THE PATIENT NAME---Anniki M nisi-------------------------------------------
Index date-16/03/2010-----------------------------------------------------
Activity score for the last week
FEEDNG
0= Unable
5=Needs helpcutting, spreading butter,etc
10=Independent---------------5
GROOMING
0=Needs help with personal care
5=independent face/hair/teeth/shaving/implements provided-----------5
BATHING
0=Dependent
5=independent (or in shower)------------0
BOWELS
0=Incontinent
5=occasional accident
10=continent-----------10
BLADDER
0=incontinent
5=occasional accident
10=continent--------------10
TOILET USE
0=dependent
5=needs help but can do something alone
10=continent----------------5
TRANSFERS (BED TO CHAIR AND BACK)
0=Unable no sitting balance
5=major help (one or two people, physical)
10=major help (verbal or physical)
15=independent ------------------------5
MOBILITY
0=Immobile or<50 yards
5=wheelchair independent, including corners>50 yards
10=walks with the help of one person >50 yards
15=independent but may use the aid, for example stick >50 yards--------------10
STAIRS
0=Unable
5=needs help
10=independent-------------------5
TOTAL (0-100)----------------50
A total score of less 100 means that the patient needs some intervention ,but there is an improvevement
Tuesday, March 23, 2010
The Bathel index scale
THE PATIENT NAME---Anniki M nisi-------------------------------------------
Index date------------------------------------------------------
Activity score
FEEDNG
0= Unable
5=Needs helpcutting, spreading butter,etc
10=Independent----------------5
GROOMING
0=Needs help with personal care
5=independent face/hair/teeth/shaving/implements provided-----------5
BATHING
0=Dependent
5=independent (or in shower)------------0
BOWELS
0=Incontinent
5=occasional accident
10=continent-----------5
BLADDER
0=incontinent
5=occasional accident
10=continent---------------5
TOILET USE
0=dependent
5=needs help but can do something alone
10=continent----------------5
TRANSFERS (BED TO CHAIR AND BACK)
0=Unable no sitting balance
5=major help (one or two people, physical)
10=major help (verbal or physical)
15=independent ------------------------5
MOBILITY
0=Immobile or<50 yards
5=wheelchair independent, including corners>50 yards
10=walks with the help of one person >50 yards
15=independent but may use the aid, for example stick >50 yards--------------10
STAIRS
0=Unable
5=needs help
10=independent--------------------0
TOTAL (0-100)----------------40
A total score of less 100 means that the patient needs some intervention
Index date------------------------------------------------------
Activity score
FEEDNG
0= Unable
5=Needs helpcutting, spreading butter,etc
10=Independent----------------5
GROOMING
0=Needs help with personal care
5=independent face/hair/teeth/shaving/implements provided-----------5
BATHING
0=Dependent
5=independent (or in shower)------------0
BOWELS
0=Incontinent
5=occasional accident
10=continent-----------5
BLADDER
0=incontinent
5=occasional accident
10=continent---------------5
TOILET USE
0=dependent
5=needs help but can do something alone
10=continent----------------5
TRANSFERS (BED TO CHAIR AND BACK)
0=Unable no sitting balance
5=major help (one or two people, physical)
10=major help (verbal or physical)
15=independent ------------------------5
MOBILITY
0=Immobile or<50 yards
5=wheelchair independent, including corners>50 yards
10=walks with the help of one person >50 yards
15=independent but may use the aid, for example stick >50 yards--------------10
STAIRS
0=Unable
5=needs help
10=independent--------------------0
TOTAL (0-100)----------------40
A total score of less 100 means that the patient needs some intervention
Reflections
My experience in rural block
During my rural block at Elim I had a lot of experiences, to work as a multidisciplinary team (OT, SPL&Audio, Diet, Optom and physios) when treating patients during out reach/clinic visits, this helped me to gain knowledge on referring patients to an appropriate professional as they were referring patients to us .I also had an opportunity to treat a patient presenting with lumbar disc prolapsed. We also attended a workshop at Thsilidzini hospital where one of the physios at Elim was presenting about head injury and he also demonstrated the physio treatment. The last thing is that I have learnt about different conditions and treated them.
Challenges during the block
The block itself to me was a bit challenging, at first at the physio department there was discrimination between Medunsa and Wits stundents,the most important challenge was the use of the computer at the physio dept because during the day the staff are very busy with it, then in order to do our school work we had to use the computer after working hours until late because the internet was another problem, then as a result of that we had to go back to the residence very late and on our way back to the residence we came across a big snake and there was a nurse walking behind us he killed the snake, there are a lot of snakes because the day before we saw that one our supervisor told us that they killed a black mamba at the residence where we stay. Another challenge was transport to home visit to do our case study because at the hospital they don`t provide transport for students to home visits, then we had to go on Tuesdays and Wednesdays when health support group are going for outreach or clinic visit and we use to came back late at around the evening. the last challenge was the use of the blogging that was introduced by our block coordinator because the internet was so bad and he expected us to send him everything we were doing almost every day, and during our last week of the block we were not allowed to go use the internet at the physio dept then we had to go to the internet cafe and pay money in order to send our tasks via blogging.
Acknowledgements
.Acknowledgements to the CEO and the clinical manager of Elim hospital for welcoming us and allowing us to do our tasks at the hospital.
.Acknowledgements to our supervisor for helping us to complete our tasks and to arrange transport to home visits for our case study.
.Acknowledgements to our rural block coordinator for making arrangements for the block and for guiding us to complete our tasks
.Acknowledgements to the sister in charge of mbhokota clinic for allowing us to conduct our screening and health talk at the clinic.
.Acknowledgments to my patient Ms Anniki Mnisi for allowing me to treat her and trusting me that I will make a difference in her life.
SWOT NOTES (week 1)
Strengths
To do a full assessment and treatment of patients presenting with back problems and applying of OMT techniques
Weakness
Treating and strapping if a club foot
Opportunities
Learning how to strap a club foot
Threats
To treat patients being observed by the supervisor and the language barrier
WEEK 4
Strengths
Treating patients presenting with different conditions
Weakness
Nothing because i was able to strap a club foot and to treat any condition a patient may be presenting with
Opportunity
I had an opportunity to learn more about head injuries and haemophilia
Threats
Nothing because I was used to be observed by the supervisor when treating patients
SPAR NOTES
Situation
The situation occurred at the physiotherapy department at Elim hospital
People
The physiotherapy staff, HOD and Medunsa students
Activity
There was a problem with the printer at the HOD`s office where the Medunsa students were accused of using the printer after working hours ,then one of the physio assistants insisted that we are the ones who were printing .
Reaction
We denied that we used the printer ,but at the end we went to the HOD`s office and apologised for using the computer to search for articles and she also apologised to us for accusing us as we were not the only ones using the computer after working ours, then problem was solved.
Daily diary (week 4)
Day
Date
Time
Activities
Monday
15-03-2010
07H30-10H00
10H00-10H30
10H30-13H00
13H00-14H00
14H00-16H30
Treating OPDpatients
Tea
Treating OPD patients
Lunch
Treating ward patients
Tuesday
16-03-2010
07H30-8H30
08H30-16H30
Discussion of our tasks with the supervisor
Home visit
Wednesday
17-03-2010
07H30-10H00
10H00-10H30
10H30-13H00
13H00-14H00
14H00-16H30
Treating ward patients
Tea
Treating OPD patients
Lunch
Typing our tasks
Thursday
18-03-2010
07H30-08H30
08H00-15H00
15H00-16H30
Discussing results for screening with our supervisor
Workshop at Tshilidzini hospital about head injuries
Consulting at IT dept for help about analysing screening results
Friday
19-03-2010
07H30-10H00
10H00-10H30
10H30-12H00
Treating of OPD patients
Tea
Treating OPD patients
During my rural block at Elim I had a lot of experiences, to work as a multidisciplinary team (OT, SPL&Audio, Diet, Optom and physios) when treating patients during out reach/clinic visits, this helped me to gain knowledge on referring patients to an appropriate professional as they were referring patients to us .I also had an opportunity to treat a patient presenting with lumbar disc prolapsed. We also attended a workshop at Thsilidzini hospital where one of the physios at Elim was presenting about head injury and he also demonstrated the physio treatment. The last thing is that I have learnt about different conditions and treated them.
