2nd week in Lehmolan Fysioterapia

   Introduction

   My second and last week in Lehmolan Fysioterapia was as busy as the first week. I worked with new neurological patients but also with patients from last week. Me and my supervisor did quiet the same physiotherapy treatment to the patients from last week but with some new methods. I learned about a disease that was new for me, the Catch 22 Syndrome which is characterized by cardiac defects, abnormal facial features, thymic hypoplasia, cleft palate, and hypocalcemia. It results from a deletion within chromosome 22q11. This syndrome is not a simple disease. It includes DiGeorge syndrome, conotruncal anomaly face syndrome, and velocardiofacial syndrome. The authors report two cases of CATCH 22 syndrome. the Fallot's tetarlogia and bronkomalasia. It is so interesting, because everytime i learn something new and usefull for my knowledge!

   Main part

Physiotherapy treatment of a 2,5 years old girl

   Me and my supervisor went to a little 2,5 years old girl's home, to rehabilitate her. She had had the catch 22 syndrome, fallot'n tetralogia, bronkomalasia and heart problems. For these reasons, she had done surgery on her heart to open the pulmonary valve, because it was closed and wasn't working. For one year she was in the hospital and was feeding by machines and breathing by tracheostomy, so she wasn't moving at all. She has some difficulties in developement, but thanks to physiotherapy sesions, she is improving all the time and increasing the developement abilities. The treatment that we followed, included climbing and decending from the stairs, reaching objects from the window that were sticked to it, magnetic fishing game, walking with hands while laying on prone position on yoga ball, rolling and sitting on yoga ball.  Our little patient was very cooperative and happy for doing this physiotherapy-games!

magnetic fishing game

Physiotherapy treatment of Multiple Sclerosis

   A middle aged woman with multiple sclerosis came to Lehmolan Fysioterapia to have some physical exercises for improving her endourance and muscle elasticity and strength. Her left side was worse than the right side, she was also feeling pain on her cervical spine and shoulders. For this reason, we did massage on her cervical spine muscles (trapezoid). After the massage, she went to the bed by our assistance, to do some exercises. The first exercise that I did to her was balance disorders, on sitting position. The aim was to keep her balance, activating her core muscles against our resistance. The next exercise was in supine position, doing dorsi/knee/hip flexion and plantar/knee/hip extension with resistance and stretching to hamstrings, quadriceps, gastrocnemious, feet flexors/extensors. At the stretching time, there was appearing spasticity because of the muscle rest. In general, this client was quiet functional and with a lot willpower! I enjoyed working with her!

Physiotherapy treatment of Epilepsia

   An adult woman around 40 years old, was handicapped and had myoclonus epilepsy. She was very functional although and did all the exercises that we showed, at the Lehmolan's gym. The exercises included strengthen of upper-lower limbs muscles (pulldown, pushup) and balance of the core. She was very serious and sometimes had problem cooperating with other students, but in my case, i didn't face any problems with her!

Physiotherapy of Duchenne Muscular Dystrophy

    A very hard disease had a 27 years old patient, the duchenne muscular dystrophy. His muscles were totally atrofic and stiff, so I did to him only passive mobilization on his upper-lower limbs muscles from the supine position and at the end i did stretching to all the upper-lower limbs muscles from supine and lateral position. He was very adorable and was happy doing the exercises!

Physiotherapy of Paresis Erb's

  This week i had three young girls with paresis erb's. One girl was new for me and the other two were also last week. I followed the same logic of physiotherapy treatment to the young patients as last week, with some variations. They trained most of all their functionality and did a lot of athletic activities and memory games, as they were able to do almost everything.
   The new patient with paresis erb's on left upper limb, was a 14 years old girl. I evaluated her movements of both limbs, to see the limits of the movements and to compare both sides. As usual, she couldn't do the whole ROM of shoulder flexion, abduction, external rotation, elbow supination and some functional movements like brushing her hair, where she was using her core muscles to rise her hand. 

