Situation
On the third week of my placement, on a Wednesday the 24th of February, I was asked to conduct an individual hydrotherapy session for a 14 year old girl with Transverse Myolitis. She contracted the virus 2 months ago and this virus manifested itself as a neural virus. The virus caused inflammation and scarring of the spinal cord at level T8, the result of this was paralysis of her legs (she now mobilised in a wheelchair), bowel and bladder, a loss of sensation to her legs and a loss of reflexes to her legs as well. As a result of these consequences this girl was having an enema administered in the morning before she entered the pool to make sure she had completely emptied her bowels. Another complication to this girl’s condition was that she was very obese, and her tolerance for exercise was low, it was very difficult to motivate her.
The girl I was conducting the hydrotherapy session for was receiving hydrotherapy 3 times a week and 2 land sessions a week. She had been having hydrotherapy sessions for over a month now and she was quiet confident in the pool.
The recovery from Transverse Myolitis is variable, with some people recovering completely while others are totally paralysed for the rest of their lives. Therefore physiotherapy had to include the possibility that this girl will be wheelchair bound for the rest of her life.
Task
I was asked to perform a 40 minute hydrotherapy session that catered to this girl’s needs. I was conducting the session with my supervisor present beside the pool. I based a lot of my treatment around firstly preventing generalised deconditioning, secondly improving the strength of her upper limbs, thirdly encouraging any recovery of her lower limb muscles and lastly raising her cardiovascular fitness ( in the hopes of addressing her weight issue as well).
Action
After transferring the girl to the pool using a chair lift; I began my treatment session. I asked her to perform;
1) 2 laps of the pool, choosing her preferred stroke.
2) shoulder, arm, wrist and chest exercises using resistor pads.
3) 2 attempts at diving for sunken objects ( rings etc.)
4) treading water for 2 minutes
5) facilitated hip flexion, encouraging any activity of lower limb muscles.
Result
The girl did enjoy the hydrotherapy session however she did seem tired after the session commenced. During the session I did see a bit of hip flexion being exerted on the left hip, which is encouraging and is something to work with in the future.
Evaluation
I think the session went well. I addressed the girls deconditioning by giving her lots of cardiovascular exercise such as the laps in the pool and treading water. I also gave her some choice as to which activities she wanted to do (so she felt as though she had some control over the session). My supervisor said my arm exercises were a bit too general and I needed to concentrate on giving her more specific exercises that would target muscle groups that she would defiantly need to be stronger (eg. the triceps for the ease of transferring between her wheelchair and her bed/toilet etc.). My supervisor also said that I needed to allow her to keep her independence in things, so teaching her how to move around the pool on the steps and the hand rails independently and without the use of her legs is also pertinent in her hydrotherapy session.
Strategies
I think next time I would firstly try to make the session more tailored to my patients needs. The girl was having difficulty with her transfers (as she couldn’t clear her bottom off the surface it was on) so I should have focused on strengthening her tricep muscles to improve her independence in transferring herself. Next time I would also keep the activity as fun as possible. I would try to add in some music, or ask her if she had an activity in mind that she would like to do for 5 minutes. Lastly another good strategy would be to incorporate into the session activities that allowed her to keep her independence in and around the pool. I would teach her how to get on and off the steps and teach her how to take care of her legs when other people are helping her into the pool.
Sunday, February 28, 2010
Saturday, February 13, 2010
FIRST ENTRY- WEEK 1
Situation
It was the third day on my placement (10/02/2010) that I was asked to treat a child with my visiting clinical tutor. This was the first time I had seen this child. My patient was a four year old girl who had sustained a hypoxic brain injury post resuscitation. My patient had endured damage to her basal ganglia and cerebellum. With the help of my supervisor we had established the child had difficulty initiating movements, continuing in automatic movements, poor balance, and a high level of weakness and spacticity in her lower limbs. All of these factors had considerably contributed to her delay and even regression in her age appropriate developmental milestones. My patient could not move from a seated position to a lying position, she had difficulty rolling over and could not crawl or even walk without assistance.
Due to the fact that most of the damage was on the right side of her brain, my patients speech and level of understanding of words had also regressed significantly. Therefore communicating with her was also very challenging.
Task
My treatment was therefore not only to address her physical delay in developmental milestones, but also to encourage her to talk instead of pointing with her hands to communicate. In addition to encouraging my patient to talk I needed to be able to make sure the language I used was appropriate to my patient’s age.
Action
I was facilitating my patient to transition for a seated position to a lying position on a mat on the floor, all the while I was talking to her trying to get her to communicate with me.
Result
My patient ended up moving from a seated position to a lying position on the mat, however it took several attempts. I needed to change how I spoke to her several times as well.
Evaluation
I don’t think I was affective in this first treatment session with my patient. I found it hard to get her to “ speak up” and talk to me, especially when I was facilitating her to progress in her physical development. Her reluctance to talk to me could have been that my patient was shy around me but most likely it was because I was not using age appropriate language and I was failing to use techniques that would facilitate her to talk to me.
