Client Communitaction -

Sometimes it is necessary to talk about a kid while they are still in the room. You have to keep an eye on them and talk with the parents about what you found during the assessment or discuss what you are doing with them at that moment or how they responded to your treatment session. Really, its unavoidable a lot of the time.

But sometimes it seems like its detrimental to the child. When a talking about their child they often describe their personality. "Timmy* is really doesn't like playing with other kids", just for example. *This is not a real client. I am not a psychologist nor claim to be a behavioral expert, but I feel like this would rub off on a child over time. If your parents keep telling you that you are a certain way. Aren't you bound to believe them and will act in a way to reinforce this believed identity and hang onto it longer than the behavior may have otherwise lasted? Will Timmy now demonstrate how he does not play well with others during the session now that his parent has said that.


I feel like its really important to discuss with the therapist certain behaviors that you are seeing in your child or what you are concerned about, but I think it can have an impact on the session. For example when I was younger and we went to the Doctor's office and I was sick and my Mom described the symptoms for the Doctor I would always play up my symptoms. If she said I was coughing i would make sure that I got at least a few good hacks in there. If she said I was limping or favoring a leg, I would definitely limp for all I was worth when asked to walk.

(I am sure similar things occur internally with adults. I haven't had any experience there yet, but I will keep you posted. I am sure it is even more complex based on whether or not they want to be seeing the physiotherapist... to be continued.)

Maybe it would be best to discuss the subjective history of the child somewhere where they can't hear you. I know that the logistics make this difficult, but I think it would give the child a chance to present 'normally' without a trying to do what their parents are asking.

In the 0-2 category this is probably not as necessary as a lot of the kids are either infants and to young to hear you are don't have the language skills to really get a grasp on what you are saying. But for pre-schoolers who have been probably told why they are coming in to see the physiotherapist and what for they may present differently based on the information they have been given.

Bringing it back to communicating assessment findings etc. in front of the child; what is the parents obligation to tell the child about their diagnosis or progress. Should a child be kept in the dark about why they are seeing a physiotherapist. This is completely possible being that most of the therapies are disguised as games. A child may never know that they have below average balance for their age, they are just excited to be playing on the balance beam and doing obstacle courses. but do they have a right to know that they are 'behind'? I don't know if 'right' is the word to use, maybe another way of putting it would be: will telling the child that they have weakness or a balance issue help or hurt them more? Will telling a child that they have poor balance just make them fall more or would it help them overcome it? Of course a lot depends on the child and how the family approaches the disability.

Home Visits

Home visits are different. Home visits are unique. Home visits aren’t awkward. Home visits give the therapist a lot of information about the level of stimulation the child is exposed to and what sort of environment they are developing in.

It is pretty eye-opening going into a client’s home to see how they live. I like it for the kids because I think it’s a great way to get them to be more comfortable with the idea of physiotherapy. They are in their home, a familiar environment. And just like the crayfish I studied in Biol 345 lab, they have the home field advantage. Which is good, since as a therapist you have at least 20 years and a degree or two (not including the kindergarten diploma on them). Sure the kid would eventually get used to the centre and coming into visit and there are a lot more variety of tools available at the centre, but the child is pretty comfortable right away. Case in point: a client was showing me off his entire car collection and all of his favorite toys right within 5 minutes. I could see this being a bad thing if they started to domineer the environment, in that case it might be good to get them in the centre and on your turf to be in more control of the situation, but I feel like this can be avoided with routine and parental support.

Speaking of parents it is also really convenient for them, especially in the rural areas of the south Okanagan Valley to be able to be seen at home. Instead of 5 families making 5 separate trips to the centre in Penticton, 1 therapist travels to somewhere like Oliver for the day to visit those 5 clients. And in some cases therapists from separate disciplines can travel together to see the same clients at the same time if they are both administering therapy to her.

