Charity’s Two Cents…

6-3-09

On the 29th of May, I went to my last day of fieldwork 1 clinicals.  Steve was still on maternity leave and is due to come back on Monday.  Brooke, the COTA that I have been observing the last 4 days of my FW, was extremely busy that friday.  I helped her prep rooms for upcoming appt.’s, I cleaned the rooms after the sessions were over, I gathered cervical packs and e-stim machines for her, and I folded a lot of laundry to help out all the employees.  This was probably my busiest day at the 311 bldg.  The gang took me to the Yucatan, a mexican resturant, for a farewell luncheon.  I was so lucky to have had my FW there.  I enjoyed my time there and I feel as though I have learned a lot.  I am so interested in the outpatient rehab part of OT, that I can see myself working there in the near future.

Discontinue note

Charity Orlando, S/OTA

5-22-09

Steve, my FW 1 supervisor, and his wife, Angie welcomed their little baby girl at 7:30pm on 5-22-09.  They named her Leah Elizabeth Copenhaver.  She was 8 lbs. 6 oz. and 21.5 inches long.  They said she looks like Steve ( the poor girl!!)

5-28-09   This is the 2nd to the last day of clinicals for me.  I am kind of sad about finishing up my 100 hours here at the 311 Bldg.  in Coshocton.  Although I am sure it is a happy time for Steve,  he said “he wants to hire me so he can turn around and fire me!”  Yep, I think he is proud of my work performance.  Some of the people at the facility want to take me to lunch at a mexican resturant tomorrow on my last day of FW clinicals.  I have been so lucky and I have learned so much from this experience.  I cannot even believe it!  I hope my FW 2 clinicals is just as fun and rewarding as this one has been. 

I sat in on a therapy session with “M” again today.  (the 4th time I have observed her)  The session was for 1 hour and she is working on all new ax.’s.  She can ambulate alone without the use of a cane now and her cursive writing is legible, although she said it is still messy.  Some of the ax.’s she is doing is active reaching with a 1 lb. weight, cutting putty with scissors, pressing a cone into the putty making round impressions in it, standing while tossing a 2 lb. ball, parascapular lifts with 1 lb. wt. on her shoulders.  She also worked on removing bottles from a cupboard and then replacing them once she had them all removed.  She stated she was tired after her PT and OT sessions today.  She only has one more Speech session and 12 more OT sessions before she is finished with therapy. (I am not sure on how many PT sessions left)  She still comes to therapy 2/wk.  She still needs some assistance with washing her hair and she does fatigue easily.  The motion and strength she has got back is amazing.  She still needs therapy to increase her endurance.  “M” and her husband said that they are going to wait to go to TN after her therapy is over, which is 7 more weeks away. 

S/OTA, Charity Orlando  5-28-09

I sat in on an OT therapy session with “M” this morning, May 14, 2009.  The returns she has made have been increasingly impressive.  She reported to us that she is writing in print with her affected (R) side dominant hand.  She said that she cannot write in cursive and it be legible to read.  She can self feed herself with the use of utensils using her right hand but tires after a few minutes, and then switches to her (L) hand.  She is not using her w/c any more but a quad cane.  She shows some incoordination when performing bicep curls, but can actively touch her (R) fingers to her shoulder.  Some of the activities she participated in today was ball tossing back and forth with me while standing.  She did some ball tossing while sitting as well.  She reached for Post-Its on the wall-labeled 1, 2, and 3.  Then she was instructed to touch the # that the OT sporatically  spoke.  She performed some weight bearing exercises and recovered 4 small washers out of the red theraputty while in a standing position.

Just as a refresher, “M”, is the pt. that had the intercranial hemmorage on 2-10-09.  She is also the pt. that regained feeling distally, rather than proximally.  She falls within the 5% of the population of CVA pt. that start regaining feeling in the hand then up towards the trunk.

