"For many stroke survivors and their families, the real work of recovery begins after formal rehabilitation. One of the most important tasks of a rehabilitation program is to help those involved to prepare for this stage of recovery" (Gresham et al, 1995, p143).
Ive never recieved therapy of any kind in my own home. And I havent spent any time as a patient in a hospital since I was 4. But if I had to choose between the two I would pick therapy in my own home. Community OT, Ive found as a student is intense. From the outside looking in, it looks simple. Before placement I always read up on what roles to expect and what kind of workload etc. I always go into each placement gearing to just jump in. Entering community therapy was tricky for me. Working relationships are different between client and therapist, theyre closer. Interdisciplinary relationships between colleagues was the norm. I observed far more emotional investment in this context that I did at my hospital placement. I was gobsmacked how my supervisor could turn simple chitchat and a cup of tea into a simple and straightforward home assessment, to then later look at the notes and see details that were incrediably expansive and I remember thinking, "how did she get all that information from what I just saw?"
Observation and interpersonal skills need to be very much honed in this context, among other things. In a qualitative study on the perception of community occupational therapy, participants with hemiplegia rated these things to have a positive affect: convenience, therapeutic environment, social contact and control (Stephenson & Wiles, 2000).
Although most individuals who have had a stroke improve in basic functional abilities such as self cares, activities in the home and walking, a lot still have limitations in getting back their their original social role. Again, from my teeny tiny scope of student experience I found that men were more unhappy with recovery in the home. When I asked them what they wanted I got, "I want to go back to work." Going back to work was a huge motivating factor that can spur both men and women on. As an occupational therapist (soon to be), that doing is integral to human life. It is what makes us - us. Our doing gives us our role, our efficacy, it affects our body both positively and negatively, it affects future generations as well. To some people their job is tied in with their wellbeing. Helping them get there sounds almost cliched yet a wonderful kind of occupational therapy.
References
Gresham, G. E., Duncan, P. E., Stason, W. B., Adams, H. P., Adelman, A. M., Alexander, D. N., Bishop, D. S., Diller, L., Donaldson, N. E. Granger, C. V., Holland, A. L., Kelly-Hayes, M., McDowell, F. H., Myers, L., Phipps, M. A., Roth, E. J., Siebens, H. C., Tarvin, G. A., & Trombly, C. A. (1995). Post stroke rehabilitation. Clinical Practice Guideline 16. (AHCPR Publication 95-0662). Rockville, MD: United States Agency for Health Care Policy and Research.
Stephenson, S., & Wiles, R. (2000). Advantages and disadvantages of the home setting for therapy: views of patients and therapists. British Journal of Occupational Therapy, 63(2), 59-64.
Sunday, September 5, 2010
Friday, September 3, 2010
Compensatory techniques
While on my 4th placement (neuro rehab) I often had clients who had hemiplegia or hemiparesis. After a couple of seperate sessions I had with two male clients (one a stroke survivor and the other had MS) I noted both of their opinions toward dressing. They both had a high regard for indepedence, and told me of their multiple frustrations of tying their shoes in a way that was presentable, easy to administer strong during wear and easy to undo. This piqued my curiosity and I asked my supervisor if there were any resources to do with techniques for tying shoelaces one handed. There were a few pictorial examples which I showed to my clients and as a joint session the three of us trialled this version. I was the only one to achieve the paper version. This would not do. And I felt I really need to know a method really well in order to confidently assist them.
I found a video similar to this and asked permission to access youtube during work hours for my clients. I practiced the technique at home multiple times. I remember it took both men about 4 sessions to master this skill and they were really pleased with the results. So was I.
In society, shoelace tying is a milestone often associated with child development. We may not often look at a person's shoes, but to these men, the ability to independently tie their shoelaces was very important and was a skill that also encouraged hand and finger dexterity and tactile perception. It increased their motivation and self efficacy and gave me (the student) a teaching AND learning opportunity.
I found a video similar to this and asked permission to access youtube during work hours for my clients. I practiced the technique at home multiple times. I remember it took both men about 4 sessions to master this skill and they were really pleased with the results. So was I.
