When the Jennifer Tory Trauma Recovery Clinic opened at Sunnybrook in April 2021, physiotherapist Carly Orava was one of the first people to join the newly-created team.

“I was excited about the creation of this clinic because we’re able to follow and care for trauma patients for up to a year after they are discharged from the hospital. This model gives us a deeper level of insight into our patients’ recovery process that we didn’t necessarily have before,” she says.

Carly says the patients they see are dealing with a variety of issues after an injury, including physical disability, pain, mental health problems and the effects of brain injuries. The new clinic operates in a dedicated space where patients receive care from a range of health professions including physiotherapy, occupational therapy, social work, physiatry, psychology, clinical psychiatry and pain services.

Before the clinic opened, a trauma patient who had been discharged but still required follow-up with multiple care providers would have needed to visit several different areas of the hospital. Patients who live further away from the hospital may have also had trouble accessing care in their home communities.

“Now, we can identify and address gaps in care pathways to make sure no one is falling through the cracks,” says Carly, who has worked with trauma patients at Sunnybrook since 2013, first as a student in the inpatient trauma unit and then at St. John’s Rehab.

The clinic, which is the first of its kind in Canada, has booked close to 1,900 appointments over the past year. Carly says that while there are ebbs and flows, no two days are the same.

“Some days I may only have a few patients scheduled, but then one of the occupational therapists identifies a patient who may benefit from physiotherapy during one of their appointments, so I will drop in to do an assessment. Or, I could be called to the inpatient trauma unit to evaluate a patient and help put together their discharge plan. You definitely have to start your day with an open mind,” she says.

As the team celebrates the successes of the clinic’s first year, they’re already looking ahead to the future.

“We’re still growing and figuring out how best to meet the needs of all our patients,” says Carly.

However, one thing she knows for sure is that the collaborative environment of the clinic has made for a seamless experience for patients.

“Our patients are happy knowing that somebody still cares about their recovery, even when the acute care phase of their journey is complete, and we are happy to be able to provide that to them,” she says.

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How long have you been a physiotherapist?

Two years. I started working at Sunnybrook in the Schulich Heart Program, helping patients recover functionally after heart surgery. For me, it’s very rewarding working in the hospital setting with patients and their families, seeing them progress. I get to help acutely ill patients get stronger and back to their lives.

How did you become a part of the COVID unit?

I volunteered as staff were being recruited for the unit because I had experience working with cardiac surgery patients in the intensive care unit (ICU) setting. In the ICU, my patients were on ventilators, which are machines that help them breathe. Through active mobility and breathing exercises, patients are able to wean off of the ventilators and return to their previous level of function. I thought my skill set would be a good fit.

Another reason I volunteered is because my partner is a nurse in a Toronto-area emergency department, and she was already on the frontlines screening patients. She never hesitated going to work, so she inspired me to help out where I can. At the time I volunteered, I didn’t really think about all the different ways this would affect my life.

What has the work been like?

At first, I was very anxious about all the different situations that could arise and how I would keep safe. But from day one, I felt very protected as we have access to appropriate personal protective equipment (PPE), safety officers and the updated infection prevention and control protocols. The team here is very collaborative and many volunteered to be here, and are great to work with.

I’ve adjusted to the day-to-day processes, but that said, policies and procedures are always changing. We started out as a COVID-19 ward, then it became a full ICU about four weeks into my placement. Working in an environment with frequent changes in patient populations, policies and procedures has been stressful, but we all try to take it one day at a time.

What does your work entail?

My role focuses on helping patients rehabilitate while preventing respiratory complications. I often help patients recover functionally after they have been intubated. This procedure is hard on the body, as a tube is inserted through the throat down into the windpipe so a ventilator can breathe for them. Even if they haven’t been intubated, prolonged bed rest can weaken muscles. I help patients preserve and build up their functional strength by doing things like helping them sit up, perform bed and breathing exercises and eventually walk again.

These areas of focus apply for COVID-19 patients, but if they are more critically ill, there are different aspects I focus on during treatment. One thing we’ve been doing frequently is “proning” patients, as research has found placing them on their stomachs helps with breathing over time on a ventilator. Even for patients not on a ventilator, if they are able to prone themselves, that appears to help improve their oxygen levels and breathing.

On the COVID-19 unit, we’re also receiving patients from all over the hospital, including those sustaining burns, traumas or strokes. That means we have to be very adaptable with the kind of treatments we are using. Anyone can get COVID-19, so we see all types of patient populations.

How are you doing now?

