Week 5: Back to Prac

Week 5: 7-10 April 2015...

 

After a welcome week of midterm break, Tuesday morning saw us delve straight back into fieldwork.
Having gone straight from midterm demo's & case presentations into the holiday, we'd had plenty of time to think through our first month of fieldwork over the break.

 

Being assessed for midterms had been quite an experience: not only had my body chosen that particular week to succumb to food poisoning , but my only remaining client had been transferred to another hospital just before my treatment demo was to take place. Luckily, one of my fellow student colleagues was able to stand in for my client so that we could simulate the treatment session I had planned: a grooming activity involving the tying of a traditional African doek.

 

Apart from enabling the client to perform her own self-care tasks independently and thus improving her sense of autonomy and self esteem, the task also focused on many of the performance components that had been affected by the injury. Having to reach upwards holding the comb and doek ensured that full range of motion and muscle strength of the unaffected arm was being maintained. This made sure that prolonged hospitalisation would not prevent the client from performing home management and self-care activities once she returned home. The repetitive above head motions also required a significant amount of energy and concentration, ensuring that physical and mental endurance was maintained.

 

Although we bandaged the student's arm in the same way as the client's to simulate the same diagnosis, and used similar structuring, the student's response to the activity was different to the imagined response I'd had for my client. To me, this highlighted why such importance is placed on the client's context over and above their diagnosis.

The student was younger, fitter and, as a white female, had soft, straight hair and had never tied a doek before. This meant that the activity was completed in a much shorter time as it would have with the actual client, because the good physical endurance of the student meant that there was no need for rest breaks, and that movements in general were faster. Because the student had soft hair, it was faster to brush, but more difficult for her to tie the doek one-handed without it slipping off her head. As she was unfamiliar with doek-tying given her cultural context, the end product was not as neat as I'd expected my client's to have been, and she was not as motivated to ensure a perfect end product.  There were aspects, such as posture, that I would have had to correct for my client, but that were irrelevant for the student.

It was eye-opening to see how the same session, performed on someone with the same 'diagnosis' could yield such different interpretations and results when applied to someone with a different context and value set.

 

 

Following the treatment demo's came the case presentations: presenting our entire plan for our client based on their background within 20 minutes. Prioritising what to include in the presentation proved to be a challenge, ensuring that while a comprehensive picture of the client was presented, sufficient time was given to the treatment plan. My presentation ran two slides over time, indicating that I would benefit from doing a quick timed run-through before my final case presentation to ensure timing is optimally utilised.

 

 

 

With the new term came a new challenge: my first paediatric client. Diagnosed with cerebral palsy secondary to TB meningitis she contracted at the age of one, the little 6-year old weighed just 9kg and had no active movement. She did not respond to visual stimuli , and only responded to auditory stimuli during the second session by a flicker of her eyelids.

 

My first treatment session consisted of basic positioning and sensory stimulation, which were all done passively as the child had no active movement. As the child was drowsy, possibly due to medication, it was not surprising that there was no response apart from the flickering of her eyelids. It will be a good idea to see the child at different times of the day to determine whether the lack of response is a permanent factor, or whether it is only present after medication.

   

With her lack of responsiveness, it will be important for me to consider all the necessary downgrades that will be needed when applying the relevant NDT principles. I know that for my treatment to be successful, a great deal of research will need to be done on this client's condition and presentation so that therapy is pitched at the correct level for her.

 

For the first time, I also have two other clients to look forward to next week: a client with a dual CVA and below-knee amputation and a rheumatoid arthritis client.

The variety of conditions, comorbid factors and aspects of client context that need to be taken into consideration means that I have a great deal to consider and research over the weekend so that, come Tuesday, I can tumble into prac feet first.