Today started with another great breakfast made by our house mom and a walk to the local church.
Today I went with a second group of students. We have 11 groups of students so the licensed therapists took 2 groups. This group had 3 patients to see today and did not have mentorship the first day so they had some great questions.
Our first patient was a middle aged male who was in a wheelchair. The students did a great job working together to get as much information as possible but I did not fully understand what happened so we had to dive into that a little more. Come to find out he had scoliosis and they did a lumbar and thoracic fusion which lead to paralysis of his lower extremities. This scenario shows how dangerous surgery can be. During the evaluation the students perfected their technique and improved their clinical thinking. We were able to address multiple issues with this patient including core strengthening, gait, foot posture in sitting, and education. We found out that he will be having surgery for the plantar flexion and inversion. He reports he will be having a tendon release and possibly a "screw" in his ankle. I was shocked and angry at this concept as he had 10 degrees of passive dorsiflexion and the pinning would only cause more problems!! Spent time educating him about this and trying to take control of his healthcare. Sadly this may not help but it is worth a shot.
After the therapy and Exercise education he reported much more confident and tired. He reported doing therapy in the past with similar exercises but not "feeling it in the same muscles". I really wanted the students to take this point with them for the future. I truly believe that as therapists we need to emphasize motor recruitment and motor planning. Making the patient aware of correct patterning has a huge impact on body awareness and reducing compensations. For this patient to have done these exercises such as planks, hip marching and standing hip extension but never feeling glute activation makes sense as to why he was moving the way he was. After one session he had much improved gait with video observation. We left with a plan to buy equipment to modify his wheelchair to get his foot in a better position and solidify a HEP for when we leave.
The second patient was not available but when we went by his house we looked at the ramp that was built last year and it had eroded so we devised a plan to help rebuild the ramp later in the week and evaluate him on Thursday or Friday.
The third patient was one they saw the first day. She has Rheumatoid arthritis and a history of 4 strokes that have caused her to limit activity and function. They reported that the first day she was unable to flex her left leg but after some manual therapy and exercise she was able to move it. However she was unwilling to let the students touch her hand which was held in a fist. She had a very supportive husband and child who informed us that she was having trouble with long nails and a lot of hand pain. So I decided to give it a shot to see if we could change anything with her hands today. She was resistant to movement yesterday so we decided to put her hand in water to gain her trust and slowly worked on movement. By the end of the session her fist was open to where she could grip a tennis ball! We emphasized education about the importance of passive movement to maintain motion and increasing waking with her husband.
We ended the day attempting to see one more patient but they were not at home.
After lunch we met with all of the equipment and divided it based on need to each group and then we went to find other materials we needed. However the rain started as we shopped around for materials and prepared for the next few days. We had to go from stand to stand to find all of the materials we needed but it was fun to practice our Spanish and think outside the box with the materials we could get.
We met up with local children to play soccer again but a few minutes into the game it started to pour so we hung out under tree shelter. We used some of our clinic paper to make paper airplanes, played tag, and made a piñata. We all had a great time together.
My favorite part of today was talking to the first group from yesterday who stated they saw all 6 patients and felt confident. They said that yesterday gave them confidence and prepared them well. I was so proud of their effort and willingness to learn and take the advice!b
After amazing home cooked taquitos we all went out to reflect on the days and enjoy ourselves.
All of the other groups had so many great stories and creative ideas for treatment. Throughout the night I would see groups asking for ideas and working together to help each other. Already so proud of this group of students in their efforts and cultural awareness.
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