therapeutic skills scenario 10

THERAPEUTIC SKILLS EXAMINATION CARD 10


Note, we have been given a handout on cryotherapy, this piece entails that handout plus additional information and dialogue to be expected

Soft tissue trauma to lateral ligament of ankle

Cryotherapy: ice pack to be applied
Iniatally note that you have assessed the enviroment for health and safety

Physio:
Explain procedure
I have assessed your ankle and I have concluded that you have suffered soft tissue trauma to your lateral collateral ligament of your ankle.
With your permmission I would like to apply an ice pack to the damaged area.
The purpose of the ice is to decrease the anti inflammatory response,swelling and to decrease the pain levels

2. Question patient

Do you have any contraindications that would prevent me from applying the ice pack
Have you had any other treatment on the affected area to date??

3.  Collect equipment

wash hands first
check freezer
dry towels, plastic sheeting, paper sheeting
damp towel for ice
oil
extra pillows ( as appropriate)

4. Position patient
adjust bed height
using the position selected for effectiveness ( elevate approp,support patient comfortably, protect the treatment area, prepare an additionl dry towel (to insulate pack)
expose body part to be treated

Place there leg on pillows

put paper sheets under there foot
drape the patient to preserve modesty
ensure draping will catch any melted water from ice pack



5. Inspect part to be treated
Verify no open wounds or rashes

Check for pulse posterior to medial maleolus
Hot / cold sensory test with hot and cold water in different test tubes
Rube test tubes on affcted area and ask patient can they distinguish between the two temperatures with out looking
Squeeze big toe to chech for ciculation, blood should return immediately, tests for pvd
Hammer and pin, soft side rub and prick with pin
Apply baby oil to foot, acts as an extra layer between foot and ice

6. Prepare ice pack with crushed ice
Wrap crushed ice in a damp towel
This allows ice to be at 0 degrees and not below
Usually below when taken out of freezer

7.Application
Warn the patient of the expected sensations
Aplly ice pack
Insulate the ice pack by putting a light towel over it
Check the patients response by asking how it feels after 2 mins, then after every 5mins complete a visual check
Ice should be on for no longer than 20mins

8.Complete treatment

Remove ice pack and dry area with a towel
Remove towels used for draping
Clean treatment area and dipose of ice

9.Assess treatment efficiency
Ask patient how the ankle feels
Visually inspect the area for any adverse reactions and tell patient that everything looks fine
Cont with next stage of treatment and ask patient to dress
Perform functional tests as appropriate




Second part of scenario
Partial weight bearing gait pattern

1st measure the crutch length

get patient to stand up against the bed with the assistants help as the physio measures from the ulnar styloid to the ground. 

the patients arms must be flexed to approx.15 degrees

the handle should be equal to this height

get the patient to sit back up onto the bed and the physio demonstrates the partial weight bearing gait

1) place the two crutches out in front first, have them slighty out in a triangular pattern

2)tell them to slowly bring there affected leg forward, putting a bit but not to much pressure on it

2)then tell them to bring there unaffected leg forward

3) teach them how to turn- one crutch in front, one behind

Ascent of stairs:

Bring one crutch around and horizontaly place it on the outside against the vertical one

Hold onto banister
Place good/unaffected limb on step ( as patient is partial weight bearing)
Hop up onto the step with good limb while holding banisters 

Then bring the crutch up

physio behind ,assistant in front

Coming up - good leg, bad leg, crutch,       good up to heaven

Descent of stairs:

Again have the crutches as above

Hold onto the banister

Place crutch onto the middle of the step

Then put affected foot on the step

Finally put unaffected leg on the step

Coming down- crutch, bad leg, good leg,     bad down to hell

When teaching physio must be behind patient at all times while the assistant stands at the side of patient

Third part of scenario

Functional activity of step-up with emphasis on hip joints

Start:

Double limb stance

Good base of support with two feet planted

Most stable at this point

COG going straight through from head to foot
Leading with left leg for arguements sake
Left hip flexion

Single limb stance

Less stable at this point

line and centre of gravity is shifting forward
Going through saggital plane and coronal axis

Concentric muscle contraction
Hip flexors ® psoas major, pectineus, rectus femoris, iliacus, sartorius

Hip extension as leg is going down onto step

saggital plane and coronal axis

When coming back down, COG is lowering becoming more stable
Eccentric muscle contraction
Hip extensors ® glut max,biceps femoris, semitendinosus, semimembranosus

Foot becomes planted on the step

Double limb support, more stable

As this occurs the right hip is in extension
The right hip is taking all the force of the body until the left leg is planted and is the base of support while the left hip is in swing
The right hip then follows the same pattern as the left hip as it steps up

As it does so the left hip is extending more and more and is the primary base of support

Again this is an unstable phase

Note; watch out for patient tilting, side flexing etc and mention this if it occurs