It is truth universally acknowledged, that the first week of
a physical practical block is always the hardest. Though notes were poured
over, goniometers were buffed, and textbooks were investigated- nothing can
quite prepare a student to leave the safe and predictable lecture room for the
whirlwind of hospital life. Before you
know it, the day has begun, and the fledgling therapist must fly.
My first week of fieldwork has served as both a refresher on
assessments and as an introduction to treatment. My first client for the year,
Mr A., has a TBI and presents with right hemiplegia. Through my theoretical
lectures, I have learnt the importance of using the diagnosis to guide general
assessments. Immediately, it triggered me to assess cognition and perception. I
also chose to focus on muscle strength and range of motion assessments, but was
reminded by my supervisor about the importance of tone assessments in clients
with brain trauma- which I had overlooked. A clear case of where theory needed
to be thoroughly understood to incorporate into practice. While researching TBI’s
I also found that taste and smell are often altered or lost, and return of these
senses is rare[1],
therefore I’ll be sure to assess these senses as well.
A major factor in the transition between theory and practice
is time management, which has become pertinent now that I’m treating clients.
When I perform assessments, I am generally quite slow, and this week was no
different. In theory, it would be ideal to come into a session with a list of
assessments that I need to do, allocate 10 minutes to each of them and begin
treatment right after. My nerves add on an additional 10 minutes due to
excessive fumbling and note-consultation and after 30 minutes I was only able
to complete one muscle strength assessment. My supervisor intervened by
teaching our group how to effectively screen our clients, which saves us time
and zones in on problematic areas very quickly. In my next session, I’m going
to give myself around 1.5 hours to accomplish all I have planned, as my
supervisor rightfully pointed out that in professional practice sessions with
the client are only around 45minutes- this means that I can’t just accept that I’m
a slow assessor, I must actively focus on improving and prioritizing.
Intervention is a curious process. It can be guided by prior
planning, but for the most part intervention is the skill of quick thinking and
knowing when to adapt. At the moment, intervention doesn’t come naturally to me.
I only noticed halfway through my assessment that my client’s positioning was
not ideal and intervened by placing the flaccid limb in a more therapeutic
position, my supervisor pointed out that this is best achieved through
incorporating the limb in activities by using it to weight-bear. In future
sessions, I now know that the first thing I’ll have to do before any session is
to intervene and ensure the client is positioned correctly so that he can
perform sessions to his best ability and will be sure to use the flaccid limb
more strategically to assist the client with his execution of these activities.
I was also advised to plan my intervention on areas that I’ve already thoroughly
assessed, as I’ve incorrectly been intervening whilst the client performs
assessment tasks. I’ve now learnt that by intervening I’m altering my
assessment findings and should rather allow the client to complete the activity
in its entirety to assess their competence and, once they are finished, I can
point out and improve problematic areas. My plan is to implement this in my next
session where I will assess toileting and thereafter work on intervention.
Another learning curb this week has been having an aphasic
client. I knew to incorporate ‘yes’ and ‘no’ questions and to establish a
mutual understanding about gestures from my theory lectures. My supervisor
noted that there were some flaws in my communication attempts, as I would
sometimes misinterpret the client’s responses when I gave him multiple options
to respond to. She advised that I always use two types of communication, one
being verbal and the other symbolic to reinforce the message and ensure there
is no confusion. I’ve since created a
communication board and plan to consult with the Speech Therapist to discuss universal
gestures or basic sign language that I can also incorporate. As my client does
not speak, I’ve noticed that I tend to fill up all silences with general
chatter which doesn’t seem like too much of a bad thing, but what I hadn’t
noticed was that I would excessively give praise to the client during tasks. I’ve
had to reign this in because my supervisor pointed out that I may be giving the
client a false sense of accomplishment.
Now that the majority of my assessments have been completed,
I’ve slowly begun to incorporate treatment into sessions. My first treatment
session went well as I was able to achieve my aims. Upon further research and
advice from my supervisor, I’m going to try implement some principles of the
Neurodevelopmental Treatment approach, as it is useful when there is a
diagnosis of brain injury, and this will help to correct underlying impairments
that interfere with movement through the use of key points of control[2].
I will introduce these slowly during warm-ups to my sessions with the client to
activate muscles and encourage movement.
Overall, yes, it is truth universally acknowledged that the
first week of a physical practical block is indeed the hardest. However, this
fledgling therapist is flapping her wings and will not give up on making it
through the eye of the storm. Practice makes perfect and preparation relieves stress:
so that’s the life recipe to follow.
[1] Ahmed,
T., Horton, S., Worthington, E. and Morris, R. (Eds). (2018). The
effects of brain injury and how to help. 5th ed. [ebook] Headway- the brain
injury association, p.7. Available at:
https://www.headway.org.uk/media/4003/the-effects-of-brain-injury-e-booklet.pdf
[Accessed 20 Feb. 2019]
[2] (Pendleton
H.M & Schultz-Krohn W (Eds.).(2013) Pedretti’s
occupational therapy practice skills for physical dysfunction (7th ed.).
St. Louis, MS: Mosby Elsevier)
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