Journal

5/16/11 I was so happy for Patient X this past Friday (May 13). After being in so much pain for so many weeks—my former PT did tell me that a total knee replacement is equivalent to breaking your leg in three places, since the surgeons have to cut the femur, tibia and patella to put in the prosthetic—they seemed to be doing so much better and getting around much easier! I think that has been the best part of this experience; seeing how physical therapy helps these patients so well. I plan to volunteer at the office one more time; I’ve had such a great experience there and cannot thank everyone enough for all the opportunities they have offered me in shadowing and volunteering!

Likewise, my senior seminar project itself has been an incredibly rewarding experience. I have learned so much through my research and hands-on work, and the opportunities to further explore my college major and career interest have been excellent. Admittedly I felt overwhelmed at the onset of this project—it just seemed so extensive to complete! But the curriculum structure’s breakdown into manageable steps has helped me feel capable and accomplished; I am very pleased with the outcome of my work, and I hope you enjoy it too!

4/26/2011 So, one week ago I had the great opportunity to volunteer during the day on Monday, April 18 and Tuesday, April 19 as part of my Spring Break. With that, I got to interview my former PT about my project (Due in a month, Powerpoint pending!), and in turn he relayed to me the basics of the “scientific method” for determining hip weakness—my thesis involves how weakness in the hips throws off lower leg alignment and in turn increases propensity for stress fracture.

A lot of it, he explained to me, goes in to gait analysis; looking at the interrelated positioning of the hip, knee, and ankle during the flight phase of running/walking(when the foot is in the air) and stance phase (when the foot is on the ground—heel strike, mid stance, then toe-off). When the hip extends backward at toe-off, the iliotibial band (tendon connecting part of the buttocks muscle near the hip to the top of the shin bone) tightens; if it is too tight, which is common when the hip is weak, one can observe a “lateral whip” where the foot swings out sideways instead of rising straight forward. If this issue is not apparent when walking, the PT explained to me, one has to look into changing variables in order to discover it—one variable being speed. One of the great principles of physics is Force = mass*acceleration (Newton’s 2nd Law); since a patients’ mass wouldn’t really change, one could ask them to walk faster to increase the force on their legs—creating more pressure on the hip to roll in more and in turn exacerbating the lateral whip. Similarly, the length of the patient’s stride would be another variable that could be applied.

After the interview, I had the privilege of shadowing my PT while he worked with a recovering stroke patient. Patient X is truly an inspiring individual, constantly working hard and doing their best to improve—their determination to refine the use of their right arm/leg is highly admirable. While working with Patient X, my PT helped me to recognize other treatment “variables,” one being gravity (doing exercises on the table puts less pressure on the body compared to standing) and the other being touch—specifically, sensory bombardment. Since Patient X’s brain’s connection to their muscles is particularly weaker, touching or tapping the muscle one wants them to use to lift/bend their arm/leg/etc. can give them a stronger idea of how to go about the exercise.

My PT also explained to me the difference between muscle spasticity and spasm: spasticity, which is common with stroke patients, is the nervous system’s influence on the muscles’ reaction to stretch; for example, when my former PT uncurled Patient X’s fingers to stretch their hand, the tendons and muscles in their forearm instantly tensed up to try to pull them back. Spasm, on the other hand, is the muscle’s reaction to pain; if an area is sore, strained, inflamed, etc., the muscles will seize up (spasm) to try to keep the joints around that area immobilized.

Words cannot express how much I appreciate all the lessons and opportunities my former PT and everyone at the physical therapy center are giving me. I love what I am doing and learning and cannot wait to go back to volunteer!

4/11/11 This past Friday (April 9) I had the pleasure of returning to volunteer! I believe I'm getting faster/more efficient at changing and folding sheets and towels--and more importantly, I'm continuing to learn so much! My former PT showed me the workings of a reflex hammer--as silly as it sounds, I did not think it could be used for any tendon, not just at the knees. When you hit a tendon with the hammer (hit it with good momentum, not just tap it), if it is healthy it will "jolt"/move slightly.

Then, I shadowed another PT at the office who was working with a patient with tennis elbow. Apparently, "tennis elbow" covers a variety of conditions, the most severe cases being a torn tendon and the slightly less damaging being an inflamed tendon (tendonitis). Before giving the patient their exercises, the PT used an ultrasound wand on their elbow--the deep heat, he explained, helps relax the scar tissue and circulate blood (which contains most of the body's healing elements) to the affected area. In fact, he told me that in some cases, for a variety of injuries, specialists spin patients' blood to isolate the blood plasma (generally where the healing elements of the blood are) and then inject it directly at the site of injury--fascinating, right?

As always, conversing with the patients is a wonderfully rewarding experience.

This weekend I will be visiting a college for an admitted students open house, but be prepared for another volunteering reflection over spring break!

