Study Group & Revision - Spring Term
Week Two (14.01.2013)
Myself, Wes Tubb and Lucy Osborne-Kirby have been asked to lead a tutorial on clinical neurological testing, so we got together today to discuss several tests and what they mean. Firstly we went through upper and lower extremity power testing, discussing what levels and what order to do them in. We then went through dermatomes to be able to carry out light touch and crude touch testing. We then discussed straight leg raise testing, which is mainly for nerve root irritation provocation but can also suggest a space occupying lesion such as a herniated disc if there is a positive cross leg straight leg raise. We also discussed traction tests and Kernigs test, which involves stretching the spinal cord through Csp flexion to test for meningeal irritation, nerve root involvement or irritation of the dural coverings of the nerve root.
Week three (28.01.2013)
Today we decided to bring some case histories that we had taken in clinic and test each other on differential hypothesis basing on pain patterns and other symptoms. It was a really good way of allowing you, as the case history taker, to broaden your thinking, be reflective and to explain justification for my reasoning and diagnosis.
Technique practice 31.01.2013
A second year student at the BSO asked me to help her with techniques to build up her confidence, experience and palpation skills so we swapped roles of being patient and practitioner to demonstrate and gain feedback from one another. I was really pleased and honoured that she had asked me as she felt I was a skilled practitioner in clinic! I helped with cervical spine scanning, examination and articulation in a supine and seated position. We also went through prone thoracic spine short lever examination and articulation, which can be tricky with patients who have an increased thoracic kyphosis. The practical session helped me as well as the second year student as it made me realise how far I had come from being in her position and how comfortable I have become in trusting my palpatory skills!
Technique practice focusing on HVTs
I believe that I have quite a good success rate of most HVTs however there are some that I have failed to ever get the technique, angle and successful cavitation with. These particular techniques include the lumbar role, sacro-iliac joint anteriorly, and C/T lift offs. I did a practice group with Patricia Wojkowski and Lewis Clarke, two completely different morphologies, and we verbalised what we were doing and what direction the thrust would be delivered in. When practicing the C/T lift off on Patricia, I overdid the levers on the first attempt and went past the segment. Patricia then guided me through making my levers minimal and then delivering the thrust by retracting my shoulders and contracting my rhomboids and the segment cavitated!! My first successful C/T thrust! Phew!