2nd week in the Central Hospital

Introduction

   The 2nd week of my traineeship in the Central Hospital was interesting and busy as the previous week. I worked in the surgical, outpatient, children and internal medication department. I learned some new diseases-syndromes such as CRPS, Syndrome Turner with mosaicism, and methods of treatment (such us the blowing bottle that is used for breathing exercises, which is a different equipment from the equipment that we use in Greece, called Tri-Flo). I also got familiar with the way that the doctors transfer orally all the informations and backround about the patients to the secretary, through a small chip-phone, so that they have more time to be involved with the patient and not to write down all the informations by themselves.
The most of the patients that I worked, were able to walk and were quiet independent. I was very surprised with the way that Finnish system works, where the patients can go home after surgery the same day, if the surgery is non-important like canalis carpi, meniscus, anterior cruciate surgery etc., or that the maximum stay of a patient in the Hospital is 3-5 days depending always on the type of surgery and the situation of the patient. It is really amazing how the patients become rapidly functional and independent!

Main part

Physiotherapy treatment of 3 women with canalis carpi

                                              canalis carpi syndrome

 Two women patients had done surgery of canalis carpi, the one one her right hand and the other on her left hand and one woman came for physiotherapy treatment before doing surgery on her left hand. 

The two after-surgery patient that came for physiotherapy, had done the same surgery but on their left hand, the first 5 years ago and the second 2 years ago. The pre-operated 59 years old patient had done the same surgery but on her right hand at 1991. The exercises that the physiotherapist with whom i cooperated, were the same for each of the patients. 

So, the exercises included:

• Punch and abduction of fingers
• Wrist flexion-extension
• Ulna-Radial deviatin
• Cubit pronation-supination
• Thumb movements
• Median nerve mobilization

The 3 patients were very funtional and independent. The after-operated went home the same day and we gave them the exercises on paper so that they could remember how to do them.

Physiotherapy treatment of an opareted left lung elderly woman

A 77 years old woman, had a surgery on her left lung because of cancer. Our treatment was to increase her aerobic capacity, so she walked in the Hospital's corridor for few meters by our assistance and climbed-descended the stairs. Before the walking her SPO2% was 97 and the pulse 88. After the walking the SPO2% was reduced to 89. Between the walk and the stairs, she got rest periods. She was very worried about climbing stairs at her home, that's why we trained with her on the stairs. After the training, she did the bottle blowing in order to train and increase her oxygen.

bottle blowing

Physiotherapy treatment on two patients with amputated leg

The first patient with left amputated leg was an elderly man, who was on bed for 2-3 weeks without any movement. The only thing that I did was passive movement of his right leg, because he was very tired and didn't want to do anything.
The second patient was an elderly woman, that amputated her leg in 1976 after jumping from the 3rd floor as she said to us. She had schizophrenia, so we were very careful with her. The only thing that i did, was trensfer from the bed to her wheelchair by assistance from a physiotherapist and going for ride in the hospital's corridor.
This cases are usually very hard and difficult, because we have also to encourage those people with amputation and working with their psychology.

Physiotherapy treatment of elderly man after intestine surgery

An elderly man had done surgery on his thin intestine on 15/04/2016. He was alcoholic. The physiotherapy treatment was walking some metres in the hospital corridor with his walker and blowing into the blowing bottle for increasing his aerobic capacity and the gases of his lungs.

Physiotherapy treatment of a low back pain

Προσθήκη λεζάντας

Two cases i had this week with patients with low back pain.
   The first patient was a 37 years adult patient, that was operated for the second time on L4-L5 on left side because of a large prolapse on his disc and symptoms on his left leg. Before this operation, he had done in the past 2 more surgeries on L3-L4 after trauma with his motorbike and again on L4-L5 after big pain on his back, that was caused after riding the motorbike for 4 continuously days and after stopping going to the gym. A doctor checked his leg sensation and muscle strenght and everything was normal.

According to his functionality, first he walked with the canes and then he tried to walk without them. He did it very well, but still he was feeling uncomfortable without the canes. His right side (right major gluteus muscle etc.) were normally more hypertrophic because he used to use more that side because of the left side pain.

  After the walking, he did chair squats, activating of the transverse abdominal and sciatic nerve mobilization. The only pain that he felt was when he turned on the right side of the bed.