4/7/11 Well, due to my involvement in the school show, I was unfortunately unable to volunteer last Friday, April 1. But expect some great reflections from my volunteer work tomorrow! In the meantime, I thought I might as well reflect on the Informative Product creation process. While I knew a video/documentary would be particularly compelling to my audience, I did not trust my rather limited video editing experience to make what I envisioned within two weeks. So, a Mixbook (see http://www.mixbook.com) it is! My teacher also supported the idea, as my research does almost read like a story (what happened and my investigation as to why). And Mixbook has been a particularly fun tool to work with--I enjoy scrap booking/photo-editing/poster making, so I usually lose track of time when I'm working on it. The variety of layouts, backgrounds, stickers/labels and editing tools is perfect for this project, and I keep on learning more as I'm using it: for example, you can use your mouse to "group" objects just like in Word! I thought it was cool, anyway. Seeing my work come together in such an aesthetic, visual product has been very fun and rewarding, and I cannot wait to put together the rest of it!

3/25/11 There are so many things that I’ve observed/learned (!) while volunteering a week ago (March 18) and today—recognizing that we are required to have a journal entry per volunteer experience, I will signify each day separately, but as many of the topics connect to each other, I will address both days together in separate “categories.” The physical therapy office is a true hub of activity, with so many different people with so many different physical rehabilitation needs—it is an incredibly inspiring dynamic for helping others through medicine! I am greatly enjoying everything I’m learning so far:

__A Shattered Arm__ The very first patient I conversed with (on March 18) significantly helped me gain a broader perspective and greater admiration of those who need physical therapy—and I mean REALLY need it. My stress fractures were nothing. Patient X broke their arm in 15 places—yes, 15, I couldn’t imagine—in a car accident a little while ago, and is still working to regain full flexibility/range of motion. They told me about this neat product they were looking into called a dynasplint (See more extensive information here: []), which would hold their arm in an extended position to help it regain that greater range. I was able to speak with Patient X again today, and I must say their upbeat personality and determination in light of their situation is truly awe-inspiring.

__Knee Replacements__ I have met more knee replacement patients during these past two five hour sessions than I ever had before. Well, the only other knee replacement patient I know is my own grandmother, but I was too young during her recovery to honestly appreciate everything they go through. Last week I learned that it takes about three months for those with knee replacements to get to about 90% of where they should be—but takes a solid nine to 12 months for the bone to fully “readapt” to the implant! Besides all of the incredibly painful scar tissue and swelling, my former PT told me that patients have the uncomfortable and scary situation where they do not precisely know where their knee is in space; the surrounding muscle tissue has to adapt to sense the knee and “tell” them where it is. It makes sense; obviously nerves aren’t connected to a metal implant, I just hadn’t ever thought of it before.

Today, I was able to learn and experience even more. For example, the whole process of the bone readapting to the implant relates to the design of the implant itself—apparently, the alloy used is porous so that the osseous (bone) tissue can grow and “fuse” into the implant! And the PT (another one) that I was shadowing with Patient Y implied that this is a more recent innovation; implants used to be solid. And then Patient Y relayed additional “today’s innovations” information: before, surgeons would sever the muscle covering the knee to cut it out and replace it (ouch!)—but today, they merely part the muscle fibers, almost like a set of curtains. How far we have come! I hope I’ll be designing innovative devices/ideas/methods such as that once I get my degree…Anyways, another interesting tidbit: the surgeons cut the knee when it is bent, not extended, which is why the characteristic scar may look crooked when the leg is straight, but smooth when it is flexed. And, as a part of the recovery process, the PT measures the angle to which the knee can bend using an instrument called a goniometer (Figure 2). The larger the angle, the better the progress! Although upon speaking with/observing the patients, I can’t imagine how painful it is to coerce one’s replaced knee into that position. But immense kudos go to Patient Y—their astounding vitality, even stating how others requiring PT have it so much worse than them, is once again humbling and inspiring.

__Off Balance__ A very sweet elderly individual, Patient Z suffered a fall and in turn a fracture in their tibial plateau (at the top of their tibia, near the joint with the knee). Until I met Patient Z, I do not think I ever fully appreciated how much it must be difficult for the elderly to feel solidly confident in walking/standing unaided—a little shaky, they had difficulty standing for no more than ten seconds, and have, as my former PT stated, “TRUE muscle weakness” in that they had difficulty turning their feet inward.

But I am very happy for Patient Z this week, for while they still have much progress to go, they were up and standing/walking with two canes instead of a walker! (Cane tidbit: canes/walkers/crutches are the most efficient/least straining on the arm when one’s arm is straight while using them. I accidentally adjusted Patient Z’s one cane the wrong way before the PT corrected me—one lesson well learned!) But, of course, the PT was right behind Patient Z the entire time—he explained to me how one needs to keep their hands lightly at the patient’s back, focusing on their weaker side in order to step forward and hold the patient the instant they may start to fall. If they fall too far forward, it may even be more practical to slowly lower them to the ground. Luckily that did not happen—regardless, Patient Z’s unsteadiness is generally resulting from them focusing their weight too far backward (A mini AP Physics refresher: if an object’s center of mass is positioned past its point of support, the object will fall). And, I soon learned that when the PT asks me to grab a chair, it means to QUICKLY get it to the patient and touch it to the back of their knees so that they sense they can safely sit down—without turning around and thus shifting their balance. I’m learning as I go—far before this is through I hope to become a much more improved/educated shadow/PT aid!

