They were not joking when they said i would see a lot of torticollis! Around 90% of the patients we saw were referred for treatment of toricollis and plagiocephaly. The other 10% were for developmental delay or DCD.
It was tough at the start of this placement because the centre were changing to an electronic database so the first 2 weeks I was there, the Physio department had dedicated it to getting logged on, learning and getting their patients onto the database. So I only got to see around 3 patients a day if i was lucky, which was a bit dissapointing. Then they didnt end up getting onto the database till the 3rd week i was there so even that was slow with minimal patients. This took up a loy of my supervisors time so i spent the majority of the time with the pther physios who were in the middle of not having their contracts renewed so they weren't taking on new patients. So unfortunatley i didn't get much of an opportunity to begin to handle the patients until the end of the 3rd week.
Though I think now I could safely say I feel confident in prescribing exercises for treating torticollis!! But what this placement did show me was how important teamwork is and how important it is to keep up communication between the diciplines on multi-disciplinary patients. The importance of getting the family involved and on-board with treatments was also showed espcecially with the patients with torticollis as it is the parents who will be doing the treatments in their daily lives.
I think it was unfortunate that I was at this placement when I was because of all the changes that were happening at the centre and in the physio department and would have been a good placement had I been there at a different point.
Friday, August 28, 2009
Thursday, August 27, 2009
Week 5 Entry
Situation
PT/OT groups are run weekly for children that require multiplinary discipline treatment and may benefit from group settings to learn the correct behaviours when playing with peers.
Task
To run a group with 4 children who have different ranges of gross and fine motor development delays, all with different personalities.
Action
Arrange the gym into a friendly and easily followed obstacle course on the outer perimeter of the room and mats with fine motor tasks in the middle. The children come in with their caregiver and play with their child. The clinicians try to spend soem time with each child to see how they are performing and their relationship in this setting with their caregiver. The child needs to attempt to do all parts of the obstacle course so as to get a good idea of their gross motor capabilities and how they take to following instructions and packing away and activity before continuing with another.
Result
Before groups begin, the children are placed into similar age groups and how they will possibly interact with each other. This group really works well together. It is a good opportunity to let the children work on their gross and fine motor skills but also allows them to attain social skills of turn taking, following instructions and gentle play.
Evaluation
From week to week the children's behaviour changes, depending on if they had a good sleep or not, if they've been sick or not, if they have eaten yet or not. One week the child can be great and doing all the activites and behave well without any tantrums, but then the next week he could cling to mum and scream, not want to participate and throw items around the room. However because there are other kids who benefit from the session, the session continues, and the parent is advised to do what they need/ feel they need to do for their child. If there is a child that is constantly not participating or just not fitting in and benefiting from the group situation, private sessions can be arranged.
Strategies
Always plan for more activites and toys then you may need, so that you don't have to leave/ get put on the spot for more activities or toys for the children to do.
Have the room pre-set up so that it is there for them to begin when they arrive and so that it is easy for the parents and children to follow and even though there may be lots of things they can do, to have the activites one after each other it helps for them to understand they have to do this activity before the next and they also have to pack it away before moving on.
PT/OT groups are run weekly for children that require multiplinary discipline treatment and may benefit from group settings to learn the correct behaviours when playing with peers.
Task
To run a group with 4 children who have different ranges of gross and fine motor development delays, all with different personalities.
Action
Arrange the gym into a friendly and easily followed obstacle course on the outer perimeter of the room and mats with fine motor tasks in the middle. The children come in with their caregiver and play with their child. The clinicians try to spend soem time with each child to see how they are performing and their relationship in this setting with their caregiver. The child needs to attempt to do all parts of the obstacle course so as to get a good idea of their gross motor capabilities and how they take to following instructions and packing away and activity before continuing with another.
Result
Before groups begin, the children are placed into similar age groups and how they will possibly interact with each other. This group really works well together. It is a good opportunity to let the children work on their gross and fine motor skills but also allows them to attain social skills of turn taking, following instructions and gentle play.