In society, shoelace tying is a milestone often associated with child development. We may not often look at a person's shoes, but to these men, the ability to independently tie their shoelaces was very important and was a skill that also encouraged hand and finger dexterity and tactile perception. It increased their motivation and self efficacy and gave me (the student) a teaching AND learning opportunity.
Hemiplegia and the shoulder
Shoulder dysfunction is a common post CVA complication. In the acute phase the hemiplegic upper limb is often flaccid, and unless properly positioned and handled during this crucial period, subluxation and joint malalignment can occur (Roy, Sands, & Hill, 1994).
Neurological recovery is most often very rapid in the first three months but continues throughout the first year and beyond. Because of its rapid pace, acute assessment and intervention is very important in predicting future outcomes with recovery.
Relevance to Occupational Therapy
A patient is referred to occupational therapy because of deficits in the performance areas of activities of daily living (ADL's), work and leisure. The assessment and evaluation process identifies the underlying components (sensorimotor, cognitive, phychosocial) and contextual factos that limit functional performance (Van Dyck, 1999). In the case of the hemiplegic shoulder, only neuromuscular skeletal aspects are looked at in the acute phase. Upperlimb (shoulders, arms & hands) mobility has an important focus to the occupational therapist as it is essential for the basic completion of ADL's. While physiotherapists typically focus on the same performance components but usually in relation to the lower limbs and improving the patient/client's general energy levels. This is why occupational therapists and physiotherapists share such a close working relationship. Walking and improving one's physical endurance after a CVA as well as regaining functional skills are placed in high regard by the patients/client's as well as the health professional. When people ask me for a basic comparison of skill definition between the two groups that is what I usually give. I know that it is generally a stereotypical casting of two professions but it is based on my student experiences. I personally view physiotherapy as like a sibling to OT in the world of allied health.
As stated before, hemiplegia is a common side effect of a CVA. So is unilateral neglect. I will mention this briefly and how it affects recovery in the upper limb after a stroke. Unilateral neglect is a neuropsychological condition which occurs when damage (eg by a stroke) is done to the right cerebral hemisphere side of the brain. This causes a visual perceptual deficit where the person becomes unaware of that side of their body (Menon-Nair, Korner-Bitensky, Wood-Dauphinee & Robertson, 2006). To a client the left side of their body will not exist to them. For example they will bump into things, shave one side of their face (even if their looking in a mirror), or when asked to draw a clock may draw a circle then put all the numbers on one side. Add this side affect to hemiplegia and you've got a recipe where the most robust joint in the body (shoulder) is weak, or heavy or worse ignored due to impaired perception. Add in gravity which naturally pulls us towards the ground. If the shoulder joint is not protected or used during the acute period then deconditioning, pain, immobilization, contractures and subluxation occurs. Contactures are when the muscles and skin around the ground shorten, making full range of motion painful and near impossible. Subluxation is where the muscles and tendons protecting the shoulder girdle weaken against gravity and the humerus bone slowly and painfully dislocates. I saw this once on a client where their clavicle was raised and their arm was just hanging there. There was also this reasonably sized dent in their shoulder that was big enough to stick my finger in (though of course I didnt).
Heres an exemplar picture of a subluxed shoulder:
So what does an OT do?
For a definition on the service of occupational therapy please click here
References
Menon-Nair, A., Korner-Bitensky, N., Wood-Dauphinee, S., & Robertson, E. (2006). Assessment of unilateral spatial neglect post stroke in Canadian acute care hospitals: are we neglecting neglect? Clinical Rehabilitation, 20, 623-634.
Roy, C., Sands, M. R., & Hill, L. D. (1994). Shoulder pain in acutely admitted hemiplegic's. Clinical Rehabilitation, 8(4), 334-40.
Van Dyck, W. R. (1999). Integrating treatment of the hemiplegic shoulder with self care. OT Practice, 31(1), 32-37.
