Fall down seven times, Get up eight.

I have always struggled with midterms, as I take more time to adapt to a new year’s requirements than other students do. I also feel as though strikes really affected my preparation for my demo treatment session. I was originally going to do my demo on my Case study client, however strikes cancelled our prac day and my client was discharged the following day. Hence, I had to change my demo and prepare one for my tetraplegic client. 

This client had poor UL JROM as a result of very weak MS. I therefore found it very challenging to perform a successful ADL. I would have preferred to use ‘activity as a means’ for the client, but Demo’s are meant to incorporate a functional ADL task and I therefore had to do feeding with the client, with the use of a suspension sling. 

I needed to perform the activity with a ‘where is my client at’ mindset as the client had an extremely weak right UL which was in a splint. He also had limited active Left elbow extension and passive wrist flexion JROM as a result of extreme muscle stiffness of the left UL. I therefore positioned the bowl on the client’s right side, as this was a technique I knew my client could cope with and I could physically assist appropriately with, considering his client factors. I also did not want him to be so challenged that he spills the yoghurt a lot and does not enjoy the activity, as a result. My aim was not to encourage feeding, but rather improve left active elbow flexion. I therefore shouldn’t have positioned the bowl on the right side but rather in his midline, as this would have required greater elbow flexion, despite the increased difficulty he and I may have faced. I would have then achieved my aim more effectively. I also learnt that an aim to improve active JROM should incorporate a Muscle strengthening activity as a warm up, including resistance of that muscle and possibly including weighted cuffs in the activity.

In terms of my midterm presentation I discovered the need to research my diagnoses in depth and incorporate these facts into the presentation. This allows for an informative, more objective approach, rather than an uncertain opinionated view on the client. I also discovered the need to  allow time to practise the speech for a more fluent, less shaky delivery.

These are aspects I will work on before performing my next presentation:

·         Reading from a word document and not the slides. 

·         My posture whilst presenting must be upright and confident. I should therefore not be fidgeting whilst presenting, as this distracted my listeners.

·         Practising my speech and timing it so that I am not so nervous with regards to this and the pitch of my voice will not change so drastically.

This week Monday I performed a bed mobility and dynamic sitting balance treatment sessions with my two clients. My client performed well in the bed mobility, coping with grasping the new technique for rolling and getting into short sitting. My dynamic sitting balance activity with my second client needed to be adapted to incorporate a greater trunk rotation and I therefore positioned the puzzle pictures behind the client on her affected side. My weaknesses during this session were my height of the table, which did not allow for effective bilateral hand functioning. I also need to ensure my tone does not change despite a low cognitive level with this patient. 

After a great break down from the head of OT, regarding midterms feedback and finally making a start to NDT practical lectures I am feeling more confident for my next few weeks.

Today was a productive day in terms of my development and progression as a therapist. I taught my patient how to use her strong foot to propel herself in her wheelchair and she even managed to turn independently into her ward. I then performed multiple NDT techniques as a warm up and proceeded to use the Bobath bed mobility technique to get into short sitting and perform UL dressing. We laughed and connected well throughout the session. My therapeutic relationship with the client definitely improved through today’s session. She spoke of her stressors including her poor speech (which is a result of anomic aphasia) and laughed loudly at silly errors she made e.g. gathering the sleeve and then trying to place it on her head and not her arm.

I became quite emotional after receiving my midterms results today. Failing can be stressful considering the hours of effort I put in and being overwhelmed about how to improve.

As blogger Beth Werrell says, “Let’s face it. Criticism can be hard to take. Depending on context, our critic’s delivery, or the mood of the moment, even well-intentioned criticism can make us feel embarrassed, devalued, or just plain angry. Yet criticism is an unavoidable fact of life. Learning from criticism is an essential life skill”. 

These are the strategies I am going to use with regards to receiving criticism:

·       Pause and reflect on what is being said. It is very important to understand the criticism in  order to improve.

·       Accept the points and ask questions on how these attributes can be developed.

·       Formulate an action plan for the changes to be made.

My action plan includes: Research, Being more organised and planning effectively, practising my assessment techniques, treatment sessions and presentation skills and organising a buddy in order to improve my skills for our Client Presentation and Case study.

 

1. Werrell, B. (2017). How students can accept criticism and Grow From Feedback. https://blog.connectionsacademy.com/how-students-can-accept-criticism-and-grow-from-feedback/

Metamorphosis

After an extremely exhausting and overwhelming week, I sit here grateful for my opportunity to study such a challenging, innovative and distinctly unique course.