Challenges during the block
The block itself to me was a bit challenging, at first at the physio department there was discrimination between Medunsa and Wits stundents,the most important challenge was the use of the computer at the physio dept because during the day the staff are very busy with it, then in order to do our school work we had to use the computer after working hours until late because the internet was another problem, then as a result of that we had to go back to the residence very late and on our way back to the residence we came across a big snake and there was a nurse walking behind us he killed the snake, there are a lot of snakes because the day before we saw that one our supervisor told us that they killed a black mamba at the residence where we stay. Another challenge was transport to home visit to do our case study because at the hospital they don`t provide transport for students to home visits, then we had to go on Tuesdays and Wednesdays when health support group are going for outreach or clinic visit and we use to came back late at around the evening. the last challenge was the use of the blogging that was introduced by our block coordinator because the internet was so bad and he expected us to send him everything we were doing almost every day, and during our last week of the block we were not allowed to go use the internet at the physio dept then we had to go to the internet cafe and pay money in order to send our tasks via blogging.
Acknowledgements
.Acknowledgements to the CEO and the clinical manager of Elim hospital for welcoming us and allowing us to do our tasks at the hospital.
.Acknowledgements to our supervisor for helping us to complete our tasks and to arrange transport to home visits for our case study.
.Acknowledgements to our rural block coordinator for making arrangements for the block and for guiding us to complete our tasks
.Acknowledgements to the sister in charge of mbhokota clinic for allowing us to conduct our screening and health talk at the clinic.
.Acknowledgments to my patient Ms Anniki Mnisi for allowing me to treat her and trusting me that I will make a difference in her life.
SWOT NOTES (week 1)
Strengths
To do a full assessment and treatment of patients presenting with back problems and applying of OMT techniques
Weakness
Treating and strapping if a club foot
Opportunities
Learning how to strap a club foot
Threats
To treat patients being observed by the supervisor and the language barrier
WEEK 4
Strengths
Treating patients presenting with different conditions
Weakness
Nothing because i was able to strap a club foot and to treat any condition a patient may be presenting with
Opportunity
I had an opportunity to learn more about head injuries and haemophilia
Threats
Nothing because I was used to be observed by the supervisor when treating patients
SPAR NOTES
Situation
The situation occurred at the physiotherapy department at Elim hospital
People
The physiotherapy staff, HOD and Medunsa students
Activity
There was a problem with the printer at the HOD`s office where the Medunsa students were accused of using the printer after working hours ,then one of the physio assistants insisted that we are the ones who were printing .
Reaction
We denied that we used the printer ,but at the end we went to the HOD`s office and apologised for using the computer to search for articles and she also apologised to us for accusing us as we were not the only ones using the computer after working ours, then problem was solved.
Daily diary (week 4)
Day
Date
Time
Activities
Monday
15-03-2010
07H30-10H00
10H00-10H30
10H30-13H00
13H00-14H00
14H00-16H30
Treating OPDpatients
Tea
Treating OPD patients
Lunch
Treating ward patients
Tuesday
16-03-2010
07H30-8H30
08H30-16H30
Discussion of our tasks with the supervisor
Home visit
Wednesday
17-03-2010
07H30-10H00
10H00-10H30
10H30-13H00
13H00-14H00
14H00-16H30
Treating ward patients
Tea
Treating OPD patients
Lunch
Typing our tasks
Thursday
18-03-2010
07H30-08H30
08H00-15H00
15H00-16H30
Discussing results for screening with our supervisor
Workshop at Tshilidzini hospital about head injuries
Consulting at IT dept for help about analysing screening results
Friday
19-03-2010
07H30-10H00
10H00-10H30
10H30-12H00
Treating of OPD patients
Tea
Treating OPD patients
Reflections
My experience in rural block
During my rural block at Elim I had a lot of experiences, to work as a multidisciplinary team (OT, SPL&Audio, Diet, Optom and physios) when treating patients during out reach/clinic visits, this helped me to gain knowledge on referring patients to an appropriate professional as they were referring patients to us .I also had an opportunity to treat a patient presenting with lumbar disc prolapsed. We also attended a workshop at Thsilidzini hospital where one of the physios at Elim was presenting about head injury and he also demonstrated the physio treatment. The last thing is that I have learnt about different conditions and treated them.
Challenges during the block
The block itself to me was a bit challenging, at first at the physio department there was discrimination between Medunsa and Wits stundents,the most important challenge was the use of the computer at the physio dept because during the day the staff are very busy with it, then in order to do our school work we had to use the computer after working hours until late because the internet was another problem, then as a result of that we had to go back to the residence very late and on our way back to the residence we came across a big snake and there was a nurse walking behind us he killed the snake, there are a lot of snakes because the day before we saw that one our supervisor told us that they killed a black mamba at the residence where we stay. Another challenge was transport to home visit to do our case study because at the hospital they don`t provide transport for students to home visits, then we had to go on Tuesdays and Wednesdays when health support group are going for outreach or clinic visit and we use to came back late at around the evening. the last challenge was the use of the blogging that was introduced by our block coordinator because the internet was so bad and he expected us to send him everything we were doing almost every day, and during our last week of the block we were not allowed to go use the internet at the physio dept then we had to go to the internet cafe and pay money in order to send our tasks via blogging.
Acknowledgements
.Acknowledgements to the CEO and the clinical manager of Elim hospital for welcoming us and allowing us to do our tasks at the hospital.
.Acknowledgements to our supervisor for helping us to complete our tasks and to arrange transport to home visits for our case study.
.Acknowledgements to our rural block coordinator for making arrangements for the block and for guiding us to complete our tasks
.Acknowledgements to the sister in charge of mbhokota clinic for allowing us to conduct our screening and health talk at the clinic.
.Acknowledgments to my patient Ms Anniki Mnisi for allowing me to treat her and trusting me that I will make a difference in her life.
SWOT NOTES (week 1)
Strengths
To do a full assessment and treatment of patients presenting with back problems and applying of OMT techniques
Weakness
Treating and strapping if a club foot
Opportunities
Learning how to strap a club foot
Threats
To treat patients being observed by the supervisor and the language barrier
WEEK 4
Strengths
Treating patients presenting with different conditions
Weakness
Nothing because i was able to strap a club foot and to treat any condition a patient may be presenting with
Opportunity
I had an opportunity to learn more about head injuries and haemophilia
Threats
Nothing because I was used to be observed by the supervisor when treating patients
SPAR NOTES
Situation
The situation occurred at the physiotherapy department at Elim hospital
People
The physiotherapy staff, HOD and Medunsa students
Activity
There was a problem with the printer at the HOD`s office where the Medunsa students were accused of using the printer after working hours ,then one of the physio assistants insisted that we are the ones who were printing .
Reaction
We denied that we used the printer ,but at the end we went to the HOD`s office and apologised for using the computer to search for articles and she also apologised to us for accusing us as we were not the only ones using the computer after working ours, then problem was solved.
