Saturday, December 15, 2012

I guess I need a new blog name

It's official...I have my Masters of Occupational Therapy as of yesterday :)

sooo I guess now I'm an OT Practitioner instead of A Soon To Be OT !

... now I reallllly need to buckle down and get some studying done for the NBCOT!

Tuesday, November 13, 2012

First job interview and offer

I had my first job interview on Friday afternoon. It was with a Skilled Nursing Facility in Norfolk, VA.
To say I was nervous would be an understatement but it went so well! The HR manager and the Rehab Director were so friendly and welcoming which made all the difference! They asked me questions for about 30 minutes and then I got a tour of the facility.
Here are the questions I got asked...that I can remember
1. In terms of clinical skills, what would you consider to be your strength and your weakness?
2. Tell me about a time when you were working with a group and things did not go well.
3. Tell me about a time you had to explain something complicated and how did it go?
4. Tell me about a time you set a goal for yourself and did you achieve it, why/why not?
5. How do you determine if a patient is ready to be discharged?
6.  Describe a time you were working with a pt and their family members had unrealistic expectations. How did you deal with this?
7.  Describe a time when you had to deal with an emotion patient or family member.
8. Tell me about a time when you were proud of yourself
9. How do others in the workplace see you as a role model?

I got asked a few others but I cannot remember them! I left feeling great about the interview but had concerns about being the only OTR at the facility, with 2 COTA's to supervise. When I left, the HR person said I would hear back by Tuesday.

Fast forward to Monday and I got an email from the HR manager asking me to call her. I tried calling when I got off work but she was already gone for the day. This morning she called and left me a voicemail asking me to call her back so we could discuss a few things....
I called her this afternoon after I got off from work and she said they would love to have me join their team!!!! :) BUT since I would be the only OTR there, I would have to work as a Rehab Tech until I pass the NBCOT...which I'm not too thrilled about...but I don't plan on waiting too long to take the exam so I wouldn't have to be a Rehab Tech for more than a month or so.  I am very happy with the salary they offered once I pass the exam though...

I have another job interview this thursday that I am really excited about. I have had the best feeling about it after speaking with them. There is another OT there so I would be able to work while I study for the NBCOT.
I can't wait to get another interview under my belt and hopefully get another offer so that I can compare and weigh the options.

I also am hoping to set up a couple more interviews with Sentara- a large hospital system here, Genesis and RehabCare. We'll see!

Send positive thoughts my way-- and prayers appreciated as I make these decisions!!

Friday, October 12, 2012

ASIA testing

Today, we did ASIA testing on my Spinal Cord patient.. The PT had done a couple ASIA testings on other patients but me and my supervisor had never done one before so it was really neat to participate...and I got to test his legs :)
This is the form that is used...
The dots on the body to the right of the form are the areas that you test sensation using the cotton or the pin prick..the pt has to tell you what they feel, and where they feel it. It wasn't as complicated as I was originally thinking! The pt came it diagnosed as a t12  SCI but we found out that he is more like a t10 SCI with his motor movement and sensation.

Today, I used a reacher, cones and a ring toss activity to work with him on seated balance activities, I wrote a short term goal for him to be able to sit on the edge of the mat table for up to 1 minute with min assist...this will be important for transfers to the bedside commode, and especially when he goes home. I'm looking forward to monday bc we are going to get on the mat with him and do some fun things! I can't wait to learn so much about SCI and how to treat and teach them different techniques! Keep ya posted :)

Have a great weekend :)

Thursday, October 11, 2012

week 6

Hello all (all 1 or 2 people that actually read this haha)
I'm not in my 6th week of this fieldwork. ONLY 6 MORE !!!

So far I have had pt's with hip replacements, knee replacements, multi trauma,  and stroke. Today I got my first SCI patient. He is a t12 paraplegic and it is OVERWHELMING..there is just soo much different stuff between the ortho patients and a cord patient. I did his eval today and it took 4 of us to get him sitting EOB and then to do a sliding board transfer to the w/c. He is going to be a great learning experience and I'm excited to see how far he comes!! Tomorrow we are doing ASIA testing on him bc he isn't really presenting like a T12 that will be really interesting!

Man I am sooo over my multi-trauma patient- he has a long history of back pain, and then was in a car accident and pretty much shattered his leg from the knee cap down. He is seriously addicted to pain medications. He knows exactly what time of day he gets which pain medicine and if you ask his pain level, he will just be sitting there saying he is a "high 9" or "oh its about a 10 right now"...when a 10 is the WORST PAIN EVER you would not be able to sit there without screaming bc its so bad!! And he is just getting on my nerves- he talks badly about his wife EVERY day- today he called her "the pitbull" and he has been inappropriate with me - calling me 'sweet cheeks' and saying "i cant afford a divorce but if i could, youd be worth it" we had to have a little talking too and he's straightened up some now thankfully! He is scheduled to go home on the 18th but we are trying to get him out sooner!

My other pt now is a double hip replacement. Hes a real nice guy and easy to work with. Its challenging bc of his size- he's very large- if he was going down there is absolutely nothing I could do to stop it!

I really need to start on my graduate project and my inservice ASAP- maybe this weekend? I am making a vision assessment kit for my facility, and doing my inservice on spinal cord injury. Should be a good learning experience but I am NOT looking forward to the presentation that's for sure!

Alright, well that's about it for now :)

Tuesday, September 25, 2012

week 4 already??

