Reflection 14

From OTH 364 Vision, Perception, and Cognition, we got the opportunity to visit with clients from QLI which stands for Quality Living, Inc. It is a Rehabilitation Center for people usually following a traumatic brain injury or have visual and cognitive impairments. A week prior to getting to the facility, two OTs from QLI spoke with us about what they do and how everyone who works with the patients focus on OT aspects regardless of their title (nurse, life path services, residential staff, etc). It is different for billing insurance which allows for greater flexibility of therapy than other settings.

The clinical reasoning I chose for this visit was Ethical Reasoning. In our OT code of ethics, there are seven principles a few of which I will explain. Confidentiality is an obvious principle important in this matter. We will have to do an assignment in which we gather up our observations and reflect without giving away our client’s real name. Beneficence is another principle; in every way possible, the QLI staff are doing their best to benefit the clients in their care who have visual and/or cognitive setbacks. As student guests, we were given a chance to practice a few visual assessments for us to see what the outcome looks like. We wore our OT uniforms and nametags to represent our background as learners. Veracity is telling the truth and we do not have all the skills. It’s important for the clients to know we are in a process of becoming OTs.

Thinking through the ethical reasoning process is important when we go out into our careers and fieldwork because I will deal with clients and a facility. In the real world, there are consequences to breaking confidentiality including getting written up and worst of all, getting fired which goes onto a permanent work history record. I represent myself and my future workplace and following the code as best as I can will lead me to do the right thing in difficult situations.

Blog 13

OTH 362 Principles of Kinesiology

We learned Manual Muscle Testing (MMT) of the scapula, shoulder, elbow, and wrist. We will also be having a practical with a partner from our cohort. During MMT, I am analyzing a patient’s level of motion; full or partial and if they are able to withstand resistance. Each motion is graded on a 5-point scale; 0 being no movement to 5 being the strongest. This involves much dialogue and explaining to a patient where to place their arm, encouragement for best results, knowledge of where to place my own hands on the patient for support or resistance for each test, and judging if the patient needs to be in a gravity-minimized position.

The clinical reasoning I used for reflecting on MMT was accuracy. On that 5-point scale, there are actually half step increments starting at 1 (0, 1, 2-, 2, 2+, 3-, etc). Accuracy means correct, true, or not distorted. As we give a grade to our client, we want that number to be accurate to their current abilities. In the middle of the scale is a 3 which means full range of motion without resistance. If they show full ROM, then you continue to see if they can handle resistance to the motion/muscle. It goes up if they can take resistance. It will be a grade below 3, between 0 and 2+ if less than full range. I would then set my patient into a gravity-minimizing position for that motion which is sometimes laying prone or on the side. As the therapist, I also want to do the correct test. For example to test scapular retraction, I want them to watch their scapula movement and not their shoulder.

Since we are going to have a practical in which we measure manual muscle testing, this is going to be something we do in most cases with adult patients. Our patients aren’t all strong and healthy. They may have weakness either temporarily or long term and the MMT can determine if there is a change from one week to another. It also indicates the current level of range of motion and strength at one point in time.

Blog 12

In OTH 364 Vision, Perception, and Cognition, we had a lecture that focused solely on agnosia which is an umbrella term for the inability to name and identify daily objects, faces, sounds, shapes, smells, etc. The activity was administered by the professor. One student was tested on a few tactile agnosias. While the receptors of touch, pain, and temperature don’t seem to be a problem, the ability to attach meaning to somatosensory stimulus is. So there are various forms of not being able to determine characteristics of an object by touching it.

The type of Clinical Reasoning is Diagnostic Reasoning. First was an assessment for astereognosis: inability to identify objects by touch alone. In this case, without the patient looking, familiar objects are placed in their hand and they must try to name them. Another was Ahylognosia which means not able to discriminate between differing types of materials.Then, still not looking, a patient is given one at a time a cotton ball, rubber band, piece of wood, cloth, and metal. Finally, amorphagnosia is specific to the inability to differentiate different forms by touch such as triangle, circle, star, and square. The patient is given objects and must identify by feeling it with their hands alone, no visual or other senses. If in any of these cases, they fail at identifying at least 3 out of 5 or 6 items, then they are diagnosed with the respective agnosia.

How this reflection will help in the future? The professor indicated that in patients with tramatic brain injuries, their cognition and perception can change. To quickly screen for and diagnose a client is easy. These assessments can be put together with objects found around the home or inside the hospital or clinic. The client touches objects for identification and you use things such as paper clips, keys on a key chain, stress ball or a round object that fits in the palm of the hand. If you trust them to keep their eyes closed, you may do so or put them under a table so they can’t peek. This is one of those things that seem like fun in OT that I will have to remember.

Reflection 11 – Happy Easter 2015

From OTH 350: Evaluation and the OT Process, I was taught another assessment tool for my OT toolbox. The Allen’s Cognitive Level Screen 5th Edition (ACLS-5) used to determine adult client’s cognitive functioning and capacity to learn by leather stitching. There are three patterns; running stitch, whipstitch, and a single cordovan stitch. I assess if the client can make the stitches, recognize errors, and if they can fix those mistakes.

This was not my favorite activity. The instructions for how to verbalize and show the task was such a challenge for me to do and expect my client to understand. It will take practice before the final as this will be covered again. One of the teachers said she used this assessment often in her career. It is likely to come up depending on the setting.

This ALCS-5 tool fits into the relevance universal intellectual standard. The ACLS-5 is relevant in determining how much problem solving a person has on a craft task. The OT intentionally inserts twisted lace for the client to untwist. Also, we can identify motor and cognitive skills or impairments. This is a fine motor skill manipulating a lace to fit into consecutive punched holes. It looks at more than one area of performance. In other words, the ACLS-5 requires a lot of skills from the client.