Daily diary (week 4)
Day
Date
Time
Activities
Monday
15-03-2010
07H30-10H00
10H00-10H30
10H30-13H00
13H00-14H00
14H00-16H30
Treating OPDpatients
Tea
Treating OPD patients
Lunch
Treating ward patients
Tuesday
16-03-2010
07H30-8H30
08H30-16H30
Discussion of our tasks with the supervisor
Home visit
Wednesday
17-03-2010
07H30-10H00
10H00-10H30
10H30-13H00
13H00-14H00
14H00-16H30
Treating ward patients
Tea
Treating OPD patients
Lunch
Typing our tasks
Thursday
18-03-2010
07H30-08H30
08H00-15H00
15H00-16H30
Discussing results for screening with our supervisor
Workshop at Tshilidzini hospital about head injuries
Consulting at IT dept for help about analysing screening results
Friday
19-03-2010
07H30-10H00
10H00-10H30
10H30-12H00
Treating of OPD patients
Tea
Treating OPD patients
During my rural block at Elim I had a lot of experiences, to work as a multidisciplinary team (OT, SPL&Audio, Diet, Optom and physios) when treating patients during out reach/clinic visits, this helped me to gain knowledge on referring patients to an appropriate professional as they were referring patients to us .I also had an opportunity to treat a patient presenting with lumbar disc prolapsed. We also attended a workshop at Thsilidzini hospital where one of the physios at Elim was presenting about head injury and he also demonstrated the physio treatment. The last thing is that I have learnt about different conditions and treated them.
Challenges during the block
The block itself to me was a bit challenging, at first at the physio department there was discrimination between Medunsa and Wits stundents,the most important challenge was the use of the computer at the physio dept because during the day the staff are very busy with it, then in order to do our school work we had to use the computer after working hours until late because the internet was another problem, then as a result of that we had to go back to the residence very late and on our way back to the residence we came across a big snake and there was a nurse walking behind us he killed the snake, there are a lot of snakes because the day before we saw that one our supervisor told us that they killed a black mamba at the residence where we stay. Another challenge was transport to home visit to do our case study because at the hospital they don`t provide transport for students to home visits, then we had to go on Tuesdays and Wednesdays when health support group are going for outreach or clinic visit and we use to came back late at around the evening. the last challenge was the use of the blogging that was introduced by our block coordinator because the internet was so bad and he expected us to send him everything we were doing almost every day, and during our last week of the block we were not allowed to go use the internet at the physio dept then we had to go to the internet cafe and pay money in order to send our tasks via blogging.
Acknowledgements
.Acknowledgements to the CEO and the clinical manager of Elim hospital for welcoming us and allowing us to do our tasks at the hospital.
.Acknowledgements to our supervisor for helping us to complete our tasks and to arrange transport to home visits for our case study.
.Acknowledgements to our rural block coordinator for making arrangements for the block and for guiding us to complete our tasks
.Acknowledgements to the sister in charge of mbhokota clinic for allowing us to conduct our screening and health talk at the clinic.
.Acknowledgments to my patient Ms Anniki Mnisi for allowing me to treat her and trusting me that I will make a difference in her life.
SWOT NOTES (week 1)
Strengths
To do a full assessment and treatment of patients presenting with back problems and applying of OMT techniques
Weakness
Treating and strapping if a club foot
Opportunities
Learning how to strap a club foot
Threats
To treat patients being observed by the supervisor and the language barrier
WEEK 4
Strengths
Treating patients presenting with different conditions
Weakness
Nothing because i was able to strap a club foot and to treat any condition a patient may be presenting with
Opportunity
I had an opportunity to learn more about head injuries and haemophilia
Threats
Nothing because I was used to be observed by the supervisor when treating patients
SPAR NOTES
Situation
The situation occurred at the physiotherapy department at Elim hospital
People
The physiotherapy staff, HOD and Medunsa students
Activity
There was a problem with the printer at the HOD`s office where the Medunsa students were accused of using the printer after working hours ,then one of the physio assistants insisted that we are the ones who were printing .
Reaction
We denied that we used the printer ,but at the end we went to the HOD`s office and apologised for using the computer to search for articles and she also apologised to us for accusing us as we were not the only ones using the computer after working ours, then problem was solved.
Daily diary (week 4)
Day
Date
Time
Activities
Monday
15-03-2010
07H30-10H00
10H00-10H30
10H30-13H00
13H00-14H00
14H00-16H30
Treating OPDpatients
Tea
Treating OPD patients
Lunch
Treating ward patients
Tuesday
16-03-2010
07H30-8H30
08H30-16H30
Discussion of our tasks with the supervisor
Home visit
Wednesday
17-03-2010
07H30-10H00
10H00-10H30
10H30-13H00
13H00-14H00
14H00-16H30
Treating ward patients
Tea
Treating OPD patients
Lunch
Typing our tasks
Thursday
18-03-2010
07H30-08H30
08H00-15H00
15H00-16H30
Discussing results for screening with our supervisor
Workshop at Tshilidzini hospital about head injuries
Consulting at IT dept for help about analysing screening results
Friday
19-03-2010
07H30-10H00
10H00-10H30
10H30-12H00
Treating of OPD patients
Tea
Treating OPD patients
SCREENING REPORT
Topic: Screening for the disability index in osteoarthritis patients
Background
Osteoarthritis is the degenerative changes in the articular cartilage and other joints structures; it may be secondary to an injury or disease in the majority of cases. Osteoarthritis develops in the middle- aged and elderly, it appears in the these joints which are most subjected to strain, either the weight bearing joints such as the hip and knee or those which according to the particular occupation are most used such as the spinal articulations of the Agricultural and manual worker or terminal interphalangeal joints of the of the hands of the gardener or cleaner (Joan E.Cash, 1965)
Though much discussion exists as the exact cause of the development of OA, it is likely that resistance of the joint surfaces reduced by the wear and tear of life. Direct trauma such as a fracture involving the articular surfaces and damaging the cartilage is often followed by the OA, faulty posture is a possible cause of degenerative changes because it upsets the mechanics of the joint, abnormal strain is, therefore, brought to bear cartilage and bone, as well as on joint capsules. For example OA of spine is secondary to structural kyphosis and scoliosis. Obesity is an important contributory factor to OA of the hip and knee (http://www.medicinet.com/osteoarthtis/article.htm)
Reasons for screening
During the past two weeks of my rural block at Elim hospital I have treated many patients with Osteoarthritis from Mbokota village, most of them they have already developed deformities secondary to OA, then as a result of this deformities the patients will end being disabled, that is why I have decided to screen for the disability index in OA patients of Mbhokota village.
Aim of the study
. To determine the functional abilities of patients with OA
Targeted population
All patients attending mbhokota clinic suffering from OA
Objectives
.To determine the functional abilities of patients suffering from OA.
.To determine how OA interferes with the patient`s ADL.
.To determine how pain affects patients with OA
Tools
A disability index questionnaire (Health assessment questionnaire from Stanford University school of Medicine) was used which was translated to Tsonga.
Method
Disability index questionnaires were distributed to the patients who were gathered in same place, the instructions were fully explained on how to complete the questionaire, those who were unable read and write we helped them on how to go about filling the questionairs.all the questionnaires were completed and collected at the very same day.
Significance of the study
The patients will be taught how to manage ADL`s with OA, also they will be shown how to do exercises and there will be less referral to the physiotherapy department
Results
Dressing and grooming
7(63, 6%) of the participants can dress themselves and tie shoe laces without difficulty, while 3(27, 3%) can dress themselves with some difficulty, 1(9, 1%) can dress with much difficulty and 0% were unable.