Well here we are, already in week 4, almost 1/3 of he way done =)
Right now I am seeing 3 patients, adding a 4th tomorrow and an eval tomorrow. I will be doing my first eval on a pt with CVA. I am a little nervous about it but I know it will go okay, and my supervisor will be there to help if I need it. I read a little bit of information on him today and he has significant global aphasia (problems with receptive and expressive communication) and he only understands about 1/2 of what we say to him! So this should be a little tricky.

The past two weeks, I have been a little board with my patients so I have asked for some different diagnoses as they come in, I am getting the CVA pt tomorrow, will hopefully had a TBI and SCI before its over. Census has been low still so there just isn't much going on-most of the pt's are gen debil, amputees or joint replacements. I'm kind of at a standstill with my patients right now.

I have also been slowly realizing that its OKAY to not know the answer to something, my supervisor likes to ask me random- well not really random as far as content goes but timing wise- questions and sometimes i just have to say "i don't know". Interesting fact I learned today: A metronome is used for pt's with parkinson's in order to work on gait training and their rhythm when walker. Yeah, I didn't know that and was asked today.

Oh, last week, since the census is so low on our floor, we have been going to help out on the LTAC floor (i may have mentioned this already) but I am certain that acute care is NOT for me, I cannot handle the smells, the tubes/lines coming out of everywhere on the just makes me nervous and slightly nauseous. I thought I was going to have to leave the room the other day.

So that's what's been going on with me.
Oh and I also picked up my NBCOT book for the first time last weekend =\ YIKES i got a lot to review and learn still before taking that!  #wakeupcall

Wednesday, September 12, 2012

Level 2 number 2 weeks 1-2

Well here I am, in the middle of week two of my second (AND LAST) fieldwork placement! I Arrived in Newport News almost two weeks ago- on a thursday morning- and spent all day thursday and friday organizing and unpacking. It was a little rough thursday night after my mom left bc I was just so sad and nervous about being over 4 hours from home but things are getting much better now and I'm settling in pretty good.

That monday I had to be at the facility at 8:30 for orientation most of the day. The lady that did my orientation was nice, but kindof odd and I didn't really feel that comfortable around her. She had way too many awkward pauses and gave me some odd looks. Then I met my supervisor and the other people on the 3rd floor around lunch time. That just wasn't a good day for me. I sat with them all during lunch and no one said anything to me the entire 30min lunch break...i mean NOT ONE WORD. I was just sitting there wondering why they are so unfriendly?? oh and that day, the doctor's bought them a few papa john's pizzas and they were all digging in right in front of me and didn't even offer a piece.... i just thought that was extremely rude.

Luckily, things have gotten better and people are much more friendly now, BUT you only get one chance at a first impression...and that wasn't a good one.

Anyways, the place I am at is an Inpatient Rehab Hospital. I am on the 3rd floor which is mainly Ortho, General Debilitation and SCI. The 2nd floor is the Neuro floor (CVA, TBI) and then there is a 4th floor that is a long-term acute care unit.  The patients on the 2nd and 3rd floor get 3 hours of therapy a day meaning they get 1 1/2 hr each of OT and PT (if speech isn't involved). They usually break it up and see each patient 3x a day for 30 minutes at a time. So it makes scheduling kindof weird.

Last week on Wednesday, I got my first patient to treat. He had a R BKA (below the knee amputation) We have been working on transfers, dressing, bathing, core strength/stability, balance, and upper body strengthening. On Friday I got a second patient- she has back surgery and ended up leaving today to prepare for her son's wedding on friday. Today, I got a third patient and actually did her eval. She is the cutest old lady and so tiny. She fell at home and fractured her patella (knee cap).

But, there are only 6 patients on the floor right now which is just RIDICULOUS. So they are possibly going to close the floor and send the rehab staff to a different facility until they get more admissions.

So that has been my week and a half in a nutshell.

Wednesday, August 22, 2012


Well as of Friday, I have successfully completed my first Level 2 Fieldwork!! I never would have imagined that i would have loved it as much as I did. I am truly blessed to have been placed at Springtree and to have met the wonderful people that I met. On thursday, my supervisor and the other OT staff threw me a surprise party with yummy food and a cookie cake! It was so nice of them and I was completely surprised. Also on Friday, I gave them each a small thank you gift and card.  This is what I made for each of the OT's and COTA's:

Luckily I pinned this idea on Pinterest a while back and was able to use it! I had originally thought I was going to use vinyl and my friends Cricut machine to put each of their initials on a mug. But because her Cricut was being used by a family member out of town- this was plan B! I actually liked it a lot better than just their initials anyways and they seemed to really like them too! All you need is a mug (I found these at TJ Maxx for $2/each) and sharpees. Once you write on the mug, they go in the oven for 30min at 350 degrees to make it 'permanent'. They do need to be handwashed after they have been used tho- apparently the dishwasher messes up the writing/drawing.

Anyways, that was on Thursday. On Friday I saw my final patients, said my 'Goodbyes' and my supervisor and I had our final meeting to go over how she evaluated me and my eval of the fieldwork site. I honestly couldn't believe how high she rated me on the AOTA form. I was shocked to see the final percentage, especially when the form itself says that 4's are very rare, and here she is giving me all 4's and two 3's.  She said she didn't think she has ever rated a student that high...which makes me feel pretty proud.
She also took me to speak with the HR person about working there doing PRN work (unless a full time OT spot opens up) when I get back from my next placement. Will definitely look into that because I just loved the facility and everyone so much, and by the end of the placement it felt like I worked there already anyways.

