My clinical experience is through contract services at Winchester Rehabilitation, meaning that we travel to different local inpatient and outpatient clinics filling in for other physical therapists. This Tuesday we spent the whole day at Winchester Medical Center covering for an inpatient PT. Our last patient was a 31 y.o. white female who was diagnosed with Lyme’s disease. I had heard of the detrimental effects of Lyme’s disease, but I had no idea really what to expect.
After we entered the room and went through our few subjective questions, my CI instructed me to take the pt through our regular “warm-up” exercises. I attempted to start with bending the hip and knee with heels slides, however it was quickly evident that this was a struggle for her. My CI then asked the pt to attempt ankle pumps. Even this was impossible for her. My CI pointed out that this was an example of a trace contraction, or a 1 on the MMT scale. We could see and palpate the tibialis anterior twitch while the patient was attempting to push against our hand into dorsiflexion. We tried to utilize a quick stretch in an elongated position in order to help facilitate more contractions. This was really interesting to be able to finally witness a trace contraction and be able to apply the quick stretch tactic that we were currently learning in adult neuro to increase contraction of the muscle.
During this process, I looked at the pt’s facial expression to see her in intense focus on the small task of trying to bring her toes toward her. Looking back, I think I should have given her more encouraging feedback, especially knowledge of results. I realized too late that she wasn’t able to tell if she was pushing against my hand into either DF or PF. We were eventually able to get her standing and ambulating with a front wheeled walker. Initially, we had to give her frequent knowledge of performance to help facilitate proper DF during her gait without her compensating with increase hip flexion. She was able to ambulate 175ft (100ft more than her last PT session). This experience was a very rewarding one with being able to see how much positive impact we had on the patient with just one session. This experience showed me the importance of giving appropriate feedback to help the patient gain self-esteem while relearning motor control. In the future I will attempt to be more aware of how and when I give extrinsic feedback to the pt.