The session I wished to reflect was last Monday’s with CGFC, a 7-year-and-1-month-old female, diagnosed with global developmental delay, Rett syndrome and neuromuscular thoralumbar scoliosis. The aspect I wished to highlight in this entry was how the session went through.
Most of the time, I do preparations for my clients’ sessions. I usually work best with Plans A, B and so on and I am quite certain that that’s how it also works for everyone else. Anything goes wrong and I still have Plan B. I have to admit though that when my finite number of plans were exhausted, I usually panic; that’s probably why I have been called rigid by most (I hope not all) my clinical supervisors most (I hope not all) of the time.
During my session with CGFC, I brought my bookstand and my tablet for the session. The first one was for story-telling and the latter for music therapy. During my session with another client whom I also did story-telling for sitting maintenance, I had a difficult time because of simultaneously translating the story to the Filipino language, holding the picture book and doing what I should do with the client. (The caregiver did not stay in the clinic.) However, during this session of concern, I could concentrate on correcting the client’s postural faults, which was the focus of the activity.
During my previous session with CGFC, the mother also played nursery rhyme songs on her mobile phone to facilitate the client’s movement. However, besides the volume’s being low, the room did not also loud enough due to the large room so there was difficulty using the phone as a tool for facilitation. During the session of concern, the session was held in the Sensory Integration room, a smaller room than the previous one. (I could have use the Isolation Rooms 1 to 3 but the former room had the pediatric standing frame, which I also planned to use for the patient’s physiologic standing.) I used the tablet, which provided me three advantages: (1) it has greater number of nursery rhyme songs; (2) it shows the lyrics of the rhymes and; (3) it is easier to manipulate than the caregiver’s mobile phone because of its larger screen.
I also prepared the pediatric standing frame for CGFC. However, the client could not be properly positioned due to her flexed knees that were difficult to straighten passively, most likely to the client’s fear of assuming upright. In the end, I decided against using it and proceeded with the physiologic standing with I and the caregiver’s providing the support. Despite not using the frame, standing was still maintained with proper joint alignment. Also, the table complement of the standing frame was where the client propped her arms.
I consider the session successful because the activities were executed properly and the client responded, although not optimally, in a way that she would still benefit from these activities. Moral of the story: Preparation counts.
I may
not be like Aizen of Kubo’s Bleach
whose plans were almost always realized, but just like what Kagami of
Fujimaki’s Kuroko no Basuke said,
“There’s no such thing as useless effort.” Something from this unrealized plan,
or from this useless effort, may come
in handy later. Just like the standing frame table.
Tuesday, January 28, 2014
Sunday, January 26, 2014
January 2014, Week 3: The Week Before All Ends
I would like to call last week the "Week of Requirements". During this time, I rushed to accomplish most of the clinic requirements before the rotation ends this week. The rotation of the batch in this clinic was cut to 6 months, stripped of two months due to the Christmas break, so the interns have to work double time.
In this journal entry, I wish to chronicle what transpired last week and reflect on my course of actions:
At the start of the said week, I still had the following requirements yet to be done: (1) three evaluations (performance and documentation); (2) endorsement notes for all my patients and; (3) clinical case presentation. [Case Pre]. Add to these were the handwritten running notes that I had to do daily.
During the past weekend, I failed to finish the requirements I could have done such as the endorsement notes and Case Pre PowerPoint slides because I was busied by another important academic-related matter.
I decided to do the endorsement notes in a day-by-day basis and not pass all of them in one go. I had planned to start doing the three evaluations on Monday but only did so on Wednesday because the patients set for re-evaluation did not attend their sessions.
On Wednesday, I had one evaluation documentation due on Friday, three running notes, and four endorsement notes due the next day. On Thursday, I had two evaluation documentations, four running notes, two endorsement notes and PowerPoint slides due the next day. Fortunately, I finished the requirements although much to my chagrin, the quality of each was compromised.
All those cramming were admittedly my fault. As I had said on the second paragraph, I could have done most of them in advance but did not do so. What I did was technically procrastination but I like others to empathize and see it as a sign of my giving up. I am probably at the threshold of my frustration tolerance.
I started the rotation with an optimistic attitude, genuinely hoping that I could maximize my stay in the clinic and help all the pediatric patients entrusted to me by the institution . I tried to keep the optimism but cannot keep it from wavering. I believe I did a good job of keeping my optimism at its highest every my patient care because I did not want to do disservice. My goals for the patients were genuinely considered, the treatment properly done, and the evaluations performed thoroughly, all to the best of my abilities, all in the hopes that the patients would benefit.
I seem to have no place in this profession, considering all my feedback as an intern. Despite doing my best, I failed at an institution. I tried to prove that my failure was a mistake but before I even proved it, I was told that my claim was all in my mind.
I had initially intended to end this entry in a bad note but decided against it in the end. I believe that despite my performance's being barely average as rated by my supervisors, as long as my intention is sincere, I can still do my purpose. Also, with the sincerest hopes of my instructors for me to improve, why should there be an option for me to fail?
