32
Professional Portfolio Adam Norman Physiotherapist
| Date post: | 12-Apr-2017 |
| Category: |
Documents |
| Upload: | adam-norman |
| View: | 55 times |
| Download: | 0 times |
Professional Portfolio
Adam Norman
Physiotherapist
2
Table of Contents
Bond University Doctor of Physiotherapy
Supervised Clinical Practice Information…..………...………………… 3 - 211. Cardiorespiratory Physiotherapy Clinical Practice……....…………42. Musculoskeletal Physiotherapy I Clinical Practice………………….73. Neurological Physiotherapy Clinical Practice……………………….…94. Musculoskeletal Physiotherapy II Clinical Practice…………..…11 5. Chronic Disease and Disability Physiotherapy Clinical
Practice………………………………………………………………………………146. Diversity and Life Stage Physiotherapy Clinical Practice……..167. Clinical Internship………………………………………………………………18
Academic Awards…….……………………………………………………….22-25Research Projects……………………………………………………….……………..26 Physiotherapy Professional Development……………………..………….27
Adam Norman – Professional PortfolioPhysiotherapist
3
Bond University Doctor of Physiotherapy Supervised Clinical Practice Information
Name: Adam Norman
Student Identification Number: 13343730
Total Clinical Hours: 1, 482 hours
Total Clinical Credits: 80 credit points
Clinical Practice Average Grade: 83%
Adam Norman – Professional PortfolioPhysiotherapist
4
1. Cardiorespiratory Physiotherapy Clinical Practice – Logan Hospital, Loganlea, QLD, Australia
a) Wards: General Surgery, Respiratory, Maternity Wards b) Patient Caseload: Average 7 patients/dayc) Hours: 212 hoursd) Patient Population: Adult, Geriatric, Maternity
Patient Presentations Respiratory Conditions:
o Post-operative atelectasiso Exacerbation of Chronic Obstructive Pulmonary Disease (COPD)o Bronchiectasiso Pneumothoraxo Pleural Effusiono Community Acquired Pneumonia (CAP) o Palliative Lung Cancer
Women’s Health/Maternity:o Hysterectomyo Prolapse repair o Perineal Tear
Surgical Patients:o Ileostomyo Bowel Resectiono Appendectomyo Hernia Repair
Other Conditions:o Cellulitiso Drug induced overdose o Alcohol dependence (ETOH)
Assessments Subjective assessment and documentation:
o Personal details o Interpretation of medications o Pain /Numerical Pain Rating Scale (NPRS)o Past Medical History (PMHx)o Surgical Historyo Social History
Adam Norman – Professional PortfolioPhysiotherapist
5
o Smoking History/ Pack-Years o Yellow or Red Flags o Examination of test/imaging results:
Chest X-Ray, Spirometry, Blood tests, Electrocardiogram (ECG)o Patient Goals
Observation of attachments:o Supplementary Oxygen o Urinary Cathetero Patient Controlled Analgesia (PCA)o Intravenous Line (IV)o Intercostal Catheter (ICC)o Peripherally Inserted Central Catheter (PICC) o Nasogastric Tube (NG)
Respiratory assessment:o Spirometry o Auscultation o Cough assessmento Sputum assessment/examinationo Palpation/ Bi-basal expansion o Breathing pattern analysis
Monitoring of vital signs:o Blood Pressure (BP)o Oxygen Saturation (SpO²) o Heart Rate (HR)o Respiratory Rate (RR)
Functional Assessments:o Bed mobility o Lying to sitting o Sit to stando Transferso Stairs
Mobility/Balance Assessments:o De Morton Mobility Index (DEMMI)o Six Minute Walk Test (6MWT)o Timed Up and Go (TUG)o BERG Balance Scale o Modified Clinical Test of Sensory Interaction in Balance (CTSIB-M)
Manual Muscle Testing (MMT) / Strength Testing Sensation Testing Deep Vein Thrombosis (DVT) and circulation testing Review of surgical procedures and post-operative instructions for care Wound and Dressing observation Stoma observation
Adam Norman – Professional PortfolioPhysiotherapist
6
Interventions Deep Breathing Exercises
o Incentive Spirometry/ Tri-Flow o Upper Limb Demand Ventilation (ULDV)o Active Cycle of Breathing Technique (ACBT)
Airway clearance techniques o Manual suctioning o Postural Drainageo Percussion and Vibrations o Huffo Supportive Cougho Assisted Cougho Bubble Positive Expiratory Pressure (PEP)
Optimal bed and chair positioning Prescription of anti-embolism stockings (TED) Prescription of circulation bed exercises Prescription of seated and standing exercises
