Day 78…

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Well, again not as productive as I had of hoped, feeling a bit lethargic today and there is almost so much pressure now to get everything finished, it is frightening me from doing anything. I completed the legislation leaflet which is a plus and I am 50% through an intervention plan that needs finishing. I have written down of the child’s goals, identified the approaches I am using for the interventions and started to gather a variety of evidence to support the interventions I am doing. Although intervention plans are often difficult to compile, I feel they are a great way of putting together everything you need in order provide sound evidence based practice. Completing the intervention plan, has made me justify to myself why I have made that clinical judgements that I have and this will make my practice more efficient.

Now I am off to find some evidence on sensory diets, use of timetables, use of ear plugs to reduce auditory defensiveness. I will turn to a good book for this: Bundy et al 2002.  

NOTE TO FAMILY: Better news everyday and steady improvements make the world a happy place. Also managed to finally arrange a house to move into in January when I go back to Cardiff. Good day today.

References

Bundy, A. C., Lane, S. J., Murray, E. A. (2002) Sensory Integration Theory and Practice, second edition. USA: F.A. Davies Company.

Day 77…

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Not as much of a productive day as I had hoped, I have been working on a leaflet about legislation in the UK and the country I am in now. I wanted to show the difference in the two legislative frameworks and write a short reflection on the cultural difference. A good rest tonight is in order and then finish off the leaflet tomorrow.

NOTE TO FAMILY: Best possible news today, Nan is off of the breathing tube and now onto a mask. I have been on cloud 9 ever since. Keep the positives vibes flowing, in the words of Bob Marley “every little thing is going to be alright.”

Day 76… (I love becoming an OT)

Day 76...

This morning we had a sensory motor group with the pre-prep children at school then off to the hospital for the final clinical skills session with our child. This afternoon I spent in a ‘leisure and therapy inclusion centre’ for children.

The final clinical skills session went really well today. We focused the intervention session on supporting the child to improve bilateral skills and fine motor skills as our play observations and Movement ABC identified his manual dexterity needed improving. We had inspiration for todays session from www.otplan.com, we completed the salad bowl activity with different textures materials, and glitter as salt and pepper, we also made a hedgehog with a potato and toothpicks. Now for clinical skills, we meet with the OT that has been supervising us next week and then the following week we have a feedback session with the parents. Clinical skill sessions have been a great asset to this school placement and it is good to goo away, having experience from school and clinical setting.

The afternoon at the leisure and therapy was fantastic. 4 full time OT’s are employed at the centre and the children attend on different packages for therapy and/or education. We were also able to watch a hydotherapy (i hope that is the correct spelling) assessment take place which is therapy on a horse. This type of therapy is useful to children to improve balance, posture and they even play games to improve fine motor skills. Being on a horse provides both proprioceptive and vestibular feedback for the rider, what a holistic therapy! We were able to see the multi-sensory rooms and watch a short part of a session being completed, as well as this we were able to play with the bubble tubes and lye on a water bed!! So many new ideas to think about, a good OT day.

NOTE TO FAMILY: I love you all very much!

Day 75… (meaningful occupations and children)

Day 75...

Three quarters of my final placement evaluation placement are now complete, how, is the only word that comes to mind! The last two and half years have flown by. I have been thinking today and thinking about ‘occupation’ and being ‘occupational focused.’

Since being on this placement, I have never acknowledged the impact working in the school may have on the OT role. What I mean is, being an OT based within a school, means naturally your main concern is school and schooling occupations for the child. It also means you know the teaching staff well and think of them as colleagues. Whereas if you were a community OT that visited school, there maybe more of a boundary.

Personally as I reflect on the work I have done with some of the children, I wonder if I have been completely holistic and occupationally focused. The assessments I have completed for example, Movement ABC and sensory profile lead you to see ‘needs’ in coordination and sensory processing, what about other areas of occupation and the child’s lifestyle? With each initial meet/assessment I have asked the children their likes and dislikes what they find difficult or what they want to improve in but it is difficult for children to express or pinpoint exact occupations they want to improve in. With the assessments you can use your OT skills to know that a child with difficulties in manual dexterity may need assistance with washing & dressing, handwriting, crafts but is an assumption, the occupationally focused goals will then not necessarily related to the child’s meaningful occupations. It is challenging.

Well I have identified an area of my learning I want to investigate, no luck finding any good resources explaining this, this evening but I will continue to explore.

NOTE TO FAMILY: Had a lovely chat Grandad this evening, he told me he has cleaned the oven and fed the dog, although he had to buy more dog biscuits because he started to run out. Grandad you being very strong and I am so proud of you and I am so proud to be one of your granddaughters!

Day 74… (sensory integration workshop)

Day 74...

We completed our sensory integration workshop in school today as we had identified it as something that would be beneficial to the school and we had it as an additional learning need on our learning contracts.

Overall, the session went well. We originally thought the talk was for the entire staff team but it was for approximately 30 LSA’s on the day. This worked reasonably well because we could relate examples to the role of an LSA.

