Placement Day 12 (with the physiotherapists)

20/2/13

Today I was with the 3 physiotherapists, A,B and C, and helped in two hydrotherapy sessions and two assisted stretching classes.

Hydrotherapy Session - Pupil 2, Class D

Before the session began Physiotherapist B gave me a chance to peruse the notes take from previous hydrotherapy sessions with the pupil I would be seeing next. It was Pupil 2 from Class D, who has cerebral palsy. From his notes I found that Pupil 2‘s cerebral palsy effects him in a diplegic manner, meaning that his body is symmetrically paralyzed on one side. I also came to learn that Pupil 2 is also scoliotic, which I did not realise before. This is  a postural deviation of the spine where the natural curves become more like an S shape due to overuse on one side of the body or a distinct lack of use from one side of the body. This can cause a number of postural problems as many muscle groups can undergo adaptive shortening in order to compensate lacking areas during particular movement patterns. It was clear from the notes, as I had already noticed during my sessions with him, that Pupil 2 had tight adductors, hips and feet. The notes implied that a method of tackling this shortening was for Pupil 2 to perform a number of side-steps in the hydrotherapy pool.

When heading to the pool, Physiotherapist B explained to me that the temperature of hydrotherapy pools needed to be accurately maintained, specifically between 37 and 38 degrees centigrade. This made sure that when a person entered the pool their muscles would relax and expand with the warm temperatures, making them more pliable and suited to stretching.

When Pupil 2 arrived I am happy to say he seemed pleasantly surprised to see me and agreed to show me some of his basketball skills he had told me about before at the end of the session. Pupil 2 was encouraged by Physiotherapists A and B to walk up the steps himself and down into the pool. The Physiotherapists made sure he was mindful of how he was stepping, with his heel down on the floor. As soon as he was in the side-stepping began, with Physiotherapist A who was in the pool with him, holding his waist to maintain an upright posture. She was ruthless with Pupil 2’s technique, making sure he was straight as possible and was more bothered about good performance than how many steps he could take. As a remedial exercise for his scoliosis, Pupil 2 was then challenged to hold onto a float with both hands in front, float on his belly and kick forwards with is legs. Physiotherapist B, who was on the poolside with me, pointed the curvature in Pupil 2’s spine and how one could see it straighten during this exercise. This was clearly a taxing task for Pupil 2 who struggled to perform half a length of the pool; the Physiotherapists and myself encouraged him with how impressed we were by how far he had travelled and urged him to keep trying. Remarkably he did so, expressing a brilliant attitude towards his hard work.

At the end of the session, Pupil 2 got to play his basketball skills with a floating net, which I held steady for him while he practiced taking shots with both hands. I knew Pupil 2 liked playing basketball in his own time so it was nice to see him thoroughly enjoying himself and showing off in front of me.

Hydrotherapy Session - Pupil 1, Class E

The second student was Pupil 1 from Class E who seemed very happy to come in and get on with the session with me as a part of it. Similarly to Pupil 2 of Class D, Pupil 1 has a symmetrical paralysis of a her body. However in her case it is called hemiplegia as this refers to a spasticity or hypertonia on the side of paralysis, which is particularly visible in Pupil 1’s right hand. Again she was encouraged to tackle the stairs by herself when entering the pool and also began with some side steps for decent adductor stretch. The session continued with lots of leg stretching, as I had noticed Pupil 1’s right leg is obviously difficult for her to use and tends to hop or even drag her leg when trying to move quickly in PE. Pupil 1 was then assisted at the rail to hold on with both hands and perform a hamstring stretch. Despite the difficulty, Pupil 1’s spirits was still sky high as she continually amused herself by poking her tongue out at me. I laughed and copied her to keep her happy, but she had a tendency to get too distracted and I occasionally needed to redirect her to the tasks she was asked to perform. Even though she was obviously having a good laugh she worked well in the end.

This session also closed with a basketball practice with the floating hoop that I held still. The Physiotherapists made sure that Pupil 1 was using her right hand when shooting, and encouraged her throwing technique more than how many she was scoring. Occasionally, she accidentally splashed me with the ball and as a joke I decided to splash her; she splashed me back even more which the Physiotherapists didn’t mind and even then were encouraging Pupil 1 to use her right hand to splash me with, which she did.

