What is wry neck. How do we treat acute neck pain.
Neck pain as a whole is a major contributor to disability worldwide, with about 70% of the population experiencing an episode of neck pain at some point in their lives. Wry neck is a recognised syndromes causing pain in the neck it occurs as involuntary contractions of the neck muscles, leading to abnormal postures and movements of the head. Fortunately wry neck is a transient and self limiting condition that can usually recover in a few days to a week. There are usually no risks or complicating however neck pain can return. Statistics show that around 10-15% if the population has neck pain at any given time.
What causes wry neck?
The exact cause of wry neck is not know but usually results from unusual movements or prolonged abnormal postures. It is thought that one of the joints in the neck become jammed or locked, resulting in a painful, protective muscle spasm. Any one can get wry neck but is typically occurs in young people between 12– 30 years of ages
Characteristics of Wry Neck
• A sudden onset of sharp neck pain
• Pain can be anywhere in the neck extending the head, shoulder and upper back, usually worse on one side.
• Difficultly turning head in one direction
• Patient is unable to correct posture due to pain and muscle spasm.
• Palpable neck spasms on affected side.
Differential Diagnosis
It may not be Acute torticollis
• Non Specific neck pain
• Cervical postural syndromes
• Cervical spine degeneration
• Acceleration / deceleration injuries
• Cervical spine fracture
• Acute never root pain
Explaining the Symptom
As Wry neck an abnormal contraction of the muscle in one side of the neck, people may appear with their head turned to one side. Their head is rotated due to the attachments of the spasming muscle and the pull of the muscle on the neck whilst contracting. The loss of movement in the neck may be due to pain and tightness of spasming muscle.
Evidence based Treatment
What work and what doesn’t
Multi-modal treatments – stretching/strengthening exercises and mobilisation/manipulation
Proprioceptive and therapeutic exercise—Muscle energy exercise
Massage - release tight affected muscle and reduce pain
Thermotherapy - heat pack applied to painful muscle
Acupuncture—short term pain relief. Can help with muscle tightness.
Temporary use of a soft collar – collar can provide support and comfort for a short period for acutely painful necks. Not generally recommended as the neck is best kept mobile and exercised naturally
Thank you
Saturday, November 29, 2008
AGED CARE LOW VS HIGH
Recently on my gerontology prac, I wondered what determined whether a patient that required aged care went into low care or high care.
There was a patient on my prac who was admitted due to hospital from an aged care facility due to functional decline, staff at the low care facility report this particular patient was to not able to return to the facility because they were unable to cope with their needs, and basically admitted the patient to hospital because they believed they required a high care facility to “cope” with this patient.
This patient’s mobility was limited in terms of distance although they were independent with a WZF up to 30 metres. If they were to return to the low care facility they needed to walk independently to the dinning room, which was 80 metres. My aim of treatment was to build to this level so that the patient could return to the low care facility. The patient’s mobility had a big influence on whether or not they went into low or high care. This reflects in the staffing and funding difference between the low and high care facilities.
From this example we see that mobility has an influence in whether a patient requiring aged care goes into low or high care, but not the whole picture.
Assessment of patients going into residential care is done by someone on the Aged care assessment team (ACAT) they ask a number of questions relating to the patients needs and determine what appropriate placement for each individual is. This essential determines the funding paid to the residential care facility.
Funding is based on three domains
Activities of daily living
Behaviours
Complex Health Care
In reflection, it is not the physiotherapist job to determine whether or not a patient goes into aged care, although in the hospital system we are the experts on patients mobility and are uniquely positioned to rehab patient to a level which achieves there maximal level on functionality. I thorough knowledge of discharge options is required to discharge patients to the most appropriate facility to care for there needs.
There was a patient on my prac who was admitted due to hospital from an aged care facility due to functional decline, staff at the low care facility report this particular patient was to not able to return to the facility because they were unable to cope with their needs, and basically admitted the patient to hospital because they believed they required a high care facility to “cope” with this patient.
This patient’s mobility was limited in terms of distance although they were independent with a WZF up to 30 metres. If they were to return to the low care facility they needed to walk independently to the dinning room, which was 80 metres. My aim of treatment was to build to this level so that the patient could return to the low care facility. The patient’s mobility had a big influence on whether or not they went into low or high care. This reflects in the staffing and funding difference between the low and high care facilities.
