-a-small-commemoration/

Path switched tracks this week to look at liver disease, but not before our tutorial examined deep vein thrombosis, "junk in the pulmonary trunk" (saddle embolism), and other thrombi-embolus related case studies. We've got a path exam next week, and so we'll probably spend the weekend revising our notes. I suspect there'll be similar questions (with the addition of histological images) to what we've had in our weekly pre-tutorial quizzes - here are five examples of questions we've had so far (answers are at the bottom of this week's blog).

 1. The inflammatory exudate consists of:
A) Cells accumulating outside the blood vessel
B) Cells and fluid accumulating inside the blood vessel
C) Fluid accumulating outside the blood vessel
D) Cells and Fluid accumulating outside the blood vessel
E) Proteins accumulating outside the blood vessel

2. In acute inflammation, the kinin and coagulation cascades may be activated by:
A) CRP
B) Factor XII (Hageman Factor)
C) Complement
D) Fibrinogen
E) Bradykinin

3. Which of the following is usually the cause of rheumatic fever?

A) A highly virulent organism affecting a normal valve

B) A low virulence organism affecting a damaged valve

C) Sterile vegetations on a damaged valve

D) Exacerbation of the immune response

E) A low virulence organism affecting a normal valve

4. Which of the following is true about polymorphisms in apolipoprotein E?

A) They lead to at least 6 Apo E phenotypes

B) They are genetic variations in the coding genes for Apo E

C) They are associated with changes in LDL levels

D) All of these options

E) They can be used as risk markers for atheroma

5. Platelets become activated, adhere and aggregate on contact with:

A) Aspirin and warfarin

B) Collagen and von Willebrand factor

C) Red blood cells and megakaryocytes

D) All of these options

E) Intact endothelium and endocardium

We've had our first lab for electrophysical agents, and although there wasn't much 'electro' (unless you count the freezer, or heating appliances) we did experience some heating and cooling agents.  We practiced our ice massage, paraffin wax 'dip and wrap' technique, using the hydocollator heat packs, cryo-cuffs etc - all taking in to account the preparation, application, precautions/contraindications/indications for each modality. My favourite was the paraffin wax! The wax is quite hot on the bear hand, but feels cooler with each dip and layer. We then place our plastered hand in to a plastic bag and wrap it in a towel - this feels very relaxing. It's fun taking the wax off too. The wax is stretchy and peels off cleanly. Once it's off, you can play with the warm ball of wax before putting it in the tub to heat up and liquify again.

Paraffin Wax!!

We had a MSK lecture, lab and tutorial this week. In the lecture we took a step back to recap exercise prescription principles, then we applied these to two upper limb case studies in the lab. Exercises ranged from reeling up a weight on a stick and twisting a towel, to using a hockey stick (acted out with a walking stick).

Neuro was all about perception. If you enjoy visual illusions, then you would enjoy this lecture. Our lecturer also presented info on agnosia and apraxia. An interesting video clip of a man with an ideomotor dressing apraxia was shown - he took many minutes to put the shirt on. The length of time taken wasn't due to him not knowing what it was, or not knowing what the action should look or feel like, the problem was executing a motor programme in the right sequence to successfully put the jersey on. The image below is an exaggeration, but accurately depicts how we felt watching the clip (face-palm)...

I was at the sport injury clinic on Saturday from 1-6pm. We had a range of sports injuries flow through... some patient's appeared to be in the wars! The highlights for the day (for me at least) were two dislocations. The first was a dislocation of a patella. Three medics (myself included) arrived with a stretcher to find the basketball player lying on court (in which they were playing on). The patella was stuck on the lateral aspect of the players bent leg. We guided the patella back as we straightened the leg, and it relocated easy as! We then had the player on the stretcher and back to our clinic for an assessment and referral for an x-ray to rule out any bony damage. As we left the bball court the teams gave us a cheer and an applause before the game resumed. The second dislocation was of a rugby player who went into a tackle and came out second best. Two of us medics were needed to relocate the shoulder. Under a medical doctor's supervision, we had the patient in prone lying, one sports medic was applying a sustained distraction to the patients shoulder at about 100deg flexion and I was sustaining an end-range passive scapulae rotation. Soon enough there was a clunk, and the shoulder was back in place. Other injuries I saw today included a suspected concussion, upper thoracic pain following a rugby scrum, thigh contusion, suspected radial fracture, and knee MCL sprain. Other medics helped suture a few eyelids amongst other things (we were all pretty busy!)

