My beginning in Lehmolan Fysioterapia

Introduction

1st week:

   My first week in Lehmolan Fysioterapia was very multiple, busy and interesting. Most of the patients were neurological patients (for example cerebral palsy) and some of them had very hard disseases. I worked with my supervisor at the Lehmolan's Fysioterapia and also at client's houses and places with people with disabilities. I learned about some diseases that i didn't know before, like the corpus callosum, the hallerworden spatz and also about some physiotherapy equipment like Spine Gym Core Exerciser. I was very interested and surprised for umpteenth time in the finish way of rehabilitation!

Main part

Physiotherapy treatment of dystonia

   My first client at this traineeship was a home visit of a 6 years old boy, that had dystonia, spastisity, hypotonia, hydrocephalus, bad vision, trempling on his whole body and clone on his upper and lower limbs. He had tracheostomy for the breathing and a feeding machine. We did exercises and stretching with him, to reduse the tonus of the muscles and the clone. Especially on the hands, his tone was very big. I did extension, external rotation of his shoulder, supination and radial deviation for redusing the tone, and all the movements of the upper limbs, in order to motivate and activate the muscles. I did the same exercises at his lower limbs. Hip flexion/extension, internal/external rotation, abduction-adduction from the supine position, stretching of hip flectors and knee extensors from lateral position. At the end, we did traction-compression of the shoulder from sitting position and put AFO orthosis, in order to keep the feet in the right position. This boy was really happy and cooperative with us!

  The second dystonic client was an elderly man that came to Lechmolan's Fysioterapia to have some treatment and physiotherapy. He had many problems, like dystonia, hypotonia, variations of muscle tone and clubfoot. He was quiet funtional, as he could take of and put on his jacket, he could throw things into a basket and he could scrolle. Although, his balance and muscle tone wasn't good, because he couldn't keep balance in an appropriate position because of the quick changes of the clone. I facilitated his movements on key points of his body like pelvis, shoulder in order to manage to keep the balance from the sitting position and the back extension, and standing-walking on the knees. At the end, we played a memory game with overturned cards that had as picture differend kind of transports, and he had to find the other pair of the picture. His memory was very good and i was surprised!

   The third client with dystonia was an elderly man. His symptoms were a little bit different from the previous client, as he had hypertonia and the dystonia was milder. He had more difficulties to take of and put on his jacket and an hyperactivity everytime that he was talking about his mum. He could keep his balance standing on his knees, he could scrolle on the floor or on the bed, and also he could stand up from the floor on his knees. All the physiotherapy treatment was about improving his functionality and balance ability.

Physiotherapy treatment of Corpus callosum

   

   Our visit was to a kindergarden for treating a 3 years old little girl with corpus callosum agenesis. Her left side of the body was hypotonic and especially the major thoracic and she also was wearing the AFO orthosis because of the hypotonia of her leg musles. We didn't do a lot of exercises to this girl, because she couldn't focus with her eyes, wasn't feeling good and was crying most of the hour. We could olny do exercsises from sitting and prone position on a yoga ball and some functional movements with her hands, like touching her hair or nose or putting something on her lips. She did excessive movements and couldn't cooperate with us, so we stopped the physiotherapy after a while.

Physiotherapy treatment of choreoathetosis

   An elderly woman was born with right hemiplegia, but after some years her left side got worse and the result was left hemiplegia and couldn't move well. A couple of years ago, she did an operation to her cervical spine for improving her cervicl spine position that was in anterocollis, so they put metals, in order to keep the head at better position. The diagnosis of this woman isn't very clear, but her symptoms seem that she has choreoathetosis, because she has spasm on her face muscles and athetotic walk.

She did exercises with the machines in the gym of lechmolan's fysioterapia, for strengthening the upper-lower limbs and exercises with the Spine Gym Core Exerciser for improving her core balance by activating the deep muscles of the core like transverse abdominals and multifidus muscles and at the same time stretching the major thoracic. The client was quiet good with the exercises.

Spine Gym Core Exerciser

Physiotherapy treatment of Paresis Erb's

Two clients were this week with Paresis Erb's. The first one, was a 3 years old little girl in a kindergarden. She was very active and functional. She played a lot with us, she climbed, jumped in the trompoline. The physiotherapy included everything that could improve her paretic hand movement and functionality. At the end, she trained her handle by creating shapes with plasticine and also did passive stretching of her hands separately. In general, the development of this little client was increased, as she understood everything that my supervisor told to her, and her speach was perfect for 3 years old child.

