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OT role in primary health care, and examples of how you can use media as a tool for health promotion and prevention.

OT is one of the disciplines people call “jack of all trades,” this is because of its ability to play many different roles, having many different responsibilities and having many skills to teach in different contexts including primary health care. Primary health care is a healthcare aimed at providing accessible, acceptable, affordable, available and equitable health care for all using a multisectoral approach and aims to shift away from a mainly curative focus to a rehabilitative, preventative and promotive one, prioritizing service delivery to those who need it most.

Articles trying to describe the role of this wonderful profession called OT in primary health care cover aspects like advocacy, building community capacity and one of the given cited roles is health promotion and prevention (Mitchell & Unsworth, 2004). This is because OT in primary health care does not focus on one element, but it focuses on many elements including health, education, livelihood, social and empowerment elements. The focus is not on rehabilitative services only, but also on preventative and promotive care too.

We conduct home visits in one of the communities we are working in, with an aim of assessing and providing therapy to clients within their home environments rather than solely at the clinic or health center. This is another way of health promotion that OT provide, and it is easily accessible to those who need it. We also advocate for services or facilities that might enable better health for its community members. This includes advocating for the ICWP in community B with the aim of promoting childhood development through play and engagement with the nature. OT also have a preventative role in primary health care whereby we do screening at clinics and creches with an aim of picking up developmental delays at an early stage, treat and prevent further disabilities.

The role of media intrinsically links to a form of health promotion as with the world becoming a technologically advanced era, it is of a great resource by using the internet, websites and social media to promote health and well-being. Media helps health workers expand their audience reach, which is crucial considering the fact that face-to-face channels of communication often require too many human resources and reach only a small number of people in large (Unite For Sight,2009). We do face-to-face health promotion talk in both communities we are working in and it is effective because we see people coming for our services. This shows that the way we use to promote health is effective, but I feel like there would be a huge difference if we were doing health promotion through radio, tv, newspaper or social media. The reason I say this is because many people have access to these social media platforms. 

Campaigns can also be used as an effective tool for health promotion and prevention. An example of this is a campaign called Onelove that was aimed at reducing new HIV infections in South Africa. Its aim was to shift social norms away from multiple sexual partnerships and encourage fulfilling monogamous relationships that will prevent the need for other relationships. As part of its communication strategy, the OneLove campaign used mass media, which included the Soul City television drama series, a radio drama, print materials, and advocacy to achieve its aims, and it was effective.

There is free WIFI in both communities I’m working in, for Community A free WIFI is at the library and for community B free WIFI is at the clinic. Many people from these communities go to these facilities with an aim of accessing WIFI to log in to their different social media platforms. Using social media platforms like twitter, Facebook and Instagram to do health promotion and prevention can be effective in these two communities because there is a high number of people having access to social media and free internet.  

#OT

References:

Mitchell, R.,& Unsworth, C.A. (2004). Role perceptions and clinical reasoning of community health occupational therapists undertaking home visits. Australian Occupational Therapy Journal, 51, 13-24

Uniteforsight.org. (2019). Health Communication Course: Module 5 - The Role of Media in Health Promotion. Retrieved from:https://www.uniteforsight.org/health-communication-course/module5 

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Using a political practice model of OT to discuss life in the community.

When I was going through this week blog topic, I won’t lie, I didn’t what it was about or how its related to the community. I then started to do more research on Occupational Therapy political perspective to get more insight on this topic, and other people’s views and perception towards OT political perspective. Through my research on this topic I came across words like Occupational Apartheid and Occupational Justice, which were sounding familiar. After that I couldn’t stop asking myself “what does this have to do with OT practicing in the community?”

Occupational Therapy’s centre of attention is independent engagement in meaningful occupations, these occupations include Activities of Daily Living as means to improve (occupation as means), maintain or restore people’s functional capacity. The environment in which people perform these occupations has a lot of influence in their occupational performance (Scaffa & Reitz, 2001). Political governance and laws are some environmental factors that affect occupational engagement and development in communities. For example, it is very difficult for community members to engage in their meaningful occupations when their suffering from poverty, it is very difficult for them to engage in leisure activities like reading if they don’t have resources like library in their community. So, you see how environmental factors like lack of resources and poverty affect these people’s performance capacity.