Quiz Answers: 1D, 2B, 3D, 4D, 5B

Y3S1W7: It's in our blood

The week really began on the Sunday night of the mid-semester break with our pre-tutorial pathology quiz. It's an online quiz with a 10min timer. It's open book, but you had better have super-hero Ctrl+F, 'find' on the page or in your text book, powers to be able to use this method for completing the test. You really need to know these off by heart. Anyway, I thought I had downloaded the lecture slides file, but I discovered (midway through my test) it was a broken file and I needed to re-download it. It was a race between my internet speed for downloading the lecture slide VERSUS timer on Blackboard's pops test. Internet timer 1: My flat internet speed 0. Lesson learnt, but I still got 9/10 in the test.

Pathology was all about blood. Our lab tutor was taking this lecture series so we knew we were in for a treat - she has a superb sense of humour! "Red blood cells are called erythrocytes... as you'll know, there is never a condition that has more than one word in pathology." And just like in tutorials, there were food analogies... here was this weeks shopping list: donuts (healthy RBCs), biscuits (resting platelet), splattered egg (activated platelet). To further emphasise the food theme, there was a powerpoint slide of a boy with a frog in his mouth and the anaemic symptom "pica" listed next to it, which describes unusual cravings (such as eating ice during pregnancy). Then, not to our surprise, the lecturer expanded on some different types of anaemia: microcytic hypochroic, macrocytic and normocytic normochromic anaemias.  There were the usual coagulation pathways covered in slightly more detail than in last year's physiology or pharmacology with the associated pathologies. She warned us against banging our head against the wall or stomping our feet too much when we got stuck revising due to the destruction of RBCs (and associated haemolytic anaemia). With a different analogy she described G6PD deficiency to be like that of a perm in a hairdressing salon (Heinz bodies need G6PD to avoid getting stuck in the spleen - they look a bit messy, like hair after  a perm). We discussed Vitamin K deficiency and it's effects on the blood, jokingly advocating chocolate and garlic as anti-coagulatives. In a different moment of brilliance she warned us against taking party pills off strangers as once having a case where a person was showing signs of acquired haemophilia without the usual pathology or history. It was a good week of pathology.

Along with megakaryocytes in our blood, the drive to have mega-expertise as physiotherapists is some other intrinsic factor that is flowing within our veins. This was evident in our careful and specific palpation of structures of the wrist and hand in MSK Initially we thought orthopaedic testing and treatment of the wrist and hand would be similar to the foot - in many ways, it was - but due to its importance, a whole specialisation for physiotherapists and occupational therapists has been created, "Hand Therapists". One cool thing hand therapists get to do is make individualised splints. In our lab, the closest we got to splint making was a taping technique to limit hyper-extension of single joints of the hand (this was still very cool). We covered a few tests of instability (e.g. Watsons test) and techniques to reposition carpal bones in the wrist (e.g. a manipulation of the capitate carpal bone).

We're starting a new area of physiotherapy called 'electrotherapeutic agents'. This week began with a recap of the basics for hot/cold/contrast therapy. I'll tell you more after labs start next week! Hot/cold therapy seemed to be a weather systems intervention on the lower South Island this week. Dunedinites woke to a light covering of snow/ice on Tuesday which made getting to class early a bit hazardous and cold. There were some (myself included) that hadn't checked their email and ventured down to the cancelled 8am lecture. We surrendered to a warm beverage in the Hunter centre for general catch up and grumble about the weather. The weather had us questioning whether it was autumn or winter... the trees hadn't yet shed their autumn leaves so we concluded winter was still a few months away! We also had a good chat about Crossfit gyms. By the end of the week, the sunny weather with its glorious warmth had been revived and we were back to our enthusiastic selves in time to finish our first rotation of placement with a smile.

