Always Learning

I now have three of my very own patients. We have a low census at the IRF, so my CI went home this afternoon. I was supervised by another therapist, but I treated the last three patients of the day by myself. I came up with the activities and carried them out on my own. Right now, coming up with the actives is the hardest part. I second guess myself, and I'm frustrated because they are not "functional" activities. In school they always stressed function- but sometimes you need to use the bean bags, or the weights, or the arm bike to  build strength, endurance, and ROM in the patient before you can get them cooking in the kitchen, or dressing themselves. I feel like school prepared me as best as possible- but its still unbelievable how much I'm learning. I know how to do an eval, and I know how an aphasic patient presents- but school doesn't tell you how to eval an aphasic patient. I know the difference between supervision and modified independent- but when you are in a facility and watching the patient preform a task (supervising)- how do you know when they are at a MOD I level?

I love to learn. Even during breaks from school I've missed learning. So I'm making it my personal goal to educate my patients as best as possible. If I can't make an activity functional, I'm going to at least explain to the patient why I'm doing it. There is a patient I have right now. She has Central Cord Syndrome- essentially the middle of her spinal cord was stretched when she fell, and because the the motor tracks to her upper extremities are in the center part of the spinal cord, she is unable to use her arms and hands very well. She has significant pain, swelling, and decreased ROM. She has been in the IRF for 5 weeks. Monday when I was working with her, I was trying to explain to her why her thumb was painful when she moved it, but not when I moved it. I said "When you fell and hurt your neck, you hurt your spinal cord too..." I didn't get a chance to finish my sentence and her eyes got big and her jaw dropped. She had no idea that she had injured her spinal cord. Tell me how she has been in rehab for 5 weeks and NO ONE told her WHY she couldn't move. I don't understand that. I have her do "silly" things like use a peg board, or stack one inch blocks. But I explain to her that I'm working on her pinching grasp, and the more that she uses it the sooner the motion will come back. I explain that she is strengthening it. I explain that using it decreases the swelling, which in turn, will help to decrease the pain. It blows me away that no one has taken the time to do this.

My aphasic patient is doing better. She is VERY emotional, and cries frequently during therapy. She is unable to express why she is upset- but I tell her that I understand that she is frustrated by not being able to talk. She tries so hard to use her right (effected) upper extremity. She tries so hard to talk. So far I've heard her say yes, no, well, I don't know why I'm here, and I don't remember her. It's a huge break through. I'm so excited for her- knowing that came only 3 days after she was admitted; she's frustrated that she can't say more. I don't blame her.

That's all I can think of to update now. Hope you are all doing well.