I haven’t seen a discharge yet as of this date. My last day will be this Thursday and I will ask again about it. I observed a client with R wrist/elbow tenosynovitis. I asked if it was inflammation of the tendon and the COTA directed me to look it up. When I did, it stated “Inflamation of the tendon sheath”…. I observed Iontophoresis, MFR, wrist joint mobs, and R scapular mobs. <–another new diagnosis I had not seen before. The next client was a CVA with visual and coordination deficits (L). We worked on the pipe tree, and the connect 4 game, —–we also worked on left side awareness….the COTA sat on his left and placed items for him to grab on his left. the LE lymphedema patient was next to be seen and is progressing with treatment. I have found that if clients do not do their home exercise programs, their chances of getting better are not good at all. This is something that we have to stress to our clients. We don’t want them to over do…. just do.
I can’t believe Thursday will be my last day at COOR. I am going to miss it!!
On the 15th of May, I went to Columbus with a few other students, OT’s and OTA’s. It was OT Advocacy Day at the Statehouse. For the first few hours, we sat and listened to Marc Shaffer (President of OOTA), State Rep. John Carney, Jeff Rosa (Executive Director OTPTAT Board), and a woman from Capital Consulting Group who has been helping OOTA with matters in the Statehouse. They talked about what was up and coming in OT. We then had lunch and then we finally went to talk to the Reps about Occupational Therapy. We talked to Troy Balderson first and he was a very funny, talkative man. After discussing OT with him, we then went and talked to two aids (the representatives were in meeting). I think it was a very productive and interesting day since I have never been to anything like it before.
On thursday (21st) I observed five clients with their therapy. The first client had the scaphoid extraction and partial fusion (talked about in an earlier blog). He complained about pain between his shoulders—they let him borrow a theracane. This piece of equipment is a cane with knobs on it. The client can use it for MFR (myofacial release)–a type of massage to ease the pain of tight muscles. the second client was the LE lymphedema (also discussed in an earlier blog). His LE is now more softer than I have seen in the past, which means that therapy is working!! Such a good thing to see!! The next client suffered a CVA. She had loss of balance 2x during the session, poor balance was not marked in her file, so we marked it in the SOAP note. Client #4 had R elbow surgery. She needed help with AROM of the elbow. We did manual stretching with her while she was supine. She used ice after session to elevate pain. Client #5 was a TBI with a R UE spacistity. She has splints that need adjustment but has not brought them in (Darn!!) I would like to see this!! I was able to see e-stim therapy on her though.
I can’t believe it is almost week 9….I am learning so much from my fieldwork facility that I actually don’t want this quarter to be over.
S: I saw many different diagnosis this week. Was able to pick activities for clients. Saw how Iontophoresis was used. Working on making a folder for all the information I am learning at fieldwork.
O: I worked on SOAP notes, performed joint stretches on a client with Gout (Tophi excision), picked activites for client therapies, working on a Fieldwork folder.
A: Becoming more proficient in writing notes. I feel more comfortable in doing joint stretches on clients and picking what type of activity to use for therapy.
P: I plan on working with as many clients as possible before this experience ends.
This week I observed three CVA clients, a lymphedema client, a RA client with pain in both hands, a client with both shld frozen, a lateral epicondylitis client, a L wrist s/p scaphoid extraction and partial fusion client, a gout excision with multiple tophi on R hand/forearm client, an OA-CTS-fibormayalgia client, and a R UE contracture client. WOW….I have seen different diagnosis this week! I was able to observe Iontophoresis for the first time also. This is when the patient brings in prescribed liquid meds (for inflammation) which is put on a patch and laid on a problem area (lateral epicondylitis). Another patch is the ground. Electric is used to help the med. enter the skin….once treatement is over, the patch stays on for 1 hour. I learned about nerve and tendon glides—-yep, looks like we are going to have to know the names that they affect too!!
I saw gout for the first time too. The client came in and had huge knots on his mcp’s, pcp’s, dip’s and wrist joints. It was really gross….You could see white dots just under the skin. —These are called Tophi. He had most of them removed on his R hand and had multiple scars. I was able to do joint stretches with the client after we used paraffin to relax the joints.
I was also able to pick activities for a client with CVA. Which is kinda weird since Amy just asked us to find out how OT’s and OTA’s figure out what activities to use with their clients. I picked out three activities that had to do with shld flexion, extension, and external rotation. LOVED IT!!
I am working on making a binder with all my fieldwork info. to help me with my school work and possibly with my cert. exam when I graduate.
SOAP NOTE WILL SOON FOLLOW.