Now that I'm on a two week break, I have just been relaxing and getting prepared for my next affiliation. I'm moving down to Newport News next Thursday- eeek it's SO soon!!! Will keep you posted on how that goes!!

Friday, August 10, 2012

week 11

I've just finished by 11th week at fieldwork! SO crazy. only 1 more to go!
This has been a weird (but good) week- Two of the ladies I have been treating were discharged. One of them was just my favorite patient, I always looked forward to our sessions and we just had a great relationship. she really trusted me and let me push her a little past her comfort zone...we laughed a lot during every session and just had such a good time together. She taught me some good recipes and made copies of her fave ones for me when she left. As she was leaving yesterday she came to the rehab gym with tears in her eyes telling me just how much she enjoyed working with me and told me she loved me! Which of course made me tear up- I'm such a sap! Its hard to see these people for so long, build a relationship with them, and then they get better and go home. That's the hardest and the best part of this job.
I was SO proud of her for how far she had come. When she first got there, my supervisor and I were reading the eval and it said she was a danger to her self and staff, and that she required max A x5 people to get out of bed. We went to perform her eval and she was just anxious and explained how difficult her hospital stay had been, how she didn't trust the CNA's at the hospital and that's why they had put that stuff in her paper work. She just cam out of her shell so much within those first couple weeks, It was amazing to see her progress to where she was yesterday. That's what makes all of this worth it and I am so thankful that I get to help people like her get back to living their lives.

Its time like that where I know I chose the right profession! I hope everyone feels that way about their job/future job.

This week I have really been on my own with treating pt's and doing about 1 eval a day- one day I had to do 2 evals. One lady was just so feisty, and not nice to me! which was a first. but I made it through the eval and then got to pass her tx session to one of the COTA's. She was just frustrated and confused...I think she will start on the upswing soon.

Anyways, that's about how my week went.
I'm SO sad that next week is my last week, but then again I know it's time to move on. I will miss everyone there so much and I hope I'm lucky enough to have such great co-workers at my future job site. I'm going out this evening to get thank you gifts for my supervisor and the other OT's there. Hopefully I have luck finding the kind of things I am looking for!

Friday, July 27, 2012

Week 9 down

Wow, I can't believe I only have three weeks left!!! I am starting to realize how much I will miss everyone I have met at the facility.
I'm seeing 5 patients now but this week was kind of weird because the case loads were a little low so we had to pass some of our patients to the COTA's so I had 3-4 patients all week.

I did 2 evaluations by myself this past week. One was a man that has stage 4 melanoma and the other had abdominal surgery (very confusing PMH).
The man who had abdominal surgery is now on my caseload. During the evaluation he was so inappropriate and his son/his sons friend were in the room/hallway just laughing at everything he was saying. I was a little hesitant to take him on as a pt for my caseload but he has been completely different than that first day. My supervisor and I think that his son probably liquored him up (he has a hx of drug/alcohol abuse) before they brought him it. Because of that his notes show a drastic improvement in just the week he has been there and I think he will be d/c'ed next week. I just really do not feel he is appropriate for OT now. This week he refused me 3x in one day and 2x the next day but he finally came down after speaking with the doctor and my supervisor. I just don't know what to do with him anymore so I am crossing my fingers he gets to go home soon.

The man with stage 4 melanoma that I eval'ed just reading his background info made me sad. He noticed a lump under his arm and then let it grow bigger and bigger for 6 months before getting it checked. He was taking care of his mother who was dying and said he just put his own health on the back burner. Makes me so sad because they could have prob caught it before it spread to his spine and sternum.  He said he is real hopeful and has a lot of people praying for him.

My pt with the TKA finallllly got an upgrade in her weight bearing status thank goodness!! She was an independent as possible at w/c level so I really needed her to get weight bearing as tolerated (WBAT) when she went to her appointment this past week. She has been doing so good standing =) She is prob my favorite patients right now because we have really formed the therapeutic relationship and she trusts me and lets me push her a little more than she is comfortable with because I just know she can do it! I'm going to be sad when she leaves next week (that's the plan at least).

My pt who had a stroke is still doing really well. I'm concerned he may be getting depressed though. This week we started working more on his L neglect. He is always looking straight ahead and doesn't really acknowledge anything to the L or R really. I attached a timer to his L forearm and set it to beep every 10 minutes to get him to turn his head to the L side. The first time it took him 11 seconds to find and turn off the timer.  By the end of the session it only took him 3 seconds so that showed a good improvement!

Anyways, that pretty much sums up whats been going on so far... Can't wait to see what these next three weeks bring!

Wednesday, July 11, 2012

week 7

Wow, how is it already week 7?? I'm over halfway through with this placement now.
Things have been going really great. I had my midterm review last week and got really great feedback. My supervisor gave me all 3's (out of a possible 4)- and said I already had enough points to be passing at the end if I just keep on doing what I'm doing. She said that she feels I'm just about at the level of an entry-level practitioner which is amazing because I'm only in my first fieldwork placement!
Today she basically said I would definitely be able to get a job with one of the facilities under the same company as my placement. That is really exciting because right now I am looking to move to Arlington, Va or Charlotte, NC and this company has facilities in both of those cities!

I'm treating 4 patients right now and will probably add a 5th next week. My patients right now are 1. CVA with L hemianopia (meaning he has vision loss in the L side of each eye),  2. R foot fx and R wrist fx, 3. TKA, 4. CABG.

