Internship Journal

Day 1 (3/27)
9:30 AM: Laura Perry showed me around the clinic. Impact has a nice waiting room, and a nice
gym. There are several warm up machines along with plyometric equipment as well. There are
3 evaluation rooms which are all themed as different local teams. One is Hillsboro Hops, One is
The University of Oregon, and the other os Oregon State University themed. They seem to be
very community oriented, as they have all of the local high schools painted up on their wall.

10:00 AM: Our first patient was a lady in her late 60s who had fallen and broken her upper
humerus 3 months prior. She did not have surgery because of her existing condition of blood
clots in her legs. Laura Perry, PT, gave her exercises to mobilize her shoulder, she also stretched
her out in an eval room.

12:00 PM: there was a man who came in that had been in a head on collision, he was the driver.
His patella was broken into 6-8 pieces and his calcaneus was shatters into 30+ pieces. The patella
was wired together, but the calcaneus was left to conglomerate. He came in using a walker, but
after his session with Nancy, he was walking slowly on his own.It seemed that not only can PTs
heal people physically, but mentally and emotionally as well.

Throughout the day there were 4 Total Knee Replacements (TKR). When I asked why there were
so many, the PTs guessed that because of the snow storm, many people were hurt or had fallen,
but they really didn't know. Sometimes injuries come in waves. Shoulder injuries in the
summer, hip tightness in the fall, and now TKRs.

One aspect of the job I did not realize was that you are standing all day long. It is also important
to wear comfortable clothes, as you will be performing some of the exercises with the patients.

Brian Mulligan: Mobilization with Movement: Moving muscle and joint at the same time is
better than just movement on its own. ( https://www.youtube.com/watch?v=1_5EKqJNimc )
4:00 PM: On of the last patients had ankle instability and played volleyball. She warmed up on
the bike, then went right into passing and hitting the volleyball. It is important to incorporate the
activity they are trying to get back into as much as possible because that is the whole point of
physical therapy.

Day 2 (3/28)
8:00 AM: I got to the clinic and everyone was documenting and getting ready for their patients.
Ive noticed it's about 65% working with patients and 35% documenting on the computer.

8:30 AM: Patient who broke left tibia and fibula skiing, 5 weeks post injury and surgery, just
started walking without crutch, warmed up on bike, then worked on strengthening the rest of the
body because he had spent 2 weeks doing nothing.

8:45 AM: Patient dislocated patella 2 weeks ago, does colourguard, KT tape, leg press, assisted
flamingo, then on foam, hip bridge with yoga ball, single leg lifts x4 (stomach, side, back, side)

9:45 AM: Patient with broken elbow and bimalleolar ankle breaks from falling while walking
dog in snowstorm. Started with bike, then graston to break up scar tissue near incision. Measures
degree of flexibility before and after session, improved by 1.

10:00 AM: Plantar Fascia (thick tissue) runs from calcaneus and splits and runs along the toe
bones. Waxing and waning levels of pain with Plantar fasciitis. Stretching: gastrocnemius and
sartorius. Idiopathic injury. Eccentric= contracting (strengthening) while stretching/lengthening.

11:00 AM: Patient fell off wall at warrior dash and hurt shoulder. For no apparent reason it got
VERY tight. She has been seeing Laura Perry since november, but just got past 90 today.
ROM= not very good, but is improving.

12:00 PM: As you age, balance deteriorates.You have to practice.

2:00 PM:Older woman with Multiple Sclerosis has trouble with Left side up to her hip. Nancy is
helping her with balance as well as walking without dragging her foot. She used resistance coil
to control and strengthen her leg while lying on table. She keeps telling Nancy and I that her
mind is telling her leg to do things but it won't listen to her. Her brain gets more fatigued than
her leg muscles during PT. She is a very positive lady and is super sweet.

3:15 PM: Man has surgery on left shoulder that popped out too much. He has to mobilize and
stretch it without undoing what surgeon has done. He lays on the ground and moves shoulders up
and down. This gets rid of gravity. PTs spend a lot of time trying to defeat Gravity. Gravity = a
PTs nemesis.

4:00 PM:Couple came in, husband hsd parkinsons and has had Deep Brain Stimulation. He
spent his session doing activities like hitting a tennis ball and doing big steps (modified lunges)
with a stick, like he was rowing. Whif spent her session getting her heart rate up because she was
overweight. Husband also used the punching bag. He is surprisingly coordinated for having
parkinson's. Now, 4:10, he is kicking, like actually kicking, the punching bag. He is at least 70,
maybe 80 years old!

4:30 PM: Football family came into clinic for a training session. Dynamic warm up, Y Balance
Test Mountain Climbers, Yoga ball abs, med ball tosses.

Day 3 (3/29)
9:30 AM:Slow in clinic right now. Sophie is studying for boards, Nancy is going over Medicare
online, There is one patient getting ultrasound for Plantar Fasciitis. Lots of talk about final 4
(NCAA Basketball).
10:00 AM: Young lady with shoulder stiffness, had pain lifting arm, after Laura used
Mobilization with Movement, she had no pain and a greater ROM.

10:30 AM: 2 TKRs (one young, one old) came in at the same time and performed same treatment
regimen. Great conversations and great results as well.

1:00 PM: Stroke patient (older man) with little function on left side. Played cornhold for balance
and strenght. He enjoys playing cornhole in his spare time so the PTs incorporated that into his
session.

3:10 PM: Teen girl came in with knee and quad pain. Taped patella over so it would stay in
correct place. (McConnell Taping)

3:30 PM: All patients I saw on Monday. NOthing really new.

4:00 PM: Alise (aide at Impact) got Ultrasound therapy.