Standing
2(18, 2%) of the participants can stand from a chair without difficulty, 7(63.6%) can stand with some difficulty,2(18,2%) can stand from a chair with much difficulty while 0% were unable.
Eating
7(63, 6%) of the participants can lift a cup glass of water to the mouth without difficulty, 2(18, 2%) can lift the glass or a cup of water with some difficulty, 2(18, 2%) can with much difficulty, while o% were unable
Hygiene
7(63, 6%) of the participants can wash and dry their bodies without difficulty, 2(18, 2%) can with some difficulty, 2(18, 2%) can with much difficulty while 0% were unable
Walking
4(36, 4%) can walk on a flat ground without difficulties, 1(9%) can walk with some difficulties, 6(54, 5%) can walk with much difficulty, while 0% were unable.1(9,1%)can climb stairs without difficulty,2(18,2%)can climb stairs with some difficulties,3(27,3%) can climb with much difficulties while 5(45,5%)were unable to climb the stairs
Activities
0% of the participants can do chores and yard work without difficulty,0% of participants can with some difficulty,2(18,2%) can with much difficulty, while 9(81%) of them were unable to do chores and yard work
Pain
2(18, 2%) of the participants were affected by pain with the scale of up to 6/10, 3(27, 3%) were affected by pain up to scale of 5/10, 2(18, 2%) were affected up to the scale of 8/10, while 4(36, 4%) were affected up the scale of 7/10
In conclusion
There a few percentages of patients who had difficulties in in dressing grooming, reaching, eating, gripping, arising, and standing, but most of the patients have much difficulty in walking and climbing the stairs and we had higher percentage of those who were unable to do activities such as vacuuming and yard working with 81% and most of the patients with the percentage of 34% are affected by pain during ,this patients are at high risk of disability if they don`t adhere to the home programme and exercises .
Ethical considerations
A permission letter was written to the sister in charge of Mbhokota clinic and permission was granted, and also consent forms were distributed and signed by patients before the screening took place. The patients were allowed to withdraw at any time if they don’t want to continue with the screening
.
Recommendations
I recommended that the other groups of physiotherapy students should continue giving the patients education about OA, how to mage ADL`s, the importance of doing exercises and also give them pamphlets about OA
.
Acknowledgemements
.I acknowledges the sisters at Mbhokota clinic for making arrangements with the patients on our behalf and allowing us to use their venue for our tasks.
.I acknowledges the patients for trusting us and being cooperative through out our screening.
. I acknowledge our supervisor for arranging the transport to the clinic and helping us where we needed help.
Topic: Screening for the disability index in osteoarthritis patients
Background
Osteoarthritis is the degenerative changes in the articular cartilage and other joints structures; it may be secondary to an injury or disease in the majority of cases. Osteoarthritis develops in the middle- aged and elderly, it appears in the these joints which are most subjected to strain, either the weight bearing joints such as the hip and knee or those which according to the particular occupation are most used such as the spinal articulations of the Agricultural and manual worker or terminal interphalangeal joints of the of the hands of the gardener or cleaner (Joan E.Cash, 1965)
Though much discussion exists as the exact cause of the development of OA, it is likely that resistance of the joint surfaces reduced by the wear and tear of life. Direct trauma such as a fracture involving the articular surfaces and damaging the cartilage is often followed by the OA, faulty posture is a possible cause of degenerative changes because it upsets the mechanics of the joint, abnormal strain is, therefore, brought to bear cartilage and bone, as well as on joint capsules. For example OA of spine is secondary to structural kyphosis and scoliosis. Obesity is an important contributory factor to OA of the hip and knee (http://www.medicinet.com/osteoarthtis/article.htm)
Reasons for screening
During the past two weeks of my rural block at Elim hospital I have treated many patients with Osteoarthritis from Mbokota village, most of them they have already developed deformities secondary to OA, then as a result of this deformities the patients will end being disabled, that is why I have decided to screen for the disability index in OA patients of Mbhokota village.
Aim of the study
. To determine the functional abilities of patients with OA
Targeted population
All patients attending mbhokota clinic suffering from OA
Objectives
.To determine the functional abilities of patients suffering from OA.
.To determine how OA interferes with the patient`s ADL.
.To determine how pain affects patients with OA
Tools
A disability index questionnaire (Health assessment questionnaire from Stanford University school of Medicine) was used which was translated to Tsonga.
Method
Disability index questionnaires were distributed to the patients who were gathered in same place, the instructions were fully explained on how to complete the questionaire, those who were unable read and write we helped them on how to go about filling the questionairs.all the questionnaires were completed and collected at the very same day.
Significance of the study
The patients will be taught how to manage ADL`s with OA, also they will be shown how to do exercises and there will be less referral to the physiotherapy department
Results
Dressing and grooming
7(63, 6%) of the participants can dress themselves and tie shoe laces without difficulty, while 3(27, 3%) can dress themselves with some difficulty, 1(9, 1%) can dress with much difficulty and 0% were unable.
Standing
2(18, 2%) of the participants can stand from a chair without difficulty, 7(63.6%) can stand with some difficulty,2(18,2%) can stand from a chair with much difficulty while 0% were unable.
Eating
7(63, 6%) of the participants can lift a cup glass of water to the mouth without difficulty, 2(18, 2%) can lift the glass or a cup of water with some difficulty, 2(18, 2%) can with much difficulty, while o% were unable
Hygiene
7(63, 6%) of the participants can wash and dry their bodies without difficulty, 2(18, 2%) can with some difficulty, 2(18, 2%) can with much difficulty while 0% were unable
Walking
4(36, 4%) can walk on a flat ground without difficulties, 1(9%) can walk with some difficulties, 6(54, 5%) can walk with much difficulty, while 0% were unable.1(9,1%)can climb stairs without difficulty,2(18,2%)can climb stairs with some difficulties,3(27,3%) can climb with much difficulties while 5(45,5%)were unable to climb the stairs
Activities
0% of the participants can do chores and yard work without difficulty,0% of participants can with some difficulty,2(18,2%) can with much difficulty, while 9(81%) of them were unable to do chores and yard work
Pain
2(18, 2%) of the participants were affected by pain with the scale of up to 6/10, 3(27, 3%) were affected by pain up to scale of 5/10, 2(18, 2%) were affected up to the scale of 8/10, while 4(36, 4%) were affected up the scale of 7/10
In conclusion
There a few percentages of patients who had difficulties in in dressing grooming, reaching, eating, gripping, arising, and standing, but most of the patients have much difficulty in walking and climbing the stairs and we had higher percentage of those who were unable to do activities such as vacuuming and yard working with 81% and most of the patients with the percentage of 34% are affected by pain during ,this patients are at high risk of disability if they don`t adhere to the home programme and exercises .
Ethical considerations
A permission letter was written to the sister in charge of Mbhokota clinic and permission was granted, and also consent forms were distributed and signed by patients before the screening took place. The patients were allowed to withdraw at any time if they don’t want to continue with the screening
.
Recommendations
I recommended that the other groups of physiotherapy students should continue giving the patients education about OA, how to mage ADL`s, the importance of doing exercises and also give them pamphlets about OA
.
Acknowledgemements
.I acknowledges the sisters at Mbhokota clinic for making arrangements with the patients on our behalf and allowing us to use their venue for our tasks.
.I acknowledges the patients for trusting us and being cooperative through out our screening.
. I acknowledge our supervisor for arranging the transport to the clinic and helping us where we needed help.