My favorite patient is the guy with the CVA just because he is so interesting and he is the first stroke pt that I have been able to treat on my own. Its fun getting to do some tx for the vision loss. Here are a few things that I have done with him:
1. Put numbers 1-10 on post-its and taped them to the wall - 5 on R and 5 on L but with the numbers mixed up. I had him stand up in front of the numbers and I stood behind him. Then I would call out a number and he had to visually scan through the post-its to find the number I said. This worked on visual scanning and learning to compensate for the loss of vision by turning the whole head to look to the L
2. I set out two rows of playing cards and asked him to scan through all the cards and flip over all the black cards. He left ones on the L side so I had to cue him to look to the left to find them.
3. There is a US quarter map in the dept so I got that out and set it on the table. The quarters are in little slots at each state (i'm sure you have seen them). I instructed him to find 5 quarters with his left hand and hold them in his hand. He was then supposed to keep them in his hand and set them back in their slots one at a night. He had decreased strength and some sensation deficits in his L hand. This worked on in-hand manipulation, visual scanning and fine motor skills.
4. To work on item retrieval- such as gathering clothing in room or items in the kitchen- i placed about 8 colored cones in the room and asked pt to walk about and find each cone.  If cones were to pt's left side, he really didn't see them and so he needed cuing to look to the left side.
5. Ball toss- when i toss the ball to the L of midline he just totally loses sight of it and it just kind of bounces off of his hands because he isn't anticipating it coming at him but its good to cue him to turn to the left and try to focus on the ball the whole time.
6. He has decreased strength in this L UE so we have done some simple strengthening using hand weights

He's really fun to work with and had a great sense of humor. He said that if he needs to look to the left I should just sing The Cupid Shuffle part where they say "to the left to the left to the left the left the left..." if you have heard it you know what I'm talking about it.  We have a fun time in therapy and he keeps me laughing!

Anyways, that's just a little update on what's been going on with my fieldwork since I last posted!

Friday, June 22, 2012

4 weeks down - a little about evals

I just finished my 4th week at the rehab center! I'm still really enjoying it and learning a lot. I have now gotten into doing evaluations on the new patients which I really like! I have done 2 this week! At the facility we only get 15 min for each evaluation and here is how we go about them for most of the pts I have seen thus far

1. Intro self and purpose of Occupational Therapy
2. Assess their cognitive status: judgement, insight, safety awareness, orientation (x4), problem solving, memory etc..  Do this by asking questions (address, what happened to bring them to the facility, their bday, where they are, what day of the week it is etc..).
3. Pain- rate it on a scale of 1-10
4.  Endurance- note any shortness of breath after activity
3. UE ROM and Strength.
4. Functional Mobility: bed mobility, transfers sit-stand onto/off the toilet, into/out of w/c, whether they walk indep, use a walker or w/c. sitting/standing tolerance and balance.  Include level of assistance with transfers,
5. ADLs: UB dressing/bathing, LB dressing/bathing, toileting, eating/feeding,  include level of assistance for each ADL
6. IADLs: meal prep, shopping, cleaning.... most of our pts are dependent for IADLs at eval status..

After the evaluation portion is over, the pt is taken to the rehab gym for their first session- which is usually pretty short just to ease them into it.

This is just one what to organize an eval....of course there will be many other components for more complex patients such as sensation (2 point, pain, temperature, touch), vision, trunk control, reflexes etc..

I find this outline really helpful to go by when evaluating patients (esp ortho and cardiac pts like I have been seeing).

Thursday, June 14, 2012


Because not everyone that reads this knows the terms that I use pretty often, I thought I would have this little 'glossary' post for the abbreviations! Sorry these aren't in any particular order and I will prob add to this as I use them or think of them-and feel free to ask me about any terms or abbreviations!

UB- upper body
LB- lower body
UE- upper extremity
LE- lower extremity
R- right
L- left
B- both (i.e. B UE= both upper extremities)
ADL- Activities of Daily Living (incl dressing, bathing, toileting, grooming etc..)
IADL- Instrumental Activities of Daily Living (incl shopping, meal prep, pet care, child care etc..)
AE- adaptive equipment (ie reacher, sock aid..)
d/c- discharge
ROM- range of motion
MMT- manual muscle testing
max A- pt needs maximum assistance (pt does less that 25-49% of task)
mod A- pt needs moderate assistance (pt does about 50-74% of task)
min A- pt needs minimal assistance (pt does 75% or more of task)
mod I- modified independence- pt is independent with task but uses adaptive equipment
dep- dependent
SBA- stand by assistance
CGA- contact guard assistance
EOB- edge of bed
SOB- shortness of breath
HEP- home exercise plan
tx- treatment
NWB- non weight bearing
WBAT- weight bearing as tolerated by pt
TTWB- toe-touch weight bearing
PWB- partial weight bearing
fx- fracture
CABG- coronary artery bypass graft
CVA- cerebrovascular accident (aka stroke)
TBI- traumatic brain injury
SCI- spinal cord injury
THA- total hip arthroplasty
TSA- total shoulder arthroplasty
FM- fine motor
GM- gross motor
Ther ex- therapeutic exercise
Ther act- therapeutic activity

Tuesday, June 12, 2012

Here we are in week three

Wow, its my third week already and even though it has only been 2 days, its been one of the busiest!! Yesterday I had two clients scheduled but I found out (about an hour before my tx session) that one was being d/c'd... I didn't have a chance to say buy to her because she has already left for a doctor's appointment. I was kinda sad because she was my first client that I was treating there. My other client is doing really well, she has not been complaining of pain as much lately (she had an acute flare up of arthritis in both upper extremities). I am having such difficulty writing her daily notes though, I feel like she is so high functioning right now that I'm not really doing that much and I have to put what skilled intervention I DO in my note.
I just hate the whole business i said in my last post and because even though my client is basically independent in her ADL's and we have cooked and she did fine with that, she can clean her house and has been demonstrating normal ROM in her UE and not complaining of seems that I'm not allowed to put in my notes that she is independent...because they want to keep her in the facility to make money (since Medicare will pay for 21 days they want her to stay those 21 days). It really irks me because I feel like she has the tools and skills necessary to be independent at home again..but I can't say that. it is sooo annoying. makes me wonder if it is like this every where? if not, I must find that exception!

