Reflection 3- Week 5

Situation
On one of my last days at my placement (10/03/2010), I was asked to treat a 10 year old girl with my visiting clinical supervisor. This girl had severe left sided weakness only present in her right arm. The day before my treatment session with her, she had undergone a MRI which revealed that she had a cavernoma ( benign tumour) in the frontal lobe of her brain which was occasionally bleeding. This bleed resulted in her presenting with left hemorrhagic stroke like symptoms. On assessment it was found that her strength was severely affected with varying degrees through her whole right arm, her sensation was completely intact and her tone was generally low (hypotonic) in her right shoulder and arm.
The girl told me she was occasionally banging into things on the right side and on observation I noticed she tended to “leave the right arm behind” when she was completing tasks.

Task
I was asked to treat (with my clinical supervisor watching) and address the problems this girl had as a result of the hemorrhagic stroke.

Action
I firstly identified the areas which the girl needed treatment on. She had; 1) decreased neural input/altered neural pathways to her right upper limb. 2) low tone in her shoulder girdle, possibly leading to a subluxation. 3) significant decreased right upper limb strength. 4) increased weight bearing to the right side in sitting/altered midline in sitting.
So I treated her, and gave her exercises that, encouraged weight bearing to the left side in sitting (increased her awareness of her midline, by showing her a mirror), I gave her neural input and stimulation to the right hand using different textured materials. I educated her about taking care of her right upper limb and refraining from doing any movements that would injure the joint and lastly I gave her some strengthening exercises for her right arm.

Result
The result was a straighter alignment in sitting on reassessment, with almost a even weight bearing on both sides. Other improvements from the treatment could be seen further down the track.

Evaluation
I think my intervention was a bit mediocre. I think I had some strengths in the treatment but I had a lot of weaknesses as well.
My strengths were that I engaged the child well during the treatment session and I think I selected appropriate exercises that targeted her problems.
My weaknesses were that; Firstly, I needed to cater my exercises to a more paediatric level, I needed to make them more exciting. Secondly I needed to have progressions on the exercises. I needed to make the exercise more difficult by adding in different and harder dimensions once the child had mastered the easier version of the exercise. Thirdly the treatment session needed to be longer, it was only 40 minutes when it was supposed to be a hour; I needed to plan out a variety of exercises that would achieve the same result. Lastly my supervisor said I needed to also investigate the fact that the child was banging into things on the right side. I needed to check her vision filed on the right.

Strategies
I think next time I will try to improve my treatment session by implementing these strategies;
1) Plan out the treatment session so I know how long each activity will take and hence I will be able to treat the patient for their given time.
2) Research treatment ideas, if I cant think of enough exercises, I will go research some different ideas that achieve the same result.
3) If the child identifies a new problem in my subjective, make sure I assess it at the beginning of the session to find out if it is a problem.
4) Try to incorporate childish games into my treatment to make the session more appealing to the child.