Health talk Report
HEALTH TALK REPORT
Topic: Educating the patients from Mbhokota village about Osteoarthritis
Background
Osteoarthritis is also known as the degenerative arthritis and is mostly related to aging, with aging the water content of the cartilage increases, and the protein make up of cartilage degenerates. Eventually the cartilage begins to degenerates by flaking or forming tiny crevases.In advanced cases, there is a total loss of cartilage cushion between the bones of the joints. Repetitive use of the joints over years can irritate and inflame the cartilage, causing joint pain and swelling. Loss of the cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. Inflammation of the cartilage can also stimulate new bone outgrowths to form around the joints. A occasionally can develop in multiple members of the same family, implying a hereditary (genetic) basis of this condition (http://www.medicinet.com/osteoarthritis/article)
Reasons for the health talk
During the day of screening at Mbhokota clinic many patients were asking many question about this osteoarthritis, they wanted to know how do we know that a patient has OA and the causes ,then I have realised that they don`t have knowledge about this OA and I have decided to educate them about OA, causes, signs and symptoms, treatment and exercises and the importance of doing these exercises.
Aim of the talk
To educate the patients from Mbhokota village about Osteoarthritis.
Targeted populations
All the patients suffering from Osteoarthritis from Mbhokota village attending clinic at Mbhokota and Elim hospital.
Objectives
.To educate the patients about Osteoarthritis
.To educate the patients about the causes of OA
.To educate the patients about the signs and symptoms of OA
.To educate the patients about the treatment of OA including the exercises
Tools used
Posters and anatomical model from the physiotherapy department and a camera were used.
Method
The information was delivered to the patients in the form of a lecture and demonstration of exercises
Ethical consideration
A permission letter was written to the sister in charge of Mbokota clinic and permission was granted to go ahead with the health talk and also consent form was issued to the patients to sign before start with the talk and to allow us to take pictures.
Recommendations
I recommended that the following groups of physiotherapy students should continue giving lectures about OA and issue pamphlets about OA,i also recommended that the physiotherapy department should conduct OA classes at the hospital and at the clinics during their visits Acknowledgements
.Acknowledgement to my supervisor for arranging the transport to the clinic and for helping with the preparation s for the task
.Acknowledgement to the sister in charge for granting me the permission to conduct a health talk at the clinic
.Acknowledgement to the patients for giving me the opportunity to conduct a health talk
.Acknowledgements to my colleagues for assisting with preparation and taking pictures
.Acknowledgement to the Elim hospital physiotherapy department for allowing me to use their posters and the anatomical model
Topic: Educating the patients from Mbhokota village about Osteoarthritis
Background
Osteoarthritis is also known as the degenerative arthritis and is mostly related to aging, with aging the water content of the cartilage increases, and the protein make up of cartilage degenerates. Eventually the cartilage begins to degenerates by flaking or forming tiny crevases.In advanced cases, there is a total loss of cartilage cushion between the bones of the joints. Repetitive use of the joints over years can irritate and inflame the cartilage, causing joint pain and swelling. Loss of the cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. Inflammation of the cartilage can also stimulate new bone outgrowths to form around the joints. A occasionally can develop in multiple members of the same family, implying a hereditary (genetic) basis of this condition (http://www.medicinet.com/osteoarthritis/article)
Reasons for the health talk
During the day of screening at Mbhokota clinic many patients were asking many question about this osteoarthritis, they wanted to know how do we know that a patient has OA and the causes ,then I have realised that they don`t have knowledge about this OA and I have decided to educate them about OA, causes, signs and symptoms, treatment and exercises and the importance of doing these exercises.
Aim of the talk
To educate the patients from Mbhokota village about Osteoarthritis.
Targeted populations
All the patients suffering from Osteoarthritis from Mbhokota village attending clinic at Mbhokota and Elim hospital.
Objectives
.To educate the patients about Osteoarthritis
.To educate the patients about the causes of OA
.To educate the patients about the signs and symptoms of OA
.To educate the patients about the treatment of OA including the exercises
Tools used
Posters and anatomical model from the physiotherapy department and a camera were used.
Method
The information was delivered to the patients in the form of a lecture and demonstration of exercises
Ethical consideration
A permission letter was written to the sister in charge of Mbokota clinic and permission was granted to go ahead with the health talk and also consent form was issued to the patients to sign before start with the talk and to allow us to take pictures.
Recommendations
I recommended that the following groups of physiotherapy students should continue giving lectures about OA and issue pamphlets about OA,i also recommended that the physiotherapy department should conduct OA classes at the hospital and at the clinics during their visits Acknowledgements
.Acknowledgement to my supervisor for arranging the transport to the clinic and for helping with the preparation s for the task
.Acknowledgement to the sister in charge for granting me the permission to conduct a health talk at the clinic
.Acknowledgement to the patients for giving me the opportunity to conduct a health talk
.Acknowledgements to my colleagues for assisting with preparation and taking pictures
.Acknowledgement to the Elim hospital physiotherapy department for allowing me to use their posters and the anatomical model
Thursday, March 18, 2010
Daily Diary
DAILY DIARY WEEK I (22 – 26 FEBRUARY)
DAYS
DATES
TIME
ACTIVITIES
Monday
22-02-2010
07H30-10H00
10H00-13H00
13H00-14H00
14H00-15H00
15H00-16H30
Orientation and tasks discussion
Treating OPD pt`s
Lunch
Packing to change a room
Discussing topics
Tuesday
23-02-2010
07H30-8H30
8H30-10H00
10H00-10H30
10H 30-13H00
13H00-14H00
14H00-16H30
Discussing topics with supervisor
Treating OPD pt`s
Tea
Treating OPD pt`s
Lunch
Treating ward pt`s
Wednesday
24-02-2010
07H00-8H30
08H30-13H00
13H00-14H00
14H00-16H30
Discussing topics
Treating OPD pt`s
Lunch
Home visit
Thursday
25-02-2010
07H30-8H30
08H30-10H00
10H00-10H30
10H30-13H00
13H00-14H00
14H00-16H30
Discussing topics
Treating OPD pt`s
Tea
Treating ward pt`s
Lunch
Treating ward pt`s
Friday
26-02-2010
07H30-9H00
9H00-10H00
10H00-10H30
10H30-13H00
