Today i needed to try a car transfer with patient Y. Patient Y had a stroke, resulting in L side weakness. He also has reduced hip flexion on his L due to an arthrodesed hip. I think i handled this transfer very well. Before taking the patient out to the car, i set up my environment. I made sure there was no clutter around the car seat. I then pushed the chair back as far as i could to enable more foot space as he has such little hip flexion. I also tilted the chair back, to compnsate for the decreased L hip flexion. I took patient Y out to the car with his 2wzf and made sure he walked right up close. Supporting his pelvis i asked my patient to let go of the frame so that i could clear the space, and hold onto the door frame. I then asked my patient if he could try himself to get in the car, sliding his bottom in first. I think it was good that i did not offer immediate assistance as my patient was capable of independently transferring into the car under supervision, with verbal ques. This meant that he wsa working to his optimal level but in a asafe environment.

Week 5

Patient D was cleared for WB on monday this week after orthodpaedic reveiw, post fractured NOF. Prior to the orthopaedic review i have been doing alot of strengthening work, particulary on her quads. I have also had patient D in single leg standing, and doing small repetitions of single leg squats. Patient D usually ambulates with a 4 WZF however has been using a 2WZF to transfer whilst NWB on her L LL. During my treatment session today, patient D asked if she could return to using her 4 wzf. I decided to let her walk to the end of the corridor and back to her room wih her old 4wzf. Reflecting on this decision, i think i should not have tried her with the 4wzf. Patient D was very unsteady on her feet. I need to do alot more dynamic standing balance work before i progress her aid. I also noted that this was not an apprpopriate aid as she is ambulating with a very NBOS. Although i have attempted to correct this and continue to remind my patient to walk with a wider BOS, she has early onset dementia and needs constant prompting. I think that enabling my patient to try ambulating with the 4 wheeled walker affected her confidence, as she did not feel stable on her feet, and seems to have a more apparent fear of falling now. In future i need to think about, dynamic balance, BOS and general gait pattern more carefully before i progress a walking aid.

Week 5

Patient z presented with a fractured left head and neck of humerus 15/10/08. The fracture was to be managed conservatively in a sling for 6 weeks. For the first two weeks i introduced pendulum excercises and gentle passive ROM. I did not begin AROM as the patient is very frail and was experiencing alot of pain. During the 3rd week patient z started to have swallowing difficulties. She was transferred to the emergency hospital and underwent oesophagitis secondary biphosphonate therapy after not eating or drinking for two days. Patient z has returned to the facility for the remaining rehabillitatory period. She is now eating and drinking, however is very weak and has had quite a major set back in her fracture rehab. During my treatment session today, patiuent z complained of neck pain. I had a look at the sling that she has been wearing and it occured to me that all tghe weight of her L UL has been resting on her neck and pulling her into a kyphotic cervical neck position. i decided to go straingth to the OT and organised for another sling to be made with two loops supporting the elbow and the wrist, so that the weight would be evenly distributed across her back. I then began some active assisted ROM excercises. Usuallly by week 4, a patient who is conservatively managed should be introduced to isometric astrengthening exercises. As i do not feel my patient is ready for this progression i will monitor her AROM and progress her when she is ready.

Wk 5

Today i needed to assess patient B's ability to stand with assistance. Patient B had a stroke affecting the middle cerebral artery territory. Patient B has right side hemiplegia, expressive and receptive dysphagia and increase tone on the right side resulting in an elbow flexion contracture. I began with getting my patient into sitting on the edge of the bed. This required the assistance of two people as we rolled her to one side and then pushed up through side lying to sitting. Patient B had difficulty in sitting. She had poor trunk control and tended to fall to the right. Based upon her sitting posture and stability we decided that it would be a better idea to use a tilt table to get the patient into the standing position. To transfer her from the regency chair to the tilt table we used 3 assist and a slide sheet. We then strapped her down, ensuring that the straps were not too tight.

Week 4

Another issue we discovered during our home visit was over seating. Patient s has been ambulating in a 2wzf with one assist/ supervision however he has been using a tilt recline wheel chair for seating. This has enabled patient s to sit in less hip flexion, it is also optimal for pressure care and has long enough arm rests for the patient to push of during a sit to stand transfer. The wife informed us during our visit that the patient is inclined to spend most of his time in his lounge room chair. We assessed the chair for comfort, transfers and pressure care. The chair is too low for the patient as he will require too much assistance to go from sit to stand. The arm rests are also curved downwards at the front making it impossible for him to push down during the sit to stand transfer. Due to the L hip arthrodesis and limited hip flexion, patient s is also far better off in a seat that can tilt backwards to take the pressure of his lower back. After a discussion we decided that the best thing would be to consider getting him an electric wheelchair to sit in when he is in the lounge chair. We called independent living center to organise an appointment so that we can ensure patient s gets the best possible seating for himself.

week 4

Today i went on a home visit with patient s. Patient s is due to be discharged in a few weeks to the community with his wife as the primary care giver. The Physio's and OT staff however are concerned about the patient's 'safe' ambulation in the house. We needed to assess whether a wheel chair would be needed in doors, whether the 2 wzf would fit in all of the rooms and whether the lounge chair was comfortable and safe to transfer into and out of. I set out with another physio student the OT and patient s to the house where we met the wife. The first discussion was in regards to the front door step. Patient s is not always steady on his feet and would need assistance stepping over the door frame however it is a very narrow confined corridor and it is difficult for his wife to guide him through. We then discussed putting in a ramp, so that the patient could use his wheel chair to get into the house. Due to L hand weakness however the patient cannot wheel independently and would need his wife to push him up the ramp. The wife would then not be able to squeeze past him in the corridor to assist sit to stand.We decided that this was not going to be a safe or realistic transfer and that we would need to introduce a handle at the front door which he could hold onto and step over the door frame. The wife could supervise from behind and ensure the patient did not fall backwards.

week 4

Today i was asked to walk patient s, a new admission. Patient s had a stroke 3 months ago. He has a left arthrodesis, limiting his range of hip flexion and L sided weakness. Patient s uses a bed rail to roll onto his side and swing his legs over the edge of the bed. He needed assistance for sit to stand as he cannot get his weight forward with his limited amount of L hip flexion. Patient S was ambulating with a 2 wzf. I decided to stand on his left side, being his weak side. Once we were out in the corridor, my patient lost his balance and nearly fell to the right side. This was because he did not have enough pressure on the zf with his L hand, and his L foot lifted off. I then had to reassess what the best way to walk him was. i decided to stand on the left with my hand on his to assist with downward pressure in case it lifted off again. I also made sure that i was far enough behind him with my arm on his right pelvis so that i could stop him if he tilted off to the right. This was a far safer way of walking my patient and minimising the falls risk.