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.