This was the last week of my Umove placement (neurological rehabilitation). It's now time to reflect on the placement and complete the necessary paperwork to pass PHTY355. Looking back, I feel that I have been able to put many neurological tests, outcome measures and interventions that we had discussed last year in to practice. The clients that attend Umove are great! Although they attend the clinic to improve their own health, they are very receptive to new students every three weeks even though this must become a bit frustrating. The clients look to us for crucial information about their condition and hope that improvements will come with physiotherapy. One of the tasks I had this week was to dip into the literature about homonymous hemianopia and whether a patient would be able to improve their vision enough to regain their drivers licence. The literature, as usual, was inconclusive but suggested that small improvements may be gained in the long term with intense training, however the error of measurement in these studies suggests that this 1-2degree improvement may be due to improved visual scanning during the task. My advice to the patient was to practice scanning to the affected side using eye and neck movements so that it becomes an automatic process, and to practice a visual task at home using their peripheral vision. The visual task was similar to the neuro screening test for homonymous hemianopia. The beauty of physiotherapy is that many of our screening tests can be adapted or used directly as training exercises.

We were off to Med Red lecture theatre (a School of Medicine lecture theatre with very comfortable red seats) for an interesting lecture about the history of physiotherapy in New Zealand and how the legal system here protects the citizens of New Zealand from any malpractice of professionals practising under our regulatory body. We were informed about the process for becoming a registered health professional and the importance of retaining a current annual practising certificate, auditing health professionals and the importance of professional practice. This is the second lecture where we've explored how professional and governing bodies can help us as physiotherapists (Physiotherapy New Zealand (PNZ); World Confederation for Physical Therapy (WCPT)) and protect the public (Physiotherapy Board of New Zealand).

In social events this week, the School of Physio had their annual cultural dinner on Friday at 7pm in the Hunter centre. Staff and students put on a spread of wonderfully diverse foodstuffs, from Kiwiana themed (South Island) cheese rolls and pineapple lumps to Philippines inspired family recipes with coconut and cheese in the same dish (p.s. top quality dish - yum!!), from nutritionally sound home made cakes and slices to the staple student dishes. It was an enjoyable night for all that attended, with many interesting stories shared and bellies filled with delicious food.

Y3S1 Mid-Semester Break: UoO Campus!

It's Easter Break!!
(& it wasn't just chocolate eggs that were breaking!)

I spent the vast majority of the break catching up on Neuro modules and notes for pathology! Over the Easter weekend there was a Chinese sport tournament and so I volunteered my time to medic for them. I saw a few interesting injuries including a fractured distal radius, broken nose, fractured 1st metacarpal, fractured fibula, high ankle sprain, inversion ankle sprain and a few tired muscles. "If there are 4000 physios in NZ, there'll be 4000 different ways to strap an ankle". I also got to observe a soft-cast being made and placed on a wrist and a device with a hot tip, burn a small hole in a toenail to relieve the blister beneath. In other sport medicing news, Dunedin Tech Football (soccer) won their first match (pre-season) of the year 4-0 - a good start for them. At the other end of the holidays, we had another broken fibula and a guy who had a intravenous haematoma i.e. his varicose vein had burst and blood was bleeding out of the vein into the surrounding tissues!! I'm keeping this week's blog simple. I thought you would be happy to see something that wasn't physio related and so I have compiled a few images of other departments and buildings from around our Dunedin University of Otago campus!

Here's a brief tour of University of Otago Campus!

... These are buildings that we physio students don't see too much of!

... The best time to photograph the university is when there aren't any students about!!

