Another lesson learned

Hello Everyone,

This week I learned probably my most important lesson of all. I did my first assessment of a lady who’s showed up to the outpatient client. During the assessment she said she was referred to physiotherapy because she has been experiencing bilateral paraesthesia and numbness in her arms. She has had 7 episodes over the past 6 years. These episodes mostly occur at night and some during the day. When I initially questioned her about the episodes she was very vague and did not really know the details to any of the questions I asked. She kept repeating how her last episode was 6 months ago. So from that point on of the subjective I moved onto the other parts of the body chart and questioned her about other areas of pain. She reported she did have stiff neck and I knew she had x-rays taken with evidence of degeneration at C5C6. Therefore I started to go into the necessary detail into the neck stiffness/ pain. She was a lot more aware of this and was able to describe it in a lot more detail then the bilateral numbness and paraesthesia. But I also think I am more skilled at questioning issue of pain/ stiffness then other problems. When I went and discussed my subjective findings with my supervisor he asked me what her main complaint/ concern was. I said "the numbness and paraesthesia" he said "yes and what do you have the most information on"? He was right I had transformed the subjective assessment into dealing with her neck pain because is was a more concrete problem that she was able to confidently and directly answer questions about as appose to the vagueness which she used with the neural symptoms. It reinforced that based on the questions we ask we are in control of the direction of the subjective exam. But the subjective exam is so important and inorder to have an effective assessment it should be centered around the patients primary complaint. You have to be careful not to enter with any presumption ( ie X-ray results) so that you don’t narrow your focus to early in the examination. I returned and with more firm questioning and investigation I was able to get more detail on the primary complaint of bilateral numbness and paraesthesia. It was a really important lesson to learn in a clinical situation one that I will remember for a long time to come.


Good luck with PCR studying!

PS- Yes I know its a red flag and I referred her on for further neurological investigation.