Many articles argue that the role of Occupational Therapy does not only focus on rehabilitation aimed at restoring and adapting function yet should develop a new dimension focusing on social and political circumstances especially within a community context (Nicholas, 2013). Often this lack of occupational engagement due to restrictions, brings about Occupational Injustice and leads to Occupational Apartheid. The belief of Occupational Apartheid focuses on communities being unable to engage in meaningful occupations due to social, economic, political or social status reasons (Kronenburg,2005).

I’ve seen these restrictions in the communities I’m working in, people can’t access health care services because they don’t have money to take transports to health care services, there are no ambulances taking them, and there are no mobile clinics that bring services for them in their communities. It then becomes our responsibility as occupational therapist to make sure that these communities have access to healthcare services regardless of what their circumstances are. We as occupational therapist must come up with a plan to make sure that these people do get help, either through doing home visits for them, finding the nearest home clinic that have a transport that can take them to government hospital, or having a community programme facilitated by community members that will do selling to make sure that anyone who wants to go to hospital gets a taxi fee.  

“To every problem there is already a solution, whether you know it or not. To every sum in there is already a correct answer, whether the mathematician has found it or not.”

                                            -Grenville Keiser-

#OT

References:

Kronenburg, F and Pollar, N. (2005). Overcoming Occupational Apartheid in Kronenburg, F. Algado, S.S. Pollard, N(Ed) Occupational Therapy Without Borders. (pp 58-85) United Kingdom, UK; Elsevier Limited.

Nicholas, P. (2013). Occupation in occupational therapy, a political perspective [Ebook]. Sheffield Hallam University. Retrieved from http://shura.shu.ac.uk/17029/1/Pollard_40166.pdf

Scaffa, M., & Reitz, S. (2001). Occupational therapy in community-based practice settings(2nd ed., p. 46). F.A. Davis, 2013

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How economic factors impact on health and wellness in South African communities

Socioeconomic factors can determine an individual’s overall well-being (WHO,2019). Income, housing, employment, education and access to health care services are some of these economic determinants of health (Senterfitt, Long, Shih & Teautsch, 2013). These factors are interrelated and cyclic in nature with the cycle often starting with income and economic status.

Easterlin et al. (2010) found that an increase in income facilitates the fulfillment of a greater number of needs, leading to the attainment of higher levels of well-being (as cited by Mafini, 2017). Individuals with high economic statuses were also found to present with greater life satisfaction (Mafini, 2017), as their environment and available resources supported their engagement in meaningful daily life activities. This is not what’s reflected in the two communities I’m working in. In Community A most people do not have decent shelter, they live in old flats housing, in which some of them there is no water or adequate sanitation. Community B is a township with a lot of formal houses, not that it’s a better community, but yes, it is better in terms of housing when compared to Community A. Unemployment rate (another economic determinant of health) in community A is very high compared to community B, this is reflected on the high number of individuals you see in community A sitting the whole day doing nothing constrictive with their time, which leads to occupational imbalance. Occupational imbalance refers to an individual or group experience in which health and quality of life are comprised because of being unoccupied, over occupied or under-occupied (Brown, 2013). I can then use reasoning and say high rate of unemployment and occupational imbalance is the reason why many members in community A are substance users and addicted to substances.

We all know that high unemployment rate is one of the reasons why most people are victims of poverty. There is also a high possibility of poverty resulting in occupational deprivation, which can be defined as “a state in which people are precluded from opportunities to engage in occupations of meaning due to factors outside their control (Whiteford, 2000).”  Members in both communities I’m working on can go to skills training centre or skills academy and learn a certain skill that they can use to make a living, but they can’t do this because lack of finances limit them.

Lack of access to effective health care service is another economic determinant of health. Unequal distribution of resources and burden of work placed on health professionals are other factors that impact on the efficiency of South Africa’s health care system as treatment is often delayed due to scarce resources (Seekoe, 2007). In both communities I’m working in there is a good running clinic, but the problem with these two clinics is that there is no Occupational Therapist. Every morning when we do health promotion talk as OT students at these clinics, we see that people many people need OT service, but there is none at these community clinics. This also affect people’s well-being in these communities.  

