10/9/2017

Monday the 9th was the first day of my internship. I completed a total of five hours that day. In

the beginning, i was just meeting the Exercise Physiologist and was told the rules to the

internship. I followed three different exercise physiologist throughout the day. The first exercise

physiologist was working with middle age women, I observed them throughout their exercise

program, and I asked general questions. The second exercise physiologist I watched her work on

older women who had two knee replacements and a mid-age man who broke his foot. It was

fascinating watching, and I learned that you need to adapt to your exercise plan after you meet

the patient. The older women were completing workouts that an early thirty-year-old would have

done. The last exercise physiologist I observed was working with a twenty-year-old weightlifter.

It was nice to watch all the different age groups and various injuries and exercises. The one thing

I would change is to ask more questions, I was nervous, and didn't want to interrupt the exercise

physiologist.
 10/ 13/2017

Today internship was mostly focused on ankle and foot injuries. Also, I saw a regular

fitness patient which I haven’t observed yet at the facility. The fitness patient was going through

his exercises with the improper forms which can lead to injuries down the road. After the patient

left the exercise physiologist told me that he never listens to us on his form. From this, we do not

even bother fixing it, although I feel that leaving him to do the workout with improper technique

will do more harm than good. The next set of patients were different types of foot and ankles

injuries. They had them focusing on strengthening and range of motion. This facility is really

into the slide board and told me that for all their lower extremity patients they have them try the

slide board for an exercise. Also, with any foot or ankle injuries, they have them work on the

arches. The one question I asked was if the patient already had high arches would this do

anything for them? They said that it might not, but we still want them to complete this, so their

strength is still there. I feel good about my internship that day, I asked more questions and left

knowing more knowledge.

 10/16/2017

During my internship, I was with exercise patients. These are the clients who use to be here for

injuries but stayed after for the exercise program. For these clients, you need to need still to think

about previous injuries to make their fitness plans. You want to keep strengthening the part of the

body that was previously injured and also work on new muscles and show different exercises.

With these clients, the exercise physiologist was more relaxed and was having conversations

with the client throughout the workout. It was nice to see a different atmosphere of what the

exercise physiologist do.

 10/23/2017

Today I was observing a client with an ACL repair. She had the repair done about 2-3 months

ago and was focusing on squats. I was told with any knee injury you want your primary focus to

be on balance and knee flexion. The second client was an exercise client who I had before. It was

interesting to see her progression because we increased her weights and resistance in her

workout. This is because you need overload to make changes. The last client was a weight lifter.

She had knee surgery and wanted to keep increasing her wait and push her recovery. The

exercise physiologist let her, but I thought he would have kept her on the same weight. He told

me after that I let her do 2 with a higher weight because if she didn’t do it here, she would have

done it at the gym. This way we can watch her form to make sure we won't cause more damage.
 10/24/2017

Today was my first day of observations at the outpatient physical therapy office. At first, it was

very slow but then became busier. I saw a foot, knee, shoulder, and back injury. The one thing

that stuck with me is when the physical therapist said he thinks the most important thing is

strength, Yes you want range of motion, but without strength, you will not heal the injury. Also,

while he was talking to a patient, he said that pain is 50% the injury and 50% psychological. I

thought this was really interesting and want to look up more information on this topic. The last

thing that was strange was that they had their patient only do one sometime two sets. In class, we

learn the normal is three sets, but it will change as seen in the observation.
 10/26/2017

Today I saw some of the same patients as last time I was at the physical therapy office. This one

male had a shoulder injury that happens more than once. So my big question was because there

was tissue damage is it the same tissue that was injured before or different. I was told it really

depended but because he injured it the same way it was probably the sam tissue. I also was

allowed to sit into two new patient evaluations. It was really interesting, the patient had the same

low back pain, but treatment plans had to be different. The first client did not believe in

stretching and said he will not do any of it and didn’t know if he believed in physical therapy.

The physical therapist had to take the treatment differently by adding stretching he did not realize

he was doing. The next patient was excited to start and willing to try anything. This just shows

that every patient is different.

 10/27/2017

When I first came into the exercise physiologist office, I received a case study. The case was on a

lower extremity patient with patellofemoral pain syndrome. I was instructed to follow exercise

physiologist who had similar patients so I can make an exercise plan for my mock client. This

was very interesting because I got to think differently. I am still working on the case study but

was able to ask staff some advice. When someone has a knee injury start them on a bike so it will

not cause more damage. Also, make sure the patients are doing the exercise correctly with the

right postures. This office is very fond of this so they gave me some verbal cues for when I have

patients. I watch a patient who had big toe injury and thought that it was interesting how only

two exercises focused on the big toe. The other exercises focused more on hip and posture. This

way that if something is causing the big toe pain, it will be fixed. This weekend I plan to finish

the case study for the office.

 10/30/2017

Today at my internship I focused more on the fitness prescription of the patient. I handed

in my case study that I had to make a fitness plan for. The most significant comment I received

was adding more dynamic stretches, and to think of the order these exercise should be performed

in. After receiving these comments, I watch and took notes on the order of the plans for the

patients. The order or most of the programs were a cardiovascular warm-up, strength, resistant,

balance, and lastly flexibility. This order is something to think about when I need to make a

fitness plan for my clients. At the end of the internship, we discuss that I will receive another

case study in two weeks on the upper extremity.