Picture of cat. Retrieved from http://thenonist.com/index.php/annex/permalink/hemispatial_neglect/ on 04/09/10. Site last updated on 04/09/10.
Neurological recovery is most often very rapid in the first three months but continues throughout the first year and beyond. Because of its rapid pace, acute assessment and intervention is very important in predicting future outcomes with recovery.
Relevance to Occupational Therapy
A patient is referred to occupational therapy because of deficits in the performance areas of activities of daily living (ADL's), work and leisure. The assessment and evaluation process identifies the underlying components (sensorimotor, cognitive, phychosocial) and contextual factos that limit functional performance (Van Dyck, 1999). In the case of the hemiplegic shoulder, only neuromuscular skeletal aspects are looked at in the acute phase. Upperlimb (shoulders, arms & hands) mobility has an important focus to the occupational therapist as it is essential for the basic completion of ADL's. While physiotherapists typically focus on the same performance components but usually in relation to the lower limbs and improving the patient/client's general energy levels. This is why occupational therapists and physiotherapists share such a close working relationship. Walking and improving one's physical endurance after a CVA as well as regaining functional skills are placed in high regard by the patients/client's as well as the health professional. When people ask me for a basic comparison of skill definition between the two groups that is what I usually give. I know that it is generally a stereotypical casting of two professions but it is based on my student experiences. I personally view physiotherapy as like a sibling to OT in the world of allied health.
As stated before, hemiplegia is a common side effect of a CVA. So is unilateral neglect. I will mention this briefly and how it affects recovery in the upper limb after a stroke. Unilateral neglect is a neuropsychological condition which occurs when damage (eg by a stroke) is done to the right cerebral hemisphere side of the brain. This causes a visual perceptual deficit where the person becomes unaware of that side of their body (Menon-Nair, Korner-Bitensky, Wood-Dauphinee & Robertson, 2006). To a client the left side of their body will not exist to them. For example they will bump into things, shave one side of their face (even if their looking in a mirror), or when asked to draw a clock may draw a circle then put all the numbers on one side. Add this side affect to hemiplegia and you've got a recipe where the most robust joint in the body (shoulder) is weak, or heavy or worse ignored due to impaired perception. Add in gravity which naturally pulls us towards the ground. If the shoulder joint is not protected or used during the acute period then deconditioning, pain, immobilization, contractures and subluxation occurs. Contactures are when the muscles and skin around the ground shorten, making full range of motion painful and near impossible. Subluxation is where the muscles and tendons protecting the shoulder girdle weaken against gravity and the humerus bone slowly and painfully dislocates. I saw this once on a client where their clavicle was raised and their arm was just hanging there. There was also this reasonably sized dent in their shoulder that was big enough to stick my finger in (though of course I didnt).Heres an exemplar picture of a subluxed shoulder:
So what does an OT do?
- (Re)Education: This starts the minute the client/patient is medically stable and carries through all the way to community services. Eg Involving the impaired side in tasks, educating and reinforcing medical staff on preventative positioning, slow upper body rolling, positioning of shoulder/arm while sitting, indorsing symmetrical standing.
For a definition on the service of occupational therapy please click here
References
Menon-Nair, A., Korner-Bitensky, N., Wood-Dauphinee, S., & Robertson, E. (2006). Assessment of unilateral spatial neglect post stroke in Canadian acute care hospitals: are we neglecting neglect? Clinical Rehabilitation, 20, 623-634.
Roy, C., Sands, M. R., & Hill, L. D. (1994). Shoulder pain in acutely admitted hemiplegic's. Clinical Rehabilitation, 8(4), 334-40.
Van Dyck, W. R. (1999). Integrating treatment of the hemiplegic shoulder with self care. OT Practice, 31(1), 32-37.
Picture of cat. Retrieved from http://thenonist.com/index.php/annex/permalink/hemispatial_neglect/ on 04/09/10. Site last updated on 04/09/10.
Thursday, September 2, 2010
Hemiplegia & Acute Services
So this is going to be the first of a few posts I would like to make in relation to stroke recovery. Because the implications of a stroke are so varying and many, I have chosen to stick with hemiplegia because of its relevance to occupational therapy and because it is probably the most common disability (due to stroke) I have worked with as a student.