In general, the patient was very functional and independent. More carefull he had to be the first months with the movements, and after 2-3 months he could do more activated activities.
   The second patient, was an adult woman, that was opperated on her L4-L5 one year ago. Before the opperation she had pain on her back and on right leg, but after 4 months of the surgery, she had a new resistive prolapse, and a scar tissue that irritates the nerve root on the right side, so she needed to do physiotherapy to reduse the symptoms. She came to the hospital's gym to do some exercises in order to improve muscle's strenght and endourance. The exercises included static bicycle for 5 minutes, rowing machine and with theraband, exercises for latissimus dorsi and quadriceps. In all the exercises, the patient should activate at the same time the transverse abdominals, in order to keep her core stabilized and in the right posture.

Physiotherapy treatment of a patient's shoulder

An elderly man who was 60 years old, did shoulder partial replacement after the arthritis that he had on right shoulder. He had also tear in supraspinatus after the surgery, in order to put the prothesis and to regenerate the rotator cuff. We showed some exercises to the patient, so that he could move in a permitted ROM his shoulder. The exercises included almost all the movements, except of external rotation. A very important shoulder exercise that we gave to him, was the shoulder centralization.

Physiotherapy treatment of a knee replacement

An elderly woman 70 years old was our patient. She had done a surgery on her left knee, which the doctors replaced. Her backround was with epilepsia and mental problems. She couldn't walk or stand up alone because of the surgery, so we assesed her to stand up. Her opperated knee was very swallow, warm and painfull, so the only exercises that we did to her, were active with and without assistance motivation.

Physiotherapy treatment of neck pain and diziness

A very interesting case, me and a physiotherapist had. It was an adult woman, who had multiple problems because of her neck. Her backround was 2 months of diziness and pain for 24 hours per day on her neck (right upper neck). The physiotherapist made some test for checking her visuality, in which she had difficulties to look on the right and also her right neck movement was limited. She had also other problems such low movement on her cervical spine, in tension temporalis muscles, weak down trapezious, tilting scapula, weak major gluteous on both sides (worse on right side). 

The exercises that we gave to her in order to improve the movements and the position of the head, were exercises on deep down flexors of the neck, kinetic control, cervical nutation-counter nutation, bridge exercise by rising also each of the legs at the same time with the transverse abdominals activated, activate of major gluteous, posterior pelvic tilt, exercises for the upper neck, concetralize of humeral capita and neck rotation with control. The patient did all the exercises, but in some, she faced some problems because of the pain and the limitations.

Physiotherapy treatment of CRPS

A different kind of treatment we did to an elderly woman with CRPS. Complex regional pain syndrome is a chronic pain condition most often affecting one of the limbs (arms, legs, hands, or feet), usually after an injury or trauma to that limb.  CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems.  The central nervous system is composed of the brain and spinal cord, and the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body.  CRPS is characterized by prolonged or excessive pain and mild or dramatic changes in skin color, temperature, and/or swelling in the affected area.

So, this patient was bitten one year ago on her thenar muscle by a dog and since then, she had many treatments such as splints, ergotherapies. At the beginning the pain was really high 8/10, but now it is only 1-2/10. She does scan mirror laterality cards exercises, and we also evaluated her sensibility with a piece of wood and cotton swab. At the end, she was evaluated with the DASH scale (Disabilities of arm, shoulder and hand) in which she had to answer some questions associated with the sensibility and functionality of her upper limb.

scan mirror laterality cards

http://www.orthopaedicscore.com/scorepages/disabilities_of_arm_shoulder_hand_score_dash.html  DASH scale

Physiotherapy treatment in the therapeutic swimming pool

A different kind of physiotherapy session, took place in the Hospital's swimming pool. Our patient was an adult man with heavy backround, for example in total 19 surgeries (9 of them were on bones) and multiple problems, for example problems with his shoulders, rupture in supraspinatus, hips, little prolapse in L4-5, back injuries and general acute problems. He had also had psychological therapies and support. In the swimming pool he did a lot of exercises, such as cycling, exercises for the upper-lower limbs and for the core.

Physiotherapy treatment in the children's union

I had two children with my supervisor. The first child was 1 years old and 10 months boy. I only had to evaluate and observe his movements, motor skills and abilities. He could crowl, but not walk without support because of the hypotonia. He also had hyperpronation on his both feet, so it was more difficult to stand on his legs without any support and assistance.

The second child was a 1 years old 4 months girl, that had the Turner syndrome with mosaicism. 
Turner syndrome, also known as Turners syndrome, Ullrich-Turner syndromeor Gonadal dysgenesis, is a chromosomal disorder that affects only females. It is characterized by the absence of part or all of a second sex chromosome in some or all cells. There are two types of Turner syndromes: 

• Classical Turner syndrome - an X chromosome is completely missing. 
• Mosaic Turner syndrome (mosaicism or Turner mosaicism) - the abnormalities only occur in the X chromosome of some of the cells in the body.

