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!