 10/31/2017

Today was a slower day because it was Halloween. There were not many clients that scheduled

appointments because of the holiday. One of the clients who came in just came to get aligned. It

was interesting to watch a physical therapist aligned a person's leg. Alignment changes when the

hip posterior rotate on one side and anterior rotate on the other side. The physical therapist and

using the muscles to help the pelvic. I also was able to watch a discharge today as well. The one

big things with discharges are making sure the client can handle their injury and exercises when

they leave. The one thing you want is the client to be in no pain and can handle at home work.
 11/2/2017

Today a client came in with vertigo. I have never seen this before in a physical therapy setting.

Vertigo is a sensation of feeling off balance. These dizzy spells make someone feel like they are

spinning or that the world around them is spinning. This is mostly caused by an inner ear

problem. When someone comes in with this, you want to work on their balance and helping with

the technique of turning their head. This will not be comfortable for the client in the session. The

most important thing is to make sure there is no sign of cranial nerve damage if there is any sign

send them straight to the doctor. Another thing I learned was that is you do not treat a muscle tear

right away; scar tissue will form causing a higher risk of injury.
 11/3/2017

Today we talked about the next case study I will receive because it is coming to an end of my

internship. This case study will focus on the upper extremity and posture. Because of this, I

followed clients who have upper extremity problems or posture issues. The main thing ever

client program had in common was upper extremity range of motion exercises and strengthens

exercises. The pectoral fly and saunders total backboard were used a lot. With these, you want to

make sure the client posture is right while doing the exercises. This day helped me a lot to think

of ideas for the case study. One exercise I liked a lot was the wall stars; this is where the client

has a band around their hands making a star and going back to the center.
 11/6/2017

Today was a busy day at Zarret Rehab, because of this the exercise physiologists had two clients

and did not have that much time to answers questions. At this point of the internships, the clients

are the same, so I get to observe their progression. There is one client I saw last week which is

relatively new. He has an ankle injury and last week was only able to do range of motion

activities because of the pain he was in. Today he was ankle to more strength activities and

worked on his hips as well. When someone comes in with a lower extremity injury, you need to

make sure you are treating the whole lower extremity. This is because the ankle can affect the

knee that affects the knee that affects the posture.

 11/7/2017

Today a client came in with back pain. She had an internal stimulator put into her back. She was

using this with heat so much it caused burns and welts on her back. The client is also getting a

new stimulator put in, and her doctor told her to go to physical therapy while she waits. It was

fascinating to see this case and was able to ask questions to the physical therapist. The therapist

told me that they put the stimulator in when there are no more options to heal the back. The

stimulator is used as a pain management tool, but it needs to be used correctly. I also was able to

sit in on an evaluation and learned the major thing to do during it. You need to get the client

family and social history, look at the posture, gait, balance, and watch the client bend. Once this

is evaluated you want to test the client strength and flexibility, and see what they are expecting

out of physical therapy. This way you can make the best plan of treatment you can. Lastly, we

discussed the treating other therapist clients. You do not want to change the plan or the exercises

this is because you do not have the trust with the client. You can, however, increase reps or

weight in an exercise.
 11/09/2017

Today I saw many of the same clients again. I believe it was a good day I had many questions

and was involved. One client was being discharged today he had surgery on his ankles and was

not 100 % yet. The therapist explained to me that this client had been here for three months

already and you really do not want to keep a client longer. He was certain that he would keep up

with the exercises and improve. I really do not understand why insurances only let client attend

physical therapy till the insurance company guidelines of better is met. I beielvep that patients

should be able to go to physical therapy till the client goals are met. The last patient I saw was at

physical therapy for only her second time. She improved a lot and it seemed that she was

responding great to the exercises. This shows that not every patient will be at physical therapy

the max amount of times. She should be here for a month tops and then be on her way. Lastly, I

saw a patient who had patella pain the therapist completed special test and saw nothing else

wrong. The pain and inflammation has not decreased yet and the client been and physical therapy

for over a month now. The therapist was explaining that we are at the point of sending them back

to the doctor to re evaluate them. You do not want to keep a client in physical therapy if there is

not any sign of improvement. Overall I learned many things today and made of list of facts to

look up that I found out at my internship.

 11/10/2017

Today I received my case study for the end of my internship. It is based on upper extremity

(impingement syndrome) and posture. So I based my observing on that but there was not many

upper extremity patients today. The one I saw today had a rotator cuff injury. I learned that it

does not matter what cardiovascular warm you put them on if they are just starting out, but if

they can handle it you can put the client right on the rower. The facility does not use the arm bike

that often so I am not aware when to use that. But a couple exercises they are into are cross pulls,

the rope, and Y,T,V on the total back table. This gave me many ideas on the exercise program I

am going to make for my case study. Later I saw many knee injuries and got to see their exercise

program. The one big thing that almost every client had issues with is the knee going over the

foot in squats. You want to make sure the client do not do this because future injuries can

happen. Also, many knee injuries could be from the quads being tight and the hamstrings being

too weak. You want to find the perfect balance between he two. If a client is experiencing a lot of

knee pain you can have the client try reverse lunges this way they will not damage their knees.
 11/13/2017

Today I just observed exercise plans with the clients so I can get an idea for my case study. The

orders of the programs are normally the same. You start with a cardiovascular warm-up, then

resistance and strength, the core stability and balance, and lastly flexibility and mobility.