This little girl could crawl, walk, scrolle and play. Although she had difficulties in her speech, as she couldn't pronounciate a lot of words,  she could understand and do whatever we said to her. She also had good muscle tone. At the end, she wasn't independent at all, because she was crying and wanted the attention of her parents, so it was quiet difficult to cooperate with her.

Physiotherapy treatments of several patients

Other patients had problems such as rheumatoid arthritis on back and other had done surgery on their heart and kidney. To this kind of patients, we practiced the heart and lungs training by walking and in some cases, by stepping on stairs. At the end, we also had one case, in which was a girl with syndrome down and we just evaluated her SPO2 and heart rate by the 6 minutes walk.

Conclusion

To summarize, this week I learned many things about the finnish system in hospitals. Of course between the finnish and greek system, are a lot of differensies. First of all, the finnish system is more advanced and flexible (because of the better technology) than the greek one. Secondly, Finland has created her own equipments and gives to the patients the opportunity to be treated in a very short period. Third, there is no shortage in the field of health and hospital provides everything concerning the treatment, rehabilitation and hospitalization. To conclude, adding also the stuff that is available and works in the health centers or hospitals, and that i had also collaborated, is so kind, friendly and helpful, that makes the system working better and without stress or negativity! 

My beginning of traineeship in the Central Hospital

Introduction

   My beginning as a physiotherapy trainer in the Central Hospital of Joensuu was very busy, interesting and lovely! The hole week i was in the Neurological Department, where i worked with patients that had multiple neurological diseases. The hospital didn't have as many patients as I expected. From the one hand it is good for a Hospital not to have many patients, because that means that the stuff is really good and appropriate to treat and rehabilitate every type of diseases, but from the other side, it is bad for students like me, who are doing their traineeship, that there are not many cases to see and therefore to learn more things. To sum up, I had about 10 different patients the whole week, and cooperated with other physiotherapists for their rehabilitation.

Main part

Physiotherapy treatment of elderly man with multiple sclerosis

1st visit:

   At first, me and other two physiotherapists, had a patient with multiple sclerosis. He was wearing the tracheostomy for better breathing, and also was sitting on the wheelchair. He went to the Gym of the Hospital, to do some exercises for strengthen of his muscles. The exercises that he did were on the rowing machine and strengthening of the cervical-neck muscles with the theraband. He had ataxia, dysmetria, diplopia, unstable mood, spasms and dysarthtria. He comunicated only with the letter board.

  

2nd visit:

   At the second visit, i was again with two physiotherapists, and tried to stand the patient up and walk with the support walker in the coridor of the hospital. It was difficult to handle him, because his walking was very ataxic and quick. After the walking, we transfered him back to his bed. He was getting angree sometimes, because we didn't underastand what he wanted to say in the letterboard, so his sittuation was really bad.

support walker

Physiotherapy treatment of patient with Guillain Barre syndrom

   A very hard case was a 40 years old man with Guillain Barre syndrom. He was lying on the hospital's bed, with tracheostomy, oxygen machine, urinary catheter and was wearing the pressure socks, for improving the circulation of the blood. He couldn't move his whole body, neither the lower/upper limbs, neither the core, because the muscles were paralyzed. The only movement that he could do, was elevation/depression of the scapulas, right/left rotation of the neck and expressions of the face.

1st visit:

The physiotherapy treatment that I did with another physiotherapist was:

                           

                                Lower Limbs

1. Passive plantar/dorsi flexion of feet and fingers + Stretching
2. Passive roaming of the feet
3. Passive knee flexion/extension + Stretching
4. Passive hip flexion/extension + Stretching
5. Passive hip roaming 
6. Passive internal/external hip rotation + Stretching

                                Upper Limbs

1. Passive wrist flexion/extension + Stretching
2. Passive wrist roaming
3. Passive elbow flexion/extension + Stretching
4. Passive shoulder flexion/extension + Stretching
5. Passive shoulder roaming
6. Passive shoulder internal/external rotation + Stretching
7. Active scapula elevetion/depression 
8. Active neck rotation (right/left)

2nd visit:

   At the second visit, we were 4 physiotherapists in the patient's room, in order to put him on the Tilting Up table. It was quiet difficult to move the patient from the bed to the tilt table, because he was portly and paralyzed, but with good cooperation, we did it! The tilt of the table was 60 degrees, so that the patient's arterial pressure whould not be influenced.

