Winston Churchill Fellowship – Week 2

by Carolyn Bell (@bellcarolyn13)

Physiotherapy Lead for Monklands, NHS Lanarkshire

Friday 19th February

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Back in the clinic today with Janet. Totally different approach to treatment. Lots of emphasis on postural control and muscle balance. She obviously builds a really good rapport with her patients and continually asks their opinions. It is good to see how breathing control is integrated into treatment in a totally different way.

It’s also interesting to see the type of patients who present. Parents bringing in children with signs of anxiety which they have recognised. They are very pro-active in the management of breathing dysfunction. One of my aims is certainly to raise awareness thereby allowing people to recognise the importance of breathing control in the maintenance of good health.

This afternoon I have travelled to Middlemore Hospital. In some way I feel much more at home in this setting!

I met with two physiotherapists working within the hospital, providing treatment to patients with dysfunctional breathing. They receive approximately 260 referrals per annum! To cope with demand they have commenced classes for patients with dysfunctional breathing. They have a staff to patient ratio of 1:4 so some 1:1 interventions can occur. Only 20% of their class attendees convert to 1:1 treatments. An interesting concept and one to consider if demand outstrips capacity. I am sure these patients are out there in all communities but we need to establish why they are recognised in New Zealand but not at home in Scotland.

Another physiotherapist deals with all Dysfunctional patients who require 1:1 treatments. This is a concept that is closer to home.

Vicki Li Ogilvie , like many of us, uses the Nijmegen questionnaire however is currently looking at its use and validity. We spent a good few hours ruminating over this patient group. I will definitely be looking out for her research!

Another day full of learning!

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Saturday 20th February

A day off today!!! Taking the opportunity to go to Waiheke. Fabulous weather and an amazing boat trip over. Met some really lovely people. A thoroughly enjoyable day.

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Sunday 21st February

Another lovely day and time to catch up on the more mundane side of travel. Washing…and emails!

Off this evening though to meet Jim Bartley. An ENT surgeon with an interest in dysfunctional breathing….amongst many other areas! Many areas for me to look into but my biggest take home message is “the nose is key!” We definitely need to consider the role the nose plays in respiration and prevention of infection. Another key activity for me is to liaise with my respiratory and ENT colleagues.

I have many references and areas to evaluate so I would imagine that my two hour meeting will translate to many hours of reading and contemplation!
I am again blown away by the generosity of people in giving up their time to meet with me and share their passion and experience.

Monday 22nd February

Yet more interest in the nose today! David White, a mechanical engineer working in Auckland University, has developed an interest in the nose! Who knew that an artist in the 19th Century recognised nose breathing had major health benefits?

There is some amazing information out there which definitely needs more consideration from a Physiotherapy perspective.

Hopefully there was mutually beneficial discussions between an academic engineer and a working Physiotherapist. We were certainly both very animated during our discussions!

Once again taking time out to actually think can yield huge results.

Tuesday 23rd February

Last day in the breathing works clinic today. Working with Tania Clifton Smith. Yet again a slightly different approach however the results speak for themselves.

It is evident that there are a number of different client groups attending the clinic.

Clients suffering from anxiety will refer themselves to the clinic or be referred by their Doctors. Addressing their breathing control not only helps relaxation, but also gives back to the patient a sense of control.

High performance athletes are also seen within the clinic. Addressing muscle imbalance, breathing control and improving the function of the diaphragm can yield huge results for these individual sportsmen and women.

Individuals who show signs of breathing pattern dysfunction or general ill health which may be attributed to breathing pattern dysfunction.

Each of the therapists that I have had the pleasure of observing at work have all approached the client groups slightly differently. Some from a respiratory background and some from an Msk background. It just goes to show good clinical reasoning skills allow us to asses and treat individuals exploiting our own strengths.

I feel it is now time for me to revisit some of my less practiced skills and join my MSK colleagues to share knowledge. By carving up Physiotherapy practice into smaller specialisms have we lost some of the skills that as Physiotherapists we excel at ….looking at the whole individual? More thought is required!!!

Observing the way other therapists work has been a huge learning experience for me. Its not necessarily what therapists do but how they do it that has made the greatest impression. This is definitely something that more Specialist therapists don’t do enough of! Could we build a network and allow ourselves time to do this?

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I really want to thank all the team at Breathing works in Auckland who have welcomed me as part of their team. This Fellowship would not have been possible without their support.

Wednesday 24th February

Off to Wellington today. The time is flying by! Looking forward to meeting other Physios and medical staff who are involved in the treatment of dysfunctional breathing. It’s a huge opportunity to benchmark services.

Thursday 25th February

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First a little light lunch and then a meeting in Wellington this afternoon with Liz Childs. Liz is a Physiotherapist who now specialises in treating individuals with problems associated with the pelvic floor. Early on in her career she recognised the close links between pelvic floor problems, particularly individuals with overactive pelvic floor muscles, and breathing dysfunction. She now considers breathing pattern awareness in all of her clients.

Again this stresses the need for all individuals to be aware of the importance of breathing control.

Breathing control is linked with all facets of Physiotherapy and should not just be seen as a respiratory problem.

Could all Physios carry out a” brief intervention” with regard to breathing control when treating their patients?

Again I currently have as many questions as answers however having time out of day to day service delivery allows for a prolonged period of reflection!!

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