Reflective log - MDT working and trismus

1. Think of a recent therapy session or event.

I assessed a 48 year old patient who had had a left sided pontine bleed and presented with a moderate flaccid dysarthria and LMN facial weakness involving the upper and lower portion of her face on her right side.

I was unable to explain the patient’s trismus (jaw opening to a max of 12mm) by looking at her neurological symptoms. The patient’s jaw also deviated towards her right (weaker) side when depressed. I developed an exercise program including resistance jaw exercises and stretches to alleviate the patients trismus. After 2 months the patient was able to activate muscles on the right side of her face but her jaw trismus had not changed. I organised a joint session with the lead physiotherapist who thought that jaw muscle massages, stretches and neck stabiliser exercises in lying might help. I contacted the botox team to see if they would consider looking at the patient’s jaw, however they stated that they would not look at jaw’s. Eventually I asked a doctor to refer the patient to the maxillofacial department.

2. Describe the session/experience

I accessed support from multiple specialists concerneing the patients jaw. In the maxillofacial appointment they stated that the patient’s trismus was likely to be due to a fracture when she fell onto the pavement after having her stroke.

3. What did this session make you feel?

I felt that I should have referred the patient to specialists sooner since trismus is not one of my areas of expertise. I also felt that it was important to evaluate whether the patient had achieved the goals we set (to be able to fit a malteser into my mouth) in order to consider whether I needed to change the therapy plan or seek an expert opinion. The medical team had missed the jaw fracture as well and I think that it was important to consider the patient’s quality of life, as this is something I would not normally work on directly in therapy.

4. What has this session has taught you?

 - To look for expert opinion in the MDT.

 - To consider the impact of impairments on a patient’s quality of life.

 - To keep the MDT up to date on the progress of my therapy programs and what I work on in therapy.