Increasing my confidence in working in phys dys

I have been meaning to write something about my phys dys subacute rehabilitation fieldwork setting, but have not gotten around to it yet, again due to OT-student related activities. However, as I now start the job search process, I realize I should not be presenting myself as only one type of therapist… so below will follow a summary of my experiences at my site.

My fieldwork was for three months at a major rehabilitation hospital. It is really well-known…whenever I told people at my first site that I was going to that site for my second placement, they always said something like “Oh. that place. It’s really professional, you’ll learn so much there!” Needless to say, this greatly increased my fear of going there, especially because I did not feel that phys dys, especially rehab, was my forte. However, that all changed, thanks to a couple awesome clinical supervisors.

I learned so much during this fieldwork. All of a sudden, things I learned in my neuroscience and certain interventions courses FINALLY fell into place in my mind. Not only did I learn about the actual intervention process, but also about how to build my skills in establishing therapeutic rapport.

Grading Activities

One of biggest things that sticks out in my mind is that I finally learned what it means to “grade activities.” I’ll have to say that this was very much of a problem solving challenge, as I didn’t know that doing simple things such as involving more of a reach in the activity or placing blocks under the patient’s feet to increase weight bearing would be enough of a grade in the activity. However, this slow incremental challenge in the activities makes sense for this setting where the clients are making gradual progress in their physical capabilities.

Not taking things personally

Rehabilitation is one of those settings where you really have to pay attention to how the client is performing¬†initially¬†during the treatment session to decide how to proceed in that treatment session; how much should the client be challenged? are they exhibiting increased movement return, or weight shift? In order to do this, as a therapist, your observation skills really have to be up to par- and so do your “thinking on your feet” skills.

However, the biggest challenge in this process is not that you have to do some quick thinking, but that some clients have the personality type where they always need to know what you are doing with them and why, and, especially, what is coming next.

Initially, when a client asked me “what are we doing?” or “what are we doing next?” I would get really upset because I felt that they did not trust me ( as my clinical supervisor and I discussed, this was rooted in my initial insecurity/diffidence working in phys dys.) I came to realize that the clients asking me these questions was rooted more in the need for them to know what was being done in therapy and feel like they have at least some sense of control over their experiences during their rehab stay; it did not have anything to do with the fact that I was a student therapist working with them.

Clients like students 

In fact, my clinical supervisor even told me that clients, especially older clients, LOVE working with students. When they are in a rehabilitation setting, they don’t have much control over the things they can do and can’t do- some may have physical limitations, and then there are rules like how they can’t even get up to go to the bathroom by themselves without calling for someone to make sure they get safely onto the toilet. In working with a student therapist, they are given the option to influence someone, to help someone learn, do something meaningful during their stay there. I was surprised that they’d be happier helping me learn than working with an experienced therapist for their best benefit, but its true. Clients like (love) working with students.

I also learned a lot about building therapeutic rapport, but I think that will have to be a separate post. My fieldwork was “information overload” for me, and I don’t want my blog post to be that for the readers. So, leaving on a positive note…. phys dys is awesome! It’s not scary, you learn a lot, and you know a lot more than you think you know. The clients love you, and everybody will help you learn.

Would I now consider working in rehab or any other sort of phys dys setting? Of course. I got this.



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