PT Clinic Reflection Journal

11/28/07

P: Today I worked with two new patients. The first patient was post CVA and I mainly worked on getting the patient to balance on the unaffected leg and using the appropriate muscles on the affected leg. I did this by using reciprocal stepping and alternating stair stepping. The patient was unable to do this with out substituting today, so we had to back up and just practice getting the right muscle to contract in sitting.

My second patient was post knee replacement. I worked on strengthening the quads and increase both knee flexion and extension. I mainly did therapeutic exercises. The exercises I practiced today were the Nustep, lunges with the right leg on a step, wall climbing, SLR with external rotation, and a prolonged prone stretch to the hamstrings with the cool pack to the anterior knee.

O: Today I observed one of my instructors show me how to facilitate the muscle of my first patient. I also observed my first year student do goni measure to the knee of my second patient along with apply a cold pack.

L: Today I learned how to work on muscle re education on CVA patients. My instructor really helped my on how to facilitate the muscle to contract and how to pick an appropriate exercise depending on how the patient is doing that day.

K: I already knew how to perform the therapeutic exercises on my second patient. I have used these types of exercises on other patients before in the clinic. Although for each patient exercises are done a little different. I feel fairly comfortable adjusting the exercises from person to person.

A: I felt like today could have gone a little better. It wasn’t my best day this semester. The treatments went well today. I just need to practice working with people post stroke and look over my notes. I also plan to make sure my first year is really understanding the treatments. I also need to make sure the first year is more involved in the planning of the treatment. This week was kind of hard to have the first year plan because I had two new patient, so during the prep time I was concentrating on learning about the patients. Hopefully next week will go better.

11/21/07

P: This week in clinic I worked with two patients. The first was a patient I have not worked with before. I did ultrasound, pec, upper traps, and scalene stretches, strengthening of the middle traps and rhomboids, and massage.

The second patient I worked with was the pediatric patient I worked with last week. I worked on sitting balance, weight shifting with approximation, getting on all fours, head control, sit to stands, and walking.

O: I observed the PT perform joint mobs on my first patient’s spine and ribs. It was really fascinating to watch.

L: I learned how challenging and exhausting to work with pediatric patients. It was easier to come up with ideas working with this patient last week, but it was a challenge to get the patient to do what I was trying to do. I was trying to concentrate on what I was doing while trying to keep it interesting. The biggest challenge came at the end of the treatment when the patient just didn’t want to do anyone. I definitely needed more ideas than I had prepared.

K: I already knew how to do the stretches and exercises. I also knew how to do ultrasound and massage also. This was the first time I performed ultrasound on a patient in the clinic. I am also really starting to become comfortable doing massage.

A: This week in clinic went well. I need to work on coming up with more ideas before the treatment with my second patient. This will help when the patient does want to do one thing I can try another. I also need to make sure I get done with my first patient on time because I tend to run a couple minutes over then I start my second patient late.

In last blog when I said I hadn’t wrote a soap note in awhile it was because I was on a stretch of only having one patient. My first year would write the note and then I would look over it. I hadn’t myself in awhile wrote my own soap note.

11/14/07

P: Today I worked with two patients, one I have worked with once previously and the other was my first pediatric patient ever. With my first patient I worked on stretching, balance exercises, and massage. I performed a hip flexion, hamstring contract relax, and pec stretch. For balance exercises we worked in the parallel bars on single leg stance and tandem standing. We only got through these balance exercises because the patient became fatigued. I also gave a 10 minute massage to the upper trapes.

For my second patient another second year and I worked together. We worked on sit to stands, getting the patient on all fours with approximation, taking steps with approximation, sitting balance, and reaching for toys. We basically focused on getting the patient into different functional positions and approximating to get the patient to be comfortable in these positions.

O: With my second patient I did a lot of observation with the other second year taking the lead. I watched her do a lot of the treatment and helped out when I was needed. I also watched the first year student do stretches on my first patient. I had her watch while I stretched one side and then talked her through how to stretch the other side.

L: Today I learned a lot about working with pediatric patients. We have learned a lot about working with pediatrics with brain damage this year in class, but I got the chance today to actually use these skills. The other second year has worked with this patient before and really helped me out a lot. She came up with the majority of the treatment and I learned a lot from watching her.