From this example we see that mobility has an influence in whether a patient requiring aged care goes into low or high care, but not the whole picture.
Assessment of patients going into residential care is done by someone on the Aged care assessment team (ACAT) they ask a number of questions relating to the patients needs and determine what appropriate placement for each individual is. This essential determines the funding paid to the residential care facility.
Funding is based on three domains
Activities of daily living
Behaviours
Complex Health Care
In reflection, it is not the physiotherapist job to determine whether or not a patient goes into aged care, although in the hospital system we are the experts on patients mobility and are uniquely positioned to rehab patient to a level which achieves there maximal level on functionality. I thorough knowledge of discharge options is required to discharge patients to the most appropriate facility to care for there needs.
patella femoral pain
My musculoskeletal prac, included a lot of patients with anterior knee pain. I would say it was one of the most commonly seen area of visits by patients. I effectively treated this condition but I wanted to search the literature to see if my treatment techniques had any evidence base behind them.
Patellofemoral pain (PFP) is used to describe pain in and around the patella. It is an umbrella term used to embrace all peripatellar or retro patella pain in the absence of other pathologies. Other terms of chondromalacia patellae, anterior knee pain, patella malalignment and patellofemoral arthralgia have all been used synonymously with PFP. PFP is often seen in physically active individuals and may account for almost 10% of all visits to a sports injury clinic, reported incidence rates of 7% exist among young active adults. The cause of pains may differ among patients, with the pathologic origin of the disorder not clearly understood. Numerous structures within the patellofemoral joint PFJ are susceptible to overload. A number of these intra and extra articular components can be responsible for the generation on neurosensory signals ultimately responsible for the perceived pain.
PFP is believed to develop when an individual experiences an increase in the magnitude of the PFJ load. The increase in magnitude of load can be considered in two categories intrinsic and extrinsic. Extrinsic load being affected by the bodies contact with the ground therefore moderated by body mass, speed of gait, surface and footwear. Intrinsic factors can influence both the magnitude and the distribution of the PFJ load. Increased femoral internal rotation, knee valgus and subtalar pronation are all intrinsic factors that can contribute to the development of PFP. The overload the PFJ structures may be sufficient to initial a painful response. The increase in PFJ load results in PFP through injury of the musculoskeletal tissue from supra-physiological loads, either single maximal loads or lower repetitive loads. Injury to these tissues initials a cascade of events encompassing inflammation of the peripatella synovium through bone stress. Thus any number of pain sensitive structures can results in the conscious sensation of patella femoral pain.
Differential Diagnosis
• Patellar tendinopathy
• Fat pad impingements
• Osgood-Schlatter lesion
• Referred pain from hip
• Quadriceps tendinopathy
• Patellofemoral instability
Characteristics of Patellofemoral Pain
• Pain in anterior knee may be non-specific or vague. Medial, lateral or infrapatellar
• Pain aggravated by activities that load the patellofemoral joint – eg stairs, running
• Insidious onset unrelated to traumatic incident
• May have small amount of swelling above or below the patella
Functional Anatomy of the patella femoral joint
At full extension, the patella sits lateral to the trochlea. During flexion the patella moves medially and come to lie within the intercondular notch until 130 degrees of flexion, when it starts to move laterally again. The patellas mediolateral excursion is controlled by the quadriceps muscles, particularly vastus medialis oblique (VMO) and vastus lateralis (VL) components. With increasing knee flexion a greater area of patella articular surface comes into contact with the femur, thus offsetting the increased load that occurs with flexion. Loaded knee flexion activities subject the PFJ to loads many times the body weight (eg 7-8 times for climbing stairs) Anatomically the lateral structures of the PFJ are much stronger than the medial structures, so any imbalance in the forces will cause the patella to drift laterally.
Intrinsic contribution factors
These factors may contribute to the development of patellofemoral pain
Remote factors
Increased femoral internal rotation
Increased knee valgus
Increased tibial rotion
Increased subtalar pronation
Inadequate flexibility
Local factors
Patella position
Soft tissue contribution
Neuromuscular control of the vasti
Diagnostic features of PFP
• Display typical clinical features without other pathology on the knee
• Positive McConnell’s Critical
• Pain on palpation of patella facet joints
• Medical Imaging
• X-ray – can show osteoarthritis and an increased likelihood of sinding-larsen-johansson lesion
• MRI- increasing popularity of investigating PFP, due to its capacity to image the patella articular cartilage.