“M” and her spouse stated their excitement about a trip to TN they are planning to go on in a few weeks.  She has made such progress that her physician, OT and PT therapists have approved the car ride there.  She is still continuing OT, PT, and Speech therapy 2x/wk for 30 minutes each session.  Charity Orlando, S/OTA (Narrative format note)  5-16-09

5/1/09

The second visit with “M”, the CVA patient, she started showing improvements with shoulder AROM.  The OTR tried new therapuetic modalities to help her increase her ROM further.  He stuck Post-Its on the wall, then had her reach with her R affected arm and touch them, having her bring her arm back down to her side before attempting to do it again.  He also had her perform this ax. while standing.  After 5 reps. of those, he stuck the Post-Its higher on the wall to see if she could do it.  She managed to do 5 more reps. although her hand started to shake while reaching to touch the Post-It.  It appeared to me that she was tiring.  The OTR also introduced a tougher theraputty to “M”.  She was used to pulling washers out of the yellow putty, whereas today he had her do the same ax. with the red theraputty.  She accomplished the task in under  5-6 minutes.

I prepared a SOAP note that my FW 1 supervisor approved of

“M” R CVA   5-1-09

S:  Pt. stated that she is excited and pleased with the gains she has made within the past week.  She  commented on making progress with her ADL’s.

O:  While in a standing position, the pt. prformed R UE isometric exercises, as well as, weight bearing on her wrist and elbow using a table riser and pillow.  The pt. practiced reaching while in a standing postion.  The pt. also sorted out washers in a tougher putty than what she previously used.

A:  The pt. can touch her face and hold that position for 1 minute before tiring and dropping her hand to her side.  Last week she could only raise her hand to her face for a few seconds before tiring.  Her AROM as also improved from a week ago.  He AROM R shld. flex. 0-58 degrees.

P:  The pt. will continue OT therapy 2x/week for 30 minutes as per plan of care (POC).  Pt. will also continue HEP per OTR directions/instructions.  Pt. provided with red therapy to take home.

S/OTA, Charity Orlando

4-24-09

Today I saw my first therapy session with a R CVA patient. 

 M, a married,  middle-aged woman  suffered from an intracranial hemmorage. On 2-10-09 she underwent surgery at OSU Hospital.  She started feeling movement in her fingers, then wrist, then elbow, and is waiting to experience movement in the shoulder.  Statistically, she is among the 5% who has regained motion distally rather than proximally.  Steve, my FW 1 supervisor said in all his 11 years working there he has never seen a patient recover in that way.  She stated how difficult it was needing so much help when before she was totally independent in all her ADLs.  She uses a wheel chair, but has started walking.  She has some weakness so her ambulation is limited to 10 to 15 paces maximum.  She also stated that car rides physically drain her.  Her  recent trip to Columbus exhausted her.  Her spouse explained to us how they vacation in TN every summer and was concerned if his wife could handle the trip. She stated how she has always looked forward to their vacations together.  Her progress over the next several weeks will determine whether or not they attempt going.  She is currently participating in OT, PT and Speech, 2x/wk for each.  She participated in weight bearing exercises in the the hand and elbow, 10 repetitions each.  She pronated and supinated both of her forearms 12 times and reached for cones as the OT held them at a distance of about 2 feet from her.  She also reached out to touch post-it notes that were placed on the wall in no particular order, she had to return her R hand back at her side before touching another post-it.  She completed all of her exercises in a standing position with the exception of the weight bearing exercises.  M will continue  HEP (Home Exercise Program) as directed by the OT.

S/OTA, Charity Orlando

This was my 1st attempt at a narrative note:)

On Friday, April 17, my FW supervisor had the day off, so arrangements were made for me to shadow Brooke, a COTA, that usually goes to the schools in Coshocton to give therapy.  The first school we visited was Lincoln Elementary.  Brooke met with a 3rd grader, who was to possibly have ADD and behavioral problems.  I was told that the boy lives with his grandmother who is against medicating her grandson.  Brooke has been working with this child for 3 years.  The family is using fish oil as an alternative for meds. to help manage the ADD.  I thought that was very interesting.  I had never heard of that before.  The activities that were addressed in therapy were handwriting, tracing, a word find, and we all 3 played the Maisy game.