My overall anxiety has improved, but no matter what, working in this environment means there is a level of background stress that can have numerous effects. A lot of us are just feeling more tired in general. That’s not because we are doing more physical labour, but rather coping with the heightened stress and day-to-day changes that COVID-19 is causing, both inside and outside of the hospital.

At home, my partner and I can really relate to each other’s work settings, so it’s nice to have that deep understanding. COVID-19 news is everywhere, and in the beginning, I was really immersed in it. Now, I try to limit checking the news to just once a day for any big changes. Creating a bit of an escape at home helps me manage my mental health and level of worry.

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The post Inside the COVID-19 unit: Helping patients regain their strength through physiotherapy appeared first on Your Health Matters.

These elbow injuries can occur following an increase in activity or start of a new activity that involves repetitive gripping and use of the wrist. So, if you’ve been inspired to pick up a racket or club, learn more about how to avoid these elbow ailments.

Tennis versus golf

Tennis elbow typically an overuse injury from excessive, quick or repetitive movement of the wrist (especially bending/extending the wrist back or turning the hand). Golfer’s elbow also occurs with wrist movement but in the opposite direction (curling or flexing the wrist). This leads to inflammation from micro trauma of the tendons that attach to the elbow. While named for sport-related injuries, these conditions may result from work-related activities, including gardening.

Symptoms are typically gradual, but can occur suddenly with an acute injury.

What to look for?

• Tenderness over the outside of the elbow (tennis elbow) or the inside of the elbow (golfer’s elbow) that may radiate into the forearm.
• Pain may be: achy, sharp, or stabbing
• Weakness and decreased endurance of wrist movement and gripping. This can lead to difficulty with activities involving carrying, lifting, using keys, opening jars.

What can help?

Try to rest and avoid activities that aggravate the injury. But it’s important to stay active in other ways. Complete rest should be avoided as it may lead to decreases in muscle strength and endurance as well as decreasing blood supply to injured tissues, which can slow healing.

Pain will determine what activities are appropriate: if it hurts don’t do it!

Allow for healing time before resuming any aggravating activities to ensure the muscles and tendons are healthy and able to withstand stress. So, if your last 18 holes upset your elbow, be sure to give it some time before hitting the tee blocks.

Through a gradual return to activities, your muscles will build strength and endurance required for daily activities. A specific stretching and strengthening program for forearm muscles can prepare for return to sport/leisure. Talk to your health-care provider or physiotherapist.

Final Tip:

A proper warm-up before activity will prepare your muscles for use and decrease the risk of future injury.

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Repetitive strain injuries aren’t just from heavy lifting. Something that seems light — like typing or clicking a mouse — can also cause problems if you do it over and over for a long time.

Repetitive strains are injuries to the soft tissues of the body including muscles, tendons, and nerves and are caused by repetitive movements or overuse of the same body parts.

Repetitive strain injuries are cumulative in nature; the load of tasks adds up over time, especially if they are done improperly and without proper rest.

Here are some tips to prevent these types of injuries:

Plan and pace your tasks:

Doing the same motion over and over for a long time will tire and weaken your soft tissues. Weakened muscles and tendons become more prone to injury. So, switch up your tasks and positions regularly — this will allow you to use different muscles (and give the other muscles a break.)

Remember: a change is as good as a rest. If you are at a desk or machine all day and varying tasks is not possible, take regular breaks from prolonged repetitive tasks.

Maintain good neutral postures:

Neutral postures put your muscles and joints at an optimal length and position. These positions need the least effort on your muscles and they place the least amount of stress on your joints and surrounding structures. This means your muscles won’t get tired quite as fast.

What is good posture? Try it now: Stand or sit tall by pulling your chin in, drawing shoulders back, and maintaining the lumbar (low back) curvature by drawing your tummy in. For your arms, keep your shoulders relaxed and avoid shoulder hiking. Keep arms relaxed by your sides with elbows at right angles and wrists straight. This neutral arm posture is ideal when performing keyboard activities at the computer.

Of course, some tasks may require you to come out of neutral posture, but keep trying to return to neutral when you can.

To keep neutral posture and reduce reaching, place frequently accessed objects within reach and always get as close to your work as possible.

Physiotherapy and exercise

Throughout the day, pause what you are doing at work and do some stretches on muscles that are constantly at work.

You also may find it helpful to see a physiotherapist for advice on posture, proper body mechanics, and treatment if you have a repetitive strain injury.

Thanks for reading – now take a break, stand up and stretch!