Home visits also let the therapist into the world of the client. They show the therapist if the client is being under-stimulated or what types of treatments the family would be able to support for the client. I think this is really important as it helps the therapist give meaningful interventions for the family that they are able to do in the home. For example, if you go into a home where there are not a lot of stimulating toys for a child to play with you can lend them toys from the centre or suggest to the parent what sorts of toys would be good to look out for at the second hand stores.

I have also enjoyed home visits for selfish reasons! At one client’s home I have been going to on a weekly basis his grandma has been making Indian tea for me. It’s pretty yummy. It’s not that I expect to get this sort of treatment when I go into everyone’s home but it’s nice to experience the culture of the clients that you are visiting with.  Also today the little girl I saw gave me a tomato plant that she was growing.  Not to get all sappy or anything, but it’s really touching to see how much some of the kids look forward to your visits. Last week one of my clients was noticeably sad that I was leaving. He talked me all the way to the door and continued carrying on the conversation as I was loading up the vehicle and getting ready to turn the ignition. It’s gratifying as a physiotherapist to see that the work that you are doing is having an impact and is something that they have fun doing.

Last Weekend in the Okanagan!

Wow, that came quickly!


Nice to have a long weekend that I could actually enjoy and not have to worry about studying for exams or doing something for the Dillman Project.

Cameron came up this weekend late on Friday and it was great to see him, eventhough it had only been a couple of weeks since we last saw each other.

On Saturday we had a pretty lazy day. He helped around the house a bit after our late breakfast. And then he helped his mom get a few things done for her Masters stuff. And we hung out for a little bit before venturing off to Save-On-Foods to get a few things as we promised to make dinner. We ended up making some chicken burgers with kiwi salsa. Which were excellent!

On Sunday the plan was to do the KVR on bikes, but not enough bikes were in working order so we went for some yummy lunch at a restaurant called "Cabana" and walked along Mill creek with the dogs.

On Monday we went for a quick but yummy and delicious brunch across from the Greyhound station and ran to the bus after slow service on the meal and Cameron was off back to Vancouver as he had to tutor that evening.

Monday afternoon I went for a hike in Okanagan Mountain Lake Provincial Park. I took the dogs. Wally managed not to barf on the car ride, but he puked once when we were walking to the trail head and once after we were reading the sign. And they both saved up their poop for the trail. The joy of dogs. Halfway along the trail I ran into a few of the people who are doing their placement in Kelowna! What a coincidence and proof of small town Okanagan! Anyways we made plans to have dinner later. The hike was really wet. It rained like it was Vancouver. But it was still a really interesting hike. It was an area where the fires got to a few years ago and there was a lot of burn damage. Made for a great view and interesting scenery.

After getting the soaking dogs home in a car that may permanently smell like wet dog, I went down to Westbank to have pizza and a Batman movie that I felt like I never saw with some phresh physios.

Good weekend :)

Intoeing Referrals Fact Sheet

This is something I put together for the centre.
They get a lot of referrals for in-toeing which is a
normal part of development.
However, below outlines when you should refer.
Enjoy :)

In-toeing Referrals

The primary health care practitioner such as a GP or nurse can monitor the rotational variations of most children as they grow. Most children who are referred beyond primary care to either an orthopedic surgeon or a physiotherapist for in-toeing are discharged after their first visit. The following are guidelines to assist primary care providers in knowing when to refer a client with an in-toeing posture or gait to an orthopedic surgeon, physiotherapist or pediatric neurologist.

Refer to an orthopedic surgeon if you observe:

●  Metatarsus adductus beyond 2 to 3 months of age

 ○    Metatarsus adductus is a foot deformity seen at birth where the bones inthe front half of the foot bend in toward the body. If the foot can be passively moved into a neutral position it will usually correct itself within the first 2-3 months; refer if it does not correct. If the foot is unable to be passively moved into a neutral position this is known as rigid metatarsus adductus, which requires an immediate referral.