Yesterday, I participated in my first evaluation. I feel so bad for this client, she makes me sad! She is in her 70's and fell last week and broke her left distal radius (one of the bones in your forearm) and has severe bruising on her left hip. Also she had torn her rotator cuff in her right arm a couple years ago and she has decreased range of motion and strength in that arm. AND on top of that, she has had back surgery and has severe pain from that. Its just sad bc I feel like she is in pain all of the time!
Anyways, I was responsible for filling out the eval and writing her eval note and daily tx note yesterday. And today, I saw her this morning for bathing at the sink, grooming and dressing. I was sweating so bad bc her room was hot and she is max A for pretty much everything from getting out of bed to the wheel chair, to washing her back and legs to transferring from her wheel chair to the its a lot of work to get her up, bathed and dressed. I have my work cut out with her that's for sure!

Today I just did not have that great of a day though. Last night we had to sign the papers to officially sell my grandparents house (since my Nana died in December and it just now sold). I have been sad ever since and just holding back the tears and keeping myself from really thinking about the fact that I will never go to their house again. so I was a little emotional inside today and then when I started getting 'constructive criticism' on my daily notes I almost started crying but I held it back thankfully. I just wasn't in the mood today bc my mind was flooded with other emotions. Luckily we finished the day around 3 so I didn't have to stay a full work day.

  I've decided that tomorrow will be better!

Tuesday, June 5, 2012

the 'bottom line'. a rant.

I hate hate hate how everything is about the 'bottom line'  ...aka dollars and cents.
Throughout my past two years of OT school, I can't tell you how much it was drilled into us about getting the patient's occupational profile and taking time to interview them and really learn what occupations are meaningful to each individual. That is the basis of occupational therapy- being client centered and using the occupations that the client finds meaningful as the means and ends in treatment.

I'm getting frustrated already with how the whole payment system works and what is considered 'billable' and whats not, productivity demands yada yada yada...

Between all of the paperwork and stuff dealing w/ the $$, there just is no time to really get to know the patient. No time to spend more than 10-15 minutes on an Eval (apparently OTs in my facility can't bill for time spent doing evals so it doesn't count as 'productive time'), no time to develop an occupation profile- and the eval form they use don't even include a spot for the occupational profile anyways! I want to spend time with the patient before beginning treatment so that I can really tailor the sessions to what THEY want to do, not what I think they would want to do.

I find that the OT I am with pretty much has the same goals for every patient..and while self care and IADLs are VERY important..there are other things that the patient may really want to work on that she doesn't include in the goals (short or long term)....I don't feel like we ask the patient what they want to focus on enough.

Now, I know that as the OT's we are the 'experts' and are the ones who set up and grade activities for the patients needs, but I just feel like the patient should have a say in their goals and what the tx sessions focus on in general.

So basically, I just wish there was a balance between the business aspect of OT and the foundational quality of OT as being client-centered.

// end rant.

Hello, week 2

Well I'm not almost halfway through week number two. I have gotten my second patient who has arthritis in both upper extremities, every joint except her elbows.
Yesterday we did a quick eval and then I got to wrap her fingers in coband because of the edema (it is similar to an ace bandage but is thinner and more porous. You wrap it tight at the finger tips and then make the wrapping more loose as you move proximal to 'squeeze' the fluid out of her fingers. White the fingers were wrapped we had her hands on a wedge to allow gravity to help move the fluid and we also worked on some fine motor activities (peg board, putty..) to get her fingers moving to help move the fluid.
She is such a great lady, SO motivated, I think she would stay in the rehab gym alll day if we would let her. She seems to want to push her self too hard thought, esp being in the acute phase of inflammation and pain.
Today we did the shoulder arc (see pic for a similar one) to work on shoulder flexion, abduction and horizontal adduction. Then I got to do ultrasounds on both of her shoulders for the pain and then we did the shoulder arc again to see if there was a difference in pain level before/after the ultrasound. She loved the ultrasounds and said it really helped so that was great.

I also saw my other client this morning, who had a CABG and we worked on sorting and stapling packets of paper for the department, to work on hand strength and FM and then stood at the counter to make a sandwich and wash the dishes. I'm kindof getting stuck with her though because she is doing so well but still gets OT every day.

As far as documentation goes today, I had to write a daily note for my two patients and a weekly note was due today for one of them so I had to do that as well. I struggled a little with the weekly but I think my next one will be easier!

Friday, June 1, 2012

Week One: complete

Well I have officially completed my first week of fieldwork :) I feel really great about how the first week went and I'm starting to get a hand of the schedule there and get to know the other therapists too :) They are all so nice and willing to help me out so I def appreciate that!

