Barriers

While reading a paper on Parkinson's Disease this week, I came across this gem:

"Research demonstrates that people with disabilities are less physically active than people without disabilities, although the reasons for this are unclear." - 2009

Really?!

Thinking of my patients I can think of several reasons for each of the patients I have seen in the past few weeks as to why they would be less physically active than the non-disabled population. Maybe this is demonstrating a gap between researchers and clinicians. I am sure there are other researchers that are well aware of the barriers to activity for disabled people.

From these past two weeks alone I can think of several reasons
1. Fatigue - usually a symptom of brain injury like stroke or traumatic head injury. People with these types of injuries require more sleep and have barely enough energy just to get through their activities of daily life, let alone go for a walk or participate in a community exercise program.
2. Mobility - people with disabilities often have a more difficult time getting around from place to place. If they feel like they can't exercise or be active in their home or neighborhood for safety concerns it is an extra effort or expense or burden on a family member to get them to a place where they can participate in an activity.
3. Stigma - Firstly, there is the idea in many cultures and the older generations that once you are injured or sick that you should rest and take it slow. Secondly, there are the stares when someone with an impairment is in public.
4. De-conditioning - after an injury there is often a certain amount of time spent in hospital or physically unable to participate in usual activities. This leads to a decrease in cardiovascular capacity and a decrease in strength. This makes it harder to get back to doing the same thing you were doing previously.
5.Physical Impairment - its possible that the physical impairment itself is inhibiting participation and activity. For example, if a person has difficulties balancing, walking is going to be a lot harder for them and so they may not be able to walk as far as an able bodied person because walking even a shorter distance requires a lot of effort.

These are just a few examples.

As physios its our job to help the patient overcome these barriers. We can do this by minimizing the impairment, encouraging activity and participation.The optimal situation would be to help repair their impairment, however, this is not always possible, so we help them find ways to adapt activities so that they can fully participate and be active members of their communities.

Exam Week ... By Special Request

Imagine my delight as one clear autumn afternoon in October I was riding the #99 home with Krista and Alison when I got this email on my blackberry:
Needless to say I was overjoyed.... not.

Anyways since Paeds is and Adult Neuro are tow different tests we technically wrote 6 exams in 4 days. That includes the infamouse OSCE on Tuesday.

So to prepare for exams, I basically became a hermit along with the rest of my classmates for the better part of 3 weeks... maybe more. I was certainly unpleasant to spend time around. Now, for those of you who don't know our class schedule is already pretty intense. We are in class from 5-7hrs on most days. Meaning we  start class at 8am and get off at 4pm with an hour for lunch on a longer day. Maybe get off at 3 on a earlier day. So this means you only have from 4pm onwards to study for 6 exams as well as eat, bathe, exercise, grocery shop, etc.

Busy.

One of my classmates pointed out that "studying" is just student and dying put together.

This is why I am cranky around exams. Lack of sleep, exercise and the overwhelming feeling that if you don't pass your exams you could potentially be kicked out of the program (or at least your year) wont get to go on placement, will have to repeat a placement and not get to go to Sri Lanka. And of course, endure the shame of failure.

So exam week came around:

1. Electro - good times. Its always great to open to the firs page and be like "oh man, I have no idea even what you are asking" for 2 questions. It didn't get better after that. Although I can say I nailed drawing a leg, however, the placement of my electrodes on my hand-drawn leg....

Then after that I studied like a demon for 10+ hours for the practical exam the net day. Studying for a practical is sort of fun? But it really drains the energy out of you. Thank goodness I had Disney Princess Alphagettis to get me through the evening... (note to self: alphagettis are not as good as you thought they were when you were 6).

2.  OSCE - Objective Clinical Standard Exam
When you get the email a week before telling you your time for the OSCE and you are shaking and your bowels loosen, its not a good omen. I am sure I made several mistakes during the test. I made up a name for a patient in one station. Actually I am going to go ahead and blame it on the first station, I opened up the card for the question/objective outside the door and it was Laser. I ruled Laser out definitely as a possibility to be on the test. But there it was, with its stupid clinical-evidence staring at me in the face..... I babbled on and on in the cardio station giving the patient  a million ways to avoid raising their heart rate too high I fumbled through sit to stand and for got that raising the plinth not lowering it made it easier for the patient. I was re-directed by the examiner a couple of times "Please, re-read the question." Nobody likes to hear that. So I was pretty anxious while stu-dying in the library for my net exams, waiting for the ominous email that I had failed and would have to come back on Thursday.

But the email came and I passed. So I was able to focus more on studying for the next 4 exams.

3. MSK -
I felt like a King writing this exam.

but after we studied for patho, not to fun.

4. Patho
not going to brag, but I wrote the answer key probably, just saying. It was nice to get a nice gentle lob during exam week.

5. Paed neuro
Thank sweet nectar of the gods that this was multiple choice, otherwise this could have been a trainwreck. This being one of the last exams of the session, I had not focused a lot on it previously and felt pretty nervous going in, but had the feeling that I did enough to pass walking out.