Sometimes this does change depending on what is available at the time. You also want to include

many dynamic exercises throughout the program. The big thing Zarret rehab wants to make sure

of is making sure the exercise is performed correctly. One correction that was made many times

is when the client complete back extension, make sure their hands are by their ears and their

elbows are out. Also, if the client has low back problems make sure their pelvic posteriorly tilts.

This will relieve the pain during exercises.The one thing I need to work on though is making

quick decisions when making up exercises for clients. I had exercise physiologist ask me what

would have them next, and I had trouble think quick on my feet. I needed a few minutes to think

it all out. From this, I learned that I need to practice making up exercises and knowing exactly

what muscles are used and how. Beside this the internship today went amazing. I was able to

communicate with the exercise physiologist and clients and also was able to ask questions.
 11/14/2017

Today I saw many spine patients at the physical therapy office. There were cervical and lumbar

post-surgery patients. The big take away from this day was that if there is any nerve damage you

need to treat it right away. This is because it will cause muscle damage to the muscles that the

nerve supplies too. Many clients who have nerve damage will have a lot of weakness and then

you have to rebuild it back up. Also, right after surgery encourage your client to move around,

this will cause better chances of healing. I also saw a retraction tool used with a cervical neck

client. This stretch the neck by pulling up and forward. You leave the client like this for five

minutes then have them do their stretches. This is not a long-term tool just to start the healing

process. Also, every client have different needs for exercise. One exercise might not work for a

client even though it is the same injury as someone else. You just need to test the exercise and

see what works for the client. Also, it was interesting to see how each therapist in the office have

different techniques for treatment. One like hands-on stretching while the other uses these metal

plates. Each do the same thing but it really depends on the preferences of the therapist.
 11/16/2017

Today I was at the physical therapy office I was able to observe many patients I saw before. I

was able to sit in on a re-eval and thought it was interesting how when he tested the grip strength

he had the client sit down. When we went over testing in class, we were told that when

completing grip strength you should have the client stand up with their arm at a 90-degree angle.

When I brought it up, he told me that you are supposed to have the client sit down because they

have a more significant base of support. Also, we talked about client motivation. When a client is

willing to work on their exercises at home, they will have a higher recovery rate. Although, we

do not want the client to overdo it and cause more injury. When a client does not want to work at

home, they will reach a plateau and will have been discharged. Lastly, we went over stretching

before physical therapy. This facility completes re-evals after the physical therapy session, and

the physical therapist brought up how stretching, in the beginning, will increase the client range

of motion. We also went over the worse types of shoulder injuries that cause the most effects. A

total shoulder replacement is the worst because this is done when there is no other treatment

available, though the worst injury not treated is a rotary cuff injury.
 11/20/2017

Today we went over my last case study, which was a posturer parent. From being at the

internship for a month, I was able to use skills I have learned to put together a fitness plan. This

plan included the TRX machine, ropes, and more weights. The most significant feedback I

received was to add more dynamic exercises to the program. This means I need to work on

keeping the muscles moving throughout the exercises. This internship made me more aware of

isolating a particular muscle for a fitness plan. Also, you need to keep an adequate amount of

time for the muscle to cool down, so you are not overworking the muscle and causing injuries. I

also thought it was interesting for a lower extremity patient you need to be careful about what

cardiovascular warmup you give them. Though, with a posture and upper extremity patient, you

can use any cardiovascular warmup. Normally people forget that even though the client is an

upper extremity patient, they still need a warm up, so you do not cause injury to the muscles. In

the end, I enjoyed this internship because I was able to see the difference between physical

therapy and an exercise program for patients. Also, because many different people are working, I

was able to see various techniques through out my time there.

 11/21/2017

Today was my last day at Wallace and Nolan Physical Therapy. I saw many of the same clients as

before. We reviewed the risk factors of over stretching. If the joint is pushed past its normal

range of motion, there is a risk of damaging the surrounding tissues and ligaments. This is a

higher risk of adolescents because their bones are not fully developed so that they can receive

stress factors. Next, we went over the Graston technique with adolescents. This office does not

believe using Graston with children because their bones are still growing. Although, when I went

home to do more research on this topic there is nothing that states a physical therapist should not

perform this technique with children. Every client is different, and you need to try various

treatments to see what works for that client and what does not work. Lastly, we talked about heel

lifts in children shoes. There was one client who could benefit from heel lifts their shoes,

although this client is young and have a lot of growing left to complete. If they put heel lifts in

their shoes, her growth pattern could be messed up, or her hips can be displaced from growing.

After researching I did not find any evidence that state children should not wear heel lifts. If they

decided to wear them, they should see a doctor make sure they are necessary and get the lifts

molded.