Developing a Physio Voice

Over this placement I have noticed something. I am pretty quiet and don't always jump at the chance to put in my opinion when there is a discussion going on.

This was especially apparent when driving back from Merritt with one of my preceptor Physios and the Occupational therpist. To be fair to myself both of these people have a few more degrees than I do and also degrees in areas where your opinion matters like in the Arts. 

I always felt that after I was done my high school classes my opinion was never really asked again. I mean, I was asked to critique articles and evaluate research methods, but the majority of my writing was scientific and needed to be founded on research and evidence. Its been a while since someone asked me "What do you think of this?" or "What is your opinion on that?"... Maybe they asked it later in the form of "What could be a possible explanation for X?" or "How could Y improved their research?" And in those situations which were usually upper level Biology classes, and by that time I had a fairly solid foundation in Bio and felt confident answering those types of questions. So far in the physio world its been a different story....

I feel like when a someone, anyone asks my opinion, I really struggle to form one. I am going to say this has a lot to do with my inexperience in the field. Expert opinion will develop over time as I am exposed to more cases, situations and populations. I will have the clinical expertise to be able to recognize patterns in my clients and know where they are and where they should be and what they should expect along the way during their recovery. I will also have taken more classes in school and outside, read more articles and completed my own research project. Hopefully this will help me form opinions about the profession and research and be able to contribute to discussions in meaningful ways.

Sometimes though, I just feel so naive about everything. For example, not being able to contribute to a conversation between my preceptors as they discussed the conference we had attended OR not be able to form much on my side of the debate when discussing taking additional training and courses after graduation.

I also think that maybe since I am not a very opinionated in terms of my personality I think its going to be something I will need to work on as I develop my professional skills as a physio. I often borrow the ideas of others and let them influence what I think. I think this is part of my personality too... I want to weight the arguments and hear what other people have to say, but I would really like to be able to read or think about something and form my own opinion quickly enough so that I can discuss with my colleagues to get other views and opinions and then share my thoughts on the matter with my clients or others.

HINT of Merritt

Today was the much anticipated HINT course as a part of the Interior Health Inservice taking place at the Nicola Valley Institute of Technology.

I met up with most of the OT/PT department at the ESSO station in Peachland. One of the OTs was telling me how when she told a friend from Ontario that there was a place called Peachland she lost it and laughed hard for at least 5 min.

The drive to Merritt was fine, the car had satellite radio and one of the OTs got us playing a license plate game where you make up a short sentence based on the letters of a plate.

The NVIT was a swanky building. Very UNBC campus-esque. Lots of wood and glass with concrete floors. Anyways after we checked in I was made to feel right at home as the classroom we were in was colder than the Freidman Dungeon. I wore my jacket the entire morning and regretted wearing my flats because I had no socks on.

The session was a lot like RSPT 526 for the first half of the morning. Dr. Susan Harris went over the difference between an Screening Assement, Assessments used to make a diagnosis, and Assessment used to measure progress. She also lectured on how the HINT Assessment was created and the importance of Specificity and Sensitivity.

We then covered the items that the HINT test covers. HINT stands for the Harris Infant Neuromuscular Test. It is a test used to screen infants from 2.5 to 12.5 months to see if they have developmental delays. It looks at they baby's motor skills when its on  its back, tummy and in sitting. It looks at how the baby tracks an object, how much control they have over their hands and neck. It also looks at muscle tone and how independently mobile the baby is. And my favorite item #21 - head circumference.

After our lunch as wonderfully provided by the hosts of the Inservice an actual live baby was brought in and Dr. Harris did an assessment on him and we all scored him. We also got to watch a video of an assessment and score that too. My inter-rater reliability (how close my scoring was to Dr. Harris') was pretty poor. But I am going to blame that on my lack of clinical and baby experience and the fact that I was sitting where it was hard to see the baby.

All in all it was a good day. I learned about an assessment tool and put it in my tool box to be able to use later in my clinical practice.

I also ate a lot of free snacks ;)

p.s.  downside to traveling so much for a job = getting car sick 2x/day

Client Communication

Client communication with peds is unique.

Infants
The youngest population 0-18 months tend to communicate with body language or coos and crying. With these clients the verbal communication mostly occurs with the parents. Consent is taken from the parents and the explanation of the treatment is given to the parents. However there still is a lot of communication that occurs between the physiotherapist and the baby. I have seen my preceptors coo and baby talk, pat backs, rub bellies and rattle toys for the youngest ones. It was kind of embarrassing the first time I had to communicate with a 2 month old client. I was all baby talk and cooing. But then I realized this is something that the Mom does on a daily basis and definitely nothing new to my preceptor. Also, as I am starting to handle a few more infants I have felt more comfortable in my handling skills and it almost seems like the babies can sense my increasing confidence. I guess maybe to them they just feel a bit more safe in a therapists arms who is holding them in the right way and with some amount of knowing what they are doing.