The majority of patients do not require imaging although it may be useful to confirm a clinical impression obtained from the history and examination.
Evidence based Treatment
What work and what doesn’t
Based on summary of Literature found in Brukner and Khan (2006)
Multimodal Intervention – rest from aggravating activities, ice, short course of NSAID’s, electrotherapeutic modalities, mobilisation, acupuncture and taping.
Level 1 evidence
Taping – aim to correct abnormal position of the patella in relation to the femur.
Level 1 evidence
Strengthening exercises – VMO training program, generalised strength training
Level 1 evidence
Stretching—Stretching tight muscles—NA
Hip muscle retraining – retraining hip abductors and external rotators helps to control the lateral pelvis and has been associated with pain reduction in patients with PFP— NA (no available literature)
Foot Orthoses – in shoe orthoses can be an effective management for PFP
Insufficient evidience—Level 1
Surgery – to be avoided. In very resistant cases surgical options may be considered.
Thank you
Patellofemoral pain (PFP) is used to describe pain in and around the patella. It is an umbrella term used to embrace all peripatellar or retro patella pain in the absence of other pathologies. Other terms of chondromalacia patellae, anterior knee pain, patella malalignment and patellofemoral arthralgia have all been used synonymously with PFP. PFP is often seen in physically active individuals and may account for almost 10% of all visits to a sports injury clinic, reported incidence rates of 7% exist among young active adults. The cause of pains may differ among patients, with the pathologic origin of the disorder not clearly understood. Numerous structures within the patellofemoral joint PFJ are susceptible to overload. A number of these intra and extra articular components can be responsible for the generation on neurosensory signals ultimately responsible for the perceived pain.
PFP is believed to develop when an individual experiences an increase in the magnitude of the PFJ load. The increase in magnitude of load can be considered in two categories intrinsic and extrinsic. Extrinsic load being affected by the bodies contact with the ground therefore moderated by body mass, speed of gait, surface and footwear. Intrinsic factors can influence both the magnitude and the distribution of the PFJ load. Increased femoral internal rotation, knee valgus and subtalar pronation are all intrinsic factors that can contribute to the development of PFP. The overload the PFJ structures may be sufficient to initial a painful response. The increase in PFJ load results in PFP through injury of the musculoskeletal tissue from supra-physiological loads, either single maximal loads or lower repetitive loads. Injury to these tissues initials a cascade of events encompassing inflammation of the peripatella synovium through bone stress. Thus any number of pain sensitive structures can results in the conscious sensation of patella femoral pain.
Differential Diagnosis
• Patellar tendinopathy
• Fat pad impingements
• Osgood-Schlatter lesion
• Referred pain from hip
• Quadriceps tendinopathy
• Patellofemoral instability
Characteristics of Patellofemoral Pain
• Pain in anterior knee may be non-specific or vague. Medial, lateral or infrapatellar
• Pain aggravated by activities that load the patellofemoral joint – eg stairs, running
• Insidious onset unrelated to traumatic incident
• May have small amount of swelling above or below the patella
Functional Anatomy of the patella femoral joint
At full extension, the patella sits lateral to the trochlea. During flexion the patella moves medially and come to lie within the intercondular notch until 130 degrees of flexion, when it starts to move laterally again. The patellas mediolateral excursion is controlled by the quadriceps muscles, particularly vastus medialis oblique (VMO) and vastus lateralis (VL) components. With increasing knee flexion a greater area of patella articular surface comes into contact with the femur, thus offsetting the increased load that occurs with flexion. Loaded knee flexion activities subject the PFJ to loads many times the body weight (eg 7-8 times for climbing stairs) Anatomically the lateral structures of the PFJ are much stronger than the medial structures, so any imbalance in the forces will cause the patella to drift laterally.
Intrinsic contribution factors
These factors may contribute to the development of patellofemoral pain
Remote factors
Increased femoral internal rotation
Increased knee valgus
Increased tibial rotion
Increased subtalar pronation
Inadequate flexibility
Local factors
Patella position
Soft tissue contribution
Neuromuscular control of the vasti
Diagnostic features of PFP
• Display typical clinical features without other pathology on the knee
• Positive McConnell’s Critical
• Pain on palpation of patella facet joints
• Medical Imaging
• X-ray – can show osteoarthritis and an increased likelihood of sinding-larsen-johansson lesion
• MRI- increasing popularity of investigating PFP, due to its capacity to image the patella articular cartilage.
