yr4 1st placment STARES: topic 1: intervention

Situation:
32 year old female referred to musculoskeletal outpatients 8 weeks post bilateral calcaneal fractures, now weight bearing as tolerated. Has been in a wheel chair for this length of time. She has good upper limb strength but weak throughout her lower body (4/5 in manual muscle testing), plus decreased muscle length in all lower limb muscles. She is currently transferring from wheel chair by pivoting through toes, she is fearful to weight bear through her heels. Patient lives with 5 year old son and house mate in a double story house. Her goal is return to pre fracture level of activity: independent walking and return to sport.

Task:
Aim is to get patient walking independently with no aids. Short term goal is to promote even weight distribution/ weight shift and decrease fear of weight bearing. The task was gait re-education.

Action:
Gait re-education: with in parallel bars with myself sitting on a rolling stool in front as a security and safety measure for the patient. I used tactile feedback to help promote even weight shift and verbal feedback to reassure the patient. My approach to getting the patient to perform these tasks was very much staggered and in short burst as she had reduced strength and was very apprehensive.

Result:
At first the patient was very concerned about performing this task, but after I explained why it was important and how she is now allowed to put weight through her feet she was happier to give it a go. By the end of the session the patient was beginning to walk within the bars and performing a proper gait pattern of heel strike and toe off. By the end of the session she had progressed to walking outside the bars with a wheeled Zimmer frame.

Evaluation:
I think my intervention was quite effective, once I realised how anxious she was about weight bearing. I adjusted my treatment to address this through discussing how she now is able to put weight through her feet, making sure the environment was safe and secure for the patient and slowly progressing the tasks as she felt comfortable. Secondly she became tired very easily as she hadn’t used her lower limbs for the past 8 weeks, I had to make sure she had regular rests and kept the tasks to short intervals to avoid too much muscle fatigue. All in all she ended up performing the task very well and her anxiety levels fell as the treatment session went on.

Strategies:
Effective communication to reduce anxiety
Providing a safe and secure environment
Slow progression of activities
Regular rest periods