Toddlers
Often this group can understand what you are saying but are either too shy to respond or just can't form complex sentences or words. So in a way they are easier than the infants but not as straightforward as the pre-schoolers. Still they can let you know what they want fairly easily by making a fuss over an activity they are struggling with or having a terrible two moment because all they really want to do is read a book, not play some game with bean-bags or puzzles which you have put out for them. So far I have found that the parents are a big help in communicating with these guys as the parents have a lot of control over them and are in-tune with their child's unique ways of saying certain words.

Pre-Schoolers
I think these guys are my favorite to communicate with. Possibly because they understand jokes. And something that this placement has confirmed with me is that I like to tell jokes to kids and act silly! This group is also great because they can tell you what hurts or how they feel about things. They also love to tell stories and sing-songs. Maybe they are my favorite because they are the easiest to communicate with.

Non-Verbal
There have been some non-verbal kids that I have seen that you would expect to have a higher level of communication. A lot of these children have been introduced to signs. Although I don't always know the signs for things so sometimes what I am trying to say gets lost in inaccurate hand gestures that I have tried to copy from a parent or therapist. If I had more time with theses clients and they were on my case-load I would make every effort to learn the language to communicate better.

In conclusion....
Communication is  vital to any client therapist relationship. With the 0-5 population its important to use communication how you would with any other client, especially to build rapport with them. I find the best way to get children to open up to you is to get to their level. Communicate with things that interest them and are a big part of their life. I feel like this might be a really obvious thing to state and reflect on, but it is important to realize that when you are working with children you need to get on their level to not only discover what interest them, but also to find out what they are scared or tentative about and address those things to make them more at ease with the treatment session. And if this means cooing and baby talking or singing "row, row, row your boat" then that is what I am going to do because I want to connect with the client.

Flying Solo

Today was the day, well I guess I have done this a little bit before, but today was the legit full on "Here is a client, this is their diagnosis, What are you going to do about it" day.

YESSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS

I have been given a few clients who are relatively uncomplicated and asked to develop some goals and activities/treatments for them. I have spent a little time this week putting some ideas together for them and gathering up supplies to make it all happen.

On the way out my way out to the home visits my preceptor was asking how I was feeling about everything. I felt pretty good, calm and excited! Both of the kids are pretty great kids that I enjoyed seeing the first time around so I was excited to see them again.

The first session went well. There were a few activities on the fine motor side of things drawing with the non-dominant hand that frustrated him. He really loved the animal yoga and playing my new squirrel game that I invented. Its pretty fun being a ped physio because you get to make up games and do crafts as part of preparing for treatments! Also his grandma made us some Indian tea, which was delish!

The second one was outside. I was a little more nervous about this one because I didn't hit if off with him on the first visit where I observed and he had a shorter attention span. But it actually went really well. He had great energy today and was willing to do most of what I suggested without getting too frustrated. He was a little unhappy when the session was over, but I guess that just means I was doing my job.

It was really good to be able to do an entire session on my own. I feel like I am actually able to take observations and make a problem list out of them then make goals from that problem list and then make treatment around those goals. That's what a real physio does, right? It gave me a lot of confidence in my abilities. I was able to used what I learned in school  and apply it to an actual situation. Maybe its just the nerd in me, but I was pretty stoked.

My Day with the Orthotist

You may be asking yourself what is an orthotist. I was asking myself how to pronounce it and spell it properly:
The following is taken from http://www.sickkids.ca/centrefororthotics/who-we-are/certified-orthotist/index.html
A Certified Orthotist [designation C.O. (C)] is specifically trained and educated to design, fabricate and fit orthoses. They provide and manage custom-designed and pre-made orthoses to patients. Certified Orthotists conduct clinical assessments based on a physician’s prescription, make a recommendation for a pre-made or custom-made orthosis and monitor patients with the goal of restoring physiological function and/or cosmesis.

 Every other week the orthotist comes down from Kelowna to visit Penticton at the CDC. I was pretty stoked to get to spend the day with her as one of my preceptors said that he got to spend a couple of days with an orthotist during one of his placements and it was very educational.

So I got to see a bunch of new pathologies I have not yet been exposed to by only working with the 0-5 year olds. People from the entire lifespan came to the clinic to see her. It was actually pretty nice to be able to communicate with patients using complete sentences and my big girl voice ;) Some of them at least, as some of them were still kids with special needs.

The orthotist was really interesting to watch. She would do an assessment or make an observation and  get right in there and start cutting or blow torching (yes, she had an actual mini blow torch to heat mold splints). My favorite was when she asked me to grab an the anvil. Seriously. She used an anvil. Awesome. She was also very helpful in explaining why these clients needed the types of othoses or braces that they were being fit for. She was also a gait wizard.

Also I totally had a huge safety fail when I ran a foot rest of a wheel chair into a patients leg. SORRY!!! and  didn't get a chance to put the brakes on when he was sitting down... ooops.