Hemiplegia is originally a Greek word, "hemi" meaning half and "plegia" meaning paralysis. It is a common side affect after a CVA where if a lesion occurs on the right side of the brain, the paralysis will be on the left side. And if the lesion is on the left side of the brain then the same for the right side of the body (namely the head, arm and leg of that side). Hemiplegia is similar to another condition called hemiparesis, but it is far more serious. Hemiparesis is usually characterized by one side of the body that is affected not by paralysis, but by a less severe state of weakness.
In acute services, care is focus on diagnosing the the cause, the type of CVA, and the site in order to prevent further lesion progression, secondary medical complications and the treatment of acute neurological symptoms (Trombly Latham & Radomski, 2008). Intervention in an intensive care unit is usually of the pharmacological and surgical kind. During my 3rd placement, I heard about a few drugs that are used for ischemic strokes: aspirin, heparin and warfarin. Out of curiosity I perused a nurse's drug guide and discovered these drugs are commonly used as a blood thinner which restores flow of oxygen and prevents further damage. Once a client/patient is in a stable condition they are then transferred to the acute neurological ward. In a qualitative study done in Australia to define the role of occupational therapy in acute neurology, participants stated that after head injuries, strokes were the most common diagnosis on their caseload (Griffin, 2002).
In relation to hemiplegia these outcomes in acute services are described as:
References
Griffin, S. (2002). Occupational Therapy Practice in Acute Care Neurology and Orthopaedics. Journal of Allied Health, 31(1), 35-42.
Woodson, A. M. (2008). Stroke. In M. V. Radomski, & C. A. Latham Trombly. Occupational Therapy for Physical Dysfunction (pp1001-1041). Baltimore, MD: Lippincott Williams & Wilkins.
Hemiplegia is originally a Greek word, "hemi" meaning half and "plegia" meaning paralysis. It is a common side affect after a CVA where if a lesion occurs on the right side of the brain, the paralysis will be on the left side. And if the lesion is on the left side of the brain then the same for the right side of the body (namely the head, arm and leg of that side). Hemiplegia is similar to another condition called hemiparesis, but it is far more serious. Hemiparesis is usually characterized by one side of the body that is affected not by paralysis, but by a less severe state of weakness.
In acute services, care is focus on diagnosing the the cause, the type of CVA, and the site in order to prevent further lesion progression, secondary medical complications and the treatment of acute neurological symptoms (Trombly Latham & Radomski, 2008). Intervention in an intensive care unit is usually of the pharmacological and surgical kind. During my 3rd placement, I heard about a few drugs that are used for ischemic strokes: aspirin, heparin and warfarin. Out of curiosity I perused a nurse's drug guide and discovered these drugs are commonly used as a blood thinner which restores flow of oxygen and prevents further damage. Once a client/patient is in a stable condition they are then transferred to the acute neurological ward. In a qualitative study done in Australia to define the role of occupational therapy in acute neurology, participants stated that after head injuries, strokes were the most common diagnosis on their caseload (Griffin, 2002).
In relation to hemiplegia these outcomes in acute services are described as:
- Thorough assessment in order to a. make a timely and appropriate referral to rehabilitative and/or community services if necessary and b. establish the patient's baseline performance in order to plan & prioritise intervention, and to help MDT in organising appropriate discharge planning.
- Assisting the patient to reach highest level of independence (re self care & functional activities)
- Prevent/reduce occurrence of deformities that will have an impact on the aforementioned.
- Establish, maintain & improve functional upper limb movements
- Provide education to patient and/or family members on compensatory techniques and aides.
References
Griffin, S. (2002). Occupational Therapy Practice in Acute Care Neurology and Orthopaedics. Journal of Allied Health, 31(1), 35-42.
Woodson, A. M. (2008). Stroke. In M. V. Radomski, & C. A. Latham Trombly. Occupational Therapy for Physical Dysfunction (pp1001-1041). Baltimore, MD: Lippincott Williams & Wilkins.