I however realise that with such a course as this, I definitely need to begin my ‘continuous research’ journey in order to grow myself as a therapist who is now implementing treatment and dealing with real cases.

I have very minimal strengths to discuss, as I am feeling more confident, but I feel I am still learning how to treat patients, learning about each condition’s precautions and all that OT treatment entails. My strength lies in the relationships I am able to develop with my patients. A therapeutic relationship is extremely important for the patient to gain trust and therefore, engage meaningfully in therapy. I feel as though I have good people-skills which enables me to connect with my clients.

I’d like to define my weaknesses as my ‘problem list’. I am going to put great effort into improving these areas day by day, going forward. I am still learning to cope with the criticism that university throws at you. It humbles you greatly to hear so much criticism, after hours and hours of preparation and effort. However, a lot of my effort consists of my own opinion and not on the facts according to researched literature, proving the points for me. At the moment I feel like a butterfly trying to release from my cocoon, but I am confined by my own barriers preventing me from reaching new heights.

I am now going to list my ‘problem areas’ and explain how I will improve on them

Organisation and time management: It will help me greatly if I file my prac notes and organise my typed documents into a folder, so that it is easier to find them when I need them. I feel I manage my time reasonably well, but that I should manage it further to allow for increased researching and practise in order to be completely committed to my studies, so that I improve.

Planning: I learnt a new skill today, from my supervisor, which I feel will be very effective. By planning a therapy session step-by-step and writing a small note to guide you, it will prevent the therapist from having to come back to things and ensure a more efficient, successful therapy session.

Researching: I have realised the importance of research and finding evidence-based facts to support your statements. I am going to discuss, with classmates, the websites which they use and find to be effective, as I have struggled to develop the skill of researching. I am also going to get more books from the library and order Trombly as a hard copy.

Presentation skills: I have realised I get extremely nervous before presenting, as I get worried that I will not get through all the content. My pitch therefore becomes shaky. I will improve on this by creating a word document and practising my speech multiple times, with my father’s advice and help.

The following aspects are the most important summarized strategies of successful students, which I am going to make certain I consider carefully as I continue my studies in this degree and unlock my potential.

1.       Get organized.

2.       Divide it up and have a strategic action plan.

3.       Be proactive.

4.       Sleep well.

5.       Set a schedule.

6.       Ask questions.

7.       Develop resilience.

I met a 67-year-old doctor this evening, whilst babysitting. She is still practising and mainly working with rheumatoid arthritis patients in paediatrics. She therefore works very closely with OT’s and Physios.  She was so inspirational and spoke such positivity into me, which has motivated me to give the rest of this block my all and achieve my goal of becoming a paediatric OT.

I find OT to be an extremely stressful, overwhelming course which causes much anxiety for the students. This doctor encouraged me to work hard and reward myself with something I enjoy, as I get through each week. I am going to continue to set goals for myself as a therapist and I hope to see improvement in my intervention strategies each week as a result of this. 

Refernces:

1.      Opportunity International. (2019) 10 Habits of Successful students. https://opportunity.org/learn/lists/10-habits-of-successful-students#.XJKVD6SxWEc

2.      Dr Haig, J&B. (2018). What Makes a Successful Student? https://thehaigtwins.com/makes-successful-student/

3.     Healing Wings. (2018). https://healingwingstherapy.ca/welcome-to-healing-wings-therapeutic-services/

Why consider Culture in Therapy?

I believe that culture plays a huge role in our profession as occupational therapists. It affects our goal setting, our treatment planning and therefore, our intervention implemented. Cultural knowledge provides context of the client’s values, skills and beliefs which are essential in building a trusting, therapeutic relationship with the client and encouraging engagement in future therapy.       

As an occupational therapist you should enquire intensely about the client’s context as your therapeutic value depends on it. For example, if I rushed into therapy teaching my client to shower independently, without understanding his socio-economic status and context, he may actually need to wash himself in his village river or using a bucket when he goes home. This would not only be disrespectful towards the client, causing a less therapeutic relationship, but it would also have been a pointless intervention session as the client will not use what he was taught in the session post-discharge. 

I also believe therapists should consider the formal assessments they perform on clients according to the region in which the assessments were created in, as they are standardized based on that region’s culture. Otherwise, interpretation of test results would be unsuitable.