The majority of patients do not require imaging although it may be useful to confirm a clinical impression obtained from the history and examination.
Evidence based Treatment
What work and what doesn’t
Based on summary of Literature found in Brukner and Khan (2006)
Multimodal Intervention – rest from aggravating activities, ice, short course of NSAID’s, electrotherapeutic modalities, mobilisation, acupuncture and taping.
Level 1 evidence
Taping – aim to correct abnormal position of the patella in relation to the femur.
Level 1 evidence
Strengthening exercises – VMO training program, generalised strength training
Level 1 evidence
Stretching—Stretching tight muscles—NA
Hip muscle retraining – retraining hip abductors and external rotators helps to control the lateral pelvis and has been associated with pain reduction in patients with PFP— NA (no available literature)
Foot Orthoses – in shoe orthoses can be an effective management for PFP
Insufficient evidience—Level 1
Surgery – to be avoided. In very resistant cases surgical options may be considered.
Thank you
shin splints
Whilst on my musculosketal prac I treated a patient with anterior shin pain, not having come across shin pain before I had very little treatment ideas and advice for this patient in regards to managing his pain and preventing it in the future. I thought in my blog I could elabourate on what shin splints is and give some evidence based treatment advice If other student s treate a similar patient.
Shin splints are described as pain and discomfort in the leg from repetitive activity on hard surface, or due to forceful, excessive use of foot flexures. The term shin splints have historically been used as an umbrella term for shin pain which is not stress fractures. More recently descriptive terms of Medial tibial traction periostitis MTTP and Medial tibial stress syndrome MTSS have been used to more accurately description the involved anatomy and presumed pathophysiology of this common condition Beck (1998). Published studies report that shin splints accounted for 6-16% of injuries among runners, this been the third most common injury reported among runners. There is still no clear consensus of the pathophysiology in this condition thus naming of this condition may change with further research.
Differential diagnosis
• Medial tibial traction syndrome
• Bone stress reaction or stress fracture
• Chronic exertion compartment syndrome
• Popliteal artery entrapment
• Muscle-tendon injuries, strains and tendinopathy.
Signs and symptoms of Medial tibial traction syndrome
• Dull ache in over the distal one third posterior medial cortex of the tibia.
• Pain may decrease with warm up
• Pain typically worse with loading and resistance
• No focal area of pain present as that may indicate stress fracture
Diagnosis is made through
Hallmark clinical features - tenderness over a 4 to 6 cm area at the posteromedial margin of the middle to distal third of the tibia
Ruling out other pathology - Special test for stress fracture. Using a tuning for over the site of tenderness can provoke pain in the presence of a stress fracture
X-ray - indicated to rule out TSF, infection or neoplasm but findings are generally normal with MTTS
Triple phase Tc bone scan - scan is highly sensitive for tibial stress injuries with the added advantage of being able to distinguish between MTTS and TSF
MRI - has become an increasingly utilized modality for assessing tibial stress injuries.
Patho-anatomy
Neither the exact pathophysiologic mechanism nor the specific pathologic lesions are completely understood in MTP. Traditionally researcher believed the underlying mechanism was repetitive microtrauma to the periosteum and fascial attachments as a result of traction forces from the soleus and the flexor digitorum longus musculature. Although more resent research Beck (1998) is suggesting MTTS like TSF is a bone stress reaction caused by chronic repetitive loads that induce tibial bending forces. It is believed MTP is merely a symptomatic expression of normal periosteal modelling at the site of maximal tibial strain whilst under load.
Evidence based Treatment
The foundation of treatment is based on symptomatic relief, identification of risk factors and treating underlying pathology.
• Activity modification - relative rest and activity modification
Level 2 evidence
• Cushioned orthoses with a semi rigid medial arch support to assist with shock absorption and support pronated foot – can significantly reduce the overall incidence of and specifically prevent medial tibial periostitis
• Level 1 evidence
• Appropriate footwear
• Resolve acute inflammation and promote analgesia - Non-steroidal anti-inflammatory, ice, massage, ultra sound whirlpool baths and acupuncture.
Level 2 evidence
• Soft tissue therapy – digital ischemic pressure, sustained myofacial tension and transverse frictions.
