7
Jordan Knoepfel
Fundamentals of Human Performance
Field Experience Journals
March 26, 2013- I asked Chris M. Demuth, DPT (owner of Nebraska Orthopaedic Physical Therapy) if I could observe and aid for five hours at his facility in Fremont, Nebraska. He welcomed the opportunity and allowed me stay the full five hours in one day. The following is exactly what occurred in this time period. I as well included my analysis, reaction, and overall commentary on what I observed.
To begin, I was given a sheet explaining the surgery of a particular individual who would be coming in shortly. The form explained this person was a freshman in high school and had undergone knee surgery to repair a defective femur. The surgery, which was called an open scope surgery, took over three hours to complete. The cartilage at the knee had become unattached which locked the patient's knee at the bent position by lodging behind the meniscus. Apparently, this individual was born with a deficit in the femur, which the surgeons had to clean out first. After the incision was made, the doctors had to use cadaver bone to tamp into the deficit. They then placed the cartilage with three screws and nine tacks. The patient's protein plasma was then used to seal the joint so that no fluid could re-enter the wound. A sample of the patient's cartilage was then flown to Boston to grow new cartilage in case the surgery was not successful.
In response to just this sheet, I can tell that medical practice is incredible. I would never know how to fix a situation such as this and apparently these doctors knew what to do right away. It just amazes me how far modern medicine and surgeries have advanced.
Once the patient arrived, he was briefed on his current condition. Chris and Ross M. Tessendorf, DPT, ATC, CSCS, asked all the questions and I documented his responses. They first began by asking simple questions such as what he had done since the surgery. His response was he spent his first few nights at the hospital but stayed at home the previous night. We then discussed and reviewed scheduling for school because of the amount of time it now takes him to cover his knee for showers and dressing. He is not allowed to bend it at all unless in the CPM (Constant Passive Movement) machine. Chris and Ross instructed him how to increase the amount of bend for when the doctors acknowledge it is ok to bend beyond 40%.
After being briefed we went into exercises specifically made for him and the healing process of his knee. Here is a list of all the exercises performed as well as instruction to specific stretches.
Quad Set: Slight Flexion- tense muscles on top of right thigh. Hold three seconds. Repeat 20 times per set. Do 3 sets.
Knee Extension-squeeze ball or pillow between knees and straighten knee to comfortable level, lower slowly. Repeat 20 times.
Strengthening: Straight Leg Raise- Tighten muscles on front of right thigh, then lift leg 6 inches from surface, keeping knee locked. Repeat 20 times.
Strengthening: Hip Adduction-Isometric-With ball or folded pillow between knees, squeeze knees together. Hold 3 seconds. Repeat 20 times.
Knee Flexion- With towel around right heel, gently pull knee up with towel until stretch is felt. Repeat 20 times.
Self-Mobilization- Grasping kneecap between thumb and index finger, gently move kneecap side to side. Then move knee cap towards hip and down towards foot, very gently. Repeat 10-20 times per set.
I assisted the patient in the stretches that are indicated above. He seemed pretty frustrated that his strength was gone because he is very athletic, and this is so foreign to him. It takes a lot of reassurance at this point to help him see that this will come to an end and he will be strong again.
Once all these stretches were done we practiced going up the stairs on one leg. Ross and Chris have a large stair-master machine that aids in such scenarios. When the patient was practicing moving up the stairs I would stay at the bottom and spot him in case he lost his balance or fell. Once this exercise was completed, the patient was free to go.
Since this was this patient's first therapy session it took a very long time to work through everything. While I was helping him, Ross and Chris would help other patient. Obviously they would supply both me and the patient with the exercises but I was there for all the assistance. I was a bit nervous at first since I've never aided a surgery patient but after some time I became more comfortable.
The patients that came in for the next few hours were not in as serious of a condition as the first patient. Most of them were elderly having undergone a hip or shoulder surgery months prior. I helped one elderly man with a bad shoulder work with dumbbells. The exercises were as stated.
Lateral Raise: Hold dumbbell in one hand and position self in a standing up straight position. Slowly raise dumbbell from side to ceiling in a delicate motion. Repeat 20 times.
Frontal Raise: Hold dumbbell at side. While keeping the arm straight, lift dumbbell to nearly eye level. Repeat 20 times.
Arm Abduction- Isometric: hold arm at 90 degree angle and lift arm to position perpendicular to torso. Repeat 30 times.
After these exercises the patient did two sets of arm circles back to front, and front to back. We then went to the arm bike and the patient peddled for another 5 minutes. While he biked, we talked about how he had hurt his shoulder in the first place. Turns out he was quite the baseball player when he was younger.