Physicaltherapy Treatment of an elderly man with a light weight stroke

1st visit:

   At the first visit, me and a physiotherapist, assessed a man with right light weight stroke. This means that his left side of body is weaker than the right, so he need to train his muscle strength, endourance and balance. So, he walked with the walker in the hospital's coridor, to be evaluated from us.

2nd visit:

   At the second visit, we assessed his balance with the Berg Balance Scale. He had already done the half Berg Scale with the physiotherapist from 1-8. At this visit, he continued the scale from 9-14. The total score of the patient's was 36/56, that means that he is able to walk with an assistance.

Physicaltherapy in group of elderly-middle aged people

   In this group were 5 eldelrly-middle aged people, and i had 2 patients. The first was a middle aged woman, that did exercises for her shoulders with the theraband and for her abdominals. Her problem was on the left shoulder, that had a minimum weakness. The exercises that she did, was flexion/extension of the shoulders with the band, and also rowing exercise with the band. At the end, she did lateral abdominals (right/left side). It was her last day in the Hospital, so after the exercises she was discharged.

   The second patient, was an elderly man about 80 years old, who had done 3 surgeries on his neck because of the cervical stenosis and had also pain on his lower back. His posture was very bad, espessialy his neck was in forward projection and this was the reason that he was feeling pain in this aerea every day. He did some aerobic exercises with purpose to improve his physical condition. At first, he did 7 minutes MOTOmed viva2 Cycling with the legs and the cycling with his arms for 10 minutes. The exercises went quiet good.

motomed viva2 leg and arm trainer

motomed viva2 leg and arm trainer

Physiotherapy treatment of an elderly man with former hemmoragic stroke

An ederly man, who had former hemmoragic stroke on his left side, did walking and climbing/descending from the stairs with assistance from me and other two physiotherapists. His right side was paretic, so he put all the weight on his left side, because of the right side's weakness and instability. The walking and climbing/descending from the stairs went quiet good for the patient's first time.

Physiotherapy of 4 elderly-middle aged men in the Hospital's Gym

1st visit:

At this day, 2 elderly and 2 middle-aged men, did some exercises in the Gym. Each of the patients did different kind of rehabilitation depending on the nature of their neurological diseases. 

  

  The first patient had left stroke, so his right side was influenced. He didn't have enough strength for doing the handle of his right hand, he put the weight of his body on the left side because of the right side's weakness and also he had right hemianopia, which means that his vision was only on the left side, as he didn't rotate his neck on the right side to do the daily activities. 

The exercises that this patient did, were:

• rowing
• leg extension/curl
• leg adduction/abduction

Also, we were standing by his right side, so that he could train the right vision and rotation of his neck.

  The second patient had memory and heart problems, as in the past he had done surgery on his aorta. We didn't do a lot of exercises to this patient, because of his heart. He did only static bicycle and motor learning-control tests for improving his memory.

  The third patient was a middle-aged man, with memory disease and neuropsychological problems. He did:

• rowing machine
• leg extension/curl
• leg adduction/abduction

  The fourth patient had clumsiness and his eyes were confined straight, as he could't do right or left rotation of his neck. He also did the rowing machine, the leg extension/curl and the leg adduction/abduction.

Physiotherapy treatment of an elderly man with right stroke

An elderly, about 75 years old elderly man with right stroke was in the hospital for improving his motor skills and his balance.

1st visit:

At the first visit, he played the wooden peg board games, for practicing his left hand that was weak in handle movements.

Wooden peg board game

Then, he played the wooden wholescale toys shape peg board games. He had to put the different shapes of the circle, the rectangle, the triangle, the square and the pentagon into the right place.

Wooden wholescale toys shape shorting peg board games

Also, he played the Wooden Square Shape Puzzle Toy, where he had to create the right geometric shapes and put them into the right geometric shape hole.

Wooden Square Shape Puzzle Toy

The hand exercises and also the motor skills went very good. The patient was able to recognize the shapes and to handle the pegs properly.

2nd visit:

At the second visit, he did exercises for strengthen of the leg muscles, for the shoulder and for balance. I showed to him all the exercises that he had to do.
First, he began with balance exercises. They included:

• Standing position with the legs in shoulder-width apart, with open and close eyes and with flexion/extension-abduction/adduction of shoulders at the same time.
• Feet together stand with open and close eyes and with flexion/extension-abduction/adduction of shoulders at the same time. 
• Semi tandem-stand with open and close eyes.
• Standing position on one leg with open and close eyes.
• Balance impaired.
• Weight transfer from side to side and from back to front.