Looking at this as an OT say I would say an environment has a lot of impact in individuals, this is also emphasized by Urie Bronfenbrenner using ecological systems of theory. I’m saying this simply because we treat many substance abuser clients in psychosocial block, and when you look at their activity clock you see that prior to admission the client had a lot of time spent doing nothing, either because they are unemployed or don’t have leisure activities they can engage in. They then spend their free time using substances, which results in them being admitted in psychiatric facilities.

#OT

REFERENCES:

Brown, H.V. (2013) The meaning of occupation, occupational need and occupational therapy in a military context. Physical Therapy, 93(9), 1244–1253.

E. Soekee. (2007). Poverty and health in developing countries: a South African perspective. Diversity in Health and Social Care.

Mafini, C. (2017). Economic Factors and Life Satisfaction: Trends from South African Communities. Acta Universitatis Danubias, 13

Senterfitt, J.W., Long, A.,Shih, M., Teatsch, S.M. (2013). Social Determinants of Health; How Social and Economic Factors Affect Health.

Whiteford, G. (2000) Occupational Deprivation: Global Challenge in the New Millenium. SAGE journals.

WHO | The determinants of health. (2019). The determinants of health. Retrieved from https://www.who.int/hia/evidence/doh/en/

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Factors that allow communities to flourish

Community is a big word with different meanings to different people (Scaffa and Reitz, n.d.), however, Fransen (2005) defines community as a unit that has a historical depth in time and a place where people share a sense of connectedness that goes beyond living within the same geographical location. A normal human being has “needs”, so when people a living together in the same geographical location(community), they have “community needs” because this goes far beyond looking at what can benefit a person as an individual, but if focuses on what can benefit a community at large. Ability to fulfil individual’s need leads to happiness and full functioning, ability to fulfil community needs leads to the community flourishing. There are many factors that enables the community to flourish, these factors include socio-cultural factors, physical factors and economic/ educational factors.

The socio-cultural factors within the community include the norms, lifestyle, culture and the value that individuals place on activities that aim to make change in their community. If members are motivated and perceive themselves to be capable of effecting change in the environment, then this promotes well-being within the community. In Community B there are mentors who are showing interest and enthusiasm in helping the youth learn a lot about the nature, which shows that in Community B there are people who want to see change and development, and also uplift their community. In Community A we see a lot of community members spending their time sitting by the road smoking, inactive and doing nothing effective with their time. In OT perspective I would say they have unconstructive use of leisure time, because they can use their time constructively doing something effective with the least resources they have (park and the library). The lifestyle of community A people reminds me one of the YouTube videos https://www.youtube.com/watch?v=LBvHI1awWaI I saw where a guy was talking about how comfort ruin people, and how discomfort state help people to grow. One of community A members told us that “there’s no much change in our community compared to previous years.” and this is because People of community A are comfortable with sitting the whole day doing nothing, and that’s the reason why there’s not much change.

Physical factors that promote community well-being include aspects such as safety, accessibility, housing and other infrastructure within the community. In Community B we were advised to be alert and cautious when walking around the community because there is a high rate of crime, which is something we were not advised on in Community A. This tells me that there are high safety measures in Community A compared to Community B, maybe its because of the police station is very close in Community A. In terms of infrastructure, we saw a community library in Community A which is something I haven’t seen (not saying there’s none) in Community B, which leads me to the last factor (economic/educational factor).  I would say socio-economic status being low in Community B compared to Community A is the reason why community A has better infrastructure.

#OT

References:

Fransen,H. (2005). Challenges for occupational therapy in community-based rehabilitation: occupation in a community approach to handicap in development In Kronenburg, F. Algado, S.S. Pollard, N. (Ed) Occupational Therapy Without Borders. (pp 166-183) United Kingdom, UK; Elsevier Limited.

Scaffa, M. and Reitz, S. (n.d.). Occupational therapy in community-based practice settings. 2nd ed. p.5.

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Reflection of my experience at Markets of Warwick tour

On today's’ tour I learnt a lot about the history of Durban, and I have gained an experience into one of South Africa’s biggest market complexes, Warwick Junction. I have learnt that there are many markets that make up the Warwick Markets, to be specific they are 9, there is Music Market, Impepho and Lime Market, Early Morning Market, Victoria street Market, Lime Market, Berea Station Market, etc. Most people know that a place that is busy or having many people passing bye has a high rate of crime, especially when its a market or a selling area. People passing by these markets are estimated close a million a day, but there is no crime because of the high level of security.