... You'll see some more classic shots of the university upon graduation in 3.5 semesters time - I'm trying not to repeat any images/scenes (the best are yet to come).

...We are lucky to have a beautiful campus!

Music Dept

Academic Records

Theatre Dept

Psych & Commerce Depts

Library

Physical Education, Sport & Exercise Sciences Dept

Sitting area outside Archway Lecture Theatres

Y3S1W6: Gloves & Stockings

PHTY354 MSK focused on disorders, assessment and treatment of the elbow. I find it amusing that disorders of joints etc are given colloquial names ... take the elbow for example, there is tennis elbow, golfers elbow and nursemaid's elbow. Where there is no colloquial name, the physiotherapist will often diagnose a condition using technical jargon from what the patient describes! For example... Patient "I've got pain on the outer side of my elbow", Physio "okay, let me examine your elbow..." [some time later] Physio "you've got lateral epicondylalgia", Patient "you are a great physiotherapist, that was such a fast diagnosis!"... Basically pain of the outer elbow translates to lateral epicondylalgia: lateral (outter) epicondyl- (elbow) algia (pain). Physiotherapists' are geniuses!

PHTY354 Neuro introduced us to vestibular rehabilitation. When a patient presents with vertigo we send them down to the tuck shop to fetch us a BBQ roll! The physiotherapist is wise to the statistics which indicate that only one treatment is likely to be needed to fix the patient's vertigo, in light of this the physiotherapist must make the most of the patient's appointment before probably never seeing them again (tip for surviving physio: get a free lunch when you can). In return, we can perform a technique called the BBQ roll or alternatively the Dix-Hallpike manoeuvre to cure BPPV (benign paroxysmal positional vertigo). Magic!

I'm working my way through PHTY254 Neuro modules. Currently I'm at activity six module two... I've got some work to do over the semester break as there are 35 activities (ten modules). One case study I answered was to do with Glove & Stocking altered sensations. You're probably thinking that New Zealander's strategy for clothe shopping is to buy one size too small. No? Or you're thinking that students are stuck wearing shorts and t-shirts over winter, and these altered sensations are a frostbite-like numbness to our extremities? Unfortunately the advise as a physio isn't as simple as "buy clothes that fit" or "Kathmandu currently have a winter sale for merino socks and mittens". An altered sensation in the pattern of a stocking (lower limb) or glove (upper limb) usually indicates a neuropathy. Often this is associated with muscle weakness, cramps, altered gait, contractures etc. Physiotherapy can help with manual therapy, exercise prescription as well as other therapies depending on the impairment being treated.

I've finished my second week of neurological rehabilitation placement at Umove clinic. I got to use hot wax therapy and electrical stimulation (TENS) on a patient! So far Umove has provided many opportunities to try a wide range of interventions. I was asked to give a brief presentation about apraxia last week, and so I prepared a brief powerpoint and presented my findings to my peers with me on Umove placement. I'm not a great group speaker (definitely prefer one-on-one conversations, like that with clients/patients) so after a dismal presentation I put my slides up for everyone to view in their own time. Apraxia is recognised by physiotherapists, but further assessment and specific interventions can be delivered by occupational therapists.

Pathology covered valvular diseases (rhumatic fever, mitral valve prolapse, calcific aortic stenosis, bacterial endocarditis), ischaemic heart disease and atherosclerosis. The tutorial covered osteoarthritis and rheumatoid arthritis as well as primary and secondary tuberculosis. More case study fatalities were had and food analogies were made (millet seed appearance under the microscope... the tutor even brought in a bag of millet seeds for comparison!) ...classic for pathology tutorials!

Talking about seeds... here is an update on my mango plants!

April fools day was on Wednesday and although no pranks were pulled in class, I did discover a cool feature on google maps! PACMAN!! Yes that's right, googlemaps has turned the streets into a pacman game! So I spent a couple of minutes playing pacman around the streets of the school of physiotherapy! It's a shortened week, with Easter weekend starting on Friday. Next week is our mid-semester break!