19SarahE – CA Work Experience Program

Day 7

Today was my last day at Duke Physical Therapy and Sports Medicine, and it was the longest. I started my morning at 8:00am with Ashley and saw around 4 patients. 3 of the patients were in the Joint Health Program (JHP). The program was created by the Department of Orthopaedic Surgery and the Department of Physical Therapy and Occupational Therapy to try and find a better way to treat osteoarthritis and osteoporosis, which is hard to treat and comes with a lot of pain in the joints. Ashley is the only one in the clinic who does JHP, so she sees a number of patients in the program. It focuses on education about pain management, nutrition, sleep, stress management, exercise, and general lifestyle changes that can be made to better manage the pain. One big focus is making a change from overexerting yourself by doing a bunch of an activity until you’re in pain, and then taking a prolonged break. It’s better to break an activity into manageable time chunks and take breaks in between, and it makes you more productive since there will be less rest time overall due to pain. I saw a couple patients with Tyler today, one of which had a period of time in college where she was aspiring to become a doctor. Tyler took the opportunity to start quizzing me, one of the college interns, and the patient about anatomy. Needless to say, we have some brushing up to do on our anatomy knowledge. The rest of the day was just spent seeing more patients and observing various exercises until 5:45. I’ve had a great 7 days at Duke Physical Therapy!

Day 6

Today was a bit of a shorter day due to Ashley having meetings in the morning and mid-day, but I still got to observe four appointments (30 min is the normal length of an appointment) and talk some things over with her. The first patient was very active and only came in for occasional check-ins about every 4-6 weeks. She used Graston tools on him to loosen the muscles and tissues in his back/shoulder. The second patient was an older who had a mini-stroke earlier, and is now working on balancing. Ashley talked through the 3 systems the body uses to balance and how each exercise challenged a system. She walked over and balanced on foam, which provided a different surface and challenged the tactile system. Balancing on uneven surfaces is much harder than a flat surface, and is something most people come across. The next system is visual. Ashley had the patient hold a weighted ball and raise it up and down while looking up and down. This gets rid of the ability to spot a point. Sometimes they’ll also have patients close their eyes. The last one is the “inner ear” which is what creates your body’s spatial awareness and helps with movement and balancing. The third patient was a dancer who had a “pump bump” aka Haglund’s deformity , which is a bony bump on the heel caused by the soft tissue near the Achilles being irritated and becoming inflamed, which can lead to bursitis. The last patient was having neck/shoulder tension and had dry needling done.

Day 5

Today Dr. Ashley Lake was back! The first patient we saw had dry needling done which was cool to see again, and Ashley used a different device for the electric current. The next patient didn’t want an extra observer, so Ashley had me read the post-op report of another patient coming in 5 days post-op who had surgery to repair his ACL. Although it was very confusing and had a lot of new terms, it was interesting to read and I got a vague sense of the procedure that was done. I then talked it over with Ashley to more fully understand what to expect. Another patient that came in was a young (middle school age) dancer, and it was cool to see Ashley giving her some of the same exercises she gave me when I got treated by her.

Day 4

A new day, a new PT to shadow. With more appointment cancellations and schedule differences, I ended up shadowing 4 physical therapists today. I started with Zach who was working with a runner trying to regain strength. The patient ran on the treadmill for a while, and then did some isolations and strength building exercises. This was the first patient I’ve worked with who actually had the strength to do cardio and run. I also shadowed Ann Marie for the first time today while she did an ankle evaluation on a patient who came in after going to an Orthopedic Urgent Care. I got to see how she assessed the injury first, and then gave strengthening exercises. This particular patient was already in the habit of doing high intensity workouts regularly, so she would likely have a faster healing time due to her built up strength. I was also back with Tyler for a couple appointments today, and got to see one of the patients again from earlier this week.

One of the most interesting cases of the day was with Kristina. A patient came in 3 days post-op after getting 2 screws taken out of the front of his knee. He had been a regular patient before, and had other sugeries done in the past. Since he was only 3 days out, Kristina had to do a dressing change, and it was cool to see the sutures and how it’s healing. We worked mainly on strength building, since his mobility was still very good, likely due to the fact that he was a young adult and the placement of the incision at the front of the knee and not directly over the kneecap. I also got to see the Alter-G (anti-gravity) treadmill being used for the first time!

Throughout this week I’ve noticed that the majority of patients come in with either shoulder or knee mobility issues. I’ve seen patient after patient doing the same arm strengthening exercise or balancing exercise, and they’re all based around strength building and gaining mobility.