Sunday, August 29, 2010
Circulatory and Nervous Systems: Part 2
As shown above in the video, a stroke may occur when there is insufficient blood flow to the brain. What we have found out in the previous thread is that, its not the blood that the brain necessarily needs, its the oxygen that it carries. So when blood flow is blocked, so too is the incoming oxygen. As stated there are three different kinds of strokes:
- Ischemic: One of which is an embolic stroke where a blood clot (called an embolus) forms anywhere in the circulatory system then travels up to the brain and causes damage when it reaches a vessel that is too small to travel though thus creating a blockage. The second being a thrombotic stroke, where due to a disease called atherosclerosis (fatty) plaque can build up in the blood vessels and block any thoroughfare for oxygenated blood, OR the plaque breaks off from the vessel wall and travels elseware (again usually the brain) and forms another blocked entrance.
- Haemorrhagic: One type can be a intra-cerebral haemorrhage where a blood vessel in the brain bursts and blood is leaked into the brain tissue and can cause further damage while pressure in the tightly spaced skull cavity forces the blood to spread to other areas causing more damage. The second kind is a sub-arachnoid haemorrhage where a weakness in the blood vessel forms a weak bubble (aneurysm) in the vessel wall which again may burst and contaminate the brain fluid causing damage.
Monday, August 23, 2010
The Circulatory and Nervous Systems: Part 1
In order to assess, treat and evaluate clients recovering from a stroke, as an occupational therapist (or any health professional for that matter), I need to have a clear understanding of the human systems and its 'normal' physiological patterns in order to recognise when and how 'abnormal' changes occur. Like our galaxy, the human body is also made up of systems. The systems that I will be focusing on in this thread in relation to stroke are: the circulatory system and and the nervous system.
- Circulatory System: This system is the body's transport system. Like countries that have motorways, main roads, street roads, 4WD roads and tiny mountain tracks, our body's 'roads' are run by organs which transport and distribute blood. The biggest organ that runs this show is the heart. The heart is made up of valves that pump the blood. Oxygen rich blood leaves the heart via a huge artery called the aorta which then pumps it to smaller and smaller arteries throughout the body and eventually blood vessels. These vessels are our capillaries which is found in our body tissue. The capillaries then distribute the oxygen and nutrient rich blood to our cells and in return collects carbon dioxide, waste and water. The blood which by now no longer carries nutients etc is pumped back towards the heart through our veins. Our veins carry this blood back to our heart and into our lungs where it becomes re oxygenated (recycled) and waste is eliminated.
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| Heart |
- Central Nervous System: This consists of your brain and spinal cord. Like the circulatory system, the CNS also consists of 'roads'. Instead of blood, there are electrical pulses running with incredible speed between the brain and spinal cord to the peripheral system (nerves which connect to muscle and glands from the brain and spinal cord). The electrical nerve pulses send, receive and process messages. The spinal collumn and skull would then be viewed as a coat of armor to protect the brain and spinal cord. In the most simplest terms (or else I would be here all day), the brain holds approximately 100 billion nerve cells and looks a bit like a cauliflower (hahaha). Your brain is the multitasking command centre for your very own US Enterprise (your body). It integrates then dispatches necessary information on average 200 times a second in relation to everything that you are currently doing and everything you are about to do. The brain is made up of multiple sections that specifically provide information processing to all your key body systems as well as things like memory, personality/behaviour, cognition, emotions etc.