Once we were done I assisted an elderly woman with back problems. It appeared odd to me that she came in to a physical therapist since I felt a chiropractor would be more suitable for her condition. After watching Ross and Chris work with her, however, I thought differently. They had her work with mostly elastic bands since her strength wasn't high but she managed herself well. The only point where she used the dumbbells was when she was asked to lay on her stomach and lift the dumbbell to nearly parallel with the floor. This motion actually looked painful for even me to perform. After all the exercises, Ross, gave her a manual eStem therapy session. This is where he touches an electric wand set to a low frequency to the problem areas of the back. The electric pulses help soothe and relax the tense muscles.
Overall, this was a great learning experience and helped give me new insight to the life of a physical therapist. I got to work with several different surgery patients and injured individuals. I discovered new exercises that can be used to help benefit the rehabilitation of such injuries and surgeries.
For my remaining shadowing hours, I worked at the Greene House assisted living facility in Seward, Nebraska. The facility combines retirement living with an independent setting which means though the residents may need help with a few minor tasks, they are free to do as they please. My task is to assist the residents in a series of exercises that are aimed towards strengthening muscles and working their cardiovascular endurance through repetition.
I talked to Rose Beck, the woman in charge of the exercise courses offered at Greene House and asked if she would mind me helping her. Her response was surprising as she let me take charge of the course instead. Though these exercises are very easy to do for someone such as myself, I'm working with individuals in their 70's, 80's, and 90's where the tasks prove not so simple.
April 12, 2013- I began by gathering residents by going door to door inviting them to class. I assisted those who needed help by walking with them up to the exercise room. Once everyone was gathered I engaged residents and demonstrated the proper techniques for each exercise. The exercises were as follows.
Sitting Leg Extension- 2 sets of 10 each leg with 30 seconds rest between sets.
Sitting while walking in place- 1 set of 30 seconds/ 30 second rest/ 1 set of 60 seconds
Calf raises- Using the tables for support, raise self on ball of foot and lower self back down. 2 sets of 10 with 30 second rest between.
Arm circles- 1 set of 10 going front to back followed by 1 set of 10 going back to front.
Arm extensions- Raise arms to ceiling and back down. 2 sets of 10 with 30 second rest between.
Arm raises- While sitting, raise arms to ceiling while keeping them extended. Remember to exhale while raising arms and inhale while lowering them.
Once these exercises were completed I then distributed water to each of the participants. After they were ready, I would help those who needed help get up from their chairs and head back to their room or wherever they needed to go. After all this was done, I was allowed to check out and leave the facility.
April 19, 2013- I did the same routine as before by gathering residents by going door to door inviting them to class. I assisted those who needed help by walking with them up to the exercise room. Once everyone was gathered I engaged residents and demonstrated the proper techniques for each exercise. The exercises were as follows.
Sitting Leg Extension- 2 sets of 10 each leg with 30 seconds rest between sets.
Sitting while walking in place- 1 set of 30 seconds/ 30 second rest/ 1 set of 60 seconds
Calf raises- Using the tables for support, raise self on ball of foot and lower self back down. 2 sets of 10 with 30 second rest between.
Arm circles- 1 set of 10 going front to back followed by 1 set of 10 going back to front.
Arm extensions- Raise arms to ceiling and back down. 2 sets of 10 with 30 second rest between.
Arm raises- While sitting, raise arms to ceiling while keeping them extended. Remember to exhale while raising arms and inhale while lowering them.
Upon completion of the exercises, I again distributed water to the participants. I found the residents didn't talk much but rather sat in silence during the rest periods or while they drank their water. Though it's sort of awkward, I'm sure they are used to the silence. Many of the residents cannot hear very well so when I announce the exercises, I have to basically yell so everyone understands.
April 26, 2013- I followed the same routine as before with gathering all those who wanted to participate. Once everyone was assembled we began exercise class. This time we would do a variety of different exercises.
Body circles- This exercise for improving balance can prove tricky. Keep a chair or table nearby for support. Make sure knees and hips are kept straight when performing the circle.
Heel to toe- Shift weight from heel to toe and back. Perform 2 sets of 10 with 30 second rest between sets.
Arm circles- 1 set of 10 going front to back followed by 1 set of 10 going back to front.
Arm extensions- Raise arms to ceiling and back down. 2 sets of 10 with 30 second rest between.
Arm raises- While sitting, raise arms to ceiling while keeping them extended. Remember to exhale while raising arms and inhale while lowering them.
Staggered stance: Shift weight from one side to the other. Perform 2 sets of 10 with 30 second rest between sets.
At the conclusion of the exercise period, the participants were out of breath since these exercises were somewhat new to them. I felt, however, that balance is extremely important for elderly individuals since a fall could prove dangerous. I'm glad I had the chance to incorporate such exercises into their plan.
Overall, it was a great learning experience to get to work with these elderly individuals. Not only did I have a lot of fun, but I had the chance to lead a class that I find interest in. I also had the chance to interact with interesting people and friends.
-I will be leading this exercise class May 3rd and 10th for an additional 3 hours but since the e portolio was due before then I figured I wouldn't have to write about it. In total I will have completed 13 field experience hours.