   After the evaluation, she did active exercises with and without assistance, functional and athletic activities, like swing, wooden rope ladder climbing, balance and core training. She was very active and did the exercises without special problems. At the end, I did stretching to her both hands, but most on the paretic left hand. Some of the stretching were very painfull, for example the shoulder external rotation from the middle position of the shoulder and the supination of the cubit. Although the pain, she was very patient with the stretching, because she knew that it was helpfull and good for increasing the muscle elastisity and joint ROM.
  

Physiotherapy treatment of Athetosis

   This week i worked with a 64 years old patient, with whom i worked also last week. He had athetosis,  falcate walking and difficulties in speech because of torticollis. This week he did again exercises in the Lehmolan gym room. He did warming up with static bicycle, and exercises for abdominals, back muscles, quadriceps and hamstrings. Then, he trained with the theraband his lateral abdominals and his balance. At the end, i did stretching to his lower and upper limbs to gain the muscle elastisity. I didn't face imprortant problems. The session was good!

Physiotherapy treatment of Corpus Callosum

This week, me and my supervisor visited the little girl with corpus callosum, that we had visited also last week. This week, she was in better mood and condition than the previous week. We worked more with her motor learning, motor control, balance training and retraining of standing position. I worked a lot with her on the yoga ball, to gain core balance, reflexes and myosceletal activation. I did a lot of back extension to her, shoulder abductions and facilitation on key points. After the physiotherapy, she was tired and maybe unhappy because it is hard to fix the posture to the right way. Although, this week she was quiet patient.

Physiotherapy treatment of Dystonia

   This weekend, I had two patients with dystonia, that were also last week doing physiotherapy. 

   The first one was the 59 years old man. It was the 3rd time in total that i saw him. This week he was a little bit lazy, although he did quiet much things. He trained himself by sitting on an inflatable, playing with balls (catching, throwing and kicking the balls), he did scrolling on the floor and i also facilitated him by key points. At the end, i tansfered him to the bed and from the bed to his wheelchair. My supervisor showed to me an easy way to transfer the specific patient, so that he would not lose his balance by extending his back. It was very helpfull and quiet easy by this way!

   The second patient was the one with more hypertonia than the first patient. This week he was quiet in the same condition as in last week. We trained his knee standing position and balance. We also tained hand rising by putting small balls into the basket which was on the same level as his head.

Physiotherapy treatment of Choreoathetosis

For the second time in Lehmolan Fysioterapia i worked with an elderly woman who had some signs of choreoathetosis. This weekend she did the same exercsises as the previous week, with only difference that she was improved very much, as she had more endourance and strength. The reason might was that she stopped taking the painkillers for her cervical pain etc. Her head position was also improved, as she kept her head in more right posture. She did static bicycle, pulldown-pushup, exercises for legs with resistance and balance training with the spine gym balance trainer. I enjoyed this physiotherapy treatment because i reallizes that she improved herself in just one week!

Conclusion

   To conclude, this week i learned a lot of things about the NDT/Bobath (Neuro-Developmental Treatment/Bobath). The NDT is a holistic and interdisciplinary clinical practice model informed by current and evolving research that emphasizes individualized therapeutic handling based on movement analysis for habilitation and rehabilitation of individuals with neurological pathophysiology. Using the ICF model, the therapist applies a problem-solving approach to assess activity and participation to identify and prioritize relevant integrities and impairments as a basis for the establishment of achievable outcomes with clients and caregivers. An in-depth understanding of typical and atypical development, and expertise in analysis of postural control, movement, activity, and participation throughout the lifespan, form the basis for examination, evaluation, and intervention. Therapeutic handling, used during evaluation and intervention, consists of a dynamic reciprocal interaction between the client and therapist for activation of optimal sensorimotor processing, task performance, and skill acquisition for achievement of participation in meaningful activities.