Page 170 - RAPTC 23/24

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PRIMARY CARE REHABILITATION FACILITY (PCRF) LYNEHAM
Sgt (SI) R Gardiner RAPTC
PCRF Lyneham have been lucky enough to have a piece of equipment called the Lafayette hand-held
dynamometer (HHD). I am going to introduce you to this equipment and how the department have benefited from its use.
The HHD is a muscle testing device, PCRF Lyneham been increasing department awareness and most importantly creating standardisation and assessment protocols for the HHD. Using the handheld dynamometer allows the department to gather more accurate objective measures compared to manual muscle testing, giving us an instant reading into where the patient has areas of weakness.
We have been focusing our HHD training on injuries concerning the back, hip, and knee:
For the knee joint we have practiced testing the knee through flexion and extension which allows us to gain a peak force reading for the hamstrings and quadriceps.
For the hip joint we have looked at abduction, adduction, flexion and extension which gives us an insight to where there could be a strength deficit.
After gaining a peak force reading, we use it to establish a Limb Symmetry Index (LSI) ratio. The LSI is within our phase 2 testing criteria, where the aim is to regain strength and neuromuscular control. For patients to progress onto stage 3 they must achieve a LSI greater than 85%, the HHD is a tool which helps us assess this alongside functional testing.
Finally, for stage 3, where the aim is to return to running, agility and plyometrics, we’d like them to be striving towards an LSI of 95% as an outcome measure, once again this is paired alongside functional testing. By practising our efficiency with using the HHD we can gather readings for patients when time is limited during new and review assessments, allowing us to maximise that time spent with the patient.
Finally, what we have found using the HHD regularly we have allowed patients to have a greater understanding of the quantitative measures we use with the tool, both motivating and engaging the patients during assessments.
PRIMARY CARE REHABILITATION FACILITY (PCRF) TIDWORTH
Sgt (SI) J Exton RAPTC
This year, PCRF Tidworth has faced innumerable challenges in providing efficient and timely healthcare to the largest Region in Defence. A department responsible for 16 Field Army Units, multiple headquarters and Minor Units. The team set out to improve staffing by highlighting retention issues and identifying ways in which the department could improve the professional and personal needs of all clinicians in the department. Leading to a significant rise from 50% staffing to an incredible 90% as of January 24, with two physiotherapists and one ERI currently on-boarding, a combined total of 27 staff. The increase in staffing has decreased patient wait times from 7 weeks in June 23 to an impressive 3 working days as of January 24.
The main emphasis for the ERI team this year has been to bridge the gap between Level 1 and 2 PT, by identifying ways that the PCRF can best support the patient transition to the level 2 PT process. SSgt (SSI) Robinson has shaped a step-by- step process that provides mainstream RAPTCIs with a clear and comprehensive handover process to ensure a seamless transition at point of discharge. A trial has been launched to allocate each Unit an ERI representative to maintain clear lines of communication throughout the patient care pathway. In addition, SSgt Robinson has implemented several evidence-based interventions such as a conditioning workshop; nutrition and lifestyle workshop and patellofemoral pain class which are led by a group of highly-skilled ERIs.
Another key task was uplifting our delivery of women’s healthcare, we now have a full-time women’s health physio and ERI who is Pre- and Post-Natal Instructor (PPNI) qualified. Later in the year I had the opportunity to attend the Defence Women’s Perinatal Festival in Warminster to provide a workshop for return to physical training post-partum, the event was well received with over 50 servicewomen from all four branches of Defence (Including Civil Service) in
ERIs conducting athletic shoulder testing CPD
attendance. The event was an opportunity for Servicewomen to network and gather a better understanding of the PPNI support available to them. Following the success of this event, the Defence Perinatal Festival will host a north and a south event later in the year.
The challenges for PCRF Tidworth will always be diverse and complex owing to the various roles of the 16 Field Force Units within our AOR, but with the current team in place, this challenge is met with fierce commitment from a highly professional, competent team of physiotherapists, ERIs and administration staff. Led under the watchful eye of Maj Paul Thompson RAMC, who has been pivotal in shaping the department’s ability to tackle the everchanging demands it continues to face. As Seneca writes in his moral letters “If a person doesn’t know to which port they sail, no wind is favourable”.
As of writing, SSgt Robinson is deployed on Op CABRIT in support of the 5 RIFLES Battle Group where I have no doubt, he will make a huge impact. We look forward to welcoming him back to the department in July 24.
Sgt (SI) Exton training for the middle split
The PCRF Tidworth ERI & Physio team