3rd Year Prac - Initial Entry

I am excited to start my placement at Hollywood hospital and am more relaxed about prac second time round as I have a better idea of what to expect. I am certain that this placement in neurology/gerontology will be a very different and im sure rewarding experience than my last placement in paeds. I am slightly apprehensive about being in a hospital for the first time but am looking forward to working as part of a larger multidisciplinary team. Working with the elderly is something very new to me but I'm sure that all my skills learnt at uni will assist me in adapting and being an active team member at Hollywood Hospital.

Week 5: Entry 3

Today I met lovely little 11mth boy who is in the care of a foster mum as he waits to be placed for adoption. He is seen by many othe medical professionals and is waiting on an MRI to be confirmed with hyrocephallus. This is where there is too much fluid in his ventricles that is unable to move in or out of the brain causing compression from the inside out. He is most likely globally delayed and has great difficulty in planning movements. At 11mth he is functioning at a 7-8 month gross motor level and similar level in fine motor skills. It is also likely that his speech is delayed and he is waiting to be seen by an opthamologist because 0f a nystagmus query in one eye. For this baby as well as all the stresses of many different appointments and tests being done to him, his medical issues also have meant that an adoption that was lined up has fallen through.

I was given the task of an objective assessment with this boy in the session. This consisted of playing with toys in various positions and seeing how much he would tolerate. In prone he was pivoting and rolling but often found himself stuck in sidelying. In supine he would also roll but wasn't trying to play with his knees or feet and quickly moved into prone. He could sit well without support and was weight bearing on his legs. He was also low toned and probably on the borderline of being classed as hypotonic. He had significantly reduced strength and endurance in his trunk, upper limbs and lower limbs and was not showing any lateral head righting responses. I didn't have much structure to my examination but did feel that I covered most of the essential elements and was able to understand and transfer other knowledge.

Week 5: Entry 2

Yesterday I performed my first subjective assessment to a mother of a beautiful 19mth old little girl who had only just started to walk since being referred into the public system. i think it ran smoothly and I got all the information I required to write up the subjective aspect of her report. One area I think could have improved was my questioning about the birth history. I got enough essential information but could have included more questions just to clarify for my own understanding. This girl has just been diagnosed with benign joint hypermobility syndrome which is likely to be a significant factor in her gross motor delay. However, is now only a month behind for her age and fine motor skills are age appropriate so there were no major areas of concern. One thing I did find interesting was that the rheumatologist who diagnosed her hypermobility syndrome gave the mother a very worst case scanario prognosis saying she may never be able to write and will always struggle with gross and fine motor development. The mother said she was in hysterics after hearing this and it was only when she saw the physio who reassured her that she was doing well and making good progress that she didn't feel so concerned. From my perspective, I have seen many children who are far more delayed than this little girl and I think it was unecessary of the doctor to blow the situation out of proportion. Although it is important to ensure parents understand the condition and potential risks, I don't think this was the best way to help the family.

Week 5: Entry 1

A day of torticollis for me today which has been an excellent opportunity for me to reinforce my knowledge and understanding of the condition, as well as compare different babies and families of similar age. I was able to perform an assessment of one client but I don't think that I did a very good job as I didn't realise the physio wanted me to perform the whole thing so I was just prompted through it. However it was a good learning experience for me and I also wrote up the reports for the children I saw as well. I think that my handling skills still require some perfecting and I also need to improve in being able to read a baby to know if they are about to start crying or when they are crying, how long before they can get a cuddle with mum. All of this will come with practice and I hope as my final week continues I will be able to handle more babies.

As well as assessing the babies I have learnt it is also important to get an idea of the mother and how their coping with their new baby, and also any family issues that me be impacting on the situation. If concerned about issues or conditions such as post natal depression, there is the possibility to refer to social work within the SCDC. Even if you just get a sense that something is not quite right then best to review the child to get a better idea and understanding.

Week 4: Entry 3

Friday was an interesting day with not much to reflect on. It was meant to be a full on clinical day with 4 new patient assessments to be done but unfortunately all clients cancelled or didn't show up. However I did get the chance to star in a video presentation of the new Movement ABC 2 assessment tool for kids aged 4-16yrs. My supervisor is using the video to explain the tool to physios at an upcoming conference she is presenting at. It was a good oppurtunity for me to learn the tool as well as I havn't had the chance to use it on my placement. It is used by physios and OTs as it has a manual dexterity component as well as gross motor. It is hoped that this tool will become a standard assessment across paediatric physios as a baseline and then measure of progress. It is limited in that the tests do not adequately represent all components of gross motor skills however has been standardised and can give a percentile rank that the child is achieving compared to other 'normal' children of their same age.

Week 4: Entry 2

Today I saw my client who I am doing my SOAPIER for the 3rd time. He is 20mth old with history of chronic renal failure from birth. He is an incredibly petite child who is very weak and dependent on his mum. When we first saw him he was bunny hopping, not crawling, and not pulling to stand but would pull to 2 pt kneeling. However today, after home exercises and physio that promoted increasing strength especially in upper limbs, the movement experience of pull to stand via 1/2 kneel and improving his endurance, he was stepping for the first time when held in standing at his arms. Although he is still very weak, he is also trying to pull himself into standing and will take more weight on his ULs in 4pt kneeling although greatly resists it.

He is a very difficult child to treat as he cries and screams with all activities and will strongly extend his neck and body to get out of a challenging position. He would be the baby that is the most resistive to physio sessions, which may be impacted on by his severe medical history. Mum is very understanding of the importance of physio for him and will take in all exercises you give her and ask if she can have a turn so she know's she is doing them right. I admire her perserverance as she has been through so many hard times with him and is constantly seeing different allied health professionals.

Although I am not performing the exercises with him, I have learnt a lot being able to observe the sessions and also get the continuity of seeing him a few times and the changes that occur in a week. Although most babies will crawl before the walk, the main goals for this little fella is to get him pulling to stand and cruising then walking and then later in a year or so come back to crawling when he has greater overall strength and endurance.

Week 4: Entry 1

Yesterday I hope the distressing experience of taking a 10mth baby for a physio treatment session who just didn't want to be there. From the minute he left his mums arms he was crying and complaining even though I know that it wasn't hurting him. At first I gave him a bit of a break after one exercise to improve 4 point kneeling as he was screaming even more but my supervisor said to keep pushing him. I was doing the exercises correctly but I found it difficult at time to get the best handling of the baby to facilitate or restrict his movements. I am however feeling more confident about where my hands need to be for things such as practicing sit to 4 pt kneel and sit-4 pt kneel-2pt-1/2 kneel-pull to stand, it's now just a matter of practice for me to get them in the right position at the right time.

Another aspect of this treatment I found difficult was continuing to do activities as he complained more and more, screaming and at times resisting my movements. Although I have observed many sessions were babies are crying and very unhappy, I underestimated the difficulty of not giving in to the childs complaints. By the end of the session I found I was more able to block out the wild cries and just focus on my own handling to facilitate optimal movement patterns. Building up my own resilience to unhappy children is an important aspect to master to provide the best treatment and make the most of your time with the child.

I was able to reflect on the session further as I wrote up the ongoing notes for the child in SOAPIER format. I found this very helpful to think through exactly what the activities were for and what other areas may need to be addressed next time. However, I do need to try and improve on the amount of time I take to write out the ongoing and be confident in my notes. Both of these I know will just take some more practice.