I saw my patient today and we were going to do a ADL session in her room so she could get a shower today and I could try out the long handled sponge, and teach her about using a reacher for LB dressing but she was already dressed and didn't feel like getting a shower...which is totally understandable bc I see her at 1:00! So we headed on down to the rehab gym and did some strengthening exercises and worked on standing at a table to fold laundry. My supervisor did her eval and wrote the goals for her with are: to perform all UB dressing and bathing independently, LB dressing and bathing, using AE as needed, adhering to sternal precautions, performing simple meal prep while standing and perform laundry tasks while standing. On Monday I think I'm goin to try and get her to make something in the kitchen and try to stand for a few minutes at a time, she was complaining about her foot being swollen and numb today so the doctor was going to look at it this afternoon- hopefully its okay! Also we are going to staple papers for the department, I think she will really like doing that because its something 'productive' and useful, instead of doing hand weights, the stapler will help strengthen her hands even if she doesn't realize it!
Please let me know if you have worked with a pt with a CABG and what types of treatment activities you have done!
I think she is doing really well and I'm not sure how much longer I will be seeing her- we set goals for 4 and 8 weeks but I'm not sure she will be there for that long. 
I was glad to get more good feedback on my daily note today too- its good to know that I'm doing it right when I seemed to have difficulty in class with my notes and getting all the right info in it. Notes in 'real life' are different, we don't write SOAP notes at the facility, we just write a narrative that includes 1. what activity we did 2. why we did it (relate to d/c, goals, occupation...) 3. What the OT did (level of A, client education, family education, verbal cues...etc) and 4. How the treatment you did affected the client's performance, did they improve their skills from the beginning of the tx to the end, did they respond to your education, were they successful with the level of A provided...)
I think its a pretty easy way to write a note and not worry about what goes into each section..I still find myself jotting down quotes from the patient to put in the note (like the S part of a SOAP note).

We also saw the lady that had a CVA and she was looking much better today, I can tell such a difference in her head control in just the past couple of days. She seems to be in the 'anger' stage of recovery and she has every right to feel that way- I know I would if I were in her situation...I just hope she can work through it and face whats going on so she can really work on getting better. While she can't speak to us, she really knows what we are saying and can follow simple commands. Today we took her out on the porch to look at the flowers and then put her in the stander so she can engage her trunk muscles. She did really well with that and did well holding her head up on her own and looking out the window. I can't wait to see how much progress she makes in the next couple months.

Next week my supervisor said that I will get more exposure and practice doing the evaluations on new patients. I feel like there is a new patient admitted to the facility everyday, well multiple patients admitted every supervisor did 2 evals today! The evals they do at the facility seem pretty straight forward, they don't seem to use any standardized assessments like we had used in classes. They have a form they fill out and rate the patient in areas like self care, mobility etc..and then you rate them again at time of discharge and hopefully their scores are higher at d/c than during the evaluation. I'm looking forward to doing one but I DEF need to review manual muscle testing and the rating scale.

I'm super glad its the weekend, its taking a bit to get used to this 'real world' working schedule and the weekends now have a whole new meaning! :)

Thursday, May 31, 2012

day 3.

Today was great! I got to run two treatment sessions and do those patients daily notes and I found out that I will take on one of those two as 'my first patient' :)  She had a CABG and is working on getting stronger and being able to dress and bathe herself and perform the IADL's she needs to do when she gets home. Also she has to do these things while adhering to Sternal Precautions because of her surgery.
I have to take her vitals before and after each session and when I went to get her from her room and got set up to take her vitals, the BP cuff kept inflating and popping off her arm! It was a little embarrassing that I couldn't get it to stay on so I went to get my supervisor to help me! Luckily they have the electronic ones so I dont have to depend on listening to the stethoscope to find the blood pressure!  Once we got the vitals taken we headed out to the patio to fold the towels for the department since she said she is the one who does the laundry at her house. And we worked on some hand/grip strength because she had complained about her hands feeling weak after she got out of surgery. Then I had to write up her daily note! :) It was a great session and it went very smoothly :)

The other lady that I led a treatment session with was not as compliant with treatment! we worked on bilateral task- she had a hip replacement and broke her arm so it had been in a cast before this week. She is very nervous to use the arm but it is fine and ready to work! I had to keep redirecting her and keeping her on task which can be exhausting. Then we folded clothes, which is good because it is a task that just naturally facilitates the use of both arms. And we ended the session by making a peanut butter sandwich and working on opening the jar of PB and the bag of bread and using her affected arm during the activity. She complained pretty much the entire session but I just love her anyways- yesterday we saw her and when we said a phrase and it reminded her of a hymn and she just started singing. And when I took her back to her room and went to leave she said "may the blessings of the Lord be with you today" it!

I felt so good about my tx sessions and daily notes based on the feedback I got from my supervisor- she said she was so impressed with my notes and that I did really good leading the Tx sessions with each patient, and esp with the second lady that needed constant verbal cues.

I love that I'm getting more responsibility. I figured it would be another week or more until I got my first patient but I think I am ready to start with one, esp since the eval was done by my supervisor yesterday. :)

Tuesday, May 29, 2012

Level 2: Day 1

Well I have successfully completed day 1 of my first Level 2 :) I am at a Skilled Nursing Facility and it was so nice :) My supervisor is awesome, we just dove right in today and saw 3 patients in the time that I was there (She only worked a half day today so I came in at 1:00).