Insufficient literature
• Vacuum cupping
Insufficient literature
• Surgical release – in very resistant cases, has a projected success rate of 70% improvement in high-performace elite athletes
Returning to Sport
The return to activity for athletes after treatment for MTTS must be gradual and individualized. Cross training (eg cycling, swimming, deep water/pool running) and altered training is essential to resolve with conditijavascript:void(0)on. Athletes must adhere to the “start low and go slow” mantra. Once athletes are asymptomatic, it is recommended to start at 50 percent of their baseline training load and increase the frequency/intensity/duration by 10 to 15 percent per week. They should avoid back-to-back days of repetitive impact activity for the first two to four weeks, depending on the severity of the case. If symptoms recur, two additional weeks of rest are recommended and should be followed by a “downgraded” training regimen. Patients can often achieve a return to full, unrestricted activity in three to six weeks. However, a delayed return is not uncommon for this often refractory condition.
I hope this information helps any other students if they treat anterior shin pain.
Shin splints are described as pain and discomfort in the leg from repetitive activity on hard surface, or due to forceful, excessive use of foot flexures. The term shin splints have historically been used as an umbrella term for shin pain which is not stress fractures. More recently descriptive terms of Medial tibial traction periostitis MTTP and Medial tibial stress syndrome MTSS have been used to more accurately description the involved anatomy and presumed pathophysiology of this common condition Beck (1998). Published studies report that shin splints accounted for 6-16% of injuries among runners, this been the third most common injury reported among runners. There is still no clear consensus of the pathophysiology in this condition thus naming of this condition may change with further research.
Differential diagnosis
• Medial tibial traction syndrome
• Bone stress reaction or stress fracture
• Chronic exertion compartment syndrome
• Popliteal artery entrapment
• Muscle-tendon injuries, strains and tendinopathy.
Signs and symptoms of Medial tibial traction syndrome
• Dull ache in over the distal one third posterior medial cortex of the tibia.
• Pain may decrease with warm up
• Pain typically worse with loading and resistance
• No focal area of pain present as that may indicate stress fracture
Diagnosis is made through
Hallmark clinical features - tenderness over a 4 to 6 cm area at the posteromedial margin of the middle to distal third of the tibia
Ruling out other pathology - Special test for stress fracture. Using a tuning for over the site of tenderness can provoke pain in the presence of a stress fracture
X-ray - indicated to rule out TSF, infection or neoplasm but findings are generally normal with MTTS
Triple phase Tc bone scan - scan is highly sensitive for tibial stress injuries with the added advantage of being able to distinguish between MTTS and TSF
MRI - has become an increasingly utilized modality for assessing tibial stress injuries.
Patho-anatomy
Neither the exact pathophysiologic mechanism nor the specific pathologic lesions are completely understood in MTP. Traditionally researcher believed the underlying mechanism was repetitive microtrauma to the periosteum and fascial attachments as a result of traction forces from the soleus and the flexor digitorum longus musculature. Although more resent research Beck (1998) is suggesting MTTS like TSF is a bone stress reaction caused by chronic repetitive loads that induce tibial bending forces. It is believed MTP is merely a symptomatic expression of normal periosteal modelling at the site of maximal tibial strain whilst under load.
Evidence based Treatment
The foundation of treatment is based on symptomatic relief, identification of risk factors and treating underlying pathology.
• Activity modification - relative rest and activity modification
Level 2 evidence
• Cushioned orthoses with a semi rigid medial arch support to assist with shock absorption and support pronated foot – can significantly reduce the overall incidence of and specifically prevent medial tibial periostitis
• Level 1 evidence
• Appropriate footwear
• Resolve acute inflammation and promote analgesia - Non-steroidal anti-inflammatory, ice, massage, ultra sound whirlpool baths and acupuncture.
Level 2 evidence
• Soft tissue therapy – digital ischemic pressure, sustained myofacial tension and transverse frictions.
Insufficient literature
• Vacuum cupping
Insufficient literature
• Surgical release – in very resistant cases, has a projected success rate of 70% improvement in high-performace elite athletes
Returning to Sport
The return to activity for athletes after treatment for MTTS must be gradual and individualized. Cross training (eg cycling, swimming, deep water/pool running) and altered training is essential to resolve with conditijavascript:void(0)on. Athletes must adhere to the “start low and go slow” mantra. Once athletes are asymptomatic, it is recommended to start at 50 percent of their baseline training load and increase the frequency/intensity/duration by 10 to 15 percent per week. They should avoid back-to-back days of repetitive impact activity for the first two to four weeks, depending on the severity of the case. If symptoms recur, two additional weeks of rest are recommended and should be followed by a “downgraded” training regimen. Patients can often achieve a return to full, unrestricted activity in three to six weeks. However, a delayed return is not uncommon for this often refractory condition.
