Clinic Day 1

Today was a great first day in the clinic. We began with a great meal prepared by our host mom and set off to meet as a group. We planned to have 4 house visit evaluations that quickly turned into 6 when our translator explained that another two patients had asked for therapy in the area we would be treating.

The three students I was working with did a fantastic job working together during the first evaluation.  For some of them this was the first patient they have treated. Doing this is stressful enough, but add a foreign country in a language you don't speak makes it even more of a challenge. The first patient was a young man who had polio and severe scoliosis. We did not know what to expect but we all were excited when he was doing everything without an assistive device. The students did a great job working to perform a subjective and objective evaluation finding key information and looking at functional movements and patterns for treatment. They also took photos and videos as baseline measurements for objective measures. The patient was highly

Motivated as he already does 4 exercises daily which includes 50 repetitions of each workout!  We finished with a detailed explanation of his home program an de our plan for the week.

The second patient was a young girl who was the first born of twins. She was one of the patients added on to our schedule so we only knew that she was undiagnosed. When we entered the house I decide to take the lead having had PEDS experience and missing working with kiddos. It was so much fun getting back on the floor and assessing young children.  It was quickly evident that she had a severe disability. After the evaluation I found her developmental age to be about 4-5 months when sadly her biological age was 2 years old. She was very far behind her sister and was unable to sit unsupported or hold her head up in prone for more then 3 seconds independently. Today, my emphasis was education to the mother about tummy time and working on molding and hands to feet playing. Very fundamental things that she had not been doing. The aunt was able to perform the exercises and before we left we asked if she had any more questions. The mom asked if she would be able to walk soon.  The students were shocked by this question... as we just saw how far behind she was and that she could not even sit unsupported.  We answered the question by saying how she needs to master these skills and as she progresses with her strength she can continue to work toward walking. We cannot guarantee that she will walk, but we did not want to give false hope that crush dreams by making a definitive answer. We wanted to focus on the short term goals for now.  Education will be huge with this family!

The next patient was a 93 year old man who was wheelchair bound after a fall last year. He broke his hip and was unable to have surgery (the patient said his doctor told him it was due to medical issues). The students worked on a fantastic history as I looked at the x-rays his daughter provided. The x-ray was one of the worst hip fractures I had seen. The femural head was still in place but the femur fractured at the surgical neck. The bone went upward and was in line with the iliac crest. In sitting his femur was about 4-5 inches shorter on the left compared to right. He was non weight bearing and either sat Orndorff laid down all day. Our treatment and exam quickly went away from hips to working on pressure relief, transfers with the family, and positioning. This was a very interesting case and a great experience for the students. 

One of the other newly added evaluations was his other daughter who also fell and broke her hip. Luckily she was able to have surgery so we decided to focus on the older gentleman and would evaluate her the next day.

The 5th patient was an elderly female who was bedbound and relied on her family for everything. When we tried to evaluate her she was getting changed so they told us to return tomorrow. 

The final patient of the day was a stoic male with Parkinson's. He lived with a large family and those dynamics made the evaluation hard. When the students performed the evaluation the family wanted to answer many of the questions and tell the patient what they believed. They did a great job of taking control and making sure that they got the information they needed and built a bond with the patient. He was very sedentary and believed that Parkinson's caused his pain.  We had to spend time educating him about what Parkinson's is, and the effects of lack of activity on joints and pain. He seemed interested in the treatment plan for the week including music and movement. 

We had lunch back at the house and then spent the afternoon traveling by boat to see the small islands of Nicaragua created by the volcano years ago. They have 300+ islands off Nicaragua. We got to see a few including the "monkey island" with moneys living on the island and hanging out on one that had a reaturaunt and pool. At the end of the fun we sat in a group and did a fantastic reflection. The students had some great ideas and really learned a ton about themselves, the culture, and clinic which was great to see in only one day!

After a meal back at home we ended the day at a local hangout spot reflecting on the experience.

Excited for clinic tomorrow