o Body-weight resisted exercises o Isometric exercises o Resistance exercises with Thera-band
Early mobilisation Prescription and progression of appropriate mobility aids Gait retraining Prescription of hot and cold packs Pelvic floor training:
o Education on anatomy importance of pelvic floor strengtho Palpation of trans-abdominals (TA) o Verbal cueing
Bowel and Bladder Education Basic Nutritional Education Home Exercise Program (HEP) Prescription Education on return to Activities of Daily Living (ADLs) Completion of referral for outpatient follow up appointments Attendance at daily medical and multi-disciplinary team meetings Discharge planning:
o Homeo Assisted Living/ Transitional Care o Aged Care o Palliative Care o Drug and ETOH recovery networks
Special Experiences Surgical observation of laparotomy for bowel resection
Adam Norman – Professional PortfolioPhysiotherapist
7
Attended presentation on achieving and maintaining accreditation standards for Queensland Health
2. Musculoskeletal Physiotherapy I Clinical Practice – Princess Alexandra Hospital, Woolloongabba, QLD, Australia
a) Wards: Orthopaedic, ICU b) Patient Caseload: Average 6 patients/dayc) Hours: 200 hours d) Patient Population: Adult, Geriatric
Patient Presentations Motor vehicle accident (MVA) Multi-Trauma
o Femur fracture, Spinal crush fracture, Radius and Ulnar Fracture, Rib Fractures Total Knee Replacement
o Unilateral, Bilateral and Hemiarthroplasty Total Hip Replacement
o Anterior and Posterior-Lateral Approach Weber C fracture
o Open Reduction and Internal Fixation (ORIF) Pelvic fracture
o ORIF Fractured neck of femur (#NOF)
o Total Hip Replacement o Femoral nail
Laminectomy and Rhizolysis Anterior Cervical Discectomy and Fusion (ACDF) Spinal Cord Injury Metastatic Cancer
Assessments
Review of surgical procedure and post-operative instructions/precautions Subjective assessments as above Analysis and interpretation of pre and post-operative x-rays Observations of attachments as above Respiratory assessment as indicated Monitoring of blood work
o Haemoglobin levels post-operatively Circulation assessment as above Functional assessments as above
Adam Norman – Professional PortfolioPhysiotherapist
8
Mobility assessments as above Rating of Perceived Exertion (RPE) Assessment
o Borg RPE scale Goniometry
o Active Range of Motion (AROM)o Passive Range of Motion (PROM)
Neurological Examo Dermatomeso Myotomeso Reflexes
Basic swallowing assessment International Standards for Neurological Classification of Spinal Cord Injury (ASIA)
assessment Monitoring of ECG results Observation of mechanical ventilation settings Interpretation of medications used in ICU setting
Interventions Regular communication with surgeons regarding patient care Early mobility as above Prescription and progression of mobility aids as above Gait retraining as above Stair training with/without assistive devices Education on post-operative precautions
o ROM limitationso Weight bearing status
Prescription of Richard’s splint Prescription of shoulder sling Prescription of circulation exercises as indicated Prescription of hospital based exercises as above ADL training Prescription of home exercise programs as above Sputum clearance techniques as above
o Manual hyperinflation Pressure area maintenance
o Positioning scheduleo Observation of woundso Prescription of bracing/support
Contracture management o PROM stretching to upper limb and lower limbo Liaise with occupational therapist regarding bracing
Attendance at family meeting regarding long term care of spinal cord injured patients Regular liaison with ICU special nurse and medical team Discharge planning as above
Adam Norman – Professional PortfolioPhysiotherapist
9
Special Experiences Half day orientation to Queensland Spinal Cord Injuries Unit Guest presentation on the role of the physiotherapist during organ donation and
transplantation Observation of Total Hip Replacement (posterior lateral approach) Delivered staff in-service on evidence based physiotherapy interventions for acute phases of
