Help with this patient please!!! - Ankle #

[Quickstart]

Hi Kayelle,

Msk101 gave you a great response. It is easy to feel overwhelmed with your placements in third year, particularly if they are some of your first 'real' experiences as a fledgling physio.

The first step in dealing with a situation you aren't all that comfortable in is to not panic. Not only will it make your thinking all jumbled, but it is relayed to the patient as well.

Once you have your senses back, you just need to stop and think -- which can be very tiring on placement because these things don't come naturally yet.

As a student you tend to get hung up on the diagnosis and forget about the patient a bit. Here are some steps that make it a little easier until you experience a bit more, and start to feel more comfortable in your placement.

1. What is the diagnosis? We know that the patient has had a lateral malleolus fracture, what we need to take into consideration is what stage of bony healing the fracture is at. Dig up some physiology notes and see what's happening when. Obviously use mobisations with regard to the stage of healing. Otherwise be aware of basic fracture management.

2. What are the patient's main problems? Asterisk signs and patient reports tell you what you need to work on, not diagnosis, really. If your patient wants to walk without an aid, painfree and without a limp -- do a gait analysis.

Look at what's not right, and use your knowledge of anatomy to figure out what you need to do to help them target it.

3.) Based on your asterisk findings, choose a treatment technique to try to improve that finding. If a joint is stiff, try mobs. If it's soft tissue tightness, try DTM or PNF work. If their limp is a residual thing from habit, re-educate using part-practice.

4.) Reassess your findings. See whether your intervention has helped. If not, try something else. It's a good way to learn what works.

Tips:
- Do a gait Ax: Early on in post ankle # rehab patients are just interested in walking pain free. Identify problems.
- Do a balance Ax: Proprioception -- need I say more.
- Have clear measurements. How reduced is their DF/DF range? What about Inv/Ev? Grade of muscle strength? Remember calf grades are better measured with single leg heel raise. (Usually max no in 30secs, I find useful) Gives you a better idea of how much improvement.
- Hint: Wobbleboard.

Good luck. Relax. You know your stuff, just don't get overwhelmed.

[Kayelle]

Thank you both for the replies...

Musc isn't my strongest area and I'm finding it quite overwhelming. I'm a sufferer of anxiety anyway and I guess being in this situation has taken me right out of my comfort zone! I appreciate your guidance and will take it on board.

Thanks

[linbin]

hi friend
hope you are happy with the replies of some of our great friends.
there is nothing to get panicked
always keep a cool and systematic aproach-stick to basics
interact with patients with sharp ears and detect for information thru non verbal sources
seek help of superiors whenever neeeded

with god's grace you will evolve as a great physio

[toad]

Best advice i've heard or passed on for people worried about outpatients is to draw up a simple problem list with what you've found eg weakness, lack of ROM etc, including there functional problems and treat what you find - if there's stiffness focus on movement, if there's weakness strengthen and if it's a functional task either practice it or practise components of it( eg walking after a # - get them to do it non or partial weight bearing in a pool and focus on technique

[Canuck Physio]

I think the reality is that sometimes looking at patient's you can identify a million problems, and the fact is with today's posture's they are all probably true to some extent. However, focus on getting it right with the paperwork. Use a crib sheet with the key questions to ask, and make it a habit. Of course this cookie cutter approach does not make do in a busy work environment, but it will help develop good habits for when you start doing things alone.