The Jackson Clinics

6/8/11

I didn’t think I was going to make it out the door this morning, but somehow I found the strength and survived the whole day without food and still feeling pretty icky… and I am so glad that I did!

As we drove to the hospital this morning, we were in the middle of the world’s worst traffic jam as pedestrians EVERYWHERE made their way to the church for the morning service. It still amazes me that cars, cabs, mini vans and SUVs can all try to drive without lanes, honking their horns every ten seconds, and avoiding pedestrians and not get into any fights!We had three very good mentoring sessions today with the residents. The first group completed their evaluation of the patient with a clavicle fracture. With my guidance and supervision, they were able to improve her passive range of motion by about 30 degrees without pain, which they and the patient found to be very exciting. What touched me the most was how appreciative the patient was- as Lili and I walked into the building this morning, she immediately recognized and greeted me with a smile. I could detect when I was demonstrating techniques that she trusted me by the way she relaxed into my hands. When her treatment was over, she shook my hand with another big smile and agreed without hesitation to return on Monday.

The second group completed an evaluation of a patient presenting with cervical radiculopathy with pain in the shoulder. During this evaluation, I realized very quickly that the residents’ skills are still developing and that I need to help them with further development and refinement. However, through my guidance again, we were able to significantly change this man’s presentation and he left the clinic with improved thoracic mobility and a strong home exercise program to maintain these gains.

The third group treated their patient in the dark with the power having gone out around lunch. They brought in a patient who had sustained a proximal humerus fracture 3 weeks ago when involved in a motor vehicle accident. During this mentoring session, we were able to restructure the plan of care and establish a more appropriate treatment plan. When this patient left, she demonstrated a considerable increase in cervical range of motion and demonstrated good understanding of her home exercise program. She too was very appreciative of my presence and teaching and thanked me as she left.

Throughout the day, I observed so much potential in these residents. The vast majority of them are anxious to learn and have opened their minds to new concepts, techniques and treatments. We established a new standard of care today by following the HOAC model and prioritizing impairments. My hope is to open their eyes to the big picture of things so that they can plan accordingly and appropriately to treat every impairment on their list. For the most part, they can do this on paper and they know what their priorities are. However, as Lili and I have discovered, this does not translate to the clinic and these residents still rely heavily on modalities. The other area in which Lili and I have both recognized as being weak is general exercise progression. Lili described a case today where a man was asked to practice climbing stairs. As he struggled to perform this activity, she learned that he had yet to demonstrated a good quad set, glute activation or standing balance in order to perform this activity.

Having noted these things, I have decided to spend a good portion of my time these remaining days to educate the residents on prioritization of impairments, determining appropriate tactics and techniques, and proper exercise progression. And hopefully, after this week, there will be better understanding of proper exercise progression for the upper extremities that will translate to the lower half.

This evening, I am resting my stomach by snacking on saltines without salt and preparing for my presentation tomorrow… yum!