6. Adult Neuro
If your patient is struggling and getting frustrated doing up small buttons on his shirt after a brain injury and doesn't want your help, what do you do?
That was seriously a question, and that is why this was the best exam ever. It was really fair and sooooo practical. Who cares about specifics of pathways and exact location of this centre or that structure? I don't. I don't even care that much about clinical neuro, but this exam was really good at not focusing on the nitty gritty, but looking at practical application of knowledge.

p.s. I made him take a break, put on another shirt and try it later when no so frustrated. I also got a piece of cloth with bigger buttons to practice.


We ended exam week with a trip to the Bimini, where else, where after a looooong semester our very own Dill-Owl-Mouse-Killer Jen-WOO-WOO-Woo bought the Dillweeds a round of burbon. That pretty much sums it up.


Schools out!

I have never been happier to resume exercising and eating vegetables.

Next blog we get serious.

A semester in retrospective

I am so glad I survived that semester. It was a long one.

For those of you who don't know it has been an unusually long semester. We started school back up right after the end of our last placement. In July we had a few weeks of research and a case-based study week.  3 pretty intensive weeks, I don't know what it is about it, but those week long courses always seem to take the mickey out of me. (especially when you have a prof for one of them who tells you that there will be a few of you who will not pass the course on the very first day of class. Nothing like a good old spirit crush during the first lecture, but I digress.



Working hard, or hardly working? A much needed study break.

After our spirits were most definately crushed, we had 2 glorious weeks of freedom, I almost went to Mexico, but instead ended up having a few relaxing days at home,

Then I went on an awesome bike trip with Levana and Karen (two friends from the program). We biked to Ruckle beach the first day and stayed the night. After traversing the island on day 2 we spent the second night at Ganges. We drank far to much wine and ate far too much cheese and our non-cyclist friend Levana vowed to never ride a bike again because "she almost died" at the summit of Salt Spring Islands many hills.

Karen and Chelsea drinking a bottle of wine @ Mistaken Identity Vineyards

 Then wen to Victoria to visit my very pregnant sister for a few days. It was nice to have a little bit of time with her before Levi arrived. We spent a lot of the time setting the final touches to the nursery to get ready for baby and watched a lot of Olympics :) We were enthralled by "Shuttle-gate".


Kristen at nearly 9 months!


After that we spent the August long weekend in the hospital as Kyro (Taura and Spencer's son) decided to keep everyone on their toes by playing peek-a-boo. Luckily though, he decided to stay in a little longer and make sure he was ready to face the world.

August 8th rolled around and it was time to head back to the class room. On the first day back I was hit by a car on my bike on my way to school. Ouch! I ended up not breaking any bones! But scared the living daylights out of my boyfriend and Mom as they both arrived at the ER looking for a bag of bones I think. Note to self: on next ambulance ride give injury details and LOC info to person you call.

The accident made August a bit harder I have since been attending physio 2 times a  week and massage 1 time per week. It ate into my recreation time and my studies.


In mid-August we had 2 new additions to the family. We welcomed Kyro Alexander on August the 21st. Kyro surprised us a a little by how quickly he came. I was on the way to the hospital when I got news from my brother that he had arrived. Taura did great and recovered well after the delivery, Spencer took a little longer to get back to normal.

Kyro 1 day old with Aunty Chelsea

Then 5 days later we welcomed Levi Atticus. Kristen ended up having a C-section after 24hrs of hard labour and a week of labour on and off. She took a little longer to recover, but is doing well now. Both babies are growing so quickly under the care of such loving and attentive parents.




Levi with Aunty Chels on his birthday :)

As August drew to a close it was time to get ready for the next incoming class of Physio students. Brooke (classmate) and myself were the head orientation officers. We organized a welcome potluck, a mid-week scavenger hunt and a BBQ (all in one week) for the incoming students. Needless to say it was a blast as well as being a gong-show. I believe our prof on the Thursday after the scavenger hunt were most of us stayed out long past out bedtimes said he was impressed how many of us showed up for an 8am class given what occurred the night before.




Chelsea and Brooke dressed up as "Social Sheriffs" for the scavanger hunt.


The semester started to get a lot more tough after the Labour day weekend. Electro picked up we learned how to safely apply electrical current and ultrasound and laser. We also had a pathology midterm that layed some serious smack down on the class.

A few weeks into September after I had been away for a bit and Cameron had been away for a bit, Cameron took me on a walk one afternoon. We never go for walks. I thought nothing of it though, just thought he wanted to spend some time together. We walked down to the water and talked for a bit about nothing in particular and then all of a sudden he was down on one knee! I said yes and since that day we have been engaged.


My beautiful ring :)

 
The semester continued to march on as we selected placements and were introduces to Adult Neuro, Peadiatric Neuro and Manual therapy. This semester was super practical and all of the classes added something to my physio tool belt. It was lots of hands on!

Then there was the Dillman. We spent almost every Monday afternoon working on our "research project" and pasting each other's heads on animals to make the time pass more quickly.



 This pretty much sums it up.


Exams came to quickly and as per usual the PT department put all of our exams in a 4 day period. Including our practical exam. 6 exams in 4 days. Studying was my world for 3 weeks. 3 weeks I will never get back.... I would like to take this opportunity to thank all of my friends, family and new fiance for putting up with me during these grumpy days.


Dark days of studying.

Then we started placement a mere 4 days after finishing exams.... more to come on that.