Assessment

S: When working in the neurology field, your assessment is very important. This is partially because physiotherapists play a very significant role in the overall handling of the pt. handling meaning both, assessing, treating and providing feasible discharge options. When dealing in particular with stroke pts, the medical team will do the appropriate tests to decide what the underlying pathology is. This normally means a CT scan. However this test is not always reliable in determining the type or cause of stroke. Many other assessment tools are used based on the pts presentation and symptoms. Many of these assessments are performed by the physiotherapist. The assessment also extends to things such as mobility status that the nurses will use when caring for the pt.
T: The task is to fill out a thorough stroke assessment form to use as a baseline as well as an indicator of impairment and problem list. However to also think outside the box and not just focusing on filling out the generic form, but also looking at the pt holistically from the very first time you see them.
A: I was given a pt that I had to conduct an initial assessment. The stroke ward that I am working on is an acute ward. This means that we are the initial health care they seek and there has been no previous physiotherapy input into this pt. this makes the assessment even more important because it is pivotal that the physiotherapist does not miss any vital details. Prior to seeing this pt I went onto the ward and read through their medical file. This was to give me a general idea as to what I was expecting and some background social and medical history. After I became familiar with the pts medical notes I consulted the nursing staff for any other useful information. Then I approached the pt in their bed and this is where the assessment began. I was sure to be very observant from the time I first laid eyes on them. I had gained an idea from my notes what I wanted to assess and I was already looking for particular things. I then took a brief verbal history from the pt and then accompanied them to the gym. Once at the gym I went through the thorough generic stroke assessment form.
R: The result came with some help from my supervisor. My supervisor, being a very experienced and knowledgeable physiotherapist was able to guide me through the assessment to get all the information I needed. The result was, I gained a very thorough assessment, which allowed me to determine all the impairments forming my problem list. This gave me a baseline to refer to on discharge. I also gained a good understanding of the pts mobility and ambulatory status. This helped me inform the nurses what the most appropriate form of transfer was. It also allowed me to choose the best transfer that would allow the pt to move in a way that facilitated normal movement, to help the brain recognize normal movement while it was still “plastic”.
E: overall I thing the result was good. However a stroke assessment is not an easy method to grasp. Having never performed a proper stroke assessment before, I think there were plenty of things I could have done differently. For example, almost all stroke pts suffer very heavily form fatigue and drowsiness. On my initial assessment I perhaps was to methodical with the assessment sheet rather than using some common sense. I went ahead and tested everything in order, which is not necessarily in order of importance. As the assessment moved on, my pt became very tired and fatigued and I still hadn’t assessed some very important indicators. I should really have assessed them in order of importance so that I could decide upon things such as their transfer status and ambulation.
S: Some strategies I would have found helpful include –
- Becoming very familiar with the assessment form so that you know what questions you should be asking and don’t have to refer to the sheet to often.
- Being able to tick off certain parts of the assessment without having to formally assess them. Such as when testing active muscle control, watching them when they get out of bed will give you a good idea of lower limb strength. This is good for saving time.
- Understanding all the terms in the assessment form and how to assess them. The difference between receptive and expressive dysphasia can be hard to differentiate, so by first understanding what each means, will give a good idea of how to assess for them.

initial entry

The fourth and final rotation brings with it many different emotions. There is of course the element of fatigue beginning to set in. as you rotate through the working world it is only normal that you become anxious to start earning and working. There is also the beginning of another new setting with new people and surroundings. Starting any job is hard at first, when you are trying to find your feet and learn everything about the place. Starting 4 new jobs in 5 months is obviously even tougher. Im starting this one at Royal Perth Hospital. Obviously being the biggest tertiary hospital in Perth it can be a very daunting place. Unfortunately very few people will know who you are or even care to find out and add the student label on that and that’s really all you are… a student. So having to make it in the real world with a stereotypical label can be tough, however it is what it is and you must get through that. Im starting in neurology on the stroke ward. This is the first exposure to neurology that I have had since the 3rd year first semester unit. That in itself is a very daunting experience. There is no doubt in my mind that neurology is the most challenging area of physiotherapy. Yes you can clinically reason nearly everything you do, however you cannot clinical reason your way around explaining the spinal tracts in detail at your supervisors command. So there is a lot to know and it does seem very daunting. Im definitely very nervous. I have no idea what to learn and if what im learning is even relevant. Does it really matter if you can spiel off the arterial distribution of the brain or is it enough to know what will be affected with infarcts in certain areas? Lots of thoughts pop into my head and I think “oh my god I haven’t looked at that” and when I do it seems like a constant path of repeating that same question on and on. However on a more positive note I always told myself that I wanted a neuro placement that was challenging and where even if I struggled, I learnt bucket loads… and this placement seems like it will be exactly that. My attitude is, im here to give it my all for 5 more weeks learn as much as I can, accept criticism not personally but professionally. If my supervisor is strict its because they are trying to get me to learn and they want me to be competent, so it wont take it personally but instead get on with it. This is my only neuro prac and I have to be competent when im done so I can work as a new grad effectively, so im here to learn as much as I can and even when it gets tough which I know it will, remember that I only have 5 weeks and then its done. So im looking forward to this prac and although slightly nervous about the challenges that will come, im confident that I have what it takes to do well and be the best I can be so I graduate as not only a competent physio but a good one when it comes to neuro.

Final Thoughts

Tom Price was a fantastic experience over all. I learnt so much and got exposed to exactly what I had hoped for. I was left to be independent but at the same time was given the support I needed. I was nervous about doing my musculoskeletal placement and wasn’t sure what to expect. In the end I was confident with my knowledge and learnt many techniques that I will use. I had pts ranging from 10 years old to 80 and dealing with all sorts of pathologies. I go to see problems with most of the joints of the body and learnt so much. The working environment was fantastic. I had my own desk and was working next to two other very good physios. The hospital itself was small but very good. The staff were very friendly and excellent to work with. They were very accepting and tried to make me fit in as easy as possible. The social aspect was very good for a small town. There were plenty of sporting activities and it was easy to get involved. This made weekends much more bearable. There was no mobile coverage which was hard. There was also no access to social networking sites on the government computers which made it very hard to keep in contact with friends. However I managed to get by ok. We moved around to some aboriginal communities which was a great experience. It meant I got exposed to a different culture and learnt some different aspects of msk. It also made it unique and not repetitious. I was able to travel somewhere every week and that was exciting. The landscape of Tom Price is amazing. I was able to climb mount nameless and look out over Tom Price and the surrounding region. Karijini national park is absolutely amazing. One of the most beautiful spots I have seen. I was able to get along and see some of the gorges and despite being rescued by the SES it was a very good experience. I think that was my favorite part of the placement, was getting along to karijini. The placement was an excellent networking opportunity. I was able to work alongside Beth Rogers for 5 weeks. I learnt so much about work and working in rural areas. I learnt about the pay and different incentives, and different tips for finding work. A lot of these things you can only learn from people with experience so that was something I found invaluable. So overall it was a great experience and I learnt so much. I now know what working in rural areas are like and its been a great preview to help me in deciding whether I want to work in a rural area at all at some point in my professional career. I would recommend to anyone to put Tom Price at the top of their priorities for future placements.