Nicola Chesman, Teenage and Young Adult Physiotherapist at The Christie, shares a day in her life...

Plan around your patients

The start of my working day varies – 10am 3 times a week (as no TYA would attend an appointment or be available on the ward before this), or 8am when the TYA team have their MDTs: a psychosocial MDT on a Wednesday and a clinical MDT on a Friday. I’m lucky enough to be able to walk to work, and enjoy the 20 minutes of fresh air at the start of the day.

Access to physiotherapy at The Christie 

Being the physiotherapist for the TYA service here at The Christie is hugely variable and diverse. The Christie is a Principal Treatment Centre for 16-24 year olds with any form of cancer, from around the North West. Physio involvement is on a “blanket referral” basis – as long as the individual is being treated by The Christie TYA team then physio is available to them.  This means that I am involved with young people who are inpatients, outpatients, undergoing cancer treatment, have completed cancer treatment or are progressing to end of life.  From a physio point of view this means that I use a wide variety of clinical skills, regularly drawing on orthopaedic, neurological, musculoskeletal, respiratory, personal training and rehabilitative knowledge and techniques. No 2 days are ever the same!!

Good handover 

My first job when I arrive at work is to get a handover from the staff on our inpatient ward, so that I can prioritise my caseload.  High priorities for me include young people on the critical care unit, those with respiratory difficulties (such as chest infections or breathlessness), those requiring assessments prior to discharge and those with significantly limited independence and function (such as after a lengthy stay in critical care or with deficits from brain/CNS lesions).  Young people with high level and complex physio needs often require several physios to deliver effective treatments, so I may ask for assistance from the main physio department. I also work closely with the TYA occupational therapist as needed.

TYA gym

Seeing the priority patients is followed by lunch, then a few outpatients.  These sessions are completed in the purpose-built TYA treatment gym, situated above the inpatient ward.  It contains basic exercise equipment as well as equipment for specific physio treatments and rehabilitation.  It is a great space for treating outpatients, and also provides an opportunity to bring inpatients away from the ward for a change of scene and a more “normal” exercise environment.

Outpatients 

My outpatients today include a young person who had an endoprosthetic replacement of her elbow 8 months ago, due to Ewing’s sarcoma. She has ongoing shoulder and elbow dysfunction and the function of her arm remains limited. The session includes a review and adjustment of her home exercises, manual joint techniques, connective tissue mobilisation and movement control training.  Next is a review of a young person with a brain tumour, having daily radiotherapy. I re-assess their balance, lower limb power and gait.  We work on some core stability exercises, dynamic standing balance exercises and gait re-education in the parallel bars.   Both are given follow-up appointments and I encourage them to contact me if they have any difficulties with their home exercises.

Inpatients with low-level physio needs

After a quick note-writing session I am back on the inpatient ward.  This afternoon focusses on inpatients with low-level physio needs, who are independent and self-caring.  My aim is to maximise basic activity levels, to prevent the significant  side effects that can occur when young people become sedentary (chest infections, loss of mobility, restricted exercise tolerance, pressure sores, difficulty regulating blood pressure, constipation, widespread muscle atrophy).  

Multi-disciplinary approach

There is sometimes a belief that “rest is best”, or fear about “doing too much”,  which can lead to a gradual decline in the basic activities of daily living and result in someone spending all their time in bed.  Together with the ward staff, youth support coordinator, occupational therapist and other members of the TYA team we try to promote independence and self-care on the ward, and encourage people to engage in ward-based activities outside of their rooms.  I educate young people and their families on the importance of physical activity during cancer treatment, prescribe basic maintenance exercises, address mobility deficits and give supervised access to the TYA gym.

Liaison with other service

The final part of the day is used for note-writing, catching up on emails and liaising with other physio services involved in my patients’ care (such as community physio, physio outpatients, exercise-on-prescription services, other hospitals).  I share an office with the TYA occupational therapist, lead nurse, community liaison nurses and MDT coordinator and we often have informal case discussions about patients we have seen through the day and anyone else we want to discuss.  I find this really useful for picking up referrals, getting updates about patients and providing peer support.

Author:  Nicola Chesman