Week 3- Post 1

Tuesday 28th of October 2008

Jasmine**

Thoughts and feelings in the presenting situation…

Jasmine was a 4 year and 8 month young girl who came to us with a turned in foot. This was the mothers concern. She is very tall and bright. She appeared to have slightly protracted shoulders but, this was not a concern at this stage. Her hips were not in any way oblique and her femurs were not ante or retro verted in any way. This girl displayed general hypermobility and therefore she needs stronger muscles to support her joints. Jasmine had weak abdominal muscles, strong back muscles, grade 5 quads and tight hamstrings. Her tight hamstrings were interesting because this was all related in her foot positioning.

How I managed the patient…

This was the first musculoskeletal assessment I have done since beginning my prac. Jenny did not use a goniometer but another device which was much easier to manoeuvre and made for a quick and simple objective assessment. I tested for general muscle tone and Jasmine displayed slightly low muscle tone. We would always say what nice work she was doing, and comment about her beautiful toe walking right on her tip toes and say she should start ballet dancing! I would observed everything and tried to pick up as many things as possible to add to our assessment. I believe I was easy going and we created a nice friendly environment for her and her family.

What I did well…

I think I was very friendly, and I was just myself. I think I noted important observable features that were important to know, and was friendly with mum, talking about Jasmines interests and hobbies. I also came up with the appropriate exercise for strengthening peronii for toe walking.

What I could have done better…

If I had more preparation time I would have been more ready to undertake the assessment. I could have positioned myself more appropriately whilst watching Jasmine walk down the room, to watch her gait.

Forward plan…

I don’t think Jasmine will return, because if she focuses on the exercises we gave her I think she will strengthen her muscles to support her joints more. We have filed away a SOAPIER of the assessment and the stretches and activities we gave them as a home exercise program.

Changes for next time…

I would prepare myself more for the musculoskeletal assessment

Overall thoughts and feelings of how today has gone…

Today was a very busy day, but a very interesting one. It was interesting to see a musculoskeletal assessment for children because we have to distract them so they walk or move the way they normally do, not the way they want us to think they walk. Also you have to make it fun and not boring. We incorporated the ball pit when we wanted to ask mum questions to make the assessment age appropriate for Jasmine.

Strategies to improve my performance…

I definitely discovered that conducting assessments on children is quite different to adults. Children will often start to get agitated if they are in one place for too long. You have to make it fun and engage with them at their level. You have to ask questions about likes, dislikes and hobbies to keep them interested.

Questions…

I asked Jenny about the ROM device she used. I had never seen one before. It does take practice to use but I think I will invest in one later on!

**Name changed