STARES 2

SITUATION

I have conducted an initial assessment for a 10mo boy; referred to PMH outpatient physiotherapy for suspected overgrowth syndrome leading to gross motor delay. From this assessment I was able to analyse my objective findings to reveal the child’s impairments and participation restrictions. The child presented with disproportionate features; large hands, head and feet though a relatively small trunk. This gave rise to difficulties with head and trunk control, which further led to difficulties in development of gross motor functions. In collaboration with the mothers previously stated goals from physiotherapy and my own goals for treatment I was then able to construct a treatment plan for our next appointment. The treatment was to involve a significant amount of trunk activation work as well as practicing transitions and other movement patterns.

TASK

To conduct an effective and appropriate treatment session for the above-mentioned young boy.

ANALYSIS

The young boy presented for treatment a few days following his initial assessment. On this day he had not slept as of yet and was quite temperamental. After attempting for some time to build trust with the child and engage his attention, I soon found that my treatment was not effective in motivating him to do what I had planned. As a result I had to modify my treatment plan and utilise the mother to assist me in carrying out my treatment.

RESULT

As a result of this modification, the mother felt more involved in the physiotherapy session and I was able to demonstrate to her strategies that she could use at home. She was also able to get a better perception of when the young boy was responding correctly and where he needed additional support.

EVALUATION

The treatment session didn’t go entirely to plan and a lot of ideas that I had weren’t able to be used, though I feel being flexible and able to effectively instruct the mother through the treatment session worked as an advantage and a strength. I did initially falter under the additional pressure to change the treatment and work with a child that is less willing to participate, though with experience I’m sure this will gradually become less of an issue. At this stage I still feel anxious around children who are upset and to a degree would feel uncomfortable in resuming treatment or assessment. Again this is something that my supervisor has re-assured me, comes with experience in working with children.

STRATEGIES

Flexibility and adaptability. Also having a wide variety of treatment methods that achieve the same outcome as children have different preferences to games, toys, directions of movement, heights, colours, sounds etc. Incorporate family members into treatment to improve child cooperation and family involvement. Family centered practice being the main goal of Physiotherapy.

STARES 1

Situation:

The dynamics of a physiotherapy session involving a paediatric patient differs greatly from other physiotherapy sessions. Rather than patient centered, you are centering around the family unit, which can extend to friends, neighbours, grand parents etc. Within an initial assessment, family relationships, capabilities, strengths and weaknesses have to be analysed as well as the specific abilities and impairments of the child and their interaction with the family.

Task:

I am to undertake an assessment with a patient that I have not yet met. This assessment involves an AIMS and age appropriate NSMDA, as well as any other informal observations and subjective information gathered throughout the session. This review assessment is to re-evaluate where the child is at and if there has been any changes. Attending the session was the 12month old child, mother and father.

Action:

Initially I had conversations with the mother and father about their home environment, what they have been doing at home, how they felt their child was progressing and what they are concerned about. I then turned my attention to the child who I disrobed and began my formal assessment.

Result:

From the subjective information gathered from the parents, the informal observations and the formal observations of the child I was able to get all the information required to complete a comprehensive SOAPIER and the AIMS and NSMDA assessment forms.

Evaluation:

I felt the session ran smoothly but wasn’t very efficient. By the end of the session the child was quite worn out and was less co-operative. The main factor that impacted the efficiency of my assessment was that I was unfamiliar with the NSMDA entirely and quite often needed to repeat movements and postures to capture the child’s capabilities. After voicing my concern to my supervisor, she was able to give me valuable advice on how to conduct such a session.

Strategies:

On my next assessment, I will review the NSMDA fully prior to assessment, as well as being thoroughly observant of the child’s movements etc. My supervisor advised that rather than leaving the child in the mothers arms while talking to the parents, get the child undressed and watch their movements as you talk. Feel tone while undressing and roughly gauge ROM and strength. By doing it this way you are able to gain valuable information from the parents as well as from the child. The session becomes more efficient and shorter and the child is co-operative for the entire session.

Initial Entry - PMH

On finding out that I would be heading to Princess Margaret Hospital for my initial placement I was excited. Peadiatric Physiotherapy is an area I am largely interested in and at this point, have every intention of pursuing this as my future career. From my personal perspective, I feel children benefit so much more from input given and families are largely involved and open to wide varieties of treatment so you are able to experiment with different techniques, games, combinations etc. Also making every session as enjoyable as possible to motivate the child to participate is half the fun. I enjoy the energy children have and enjoy being around children. With past experience in working with children and children with a variety of disabilities I am thoroughly looking forward to expanding my experiences and knowledge in this area. PMH is solely dedicated to the treatment of children and teenagers, which will give me a good perspective on most fields of their care.

After contacting the coordinator at PMH I was informed that my placement will incorporate a variety of treatment settings.

My expectations for this placement are:

• Seeing patients in the inpatient and outpatient setting.
• Incorporating a lot of Hydrotherapy into treatment sessions as this is very useful and enjoyable for kids.
  
• Employing a family centered approach to care. Involving parents, siblings, other family members as well as the child into the goal setting and choice of treatment.
• Seeing a variety of conditions/impairments including musculoskeletal, neurological, cardiorespiratory etc.
• Will have exposure to a variety of children at different stages of development; from premature infants to teenagers.
• Also conducting group classes / sessions. (I was made aware that one afternoon I will be running a class with preterm infants and their parents)

My role as a student will be to integrate myself into the multidisciplinary team at PMH, utilise their expertise to learn and apply my knowledge to create ideal treatment sessions for my patients.

Concerns about this placement include:

• Emotional attachment - I think initially I will need to adjust to the setting and will be working on mental strengthening to be able to survive seeing innocent children in pain and difficulty.
• Communicating with families in regards to treatment strategies and likely outcomes. This will be a fairly new experience and I hope I am able to appropriately discuss their child's care so that they are confident in my abilities.
• Parents generally want the best treatment for their child. Coming as a student with little clinical experience, I hope I am able promote myself well and not disappoint.
• From students who have already had this placement, I heard that they are highly supervised and spend a lot of time observing. Hands on is what I am after so I hope the opportunities are there.
  

Overall I think this placement will be a challenging but highly beneficial experience and I can't wait.