Assisted Stretching - Pupil 4, Class C

This session was with a very young pupil, so before it began I took the opportunity to ask Physiotherapist C, who I’d be working alone with, what she thought of her work with such a young student. She explained to me that Pupil 4 has cerebral palsy which is technical a neurological a disorder with physical symptoms; even though studies have shown that no significant changes occur with the damage to the brain, the physical symptoms are always a helpful place to work on for improving a person’s day to day life, and early interventions are often favoured to do that. In fact she said the earlier the better so physical symptoms are much less likely to get worse over time.

This session was taken in a small room on a mat with Physiotherapist C putting Pupil 4 into stretched positions. She began by straightening his postural alignment, his spine, his hips, and shoulders; she said that when stretching someone like this “it’s always best to start with the trunk, then work independently. If you start with the trunk the rest will come easier.” By this she referred to the axial skeleton, the core of our skeletal system and posture. She then moved onto Pupil 4’s limbs, focussing heavily on his legs, which had tight adductors. One stretch, an external rotation of the hips, proved immensely difficult for this pupil and he began crying. Physiotherapist C tried to comfort him so she could finish the stretch but Pupil 4 was clearly too distressed, so instead she finished the stretches early and gave him a hug. She used her voice to calm him down and offered him some walking. Pupil 4 made eye contact with Physiotherapist C at this point, suggesting that he recognised the word walking. After they had taken some time to calm down, they showed me some assisted walking. Physiotherapist C had to stand against the pupil’s back, holding him up and had to prompt his legs to step forward with a few gentle tugs. Pupil 4 seemed to enjoy this part of the session and I made sure to be very vocal and enthusiastic about how impressed I was with his walking to help keep him calm and happy. Physiotherapist C had measured some angles of the stretches they had done together in the past and showed me that today had not been quite as successful as previous sessions; she said that Pupil 4 may just be behind on some home practice and was probably just having a bad day with the stretching.

I asked to have a go at assisting Pupil 4 during his walking practice before we left, which Physiotherapist C was happy to help me do. Instantly I could feel how much help Pupil 4 needed to stay up and his core muscles felt incredibly weak so he needed much help in keeping his body straight. I never knew holding up such a young boy could seem such heavy work, but Physiotherapist C guided my own posture and method of holding so that I could be the most help I could when assisting Pupil 4. As he left looking a bit happier I said that I had no idea Pupil 4 had tried walking before, and that whenever I see him in PE I will try to keep him practicing when I can.

Assisted Stretching - Pupil 2 and 3, Class E

The final session I was involved in today was with the two wheelchair users I know from Class E. I was with Physiotherapist A for this one and we were in the sports hall with a couple of mats set out. Pupil 3 could actually clamber out of her chair with the use of a table in front of her, which I was surprised to see. Pupil 3 seemed quite nonchalant about the process though which suggests that she is used to climbing out of her chair in these sessions. However Pupil 2 is heavier and tighter, and requires the use of a mechanical hoist to lift him out of the chair and ease him onto the floor. Like before this session began with some assisted stretching, Physiotherapist A took Pupil 3 and directed me as I copied with Pupil 2. When it came to the glute stretch though she needed to warn me that Pupil 2 is much tighter than Pupil 3 so I should be careful not to push him too far. I instantly felt what she was talking about as I tried to pull Pupil 2 into a lying down glute stretch and realised that his hamstrings were rock-solid from being sat in the chair. Maneuvering his legs towards his body to acquire a decent stretch actually proved hard work and emphasised for me how important these stretching session really are for these students.

The session moved with trying to get the two students to roll on the mat from the backs to their bellies, using each other as incentives. It was lovely to see that these students had a good relationship with each other as their needs were clearly so similar and needed to be worked on in the same ways. They had obviously been undergoing these therapies for a while together and did well to motivate each other and make themselves laugh.

Physiotherapist A then brought out a volleyballs to use. She got the students to sit up, pick up the ball with both hands and lift it above their heads before passing it to one another. This proved very difficult for them, as they struggled to lift the ball beyond their forehead; me and Physiotherapist A were quick to recognise any methods of compensation, the particularly common method being a lowering of the head which indicated a real struggle. We encouraged them to avoid compensating in such ways and guided their movement slowly to perform a decent stretch which just involved the arms moving. I recognised this movement pattern as a similar stretch I saw this morning with Pupil 2, Class D, when he held onto the float and tried swimming across the pool. This told me the stretch was obviously aimed at aligning their posture, which could easily deviate after being sat in a chair for so long.

Today I have had a thorough insight into the wonderful work of the Physiotherapists. I have enjoyed my interesting day and I’m delighted that I had the opportunity to see some of the students I already know from PE in a different setting, getting to know them a bit better.

Live life to the full.

Steve.