These markets consist of many different traders from different cultural background, religion and race, but they work together in peace and harmony towards achieving their common objective, which is selling their products. Research has shown that working together can inspire intrinsic motivation, leading people to work hard on difficult tasks for their inherent satisfactions. This is an evident of what I have seen at the Markets of Warwick, all the traders that are selling their products there were so motivated, you would hear them calling you with different sweet and charming words that will make you stop and give attention to be their products...one of their marketing strategies. Those who are selling music and dvds’ also use a different marketing strategy, they play their music out loud, so you can stop and check if they have the kind of music you like. 

I found Markets of Warwick Tour very helpful in terms of gaining an understanding of different people generate income, and on how they work together in peace towards achieving their goal with an aim of providing their families and loved ones

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Why I wasn’t aware about Life Esidimeni tragedy

The tragedy occurred in October 2017, and to be honest I had no information regarding this tragedy to the fact that I don’t listen nor watch news, even though that’s not an excuse to why I don’t know about this tragedy because I do have access to resources like internet. However, I have took it upon myself to do a proper research on the issue because it is relevant to my discipline or to health sciences because it is about Mental Health Care Service users which is something under Occupational Therapy students should know about.

I think the other reason I wasn’t aware of this tragedy, is that it involved government negligence so some information was hidden or not made clear. For instance, the report about the number of people died was not clear, initially they reported that 94 patients in the Life Esidimeni saga, then later reported that it’s not 94 but 118 patients, which makes it clear that they were hiding the shame that many people died because their negligence and not giving quality care to these patients.

The other reason I wasn’t aware of this tragedy is that government lawyers managed to stop the media from speaking to the to patients families because they were trying to hide the outcomes of their negligence.

Not knowing about this tragedy taught me to expose myself to news, so I decided to download News24 app so that I can updated about what’s happening in our living country.

#OT

Reference:

https://www.timeslive.co.za/news/south-africa/2017-10-09-at-least-118-life-esidimeni-patients-died/

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Mock prac - my thoughts

Today’s mock prac was more than just teaching on how to assess and treat patients, it was about having inner volition of our profession, which will lead to proper assessment and effective treatment of our patients, not just patients we will be seeing in this psychosocial block, but every patient we will ever meet in our entire life. Today I learnt that we(student-therapist) also need to have the same inner volition we expect our clients to have, because in that way we can learn a lot and become better therapist because we love our profession.

I also learnt the importance of crying for help whenever I’m stuck, ask for help from my colleagues and my supervisor, which goes back to the saying that says “Alone we go fast, together we go far,” which makes it very clear to me that I need to work very close to my colleagues and my supervisor so that I can learn a lot from them. I also learnt the importance of knowing how to reflect on ourselves and to always have a reason for everything that we do(“why”). The importance of having a good rapport with the client, nurses, psychiatrist, psychologist and social worker was also emphasized, because it makes the treatment much easier.

Today’s mock prac also taught me the importance of setting and having my own goals for this block, and to make sure I work as hard as I can to achieve them and make them come true. The importance of good time management was also emphasized, and I feel like I will really need time management skill since I will be working at an acute hospital, so I really need to practice working hard and do a lot in a short space of time.

SMART aim writing skills were also taught in today’s mock prac, and I don’t believe I will have a problem writing SMART aim because everything was made clear today. I really think today’s mock prac was helpful to all of us because a lot of things we were struggling with were discussed. We just need to go all out, love our profession and love our clients.

#OT

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PREPARING FOR PSYCHOSOCIAL BLOCK

Psychosocial block is a very exciting block because it offers an opportunity to learn more about mental related disorders like schizophrenia, bipolar,etc. In preparing for this block, I revised 2nd year assessment notes because an effective treatment starts after proper assessment. I have also decided to make my own assessment form which will help me know if I have completed my assessment or not.

I have also read some of the studies on Occupational Therapy and Mental Health book, which emphasis the importance of knowing client’s level of creative ability, as this serves as a guide to how you should structure, present, and grade your activity in an effective way. It also emphasizes the importance of good structuring in a group therapy, for example, a quiet member/ inactive member in a group session must sit opposite to the therapist so that the therapist can easily and frequently try to get client’s participation in the group activity.

