Hi guys, I hope you guys went fine in the mid placement assessment. And I would like to share something about my mid placement assessment. I am at neurosurgery ward and I have a patient who has fat emboli syndrome 4 months ago. During past 4 months he has improved significantly, from the assessment finding he has full ROM, normal tone, normal sensation, independent transfer and independent ambulation without walking aid so that he is a pretty high level balance patient. Up to dated treatment is to work on his single limb balance and gait retraining since he has hip hitching during stance phase.
On the mid placement assessment, I reported to my supervisor what I have been doing on this patient and then we have discussed what they will be doing on him during this treatment. During the treatment, I did internal and external standing balance and single limb stand as my assessment. Then I got the patient in to 2 pts kneeling and walked forward, backward, and sideways in order to improve the core stability and hip abductor strength. After that I got the patient in to standing with feet together with eyes open and close, tendon standing and single leg standing, and finally gait retraining to address the hip hitching issue.
I knew that it was not a decent treatment but I thought I went ok but I could not imagine that I had such a strong but constructive comments. First of all, I need to assess more high level balance assessment not ‘only’ single limb stand alone. Secondly, I should put my hands to guide the patient during 2 pt kneeling no matter how good the patient is. And finally I forgot to reassess the patient after the treatment.
On my self reflection after my assessment, I realized that the importance of hands on to the patient. It actually gives them a very essential sensory input for them to correct the abnormally motor pattern even in this ‘high level balance’ patient group. Also in neuro, it does not allow you to make a minor mistake as well. It was a safe treatment but it is not enough in this point. It has room for improvement especially my hands on skill as well as assessment skill.
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That's a good point, neuro is a very high stress area with little room for error. It is an area that really pushes you and the supervisors expect a lot. Coping with the pressure can be hard, particularly when being assessed. It helps to keep in mind that fact that we are there to learn. As students i think we also underestimate the effect that guidance/hands on treatment can have. In neuro i think it's important that we give as much "hands on" input as we can, and provide as much Rx as we can.
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