spinal cord injuries
3. Neurological Physiotherapy Clinical Practice – Pindara Private Hospital, Benowa, QLD, Australia
a) Wards: Rehabilitation Ward b) Patient Caseload: Average 12 patients/dayc) Hours: 200 hours d) Patient Population: Adult, Geriatric
Patient Presentations Benign Paroxysmal Positional Vertigo (BPPV) 5th Cranial Nerve Palsy Transient Ischaemic Attack (TIA) Arteriovenous (AVM) Peroneal Nerve Palsy Total Knee Replacements as above Total Hip Replacements as above Transtibial Amputation Metastatic Lung Cancer Parkinson’s Disease
o With Deep Brain Stimulation Alzheimer’s Disease
Assessments Subjective assessments as above Observation of attachments as above Respiratory assessments as indicated Monitoring of vital signs as above Functional assessments as above
o Wheel chair transfers
Adam Norman – Professional PortfolioPhysiotherapist
10
Vestibular assessmento Observation of nystagmuso Convergence/ Divergenceo Visual trackingo Vestibular Ocular Reflex (VOR)o Dix-Hallpike
Cranial nerve assessment Neurological exam as above Circulation/DVT assessment as above Wound observation as above
o Amputation stump observation Proprioception assessment
o Upper limbo Lower limb
Tone and Spasticity assessment o Modified Ashworth Scaleo Tardieu Scale
Mobility assessment as aboveo Step test
Discussion with occupational therapist regarding Mini-Mental State Examination (MMSE) results
Interventions Epley manoeuvre
o Education regarding post manoeuvre precautions Gait/ Mobility retraining
o Supervised exercises in parallel bars Visual, sensory and auditory feedback/cues Surface changes Direction changes
o Obstacle courses + or – external perturbations
o Breakdown of individual gait phases Heel strike Stance Toe-off
Seated balance training o + / - internal and external perturbations
Prescription and progression of mobility aids as above Liaised with occupational therapist regarding eye patching for enhanced visual feedback Evidence based pacing strategies for Parkinson’s disease
o Visual feedbacko Tactile feedback
Adam Norman – Professional PortfolioPhysiotherapist
11
o Verbal feedback AROM and PROM stretching and exercises Active Assisted ROM exercises UL and LL strengthening exercises as above
o Hospital based o HEP
Education regarding amputation stump care/precautions Amputee transfer training Discharge planning as above
o Home visits with occupational therapist to ensure adequate environmento Referral for assistive devices to discharge home
Referral for day rehabilitation program as indication
Special Experiences Observation of Modified Barium Swallow with Speech Pathologist Observation of Electromyography (EMG) guided Botox injection for treatment of spasticity Orthotist presentation for commonly used splints and orthosis seen in various neurological
conditions
4. Musculoskeletal Physiotherapy II Clinical Practice – Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
a) Wards: Outpatient Clinic, Women’s Health b) Patient Caseload: Average 6 patients/dayc) Hours: 200 hours d) Patient Population: Paediatric, Adult, Geriatric, Maternity
Patient Presentations Thoracic outlet syndrome (TOS) Cervical whiplash injury Degenerative Disc Disease Developmental dysplasia of the hip (DDH) Anterior Cruciate Ligament (ACL) rupture for conservative management
Adam Norman – Professional PortfolioPhysiotherapist
12
Peroneal Tendinopathy Tibialis Posterior Tendinopathy Achilles Tendinopathy Lateral Ankle Sprain (ATFL) Plantar Fasciitis Chronic low back pain Low back pain during maternity Sacroiliac Joint (SIJ) pain during maternity
Assessments Subjective assessment as above
o Mechanism of injuryo Irritability/ severity o Body weight
Palpation of structures involved in injury AROM and PROM examination
o Goniometry o Knee to wall (KTW)
Muscle length testing Neural tension testing Strength/ Power testing as above Oedema measurements Passive Physiological Intervertebral Movements (PPIVM’s) Passive Accessory Intervertebral Movements (PAIVM’s) Ligamentous testing