The second patient was a 9 years old girl, that came to the Lahmolan's Fysioterapia to have physiotherapy treatment for her right paresis Erb's upper limb. I evaluated her upperlimb movements, where she had limited movements in flexion, abduction, external rotation of shoulder and supination of the cubit. After the evaluation, she did very active exercises that demanded much strength and balance of the whole body and especially of the hands. She was climbing on wooden wall bars and wooden rope ladder climbing and jumping. At the end, i did stretching to her, to gain elasticity of the muscles of the external rotators of the shoulder, the supinaton muscles and the shoulder flexors. She was very powerful, patient and very interested in physiotherapy.

wooden wall bars 

wooden rope ladder climbing

Physiotherapy treatment of Athetosis

A 64 years old man, was our client, that had many problems. The main problem was that he had athetosis, so he had damage in his cerebellum. His walking was like a scythe, he had weakness on his muscles, right latercollis and torticollis at the same time and difficulties in speach because of the wrong position of his head. He did exercises for increasing the muscle strength, like static bisycle, abdominals and exercises for back muscles. At the end, i did some stretching to the client on upper ond lower limbs. He was functional, as he could do the exercises, although he had difficulties at walking because of the athetosis and non balance.

Physiotherapy treatment of Quadriplegia

   A 52 years old woman had quadriplegia. As a result of muscle weakness, she had right scoliosis, kyphosis, forward projection of her head, she used more the right hand for the activities, she was putting all her weight on the right side and her left side was worse.

I evaluated her muscle tone and joint rate of motion by passive movements. She wasn't able to move at all her limbs, only her right hand, as her muscles were very stiff and thick. She did some functional activities like rising her hip like a bridge on the bed by assistance, throwing soft balls into the basket and throwing the cones of the bowing with a ball, with her right hand, because she couldn't move her left hand. This patient wasn't independent at all, because of the paralysis of her whole body and because of speech problems. Although, her understanding was good and she cooperated as much as she could.

Physiotherapy treatment of Hallerworden Spatz

   An adult man with Hallerwordus Spatz and autism, came for physiotherapy. He had a lot of difficulties, especially in understanding and speech, because of the autism. We waited and were activated him for 15 minutes to manage to wake and get him up from the wheelchair to the standing position. At the end, he managed to get up and walk 1-2 metres by holding a stick and by our assistance. Then, he walked on his knees because he couldn't keep the balance from the standing position. We couldn't do a lot of things with him, because most of the hour we spent to activate him to do the walking, the dressing up etc. At the end, we managed to transfer him from the bed to the wheelcair. He had epileptic seizures, so it was quiet difficult to colaborate with him.

Physiotherapy treatment of spastic quadriplegia

   We went to a place where live people with disabilities and worked with an elderly man with spastic quadriplegia. He had multiple problems such as a lot of spasticity, hypertonia in core extensors and hypotonia in core flexors, tremur on his whole body after fatigue and relaxation, difficulties in speech and poor undertanding, very stiff joints (especially knee joints, where the patella was replaced upper because of the tightness of the quadriceps), no movements on his left hand at all, poor movements at hip flexion.
   After the evaluation, we moved on physiotherapy. We did lumbar-pelvis motivation, passive flexion and rotation of lumbar, assisted scroll on left and right side, hip extension on prone position and holding the position on his elbows, motivation of his upper limbs, where the left hand was worse than the right. At the end, i did a lot of stretching to reduse the spastisity and to increase the muscles elastisity, but everything was so stiff that it was quiet difficult to gain more elastisity. When i finished with the stretching, we tried to get him up with our assistance and then he walked with the support walker and went buck to his wheelchair. We were supporting him during all the walking, because he wasn't able to walk without support. It was quiet difficult to comunicate with him, because he couldn't speak neither he was understanding many things that my supervisor was telling to him, so there were needed a lot repeats of our guidance.

Physiotherapy treatment of Multiple Sclerosis

An adult man was our patient in Lehmolan's Fysioterapia with multiple sclerosis and some mental problems. He was very functional, as he could do all the exercises. First of all, he walked on the tradmill for 10 minutes, then he did exercises for quadriceps, hamstrings, abdominals, back muscles, pulldown and pushups. At the end, i evaluated his muscle elasticity and tone and did stretching on his upper-lower limbs muscles. He had some limites in plantar/dorsi flexion and hip rotators. In general, he was independent, but the only problem was that his mood was changing all the time, for example some times he could be angry and some times happy, because of mental problems.

Conclusion

To conclude, my first impression of working in Lehmolan's Fysioterapia was very good. I found it very usefull to work with people that had multiple and complicated disabilities, because i gained more experience for my future work, so I got familiar not only with the way of the physiotherapy treatment, but also with the way of handling hard situations and syndromes. My supervisor helped me a lot, by letting me learn better about the NDT/Bobath and about diseases and syndromes that were new for me!