During this semester I interned at an outpatient physical therapy clinic in Yonkers, New York called Professional Physical Therapy. At this location we only had one Physical Therapist and 3 physical therapy aides. Throughout my time as an intern I had the opportunity to work hands on with a variety of patient. These patients had a variety of injuries and surgeries such as Rotator cuff surgery, Knee replacement, Hip replacement, Distal Radius Fracture and Ankle fracture surgery. When working with a patient who has had a Rotator cuff surgery, we give them exercises like 4 place ball roll, seated rows, shoulder abduction, the pulley, wall push up, bicep curls, cane shoulder flexion, cane shoulder abduction and Upper Body Ergometer. However, the most common ones were the pulley, seated rows, shoulder abduction and cane shoulder flexion. The pulley machine helps the patients to be able to lift arms to ceiling which helps patients with their range of motions. A seated row consists of a patient seated on a chair, back straight at all time and with a resistance band wrapped around a role and you will pull it towards your stomach. When a patient is doing a shoulder abduction, they can either be seated or standing up while holding the resistance band in their hand shoulder with apart, they will pull their arms out to the side.
Lastly, a cane shoulder flexion, the patient stands up, hold the cane with two hands shoulder width apart and bring the cane directly overhead, leading with the uninjured hand, reaching back until they feel a stretch. Having a patient with a knee replacement the physical therapist assigns them excises such as bike, abductor ball squeeze, quad sets, quad press, hamstring press, heel raises, wall slides and hip abduction. The main excises used were the abductor ball squeeze, heel raises, wall slides and hip abduction. An abductor ball squeeze is having a patient seated on a chair and with a therapeutic pillow between their legs together. Another main exercise is a heel raise, having the patient facing the wall standing up for support they begin to go on their tippy toes, holding it for ten seconds. Wall slides is when a patient has their backs to the wall with a therapeutic back between them and the wall and they begin to do squats. Lastly, a hip abduction contains a patient stand up right and they lift their leg out to the side. These exercises are mainly common because it really helps to make the muscles about your knee strong again. Amongst the different surgeries hip replacement is also a common surgery done. With this surgery the following exercises are used bridging, double knee to chest (DKTC), left to right (LTR), clam shell supine and single leg raises (SLR). The most commonly used ones are the bridging, DKTC and clam shell supine. Bridging is when a patient is laying on their back with their knees bent while they left their bottom off the ground. Another common exercise is the double knee to chest exercise. The patient is laying on their back and they have the ball under their leg and pull it towards their chest.
In addition to the other commonly used exercise is the clam shell supine. When assisting the patient with that exercise you will have the patient lay on their back and tie a resistance band around their thigh closer to their knee, the patient would then pull their legs open. The benefits of these exercises are targeted to strength their hips. In addition to the other surgery patient I worked with was the distal radius fracture surgery. The procedures that was taken was having patients do the finger web, wrist roller, distal extension and flexion, wrist pronation and supination, and the putty. What I’ve notice is that when a patient has had surgery which had a cast on it, once they have taken it off, they have to work on strengthening their fingers. In the procedure you will notice that there is exercise geared towards strengthening both their hands and wrist. The main procedure we did was finger web, putty, and wrist roller. When a patient is doing a finger web, they will have a particular web which depends on the level they are at and they will spread their fingers out wide and put it through the web, squeeze and twist. A putty is one of the exercises used to strengthen the fingers, the patient has a putty and uses every finger one by one to pull off a piece until its finish. Wrist roller also known as the towel squeezer according to my patients has two handles on the end which the patient holds and turn it opposite ways on each side. That’s why patients refer to it as a towel squeezer because it basically like squeezing out a wet towel. One of the last surgery patients I worked with was the ankle fracture patients. The procedures taken for ankle patients are similar to a knee patient but with a little different procedure.
When working with an ankle patient they do the bike, both sides up (BOSU) balance, BOSU squats, BOSU step up forwards, ankle circles, ankle alphabets, and ankle side to side. Exercise that the physical therapy assigned for the ankle patient are BOSU balance, squats, step up forwards and ankle alphabets. Balancing on a BOSU is basically having the BOSU on its flat side and place affected foot on the round side and balance on your affected foot with unaffected foot off the ground for 5 minutes. The BOSU step ups is have the BOSU on flat side, place affected foot on round side, step up and bring other leg into the air. The BOSU squat is when you have the round side on the ground and place both legs onto the BOSU, balance yourself and start to squat. Finally, when a patient is doing the ankle alphabets, you place their leg on a stool ankle hanging off and they will begin to write the alphabets with their feet both capital letter and lower case. I’ve also observed a physical therapist with specialties in orthopedic, neurological, and pediatric conditions. My main responsibilities included getting all the flowsheets and filling them in throughout the day, assisting therapists with patients during their treatment, making hot and cold packs, and keeping the clinic organized.