NOTE!!! The patient could stand in standing position and with feet together stand with open and close eyes almost without resistance, but couldn't stand in semi tandem-stand, neither on one leg. It was difficult for him to keep the balance in that positions. Although, his balance was quiet good while the impaired and also while the weight transfer.

3rd visit:

At the 3rd visit, the patient was in the group of 4 elderly-middle aged men. He did the MOTOmed viva2 cycling-training for the legs for 10 minutes. Then, he trained again his motor skills and the handle of his hand by playing the peg board and by putting small beads into the thread.

pegboard

putting small beads into the thread

Physicaltherapy treatment of an elderly woman with left stroke

An elderly woman about 65-70 years old was in the central Hospital because of left stroke. She had weakness on her right hand, clumsiness and aphasia (global, broca's, wernicke's). So, the treatment that we did were motor control-motor learning, balance exercises and training of her upper limbs and especially of her right hand that was weak.



First of all, she trained the gripping of an airball. She had to throw the airball to us (i was with one physiotherapy) and then throw the airball on the floor. That was a practice for coordinating the movements of her hands.
Then, 1) she had to approach some targets with small balls (an example of a target was my hand), 2) she did PNF for the shoulder, by holding the tennis ball at the same time, 3) plantar/dorsi flexion of the feet in sitting position or standing position, holding a chair and 4) chair squats.
At the end, she played a game of words and pictures, in which the purpose was to match the pair of the suitable animals and find the word about that animals. She had a big difficulty to find the pair of the animals and to match them, because of her aphasia and handle problems also.

Physicaltherapy treatment of an elderly man with left stroke

1st visit:

 At the first visit, we evaluated the situation of the elderly man. He had right stroke had left side weakness on knee flexion more than extension, hand extension weaker than flexion, no movement on his ankle and was wearing a rehband shoulder-elbow-wrist support and also a floor reaction ankle foot orthosis. His SPO2% was 89, so we increased his oxygen with the oxygen machine.

2nd visit:

At the second visit, the elderly man walked with the support walker, by our assistance (i was with other two physiotherapists). He was wearing a knee splint on the left leg, so that it would be stable, ankle-foot arthosis (AFO) and the shoulder-elbow-wrist rehband.

AFO orthosis

knee splint

wrist rehband

                 

elbow rehband

After the walking with the support walker, he did by our assistance, squats on the chair, exercises for the grip and functional movements of his hand like brushing his hair.

     Exercises for grip:

squats on chair

3rd visit:

At the last visit, he did leg cycling on the MOTOmed viva2 for 10 minutes, walked with the support walker about 20 metres, did hand exercises like the previous time, and stant on the upright position by the support of the balance trainer about 10 minutes.

Physicaltherapy treatment of an elderly woman a man with left stroke

• First patient

The first patient was an elderly woman about 70 years old, with left stroke, small cerebullum and the same time right weakness. Conserning to the left side brain damage, her memory was going worse, she had a lot of difficulty in the speech, she didn't understand complicated things, she used wrong words to discribe something and she also used to think too long about saying something.

Conserning to the right side weakness, she had no sensation on her right hand and foor, she had partial movement on her right elbow, weak ability to do the rowing (movement from the shoulders), very weak contraction of her hand fingers, poor strength on the posterior tibialis and the gastrocnemius, quiet good strenght on the quadriceps and poor hip flexion muscles.

1st visit and 2nd visit:

At the both visits, we did quiet the same exercises with another physiotherapist. We evaluated her muscular ability and then continued with some passive, active assisted and active mobilization. First, she tryed to do plantar/dorsi flexion to her right foot, but she couldn't do this movement, so i helped with passive movement. She continued with knee flexion/extension, which she did better, as she had some movement. Although, she quited quickly and didn't continue. I did the passive movement also in knee and hip flexion/extension. She could do actively all the movements on the left side. 

Then, she tryed to do wrist flexion/extension without any contraction, only a very poor movement on her second and third finger, elbow-shoulder flexion/extension again withour contraction. So, to gain some ROM, i did the passive movement for her flexion/extension and she also did the same with assistance from her left hand on the desk and against the gravity, rising her hands. The only movement that she could do, was the shoulder rowing.