13H00-14H00
14H00-16H00
Writing assessment
Treating OPD pt`s
Tea
Treating ward pt`s
Lunch
Treating OPD pt`s
DAILY DIARY WEEK 2 (01-05 March 2010)
DAY
DATE
TIME
ACTIVITIES
Monday
01-03-2010
07H30-8h00
08H00-10H00
10H00-10H30
10H30-11H00
11H00-13H00
13H00-14H00
14H00-16H30
Discussing case study
Treating OPD pt`s
Stats
Tea
Meeting with DR Useh
Lunch
Treating ward pt`s
Tuesday
02-03-2010
07H30-8H30
08H30-16H30
Discussing case study with the supervisor
Home visit
Wednesday
03-03-2010
07H30-08H30
08H30-10H00
10H00-10H30
10H30-13H00
13H00-14H00
14h00-16H30
Discussing case study
Treating OPD pt`s
Tea
Treating OPD pt`s
Lunch
Treating ward pt`s
Thursday
04-03-2010
07H00-08H00
08H00-16H00
Stats
Home visit
Friday
05-03-2010
07H00-10H00
10H00-10H30
10H30-13H00
13H00-14H00
Treating OPD pt`s
Tea
Treating ward pt`s
Lunch
DAILY DIARY WEEK 3 (08-12March2010)
DAYS
DATE
TIME
ACTIVITIES
Monday
08-03-2010
07H30-09H00
09H00-10h00
10H00-10H30
10H30-13h00
13H00-14h00
14H00-15h00
15H00-15h30
15H30-16H30
Writing assessment
Treating OPD pt`s
Tea
Treating ward pt`s
Lunch
Treating OPD pt`s
Physio meeting
Treating ward pt`s
Tuesday
09-03-2010
07H30-16h00
Home visit
Wednesday
10-03-2010
07H30-10H00
10H00-10h30
10H00-13H00
13H00-14H00
14H00-16H30
Typing case study
Tea
Typing case study
Lunch
Preparing screening and health talk
Thursday
11-03-2010
07H30-16H30
Home visit
Friday
12-03-2010
07H30-10H00
10H00-10H30
10H30-13H00
13H00-14H00
14H00-16H30
Treating OPD pt`s
Tea
Treating ward pt`s
Lunch
Home visit
DAYS
DATES
TIME
ACTIVITIES
Monday
22-02-2010
07H30-10H00
10H00-13H00
13H00-14H00
14H00-15H00
15H00-16H30
Orientation and tasks discussion
Treating OPD pt`s
Lunch
Packing to change a room
Discussing topics
Tuesday
23-02-2010
07H30-8H30
8H30-10H00
10H00-10H30
10H 30-13H00
13H00-14H00
14H00-16H30
Discussing topics with supervisor
Treating OPD pt`s
Tea
Treating OPD pt`s
Lunch
Treating ward pt`s
Wednesday
24-02-2010
07H00-8H30
08H30-13H00
13H00-14H00
14H00-16H30
Discussing topics
Treating OPD pt`s
Lunch
Home visit
Thursday
25-02-2010
07H30-8H30
08H30-10H00
10H00-10H30
10H30-13H00
13H00-14H00
14H00-16H30
Discussing topics
Treating OPD pt`s
Tea
Treating ward pt`s
Lunch
Treating ward pt`s
Friday
26-02-2010
07H30-9H00
9H00-10H00
10H00-10H30
10H30-13H00
13H00-14H00
14H00-16H00
Writing assessment
Treating OPD pt`s
Tea
Treating ward pt`s
Lunch
Treating OPD pt`s
DAILY DIARY WEEK 2 (01-05 March 2010)
DAY
DATE
TIME
ACTIVITIES
Monday
01-03-2010
07H30-8h00
08H00-10H00
10H00-10H30
10H30-11H00
11H00-13H00
13H00-14H00
14H00-16H30
Discussing case study
Treating OPD pt`s
Stats
Tea
Meeting with DR Useh
Lunch
Treating ward pt`s
Tuesday
02-03-2010
07H30-8H30
08H30-16H30
Discussing case study with the supervisor
Home visit
Wednesday
03-03-2010
07H30-08H30
08H30-10H00
10H00-10H30
10H30-13H00
13H00-14H00
14h00-16H30
Discussing case study
Treating OPD pt`s
Tea
Treating OPD pt`s
Lunch
Treating ward pt`s
Thursday
04-03-2010
07H00-08H00
08H00-16H00
Stats
Home visit
Friday
05-03-2010
07H00-10H00
10H00-10H30
10H30-13H00
13H00-14H00
Treating OPD pt`s
Tea
Treating ward pt`s
Lunch
DAILY DIARY WEEK 3 (08-12March2010)
DAYS
DATE
TIME
ACTIVITIES
Monday
08-03-2010
07H30-09H00
09H00-10h00
10H00-10H30
10H30-13h00
13H00-14h00
14H00-15h00
15H00-15h30
15H30-16H30
Writing assessment
Treating OPD pt`s
Tea
Treating ward pt`s
Lunch
Treating OPD pt`s
Physio meeting
Treating ward pt`s
Tuesday
09-03-2010
07H30-16h00
Home visit
Wednesday
10-03-2010
07H30-10H00
10H00-10h30
10H00-13H00
13H00-14H00
14H00-16H30
Typing case study
Tea
Typing case study
Lunch
Preparing screening and health talk
Thursday
11-03-2010
07H30-16H30
Home visit
Friday
12-03-2010
07H30-10H00
10H00-10H30
10H30-13H00
13H00-14H00
14H00-16H30
Treating OPD pt`s
Tea
Treating ward pt`s
Lunch
Home visit
Screening Tool for disability index
The STANFORD HEALTH ASSESSMENT QUESTIONNAIRE
Stanford University School of Medicine, Division of Immunology & Rheumatology
HAQ Disability Index:
In this section we are interested in learning how your illness affects your ability to function in daily
life. Please feel free to add any comments on the back of this page.
Please check the response which best describes your usual abilities OVER THE PAST WEEK:
Without ANY
difficulty
0
With SOME
difficulty
1
With MUCH
difficulty 2
UNABLE
to do 3
DRESSING & GROOMING
Are you able to:
-Dress yourself, including tying
shoelaces and doing buttons?
-Shampoo your hair?
ARISING
Are you able to:
-Stand up from a straight chair?
-Get in and out of bed?
EATING
Are you able to:
-Cut your meat?
-Lift a full cup or glass to your mouth?
-Open a new milk carton?
WALKING
Are you able to:
-Walk outdoors on flat ground?
-Climb up five steps?
Please check any AIDS OR DEVICES that you usually use for any of these activities:
Cane
Walker
Crutches
Wheelchair
Devices used for dressing (button hook, zipper pul
long-handled shoe horn, etc.)
Built up or special utensils
Special or built up chair
Other (Specify: )
Please check any categories for which you usually need HELP FROM ANOTHER PERSON:
Dressing and Grooming
Arising
Eating
Walking
Please check the response which best describes your usual abilities OVER THE PAST WEEK:
Without ANY
difficulty 0
With SOME
difficulty 1
With MUCH
difficulty 2
UNABLE
to do 3
HYGIENE
Are you able to:
-Wash and dry your body?
-Take a tub bath?
-Get on and off the toilet?
REACH
Are you able to:
-Reach and get down a 5-pound
object (such as a bag of sugar) from
just above your head?
-Bend down to pick up clothing
from the floor?
GRIP
Are you able to:
-Open car doors?
-Open jars which have been
previously opened?
-Turn faucets on and off?
ACTIVITIES
Are you able to:
-Run errands and shop?
-Get in and out of a car?
-Do chores such as vacuuming or
yardwork
Please check any AIDS OR DEVICES that you usually use for any of these activities:
Raised toilet seat
Bathtub seat
Jar opener (for jars previously
opened)
Bathtub bar
Long-handled appliances for reach
Long-handled appliances in bathroom
Other (Specify: )
Please check any categories for which you usually need HELP FROM ANOTHER PERSON:
Hygiene
Reach
Gripping and opening things
Errands and chores
We are also interested in learning whether or not you are affected by pain because of your illness.
How much pain have you had because of your illness IN THE PAST WEEK:
PLACE A VERTICAL () MARK ON THE LINE TO INDICATE THE SEVERITY OF THE PAIN
No Pain Severe Pain
0 100
Considering all the ways that your arthritis affects you, rate how you are doing on the following scale by
placing a vertical mark on the line.
Very Well Very Poor
0 100
Stanford University School of Medicine, Division of Immunology & Rheumatology
HAQ Disability Index:
In this section we are interested in learning how your illness affects your ability to function in daily
life. Please feel free to add any comments on the back of this page.
Please check the response which best describes your usual abilities OVER THE PAST WEEK:
Without ANY
difficulty
0
With SOME
difficulty
1
With MUCH
difficulty 2
UNABLE
to do 3
DRESSING & GROOMING
Are you able to:
-Dress yourself, including tying
shoelaces and doing buttons?
