Reflection

Well its all over now. DSC wasn't what I expected, I thought the clients would have more severe disabilities and I wasn't quite sure what the physio's role would be. I was a bit disappointed that I didn't get to go out and see more patients but that's the nature of working with children. I did enjoy learning how to change your treatment and assessment for kids, it was more about playing with the child and observing. I have learnt that children do their own thing, at their own time and that its no point in forcing them to do an exercise or continue if they don't want to participate. I also learnt that you can get a child to do the exercise if you distract them or trick them into doing it. I had a lot of fun at the hydro sessions, it wasn't like a normal hydro session, it was more about teaching the children how to be safe in the water, how to get to the wall and get out if they fall in, it also involved singing a lot of songs. My last week of placement, I got some more hands on experience and I got to build my confidence. I feel that I have learnt lots about paediatric physio and their role in helping normal development. I have also learnt how important normal development is for a child and how they will develop the rest of their life. Over all I had a good time and enjoyed working at DSC.

Today was a very productive day. I went out on four visits, the first visit was seeing a little boy with down syndrome. We put out an obstacle course for him to complete and worked on running and tried to encourage jumping. The second visit was a five year old girl who is severely delayed and can not walk yet. She has a lot of equipment such as standing frames, walkers, AFOs, back brace and others. My supervisor needed to complete an assessment, so I got the opportunity to watch how it goes. I think it was called the MOVE assessment and is based on asking her mum questions and if unsure, then getting her to do the activity. I had a go at getting her to high kneel, which she needed a lot of help and support with, but unfortunately she bit me really hard, no blood luckily. The next two appointment were very similar, both girls has down syndrome and we tried to get them to do activities such as walking beam, stepping stones, throwing and catching a ball and trike riding. The young girl who I was supposed to do the NSMDA assessment on wasn't in a good mood and didn't want to do anything. To try and get her to join in, I stepped back so that mum was able to persuade her to do somethings. We did as much as we could with her but the assessment will have to be continued at her next appointment.
Only one day left :) I have only one appointment tomorrow morning but a lot of notes to write.

Today was an early start, I saw a client that I had seen on my first week, which I thought I would only see clients once as the physio only see clients every few weeks. This client has progress welled, his arm strength has improved heaps. Unfortunately, the client wasn't in the best mood but we let him do his own thing and try to incorporate some physio into his play. I also went along to an initial session with a young girl. I played with the client while the physio was try to observe her movement. It was hard to try and figure out what was happening to her feet as she was walking. The client was weight bearing on her ball of her foot and would fall back onto her heels and sometimes onto her toes, it wasn't consistent. We decided that all the movement in her feet while she was walking was due to her balance and how unstable she was. The client was two and half and had just started walking for about two months.

Tomorrow, I will going into the hills and Ellenbrook for a few appointments. I will be doing a NSMDA assessment on a four and a half girl with down syndrome. I will only be doing the gross motor section of the NSMDA for a four year old, which looks at sitting balance, walking, running, jumping, hopping and ball skills. The best way to do the assessment will be to let her have a play and go at her own pace and to just observe as much as possible.
Hope I do well in the assessment :)
Only two days left.

Yay last week of prac. Last week I unfortunately didn't have as many appointments had I would of like but I was able to photocopy a lot of the resources that they use at DSC and that one of the physio's there has put together. I went to two days of hydro, which was much the same as the weeks before. I saw a little boy would couldn't walk yet and was trialling a Sir David Brand walker. The boy still wasn't able to walk with the walker but his parent's were really pushing him too. My supervisor went through with me how to score the AIMS assessment, that I had done for my mid-place assessment. I was shown how to compare the score to the graph for that child's age and the child was very delayed in her development, much below those in the fifth percentile. This week, so far I have been to a meeting with the family to make goals for the next 6-12 months, with the physio, OT and speech present. The family had fostered the little girl and has only had her for about a month but it was so good to see how much she is part of their family and how much they are willing to do for her. This afternoon I went along to a podiatrist appointment with a client. The podiatrist is going to try some orthotics to help the clients pronated feet and help with his hyperextension of his knees.
My next few days look busy and I will be performing an assessment on a little girl with down syndrome for my final assessment on thursday.

On friday I had my mid-place assessment. I saw a client that was about a year old who doesn't have head control yet. The client was feed via a nasogastric tube and had increased tone. My observations were formed around the AIMS assessment, observing the client in supine, prone, side lying and supported sittings. I didn't proceed onto supported standing because the client had no head control it would have been too advanced. It was really interesting seeing a baby without head control at such a late age, when doing the lag test, there was no muscle recruitment at all. The client was unable to actively move their head while in supine and cheated by using gravity to assist most of the movement. Also when elbow propping the client with elbows behind shoulder, while in prone, her head was held up using her hand. ATNR was also observed only to one side of the body. It was so much harder to handle a baby that has no head control and had to consider each position carefully.

I was not able to complete my mid-placement assessment on friday because i was unwell but I will be doing it on this Friday with Jodie, because my supervisor is away for two weeks. So far this week I have done about three hours of hydro with three different classes. The classes are split up into pre-walkers and walker and the last group is for children with complex needs. The classes consists of singing songs and nursery rhymes while trying to get the children to do movements such as splashing, kicking and blowing bubbles with the songs. I will be going to another two more hydro classes on thursday with the north team.
On Monday we saw a boy who had developmental delay and was about 1 or 2 years of age, who has just developed head control. It was very interesting to see how to address this problem and the different ways of encouraging head control and upper arm strength needed for propping himself up. The physio suggested placing the child over her thigh so that the child had to push up off the floor with his arms. The boy had a PEG in place and his mother showed myself and another student the PEG site, which was interesting to see.
I went on a school visit to see a boy who was in pre-primary and the physio was working on his goal of kicking a soccer ball and football. It was a good experience to see how the teacher and the class was working to help improve the boys goals as well. The teacher was involving the whole class in the activities, which I think is great for not singling out the child and his disability.
A few of my appointments were cancelled this week due to the parents not wanting a student to be involved and be anxious.

Today I was able to observe the process of the gait clinic at DSC Myaree. I was able to observe how the physio's and podiatrist assess the gait of a child and their reasoning for their intervention. The little boy had good ROM in his ankles but they had to be passively moved with alot of force. It was interesting to see how they came up with the intervention of serial casting and I will hopefully get the chance to go allow to one of the casting sessions. In the afternoon, I saw a boy that had Angelman's syndrome, which I didn't really know what it was. There are so many different disorders that can affect development of a child that I hadn't heard of and it is interesting to see how how many children it has affected.
Tomorrow is my mid-placement assessment because my supervisor is going away for the next two weeks. I'm a bit scared on what to do because I haven't really had the chance to get too much hands on experience but i think i will be prepared. The child I will be assessing is about a year old and doesn't have head control, so it will be interesting what the child will be able to do.Hope it all goes well.