References
Picture of heart.Copyright to A.D.A.M Inc in http://www.google.co.nz/imgres?imgurl=http://graphics8.nytimes.com/images/2007/08/01/health/adam/19387.jpg&imgrefurl=http://health.nytimes.com/health/guides/specialtopic/physical-activity/exercise%27s-effects-on-the-heart.html&usg=__T_zj7OHubcI3PviZbRFdmajtBRk=&h=320&w=400&sz=62&hl=en&start=0&zoom=1&tbnid=OulHogNhHFJjeM:&tbnh=163&tbnw=203&prev=/images%3Fq%3Dthe%2Bheart%26um%3D1%26hl%3Den%26sa%3DN%26biw%3D1280%26bih%3D837%26tbs%3Disch:1&um=1&itbs=1&iact=rc&dur=992&ei=MgdzTLL2Hoj0swOmpYmhDQ&oei=oP1yTP6gNIXUtQPF-73_DA&esq=11&page=1&ndsp=24&ved=1t:429,r:14,s:0&tx=97&ty=80. On 24/08/10. Site updated on
Picture of veins/arteries. Taken from http://www.google.co.nz/imgres?imgurl=http://www.home-air-purifier-expert.com/images/circulatory-system.jpg&imgrefurl=http://www.home-air-purifier-expert.com/picture-gallery.html&usg=__OPEpNW9H5evfvSmGmWVSJiuHrx4=&h=313&w=249&sz=23&hl=en&start=103&zoom=1&tbnid=vutNzznSJgbt8M:&tbnh=169&tbnw=119&prev=/images%3Fq%3Dcirculatory%2Bsystem%26um%3D1%26hl%3Den%26biw%3D1280%26bih%3D837%26tbs%3Disch:10%2C3058&um=1&itbs=1&iact=rc&dur=468&ei=egVzTMCYOIyksQO1xZHBDQ&oei=NwVzTJmGA4a6sAP816iMDQ&esq=5&page=5&ndsp=25&ved=1t:429,r:12,s:103&tx=44&ty=92&biw=1280&bih=837. On 24/08/10. Site updated on 15/08/10.
Picture of brain, spinal cord and peripheral nerves. Taken from http://www.health.com/health/library/mdp/0,,tp10393,00.html. On 24/08/10. Site updated on 21/07/10.
Picture of peripheral system. Taken from http://www.google.co.nz/imgres?imgurl=http://www.buzzle.com/img/articleImages/271257-55223-53.jpg&imgrefurl=http://www.buzzle.com/articles/peripheral-nervous-system.html&usg=__BNrAWRBrriq5hh72kO568tUPVf8=&h=350&w=263&sz=26&hl=en&start=0&zoom=1&tbnid=bKGnHx3-ool1yM:&tbnh=134&tbnw=96&prev=/images%3Fq%3Dperipheral%2Bsystem%26um%3D1%26hl%3Den%26sa%3DN%26biw%3D1280%26bih%3D837%26tbs%3Disch:1&um=1&itbs=1&iact=rc&dur=438&ei=zRVzTJTvGof0swOww5SSDQ&oei=zRVzTJTvGof0swOww5SSDQ&esq=1&page=1&ndsp=37&ved=1t:429,r:25,s:0&tx=39&ty=69. On 24/08/10. Site updated on 24/08/10.
Saturday, August 7, 2010
My personal and professional history into neurology and occupational therapy
I grew up in Christchurch, New Zealand. What has regularly fed my interest in this area has ultimately been my mother. My mother is a registered nurse and has spent over a decade working in and studying neurology. While I spent the majority of my life being surrounded by nursing textbooks and diagrams of the brain and central nervous system and neurological assessments on the walls of our bathroom I did not show much of an interest in these matters until I was 16.
Growing up I loved connecting with people, finding out what is important to them and hearing their side of things (whatever that may be). And above all else, I loved to study - to learn. When I find out I am lacking information on something I feel uncomfortable. If someone asks me something and I do not know the answer, I make it my business to be honest, admit my gaps in knowledge and then learn so I can appropriately answer their question or refer them to someone whose knowledge and experience is far greater than mine. The more I learn the more I realise how little I know.
However, due to personal circumstances and my own personal humanity, I realised I didnt want to just tell people information and watch them struggle to understand. I felt that my personal history made me qualified to pass it forward. Then when I was 16, in the space of a fortnight I was told by three independent sources that I should study to become an occupational therapist. First, who I greatly respected throughout highschool was my physical education teacher, the second was the pastor of the church I was attending and thirdly a computer programe. It was one of those government endorsed career quizzes that asked questions then gave you a top three. My guidance counsellor had us take it three times, and every time, my number one was occupational therapy.
