Reflecting on learnings from Week 2 of the Understanding Basic Rehabilitation Techniques MOOC

As Physiopedia MOOC Manager I have really enjoyed both the discussions that have been happening in the Rehabilitation Community this week, and exploring the different ideas around managing specific cases within a range of different settings. It has been interesting looking at some of the different approaches that are taken across the globe, and it highlights the different resources available both in terms of time, equipment and support.

I have focussed on completing the Range of Motion (ROM), Muscle Length and Strength Courses this week, which together really are key in nearly every assessment I do with patients in some form or other. Going back to basics with each of these has been eye opening in many ways, it has highlighted some situations where I have modified techniques more than I should have, and possibly impacting on my interpretations.

In particular, I have relooked at how I assess ROM and muscle length and the importance of end feel and documenting what it is. Whilst I tend to consider the end feel as I assess, on reflection over the last week and looking at my documentation I realise I often forget to document what end feel is present in my assessments. In exploring the discussions involving end feel there were varied responses to the types of end feel that might be present, and for some a bit more doubt in what might be expected. For example, in the home based case study with Sarah, a 52 year old woman who has just been discharged home after removal of an external fixation device for the tibia and fibula, there were some differences in what type of end feel would be expected, which is not surprising in many ways as different end feels may be present dependant on pain, muscle shortening etc. 

“As the soft tissues around the joint may have shortened through lack of full ROM in normal mobility (muscle/tendons/ligaments) a firm end feel sooner in ROM than expected could be present but I’m not really sure!

This highlights considerations related to tissue shortening after a period of immobilisation, while in the following it highlights what other possibilities might be there as a result of pain or swelling or other factors.

“If ankle or knee ROM was limited by hardware resulting in tissue shortening I would expect firm end feels. Otherwise they could be normal (if achieved full ROM over the past 5 mths) or abnormal due to pain and/or swelling post surgery or the previous tissue shortening.”

I realise in my own practice that at times I have not been considering the end feel enough, and exploring why I am feeling what I am feeling and monitoring changes in this with rehab.

It has been great reading some of the testimonials we have had from participants who have taken the course so far.

Basic? Yes, looks basic; only because it simplifies the complex issue of rehabilitation. Great job” (PT from Nigeria). 

Fundamentals of choosing rehabilitation interventions have been depicted and beautifully woven together. ”  (PT from India) 

This first course was a marvellous conceptual overview of the necessary elements of rehabilitation, frameworks and the importance of outcome measures for practice. It succinctly and expressly impressed upon me core factors in a memorable manner that I know I will remember.” (from the UK). 

Its also been great to see participants share their experience of the course on social media. Its a great way to promote your own CPD and encourage others to participate and refresh their own knowledge of basic rehabilitation techniques that underpin all that we do.

The content is great and the case scenarios excellent for testing the application of learning in a variety of settings.”

Finally my highlight this week was the amazing live webinar which explored some more complex Lower Limb Case Studies with Stacy Schiurring, PT, DPT and Matt Huey, MPT, Dip MDT, FAAOMPT. It was great to hear about their clinical reasoning behind their choice of assessment and intervention techniques. For me practical case studies were the element that has really helped me to put the theory into a practical and clinical situation.

So thanks to everyone participating in the MOOC this year, I am loving the discussions and look forward to some more great discussions next week. Come join us in the Rehabilitation Community to discuss case studies and share your knowledge, and learn from others. And if you haven’t signed up yet then it isn’t too late to join us, the courses will remain free for the rest of September.