●  In-toeing that does not follow the normal progression

 ○   Children will start to in-toe when they begin to walk and should be straightening out by 8 to 10 years of age. At puberty the child should be slightly out-toeing. Refer if the in-toeing continues to progress after 5 or 6 years of age.

●  Children older than 8 years with tibial torsion (turning of the tibia so that the knee caps face forward, but the toes point inward) that limits their activity level or is cosmetically unacceptable.

●  Children older than 11 years with femoral anteversion (the head and neck of the femur point inwards causing the thigh to rotate inwards) that limits their activity level or is cosmetically unacceptable.

Refer to a physiotherapist or pediatric neurologist if:

●  Child presents with unilateral or asymmetrical in-toeing in addition to clinical findings suggesting a possible neurological disorder such as cerebral palsy or developmental dysplasia of the hip (DDH). DDH is dislocation of the hip joint present at birth. Signs of DDH include clicks, pops or clunks when the hip is moved passively.

●  A unilateral limp is present while walking or running

●  Child complains of pain in the hip or knee joint

●  Difficulty participating in functional age appropriate activities

●  Child trips more than peers

Weekend in Penticton...

Last weekend Connie came up from Vancouver and Jen came to Penticton from Vernon.

I picked up Jen at the Westbank greyhound and we drove down to Penticton together in Colin's BMW which I only stalled a few times. But I think that car actually might be embarrassed to be driven by me. I fully stalled at a light with people waiting behind me. Thank goodness that they eventually went around. I missed the Dale Rieu Driving Tip for that situation. I actually think I need a lesson full of Dale Rieu Driving Tips for Standard Transmission Sports Cars.

When we got to Penticton we met up with Connie and Malee at Zellers which is having a 50-70% close out sale. Then after a quick pit stop and change of vehicles (Jen reported my stalls in the BMW) we headed to check out what was left of the Penticton Farmer's market. The Farmer's market was winding down by the time we got there, so we headed to SHACK 55 for some delicious burgers. I had the 'Donde esta la biblioteca?' Yuuuuuuummmmmmy!

After lunch we were planning on going for a hike but wanted to check out a few wineries first. So we headed up the Naramata to "Elephant Island".  Elephant Island makes everything except grape wine. we sample Pear, Framboise, Black Current, Apricot etc. Sooooo delicious. I think I like fruit wines a lot more than grape wines. I mean some were not good, but some were really good. There was a little courtyard outback so we got to sit at a little table under the tress beside a vineyard. Such a nice way to enjoy an afternoon... ahhhh.

After that we went to "Soaring Eagle". The view from this winery is nothing short of spectacular. It looks west north and south over lake Okanagan. It was such a blue bird day too that the lake and the valley was visible in its all of fits glory. The wine was pretty good too... and only 3$ for like 10 wines. I think I am actually starting to develop a taste for wine and am learning how to tell them apart.

 After we decided to go for out hike. The original plan was Skaha park, but after the wine and the heat, we opted for the much shorter hike of Mt. Munsted. Which is part Mt. Tolmie part Hollywood Hills sign. It mostly turned into a photo shoot at the top because of the spectacular views.

Then we drove down to Tickleberries for massive ice cream. Apparently in Tickleberry language a single cone is three scoops..... wow. I was really full.

 Funnily enough we ended up running into someone from the Physio program there who was visiting a friend in Summerland for the weekend. Small, small world. But maybe that is just Tickleberrys, bringing the world together.

I also want to talk about Tickleberrys claiming to be "Diabetic Friendly" because of their diabetic options I guess. But  We know that a high sugar and high caloric foods contribute to type II diabetes. So tickleberrys... what are you really saying when you are diabetic friendly.

After that we went to the beach on Skaha and I left after we left.

On Sunday I took the dogs for a walk in Glen Canyon. Its kind of a neat little area. The lower portion is canyon and dry and classic Okanagan. The upper area of the creek is more riparian and reminded me a little more of home, maybe just because it was green and a little damp.

After that I weeded some patio tiles and had a nice mother's day dinner beer chicken. Delicious.

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