Second entry (fourth year neuro)

S// The following situation relates to a new stroke patient that was put in my care during my second week of placement. Prior to this patient I had only managed patients with Multiple Sclerosis so this was my first stroke patient and subsequently I was quite anxious. From my assessment I had compiled an impairment list and plan for treatment.
T// To perform an initial one hour treatment session.
A// The aim of my treatment session was to increase the patient’s awareness of his core muscle activation i.e. transverse abdominus and glute medius. I then completed a one hour treatment session with exercises focusing on achieving this goal.
R// Initially the patient had difficulty activating his specific core muscles, however as the session continued the patients performance improved and by the end of the session he was capable of voluntarily activating the intended muscles, without any facilitation.
E// The exercises I had included in my treatment session were effective in addressing the intended impairment. My reassessment at the end of the session definitely showed a considerable improvement in the patients voluntarily core muscle activation. I believe my planning and my feedback were my greatest strengths and were both crucial in making the session effective. My handling was my greatest weakness and as I later learnt actually made the tasks harder for the patient as it actually increased the patients tone. Other weaknesses included my explanation of exercises, which were too complicated and confused the patient, and also my time management.
S// On reflection I need to make my explanations as simple as possible and just use key words, which will limit any patient confusion. And this is definitely a strategy I have adopted in subsequent treatment sessions. I also need to monitor the time throughout the sessions so that I maximize actual treatment time and reduce time spent on organizing my treatment area, which I need to do prior to the patient arriving. I have also learnt the importance of time management in a rehabilitation specific facility, as the patients often have occupational and speech therapy sessions after physiotherapy and the therapists in these fields do not appreciate physiotherapy cutting into their time. I have subsequently got into the habit of finishing treatment sessions ten minutes early to allow sufficient time to get the patients dressed and back in their wheelchair prior to their next scheduled appointment.