I've taken to modified Batman quotes this week as we near two major deadlines (neuro modules and electro assignment), for no other reason than at times like these we need a little bit of humour.
Holy slipped disc, Batman! We've got a pain in the neck. This is the last MSK lab where we're asked to master new treatment techniques for the upcoming exams. It was an important lab that would either make or break our careers as physiotherapists (slight exaggeration). If we got it wrong we could do catastrophic harm to our lab partner and if we got it right it would prove our sensitivity to detecting and treating the movement of underlying tissues. What were we learning you ask? Lower cervical spine manipulations or the down-slip manipulation of the cervical spine (and somewhat the 'up-slip' technique too as it's a similar treatment plane and set-up). In the lab, we went through the full risk assessment for cerebral artery dysfunction (which encompasses vertebral artery insufficiency) with our peer whom we were practising on. After the all clear (screening and informed consent) it was on to grade four mobilisation and grade five (manipulation) of the neck. It was interesting that nobody in our lab group actually performed a cervical manipulation in the lab - either the acting patient wasn't comfortable or the practising student wasn't confident. Obviously we're not to practice the cervical manipulation unless
supervised by a registered physiotherapist, so our flatmates are safe. Actually, when screened properly the risks of dissecting the vertebral or carotid artery are very low (1 in 1,000,000)... to put it in perspective, the risks of death from NSAIDs are much higher.
In our physical agents lab we were applying FES and interferential therapy. FES stimulates your muscles to contract - it's particularly useful in neuro-rehabilitation. Interferential current is good for treating deeper tissues. Interferential therapy basically uses a low frequency of electricity to treat the tissue, but this cannot happen directly from the electrodes because it will also activate pain receptors on our skin. Because higher frequencies don't activate pain signals we can use two different moderate frequencies (e.g. 4000Hz and 3950Hz) to create the low frequency treatment needed deep in the tissue. When the two frequencies mix, the low (50Hz) treatment is produced. Interferential current seems like a useful and easy therapy to apply. Sometimes I wonder why we charge so much for treatment, because the process is relatively simple (unless we're using an interferential machine with suction cups).
Better three hours too soon than a minute too late. We're getting on with our neuro modules. I hope to be finished with it soon... as we'll be getting another assignment next week for Evidence-Based Practice!
Holy crystal ball, Batman! How did you see that coming? If you were looking through RCT (random control trials) then you mightn't have! You probably should have looked for a consort statement before believing everything you read. This was the theme for Phty355 evidence based practice. We used this theme to discuss how we will go about in-service presentations to colleagues (i.e. when we're asked to contribute to current knowledge in the workplace by giving what will resemble a 15min lecture before our 8:30am patient). Goodness, that sounds like a good way to start the day!
Quick, to the bat-mobile (Asthma Society vehicle)!! Second week out protecting the city of Dunedin from menacing modifiable risk factors and disease... "I'd better get out of my death bed" joked a patient we rang prior to visiting on Monday for COPD community placement. This patient had a few things going against him including T2DM, postural hypotension, ischaemic heart disease, idiopathic cardio-myopathy, osteoporosis, COPD (emphysema), and regularly got pneumonia. This was a new patient, so I got to observe our clinical educator and another student interview the patient. Although there were a few barriers to gaining the rapport of the patient, we got there in the end with motivational interviewing techniques. We revisited two patients' whom we saw last week, both were doing very well health and exercise-wise.
On Wednesday I had two patients of my own and I assisted another on an exercycle and bosu-ball. My first patient was the same as last week. A challenge with this patient was encouraging him to engage in a suitable aerobic exercise. Biking and rowing was out of the equation because his legs would fatigue quickly and long walks weren't particularly engaging (boring). We did ascend and descend the stairs four times which was a good enough leg workout for the day. I came up with aerobic boxing - surely I was on to a winner! When the patient arrived we asked the general health question "how are you today?" to which he replied that he was having some pain in his wrist. You might have thought that my plan was spoiled, but thankfully it wasn't. We did a brief MSK assessment and found that by stabilising the carpals we were able to reduce a lot of his wrist pain when he gripped. At the end of the session we took off to use the Umove boxing bag + gloves. The gloves offered some wrist support and the patient was able to bout out 4x 30s rounds of boxing. "Pain is the feeling of strength being sucked out of you." This patient has gone to hell and back. To reduce this patient's pain, our plan is to strengthen his muscles to pre-coma health. The second pt had severe COPD and we became suspicious of whether the oxygen saturation machine was reading accurately when at one stage it was reading 68%... this basically means that ~70% of his blood is filled with oxygen (ideally we all should be reading ~99%). The patient (almost 90y/o) was fine and I had him complete a 3MWT and some balance and core stability exercises. We're saving the world, one patient at a time!