The "Week of Requirements" may have already passed. The week where all ends will pass soon. The impression that I am not a good pediatric physical therapy intern may not be changed even after all ends, but that does not mean that my future as a physical therapist in the future has already ended.
In this journal entry, I wish to chronicle what transpired last week and reflect on my course of actions:
At the start of the said week, I still had the following requirements yet to be done: (1) three evaluations (performance and documentation); (2) endorsement notes for all my patients and; (3) clinical case presentation. [Case Pre]. Add to these were the handwritten running notes that I had to do daily.
During the past weekend, I failed to finish the requirements I could have done such as the endorsement notes and Case Pre PowerPoint slides because I was busied by another important academic-related matter.
I decided to do the endorsement notes in a day-by-day basis and not pass all of them in one go. I had planned to start doing the three evaluations on Monday but only did so on Wednesday because the patients set for re-evaluation did not attend their sessions.
On Wednesday, I had one evaluation documentation due on Friday, three running notes, and four endorsement notes due the next day. On Thursday, I had two evaluation documentations, four running notes, two endorsement notes and PowerPoint slides due the next day. Fortunately, I finished the requirements although much to my chagrin, the quality of each was compromised.
All those cramming were admittedly my fault. As I had said on the second paragraph, I could have done most of them in advance but did not do so. What I did was technically procrastination but I like others to empathize and see it as a sign of my giving up. I am probably at the threshold of my frustration tolerance.
I started the rotation with an optimistic attitude, genuinely hoping that I could maximize my stay in the clinic and help all the pediatric patients entrusted to me by the institution . I tried to keep the optimism but cannot keep it from wavering. I believe I did a good job of keeping my optimism at its highest every my patient care because I did not want to do disservice. My goals for the patients were genuinely considered, the treatment properly done, and the evaluations performed thoroughly, all to the best of my abilities, all in the hopes that the patients would benefit.
I seem to have no place in this profession, considering all my feedback as an intern. Despite doing my best, I failed at an institution. I tried to prove that my failure was a mistake but before I even proved it, I was told that my claim was all in my mind.
I had initially intended to end this entry in a bad note but decided against it in the end. I believe that despite my performance's being barely average as rated by my supervisors, as long as my intention is sincere, I can still do my purpose. Also, with the sincerest hopes of my instructors for me to improve, why should there be an option for me to fail?
The "Week of Requirements" may have already passed. The week where all ends will pass soon. The impression that I am not a good pediatric physical therapy intern may not be changed even after all ends, but that does not mean that my future as a physical therapist in the future has already ended.
Sunday, January 19, 2014
January 2014, Week 2: Sympathy to pediatric patients
If anybody asks me now why I chose BS Physical Therapy as my first-choice program in the university, I will explain, "people say PT's a financially-rewarding job abroad." Surprisingly though, my reasoning is kind of off because I never really have planned of working abroad.
My second reason is the cliche, I care for animals. I did not say "humans" because I also care for other animals besides humans. Truth be told, I probably care for other animals more than I care for humans. Surprisingly though, I never really have planned of becoming a veterinarian.
What makes me care more for animals is what I perceived as their being powerless before humans. I am not just particular to animal abuse but also to the reality where humans cook and eat animals. I see how cows, chickens and goats are butchered and displayed for sale at the wet market and I cringe at the though of animals' serving as food for humans. (Although again, surprisingly, I never really have planned of vegan.) Of course I am well aware of the fact that we are also predators so what happens is only natural. But the fact still remains, as Mikasa Ackerman of Attack on Titans (episode 7) has clearly put it, "this world... is crammed with cruelty".
Using the same reasoning, the ones I care for the most among humans are the children because they are the least powerful among us. Children are at the mercy of every adult. And among these children, the ones I care for the most are those who have disabilities. (It took me a while to establish the relevance of this entry to this blog. Haha!)
What inspired me to write this entry was my encounter with two pediatric patients this Week 2 of January 2014. (I deliberately chose not to include their initials or medical diagnosis to maintain the confidentially of these patients.) I learned about their parents and somehow I choose to believe that their parents are to blame for their condition.
I believe the parents (not just those of these children) have some sort of control in preventing their children to have these debilitating medical conditions. Conceiving a child at a high-risk age (too young or too old) or conceiving child despite financial incapacity to raise a child are just a few and what I've observed on the cases of these two children. With the lack of financial means, a mother cannot afford to have frequent medical check-ups or worse, will be force to work beyond the extent of therapeutic effect of physical activity on a place exposed to every kind of pollution.
What happens then is that it is the children who suffer. I dislike the injustice, wherein these children live the rest of their days with disabilities. This is different from what Zidane Tribal of Final Fantasy 9 said, "It's not fair... but that's the way things are. The choice is yours." The choice is not theirs.
Pediatric therapists are heroes for empowering these children with disabilities. I hope that there will be also heroes, or more heroes if already there, who can keep the occurrence of these disabilities to a minimum.