Upon reflection, I would express that having lectures after work meant the audience was not as engaging as they would have been on a different time of day. We targeted the content for people that had limited understanding of sensory integration, first explaining the principles, then the senses then some games and some strategies. A lot of members of the audience already had a good understanding of SI and I think this made the session revision for them. This is ok but I feel if we had more understanding of the LSA knowledge of SI we could have targeted the course more specific to their needs. If I was to do something similar in the future, maybe I would hand out a invitation in advantage, that people complete and identify things they want to learn within it.

We developed an evaluation form of the session, most of the feedback was positive, presentation was clear, good revision session, interactive games. Areas for development were, more use of video footage, especially footage of children with sensory difficulties as case studies/examples. The audience would have preferred to have been in smaller groups/stations to complete the games so everybody could experience the different sensory input.

I enjoyed doing the session, if we would have had more time I feel it could have been more interactive and involved more hands on learning for strategies. This would have provided a more fun learning opportunity for the audience.

Following this, our educator gave a talk on ‘working memory,’ I know understand that working memory is ‘the ability to store and manipulate information for a short period of time.’ As I understood it, working memory is how you process what is in your brain now, for example, when you try to remember directions that are given to you verbally. It is the doing of something in your short term memory. Some children can experience difficulties with working memory that impact their ability to read and write as well as impacting their engagement in other activities. Enjoyed this session too, learnt lots!!

NOTE TO FAMILY: Still no definite time for the MRI scan but Nan has been engaging with my auntie this evening, using an alphabet board, great news, keep up the positivity.

Day 73…(back to school & I confirm I have not been eaten by a Whale)

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Back to work and a productive day. Firstly this morning I started the sensory diet/behaviour timetable with one of the children. I will discuss with him tomorrow and his LSA to gain feedback on how it went.

Fig 1.                                         Fig 2.

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Fig 1. is the template that is completed everyday by this child with support from his LSA. Fig 2. is an example of a completed version on the chart. Each day the child records what day it is, how he is feeling, the lessons for the day and at what time. Then each 30 minute session is split into 6 parts. Each part is 5 minutes long, those 5 minutes are the sensory diet aspect of the chart, in which the child identifies, if he wants movement, quiet time or to use a fidget. If the child feels in a ‘just right’ place, the LSA can add positively in-force this behaviour through a specific gold star e.g. ‘good sitting’ or ‘good listening.’ If the child is at a high state of distractibility, then a reminder card can be used by the LSA, such as ‘seating reminder’ or ‘listening reminder.’ Then each day is summarised as improvement needed, OK, good or excellent. A reward can be given at the end of the week as a summary of good behaviour.

We then had the sensory motor room with the pre-prep children. This session was very special today because one of the children that has been demonstrating high levels of anxiety and not wanting to engage in play in the room, today threw the balls to and from some of his peers and even ran a short width of the room to grab a ball. Seeing children make progress and develop is one of the many perks of being in the role of a paediatric OT.

Following this, we spent the day preparing for the sensory integration we are doing tomorrow to the faculty at school as part of the professional development afternoon. Wish us luck and I will report tomorrow.

On another note, my peer informed me today, that whilst I was absent from school, one of the children asked her ‘Where is Miss Charlotte?’ she informed the child that I had gone back to Wales on an aeroplane and would be back in school next week, the child then replied ‘Miss Charlotte has been eaten by a Whale?’, my peer then informed him that Whales are an animal but Wales is a country. I love children, they make the world a happy place.

NOTE TO FAMILY: Good team work back at home today, everybody is supporting each other. Results from CT scan show some information but have identified we need an MRI to confirm what has happened. Hospital are being very supportive and informative when we asked questions, Nan is stable and resting. Continue with the positivity family, love you all.

Day 72 (post to family)

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Well of all the things I thought I would be doing during my 100 days of placement, returning to the UK for the weekend was very unexpected. But after I heard my mum on the phone on Thursday afternoon, telling me Nan had been taken to hospital, I knew I just wanted to give my mum a big hug. Sometimes it is all you can do is give a hug but it can be so special.

The doctors are not sure what has happened yet but we are hoping for the CT scan to provide us with more information tomorrow. My family have been very strong over the past few days and despite the circumstances it has been special us all being together. Strength is in numbers, so by us all staying together we can bring Nan more strength everyday and support each other to get through this difficult time.

For me, this situation has been challenging. Having important roles in different locations is difficult. Being a daughter and a granddaughter, a niece, a sister, a cousin and a girlfriend at home and here being an OT student/occupational therapist. Part of me just wants to be at home with everybody but I know as soon as Nan wakes up, she will give me such a telling off so instead I am back to business after 2 days off. I have 3.5 weeks to complete what needs doing, evaluate the work I have done with the children, visit some of facilities available for children in the community in this country and then head back home knowing I have done my best and be with my wonderful family for Christmas. This situation has shown me how to plan effectively, be flexible and adaptable when things change and has meant my transition from placement to home and back again has been as smooth as possible.

There is no need for a note to family tonight because this post is just for you all. I am really proud of us all pulling together and very grateful for all the kind support, words, from friends and family. Think positively, tomorrow will bring new information. Remind Grandad to feed the dog.