If this assessment is a common one used in OT, then I must learn to administer it. It is important that I practice how to administer the ALCS, know the stitches, and have patience. When working in class, I was transparent about my frustration with this tool. I need to find confidence in my abilities and crafts are something I actually like. However, the purpose is not about me, it is about how the client can problem solve. If I keep that in mind, I will not get frustrated and will focus rather on determining the level of my patient’s actions.

Reflection 10

In Principles of Kinesiology: OTH 362, a big assignment that we are working on is to examine a movement, naming the positions of the upper arm. Specifically we each chose an Activity of Daily living and broke it up into 3-5 steps for a  Movement Analysis. We get a chance to choose our own as well as investigate our peers’ Movement Analysis. We will discuss any parts in which we disagreed and give each other feedback and learn from that.

This type of reasoning was precision; containing the details needed to solve a problem. The picture or step was dissected at the should, elbow, forearm, wrist, then fingers. Nothing can be left out or else it would not be complete. If a position is neither flexed nor extended, neither abducted nor adducted, then it is neutral. Then each step was dissected at the same areas, but the data may change depending on the activity. My activity is zipping up a jacket. It will take a larger movement in my elbow and a slight movement of my forearm.

Precision of evaluating movement is a skill OTs are trained to master. It should become second nature to scrutinize abnormal movement per age of the arms and extremity as a whole. First in this semester, we are learning normal range of motion, then in a future class, we will learn the abnormal side of movement and how to handle those cases.

Reflection 9

From OTH 350: Evaluation and the OT Process, we learned about two more assessments: the Texas Functional Living Scale (TFLS) and the Independent Living Scales (ILS). They are each ten-pages of instrumental activities of daily living (IADLS) assessment and screening. They utilize tools such as phone books, stimulus cards, paper, pen, and telephone. These are in depth tools for OTs to use to determine if older adults are competent in their IADLS and assists in determining level of care needed following discharge.

This reflection of the TFLS and ILS are procedural reasoning because I am reading directly off of the document. There is a manuscript which tells the OT or administrator exactly what to say and also has possible situations, and a guide on how to grade etc. It is all following directions and step-by-step protocol. I deem that these assessments have such a rigid structure so that its consistency stays the same making it reliable. When, for example I would want to test for health and safety, there are many ways to ask the same baseline questions. The documents have questions in which I ask verbatim.

These assessments take practice in administering and they are beneficial because  they are used by current OTs and have good validity. Following procedural reasoning is one main method of clinical reasoning that is essential to OT. I must be prudent about wording when the assessments intention is to be so. Also, following procedure is organized and structured which helps the flow of the therapy.

Reflection 7 and 8

Reflection 7

OTH 355: Health Promotion and Education

Prior to Spring Break, our group assignment was to build a lesson plan for the Timbercreek apartment presentation.This was a seven-page template that we filled out which included our lesson title, our names, material/equipment list, and lesson plan body. We explained our 3 objectives and 1 goal. These are what we expect of the learner by the end of the session.

The Universal Intellectual Standard that best fits this lesson plan is clarity. The structure of this assignment required us as the educators of the session to organize the information that we wished to present. It keeps us on track as the teachers and most importantly establishes a document that is understandable and nothing is confusing about it. This lesson plan would be given to the Timbercreek coordinator. In the future, she or another person would be able to take the lesson plan and run the session. It must require all the information they need being as clear as possible.

OTs in clinical education write behavioral objectives; short-term goals which are oriented toward action and centered on the learner. These written objectives need to have clarity and be reached in short period of time given the client’s skills and abilities. OTs also write notes as well as plan or care and every good piece of documentation has clear points which we are learning throughout our OT education. The lesson plan objectives need performance, condition, and criterion. Another way to think about this is to ask, “who will do it, under what conditions, and how well?” Initially, our objectives were too broad and could not be measured in the time we were given. It is okay to reevaluate and keep writing goals as long as they fit the client and are logical.

Reflection 8

OTH 355: Health Promotion and Education

Returning from Spring Break, we sprang into our Timbercreek apartment presentation on exercise with adults. Following our lesson plan, my group had a greeting, held a discussion on OT, precautions, exercise, and had a demonstration of exercises. It was a great experience. It only consisted of four female residence, but they were receptive. The coordinator and professor were also present and added to the discussion.

This was conditional reasoning. This type of reasoning is typically found in experienced OTs because it is a blend of all forms of reasoning. I feel that this activity required “planning in action” and thinking on your feet. My group had to respond as the session was occuring. We were not told about the space available (pragmatic), how many people were attending, what age, or what skill level they would be. So when we got there, it was some real time interaction (interactive) and modification to our plan. We also included discussion questions so what followed was dependent on the response of the residence. When we discussed what Occupation Therapy was, one resident elaborated about her background (narrative) and knowledge of OT almost to the point of what we were planning on presenting. Under the conditions, we agreed with her response and did our best to carry on with sharing information and not overlapping what was already said.

This learning activity will help me in the future to be more comfortable and prepared to shift my plan depending on the skills and knowledge of my client. I did not want to explain what OT was after they had just told me. It would appear as if I were not listening if I continued on my plan. Also, working together in a group, we were comfortable discussing and asking questions to the residence. I am a hands on and I initiated that it was time we picked up the food cans and did a little arm exercises and stretching. First however, we went through the precautions and the important content that we wanted to cover. Switching gears of the session kept the residence engaged and I think that was the fun part when we moved our arms and got on our feet and out of the chairs for a few minutes.