__Shocking!__ At the end of the day today, the PT student I worked with on my first visit showed me another cool device: electro-stimulator pads (Figure 3-4). Essentially, when a patient is first injured (the example the PT student gave me was an ACL tear), the brain “blocks” his/her ability to use the muscle even if the muscle itself is healthy. So, two pads (one positive, one negative) can be placed on the skin over the muscle to create a current that, once charged enough, stimulates the muscle to contract, exercising it to prevent atrophy (weakening due to lack of use). Awesome, right? He also explained to me how the pads can also be used to treat pain tolerance; when applied at a pain site, the “electro-pads” provide sensation to “distract” the nerves from fully communicating the pain to the brain, in a basic sense—just like anyone might hold/rub a sore joint.

That basically sums up my two sessions, besides the regular volunteer work with folding towels/sheets, making copies, wiping equipment etc. It is all definitely worth it—I love what I am learning, and even more so enjoy conversing with the patients and realizing what incredibly strong and inspiring people they are. I can’t wait for next time!!!





3/13/11 So, once upon an August 2010 I was getting pretty pumped for running camp. My previous cross country season (2009) wasn’t the best due to shin splints, so I was anticipating camp as a great way to cap off my summer training and transition into a fresh new season (my senior year) of competition. Then, three days before it started, I started to feel pain in my inner right ankle. Of course, I didn’t think it was anything—or at least I told myself it wasn’t anything. The camp doctor said shin splints and I went with it. By the last day I was limp-running at a pace that probably doesn’t deserve to be called running.

It turned out I had medial-bilateral stress fractures in my tibias/shin bones (one on each side, worse in my right). In other words, my season was over before it even started. Strangely enough, I had had one before in my right fibula (skinny bone on the outside of the tibia) in January 2009—which is why I’ve chosen running and stress fractures in high-school female athletes as my research topic. Anyways, this time around I did what I should’ve done before and went to physical therapy. My awesome PT finally gave me an answer to help me chip away at the big “WHY?” racking my brain: my hips were the problem. No, not my ankles. As he said, word for word: “When you have a flood in your basement, where’s the first place you check? The roof.” My gluteus medius muscles (attached between the hip and the femur/thigh bone) were weak, causing my knees to turn in—more-so on the right side. That combined with my feet whipping out sideways (a “lateral whip,” also predominant on my right) = my tibias experiencing torque (being twisted) in opposite directions, i.e. strained and hence cracked! A couple of months of strengthening exercises later and my form is getting to be much better.

I owe many thanks to my physical therapist for his help, and now yet again for welcoming me back into his office as a volunteer for this project. This past Friday, March 11, 2011, I excitedly drove back to the physical therapy office after track practice (yes, I’m running again!!!!!) and began my duties. Of, course, I am more than willing to help out, i.e., I folded a lot of sheets and towels, wiped down the exercise equipment, copied blank evaluation sheets (what the PT fills out during a patient’s first visit, to get a sense for where they are in their mobility) to restock, and filed some folders. And, likewise, I am all-too excited to learn! A part-time employee and Physical Therapy student showed me around, particularly having me check out this neat isokinetic machine. Basically, a patient straps into the chair, which can either be adjusted with a lower bar for leg extensions or an upper handle for arm exercises, and then begins their sets of extensions/pulls/etc. But, the machine is set so that each repetition of the exercise is done at the same speed, no matter how much force the patient applies; so, the machine provides a resistance force proportional to the patient’s force so that his/her arm/leg travels the same speed throughout the lifting/extending motion. It is a bit tricky to explain, expect a picture soon! The student also explained to me that, besides isokinetic, other forms of anaerobic exercise include isometric (pushing against an immovable object) and isotonic (pushing against a movable object, i.e. lifting weights).

Then, my own former PT introduced me to this device used to help diagnose patients who fall frequently. It almost looks like a pair of ski goggles with the lenses blacked out, but it is actually a magnifying camera: when a patient puts the “goggles” on, a camera inside one of the “lenses” magnifies the eye and transfers the image onto a television screen, enabling the PT to see the slightest variations in the eye’s movement (which, from the naked eye, would look still)—with that information, the PT can determine which ear canals are blocked/impeded, causing the patient’s dizziness. My PT told me that I will learn something new every time I come to volunteer, so expect more cool facts to come!

From when I was a patient to where I am now, I have always enjoyed the dynamic at the physical therapy office, from the friendliness of the PTs to all of the information and insight they have to offer. I cannot wait for the rest of my 30+ hours (who says I need to stop right when my hours are fulfilled?)!

Talk to your PT about Natural Vision Improvement. This could really help their patients.