The Art of Physical Therapy

Some days are more challenging than others on the ship. As I alluded to earlier, the type of patients that the Rehab team sees are orthopedics (tibial, femoral, and midfoot osteotomies and a few tendon transfers) and plastics (burn contracture releases with skin grafts). I have not had any previous experience with this type of therapy even in a developed country. At this time in the field service we have a few orthropedic patient still, but mostly plastics.

In many ways, I feel like I am on a clinical (working in the field while still in school). When you are in the midst of it, it is hard to remember that you have learned and progressed. Not only are these types of patients new, but treating with Mercy Ships, PTs are able to peform tasks that specialists do in other counties (Orthotists, Prosthetists, burn care specialists). For example, fitting pressure garments, casting, splinting, making and changing orthotics, even one prosthesis was made. More on that later.  In order to make these, skill and ingenuity are required. The following effect the way the splint or orthotic will be made: the shape of the body part, which nerves and muscles are working, where the wounds are, and how long they have been healed, the splint or orthotic will be made.

In physical therapy school, we are taught that physical therapy is a mix of science and art. The evidence of this is played out well here. For example, a 10 year old boy who had burn contracture of his ankle released months ago was still having pain in his foot. The was his foot was positioned, he could not get is his toe or the inside of his foot on the ground making it difficult to walk correctly. Placing a 1/4 of corkboard under the outside border of his foot after performing some joint mobilizations aligned his foot completely on the ground. Usually, I am recommending orthotics for arch support (the other side of the foot).  After cutting it out and covering it with mullskin, I placed it in his shoe that was two sized too big. He was able to walk without pain.

My coworkers who are more experienced with splinting will make a splint out of different materials considering the strength needed to maintain the stretched position and the size of the splint. The complicating factor is that often we are working around wounds that are still healing or the position of the elbow or ankle is not ideal for typical splinting. The splints can often be remolded as the patients joint movement improves with stretching. Sometimes a prefabricated splints for ankle can be used and adapted to the patients individual needs. Extra padding, velcro and extra straps and a sewing machine makes it good as new.

Pressure garments are another important component of the healing process of skin grafts used in the release of burn contractures. In more developed countries, a patient is measured and a pressure garment is individually made for that specific patient. Similar to the prefabricated ankle splints, we have prefabricated pressure garments in various sizes for different body parts (chest, face, arms, hands, legs, ankles). As we all know from trying to buy clothes that fit, no one fits perfectly into a size. As mentioned above, the skin graft may be in a location that is difficult to apply pressure. Pressure garments are taken in in appropriate spots to make it fit on the skin perfectly. Sometimes additional straps are used or pieces from a different pressure garment are sewn together.

It is truly amazing how a "scrap" from one splint, strap, or pressure garment will be used in another. God provides. It is a good reminder he cares about the details. Also, sewing skills is on the list of things to learn in the next three months.