December 2013, Week 2

The session during the second week of December 2013 that I wished to reflect on in this entry was with patient LD, a 9 year-old male with the medical diagnosis of visual and hearing impairment. The father's chief complaint about the child is his inability to feed by himself, manifested by non-grasping of utensils.

The child basically demonstrated impaired hand function due to his behavior of throwing everything he would hold with either hand. The case was novel because the causes of impaired hand function I encountered so far were spasticity, loss of motion or muscle weakness. LD did not have any of those at the time of assessment. He could grasp the ball, for instance, but then I could definitely see the deliberate throwing motion after approximately 15 seconds of holding, evidenced by finger extension.

This session was the first time I meet the patient after he called to cancel during my first week in the clinic. Upon gross assessment, he demonstrated poor visual tracking, auditory localization and tracking and inabilityfor visual localization. Most likely because of these impairments, he was rarely, if not never, facilitated with toys.

Upon assessment, I came up with two goals for the patient: (1) to walk without assistance on level surfaces for at least 2 meters and; (2) to improve hand function, congruent with the father's chief complaint. My hypothesis was that his balance deficits and associated apprehension for falls prevent attainment of Goal 1 while his sensory issues and associated developed habit prevent attainment of Goal 2.

Let me discuss the problems I had encountered during the session:
First was the lack of visual and auditory localization and tracking. These caused difficulty in facilitating the child during the session because he was not attracted to toys. In which case, I learned to maximize myself, or what the other paramedical professionals perhaps call as the "Therapeutic Use of Self". During session, I switched between what I understood as "Active Friendliness" and "Kind firmness".

Second was the presence of sensory integration issues, namely tactile, vestibular and proprioceptive hypersensitivity, as endorsed by his previous OT intern. During these times, the importance of notes became evident. I addressed this issues based on the home program attached on the child's chart. I was reminded that other disciplines such as OTs are as needed as PTs and no one is a genuine "Jack of All Trades", even the OTs. I appreciated the importance of interdisciplinary approach in treating patients.

During my session with LD, I learned to be patient; that is, I should not be frustrated when I do not see any improvements during the session. I also learned that I should be confident with what I do. During the session, I was unsure if I was doing the right management. After the session, I consulted my clinical supervisor and was told that I was on the right track.