I read an article about factors affecting attendance and participation in group therapy in a private Inpatient psychiatric setting, this article was written by the UKZN student (Vicky Clark-21155049(2015)). This article was written using Yalom (2005) therapeutic factors for group work. This is very important when running group work, as it prepares you face group work challenges like poor attendance. There are many factors hindering the group therapy attendance, naming stigma and shame, a belief in the negative stereotypical portrayals of mental illness, physical pain, fatigue and negative side effects of medications. After reading this, I learnt the importance of knowing different techniques of facing group challenges like motivating and improving group members’ self esteem if they are having shame for example.

These readings were so helpful, now I must try by all means to put all the theory I’ve learnt into practice, and I must make sure that I do my assessments properly so that I can be able to do a treatment plan that will benefit the client.

#OT

Reference:

*OCCUPATIONAL THERAPY IN PSYCHIATRYAND MENTAL HEALTH Fourth Edition

Edited by Rosemary B. Crouch, PhD Occupational Therapy, Medical University of Southern Africa, and VIvyan M. Alers, MSc Occupational Therapy, University of the Witwatersrand

*Clark, V. (2015). Factors Affecting Attendance and Participation in a Private Inpatient Psychiatry Setting. South Africa.

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planning and implementing intervention

Understanding diagnoses, doing correct assessments and having accurate assessment findings will always be the important think when you want to plan and implement the intervention.  According to my experience of planning for the intervention, I found it easier to plan for the client if you assess the client correctly and then do activity analysis and see how would you do that activity to achieve the aims which will treat the problems that the client have. On my experience I would say that at first it was hard to plan for the intervention but after my supervisor and my lecture reminded me of the importance of reading and understanding the diagnoses first so that you cant plan to treat something that is not a problem or that is impossible to treat, e.g. for example with my previous C4-C5 SCI client it was important to understand that there was no way I could improve the muscle strength of the muscles that are below the level of neurological level since they didn't have sensory function. 

My other experience in planning the activity is that it is important to plan the activity with an aim of improving independency in that specific area of occupation, which our primary goal. During my demo I made a mistake of planning the activity with an aim of improving physical components, and not focusing on the independency in that activity.  During the implementation of the planned activity, I used to be more scared of seeing the client failing to do the activity, which made me to provide more help for the client and ended up missing many therapeutic opportunities which is part of intervention but after the supervisor had told me about it, I was trying by all means not to miss out therapeutic opportunities.

 I think also when implementing the planned intervention session with the client depends on the how you found your client, as the level of functioning of the client. During the intervention session I think it important to grade the activity in the middle of the activity according to client’s abilities, for example if you see that the client is not able do the activity in standing for a long duration, you must allow the client to do the activity in sitting for 5 minutes and bring him or her back into standing for +/- 3 minutes.  

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Experience of putting theory into practice

In class we learn everything about different diagnosis, how to treat which include treatment principles(how to handle the client, how to structure your treatment session, presentation and activity requirements), and in practice we are required to put all the theory learned in class into practice, which is an exciting thing because that’s when you start to understand the theory much better, and everything learnt in class starts to make more sense.

This week I was treating Right CVA, the aim of improving independence in self care while corporating the affected limb, and there are some aspects of this session that went wrong. What went wrong is that the plinth was a bit high for the client so I couldn’t get her feet to 90 degrees dorsiflexion, so I had to put a wedge underneath her feet. The basin used was also not good for the client because she was at risk spilling the water.

Aspects of the session that worked: the equipments used were placed out of the client’s base of support to facilitate dynamic sitting balance and trunk rotation which influences tone, and this aspect of session did work since the client was able to move out of her base of support.

Structuring:the client was sitting on the plinth, and I was sitting on her affected side to make sure that she doesn’t fall when moving out of base of support. The table was in front of her with all the equipment used placed far from her to facilitate dynamic sitting balance and trunk rotation.

Handling: when physically handling the client, open hand/palm techniques were used to make sure that I don’t increase tone and pain on the affected limb. Psychological handling included encouraging, motivating and giving assurance to the client to promote participation and execution of the activities.

