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!