o Knee Lachman’s test Medial Stress test Lateral Stress test Sag sign
o Ankle Anterior Draw Talar Tilt
Ankle syndesmosis stress test Ottawa ankle rules Achilles squeeze test Treatment directed testing for the aforementioned injuries Gait analysis Observation of foot arch Functional assessment
o Walk/ Run Change direction
o Double/ Single Leg squato Double/ Single Leg jump
Adam Norman – Professional PortfolioPhysiotherapist
13
o Lunge o Incline/ Flat push up
SIJ pain provocation testso Distractiono Compressiono Thigh thrusto Sacral thrust
Interventions Manual Therapy
o PPIVMS Grades 1 to 4
o PAIVMS Grades 1 to 4
o Joint mobilisations Grades 1 to 4
o High Velocity Thrust (HVT) o Mobilisations with movement (MWM)o Soft tissue massage
Modalitieso Heato Cryotherapyo Transcutaneous Electrical Nerve Stimulation (TENS)
Postural correctiono Tactile feedbacko Postural tapingo Education
Therapeutic tapingo ROM limitationo Proprioception enhancement
In clinic exercise therapyo Concentric exercises o Eccentric exercises o Isometric exercises o Plyometric exercises
Prescription of HEP as above Retraining of recruitment patterns
o Deep Neck Flexorso Vastus medialis oblique (VMO)o Pelvic floor
Prescription of lumbar / SIJ support belts Education on risk factors for pain during pregnancy Prescription and implementation of hydrotherapy exercise programs
Adam Norman – Professional PortfolioPhysiotherapist
14
Referral for follow-up outpatient appointments
Special Experiences Half day orientation to the Orthopedic Screening Clinic Half day orientation to Queensland’s Traumatic Burn Unit
o Orientation to Plastic Surgery ward Guest presentation on the impact of Motor Neuron Disease on individuals family and social
network Introduction to the use of ultra sound for visual feedback of pelvic floor activation
5. Chronic Disease and Disability Clinical Practice – Aged Care Physios, Varsity Lakes, QLD, Australia
a) Facility Attended: The Terraces Aged Care Residenceb) Patient Caseload: Average 12 patients/dayc) Hours: 200 hours d) Patient Population: Geriatric
Patient Presentations Lacunar infarct Increased falls risk General deconditioning Parkinson’s Disease various levels Cerebral Palsy Muscular Dystrophy Multiple Sclerosis Fractured pubic rami Fractured neck of femur Community acquired pneumonia COPD BPPV
Adam Norman – Professional PortfolioPhysiotherapist
15
Assessments Subjective assessments as above Respiratory assessments as indicated Pain management assessment
o Using Aged Care Funding Instrument (ACFI) Conduction of and interpretation of standardized mobility and functional testing as above Rating of perceived exhaustion assessments Strength assessment as above Oedema measurements as above Interpretation of medications as above
o Interpretation and timing of treatment in accordance with medications Neurological assessments as above Tone and Spasticity assessments as above Cranial nerve assessments as above Interpretation of cognitive screening results Observation and interpretation of surgical protocols Handover of mobility and transfer status to nursing staff and personal carers Observation of wounds and dressings
Interventions Prescription of mobility aids as above Prescription and implementation of 1 on 1 exercise programs based on functional
maintenance Liaise with Physiotherapy Assistant (PTA) regarding daily care of patients Conduction of group exercise class with focus on
o Strength o Flexibilityo Balance/ Coordinationo Maintenance of function
AROM, AAROM and PROM stretching Seated/Standing balance exercises as above Transfer re-training Liaise with occupational therapist (OT) regarding hand splinting Referral to hand and upper limb specialist Implementation of strategies for safe mobility of patients with Parkinson’s disease
o Verbal, Tactile and Visual feedbacko Optimal environment
Soft tissue massage Application of TENS Deep breathing exercises as above Airway clearance techniques as above VOR training/ Gaze stability exercises Epley Manoeuvre as above
Adam Norman – Professional PortfolioPhysiotherapist
16