3rd visit:

At the last visit, the patient's situation was better and improved. She was very active and enjoyable. We did exercises for the muscles of the weak side on the bed (active assistance and passive), transfers from the bed to the wheelchair by the assistance of me and another physiotherapist, exercises for her right hand from sitting position (she did a little contraction on her fingers) and also functional exercises for hand like brushing the hair with the brush and drinking from a plastic glass. At the end, she did rising up and down of her body on the chair for 4 times by our assistance also.

• Second patient

The second patient, was en elderly man about 70 years old, who had a left sife stroke. The symptoms that he had were ataxia, dysmetria, hymianopia, problems with vision focus, problems with the memory, stiffness, speech, oulining and understanding problems (he couldn't recognise letters, but only numbers).

1st visit:

At the first visit, he walked with the walker, climbed and descended the stairs, he bounced and catched the ball, did exercises for his right leg (knee flexion/extension) with the skate, exercises for the movement of his shoulder by rising it step by step and at the end he did the pintch grip for training his right handle.

2nd visit:

At the second visit, the patient did the MOTOmed viva2 leg training on level 5-7 for 12 minutes, exercises for the memory, the vision (by visual stimuli) and the handle with the wooden games like the peg.
He was very cooperative and did every exercise without important difficulties. The only problem was that we had to give him the guidance a lot of times, because he was forgetting and didn't focus on what he was doing.

Physiotherapy treatment of middle-aged woman with right stroke

The middle-aged woman with right stroke, had left side paraplegia. She couldn't move her left arm-elbow-hand and her whole leg, and also had paresis on her left side face muscles. I visited her 2 times.

1st visit:

At the 1st visit, we went to the Occupation Therapy room, where an occupationist made for her left hand a Help Individual sleep-orthosis - thermoplastic hand immobilization splint. It was really interesting for me to watch the way that the occupation therapist makes the splints because it was the first time for me and i was really excited!

After the therapy, she did for 10 minutes the MOTOmed bicycle.

thermoplastic hand immobilization splint

2nd visit:

At the second and last visit, the patient walked by assistance of airwalk rests H/p Cosmos and a cane that she was holding with the right hand. She walked few metres with rest periods by sitting on the chair. For her first time of walking, she was quiet good. Although she didn't have enough strength and balance, but she really tried for the best.

Conclusion

My first week in the central hospital was really amazing! I enjoyed so much the neurological department and also my physiotherapy colleges! They were very kind, helpful and friendly, thew explained me as much as they could in English language, and the most important, they let me plan rehabilitation program for some patients and work alone sometimes with them. I also liked very much and appreciate that they almost always were interested in my opinion and were discussing with me about the programs of patient's rehabilitation. To sum up, i was totally satisfied with my practice in the central hospital!

                                                            

2nd week in Fysiotikka

Introduction

This is my last week in Fysiotikka, because next week i start my traineeship in the central hospital. It was quiet busy this week. New clients came for physiotherapy treatment, and some clients from the previous week. Some diagnosis were difficult to be found, but we tryed for our best with the other physiotherapy students, so that we could give the right treatment to them. Moreover, this weekend i faced more difficulty with my cooperation with some students, because most of the time they were talking in Finnish language, and seemed that they didn't want to explain to me the things that i didn't understand. I tryed to participate actively and learn as much i could!

Main part

Physicaltherapy treatment of the musicians of Sirkkala

The 2nd week began in Sirkkala, which is one of the Karelia Universities. We worked with musician students and showed to them the musicin ergonomian. We were separeted in 5 groups:

1. Guitar and Bass group
2. Piano and Kantele group
3. Violin group
4. Harmonica and Songs group



bass

5. Drams group

guitar

kantele

piano

violin

harmonica

songs

drams

I was in the group of Piano and Kantele, with another physiotherapy student. At the beginning, we had a discussion with the musicians who played the piano and the kantele, about the points that they felt the pain after or while playing, and also about the kind of the pain on this points.

The most common and usual points that they felt the pain was on the neck, the back, the upper limbs (wrist, fingers) and sometimes on their head. The kind of the pain was usually pungent and numbness.
After the discussion, we went to the room with the musical instruments. The musicians that were in my group were 4. Two of them played the piano, and the other two the kantele.

• First, a boy started to play the piano. We checked the way that he played, and his posture was very bad and incorrect. His head was in front, he had kyphosis and the shoulders were in front.

