Wednesday, February 10, 2010, 03.33 AM
2009/11/26
KASMIAH MUSTAPHA
KASMIAH MUSTAPHA spends a day with physiotherapist Tracy Chan, who finds fulfilment helping stroke survivors regain their motor movements.
Chan, who joined Nasam four years ago, has spent more than 10 years as a physiotherapist, having worked with a private hospital and freelancing before she joined the support group.
Her day usually begins at 9am and ends at 5.30pm, and while this may seem like normal working hours, they are packed tight with activities. One wonders where Chan gets her energy from as she hardly sits down and never seems to tire.
It’s fascinating to see her interact with stroke survivors. Teaching someone who is half-paralysed to relearn basic motor skills is not easy. In addition to stamina and passion, patience is vital as stroke survivors take time to regain their strength and rebuild their lives.
Does she ever get tired or stressed out? “No. I only get stressed if the survivors do not get the support they need, especially when they are doing so well. I mean the families who no longer send them to the centre, or caregivers who do not follow instructions, hampering the recovery process.” 9.30am The first group of stroke survivors arrives with their caregivers, most of them maids. The two senior physiotherapists — Jamilah Mohd Rosli and Imtiyaz Ali Mir — and seven physiotherapy students prepare the survivors for the group therapy session.
As the group gathers around her, Chan switches on the CD player and an upbeat number blares away. Speaking in both English and Cantonese, Chan urges the survivors to follow her steps, much like aerobics, and they move to the music.
“Each step helps the survivors to strengthen their weak sides. Some of them can barely sit when they arrive. Now, most can stand and follow the movements.
“While it may seem easy to us, the stroke survivors find it really hard work. Putting one foot in front of the other requires all their strength,” she said.
As she demonstrates the movements, Chan explains why they must be done. None of the survivors protest.
10.15am The workout ends. Chan divides the survivors into English-speaking and non-English speaking groups. Jamilah and Imtiyaz plan their exercise programme for the week.
“They tell the physiotherapists which areas they need to focus most on. They may want to strengthen their stomach muscles or exercise their legs more. The physiotherapists refer to me and I design the exercise plan.” Then Chan checks her e-mail. As rehab co-ordinator, she has to be in touch with the other Nasam centres in Petaling Jaya, Ampang, Penang, Perak, Malacca, Sabah, Johor and Kuantan.
10.30am Imtiyaz informs Chan that the survivors are ready for the floor mat exercise and walks to the back of the house where the survivors are waiting.
Chan explains the exercise to everyone. The information is important to help them understand why they need to do it.
“This exercise will help strengthen their stomach muscles, shoulders and legs. They need to learn to roll over without having to rely on their elbows or feet.” She also uses this session to teach students the right techniques to use. The students must get involved with survivors and have a basic knowledge of physiotherapy. They learn all the techniques, hands on.
“The students have to assist the survivors with the therapy, work with them every day and learn everything as they become more involved with the survivors.” 11.45am It is time for the session with the second group. Chan lets Jamilah handle it as she focuses on one-on-one therapy workouts. She handles two cases.
The first survivor is 77-year-old Liew Swee Kuen who suffered a stroke a few months ago. She can’t stand and is wheelchair-bound. Chan, with help from Liew’s caregiver and a student, tries to coax Liew to put a ring into a stick with her left arm, the weak side.
“Come on, Auntie Liew, you can do it! Just stretch a bit more and you can reach the stick!” she urges. Protesting that it is painful to stand, Liew nevertheless tries her best to put the rings into the stick. Each time she manages to do it, Chan urges the student to pull the stick a bit further.
Chan then moves on to Subramaniam Ponnu. Having survived stroke for the third time, the 74-year-old is doing light exercises, stretching his arms. Chan works with him for almost half an hour, taking him through various types of exercises, including putting Subramaniam on a machine to help him walk.
“He is a survivor. He does everything I ask him to do,” Chan says, explaining that one-on-one therapy sessions depend on the severity of the cases and the survivor’s needs.
1.15pm It is supposed to be Chan’s lunch time. She has been so busy that she has her lunch during discussions with the students.
“This is the only time we can discuss things. So I have to eat standing or even walking.” During the discussions, Chan demonstrates the types of exercises used in the earlier sessions. She also quizzes the students on what they have learnt since joining her sessions.
“It is easier for them to learn this way. I want them to ask questions and I want to ask them questions so that I know how far they understand the art and science of physiotherapy.” The students usually spend between two weeks and six months at the centre.
2.30pm It’s time for the third group of stroke survivors to begin therapy. This group comprises those who are at an advanced stage of recovery. Most of them have regained some degree of movement.
The group is asked to walk slowly around the house for 30 minutes. They are denied the use of walking sticks or holding on to the caregivers. Chan explains that walking aids support their weight, making them drag their feet instead of walking.
In the meantime, Chan continues with the one-on-one session. This time, she is working on three patients, each of whom is in a different stage of stroke recovery and needs different therapy.
Chan spends about 20 minutes with each person and then turns them over to the students.
“Since my time is so limited, I cannot spend too much on one survivor. But during that limited time, I try to do as much as I can. I can rely on my students to take over from me.” 3.15pm The third group is done walking around the house. Since they have regained some of their motor movements, their exercises are different.
They are divided into two groups and asked to roll a ball, put wooden blocks inside a box and carry a glass of water on a stick.
As the group is familiar with the exercise, Chan only observes them, interrupting only if the survivors fail to complete the task or if they are not using the side affected by the stroke.
“I don’t want to see anyone not using their weak hands. You have to use your weak hand to pick up the ball and stick; otherwise, you have to repeat the exercise,” she tells them.
4.30pm The last group session ends and it is the end of therapy sessions for Chan, although her day is far from over.
While the patients are waiting to be picked up by their families, Chan uses the time to encourage some of them to do brief exercises.
Once the group leaves, Chan, Jamilah and Imtiyaz go through the day’s programme and discuss whether the exercises they put the survivors through are having the expected results. They also discuss the next day’s programme.
“We need to identify those who are doing it right and those who are not, and teach them how to help themselves.” After the discussion, it’s time for Chan’s paperwork, recording notes, reviewing the therapy programme for the week and checking her e-mail. “I get mail from caregivers who want to know what they can do to help stroke victims. I also get feedback from the other centres on what they are doing, their programmes and what they need.
“Every month, the other centres send me reports on developments. Every three months, they send their audit reports to me. Every six months, I visit the centres.” Among her tasks are reviewing the therapy provision, equipment needs, staff appraisal and patient data.
“At times, I have to transfer some of the therapists to other centres if they are short-handed or if they need to teach new staff.” Chan packs up. She is done for the day. She is still full of energy.
“I love my job. Working with stroke survivors keeps me going. I am still learning because therapy keeps changing. Although I am teaching both patients and students, I feel there is even more for me to learn. I do not feel my job is done even when the patient no longer needs therapy. It is an ongoing process.
“The reward is seeing them get better, seeing them from barely being able to sit to walking slowly. It may take some of them years to finally be able to walk again, but if they are willing to work hard, it is achievable.”
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