Evaluation
From week to week the children's behaviour changes, depending on if they had a good sleep or not, if they've been sick or not, if they have eaten yet or not. One week the child can be great and doing all the activites and behave well without any tantrums, but then the next week he could cling to mum and scream, not want to participate and throw items around the room. However because there are other kids who benefit from the session, the session continues, and the parent is advised to do what they need/ feel they need to do for their child. If there is a child that is constantly not participating or just not fitting in and benefiting from the group situation, private sessions can be arranged.
Strategies
Always plan for more activites and toys then you may need, so that you don't have to leave/ get put on the spot for more activities or toys for the children to do.
Have the room pre-set up so that it is there for them to begin when they arrive and so that it is easy for the parents and children to follow and even though there may be lots of things they can do, to have the activites one after each other it helps for them to understand they have to do this activity before the next and they also have to pack it away before moving on.
Wednesday, August 19, 2009
Week 4 Entry
Situation
Right classical torticollis client with severe plagiocephaly and facial asymmetries. Developmental delay secondary to the torticollis and plagiocephaly. Mother is of aboriginal heritage with the department of child protections constantly checking up on her and the baby. Father is not known.
Task
The task is to stretch the right SCM muscles using activities that the mother can easily do and continue with in her daily routine and teach them to her.
Action
Explaination to mother of the importance of the intervention and the consequences of the skull fusing and staying that shape, not allowing the brain to grow properly and facial asymmetry.
Stretching of the childs neck by side flexing the left ear to the left shoulder, and activites to encourage active right rotation of the baby's head. Advice was given to the mother regarding managing plagiocephaly, encouraging tummy time for play when she is watching her child, making sure to still follow the SIDS guidelines.
Because the plagiocephaly looked quite severe, my supervisor asked one of the paediatrician to quickly come and have a look. We then referred her to the craniofacial clinic at PMH to get an X-ray of the baby's skull.
Result
The mother was eager to continue with exercises but is very anxious as she doesn't want child protective services to take her child away and she stated she will try her best.
The following week we recieved the results of the X-ray from PMH which shows sclerosis of one of the skull sutures indicating premature closure. So it was lucky that the referral was made, so that they can now have surgery to stop the sutures closing prematurely and help with the plagiocephaly.
Evaluation
It was evident that the mother was very anxious throughout the session and because of this may not have understood or took in a lot of the information and exercises for her child.
With torticollis you can't evaluate anything there until the next session, because the effects of stretching aren't evident straight away so i will have to wait till the next session to see how effective the stretches and the explaination of the exercises to the mother were to see if there has been any gain in neck range.
Strategies
We gave the mother handouts with excellent pictures and explainations on them so that she can have them with her when she is performing the exercises. We will also check with social work to see if she is attending and how she is coping and maybe ask a social worker or a clinical pyschologist to come and sit in on one of the sessions.
An idea is to maybe do regular phone reviews between sessions to see how she is coping and whether she is keeping up with the exercises.
Right classical torticollis client with severe plagiocephaly and facial asymmetries. Developmental delay secondary to the torticollis and plagiocephaly. Mother is of aboriginal heritage with the department of child protections constantly checking up on her and the baby. Father is not known.
Task
The task is to stretch the right SCM muscles using activities that the mother can easily do and continue with in her daily routine and teach them to her.
Action
Explaination to mother of the importance of the intervention and the consequences of the skull fusing and staying that shape, not allowing the brain to grow properly and facial asymmetry.
Stretching of the childs neck by side flexing the left ear to the left shoulder, and activites to encourage active right rotation of the baby's head. Advice was given to the mother regarding managing plagiocephaly, encouraging tummy time for play when she is watching her child, making sure to still follow the SIDS guidelines.
Because the plagiocephaly looked quite severe, my supervisor asked one of the paediatrician to quickly come and have a look. We then referred her to the craniofacial clinic at PMH to get an X-ray of the baby's skull.
Result
The mother was eager to continue with exercises but is very anxious as she doesn't want child protective services to take her child away and she stated she will try her best.
