Potential

A big Hi to dear all again. Looks like all of us have completed clinics for the 3 main disciplines of Physiotherapy and are into the mad rush to prepare for the scary PCR.

Things are running around my head and I'm sitting here facing my notebook not knowing exactly what to type cos throughout these 12 weeks of placements, I have learnt and pondered so much that there's just too much to share. Guess a choice of just one is unavoidable.

Recalling the day I entered the Neurology outpatient department for the first time, my heart just sank cos I've always thought yours truly was hopeless at neuro and being in an outpatient setting, its difficult to actually see gains from treatment just by the nature of the duration since their stroke(which will "de-moralize" me even further). But of course, through reading your blogs and hearing the experiences of others, I've always had the belief that these patients do get better with treatment. Just that I've never experienced it myself yet. Not until this placement.

Here's a case to share:

Just a brief summary of this patient: 66 year old lady with a (L) MCA infarct about a year an a half ago. She has been coming to the outpatient department for treatment for about 8 months. Her current functional status: ambulating independently with a quad stick inside her home, and utilises a motorised wheelchair for longer distances and outdoors.
Her current physiotherapy problems is with the quality of her gait(largely compensatory) and her impairments are as follows:

Trunk
· ↓ ability to weight transfer to R when standing and during functional tasks
· poor pelvic postural stability(weak gluteus medius/maximus)
· poor dissociation of pelvis and shoulder girdle
· ↓ activation of trunk extensors

R Lower limb
· ↓ R lower limb strength(quads)
· ↓ ROM at R ankle joint (arthropathy; oedema due to heart failure)
· ↓ muscle activation throughout

So naturally, I started to work on her gait pattern by correcting her alignment, stretching tight muscles of LL as well as simple strengthening of her hip extensors/quads and giving her lots of instructions for correction.

Well, those techniques up there didn't work very well. In fact, it didn't really work for 2.5 weeks.

But my supervisor took one look and went: "Let's practice with her sit to stand. Focus on weight bearing on the right LL and get the gluts and quads firing up. Get her left leg on a small step to discourage WB-ing on that leg."

Ok, so we did just that for that session(practising standing up using almost 75% support of her right LL and maintaining good alignment in those semi-squat positions ie buttock almost touching chair but we disallowed her to sit). And guess what?

Her gait improved! No more Trendelenberg sign, no more retraction of her L hip in stance and no more hyperextension on her L knee during mid-stance. She could control her pelvis and knee really well. Walked that beautiful "catwalk" for the next 30metres. Just by practising a functional task. With a very good carry over effect. Beyond my expectations. Felt so happy for her.

You know sometimes we have big plans for the patients and it doesn't materialize? And then for those patients we don't have big plans for they just go way above what we actually thought of them?

Guess in every patient we have, there's always a potential we can tap on. A great potential. And because of this potential we can see in them, it gives me the hope that they can really get better.

At least I've experienced it myself.

All the best for PCR.