Hoist and transfer training for staff and carers Pressure area relief positioning
Special Experiences Attended educational workshop on successful management of patients with Alzheimer’s
Disease/ Dementia Attended educational workshop on elder abuse in the aged care setting Prescription of laser guided 4 wheeled walker (4WW) enhancing visual feedback for patient
with Parkinson’s disease
6. Diversity and Life Stage Clinical Practice – Allamanda Private Hospital and PhysioSpine Private Practice
a) Facility Attended: o Spinal Surgery Inpatient Ward – Allamanda Private Hospital, Southport, QLD, Australiao Outpatient Musculoskeletal Private Practice – PhysioSpine, Southport, QLD, Australiab) Patient Caseload: Average 7 patients/dayc) Hours: 200 hours d) Patient Population: Adult
Patient Presentations Chronic Low Back Pain Intervertebral Disc Disease (IDD) Cervical Whiplash injuries Cervicogenic Headache Degenerative Disc Disease (DDD) Spondylosis Peripheral Neuropathy Surgical Procedures:
o Anterior Lumbar Interbody Fusion (ALIF)o Anterior Cervical Discectomy and Fusion (ACDF)o Total Disc Replacement (TDR)o Posterior Lumbar Interbody Fusion (PLIF)o Posterior Spinal Fusion (PSF)o Laminectomy
Assessments Review of patient history
Adam Norman – Professional PortfolioPhysiotherapist
17
Subjective assessment as above Neurological assessment as above MacKenzie Assessment
o Classificationo Directional Preference
Work cover/ Return to work assessment Interpretation of imaging
o X-ray, MRI, CT, Ultrasound Pre-operative assessment
o Pre-operative Pain (NPRS)o AROM, PROMo Sensationo Powero Medications
Post-operative assessment o Observation of surgical protocols o Observation of attachments o Medications o NPRSo AROM, PROMo Sensationo Powero Mobility and transfers
Interventions Manual Therapy as above Application of heat packs and cryotherapy Application of Electrical Modalities
o Ultrasoundo TENSo Interferential Current (IFC)
MacKenzie centralizations Pre-operative education regarding
o Surgical procedure o Post-operative precautionso Inpatient expectations o Return to ADLs o HEP and progressions
Post-operative treatmento Circulation exercises as aboveo Deep breathing exercises as aboveo Prescription and progression of mobility aidso Bed/ standing strength and balance exercises as above
Adam Norman – Professional PortfolioPhysiotherapist
18
o Education regarding pain caused by Bone Morphogenetic Protein (BMP) Prescription and progression of Clinical Pilates based exercises Prescription and progression of HEP Prescription of seated lumbar support Referral for hydrotherapy based exercises Liaised with workers compensation case manager Completion of suitable duties program for appropriate return to work
Special Experiences Participation in DMA Clinical Pilates for Physiotherapy three hour workshop Introduction to MacKenzie A and B theory and framework by certified MacKenzie A/B
physiotherapist
7. Clinical Internship – Gold Coast Titans, Gold Coast, QLD, Australia
a) Facility Attended: Gold Coast Titans (National Rugby League) – Gold Coast, QLD, Australia
b) Patient Caseload: Average 10 patients/dayc) Hours: 270 hours d) Patient Population: Elite/Professional Athletes
Patient Presentations Cervical Whiplash Injuries Lumbar Disc Herniation Dislocation
o Shoulder, Elbow, Patella Shoulder Subluxation Bankart Lesion/ Bony Bankart Lesion Superior Labral Tear from Anterior to Posterior (SLAP) Ulnar Collateral Ligament Rupture Osteitis Pubis
o Conservative and Surgical management ACL rupture and repair MCL rupture and repair
Adam Norman – Professional PortfolioPhysiotherapist
19
Meniscal tear Syndesmosis strain Ankle Sprain
o Lateral and Medial Medial gastrocnemius tear Quadriceps strain Hamstring strain Impingement
o Shoulder, Ankle, Hip Contusions Concussion
Assessments Subjective assessment as above
o Sideline/ Field assessment AROM, PROM as above Strength/Power assessment Muscle Length assessments
o Pectoriso Ober’so Faber’s
Oedema measurements as above Interpretation of imaging as above Functional assessment