The following week we recieved the results of the X-ray from PMH which shows sclerosis of one of the skull sutures indicating premature closure. So it was lucky that the referral was made, so that they can now have surgery to stop the sutures closing prematurely and help with the plagiocephaly.
Evaluation
It was evident that the mother was very anxious throughout the session and because of this may not have understood or took in a lot of the information and exercises for her child.
With torticollis you can't evaluate anything there until the next session, because the effects of stretching aren't evident straight away so i will have to wait till the next session to see how effective the stretches and the explaination of the exercises to the mother were to see if there has been any gain in neck range.
Strategies
We gave the mother handouts with excellent pictures and explainations on them so that she can have them with her when she is performing the exercises. We will also check with social work to see if she is attending and how she is coping and maybe ask a social worker or a clinical pyschologist to come and sit in on one of the sessions.
An idea is to maybe do regular phone reviews between sessions to see how she is coping and whether she is keeping up with the exercises.
Week 3 Entry
Situation
Patient is 12 months old and is a complex case who has not been diagnosed but it is evident that they have global developmental delay. They are not yet able to 4PK or pull to stand. Trying to facilitate kneeling, crawling, pulling to stand and cruising during treatment. Parents are in the phase of coming to grips with their child's development and it hasn't yet registered that their child might have to go to the disability services commision because of a IQ less then 70. Social work and clinical physch are involved to help and support the family. The child becomes quite distressed with handling especially in 4PK and facilitation of crawling, because of this the mother finds it hard to sit back and watch and comes to help the child after a short amount of time.
Task
To carry out a treatment of handling the child and facilitating play in 4PK and facilitating pull to stand, crawling and cruising and familarise mother with how physio's treat patients by exposing her to how much we handle her child and the importance of the handling.
Action
It was very important to thoroughly explain to mum what we wanted her child to achieve out of the physio sessions and what the sessions will consist of. We explained that physiotherapist do a lot of hands on treatment escpecially in paeds to facilitate the baby to get into positions and treat appropriately. We explained that because physio and we as the therapists are strangers to the baby, they may cry as they are not used to us, and what we will be doing and that the reward for the hard work the baby carries out even whilst crying can be a cuddle from mum.
In regards to the child's treatment we got them into 4PK over a roll for support and rocked them forward and back to encourage WB through the limbs. We then imitated crawling by supporting them under their chest and placing their legs forwards while they moved their arms. At the end of the course the child then had to pull to stand to get to mum. In standing while holding on to the table we then rocked her to encourage weight shift and weight bearing through her LL. We then facilitated cruising by placing her feet while the child moved their hands towards the toy.
Result
The mother appreciated the explaination because the first time she saw a physio she was very protective of her child and quite alarmed at how much her child was crying and just wanted to step in but now that she has been exposed and knows that she will get to cuddle her and settle her child down she is much more accepting of us treating her child and pushing her child a bit further.
Nearing the end of the session, the child began to pulling to stand to see mum with less assistance and along with the arm actions of crawling began to do the leg actions of crawling with support under her chest to keep her in that position.
Evaluation
I was surprised to see how quickly the child started to move her own legs during crawling. Imitating that movement is obviously being effective in cementing the movement pathways in her brain. The rocking in 4PK over the roll and in standing is an effective way to help strengthen the childs limbs which will help with the milestones they are trying to achieve and should be continued in each session. The mother seemed less anxious and allowed us to push her child a little more during the treatment which was good, and she was able to see the improvments in her childs efforts in crawling and the pull to stand they did with minimal assistance to have that reassurance that her child can do it and not to let them have the easy way out.
A strength was the communication to the mother about physio's handling and what to expect and that yes you child will cry but crying doesnt mean distress, and that when the child is distress or is crying for to long we will stop and let you cuddle them.
A weakness for me would have been my handling. I was very nervous with trying the make the childs legs bend, i felt like they were going to snap! And I think the baby senses my lack of confidence and uses that to be able to move out of the position.
Strategies
I need to practice my handling of babies with a doll at home and have more handling time with patients during the day in order to feel comfortable and confident in handling babies.