The second school that we went to was Sacred Heart, a Catholic school, where Brooke worked with 2 children.  L, a 1st grade girl with CP and a 3rd grade boy who has problems staying on task.  The girl needed therapy to help with fine motor and also to establish better social skills.  The boy, not diagnosed with any disorder, needed therapy for attention.  His parents also refuse medications for their son.  L needed a weighted wrist band for hand writing, she copied the uppercase letters of the alphabet, completed 2 mazes, and strung frogs on a string.  The boy practiced handwriting by copying sentences.  He took a considerably long amount of time to complete his sentences.  He wanted to talk or watch L perform rather than stay on task.  He required many verbal ques from Brooke, then he also strung frogs.

The 3rd school we visited was Central Elementary.  I watched Brooke perform therapy on 3 boys.  She had them  balancing on one foot and doing jumping jacks.  They also practiced handwriting and we all had a good time playing the Maisy game. Brooke told me that she thinks that one of the boys we seen was possibly autistic.  One boy suffered from an axiety disorder, and the other 2 boys were diagnosed with AD/HD.

Progress Note:

4-17-09  I traveled to 3 seperate elementary schools and observed a COTA perform therapy on children with different disorders.  I reviewed the documentation that she completed on all the pt.’s throughout the day and I enjoyed participating in therapy sessions, especially the Maisy game.

Charity Orlando, S/OTA

This week my FW supervisor talked to me about starting some documentation for next week.  He also informed me that the facility will be closed Good Friday, so I will need to make up those hours later.  He showed me where the hot cervical packs were located and I fetched those off and on throughout the day.  I saw some of the pt.’s that I saw last week and met some new pt.’s too.   I reviewed more pt.’s charts and viewed more sessions that Steve had.  I met the COTA that works there, Brooke, she usually works at the schools, but occasionally has some late afternoon appointments.  I asked many questions about the charts and Steve was very informative on giving me answers to my questions.

Since the start of my clinicals, I have observed the use of the goniometer, the nerve stimulation machine, the cobb heat machine and many treatment modalities to increase the pt.’s function.  I am having a good time working in Coshocton at the 311 building.

Charity Orlando, OTAS

The first day of my FW 1clinicals was April 2.  I stayed for 6 hours and took a 30 minute lunch.  I was somewhat nervous, but not too much since I had been around Steve, my FW supervisor, before.  He is great; I could not ask for a better supervisor.  My morning was filled with reviewing the hospitals policies and signing forms.  After that, I observed 4 sessions that Steve had with his clients.  There wasa frozen shoulder, a rotar cuff repair, a fracture of the UE, and I sat in on my first evaluation.  That was cool!!  I learned a great deal from observing and it was so awesome to watch a pro work!  I was very interested in all the different activities that he (Steve) had the pt.s doing.  He had one pt. use their pinky to remove a piece of tape off the table to regain strength and control is their little finger.  Another pt. practiced crumbling up Kleenex to regain mobility in all the digits of their hand.  Lastly, I wanted to share with my other classmates some more abbreviations that I had learned from my first day.  HEP=Home Exercise Program      TAM=Total Active Motion     DBS=Dorsal Blocking Splint

Initial note:  I met with the OT, Steve, who is my FW 1 supervisor.  We discussed the hours and days that I planned on attending.  He showed me around the facility and introduced me to many PT’s and PTA’s and management.  I reviewed the CCMH policies and signed my name to many documents.  I reviewed 4 patient charts and asked questions.  I quietly observed the 4 therapy sessions that Steve had that day.  This sums up my first day at clinicals.

Charity Orlando, OTAS