Being a part-time intern in a rehabilitation setting was very eye opening. The clinic I interned at was an outpatient which was affiliated with Southern Westchester Orthopedics & Sports Medicine in Yonkers, NY. Because of its affiliation with Southern Westchester Orthopedics& Sports Medicine, 90% of our clients comes from that office. Which accounts for the reason that the majority of patients have more serious conditions than just the typical sports injury that is often associated with the field of physical therapy. I really enjoyed this aspect of the facility because my interests for my future career are mainly in neurological and pediatric rehabilitation.
Getting to work with patients with some of the more serious conditions including multiple sclerosis, Parkinson’s, and even cancer changed my outlook of the community that I live in. The clinic was located just 15 mins from where I live, there was a large amount of patient from around my town. I had never realized how many people around me had these types of conditions and were living with them and trying to learn how to advance and cope with the physical element of their disorders through physical therapy. Let’s say a patient coming in for cancer rehabilitation typically do not show any noticeable symptoms to the public. Many of them would come to physical therapy to work on getting back the strength they lost from chemotherapy or other treatments for their cancer. Coming to physical therapy was a common reason for that which I did not know, which changed my opinion of how the career that I will be a part of; have touched so many lives more that I have realized.
Working hands on with these patients gave me knowledge and understanding I could only have learned from interning at Professional Physical Therapy. For example, I saw a patient who injured his left hamstring from playing soccer. His procedure included doing a foam roll on the hamstring and the IT band and a hamstring self-stretch with the strap. We did each alternative for one minute each using the highest level, which is the black. I made sure to always show it to the patient before they do it because it’s either they don’t remember, or they try to cheat and do it the “easy” way. When doing the hamstring foam roll, I positioned the foam roller beneath my left hamstring; so, there isn’t much pressure I put my right leg on top of my left. Using my arms, I roll myself back and forth. For the IT band roll, I had him to lie on his left side of his leg and had his elbow on the floor to roll himself up and down. After the foam rolling, the physical therapist instructed me to have him to do hamstring self-stretch with the strap. I demonstrated to him how to do this exercise by putting my left foot into one of the loops on the strap and hold each side of the strap firming; raising my leg in the air I held it for one minute, doing all of this while being seated. That exercise is a main exercise I make sure to demonstrate and time it because some of the patients either would not hold their leg in the air, hold the strap firmly, or would not do it for one minute. This was a very beneficial and enlightening experience that I do not think I could have gotten without seeing it first-hand.
I had the opportunity not only to learn more about the causes and treatments of surgeries like knee and hip replacement but also about how they affect the people on a day to day basis. I attended a seminar on reasons why people need knee and hip replacement, what is done in a knee or hip replacement, and how long would it take to fully heal. I met with the surgeon who operated on my patients being able to ask the questions that my patients would ask me which I did not have an answer to. Knee replacement is due to late-stage of osteoarthritis, meaning that the cartilage that is located between the femur and tibia breaks down and it becomes bone rubbing on bone which causes the pain and stiffness in one’s knee. The procedure done in a knee replacement goes as follow they remove the damaged cartilage and underlying bone, those are then replaced with metal components that recreate the surface of the joint. Some surgeon cuts the underlying patella and resurfaced with a plastic button, but which that depends on the circumstance of the patient. Finally, a plastic spacer is put between the metal components to create a smooth gliding, when the knee is bent.
A fully healing knee replacement typically take about six to eight weeks with come two to three days a week, but that also depends on the patient’s condition and health. The common reason someone would need a hip replacement would be because of arthritis in the hip. It can also be from disease that causes the bone joint to die, injuries or fractures, and bone tumors that break down the hip joint. In a hip replacement the surgeon removes the diseased tissue from the hip joint and with new artificial parts, replace the ends of the thigh bone and hip socket. For long-term recovery, involves the complete healing of wounds and internal soft tissues. A patient could return to work and everyday activities approximately 6 months after surgery. A lot of my patients would tell me they miss going to the gym, going fishing, going jogging, even miss working believe it or not. Having a listening ear to hear about their day to day lives and how much they are thankful for the physical therapist at this clinic, made me feel tremendously blessed and encouraged to get to have an effect on someone’s life like that in the furture.