The first patient we saw was an elderly woman who lives at the facility due to alzheimers/dementia and she needed a resting hand splint because of contractures in the PIP joints of her L hand. She was so cute and her daughter was there visiting and saw my name tag and said that she went to Radford for her schooling! Then she was asking me how much longer I have left and I told her I will be there til Aug then to Newport News and she was just so excited because her family just moved to Roanoke from NN last year and they loved it there! =)

The second patient we saw was an elderly man who had a THA (hip replacement) that had gotten infected (eek!) and he only has 2 weeks left before he is d/c. He was soo cute :) He was telling me that he's been married twice, and has many grandchildren and then asked if i was married and if I wanted to be married and told me that I was a 'lovely young lady'!  We worked on transfers: supine-sit, sit-stand, w/c- arm chair. He is really good at doing a sliding board transfer to get from his bed to his wheelchair. we also worked on UB strengthening because he has gotten weak since being in the nursing home.

The last patient that we saw was an older woman who had a L CVA, pretty severe and has R side neglect- needs lots of cues in order to look to the right. She has some muscle tone returning in her R UE but for the most part the R side is a 0/5 (for manual muscle testing) which means there is no muscle contraction. She seemed like such a sweet lady, even though she was non-verbal and appears to had aphasia, her room was filled with balloons and mother's day cards/flowers. I can't wait to see her progress from now until she is d/c.

The facility is going through a medicare audit of all of their documentation right now so it was a big deal for me to learn their documentation procedures- I spent some time today going over old notes my supervisor had written w/ comments from the rehab manager just so I am familiar with the format and how they write notes there (everywhere is different!)

My assignment tomorrow is to write part of a daily note for a patient that we see. I don't think it will be too difficult.

(Please let me know if you have any questions about anything I write regarding fieldwork, diagnoses, abbreviations....or anything!_

Thursday, May 24, 2012

let's play catch up :)

So here we are, it has been an awful long time since I have updated this blog! Since my last post lots has happened! I am now done with my time on more classroom instruction!! I will be starting my first Level 2 Fieldwork next week (!!) and will be there until the middle of August before moving to Newport News for my second Level 2 placement.

The end of the semester was so busy and stressful, as usual.  This whole semester we have been working in groups of 4 to create a business plan, I am not sure if I have mentioned this before- I think I may have briefly. My group created a Transition Program for students in the three counties around my university. I had never taken a business related class in my life so this was pretty difficult for me, never had heard of a SWOT analysis, or a Market Analysis, or a Break Even Analysis..but it all had to be done and then some. During the last week of class we had to give a 30 min presentation on our business. My group did really well on it and my professor stressed that there is such a need for the services in the area that she hoped we would take the business plan and really put it into action. hmm...we'll see about that ;)

Also, I had two skills competency checkouts for my Musculoskeletal and Neurological courses. They were the same style but different clients. We had to go in an choose a 'client' from a card, spend a few minutes reviewing the case, making a list of evaluations and treatment ideas for that client and then our professor acted as the client and we carried out an evaluation and did a treatment session, and then we had a couple of hours to write up an eval note, daily tx note, and long term/short term goals.

 For Musculoskeletal the client I had was diagnosed with Low Back Pain so that was not too challenging because it is all about client education: no bending arching or twisting, and introducing adaptive equipment to reduce the need to bend/arch/twist the back.
For Neurological, the client I was assigned had a CVA with severe L neglect (meaning she did not attend to anything to the left of mid-line, for instance if i had placed items on the left side, she would not even know they were there, even if they were placed within a normal visual field). I had to do the Letter Cancellation Test for the evaluation, and a bathing task for the tx session.

Other than written finals, those were the main assignments that kept me busy through the end of the semester.

So for my first Level 2, I am at a SNF (skilled nursing facility, aka 'nursing home') in Roanoke and I'm really excited about it. I called my supervisor the other week for the first time and she was SO NICE. She just kept telling me how much fun we will have and that she does not want me to be stressed out at all. She said she had 3 Level 2 fieldworks that were all awful and she promised herself that she would never make a student feel the way that she did. She also said that she wants me to come and be a little sponge and soak up all the information and learn as much as I can, and that if I'm too stressed, I won't be able to learn as well.  I can't wait to meet her on Tuesday :)

Since I am moving to a new area this fall for my fieldwork, a friend/classmate is also placed in Newport News - we went two weeks ago to scope out some apartments that offer short term leases and found one that we both really liked and that is affordable so that takes some of the stress off with that! Now we just need to sign the leases and get it all in order for the fall.

AND last but not least, a friend of mine from highschool, who is an Occupational Therapy student at Colorado State, just started a blog that I think you all will like so go check it out when you get a free minute:

Monday, February 13, 2012

Simulated Client

Today we had simulated clients come into the department (they are retired nurses) so that we could practice doing ADL/IADL assessments on them. We went in pairs to perform the assessment.
I was so nervous and did not really feel prepared before we went in there but once we got going I really thought it was a great experience. I was in charge of monitoring blood pressure and performing the ADL assessment. Our 'client' was so nice- she had COPD,  Congestive Heart Failure, Schizophrenia, Diabetes and a Bronchial Infection! whew did you catch all that??

ADL form

our case study

Saturday, January 14, 2012

a new semester + level 2 planning

First off, if you have a Tumblr, or just want to add it to your bookmarks- one of my classmates started one to document our last year in OT school.... I'm sure you will love her!