I observed a male pt. with lymphedema in his R LE. The swelling started 20 years ago and his lower leg is huge. I don’t have the measurements (something I should have thought of while looking at the chart) but this client has to have his pants special made for him. He does have a MRSA sore on the posterior side which is bandaged. My supervisor always wears gloves and takes appropriate precautions.
I did a modality treatment on a patient!!! I used the PUS (pulse ultrasound) on the L wrist of a female client. You have to make sure to keep moving the tool moving across the muscle or it will burn them. I also worked with a patient on wrist flex/ext. stretches. Patient has RSD.
TRYING A SOAP NOTE…
S: I am feeling more secure with SOAP notes and more comfortable with talking to patients. I am learning something new every time I am at my fieldwork site.
O: I treated a female patient with the PUS for eight minutes on L wrist. Worked with a male patient on flex/ext. of R wrist stretches.
A: Female patient tolerated session well. Stated that pain decreased in L wrist and had more movement. I noted this in my notebook to transfer to a note.
Male has increased ROM in R wrist and fingers since last session.Has more feeling and decreased edema in fingers. I also wrote this for later transfer to a note.
P: I worked on writing SOAP notes for each client. I still need some practice and will continue to document what is needed.
Worked more on writing SOAP notes correctly. Worked on decoding abbreviations. Observed a pulse ultrasound (PUS) being used on a client. Observed treatment on a patient with RSD (Reflex sympathetic Dystrophy). This is a disorder that increases the size of the extremities but not the strength. The patient has persistant pain and decreased joint mobility. The skin is tight and shiny at the affected area and there is edema present. It is a very interesting disorder that was treated this session by using the BTE maching, supine/pronation stretches, joint mobility, the velcro board, and vibration for sensation. Looked through a clients file who has neuropathy—a degeneration of the peripheral nerves–She did not show up for her appointment…I hope to see her next week. I observed a 30-something y/o female go through speech therapy and then OT. Very interesting case—you can see the client is trying to form words and then the idea is gone. She has been steadly improving according to her chart. Looking forward to next week!!
Observed grip test and Codmans exercises being done by a client. Involved with a presentation about safety and drunk driving at a High school. Observed clients being treated at Hanger Prosthetics and orthotics. I am understanding more about therapy modalities and therapeudic exercise everyday. Every question I ask concerning therapy is answered in detail by my supervisor.
This week I worked more on writing SOAP notes while observing therapy on three clients. I also observed a grip test being performed by a client. I learned what a”Codmans Exercise” is: swinging an arm in a penduleum motion either by sitting down or standing while bending forward, stabilizing your body with your other hand on a table. Moving the affected arm forward and back, side to side. Letting gravity pull the arm down—this helps with relaxing the scapula, straightening the arm and letting it stretch. I also went to a school presentation conducted by Genesis about seat belt safety and the Prom Promise. Some students wore drunk goggles–trying to walk straight and throw a ball. Other students tried dressing themselves with adaptive equipment (reacher, sock aid, and button hook). At the end of the presentation, a student from that school told his story of being in a wreck and having to use this equipment. It gave me goose bumps while listening. After the presentation, I then went to Hanger Prosthetics and Orthotics. My fieldwork site wanted me to visit this business and write a report on what I saw. Hanger helps people who need braces for prosthetics for contracture, broken bones, lateral instability of the foot, amputation, drop foot along with other conditions. This week was a great learning experience for me!!
So I went to New Lex elementary school this week. This was sort of weird because it is the same building that I went to for Jr. High. Yep, it hasn’t changed a bit! So anyway, I observed 5 children with different developmental problems. The therapist used one activity with 2 children. She was able to do this by adapting the activity to the childrens goals. Pretty cool. I learned that VC means verbal cues and that coloring really dark with crayons makes the muscles in your hands weak. Using that kind of pressure throughout the day causes your handwriting to become worse. I learned a different way for a child to hold scissors to make them more stable. One child needed to work on perceptual skills and the therapist had her do a 24 piece puzzle. Seperating the inside pieces from the outside frame—-doing one first and then adding the rest.—color matching helps also. You can use verbal cues to help things along to keep frustration levels low. The therapist also used something called Brain Gym with one child. I will find out Tuesday what that is exactly. I know it has something to do with coordination…. Another good week and I am looking forward to week 4!
Visited an elementary school with my supervisor. I observed 5 children being seen for therapy. Variety of delays…problems with handwriting, bilateral integration, attention span, spatial relation and following directions, wrist flexion, perceptual skills, CP, proprioception…etc. Observed how the therapist used a different voice for children which kept their attention and frustration level low. Observed that paperwork for schools is different then outpatient therapy.
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