PTA 2600 - Clinical Experience I
Reflection:
After spending months in the classroom learning about physical therapy, I was a little bit scared about how prepared I was to treat patients; but by the end of my first week at the transitional rehab center I felt right at home. I found that my knowledge base was absolutely necessary, however, hypothetical "paper" patients could not compare to real live individuals. There were so many factors to take into consideration; whether it was cognitive deficits, depression, lack of motivation, varying abilities, or just different personalities. This made me realize how important interpersonal skills are when dealing with patients. I feel that this was one of my stronger areas during the experience, and my CI was exceptional with patients and taught me a lot.
I enjoyed working with all of my patient's, but there was one in particular that I really looked forward to seeing each day. He had had such a tough time over the past year, and even though the facility is a short term rehab, he had encountered so many problems that he had been there for over a year. While working with him I was able to see a lot of progression, and then regression at times. He had recovered from an infection of his TKR, had a spacer for months, and then had his knee replaced again. One day I was helping him by putting some lotion on his legs and noticed redness, swelling and heat on that leg. It worried me, my CI and I notified the PT and nurse. The next day I found out that he didn't have an infection. I was so glad, because he finally had a D/C date and I didn't want anything else to stand in his way.
Below is one of daily treatment notes I wrote for that patient:
Date: 5/21/2014
Change of orders by doctor: None
Contraindications: None
Precautions: Hypertension, Fall risk
Patient’s medical status: Unchanged
S: Patient reports that he is doing well today. Says that the hip flexor stretches gives him the ability to ambulate.
O: Pt able to transfer from w/c to Nu Step seat with Min A. Nu Step set to 5 for 20 minutes to increase active knee flexion and extension. Supine hip flexor stretch with legs hanging from mat table for 5 minutes to decrease forward lean and increase ability to ambulate. Measurement of active knee flexion 82 degrees, active knee extension 10 degrees. Practice ambulating with FWW and CGA for 100 feet and 2 breaks with no significant LOB and an increase in the ability to use stepping strategy to regain balance; still requires a w/c to follow because of knee buckling at times. Balance training catching and bouncing a ball while standing near FWW with CGA for a total of 10 minutes with 3 breaks. Seated quad exercise with pulley weight machine 10 pounds for 5 minutes. Seated bicep exercise with pulley weight machine 4 pounds for 5 minutes. Practice sit>stand 5 times with min assist. Practice stand>sit 5 times with min assist and verbal and tactile cueing to perform safely.
A: Knee active flexion has improved from 70 to 82 increasing ability to ambulate. Patient has improved ability to sit>stand from Mod assist to Min assist. Patient has increased distance of ambulation from 50 feet with Mod assist to 150 feet with CGA and 2 breaks with no significant LOB and increased ability to regain balance with stepping strategy.
P: Continue LE strengthening and ROM exercises. Continue UE strengthening. Practice stand>sit. Continue static balance exercises and progress to dynamic balance as able. Practice ambulating on level surface.
Problem(s) encountered by SPTA and outcome(s): None
Changes that need to be communicated to PT/nurse: None
This clinical experience was so amazing, my CI and the other staff were always willing to help or explain things when I needed it. I enjoyed working with the patients, and I learned so many things that will help me to be a successful PTA. I felt so much more confident after one day there than I have throughout the entire program. I am extremely excited to work in this field.
