Woke up ready to go back to see patients. I was back with the original group I worked with day one and we went very efficiently. We started with a quick meeting to game plan progression and treatment plans. The group really had it down and understood how much would
Be too much and what needed more emphasis. We started with the young girl who had cerebral palsy emphasizing the progression in each position. She did fantastic today and her aunt was very involved. We also saw her twin sister who may have ricketts with extreme bowing of her knees. The angle was about 20degrees is standing which is pretty severe. We assessed her movement and educated the patient of continuing with the physical therapy consult in country as well as the weight bearing modifications.
After that we went to the patient who had the broken hip and was non weight bearing. His family member was another one of the evaluations we had to see so two of the students saw the gentleman and myself and one student saw the evaluation. She was the patient who broke her hip but was able to have surgery. She is active but has a noticeable limp and is limited with long duration walking and activity. After the examination we treated using an assess treat and reassess method to help determine the most effective treatment, she reported much improved pain, less compensated trendelenburg, and improve prone knee bend. We will follow up with her the last day. The students working with the other gentleman working on standing balance/tolerance on the unaffected leg and his transfers with his family members to improve tolerance.
The next patient was the best and most rewarding interaction of the day. The stoic patient with Parkinson's was sitting in his chair with a little more of a rock and his family said it was his birthday. We sang happy birthday in Spanish and began the session. After some manual therapy and thoracic extension exercises we turned the "romantic Latin" music on and began. The students and patients rocked it. He was doing big movements, lateral walking, dancing, and turning. His movements were smooth with the music. We gave him a rest but after a few seconds a faster song came on and he jumped up on his own and started dancing. Luckily the students quickly jumped to action and began another session. After a long session he finally was tired. When we left him he stated that "we have brought life back into him today". Everyone was so happy with the impact these three sessions have had on this patient. So rewarding!!
Another group met up with us after this patient and I went with them to perform an evaluation. The patient was a sedentary lady who spent 80% of her day in bed and 20% in a chair. She was unable to roll. Unable to perform supine to sit without max assist and needed max assist by a neighbor for her transfer. She had extreme muscle wasting. Her chief complaint was shoulder pain and her motion was about 50 degrees in supone active and 110 degrees passively. We brought down a pulley and she was able to improve ROM so we left her with one. We also added rolling into her daily activity to reduce risk of bed sores, improve trunk strength and promote extension. In prone she was unable to lift her head for longer then 10 seconds which is very poor so this position would benefit her greatly. This group of students did a great job!
After lunch most of the group went on a zip lining and the rest went up to the top of the volcano. I had to join the zip line group and it did not disappoint. Speed, heights, and upside down are all things I enjoy so it was right up my ally.
Another great dinner and then one of my groups met up and we worked on evaluation writing. They had so many great questions and you could really tell how they were thinking from their writing. The organization has 6 groups of therapy students come down to Nicaragua each year so they keep documentation for future groups to review. I set high expectations for the notes and the students are working hard to write strong documentation.
I spent the time helping them, writing this blog, and talking to Olivia finalizing some wedding stuff. Very productive day!!
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