The post How to prevent repetitive strain injuries appeared first on Your Health Matters.

Facial exercises in front of a mirror can help patients with Bell palsy who suffer from persistent weakness.

Exercise physiotherapy is recommended for Bell palsy patients with persistent weakness, according to clinical practice guidelines published in the September 2014 Canadian Medical Association Journal.  A multidisciplinary panel that included Dr. Joseph Chen from Sunnybrook Department of Otolaryngology and myself developed the guidelines.

Bell palsy is a weakness or paralysis of the facial muscles, thought to be due a virus affecting the facial nerve. Most patients will have complete recovery, usually within 3 to 6 months. But about 20 per cent of patients will have persistent weakness. These people report problems with eating, drinking and speaking, as well as with facial expressions such as smiling. The psychological effects are significant.

At the time of onset, patients should seek medical attention to ensure appropriate diagnosis and medical management (like medication and proper eye care). Facial exercises are inappropriate at first, as the facial nerve needs time to heal. Forceful facial movements have little effect other than to exercise the uninvolved side. Later, they may be harmful as they can reinforce improper movement.

If there is persistent facial weakness after 3 to 6 months, an appointment with a facial physiotherapist may be helpful. The physiotherapist evaluates the patient’s recovery and works with the patient to develop an individualized treatment plan. Treatment may include facial muscle relaxation techniques, as well as retraining exercises in front of a mirror. Even patients with longstanding facial weakness may benefit from treatment.

You can read the full guidelines here.

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They also told us that 85% of the population will experience low back pain at sometime in their life (including me on occasion!)

For most people, it too shall pass. And, it doesn’t always mean the start of a lifetime of pain.

About 95% of low back pain is non-specific, meaning it is of an unknown cause, isn’t part of something serious, is isolated to the low back and doesn’t spread down the limbs.

If you experience low back pain, there are some ways you can manage it so that you can continue to live your life to its fullest. Thanks to Suzanne Denis, physiotherapist at Sunnybrook, for these tips!

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1. Bed rest is NO good. Pace yourself and stay as active as you are comfortable. Do exercises or activities that do not worsen your back pain and take breaks.  You may find certain activities actually help relieve your back pain.  Some people get relief with the trunk in a forward bend position others find it less uncomfortable to be upright.  Everyone is a bit different, and so not one exercise or activity is best for all.

2. Start low and go slow. When doing an activity you are not sure of, try 5 minutes & see what happens.  If you are not in more pain afterwards, gradually increase the time.

3.  Apply ice and/or heat. Typically, if you have suffered a trauma to the back (for example a fall), you should apply ice during the first 48 hours (For example for 10 to 15 minutes as needed.) Some low back pain sufferers find that applying a heating pad to the area provides more relief. Do not sleep with heat or ice applied.

4. Speak to your pharmacist about anti-inflammatory or other pain medications that you could use.

5. Track it. If your low back pain has not improved over a 2-week period, visit your family doctor or health care provider.

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Hello students, residents, interns, fellows! Welcome to Sunnybrook (including the Holland Centre and St. John’s Rehab) and welcome to the online community for students who find themselves here. We hope this blog will connect you with other students, offer you some tips for navigating the labyrinth that is Sunnybrook, link you with useful resources and give you a few laughs along the way.

This site is a work-in-progress, so bear with us while we launch our new look soon! In the meantime, some useful Sunnybrook links for you!

Facebook
YouTube
Twitter

A friendly reminder, be careful with your online self: don’t disclose personal health info online, and use good judgement! Any questions about our social media policy, get in touch!

Let us know if there’s anything you need, information you’d like to see on here or if you’d like to be a blogger for us to give your perspective on resident, fellow, intern or student life at Sunnybrook!

-Admin.

The post Welcome to Sunnybrook! appeared first on Your Health Matters.

Physiotherapy flash mob in C-wing.

If you’re a fan of 80’s music, you’ll remember Reel 2 Real’s smash, I Like To Move It. It’s the perfect soundtrack for a flash mob group whose philosophy boasts “Physiotherapy: It Will Move You.” It did. Some observers tapped along, while others tweeted or took pictures. Everyone noticed. In a world where there is literally a national “day” or “month” for everything, that’s exactly the point.

“We want people to see that we really live and breath what we’re trying to get people to do,” one physiotherapist told me between location changes. “Part of our job is to promote health, so we hope they take that away.” So however you like to move it, happy National Physiotherapy Month!

For more information, contact the Canadian Physiotherapy Association.

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