I spent the majority of my last year in highschool in the library or classroom. I had this invisible push to put myself into OT school, and it motivated me in a way that is hard to describe. To my joy, I passed all my high school courses with flying colours and got accepted into the school of occupational therapy. At 18 I moved to Dunedin knowing absolutely no one but being thoroughly excited as to what awaited me.
My first two years at tech were a steep learning curve but highly enjoyable at the same time. My openness to learn and seek constructive criticism grew more and my excitement to see my skills in the classroom used in practice was like a carrot constantly dangled in front of me.
My foray into neurological conditions started in my first year with my first placement, at an urban primary school. This I discovered was where the health system met with the education system and linked hands in a way. I learnt first hand the functional implications of cerebral palsy, spina bifida, hydrocephalus and a few others eg autism, learning disabilities etc. I quickly became acquainted with the speech therapist there and they took me under their wing along with my excellent supervisors.
My second placement was a longitudinal practicum where I visited a community agency once a week. The conditions were the same as my first placement except the client group were adults.
My second year had to be the most hectic period I'd ever experienced in my life. I had two placements that year as well completing six papers for each semester. The first practical was at a busy hospital with a large acute OT team and I was frequently moved between the medical, orthopaedic and neurological wards. Learning in this fast paced environment was rewarding and a lot of my first year naivete's and fears were put to the test. I was very uncomfortable at the beginning of the placement as the experience was like having to bungee jump blind folded. But then, I love bungee jumping. It was a healthy kind of uncomfortability. As my spiritual convictions tell me, its like being pruned. Painful but at the end of the day it was for my own benefit.
Later in the year I was placed at in an outpatient rehabilitation clinic in the city. I took what I learned from tech and my acute placement and applied it again. In this placement I learnt a huge amount about degenerative diseases in particular multiple sclerosis, parkinsons disease and motor neurone disease. I also closely worked with those who were recovering from a stoke (Cerebral Vascular Accident) as well as traumatic brain injuries (TBI). At this point, strokes began to fascinate me. I enjoyed listening to the clients and their stories and working with them in making goals and planning intervention with them. My supervisors hooked me up with some excellent reading material and by the time I went home for the holidays I started reading my mum's textbooks and paying closer attention to the weird pictures of brains in our house.
My fifth placement was with a community occupational therapy team, who although were based at a hospital spent the majority of their time with clients in their homes. Here was my first experience with clients who had multiple (and very complicated) diagnoses. This work environment was also the first time I worked at an interdisciplinary capacity. While the medical model definitely felt like a taboo compared to working in the hospital, the relationships with medical colleagues were still extraordinarily strong as well as with other allied health professionals. Making the house fit the clients (and their family's) needs to become a home was very important. Intervention was very often compensatory due to the level and type of disability. During this time I familiarized myself with the Maori model of health and began to agree with its points especially when involved with the social and spiritual needs of the clients and their importance.
I am pleased with the amount of learning I have achieved since high school. Though I have cried a lot at my own frustrations I have also smiled a lot. I still love talking to people - that will never change. I have also learnt when to be quiet, and to know that that in itself is therapeutic, not just for clients but for myself as well.
My growth into this richly contextual work is ever widening. Multiple sclerosis and cerebral vascular accidents still remain a special area of learning for me. And for this blog I wish to focus on the ever complicating nature of the stroke.
My goal is:
Growing up I loved connecting with people, finding out what is important to them and hearing their side of things (whatever that may be). And above all else, I loved to study - to learn. When I find out I am lacking information on something I feel uncomfortable. If someone asks me something and I do not know the answer, I make it my business to be honest, admit my gaps in knowledge and then learn so I can appropriately answer their question or refer them to someone whose knowledge and experience is far greater than mine. The more I learn the more I realise how little I know.