o Walk, Run, Jump, Squat, Lunge, Push-up (+/- incline) Interpretation of GPS data during training/competition Interpretation of WattBike data Return to sport/training assessments Treatment directed testing Palpation of affected structures Neural tension testing Special Orthopaedic tests
o Shoulder Load and shift Posterior apprehension Anterior apprehension Sulcus sign Hawkin’s Kennedy Neer and Walsh Painful Arc O’Brian’s Drop arm Lift-off Gerber’s
Adam Norman – Professional PortfolioPhysiotherapist
20
Empty-can, Full-cano Elbow
Medial/Lateral stress test o Hip
Quadrant testo Knee
Medial/Lateral stress test Lachman’s test Sag sign Anterior/Posterior Draw McMurray’s
o Ankle Anterior draw Talar Tilt Inversion/eversion stress test Achilles squeeze test Syndesmosis squeeze test
Observation of skin-fold testing Interpretation of concussion screening results
Interventions Rest, Ice, Compression, Elevation principles
o Prescription of compression garmentso Prescription of GameReady (cryotherapy, compression therapy) unit o Education regarding healing timelines/ return to sport
Prescription and progression of mobility aids as above Manual therapy as above
o Muscle energy techniqueso Proprioceptive Neuromuscular Facilitation (PNF stretching)
Prescription of exercise/rehabilitation programs and progressions Liaise with teams strength and conditioning coach regarding exercise protocols Prescription of foam rolling/ body spanner protocols Prescription off WattBike exercises Referral and observation of dry needling Prescription of slings and braces for ADLs and sport Therapeutic taping as above
o Kinesiotape Referral to clinical Pilates Referral to orthopaedic specialist Liaise with team medical staff regarding patient care Referral for remedial massage Referral for hydrotherapy based exercises Referral to team podiatrist for foot orthotics
Adam Norman – Professional PortfolioPhysiotherapist
21
Observation of education regarding medication usage
Special Experiences Presented educational in-service regarding prevalence of calf injuries in older elite athletes Observation of concussion testing for return to sport assessments Observation of recovery sessions in state of the art cryotherapy chamber Observation and introduction to Anti-gravity (AlterG) treadmills for rehabilitation of elite
athletes Introduction to clinical Pilates for conservative management of elite athletes with chronic
low back pain Attended educational in-service regarding nutrition and hydration of elite athletes Observation of educational in-service regarding legal and illegal medical substances under
Australian Sport Anti-Doping Agency (ASADA)
Adam Norman – Professional PortfolioPhysiotherapist
22
Academic Awards
Adam Norman – Professional PortfolioPhysiotherapist
23Adam Norman – Professional PortfolioPhysiotherapist
24Adam Norman – Professional PortfolioPhysiotherapist
25Adam Norman – Professional PortfolioPhysiotherapist
26Adam Norman – Professional PortfolioPhysiotherapist
27
Research Projects:
Bond University Tactical Research Unit
Research Supervisor: Dr. Rob Orr
Papers:
1) A Detailed Analysis of Serious Personal Injuries Suffered by Full Time and Part Time Soldiers (Manuscript in Progress)
Target Journal: BMC Journal of Musculoskeletal Disorders2) A Narrative Review of the Nature of Musculoskeletal Injuries
Suffered by Army Personnel in Training and Operations Target Journal: Journal of Military and Veterans Health
University of Windsor: Faculty of Human Kinetics
Research Supervisor: Dr. Nancy McNevin
Paper:
1) The Effects of Internal and External Focus Instructions on Motor Performance
Adam Norman – Professional PortfolioPhysiotherapist
28
Physiotherapy Professional Development:
Australian Physiotherapy Association: Educational Student Workshops
1) How to treat and beat common running injuries presented by Brad Beer (Physiotherapist)
2) Physiotherapy Clinical Taping Techniques by Maria Constantinou (Physiotherapist)
Rock Tape Australia (RockTape1 Certification)
Adam Norman – Professional PortfolioPhysiotherapist