-Shampoo your hair?
ARISING
Are you able to:
-Stand up from a straight chair?
-Get in and out of bed?
EATING
Are you able to:
-Cut your meat?
-Lift a full cup or glass to your mouth?
-Open a new milk carton?
WALKING
Are you able to:
-Walk outdoors on flat ground?
-Climb up five steps?
Please check any AIDS OR DEVICES that you usually use for any of these activities:
Cane
Walker
Crutches
Wheelchair
Devices used for dressing (button hook, zipper pul
long-handled shoe horn, etc.)
Built up or special utensils
Special or built up chair
Other (Specify: )
Please check any categories for which you usually need HELP FROM ANOTHER PERSON:
Dressing and Grooming
Arising
Eating
Walking
Please check the response which best describes your usual abilities OVER THE PAST WEEK:
Without ANY
difficulty 0
With SOME
difficulty 1
With MUCH
difficulty 2
UNABLE
to do 3
HYGIENE
Are you able to:
-Wash and dry your body?
-Take a tub bath?
-Get on and off the toilet?
REACH
Are you able to:
-Reach and get down a 5-pound
object (such as a bag of sugar) from
just above your head?
-Bend down to pick up clothing
from the floor?
GRIP
Are you able to:
-Open car doors?
-Open jars which have been
previously opened?
-Turn faucets on and off?
ACTIVITIES
Are you able to:
-Run errands and shop?
-Get in and out of a car?
-Do chores such as vacuuming or
yardwork
Please check any AIDS OR DEVICES that you usually use for any of these activities:
Raised toilet seat
Bathtub seat
Jar opener (for jars previously
opened)
Bathtub bar
Long-handled appliances for reach
Long-handled appliances in bathroom
Other (Specify: )
Please check any categories for which you usually need HELP FROM ANOTHER PERSON:
Hygiene
Reach
Gripping and opening things
Errands and chores
We are also interested in learning whether or not you are affected by pain because of your illness.
How much pain have you had because of your illness IN THE PAST WEEK:
PLACE A VERTICAL () MARK ON THE LINE TO INDICATE THE SEVERITY OF THE PAIN
No Pain Severe Pain
0 100
Considering all the ways that your arthritis affects you, rate how you are doing on the following scale by
placing a vertical mark on the line.
Very Well Very Poor
0 100
Case Study Report
CASE STUDY REPORT
Patient`s Name : Anniki Mnisi
Age : 76 Years
Gender : Female
Diagnosis : Left CVA, Right Hemiplegic
Physical Address : Waterval
Occupation : Pensioner
Marital Status : Single
Caregiver : Jestinah Chauke
Date of evaluation : 02 March 2010
Name of student : Mashego S.T
Supervisor : Mr Matswiki T.M
SUBJECTIVE EVALUATION
Present medical history
At around September 2009 the patient woke up early in the morning she wanted to go to the toilet ,then she started feeling that her right upper and lower limb were very weak and numb, she was unable to walk by herself, and by that time she was with her grand daughter, her daughter was still at work. When the daughter came back she took her to a nearby private Doctor who diagnosed her with CVA and referred her to Elim hospital where she was admitted for two weeks it was confirmed that she was a left CVA(Right hemiplegic). After two weeks she was discharged without seeing a physiotherapist.
Past medical history
She was a known hypertensive patient who was on medication before she suffered a stroke ,she was diagnosed with hypertension a long time ago but she can`t remember when and also the caregiver can`t remember, no other related medical history.
Socioeconomic history
Occupation: The patient is a pensioner, she is not a breadwinner ,the breadwinner is her daughter who is a police woman who stay with her.
Marital status : The patient is single, she was never married, she is a single mother of four children, three daughters and one son who are grown ups and they are married except the one who she stays with her in the house. Her daughter hired caregiver to take care of her and clean the house.
Home environment internal: The patient stays in a 7 roomed house builded by bricks, the toilet is inside and flushing, the is electricity and running in the house,the floor is cemented in the patient room and other bedrooms but the kitchen and the sitting room are tiles, there is enough space in the patient`s room for propelling a wheelchair and other walking aids, the patient sleeps on a double bed and the mattress is firm.
External environment: There is one step at the entrance of the house by the kitchen and also one at the front, the terrain is smooth the passage to the gate is cemented and by the sides is a lawn.
Transport and roads: The patient`s daughter usually use her car to take the patient to hospital, clinic and to town, and also a public transport is easily accessible because the taxis are running by the street every 10 minutes. T he road is a tar road and smooth.
Health facilities ; The hospital is about 4KM away from the patient `s home and the clinic is about 2KM away from the patient `s home and they are easily accessible.
Patient`s highest functional level: Feeding herself in high sitting
Patient`s expectations: To be able to walk by her self to the toilet and also to the church.
Caregiver`s expectations : The patient to be able to walk by her self to the toilet, to the kitchen and to be able to make tea for herself and to be able to perform activities of daily living without difficulty.
Caregiver`s role : To bath the patient, dress her, prepare food and assist her with toileting.
Activities of the daily living : She brushes her teeth, wash her face and feed herself with the unaffected upper limb everyday.
Habits : The patient never smoked cigarette and never drunk alcohol ever since in her life.
MEDICATION
The patient used to take antihypertensive medication from the clinic before the stroke, at the moment she is not taking any medication. The caregiver and the daughter were encouraged to take the patient for monthly BP check up. And also to collect her antihypertensive medication at the clinic
OBJECTIVE EVALUATION
General observation
The patient was found in high sitting on the couch, with the right upper limb supported by the left upper limb on the patient`s lap, the forearm in 90 degrees of elbow flexion, right shoulder slightly abducted, wrist in flexion and fingers in flexion. The right lower limb was elevated on the table with a pillow under it, there was swelling of the right lower limb.
Balance
Sitting: Static is good
: Dynamic is good
Standing: s static is poor
: Dynamic is poor
Muscle Tone
Normal for the left upper limb and lower limb
Right shoulder –slightly increased in abduction, flexion, extension
Right elbow – moderately increased
Right wrist- slightly increased
Right hip – slightly increased
Right knee and ankle are normal
Increased muscle tone of trunk muscles
Muscle strength
Right upper limb Left upper limb
Grade 1 of shoulder flexors Grade 4 of flexors
Grade 1 of shoulder extensors G rade 4 of extensors
Grade 2 of elbow flexors Grade4of elbow flexors
Grade 2 elbow extensors Grade 4 of elbow extensors
Grade 1 wrist flexors and extensors Grade 4 wrist flexors and extensors
Lower limb
Right Left
Grade 2 Grade 4
Range of motion
Decreased range of motion of the right elbow extension
Co ordination
The co ordination is poor on the upper limbs and lower limbs
For functional evaluation see the attached copy of Barthel index scale
POMES
Problem
Underlying reason
Limiting factor
Short term goal
Treatment
Inability to come from sitting to standing
Poor balance in standing.
Lack of head, trunk and hip dissociation.
Poor pelvic and trunk mobility.
Weak UL and LL strength
To re educate balance in standing, strengthen muscles of LL and reduce swelling
Rhythmic stabilisation, PNF and elevation of LL and foot pumps.
Manual strengthening exercises of unaffected limbs. Pelvic shifting and trunk mobilisations
Inability to walk independently to the toilet, kitchen and t church
Insufficient hip and knee flexion.
Lack of dissociation of the hip and knee.
Poor balance, co ordination and weakness.