Activity requirements: the client have impaired sensation on her left upper and lower limb, so the activity required the client to use her unaffected upper limb which has intact sensation to test out water temperature, this is to make sure that she doesn’t get burnt on her affected limb. The activity also required static sitting balance since the activity was done in sitting with no back support.

Presentation: the activity was presented verbally in isiZulu to make sure that the client understands what is required from her. It was also presented step by step she has impaired short memory.

Many theory aspects covered in class are helpful in practical session, this include models used when treating, applied frame of reference, approaches, and using OTPF to understand that you have to treat all are well Areas of Occupation. Therefore I would say it was an amazing experience to put Theory into practice, and I’m learning more through practical.

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Client’s progress

There is a progress in client’s physical components and improved independency in some Activities of Daily Living,that’s exciting because I see my input in client’s life and I’m happy to bring that little change in his life. Before therapy intervention, the client’s physical endurance was 15 minutes and this is because of general deconditioning, but now he can engage in activity for more than 20 minutes, and that shows that his physical endurance has improved from 15 minutes to more than 20 minutes with moderate exertion. His sitting tolerance has also improved because he couldn’t sit on the side of the bed for 5 minutes due to the effect postural hypotension, but now he can sit for more than 5 minutes on the side of the bed even though he still has postural hypotension.

He was completely dependent in all Activities of Daily Living except eating, but now he can participate in feeding, face washing, teeth brushing, Upper Limb dressing(shirt) with moderate assistance using assistive devices like universal cuff(when feeding and teeth brushing) and bath mitt when face washing.

The structuring: the client is always seated in his bed and wheelchair, this is to increase his sitting tolerance and decrease the effect of postural hypotension. Activities are structured to last more than 20 minutes, this is to improve client’s physical endurance.

Activity requirements: activities always require 20 minutes sitting tolerance and physical endurance, this is to improve these physical components. Activities require client’s minimum input in all activities to improve independence in ADLs.

#TheMessageOfIndependencyInAdls

#TheOT

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being assessed for midterms

I was so nervous the morning before the session which ended up affecting my handling principles, because in my handling principles I included “giving the client a positive feedback so that he can know if he is progressing or not, because it will help him know if he is progressing or not”, but because i was nervous I didn’t do enough of that.

Intervention session was based on improving client’s independence from maximum to moderate assistance in face washing and teeth brushing ADLs, and the aim of this session was met since the client only required moderate assistance from the student-therapist when doing these activities.

The structuring of the session was not good because the client was seated on the side of the bed(with maximum back support from the student-therapist) when doing these activities instead of putting him on his wheelchair where he will be supported by the wheelchair. Another thing that went wrong about my structuring is that there was a plastic on the over-bed table to protect the over-bed table from getting wet which ended up affecting the session because the client had difficulties applying the soap on his bath mitt, I was supposed to use a towel instead of the plastic when protecting the over-bed table from getting wet. 

In terms of grading the session, there was a downgrade because of the effect of postural hypotension. The client was given a break, water, and putted down to supine position for few minutes. During this time I was supposed to put in therapeutic opportunities by giving the client a chance to use his aided cup to drink water on his own, instead of giving maximum assistance when drinking. After the break, he was able to continue engage in the session. The activity required the client to use dermatomes that have intact sensation when testing the temperature of the water, and he was able to do this.  

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Success and difficulties

This blog was written today because I didn't go to prac last week Monday(19/03/2018) due to physiology test that i was supposed to write on that day. However, I took some time on Wednesday(28/03/2018) and went to Clairwood to cover up those hours.

Physical block is one of the blocks that challenge your critical thinking because whenever you are planning an intervention you have to try and include all impaired physical components in one session, without forgetting client’s strengths and weaknesses because that might affect your treatment session. I believe my thinking is challenged and I’m in the learning phase of treating holistically, which is something that is always emphasized in my Discipline(OT).   Another important thing to take into consideration when treating the client is that people are different and they do things in different ways, therefore it is very paramount to use client-centered approach in the treatment session, because this helps you as a Therapist to focus more on client’s needs. 

