PHYSIOTHERAPY

 
Beth
Ciavaglia (QCH)

1) Instructed 4 physiotherapy students
Did teaching and helped them treat cases in paediatrics and a stroke patient. Worked on the concept of goal setting and prevention, as well as contra-indications in certain cases. I was impressed by their capabilities and confidence yet open attitude to learning. It’s a challenge to impart to the families the need for early mobilization of the patient, yet the students seemed more open to this. One was even interested in acupuncture!

 

2) Pediatrics- 3 cases

a) one microcephaly 2 ½ year-old (who appeared 4 months old) caused by Zika virus. Here the focus was PROM and positioning. Tonya and I made a resting hand splint. I saw him twice, then he was discharged but ended up returning when his catheter became blocked.

b) 3 yr old with an abscess (somewhere in her throat) for which she required 2 surgeries: I was the first person to get her up walking again after having been in bed x 2 weeks. Also brought her paper and markers to work on the strength and AROM of her right arm and hand. Helped the physiotherapy students assess and come up with a treatment plan. Taught massage techniques for her upper traps which were just rigid from protecting her neck for so long. She liked that best! Encouraged coughing a deep breathing. I would visit her twice daily x 5 days.

c) 9 year-old TBI with mild residual right sided weakness. Assessed safety on stairs. Devised a home exercise program.

 

3) Pediatric ICU-1 case

a) 11 year-old with a brain tumour. Big focus was on positioning as he was spastic. Also taught the students the difference between spasticity and hypertonicity. I visited him daily x 4 days

 

4) Med/surg A-2 cases

a) TBI from a motorcycle accident: transferred him to a w/c on first day, 3 days later he was walking with an assist of 2 and a 4-point walker.

b) Possible tetanus: PROM, positioning

 

5) Med/surg B-2 cases

a) An acute stroke: PROM, position, dangling at side of bed, weight-bearing exercises, neglect avoidance exercises. Worked with the students twice with this man. Educated on caution needed around possible subluxation of humeral head over time due to flaccidity. I visited him twice.

b) A second acute stroke: this woman was more unstable. Did some education around her vitals and also pointed out how her flaccid arm did not need to be restrained!! 1 visit

 

6) Pre-op clinic- 3 cases

a) R knee OA/menisus tear: taught exercises as deemed non-surgical

b) Patient there for new left ankle fracture but had not been WB on his right femur ORIF (6weeks old): taught strengthening and AAROM exercises and educated him and his companion on the need for him to WB on that leg. On that visit, he was only flexing approx. 30 degrees. I saw him again in the courtyard 2 days later while he was awaiting the ankle ORIF, and he was now bending 90 degrees!

c) Literally right before surgery, taught the patient AAROM exercises for fingers and wrist. He was getting a metacarpal ORIF (got to sit in on this one too).

 

7) Post-op: 2 cases
a) Exercises and ROM exercises post femur ORIF x 2. WB restrictions and crutch use

 

8) Visit to general hospital
Can’t say I actually did any work here!!! More Darryl and Mahmoud catching me from fainting, but was super eye opening, and did get to see the patient with horrible bilateral femur #’s pre-op then observe his surgery. Would have been really good if I could have tried to get him up or even talk to him before he got transferred back to the General.

 

Though there wasn’t high volume on this mission for me, that is actually one thing I really enjoyed: I had the time to spend with people, where at home I am constantly running to the next person.

Cases 

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