Patient is 12 months old and is a complex case who has not been diagnosed but it is evident that they have global developmental delay. They are not yet able to 4PK or pull to stand. Trying to facilitate kneeling, crawling, pulling to stand and cruising during treatment. Parents are in the phase of coming to grips with their child's development and it hasn't yet registered that their child might have to go to the disability services commision because of a IQ less then 70. Social work and clinical physch are involved to help and support the family. The child becomes quite distressed with handling especially in 4PK and facilitation of crawling, because of this the mother finds it hard to sit back and watch and comes to help the child after a short amount of time.
Task
To carry out a treatment of handling the child and facilitating play in 4PK and facilitating pull to stand, crawling and cruising and familarise mother with how physio's treat patients by exposing her to how much we handle her child and the importance of the handling.
Action
It was very important to thoroughly explain to mum what we wanted her child to achieve out of the physio sessions and what the sessions will consist of. We explained that physiotherapist do a lot of hands on treatment escpecially in paeds to facilitate the baby to get into positions and treat appropriately. We explained that because physio and we as the therapists are strangers to the baby, they may cry as they are not used to us, and what we will be doing and that the reward for the hard work the baby carries out even whilst crying can be a cuddle from mum.
In regards to the child's treatment we got them into 4PK over a roll for support and rocked them forward and back to encourage WB through the limbs. We then imitated crawling by supporting them under their chest and placing their legs forwards while they moved their arms. At the end of the course the child then had to pull to stand to get to mum. In standing while holding on to the table we then rocked her to encourage weight shift and weight bearing through her LL. We then facilitated cruising by placing her feet while the child moved their hands towards the toy.
Result
The mother appreciated the explaination because the first time she saw a physio she was very protective of her child and quite alarmed at how much her child was crying and just wanted to step in but now that she has been exposed and knows that she will get to cuddle her and settle her child down she is much more accepting of us treating her child and pushing her child a bit further.
Nearing the end of the session, the child began to pulling to stand to see mum with less assistance and along with the arm actions of crawling began to do the leg actions of crawling with support under her chest to keep her in that position.
Evaluation
I was surprised to see how quickly the child started to move her own legs during crawling. Imitating that movement is obviously being effective in cementing the movement pathways in her brain. The rocking in 4PK over the roll and in standing is an effective way to help strengthen the childs limbs which will help with the milestones they are trying to achieve and should be continued in each session. The mother seemed less anxious and allowed us to push her child a little more during the treatment which was good, and she was able to see the improvments in her childs efforts in crawling and the pull to stand they did with minimal assistance to have that reassurance that her child can do it and not to let them have the easy way out.
A strength was the communication to the mother about physio's handling and what to expect and that yes you child will cry but crying doesnt mean distress, and that when the child is distress or is crying for to long we will stop and let you cuddle them.
A weakness for me would have been my handling. I was very nervous with trying the make the childs legs bend, i felt like they were going to snap! And I think the baby senses my lack of confidence and uses that to be able to move out of the position.
Strategies
I need to practice my handling of babies with a doll at home and have more handling time with patients during the day in order to feel comfortable and confident in handling babies.
Sunday, July 26, 2009
Yr 3 Prac - Initial Post
Im really anxious before going on my prac placement to the state child development centre. I actually havent been able to leave my room for the past 3 days so i dont know if i'll even make it on my first day which is very annoying! I dont start till 12:30 so hopefully i will be okay. I read about my placement and saw that i will mainly be dealing with children with torticollis. Its good to know what i'll be dealing with, so I can revise that. I'm nervous for this paeds placement though cause i'm not good with kids. But hopefully i can change that! It should be really interesting and eye opening to try to treat children, especially babies that can't communicate back with me. I also think it'll be challenging to build raport witht he parents, considering their child mean everything to them and i'm only a student.
I think I will have a lot of fun on this prac, it'll be very different to my last one which was gero.
I'm looking forward to it! If i make it on my first day that is!!
I think I will have a lot of fun on this prac, it'll be very different to my last one which was gero.
I'm looking forward to it! If i make it on my first day that is!!
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