However, due to personal circumstances and my own personal humanity, I realised I didnt want to just tell people information and watch them struggle to understand. I felt that my personal history made me qualified to pass it forward. Then when I was 16, in the space of a fortnight I was told by three independent sources that I should study to become an occupational therapist. First, who I greatly respected throughout highschool was my physical education teacher, the second was the pastor of the church I was attending and thirdly a computer programe. It was one of those government endorsed career quizzes that asked questions then gave you a top three. My guidance counsellor had us take it three times, and every time, my number one was occupational therapy.
I spent the majority of my last year in highschool in the library or classroom. I had this invisible push to put myself into OT school, and it motivated me in a way that is hard to describe. To my joy, I passed all my high school courses with flying colours and got accepted into the school of occupational therapy. At 18 I moved to Dunedin knowing absolutely no one but being thoroughly excited as to what awaited me.
My first two years at tech were a steep learning curve but highly enjoyable at the same time. My openness to learn and seek constructive criticism grew more and my excitement to see my skills in the classroom used in practice was like a carrot constantly dangled in front of me.
My foray into neurological conditions started in my first year with my first placement, at an urban primary school. This I discovered was where the health system met with the education system and linked hands in a way. I learnt first hand the functional implications of cerebral palsy, spina bifida, hydrocephalus and a few others eg autism, learning disabilities etc. I quickly became acquainted with the speech therapist there and they took me under their wing along with my excellent supervisors.
My second placement was a longitudinal practicum where I visited a community agency once a week. The conditions were the same as my first placement except the client group were adults.
My second year had to be the most hectic period I'd ever experienced in my life. I had two placements that year as well completing six papers for each semester. The first practical was at a busy hospital with a large acute OT team and I was frequently moved between the medical, orthopaedic and neurological wards. Learning in this fast paced environment was rewarding and a lot of my first year naivete's and fears were put to the test. I was very uncomfortable at the beginning of the placement as the experience was like having to bungee jump blind folded. But then, I love bungee jumping. It was a healthy kind of uncomfortability. As my spiritual convictions tell me, its like being pruned. Painful but at the end of the day it was for my own benefit.
Later in the year I was placed at in an outpatient rehabilitation clinic in the city. I took what I learned from tech and my acute placement and applied it again. In this placement I learnt a huge amount about degenerative diseases in particular multiple sclerosis, parkinsons disease and motor neurone disease. I also closely worked with those who were recovering from a stoke (Cerebral Vascular Accident) as well as traumatic brain injuries (TBI). At this point, strokes began to fascinate me. I enjoyed listening to the clients and their stories and working with them in making goals and planning intervention with them. My supervisors hooked me up with some excellent reading material and by the time I went home for the holidays I started reading my mum's textbooks and paying closer attention to the weird pictures of brains in our house.
My fifth placement was with a community occupational therapy team, who although were based at a hospital spent the majority of their time with clients in their homes. Here was my first experience with clients who had multiple (and very complicated) diagnoses. This work environment was also the first time I worked at an interdisciplinary capacity. While the medical model definitely felt like a taboo compared to working in the hospital, the relationships with medical colleagues were still extraordinarily strong as well as with other allied health professionals. Making the house fit the clients (and their family's) needs to become a home was very important. Intervention was very often compensatory due to the level and type of disability. During this time I familiarized myself with the Maori model of health and began to agree with its points especially when involved with the social and spiritual needs of the clients and their importance.
I am pleased with the amount of learning I have achieved since high school. Though I have cried a lot at my own frustrations I have also smiled a lot. I still love talking to people - that will never change. I have also learnt when to be quiet, and to know that that in itself is therapeutic, not just for clients but for myself as well.
My growth into this richly contextual work is ever widening. Multiple sclerosis and cerebral vascular accidents still remain a special area of learning for me. And for this blog I wish to focus on the ever complicating nature of the stroke.
My goal is:
- For you as the reader and explorer of this blog to understand more about this diagnosis and its functional implications in life.
- To gain a further understanding of the role of occupational therapy in stroke rehabilitation.
- To allow an avenue of professional development in the form of reflection, prior to my registering as an occupational therapist next year.
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