Another example, is of the country of Singapore where it’s first OT’s studied in London (A western country). These OT’s had to drastically change their mindsets towards their country’s culture and context, when returning to provide intervention for patients. 

As a result of protest action on campus the university cancelled our prac day on Monday. With permission, I still performed a brief session with my client and his therapist as I had prepared a passive exercises programme for him to take home before discharge. Through my other pamphlets I had created for Mr Udairaj I learnt the importance of simplifying documents with well researched methods for patients to easily use. I also learnt the need to use laymen’s terms and not OT terms in a programme as the patient would not understand. Despite my effort and it not being implemented for the client, as a result of my inexperience and many corrections  which needed to be made, I learnt greatly from creating the pamphlets through my supervisor’s corrections. 

Today (Wed, 13/03) I performed my Midterms Demo. Through this demo, I learned to stretch my client out of his barriers in order to reach my aims with more confidence. For example, I had placed the bowl of yoghurt on my patient’s right side as I knew it would require less effort to place yoghurt onto the spoon. However, my supervisor advised me that I should have possibly placed the bowl on his left side, requiring extension in this direction and requiring a greater effort on his part for the elbow flexion movement. Despite the difficulty he may have faced, this structuring would have been more therapeutic in reaching my aim of improving his JROM in elbow flexion. My supervisor also discussed with me my warm up with the client. I learnt a lot from this discussion as it made me realise how a warm up can influence an activity. For example, I used JROM as a warm up of the client’s biceps needed to flex his elbow for feeding. If I had used an activity which strengthened the client’s biceps muscle through weightbearing and resisting the muscle it could have positively influenced his improvement in Active JROM elbow flexion. 

I believe cultural knowledge, understanding and skills are vital in becoming a culturally competent occupational therapist, as this is essential to being a competent healthcare provider.

In my experience as a therapist last year I have learned from my mistakes, such as providing a client with a knife and fork when he never eats with this utensil, but rather a spoon. I have learnt to evaluate my sessions before implementing them, according to the client’s context and their cultural behaviours. 

I would like to end off with this inspiring quote that shows the importance of diversity, which makes each individual unique. 

REFERENCES:

Stanley, P. (1995). Culture and its Influence on Occupational Therapy Intervention. https://journals.sagepub.com/doi/

Yang, SY. (2006). Cultural Influences on Occupational Therapy. https://onlinelibrary.wiley.com/doi/pdf/10.1002/oti.217.

Leendertz, AE. (2013). Cultural competency: perceptions of South African trained occupational therapists. http://wiredspace.wits.ac.za/handle/10539/12524.

Images collected by Burten, S. Diversity. (2019). https://za.pinterest.com/real19/diversity/.

Onwards and Upwards.

After having a dissatisfying Prac day on Monday, I am feeling a lot more content after today’s intervention implemented. I was feeling quite down when leaving the hospital on Monday, as I had decreased availability of time with my clients to perform more assessments and average to poor intervention sessions implemented. One of which needed to be adapted by my supervisor (Passive mobility exercises being turned into more of an activity) and a feeding session which ended up with me feeding the client. This client did not have the PROM for wrist flexion needed for feeding.  I had not affectively assessed PROM and I have since realised its importance through this mistake.

My AFR  I have used for Mr Udairaj was the biomechanical AFR including the following approaches.

Graded approach:

·        Repetition, intensity and duration would be graded.

I used this approach by, for example, requiring the client to repeat the steps of the normal movement patterns which were taught to him. I would give him step by step instruction for bed mobility and then ask him to repeat the movement using the new method. This reassured me he was comprehending the movements. I determined the number of breaks I’d give the client based on his signs of fatigue.

Compensatory/ Rehab approach:

·        Relying on assistive devices and the unaffected hand to enable increased independence. As well as teaching him to plan ahead for energy conservation. E.g. getting the towel prepared before showering or placing the shorts in front of him to enable placing them on correctly the first-time round. I have been showing the client compensatory methods to perform tasks with the unaffected hand such as using the unaffected elbow to get into long sitting for bed mobility etc. I have also been suggesting many assistive devices during sessions, for him to buy post discharge. E.g. bath-mitt, toilet handle bars, non-slip mats, shower chair etc.