We're just a few days away from starting a new semester, FIVE classes- i think this is the first time we've had five. These are the classes we'll be taking:
Occupational Therapy Leadership and Management
Physical Dysfunction Practice: Musculoskeletal
Physical Dysfunction Practice: Neurological
Special Topics in Adult Rehabilitation
Working with Older Adults

I went and bought all of my books- luckily I already had one we needed from a previous semester but I had to buy EIGHT new books, and they cost $590 that not ridiculous?? I don't see why textbooks are so expensive!

Its hard to believe these are the last classes that I will take! I'm getting nervous that I haven't learned as much as I should have by now, that after these 5 courses I'm going to be thrown into Level 2's and expected to treat a whole case load..
Speaking of Level 2's we are in the process of figuring out where we will be this summer and this fall..None of us know where we'll be placed for the summer session and seems that only a handful of us have some idea of the area we'll be in for the Fall...this just seems a little last minute to me- like we should have started planning for these placements last year, the last semester of classes...but what do i know??
As of right now it looks like I will be at the Riverside Regional Medical Center or the Riverside Rehabilitation Institute in Newport News. I went out there for a couple of days the other week to look at the area and the facilities just to see if I would be comfortable with the area... luckily I have a couple of friends that live there o I think I would be fine! I'm meeting with our fieldwork coordinator on Tuesday to tell her about my trip and hopefully finalize the places.
Riverside Regional Medical Center

Riverside Rehab Institute- Right on the James River

Rehab Institute

For those that have been through a Level 2 already
What is your advice??

Wednesday, January 11, 2012

Student Conclave 2011- Day 2

Day 2 started bright and 8:30 with two sessions on the NBCOT exam.
The speaker went over the steps of what to do before taking the exam
Said we should set up an account at (its free), read the handbook, keep up with NBCOT on facebook, twitter and linkedin.
The exam is about $500 !! which seems crazy and I feel like I will have to take out a loan just to take the exam!
It's all on the computer, multiple choice.  There are practice exams available online as well as a self-assessment so you can see what areas you need to focus most of your attention when preparing for the real exam.
They also went over how the NBCOT is created- which is by a large scale survey of entry-level practitioners and a practice analysis that is completed ever 5 years which you can apparently download a blueprint of on the NBCOT website.
There are 4 Domains covered on the exam:
1. Evaluation- assessment tools for different populations, setting up treatment environments, theories, models of practice...
2. Interpreting  information- form conclusions regarding clients needs and priorities, i.e. appropriate short term goals
3. Selection/Implementing Evidence Based Practice- A majority of the questions come from this domain
4. Standards- documentations, ethics, supervision, scope of practice

They also went over some myths of the exam:
- Exam is based on all info in OT programs
- Exam is mostly pediatrics
- NBCOT changes the blueprint annually (this is changed every 5 years)
- You have the right to request a paper copy
- If you skip the tutorials at the beginning, you will have more time to take the exam  (the 4 hour time limit begins when you reach the first question)
- If I pass the Clinical Simulation questions, I'm likely to pass the exam
- Clinical Simulation questions are much harder than the multiple choice
- Its better to select all choices in the clinical simulation questions because you are bound to get the right answer

Next they discussed the Clinical Simulation questions
these are designed to simulate various types of focused experience that an OTR encounters in daily practice. They are like mini case studies and measure clinical reasoning across continuum of care
The problems consist of an opening screen and then there are 4-5 sections in which you choose an action to take and the one you choose determines the next screen/question.
Answers in each screen (actions) are categorized into 3 types:
1. Positive: correct answers -optimal route- adds points to your score
2. Neutral- may be helpful but not necessary- no points added or deducted
3. Negative- hinder/distract appropriate therapy- points are deducted from score

Multiple Choice Questions have 4 answer choices.
Be sure to understand what the question is asking, identify key words (best, initial, first, next)
you are able to mark questions and review them at the end of the exam if time allows

After the NBCOT sessions, I attended a Mental Health info session that talked about using Sensory Integration techniques in the acute mental health setting which I thought was SO interesting since I completed my Level 1 placement in a State Mental Hospital.

Then we went to explore Providence a little bit on our lunch break!
my attempt at a panorama on my iphone

the ones from my class who went :)

If we had gone all the up this hill we would have ran into Brown University

We may have skipped a session that we probably shouldn't have but we were just wandering around the city! oops. We made it back for the Policy and Advocacy session which I know is SO important but it was terribly boring so I will spare you.  If you want to know all about this- check out AOTPAC.

For the last session, I went to Rehabilitation, Disability and Participation which I thought was going to be great since it was supposed to focus on SCI/TBI but it was the worst session. The lady just stood there are read her powerpoint slide verbatim. it was so boring and i mean, i could have just gotten up there and read words from a power point! She didn't even put her paper down to tell us what an OT's role for someone with SCI/TBI is...which i mean she should be able to just explain that without reading a list from her slide.  Needless to say, I didn't take many notes in that session. I was wishing I could leave the whole time and go to another one but I felt bad, even though lots of people walked out after the first few slides of her just reading them.

That night we went to a local bar/restaurant for dinner/drinks and then a few of us went to a pub that turned into a dance club haha we didn't stay out too late since we had to be up early for our flight back to Charlotte.

annnd that, my friends, concludes my Conclave recap :)

Tuesday, January 10, 2012


I had every intention of finishing my recap of Student Conclave over Christmas break
BUT I came home and left all of my conclave notes at my apartment, 
my goal now is to try and get those done in the next few days 
since I will be making a trip to my apt tomorrow afternoon

I have started to see some tweets from AOTA about the Conference this April...
is anyone going??
I really want to but will have to see if I can afford it!