• The second piano player was a girl. Her posture was also incorrect. She seemed that she had scoliosis from the way that she was sitting on the chair. She also had her head in front.
• Afterwards, a girl played the kantele. Her upper body was rotated to the left, while her lower limbs were straight. She also had her head and shoulders in front and tight.
• At the end, another girl played the kantele also. Her posture was also, almost like the previous girl.

After our assessment, we showed them their incorrect posture, and tried to explain how to correct their position while playing. It was an interesting group!

Physiotherapy treatment of shoulder pain

A sportsman came to Fysiotikka, because he had pain on his right shoulder and humeral. The pain came at night, after a rowing exercise in the gym, and before sleeping. I thought that he had a rapture on his biceps, because he felt pain more in the humeral than in the shoulder. Also, he felt pain when he was groping his arm.
Afterwards, he did flexion of his right shoulder to the wall and we noticed that his right scapula was winging (because of the weakness of the serratus anterior) more than the left and that his shoulder was rounded.






We continued with exercises for the stabilization and proprioception of his scapula and shoulder.




After the exercises, the client fell better. We gave him exercises from Physiotools, to do them at home.

Physiotherapy treatment in the Gym

We did physiotherapy treatment to 4 elderly women in the Gym. I did and showed to them the warm up and then, each of them did circuit training with their own training schedule. The training included:


1. Squats with kettlebell

 

2. Leg abductions 

3. Trunk rotation

4. Biceps with dumbbells

5. Rowing with theraband while sitting on yoga ball with the legs on unstable surface area

6. Lower back exercises


7. Leg press

8. Star Excursion Balance exercise on unstable surfaces

The exercises went very good. I faced only one difficulty with an elderly woman, that didn't do the squats with kettlebell in the right way, and in my effort to help her do it in correctly, she gave up and didn't want to continue with that exercise! I was really frustrated, because the physiotherapy student that i was cooperated, didn't help me very much and i didn't know what to do, because i wanted to help the woman, but she didn't understand English, only Finnish language, so there wasn't communication between us. Except of that case, everything went very good. I was really surprised about how independent the elderly people are in Finland!

Physicaltherapy of adult woman with wight problems

An adult woman with mental and weight problems, came into the Gym of Fysiotikka to improve her physical condition. This is her 2nd year in Fysiotikka's gym, and she told that she is feeling better after 2 years. Other problems of this lady were fibromyalgia, loose joints, weakness while brushing her hair and very tight leg muscles.
Well, she started with warm up. The warm up was rowing with the theraband, 2 sets of 20 repeats. Then, she did arm extension with theraband, 2 sets of 20 repeats and also leg adduction/abduction with 30kg of 2x20 times.
When she finished with the Gym exercises, we went to the physiotherapy room, and did massage to her gastrocnemious, hamstrings for breaking the trigger points and also passive stretching to the quadriceps and gastrocnemious. Her quadriceps were very tight and stiff. At the end, she did the stretching by her-self.
It is a pity that this client is unable to be more independent in her life and do the things that she wants and loves because of her weight and mental problems.

Physiotherapy treatment of elderly man with stroke

Our client was a man with stroke and left hemiplegia, that came also the previous week to Fysiotikka.
He did again the walking with the Hp Cosmos. He walked 4 meters to the one side, and 4 meters to the other side, 6 times each side. He felt a little bit tired.

After the walking, he layed on the physiotherapy bed, and I did passive stretching to his legs. I did stretching of plantar/dorsi flexion, on quadriceps, internal/external rotation and hamstrings. His left side was more tight than the right one, and more painfull. I also did passive stretching to his upper left limb for reducing the muscle tone. He felt pain because of the stretching.

Physiotherapy treatment of Gym group

This day, we had o group of 8 elderly/middle aged/young clients (6 men and 2 women), which did Balance exercises in the room. First, we started with warming up to motivate the circulation of the body and the activity of muscles. Then, the clients did 9 balance exercises in circuit training, for 2 times and 1 minute each exercise. The exercises were the following:

1. Crossing the cones with zig zag pattern, trying to keep their balance with a thing on their head.



2. Star excursion balance exercise on the wall with the hands, while standing on the BOSU.

3. Throwing away a ball to the wall and clutching it, while standing on the BOSU.

4. Walking on a straight line, with the foot in front of the other and more progressive exercises, walking on the line while playing the badminton.

badminton

5. PNF of the upper limbs while sitting on a yoga ball.




6. Side steps with a theraband on the external side of the knees, with purpose to strengthen the leg abductions.



7. Bridge exercise and passing a ball under the back.



8. Exercises for the latissimus dorsi.



9. Foot steps and raising legs on the step.

The exercises went very well. 2-3 middle aged men, were very active and did the exercises with passion!