I think its good as a physio to be in contact with a good orthotist. This profession is able to really help out our patients if what we are doing is not enough to correct their alignment or posture. I think that sometimes patients would come to us first and then if necessary we would have to know to refer them on to the orthotist to help correct their bowing, get them more ankle foot support or get them fitted with a brace to help correct contractures.

Prince(ton) for a day

The 0-5 year old physiotherapy services for Princeton are covered by the Penticton Child Development centre. So every few weeks one of the physios heads up to Princeton to see the clients there.

We left around 8:15am from Penticton. Sadly as my preceptor pointed out Penticton only has three radio stations.... CBC1, Top40 and a Country station.... and then when you leave the city limits they vut out anyways. So it was a very quiet drive in terms of background music. Anyways, no big deal, just gave us a chance to get to know each other and the new SLP better. (The SLP also had appointments in Princeton that day).

In Princeton I went with the SLP in the morning to see a few of her clients. We actually managed to get lost on the way to our first visit, but asked a friendly local for directions! That is definitely one thing I am enjoying about the OK, the friendly locals. A home visit and a visit at the health centre. It was interesting to see what an SLP does... oh wait... nope I have already seen it before, thanks to my lovely sister! But it was interesting to see what another SLP does. I even got to run a few of the exercises including rapid fire flash cards of Dora the Explorer!  p.s. home visits are really interesting, and I am currently thinking of a way to write a blog about that without violating confidentiality.

After we met back up with the physio who we dropped off at the hippest looking coffee shop in town and had some lunch in the health centre's lunch room. After lunch I got to do my very own interview and assessment! It went well for my first time I think. I was pretty hesitant and a bit slow with some of the questions and a little unsure with explaining the assessment, but my preceptor thought I did alright, so I will take it. Lets just say my baby handling skills were better than the previous times but are still a bit lacking.... at this rate I may be ready to handle my nephews when the arrive like a seasoned pro :)

The SLP had a late session which I thought was going to be earlier so I had to text Nicky that I was going to be late, and while the SLP conducted the session my preceptor and I hung out like high school kids in the parking lot and talked shop. Its interesting to get the perspective of a physio who is fairly fresh out of school. We talked about a few different techniques and the job and taking courses.

Things I found out about Princeton:
-there has been no Physiotherapist at the hospital for 3 years. There is a job there that just has not been filled. So fellow MPT's if you are hankering for a certain job when you graduate, it just might still be open. But seriously, 3 years. That is a really long time for a facility to go without a physio.
-The main thing that people do is work at the mine
-There are 4 coffee shops
-Lots of the hospital staff smokes
-There is a one way bridge that causes some confusion
-There are marmots here too!

 The Princeton bridge.

On the drive home I totally had a moment where I knew for certain that I had been there before... we drove past "The Sunflower Cafe". Yes, its still there. I remember stopping there on the way to Apex one year and having lunch I think. I can remember also being really excited and remember that drive and the scenery as well from driving that way up to Apex a few times! Ahhh.... memories :)

On the way home from Penticton after Nicky picked my up she asked me what I thought about Princeton. And I would like to be honest, please understand that I am not trying to offend anyone. As a young active physiotherapy student I am not sure that I would like to make Princeton my home at this point in my life. It would be an interesting job working at the hospital there because you would get to see a variety of patients being the only physiotherapist in town. At the same time you would have no support from a seasoned physiotherapist to help complete your training. In addition, it might be a hard place to grow your career or diversify if you wanted to move on to another area of practice or a more specialized area you would have to move on from Princeton. At the same time you would have the market cornered so you could do anything within reason. But there is more than just the work life. Socially I think I may find Princeton challenging in that I am not sure if I would find enough to occupy my interest. I don't want to make a judgement about the citizens, I am sure I could make friends, but what if I wanted to join a gym or take a Spanish language class or fly out of an international airport or enroll my child in sports.Anyways, thoughts?

WTH? Something tells me we're not in the OK anymore, Toto.

Its been a rainy few days here in the Okanagan valley. Boo. Yesterday I woke up and looked out into the valley and saw that there was low cloud and it was rainy. Seriously, was a dopple-ganer for a rainy March day in Howe Sound.

Usain Bolt demonstrating the proper ATNR reflex.

Yesterday one of my supervisors brought his brand new baby in to teach me how to assess a baby. Its been a really long time since I held a baby (especially one with poor neck control). The baby was so small. I am really looking forward to getting some baby handling practice on my nephews because its sort of tricky. Anyways we did all the cool baby reflexes ATNR/Usain Bolt (see above picture), stepping reflex, palmar grasp, plantar grasp, STNR, and even got a Babinski reflex out of the little guy! Also I am learning a lot about Torticollis and Plagiocephaly and some other baby pathologies so I will be all geared up to "do some physio" on my nephews! Can't wait until they are old enough to try out the some gross and fine motor Assessment!

Not much else new to report. Just wanted to send a general call out for blog topic ideas. They can be reflection topics or something about daily life or something else you wanted to know about life as a physio student.