Strategies
My clinical tutor and I worked out some ideas that I could use when talking to this patient. Firstly; to use one command at a time. Secondly to give my patient choices by asking her simple questions (that required basic answers) encouraging her to verbally communicate with me. Lastly to use more age appropriate language. For example “try to stretch your leg out like a long long snake” instead of “can you straighten your knee?”.
I tried using some of these strategies the second time I saw this patient, and I found she was much more outspoken and she seemed to have a better understanding of what I was asking her to do. Overall, the treatment session was more efficient and I think it was more successful when I implemented these strategies.
It was the third day on my placement (10/02/2010) that I was asked to treat a child with my visiting clinical tutor. This was the first time I had seen this child. My patient was a four year old girl who had sustained a hypoxic brain injury post resuscitation. My patient had endured damage to her basal ganglia and cerebellum. With the help of my supervisor we had established the child had difficulty initiating movements, continuing in automatic movements, poor balance, and a high level of weakness and spacticity in her lower limbs. All of these factors had considerably contributed to her delay and even regression in her age appropriate developmental milestones. My patient could not move from a seated position to a lying position, she had difficulty rolling over and could not crawl or even walk without assistance.
Due to the fact that most of the damage was on the right side of her brain, my patients speech and level of understanding of words had also regressed significantly. Therefore communicating with her was also very challenging.
Task
My treatment was therefore not only to address her physical delay in developmental milestones, but also to encourage her to talk instead of pointing with her hands to communicate. In addition to encouraging my patient to talk I needed to be able to make sure the language I used was appropriate to my patient’s age.
Action
I was facilitating my patient to transition for a seated position to a lying position on a mat on the floor, all the while I was talking to her trying to get her to communicate with me.
Result
My patient ended up moving from a seated position to a lying position on the mat, however it took several attempts. I needed to change how I spoke to her several times as well.
Evaluation
I don’t think I was affective in this first treatment session with my patient. I found it hard to get her to “ speak up” and talk to me, especially when I was facilitating her to progress in her physical development. Her reluctance to talk to me could have been that my patient was shy around me but most likely it was because I was not using age appropriate language and I was failing to use techniques that would facilitate her to talk to me.
Strategies
My clinical tutor and I worked out some ideas that I could use when talking to this patient. Firstly; to use one command at a time. Secondly to give my patient choices by asking her simple questions (that required basic answers) encouraging her to verbally communicate with me. Lastly to use more age appropriate language. For example “try to stretch your leg out like a long long snake” instead of “can you straighten your knee?”.
I tried using some of these strategies the second time I saw this patient, and I found she was much more outspoken and she seemed to have a better understanding of what I was asking her to do. Overall, the treatment session was more efficient and I think it was more successful when I implemented these strategies.
Saturday, February 6, 2010
Initial Entry- Princess Margaret Hospital
Initial entry
I have been placed at Princess Margaret Hospital in the Neurology Department. Most days I start at 8 am and finish at 5 pm, however Monday I start later and Thursday I finish earlier. The first day on placement I am supposed to be given a pamphlet on the hospital and will introduced to people and procedures in and around the hospital.
I really do love working with children so I am very excited about this placement. However, at the same time, I am a bit apprehensive about this placement. I think in this environment it could be a bit taxing, both emotionally and physically. The reason for this being; that the children I will be treating will most likely have conditions which will affect them for the rest of their lives. I will have to be careful I don’t become too emotionally involved with my patients. I have talked to a few of my other classmates who have also been on this placement. According to them I will have mostly patients with acute brain injuries, hydrochephalus and Guillian Barre Syndrome. However, because the ward is titled ‘neurology’ I think I may see a range of neurological conditions. I hope I see a range of children with different ages, as this is also my one and only paediatric placement, I hope to see children that are in the midst of development and hopefully even some neonates.
I am hoping I will eventually be able to have my own caseload ( with a supervisor present) however, I can understand how this may not be possible as parents can be quiet understandably concerned about their child’s welfare and hence, wish their child to receive optimal treatment by an experienced therapist.
I have been placed at Princess Margaret Hospital in the Neurology Department. Most days I start at 8 am and finish at 5 pm, however Monday I start later and Thursday I finish earlier. The first day on placement I am supposed to be given a pamphlet on the hospital and will introduced to people and procedures in and around the hospital.
I really do love working with children so I am very excited about this placement. However, at the same time, I am a bit apprehensive about this placement. I think in this environment it could be a bit taxing, both emotionally and physically. The reason for this being; that the children I will be treating will most likely have conditions which will affect them for the rest of their lives. I will have to be careful I don’t become too emotionally involved with my patients. I have talked to a few of my other classmates who have also been on this placement. According to them I will have mostly patients with acute brain injuries, hydrochephalus and Guillian Barre Syndrome. However, because the ward is titled ‘neurology’ I think I may see a range of neurological conditions. I hope I see a range of children with different ages, as this is also my one and only paediatric placement, I hope to see children that are in the midst of development and hopefully even some neonates.
I am hoping I will eventually be able to have my own caseload ( with a supervisor present) however, I can understand how this may not be possible as parents can be quiet understandably concerned about their child’s welfare and hence, wish their child to receive optimal treatment by an experienced therapist.
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