I hope this information helps any other students if they treat anterior shin pain.
Tuesday, November 18, 2008
Abuse on the ward
Recently on my cardio placement, myself and another student happened to encounter a patient with an extremely violent history with unresolved severe mental illness, drug abuse and was Hep C +ive. He was admitted to the ward with a severe chest infection and subsequently stayed for most of the duration of our 4 week placement.
Although we did not directly have to treat the patient as he was deemed too aggressive, we did on occasion have to talk past him and talk to him when he confronted you. The patient hadd 14 code blacks (personal threat) called against him and required 4 point restraint on the bed and sedation on multiple occasions. He also required security guards to follow him whenever he left his room.
The patient became increasingly aggitated and restless as the weeks progressed and his behaviour more unpredictable to the point where he lashed out at a nurse who was not even looking after him and proceded to assault her. Knowing this it made it made me feel anxious and nervous around this patient when I passed him in the ward as he had a tenedency to talk to anyone he wanted to very unexpectably and would demand you reply. I found myself not acting like I usually would and becoming quite reserved around this patient.
Unfortuntely the patient picked up on this and and the change in behaviour toward him and not other patients was enough to set him off into a spat of abusive insults to all staff on the ward.
I learned as the days went on that the best way to deal with this patient was to be alert and on your toes at all times due to his unpredictability but also to treat him like anyone else and ask him how he was and try to relate things to his life even though I was not treating him in any way. The patient responded well to this and would often initiate harmless conversation with me knowing that I wouldn't judge him for his past.
Although we did not directly have to treat the patient as he was deemed too aggressive, we did on occasion have to talk past him and talk to him when he confronted you. The patient hadd 14 code blacks (personal threat) called against him and required 4 point restraint on the bed and sedation on multiple occasions. He also required security guards to follow him whenever he left his room.
The patient became increasingly aggitated and restless as the weeks progressed and his behaviour more unpredictable to the point where he lashed out at a nurse who was not even looking after him and proceded to assault her. Knowing this it made it made me feel anxious and nervous around this patient when I passed him in the ward as he had a tenedency to talk to anyone he wanted to very unexpectably and would demand you reply. I found myself not acting like I usually would and becoming quite reserved around this patient.
Unfortuntely the patient picked up on this and and the change in behaviour toward him and not other patients was enough to set him off into a spat of abusive insults to all staff on the ward.
I learned as the days went on that the best way to deal with this patient was to be alert and on your toes at all times due to his unpredictability but also to treat him like anyone else and ask him how he was and try to relate things to his life even though I was not treating him in any way. The patient responded well to this and would often initiate harmless conversation with me knowing that I wouldn't judge him for his past.
Unprofessionalism
Recently I went to a neuroloigical consultation and multidisciplinary team meeting with my senior to discuss the progress and future care plan for one of my patients. What utterly shocked me the most was the extreme unprofessionalism of the meeting particularly on the neurological consultants behalf. I had been preparing myslef thoroughly for the meeting so that I could provide all the health professionals with the best handover I could so that the team looking after my patient and the consultant knew his progress (and also so I didn't look like a really unintelligent student and make a fool of myself). I had always looked up to consultants, respecting them completely for the amount of hard work, effort and years of dedication that they had given to their field of expertise.
The meeting opened with jokes and comments regarding flatulence, with the consultant proceeding to ask all 15 people in the room their preferred way of using toilet paper (folding/scrunching). I thought that this was highly inappropriate especially for someone like me who was new to the meeting and had never met many of the health professionals before.
It took over 45 minutes to begin the actual discussion on each patient and even then the consultant continued to make bizarre and inappropriate comments about patients and other topics.
On leaving the meeting over 1 hour and 45 minutes later, my senior proceeded to tell me that she also felt that the situation was very unprofessional however I would have to draw my own conculsions on the matter. Was it purely just a bit of fun and humour? I feel not, I felt like all the staff there also thought that the behaviour was unaccebtable but laughed along anyway because it was the consultant, a senior staff member. However to me he will not be so respected in regards to his communication with other staff.