On Friday we were back in South Dunedin (after a bit of admin) for an exercise class with the Pacific Island group. We were asked to coordinate and lead an exercise session lasting ~45minutes. After a warm up we ran three stations working on strength, aerobics and balance followed by a combined group challenge and a warm-down/stretching. Following our exercise session, there was a presentation by the Stroke Foundation and a healthy lunch. We didn't stay for the presentation on Stroke, but we were given a cup of pumpkin soup each on our way out... how well looked after are we!?! Very well looked after!
On Wednesday I had two patients of my own and I assisted another on an exercycle and bosu-ball. My first patient was the same as last week. A challenge with this patient was encouraging him to engage in a suitable aerobic exercise. Biking and rowing was out of the equation because his legs would fatigue quickly and long walks weren't particularly engaging (boring). We did ascend and descend the stairs four times which was a good enough leg workout for the day. I came up with aerobic boxing - surely I was on to a winner! When the patient arrived we asked the general health question "how are you today?" to which he replied that he was having some pain in his wrist. You might have thought that my plan was spoiled, but thankfully it wasn't. We did a brief MSK assessment and found that by stabilising the carpals we were able to reduce a lot of his wrist pain when he gripped. At the end of the session we took off to use the Umove boxing bag + gloves. The gloves offered some wrist support and the patient was able to bout out 4x 30s rounds of boxing. "Pain is the feeling of strength being sucked out of you." This patient has gone to hell and back. To reduce this patient's pain, our plan is to strengthen his muscles to pre-coma health. The second pt had severe COPD and we became suspicious of whether the oxygen saturation machine was reading accurately when at one stage it was reading 68%... this basically means that ~70% of his blood is filled with oxygen (ideally we all should be reading ~99%). The patient (almost 90y/o) was fine and I had him complete a 3MWT and some balance and core stability exercises. We're saving the world, one patient at a time!
On Friday we were back in South Dunedin (after a bit of admin) for an exercise class with the Pacific Island group. We were asked to coordinate and lead an exercise session lasting ~45minutes. After a warm up we ran three stations working on strength, aerobics and balance followed by a combined group challenge and a warm-down/stretching. Following our exercise session, there was a presentation by the Stroke Foundation and a healthy lunch. We didn't stay for the presentation on Stroke, but we were given a cup of pumpkin soup each on our way out... how well looked after are we!?! Very well looked after!
Holy strawberries Batman! We're in a jam. Pathology continues to use food stuff to describe what pathological tissues look like e.g. sloppy porridge for liquifactive necrosis/puss, fried egg whites and yoke for oligodendrocytes, and intracranial aneurysms that look like berries! Our lab investigated COPD whilst our lectures raced ahead and covered neoplasms & cancer. In the lab, the thick mucus in chronic bronchitis was likened to cheese off a pizza (the stringy cheese that ends up on your chin). Our cancer series has used skin-cancer, endometrial and colon cancers to highlight the many pathways which can lead to benign or malignant cancer.
It was a privilege to attend an inaugural professorial lecture on Tuesday afternoon 'Physiotherapy: Enabling health and enabling lives through movement and support'. We celebrated Leigh Hale's promotion to a professor and her successful application to becoming the Dean of the School of Physiotherapy. It seems that when lecturers get a promotion, they celebrate by giving a lecture! Classic. There were plenty of highly important people in the room including representatives from the Board of Physiotherapy, Physiotherapy New Zealand, Vice Chancellor of the University of Otago, and many more distinguished guests. There was also staff (most distinguishable people themselves), a few students and others from the community too. Leigh shared her physiotherapy journey, research and passion for physiotherapy - in particular neuro-rehabilitation. A key message was that by giving support for activities the patient chooses, we are able to build our patient's self-efficacy, thus to enable them to engage in life-long enjoyment and participation in physical activity. By the end of the lecture we were feeling inspired and thankful that the school will continue to be in good hands. Like Batman, Leigh is also a bit of a superhero!
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| Professor Leigh Hale. |
Watch one, perform one, teach one. In the sport injury clinic we were taught how to suture wounds. We were taught two suturing techniques and practised this on cotton towels. The process is quite tricky as it requires steady hands and dexterity... but if you've had some practice tying hooks on a fishing lure, you're half way there. There are a lot of other important aspects of suturing, including patient comfort, local anaesthetic and sterile practices (this includes scrubbing and irrigating the wound). It's not within the scope of practice for the physiotherapist, physio student or sport medic to suture, but the opportunity is given to sports medics at the Otago Sports Injury Clinic because we're closely monitored and have our handy-work signed off by a medical doctor. There was a patient that turned up requiring a suture to a laceration on his arm following a ruck in rugby union. We were only allowed to watch that one (set up, irrigate, cut and clean up). Next time, it's all us.
Planting a time-bomb in the medical library is a felony... but that's just what we need.
Next week is the last week of this semester, then it's exam time!
Come on, Students', to the Bat Cave! There's not a moment to lose!
...to be continued!
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