Successes

My success so far is that I understand and know my client completely, this includes knowing his diagnosis, his roles, habits, what’s important to him and what’s not, so whenever I’m planning my treatment session I take all those things into consideration so that I wont end up treating what “I think it’s important” and failing to treat what is actually important to my client. An example of this, is that Mr X has C4/C5 spinal cord injury and he still wants to be independent in feeding, so my thinking was challenged and I had to decide on what we can do to improve his Independence in feeding since he doesn’t have hand functioning, then a universal cuff was given to the client to improve independence from maximum to moderate. This made the client happy because now he can feed himself with moderate assistance from the nurses. This also made me happy because I was able to bring that little change in his life.

Managing the client is not an easy thing but I’m happy because physical block created the opportunity for me improve that skill. Clients sometimes complain about pain and fatigue but I still manage to make them engage in the therapy session for their own benefit. Mr X the other day complained about fatigue so he wasn’t willing to engage in the therapy session, so we ended up playing a therapeutic game in his bed without him realizing that the aim of the session was achieved.

Difficulties

I still have some difficulties with my handling skills, in most cases I find myself providing a lot of assistance and the client ending up doing so little for themselves, which is something very wrong because our primary goal as OT’s is to make the clients as independent as possible. I think the reason why I’m offering a lot of assistance is that I’m scared to see the client fails because I think that might negatively affect his/her self-esteem, which may end up affecting our therapy session. I strongly believe that as time goes by I will learn the good handling skill. I still have some difficulties in finding the activity that will include many impaired physical components in one session, in most times my activity only include 2 or 3 physical components, but i believe that the more I keep on practicing the treatment plan, is the more I will learn all these skills. As the saying says “practice is the best of all instructors”.   

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Planning and implementation

Since it was observed that the client can’t participate in feeding activity without maximum assistance from the nurses due to absence of prehensile hand functioning (grasp and pinch),so he couldn’t use tripod pinch when using a spoon. Then I decided to plan a session where the client had to participate in this Activity of Daily Living (feeding) with moderate to minimum assistance using a universal cuff.

Aspects of the session that worked and did not work

Using a universal cuff when feeding did work in our session, but due to grade 1 muscle strength of both wrist extensors and flexors the client’s wrist would involuntary drop, so I had to stabilize the wrist/immobilize it to make the activity much easier for him. Well I didn’t immobilize the correct joint which is the wrist joint because my hand was orbit on his wrist joint but on his palm.

Implementation treatment principles

Structuring included putting the client in a sitting position on his bed with back support with an aim of increasing sitting tolerance since the client is always sleeping in his bed. The client was able to maintain sitting position for the whole session without any signs of fatigue or complaints about being tired. Another reason for structuring this session in this way, is to make sure that whenever the client starts to get dizzy because of postural hypotension, then I can quickly put him back to his normal positioning.

When physically handling the client I used open palm techniques even though I didn’t stabilize the correct joint.

The activity required a 20 minutes sitting tolerance and the client was able to sit for that period of time.

The activity was verbally presented to the client, telling the client what he would be doing during our session, he didn’t experience any difficulties with understanding the session because he knew what feeding is and how to do it, but I had to demonstrate the compensatory way of doing it with no prehensile hand functioning because that is new to him. The demonstration did work because he got an understanding of how to do feeding activity using a universal cuff.

[mfundot-blog]

1st week of treatment

Knowing your client’s strengths and weaknesses is the key when planning for the intervention or treatment. My smart aim write up for Monday wasn’t good and it had many errors, but after we had a lesson on how to plan for a treatment, my skill on writing a smart aim improved.

My supervisor also taught me good handling skills on Wednesday as I was doing the treatment, because my problem was that I help the client too much, and not give the client a chance to try and fail on his own. I was scared to see the client failing to do an activity, but i have learnt that i should always give the client a chance to put all his effort in an activity.

I have learnt that making a good prioritized problem list is they only way you can know what to focus on when doing the treatment, and it also gives you an idea of what functional activities to use for treatment.

[mfundot-blog]

Being on prac is so exciting because you get an opportunity to apply all the theory learnt in class into an actual practice. The most important thing is to make sure that you have a good rapport with your client, so that your client can cooperate very well in your assessment session. 

Accurate assessment findings are very helpful because they give you a clear picture of  what you should focus on in terms of treatment. I also noticed that it is so important to have a background information about different diagnosis(e.g. SCI,CVA), as this may give you a clue of what might be impaired on your client.