Activity as a means:

To improve MS and JROM of the affected side.  Performed an activity requiring interlocked fingers to reach forward and knock a water bottle off the table. I also performed a hand-over-hand  activity  to wipe a table in figures of  eight which improved JROM of the affected UL too.

·                      Activity as an end:

Client should be able to dress UL and LL as well as perform bed mobility with modified independence. Client should be able to toilet with minimal assistance and shower with minimal assistance. The client will be given a pamphlet with the steps and some pictures of the methods taught to him.

·                       Preventative approach:

Provide right UL and LL AROM and PROM exercises to prevent muscle stiffening and contractures. This was implemented with the client and the client will be given a pamphlet with pictures of the exercises taught to him. Education on his diagnosis, including his Subluxated shoulder, through teaching him techniques of how to position the arm to support the shoulder and prevent it from being damaged further. E.g. Support it with pillows when lying in bed or support it on the wheelchair armrest when seated in the wheelchair.

Mr De Grey had a TBI at age 20. This was 40 years ago and since having his incomplete C3/4 SCI Mr De Gray has become a tetraplegic patient. As the client had the TBI 40 years ago and recently had the SCI, my AFR being used is focused more on the Biomechanical framework, rather than the Neurodevelopmental. This is because remedial aspects are a lot more important to improve, at this stage, to regain MS and JROM in all areas.

The approaches used for MR De Gray include activity as a means with grading approach to improve MS of the UL from a general overall 2 to a 2+ and improve A&PROM of the UL in general, mainly the Left UL (dominant since he was 20 and less affected). This will be graded through duration, repetition and intensity. As well as the preventative approach (PROM by staff or caregiver daily to prevent further muscle stiffening and use of a functional resting splint of the R UL to prevent permanent contracture in finger flexion) and compensatory approach (Use of an assistive device e.g. a w/c with a raised back and has an angle which requires more of a posterior pelvic tilt to prevent sliding and improve client posture).  I need to speak to Erin regarding the splint as it is causing redness on the skin over the thenar muscles, which could lead to a pressure sore if not adapted. As well as educate the client on how often to wear his splint.

Through speaking to my supervisor, I have also realised the importance of education on the use of the affected hand for CVA clients and incorporating the affected hand more into activities (This is an area which I feel I could improve more in). As well as education on assistive devices for discharge. I will be including a list of assistive devices in my Discharge programme and where to possibly buy them from.

In general, I have focused on Mr Udairaj’s ADL’s to make him as independent as possible and reduce demands for the caregiver, when he is discharged next week Tuesday. This includes Dressing, Toileting, showering (Done with his OT), Bed mobility and UL exercises. I also perform NDT warm up techniques with him before each treatment session, including: hoovering, bridging and trunk rotation as well as incorporating weight bearing on the affected UL.

Mr Udairaj also complained about not being able to read anymore and I therefore included a reading assistive device to meet the clients needs and include client centeredness into therapy. Reading is an activity he has really missed being able to do for leisure. However, this was not implemented as a treatment session and rather an additional task performed for 5-10 minutes at the end of the last two treatment sessions, to ensure client independence in using the new device.

Today I performed a blow painting activity with Mr De Gray, which aimed to improve static sitting balance. It also incorporated trunk flexion through blowing and deep breathing exercises. I saw an improvement in the beginning of the session from static sitting balance of 10 seconds to static sitting balance of 100 seconds by the end of the session,  by him following verbal promptings for postural change to maintain his balance. I have been so directed towards focusing on Activity as an end, as a therapist, in these first few weeks of learning to treat and have only recently learnt the importance of implementing Activity as a means with my clients.

I am going to end off my blog with an OT on Instagram, named Courtney's, Instagram photo and caption as it impacted my passion for this career even further.

Refernces:  

1) Progress Orthosis.(2018)Progress Functional Resting Splints | North Coast Medical. https://www.ncmedical.com/item_1326.html

2) Mc Millian, I. (2016). The biomechanical frame of reference in occupational therapy. https://musculoskeletalkey.com/the-biomechanical-frame-of-reference-in-occupational-therapy/

3)  Mullersdorf, M. (2016). What, Why, How – Creative Activities in Occupational Therapy Practice in Sweden. https://onlinelibrary.wiley.com/doi/full/10.1002/oti.1438

4)  Schmidler, C. (2018). Spinal cord Injury: Functions, nerves, surgery. https://www.healthpages.org/health-a-z/spinal-cord-injury-function/