My second reason is the cliche, I care for animals. I did not say "humans" because I also care for other animals besides humans. Truth be told, I probably care for other animals more than I care for humans. Surprisingly though, I never really have planned of becoming a veterinarian.
What makes me care more for animals is what I perceived as their being powerless before humans. I am not just particular to animal abuse but also to the reality where humans cook and eat animals. I see how cows, chickens and goats are butchered and displayed for sale at the wet market and I cringe at the though of animals' serving as food for humans. (Although again, surprisingly, I never really have planned of vegan.) Of course I am well aware of the fact that we are also predators so what happens is only natural. But the fact still remains, as Mikasa Ackerman of Attack on Titans (episode 7) has clearly put it, "this world... is crammed with cruelty".
Using the same reasoning, the ones I care for the most among humans are the children because they are the least powerful among us. Children are at the mercy of every adult. And among these children, the ones I care for the most are those who have disabilities. (It took me a while to establish the relevance of this entry to this blog. Haha!)
What inspired me to write this entry was my encounter with two pediatric patients this Week 2 of January 2014. (I deliberately chose not to include their initials or medical diagnosis to maintain the confidentially of these patients.) I learned about their parents and somehow I choose to believe that their parents are to blame for their condition.
I believe the parents (not just those of these children) have some sort of control in preventing their children to have these debilitating medical conditions. Conceiving a child at a high-risk age (too young or too old) or conceiving child despite financial incapacity to raise a child are just a few and what I've observed on the cases of these two children. With the lack of financial means, a mother cannot afford to have frequent medical check-ups or worse, will be force to work beyond the extent of therapeutic effect of physical activity on a place exposed to every kind of pollution.
What happens then is that it is the children who suffer. I dislike the injustice, wherein these children live the rest of their days with disabilities. This is different from what Zidane Tribal of Final Fantasy 9 said, "It's not fair... but that's the way things are. The choice is yours." The choice is not theirs.
Pediatric therapists are heroes for empowering these children with disabilities. I hope that there will be also heroes, or more heroes if already there, who can keep the occurrence of these disabilities to a minimum.
January 2014, Week 1: Patience
The session I wished to reflect on was with MA, an 11-year-old male with global developmental delay secondary to mental retardation/autism spectrum disorder, to consider fronto-parietal atrophy. His schedule is a co-treatment session between physical and speech therapy interns. However, during this session, no speech therapy intern was present.
Gross assessment of the child shows no marked physical therapy therapy problems on the impairment level such as deficits in strength, range of motion and balance. On the other hand, the following therapy problems on the "activity limitation" level were identified:
1. difficulty in stair negotiation, manifested by refusal to do activity
2. level ambulation, manifested by assumption of cross-sitting >50% of the time
Basically, what his mother sees as problematic was the frequent and sudden sitting of the child when they are walking in public. During these events, the mother sings "Twinkle, twinkle star" and the English alphabet, songs used by the interdisciplinary care team (group of physical, occupational and speech therapy interns) who previously handled the child. These songs serve as a cue for the patient to stand up.
Because I did not identify any physical therapy impairment, I focused on these two activity limitations and addressed them through the functional training organized by the said team.
The main difficulty was making him follow my instructions. I utilized what the occupational therapy interns called the Therapeutic Use of Self [TUS], namely, active friendliness and kind firmness but with no success. When instructing him to stand without success, my last resort was to pull the child into standing with my grip on the guard belt. The child then immediately flung his arms to me upwards so I had to move my face away to continue pulling without letting myself get hurt
I learn to muster more patience every time I see this child. Back then, i gave the child an ample time (random duration between >1 to 4 minutes) to respond before forcing him to stand. I chose not to force him to stand right away so he would learn how to even without anyone forcing him to do so.
Gross assessment of the child shows no marked physical therapy therapy problems on the impairment level such as deficits in strength, range of motion and balance. On the other hand, the following therapy problems on the "activity limitation" level were identified:
1. difficulty in stair negotiation, manifested by refusal to do activity
2. level ambulation, manifested by assumption of cross-sitting >50% of the time
Basically, what his mother sees as problematic was the frequent and sudden sitting of the child when they are walking in public. During these events, the mother sings "Twinkle, twinkle star" and the English alphabet, songs used by the interdisciplinary care team (group of physical, occupational and speech therapy interns) who previously handled the child. These songs serve as a cue for the patient to stand up.
Because I did not identify any physical therapy impairment, I focused on these two activity limitations and addressed them through the functional training organized by the said team.
The main difficulty was making him follow my instructions. I utilized what the occupational therapy interns called the Therapeutic Use of Self [TUS], namely, active friendliness and kind firmness but with no success. When instructing him to stand without success, my last resort was to pull the child into standing with my grip on the guard belt. The child then immediately flung his arms to me upwards so I had to move my face away to continue pulling without letting myself get hurt
I learn to muster more patience every time I see this child. Back then, i gave the child an ample time (random duration between >1 to 4 minutes) to respond before forcing him to stand. I chose not to force him to stand right away so he would learn how to even without anyone forcing him to do so.
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