Swelling on the right foot and ankles
Poor posture
To strengthen weak muscles and normalise tone and reduce swelling and improve co ordination
Strengthening exercises (PNF, resited exercises) elevation of foot and foot pumps and frenkel`s exercises.
Passive mobility exercises of the trunk hip and knee.
Inability to dress and undress herself using both upper limbs
Limited ROM of the right shoulder.
A patient lacks initiation/stimulation in most of the activities.
Pain on the right shoulder Increased tone on UL ,weakness of muscles and decreased ROM of right UL
To normalise tone, strengthen weak muscles and improve ROM of UL and relieve pain
Weight bearing exercises,compressions,autoassisted exercises,PNF,resisted exercises and stretching exercises and gentle mobs of the shoulder
Facilitation of self-care activities.
Poor posture during walking
Increased tone of the muscles of the trunk and weakness of back extensors,
To normalise muscle tone of the trunk and strengthen back extensors
Back strengthening exercises
Posture correction
Weight bearing exercises of the ULs, LLs and trunk.
Trunk mobility exercises
Pelvic tilting exercises
Long term goals
Patient to be able to walk independently to the toilet, to the kitchen to make tea for herself and to go to church, with minimal support of the quadripod.
Patient`s Name : Anniki Mnisi
Age : 76 Years
Gender : Female
Diagnosis : Left CVA, Right Hemiplegic
Physical Address : Waterval
Occupation : Pensioner
Marital Status : Single
Caregiver : Jestinah Chauke
Date of evaluation : 02 March 2010
Name of student : Mashego S.T
Supervisor : Mr Matswiki T.M
SUBJECTIVE EVALUATION
Present medical history
At around September 2009 the patient woke up early in the morning she wanted to go to the toilet ,then she started feeling that her right upper and lower limb were very weak and numb, she was unable to walk by herself, and by that time she was with her grand daughter, her daughter was still at work. When the daughter came back she took her to a nearby private Doctor who diagnosed her with CVA and referred her to Elim hospital where she was admitted for two weeks it was confirmed that she was a left CVA(Right hemiplegic). After two weeks she was discharged without seeing a physiotherapist.
Past medical history
She was a known hypertensive patient who was on medication before she suffered a stroke ,she was diagnosed with hypertension a long time ago but she can`t remember when and also the caregiver can`t remember, no other related medical history.
Socioeconomic history
Occupation: The patient is a pensioner, she is not a breadwinner ,the breadwinner is her daughter who is a police woman who stay with her.
Marital status : The patient is single, she was never married, she is a single mother of four children, three daughters and one son who are grown ups and they are married except the one who she stays with her in the house. Her daughter hired caregiver to take care of her and clean the house.
Home environment internal: The patient stays in a 7 roomed house builded by bricks, the toilet is inside and flushing, the is electricity and running in the house,the floor is cemented in the patient room and other bedrooms but the kitchen and the sitting room are tiles, there is enough space in the patient`s room for propelling a wheelchair and other walking aids, the patient sleeps on a double bed and the mattress is firm.
External environment: There is one step at the entrance of the house by the kitchen and also one at the front, the terrain is smooth the passage to the gate is cemented and by the sides is a lawn.
Transport and roads: The patient`s daughter usually use her car to take the patient to hospital, clinic and to town, and also a public transport is easily accessible because the taxis are running by the street every 10 minutes. T he road is a tar road and smooth.
Health facilities ; The hospital is about 4KM away from the patient `s home and the clinic is about 2KM away from the patient `s home and they are easily accessible.
Patient`s highest functional level: Feeding herself in high sitting
Patient`s expectations: To be able to walk by her self to the toilet and also to the church.
Caregiver`s expectations : The patient to be able to walk by her self to the toilet, to the kitchen and to be able to make tea for herself and to be able to perform activities of daily living without difficulty.
Caregiver`s role : To bath the patient, dress her, prepare food and assist her with toileting.
Activities of the daily living : She brushes her teeth, wash her face and feed herself with the unaffected upper limb everyday.
Habits : The patient never smoked cigarette and never drunk alcohol ever since in her life.
MEDICATION
The patient used to take antihypertensive medication from the clinic before the stroke, at the moment she is not taking any medication. The caregiver and the daughter were encouraged to take the patient for monthly BP check up. And also to collect her antihypertensive medication at the clinic
OBJECTIVE EVALUATION
General observation
The patient was found in high sitting on the couch, with the right upper limb supported by the left upper limb on the patient`s lap, the forearm in 90 degrees of elbow flexion, right shoulder slightly abducted, wrist in flexion and fingers in flexion. The right lower limb was elevated on the table with a pillow under it, there was swelling of the right lower limb.
Balance
Sitting: Static is good
: Dynamic is good
Standing: s static is poor
: Dynamic is poor
Muscle Tone
Normal for the left upper limb and lower limb
Right shoulder –slightly increased in abduction, flexion, extension
Right elbow – moderately increased
Right wrist- slightly increased
Right hip – slightly increased
Right knee and ankle are normal
Increased muscle tone of trunk muscles
Muscle strength
Right upper limb Left upper limb
Grade 1 of shoulder flexors Grade 4 of flexors
Grade 1 of shoulder extensors G rade 4 of extensors
Grade 2 of elbow flexors Grade4of elbow flexors
Grade 2 elbow extensors Grade 4 of elbow extensors
Grade 1 wrist flexors and extensors Grade 4 wrist flexors and extensors
Lower limb
Right Left
Grade 2 Grade 4
Range of motion
Decreased range of motion of the right elbow extension
Co ordination
The co ordination is poor on the upper limbs and lower limbs
For functional evaluation see the attached copy of Barthel index scale
POMES
Problem
Underlying reason
Limiting factor
Short term goal
Treatment
Inability to come from sitting to standing
Poor balance in standing.
Lack of head, trunk and hip dissociation.
Poor pelvic and trunk mobility.
Weak UL and LL strength
To re educate balance in standing, strengthen muscles of LL and reduce swelling
Rhythmic stabilisation, PNF and elevation of LL and foot pumps.
Manual strengthening exercises of unaffected limbs. Pelvic shifting and trunk mobilisations
Inability to walk independently to the toilet, kitchen and t church
Insufficient hip and knee flexion.
Lack of dissociation of the hip and knee.
Poor balance, co ordination and weakness.
Swelling on the right foot and ankles
Poor posture
To strengthen weak muscles and normalise tone and reduce swelling and improve co ordination
Strengthening exercises (PNF, resited exercises) elevation of foot and foot pumps and frenkel`s exercises.
Passive mobility exercises of the trunk hip and knee.
Inability to dress and undress herself using both upper limbs
Limited ROM of the right shoulder.
A patient lacks initiation/stimulation in most of the activities.
Pain on the right shoulder Increased tone on UL ,weakness of muscles and decreased ROM of right UL
To normalise tone, strengthen weak muscles and improve ROM of UL and relieve pain
Weight bearing exercises,compressions,autoassisted exercises,PNF,resisted exercises and stretching exercises and gentle mobs of the shoulder
Facilitation of self-care activities.
Poor posture during walking
Increased tone of the muscles of the trunk and weakness of back extensors,
To normalise muscle tone of the trunk and strengthen back extensors
Back strengthening exercises
Posture correction
Weight bearing exercises of the ULs, LLs and trunk.
Trunk mobility exercises
Pelvic tilting exercises
Long term goals
Patient to be able to walk independently to the toilet, to the kitchen to make tea for herself and to go to church, with minimal support of the quadripod.
Monday, March 1, 2010
Experince in rural block
I went to home visit at Waterval to treat my patient and my patient was not there.
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