the rehab scene

i am almost done my first two weeks at my rehab placement and i have learned SO much, which is pretty exciting because only more learning to be had.

here's my perspective as an OT student on the job for 2 weeks:

as an OT in a long term acute care rehab hospital (on the medically complex unit) will see MANY things you would never imagine you would see. such 'things' include nakedness, stinky bodily fluids, decubitus ulcers- so deep you could put your fist in, almost any and all wound types, diapers, foley catheters, bare bums, and more.

i have witnessed a bunch of OT evaluations where the OT tests for range of motion (ROM), strength, sensation, cognition, and basic ADL function. the evaluation write-up is quite extensive and all documentation is on the computer- which can be both efficient and annoying. the eval includes the diagnosis (dx), past med. history (pmh), there scores on ROM, strength, sensation, pain, and fine and gross motor, etc. The OT documents the patients previous level of functioning for ADLs and IADLs such as feeding, bathing, toileting, dressing, etc. then the OT documents what they can do now in their current state, i.e., the pt can feed him/herself at bed level with min assistance with adapted devices as needed. the OT indicates all problems, such as toileting, bathing/showering, dressing, etc. and those are the problems that will be addressed in the treatment plan. the OT then makes up the treatment plan which includes the goals. there are two long term goals (LTGs) and two short term goals (STGs). THEN... the treatment (tx) sessions will include activities that address the performance component areas that address the goals, i.e. performance areas impacting dressing for a particular patient might be standing balance, upper body strength and endurance. my struggle for coming up with tx ideas is the ability to find an activity that will work on the performance component that will also be meaningful, purposeful, and client centered. as it seems that if you aren't directly working on the ADL, in this example- dressing, other activities i have seen in other tx sessions are having the patient stand and reach for cones, or stand while passing a ball back and forth. this just doesn't seem to be OT to me. i have brought this up with my supervisor and along with my concerns about OT doing ambulation (when that is for PTs to do), her response is that it is all preparatory for the ADLs. i understand that, but it goes against what we are constantly taught in OT school- which is to make our tx sessions client centered, meaningful and purposeful. any ideas?

i am still new and immersing more and more each day. i feel overwhelmed with the different dx, since this is such a medically complicated unity. almost each patient has 4-5+ issues going on. the majority appear to be wounds. i am excited to get to become more hands on, however, i still feel concerned about my competency. i am sure it will come with time.

now on to week #3