Physiotherapy treatment of the lower limbs

A young adult woman, about 30 years old, came to Fysiotikka, because of the reflecting pain on her right leg. The pain appeared suddenly 1,5 months ago on her gluteous. She feels pain while sitting for long time with bad back posture. The pain reflects on her right hamstrings, gastrocnemius and the internal side of her knee. Although, she said that she doesn't feel on her low back.
We evaluated her body posture from the upright position, from the supine position and prone position. From the upright position with 2 and 1 leg on the floor, we assessed and groped and measured the bone points of the pelvis-hip, and also the shoulder-scapula. From the supine possition we made the SLR test, to find out if the problem was on the sciatic nerve. The test was positive.

SLR Test

Afterwards, from the prone position we groped and tested if there are some trigger points on the gastrocnemius, the achilles tendon and the piriformis muscle, but there wasn't.

At the beginning, we thought that the problem was in her piriformis muscle, that pressured the sciatic nerve, as the SLR test was positive and there was not pain on her low back. But after the passive pressure of this muscle, that didn't give neither local nor reflected, we were very confused about the nature of the problem!
We continued doing passive mobilazation-rotation to the lumbar, to the S1-S2 nerve, passive dorsi/knee/hip flexion, passive internal rotation, muscle test with resistance to the iliopsoas/rectus femoris/quadriceps/tibialis anterior. We also did stretching on the tibialis anterior, gastrecnemius and back stretching (latissimus dorsi), PNF of the core and nerve mobilization.
At the end, we taped the client's back, parallel to the spinal cord from the both sides and gave to her home exercise the flexion/extension of hip and knee the same time as the flexion/extension of the head.

Physicaltherapy treatment of sacroiliitis

The client was a 19 years old girl, that suffered from pain in the right hip and knee, because of the inflamation on her sacrum. The exercises that we did to her were:

• Rotary movement of the femur
• Hip internal rotation and stretching of the external rotator muscles
• Stretching exercises with the knees to the chest (relieved from the pain)
• Back extension
• Core PNF patterns (relieved from the pain)
• Activate of transverse abdominal
• Anterior/Posterior tilt of the pelvis
• Controled pelvis lifting (bridge exercise)
• Active external rotation of the hip from lateral decubitus position
• Controled active hip abduction from lateral decubitus position

Finally, we gave to her home exercises from Physiotools, like the exercises that she did with us.

Physicaltherapy of metatarsalgia

Our client was a 18 years old football-player, that felt pain everytime that he was playing football, wearing the football-shoes, on his metatarsals on the left leg, but not in the rest. The pain came on January of 2016 and was getting worse time to time. I asked him in which exactly movements he felt the pain while training, and he said that he felt pain when he pressured his fingers (dorsi flexion of the metatarsals and fingers).
After this small medical backround, we checked his feet on the pelmatography and noticed that the left foot was more flat. Then, he stood on the metitur balance system for 20 seconds on one leg with opened and closed eyes, and noticed that with closed eyes, he couldn't keep the balance especially on his left leg. Moreover, he walked on the Gaitrite walkway system, in order to analyze the way of walking, the steps, the distance between the two legs, the way and the time that he stepped on each of the foot. We found out that his left toe wasn't in the center and was more hallux valgus.

pelmatography

metitur balance system

GAITRite balance system

At the end, we evaluated the metatarsal movements by passive mobilization, the tightness of the plantar fascia and also the plantar/dorsi flexion. His plantar fascia was very tight and stiff on the both of feet, and also the tibialis anterior and especially the gastrocnemius and achilles tendon were very tight and stiff. I did stretching to this muscles and mobilization of the metatarsals, to relieve from the pain and for their decompression.
Finally, we gave to him home stretching exercises for gastrocnemius and tibialis anterior and i recommended him to stop wearing the football-shoes, because they cause the problem and the pain because of the compression and squeezing of the metatarsals and fingers.

NOTE!!! At first, we thought that he might had Morton's Syndrome, but after the assessment we figured out that it wasn't, because the pain didn't reflect to other points, but was only local, which means that there wasn't any involve of the nerve.

Conclusion

The last week in Fysiotikka was interesting and busy too. I would prefer to work with my own clients, in order to do more things alone and independently, so that i could improve my skills, the way of assessment and the ways of treatment. I also would prefer to stay more time in Fysiotikka, in order to have time to addupt to the enviroment and to the working schedule.