Laurie's Blogs.

Today's blog was inspired by a couple of different scenarios:

1. I had an e-mail asking me about head shaking and neck pain (in two dogs that were clear of having ear infections).  So I went back through my 'rolodex' of past patients in my mind and thought - YES… I have seen dogs that shake their head if they have facet joint issues in their neck, and I have seen dogs with presumed disc lesions that, after a therapy session, may attempt a head shake (which I usually consider to be a very good sign).

1. I was listening to an audio CD - Seth Godin - Icarus Deception… So far, I think that more intelligent people than me would get more from the audio… but I'm trying to wrap my head around as much of it as possible.  First a bit of background… the premise of the book is that we all create 'ART'… but not just in ways of painting, poetry, digital creations, landscaping, etc… but with the things that we do day in and day out.  Really, what we are all doing (i.e. canine rehab) is adding our own brand of ART to the world.  My website in itself is a form of art - my creation, from my brain and inspired by my own passion.  The clinic that I co-own and work to maintain and grow.  The therapy that I provide to the dogs and the comfort, assistance, and encouragement that I give to the clients (I got 2 hugs from clients on Friday alone this past week!).  All of this is a form of art.  So I 'got that much from the audio at least.  Anyways, while driving into town on Sunday evening and listening to the audio - one of the message seemed to jump out at me.  IN ORDER TO LEARN, WE MUST FAIL.  IN ORDER TO GET BETTER, WE MUST FIRST FAIL.  AND WE MUST LEARN FROM OUR FAILINGS IN ORDER TO GROW.  

Okay… so here's where it comes together.  Over the years of teaching - I found that physios just starting out in the arena of animal rehab seemed to forget that they were physios and 'left their problem solving skills at the door' when their patient was animal, I found that the vets didn't have the same manual assessment skills at their disposal and / or were not necessarily taught how to process this new information (i.e. How to think like a physio / PT), and the vet techs / nurses were reliant upon their veterinary supervisor to get the diagnosis 'right' in order for treatment to be successful.

So… I got to thinking about the thought-processing drilling into us a physiotherapists / PT's and how that plays into our profession (and subsequently should play into canine rehab).  I used to have a handout called 'Thinking like a PT' that covered - what would you expect a disc lesions to look like, react like, what would a soft tissue injury like like / present as, what would you find with an arthritic joint & what would be the signs…' - but such a document is only useful if you cover all scenarios… and it doesn't help you to LEARN FROM FAILING or from your SUCCESSES.  And I remembered a great tool that was given to us as students in the Master's program in Animal Physiotherapy… it was an assignment to fill in for an animal patients we were to assess and treat.  It perfectly demonstrates how a physio / PT approaches a case and thinks… and I hope it will help YOU to be a better clinician as well.

Members will have full access to the document, but for the rest of you - not to be left out - so here is the run down.

Part A

1. You get the subjective history and list the functional problems that the animal is having and the provisional vet diagnosis
2. You ask yourself, what would be the top 3 probably hypotheses for these symptoms, what would be the patho/biological process for each, and the likely physical findings for each.
3. Given these thoughts… are you safe to do a full physical exam today?

Part B

After your objective assessment

• What is YOUR provisional functional diagnosis
• Outline the patho/biological mechanisms 
• What are the physical impairments (can you measure these)?
• Are there contributing factors (i.e. conformation) (can you measure these)?
• Are there any evident psychosocial factors (measurable as well)?

Management

• What is the goal of your Day 1 treatment?
• Treatment chosen
• Treatment effect
• Progression or plan for next treatment
• Home management plan

List Short Term Goals + how will they be achieved + time frame for each

List Long Term Goals + how they will be achieved + time frame

What would be prognostic factors?

• Favourable
• Unfavourable

What would be a successful outcome?

Approximate how many treatments might be needed to achieve the successful outcome?

Part C (Reflection… after full initial assessment)

1. Does your provisional hypothesis in part B match your primary hypothesis in part A?
2. If not, what info can you now recognize the thou initially missed, mis-interpreted, or over-weighted?

Part D (Complete after 3 - 4 treatments)

• Outline any changes you have had to make to your provisional diagnosis and explain why.
• Comment on the progress made by the patient with the short and long term goals

Part E (Complete after discharge)

• Comment on the progress made but he patient with short and long term goals.
• Highlight the hypothesis categories on the clinical pattern form Part F that were the strongest indicators of the patient's outcome and comment.

Part F - Clinical Pattern

How would you recognize this condition / clinical presentation again… what are it's key features?

Clinical diagnosis?  Area of pain?  Behaviour of symptoms? History? Observation & movement patterns? Neural system findings? Muscular system findings? Articular system findings?

Okay… so this is a bit of a long one today… but the point I want to make is that THIS is how we should be approaching each case.  At first, the process will seem tedious, however if you muddle through a few of these (step by step), then it becomes an ingrained, internalized process that makes you a better therapist / diagnostician / practitioners!

Give it a whirl and tell me your thoughts!

Until next time… Cheers!

Laurie

Laurie@FourLeg.com