Week 4 Day 17 Entry 1

Today I was given a patient to treat and assess unexpectedly. In the past this patient has been seen by my supervisor and I have only assisted or observed the sessions. Although I had read the pt's notes from the previous weeks, I still felt ill prepared to run the session independently with the pressure of my supervisor assessing me on my performance. I don't think I handled the session that well and I was left feeling disappointed at the end of the treatment.

I began reasonably well by determining if the pt had experienced any new problems or falls since her last visit, and then when onto begin some balance exercises. From her initial assessment and the previous medical notes it was evident that the pt had decreased balance but had not yet been prescribed exercises. Therefore I proceeded by giving the pt a high stepping exercise (performed by lifting knees very slowly, standing without holding onto anything) to challenge her single leg stance balance and strengthen her pelvic stabilising muscles. My supervisor then noted that it would have been more appropriate to re-assess the pt's balance tests first to establish a baseline from the day of exercise prescription.

I had also noted from the pt's records that the pt had reported feeling weak in her LLs. Therefore I went on to perform manual muscle testing of hip flexion/extension/abduction, knee flexion/extension, and ankle DF/PF. Yet I found this testing very difficult and was not very good at modifying the standardised test positions to suit the client's needs. Unfortunately the pt found lying supine and prone very uncomfortable, so I had to limit the time and number of tests performed in this position. The pt was also unable to lie on her L side due to a medication pump positioned on her L hip. In addition the pt had decreased ROM in her LLs (due to increased tone?) which made side lying difficult and the rating of her muscle strength performance hard to assess. In general I felt as though my time management for performing this assessment was very poor, and not well planned.

In the future it would be helpful to know (prior to the assessment time) the positions the pt is able to move into for testing procedures, when the last assessment was made and what the results were, and develop a plan for pt positioning to reduce the numbers of transfers/change of positions the pt has to make.

Therefore, I didn't feel particularly confident or comfortable during this assessment as I felt unprepared and inadequate at performing the assessment. I hope to revise the other assessment options I could have used in this situation and discuss this with my supervisor.

After this session today, I felt as though my confidence levels dropped, which then reflected in my assessment and treatment of my other pts for the rest of the day. If a similar circumstance were to arise again I would attempt to clear my mind of my previous Rx performance and start afresh with each new pt.

I am currently doing research for my end of placement presentation into disease specific risk factors for falls in Parkinson's disease. So I will also be revising PHTY223 notes for background information on falls and balance etc.