K: I already knew how to do the balance exercises and stretches I did with my first patient. I have not only worked with this patient before, but have done these exercises with other patients in the clinic. I was comfortable with this treatment plan.

A: I was really nervous about working with the pediatric patient. Luckily, someone who has worked with this patient before was able to help me out. The second year I work on with the pediatric patient was phenomenal. She taught me so much. Now I feel comfortable working with this patient and am looking forward to coming up with my own treatment plan next week.

I am also finally becoming more comfortable giving massage. During today’s treatment was the first time that I felt like I was actually accomplishing something with massage. I think my problem was I focusing on what I couldn’t see instead of what I felt. I still want to work on massage, but I am becoming more comfortable with it.

I also wrote a soap note for the first time in awhile. I though I would be really rusty since I haven’t written one in awhile, but has actually really helped me reading over the first years note. Since the beginning of the semester I think I have really improved in my documentation by decreasing the amount of time it takes me to write the notes and I was able to write a lot of my note during the treatment. Over all, today was a great day in the clinic.

11/7/07 

P: Today I worked with a new patient who was post op ACL reconstruction. I practiced biofeedback, taught a home exercise program, and did IFC. I had the biofeedback connected to the patient’s quads for muscle re education to promote the patient to contract the muscle. The home exercise program consisted of exercises to strengthen the quads and hamstrings. I also did IFC for pain and inflammation.

O: Today I observed the SPT do a treatment on his patient. They worked on trunk control specifically alternating isometrics and rhythmic stabilization in side lying on both sides and supine. The SPT also worked on strengthening in the parallel bars.

L: I learned a new way to use theraband. Another second year student helped me find the right way to use the theraband to resist knee flexion. I also learned how to do IFC better. We have gone over it in class and an instructor helped me do it on a patient.

K. I already knew how to do the skills I used today. It was just refreshing my memory on how to do them. Biofeedback and giving a HEP are skills we learned last semester, but this was my first time in the clinic using these skills. IFC we learned in class earlier this week, so I knew how to do it. I just need more practice applying it to the patient.

A: Today I felt was an off day for me. I felt disorganized. The treatment went okay, but feel I could a lot better. Again today I felt today I didn’t include my first year as much as I wanted to. I was glad to get a new patient to get out of my comfort zone. Today showed me I need to review biofeedback and practice more with IFC. Next week in clinic I plan to really involve my first year in the treatment and try to come up with a way to help him with his documentation. I also need to practice using theraband more because I am not very good at it.

10/31/07

P: Today was an unusual day in the clinic for me. I started today with two patients, one I have treated before and a new patient. Then the patient I have treated many times cancelled, and I was going to co treated with a PT student on the other treatment because there was not a lot in the POC. Also the patient needed electrical stimulation that we have not learned yet. But I ended up treating another patient that I have treated several times before because the patient showed up early. The PT student ended up observing my treatment because the patient we were going to co treat didn’t show up.

I practiced lower extremity strengthening and stretching on the patient. I did a Thomas stretch and observed the 1^st year student do a hamstring stretch. For strengthening exercises, I did knee extension, dorsi flexion, step ups on a 51/2 in block, lunges, side steps with mini squats, and donkey kicks.

O: Today I observed the 1^st year student do a hamstring stretch on my patient. After my treatment while helping the 1^st year with documentation, I was also observing another 2^nd year student give her treatment. I observed her do step ups, stretching, and rocker board.

L: Today I learned the differences a patient with MS can have. My patient was having an off day today. He was very fatigued and it took a lot of effort for him to do some exercises. He was also having a hard time with his balance today. We just learned about MS in class, but I don’t think I truly understood what it was like during an exacerbation period until today.

The PT student also taught me an alternative way to perform DF strengthening with a gait belt.

K: I already knew how to do the stretches and exercises I did with the patient today because I have worked with this patient several times before.

A: I was happy and proud of myself that I was able to plan for a patient in a short amount of time and feel comfortable with the treatment. In addition, I wasn’t really nervous with having two people watch my treatment, the 1^st year student and the PT student. Even though it helped I have worked with this patient before but, I feel it was an accomplishment. Although it was kind of a slow day in clinic because of all the cancellations, I was happy with the accomplishments.