A physiotherapist is presenting about range of motion for a group of occupational therapist (OT) and physiotherapist (PT) aides.
Therapist: Are you ready Mrs. Marks?
Patient: Yes.
Therapist: I will reposition your pillow to get it out of the way.
Mrs. Marks, we’ll start with the arms and shoulders today.
(Talking to students) To perform some arm range of motion movements, you will want to position your body at the side of the patient; one of your hands is holding the wrist, and the other one supporting the elbow of the patient. You hold so that your top arm is holding the wrist, and that is crossing over your arm holding the elbow. That way, when you extend the arm up, your arms will be free to move. That movement is called shoulder flexion and extension.
Patient: I’m getting used to this!
Therapist: The next movement will be shoulder adduction and abduction. Who can tell me the difference? What should the movement look like?
Student 1: Adduction is when you bring the arm back down on the side of your body (when it’s been stretched out straight up)
Abduction is when you lift the arm away from the body and up.
Student 2: It should look like the movement you do when you’re making snow angels.
Therapist: Yes, that’s a good analogy.
Therapist: Now, let’s deal with the lower extremities.
Of course, you would start with hip flexion, and extension. Hip abduction and adduction, internal and external rotation….But you don’t want to perform this movement after a hip replacement!
Patient: It’s ok, I haven’t had any surgery. I’ve had a stroke!! My left side is paralyzed. And that is why the physio does all these exercises….
Therapist: Let’s practice the knee flexion and extension. We will finish with inversion and eversion movements at the ankle.
Student 2: Inversion?
Therapist: Inversion is when the underside of your foot is turned inwards so that your sole is facing to the inside of the leg. Eversion is when the sole is turned to face on the outside of your leg.
Patient: I can’t walk at all; first of all I don’t feel my left foot, and it keeps dragging on the floor…
Therapist: (to all) Mrs. Marks has a condition called a “drop foot”. Her foot drags on the floor and she looses balance when she tries to walk. We have been working on this for a while.
Therapist: Thank you Mrs. Marks, we’re done for today.
Teacher: Now Josée, you may not work as an OT or a PT aide, but the notions discussed are still good to know in case you have a patient that has movement problems. You will know more about the kinds of questions to ask.
Student: What do I want to ask about?
Teacher: Aside from the actual ROM, you want to note any stiffness, redness, swelling or edema, discoloration, sores, signs of infections, or any particularly new limitations that you encounter.
Student: So I should ask if they feel pain anywhere and to describe their pain?
Teacher: Yes, that could be helpful. Any information about the patient’s level of pain, his tolerance, his abilities need to be noted too.
Student: Why does this information help the OT and PT?
Teacher: Well, those elements would provide indicators as to the progress of the patient or some of the issues that may be occurring if a complication is developing.
Student: Ok, I will make sure to keep this in mind. Maybe I’ll even become and OT aide as a specialty. It sounds interesting!