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Observational Practice Placement One!

This week I have spent an amazing week working with a fantastic community neurosciences team! It was my first placement and just an observational one to link our theory to practice and to give us some insight and experience into occupational therapy.

I feel like I have seen such a huge amount within just one week! Where do I even begin!? 

I was made so welcome on my first day by everyone (and by the way I did not get lost!) I was introduced to the members of the team which included 3 occupational therapists, 3 physiotherapists, occupational therapy assistants and district nurses. Throughout the week I had the opportunity to go out into the community with all 3 OT's (Including my placement educator who is a senior OT) on visits to people affected by neuro conditions. These complex conditions included: 

• Stroke
• MS
• Parkinsons
• Spinal Injury

The thing that shocked me the most is how common stroke is! The majority of cases I have seen over the week have been affected by stroke. Stroke is fascinating as it affects people in many different ways; It can affect a person's mobility, cognitive function, short and long term memory, visual perception, word recognition, speech, psychological impairments, sensory impairments and the list could go on! Stroke can be devastating and ultimately life changing. I have seen a number of cases this week of relatively young adults receiving therapy in recovery after stroke. It is evident that they are feeling very low and depressed. There stoke has had a huge impact on their lives and some of them have lost most of their mobility and speech and as a result are living within residential care or receiving full time care from family, friends or carers. Put yourself into that position... going from being a fully functioning individual, working and enjoying family life and then something life changing like stroke comes along and can be totally devastating. It was important to see the occupational therapists role within this recovery process. The occupational therapists offer a range of adaptive equipment such as; wheelchairs, hoists, standing aids, hand rails to name but a few to enable a person to function around aspects of their daily living activities. The occupational therapist also practised different mobility exercises such as; standing and weight bearing activities. Also the OT would provide support, empathy and understanding towards patients and their families and would work within the specific environment and needs of the individual to enable quality of life.

 During the week I was lucky enough to be invited to attend a network stroke meeting where I met a lot of different professionals from different trusts who were discussing their stroke services and how to improve them. 

                                                My little badge I was given at the meeting!

It gave me a great insight into the current climate of the NHS (scary stuff) But it also taught me about different categories of stroke and how they could be treated. (Category 1 being the most severe to category 6 being less severe). Most hospitals run an ESD service now which stands for Early Supported Discharge. This sees stroke patients length of hospital stay times significantly reduced and they are sent home and provided with an early, intensive therapy and rehabilitation programme to maximise independence as soon as possible. The sooner after the stroke the better as the brain has the ability to heal and change (neuroplasticity) to re-gain and learn new skills. The treatment will be very intensive for the first 2 weeks and then gradually reducing. This is where I experienced the neuro community team coming in! In the guidelines it says that a patent should receive up to 45 minutes of relevant therapy a day but sometimes this is just not feasible. It was great to attend the meeting as it fed straight back in to what I was observing on my placement!

It was great over the week to return to some of the same patients houses and so see their progress with ESD therapy even just within a week people were making improvements! A lot of people make great recoveries over time thanks to the amazing work of the Occupational Therapists and the wider team. 

I realise I have written a lot about stroke but I have found it fascinating!!

Some of the most interesting things I experienced through the week were the Stroke Driving Screening Test, the Chessington Occupational Therapy Neurological Assessment Test and the Behavioural Inattention Test. These assessments we're actually really fun and fascinating! AND I got the opportunity to administer some of these assessments myself which was great! They mainly test cognitive function, memory, visual and perception impairments in people with stroke and other neurological conditions. The stroke driving screening test assesses peoples ability to return to driving post stroke with a variety of different visual timed activities. The assessment I administered myself was part of the Behavioural Inattention test. This was to assess a patient with MS and who was struggling with memory and visual problems.

Here is an example of one part of the test:

                                        http://strokengine.ca/assess/module_bit_intro-en.html

This part of the test was called the Star Cancellation and patients are asked to cross off all of the "small stars" on the page. This can be quite difficult for someone with visual problems as there are a lot of distractions on that page!

Here is a picture of the COTNAB test I also assisted to administer:

This test highlights a person's ability to grip, and hand-eye coordination, fine motor skills and dexterity. http://www.saetrahealth.co.za/cognitive_assessment/cotnab.html

It really made me feel confident performing these tests and I feel I really connected with the patients :)

So as discussed throughout the week I:

• Was introduced to a multidisciplinary community team
• Have seen and learned about different neurological conditions
• Learned some basics of neuro anatomy and the physical affects of neuro conditions presented in the body
• Cognitive and psychological effects of neuro conditions
• Have attended a stroke network meeting
• Learned how different adaptive equipment works from a hoist to a sock aid!
• Have met a lot of lovely individuals whose lives are affected by neuro conditions
• Experienced how important occupational therapy is within the multidisciplinary team
• Have learned how effective and life changing occupational therapy is
• How awesome and hard working occupational therapists are
• Asked a lot of questions to my educator as I was fascinated by everything I saw and wanted to learn more
• Have administered assessments and tests to patients
• Have assisted with interventions
• Have helped to measure up for new banisters in someone's home
• Have witnessed an initial assessment of a patent and activity analysis
• Have offered therapeutic use of self to reassure and praise patients
• The many challenges an OT faces within a household environment including coordinating adaptation, extremely cluttered kitchens to very scary loud, muzzled barking dogs!
• Have supported people out into the community on their first shopping trip after stroke

I also had the opportunity to write notes and complete paperwork which was great experience to see the language used and follow their structure of writing up patients notes. I also attended joint multidisciplinary meetings with patients with other professionals including; social worker, nurse, OT and physiotherapists. It was great to see how everyone worked together complimenting each other, especially the OT's and PT's. Making phone calls and booking patient appointments was also a good experience too!

I really do feel my brain is bursting with the amount of experience I've managed to gain out of just one week and I am sad that I didn't get to stay longer! Neurological conditions are fascinating and there is so much vast information you could go into. I feel this could be an area of interest for me in the future!

As you can see, my brain is buzzing with information that I have learned this week! I am exhausted too, observing is more tiring than you think! I have loved my first placement and have gained a great awareness and understanding of occupational therapy. I have also received some really positive comments from my educator which is really re-assuring, confidence boosting and makes you realise why you have chosen occupational therapy and that I am very capable and suited to the profession... Just need to work on my level 7 writing skills and I'll get there.

I'm going to be an Occupational Therapist :)

I will leave you with a photograph of my BAOT student member badge :) I became a member this week!

By the way did you know it is Occupational Therapy week!? How ironic.

Time for an early night and to rest my brain ready for starting preparation for next week over this weekend!