The meeting opened with jokes and comments regarding flatulence, with the consultant proceeding to ask all 15 people in the room their preferred way of using toilet paper (folding/scrunching). I thought that this was highly inappropriate especially for someone like me who was new to the meeting and had never met many of the health professionals before.
It took over 45 minutes to begin the actual discussion on each patient and even then the consultant continued to make bizarre and inappropriate comments about patients and other topics.
On leaving the meeting over 1 hour and 45 minutes later, my senior proceeded to tell me that she also felt that the situation was very unprofessional however I would have to draw my own conculsions on the matter. Was it purely just a bit of fun and humour? I feel not, I felt like all the staff there also thought that the behaviour was unaccebtable but laughed along anyway because it was the consultant, a senior staff member. However to me he will not be so respected in regards to his communication with other staff.
Helping those that do not help themselves
How do we assist someone who does not want to or have the desire to help themselves? On a recent placement one of my patients who was morbidly obese with severe arthritis of most of her large peripheral joints which in conjunction with each other and her lack of motivation had resulted in a severe loss of function.
On the second time that I visited her I found that she would rather blame her lack of mobility on everything else other than her weakness, escessive weight and lack of motivation. In the public health sector, resources and staff are stretched to full capacity as it is, there simply is not the time or manpower to do everything for these patients and treat them on an ongoing basis.
I know that this particular patient may have thought I was a little cruel but I refused to be lenient as I knew she had the ability just not the motivation or the determination. When pushed this patient could get up and walk to the physio gym from her ward rather than be wheelchaired. On one particular session I managed to push her to walk 250m after she had previously been to or from the gym. On subsequent session, the patient displayed utter disgust and shock when I arrived to her room without the wheelchair in tow. She complained the whole way but I didn't care, she was safe and stable which was the most important thing. The only reason she was still in hospital was becuase of her weight and her instistance that she was not ready to go home.
She could abuse me or any other physio all she liked but we are only trying to ensure that she receives the best health outcome. Sometimes shock tactics is what is required to motivate people or to get them to take ownership of their own health. No one else is responsible for their lifestyle and health choices. She may like the nursing staff that come round to see her rather than physio but it is not their respoonsibility to know what specific areas this particular patient needed addressing in.
At some stage treatment and care for these patients has to cease, but when? However it is a fine line between ceasing treatment completely and maintaining treatment to prevent readmittance to hospital. In such an instance what do you do?
In the end the patient was discharged much to her disapproval and was provided with rehab in the home to focus on functional goals within a contextual setting. Quite frankly I was glad she had left because I felt that there were so many other patients that could of benefitted from my help, I really didn't see the point in wasting my time, her time and resources on someone who was draining the system.
On the second time that I visited her I found that she would rather blame her lack of mobility on everything else other than her weakness, escessive weight and lack of motivation. In the public health sector, resources and staff are stretched to full capacity as it is, there simply is not the time or manpower to do everything for these patients and treat them on an ongoing basis.
I know that this particular patient may have thought I was a little cruel but I refused to be lenient as I knew she had the ability just not the motivation or the determination. When pushed this patient could get up and walk to the physio gym from her ward rather than be wheelchaired. On one particular session I managed to push her to walk 250m after she had previously been to or from the gym. On subsequent session, the patient displayed utter disgust and shock when I arrived to her room without the wheelchair in tow. She complained the whole way but I didn't care, she was safe and stable which was the most important thing. The only reason she was still in hospital was becuase of her weight and her instistance that she was not ready to go home.
She could abuse me or any other physio all she liked but we are only trying to ensure that she receives the best health outcome. Sometimes shock tactics is what is required to motivate people or to get them to take ownership of their own health. No one else is responsible for their lifestyle and health choices. She may like the nursing staff that come round to see her rather than physio but it is not their respoonsibility to know what specific areas this particular patient needed addressing in.
At some stage treatment and care for these patients has to cease, but when? However it is a fine line between ceasing treatment completely and maintaining treatment to prevent readmittance to hospital. In such an instance what do you do?
In the end the patient was discharged much to her disapproval and was provided with rehab in the home to focus on functional goals within a contextual setting. Quite frankly I was glad she had left because I felt that there were so many other patients that could of benefitted from my help, I really didn't see the point in wasting my time, her time and resources on someone who was draining the system.
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