Day 3

Today I worked mainly with Kristina, but her 10am appointment cancelled, so I got to work with TJ for the first time. He had a really interesting case with a teen who recently had a femur lengthening surgery on his right femur. TJ had never treated this patient before, so the hour long session was focused on testing flexibility and improving mobility. I actually got to help stretch the quads and it was surprising just how tight it was post-surgery. I had to hold his ankle still just so his knee flexion could be measured without any slipping since he couldn’t hold it in place himself yet. I also got to see just how far he had come, as he showed TJ that right after the surgery he could barely hang his leg off a table because the tendons in his knee were so tight, and today he got well past 90 degrees.

I also did a few sessions with Tyler again, and even got to see a returning patient from earlier this week. It was interesting to see how much improvement there was in just a few days because this patient was dedicated to doing his at home excersizes. When I saw the patient earlier this week, he came in on crutches, but today he was able to walk in the boot and put some weight on the injured foot without the boot. Tyler used a blood flow restriction machine on this patient, and many others, to make simple exercises harder. When a patient has limited mobility but still needs to build strength, the machine can be used to allow the patient to keep getting stronger while doing the same exercises.

One really cool thing I happened to get to see was dry needling. I had never seen it before, and by chance I was with Kristina in a room when she noticed that one of the staff members was about to have dry needling done. He had 4 acupuncture needles placed in his hamstrings and then the needles were connected to an electrical current. It was intetesting to see his reactions when the needle hit a certain spot in the muscle, and how his muscle would twitch due to the electric current.

With Kristina, I got to see patients on complete opposite ends of the compliency spectrum. Two of her patients were well educated in athletics and how to take care of their bodies. Another two were known for missing appointments and not doing their at home exercises. One huge part of PT is patient compliency. They need to actually do exercises at home to get better. She told me that they do what they can in the clinic to help, but if the patient is known to be non-complient, there isn’t much more they can do, especially with older patients. While it would be nice to get really good patients all day, part of the job is definitely learning how to handle challenging patients.

Day 2

My second day was with Dr. Tyler Cope again, and I also did one session with Dr. Kristina Wulff when Dr. Cope’s patient cancelled. I was surprised after seeing over the past two days how many people cancel their appointments the day of or just don’t show up. I got to see how more of the machines were used, and how different weights are utilized. Dr. Cope also had me do some exercises with the patient so I could feel what muscles it was working.

Today the patients were a bit more engaging, and it was nice to talk to them and hear about their journey whether they were 2 or 12 weeks out. One patient in particular was a very successful scientist turned business manager, so he had some very interesting life advice to share with the college intern and me. The patient I saw with Dr. Wulff was older, and very reluctant to do the exercises, but got through them all with a little complaining. He told me he hated doing the exercises but it all paid off in the end. Overall, I learned that one of the most important things to do as a PT is to create a safe trusting environment for your patient and to communicate effectively.

Day 1

Due to unforseen circumstances, my schedule for the day actually changed just last night. The doctor I was originally working with is out for a few days, so I got to shadow Dr. Tyler Cope and Dr. Kristina Wulff today. I went in at 10:00am instead of the previously scheduled 7:30am and met up with Dr. Jaime Blanton to complete orientation and fill out some paperwork saying I’d abide by Duke’s rules and HIPPA. I then met Dr. Tyler Cope to tour the facility, which I had actually seen before since I used to go to the clinic for my own physical therapy. Aside from the physical therapy area upstairs, the Duke Physical Therapy Sports Medicine Clinic also contains a gym downstairs, indoor pool, outdoor track, and is adjacent to a more traditional doctor’s office. At the end of the tour and before Dr. Cope’s first appointment, I learned how the station carts are organized and how each station is set up. Each cart contains everything needed to reset the tables between appointments and some basic tools needed during sessions.

The top drawer of each cart contains gloves, scissors, gauze, tape, lotion, a goniometer, and other basic essentials.

The upstairs clinic area is split into 4 main sections: The waiting room, exam rooms, the open gym area, and staff desks. Dr. Cope stayed in the open gym area and used the tables there to assess his patients, but the doctors can also use one of the separated exam rooms. In the open area, there is a cart between every few tables, and there is also a cart in every exam room. Of the exam rooms, some are like the first one pictured below, with curtains separating them between each other and the open gym area. There are also more closed off rooms like the ones in a standard doctor’s office.

Standard Exam Rooms:

At the end of the day, I worked with Dr. Kristina Wulff who was working with patients in the pool. She explained how utilizing the pool allows patients to work more comfortably since the pool takes off some body weight pressure, which is especially useful for post-op patients. Water to hip height takes off 50%, mid chest height takes off 75%, and up to the neck takes off 90%. The water resistance also forces patients to utilize different muscles.

I’m excited to go back in tomorrow and work with Dr. Cope again to see some more patients!