July / August / September • Issue 3 • 2018
the data we gathered from our interviews with caregivers and
clients, we identified 4 themes. We found that caregivers and
clients value a practitioner who has 1)effective communication
skills to develop a working alliance, 2)provides individualized
goals and client-focused care, 3) implements therapeutic use
of self in therapy sessions, and 4) has competent skills when
delivering services.
I applied what we found in our study to the care I was
providing this client. I realized that the treatment I was providing
was not client-focused care, which is an integral part of what
we do as OT practitioners and what makes our profession so
special! I had been approaching her treatment like the other
clients I had treated with similar injuries, but I hadn’t taken into
account the temporal or personal factors that make her unique.
So I decided to make some adjustments.
I learned that this client was spending 4-5 hours after school
at gymnastics practice, so it made sense why she was unable to
complete all of the exercises I had given her. I reviewed her home
exercise program and selected what I deemed to be the 3 most
important exercises for her to complete. I gave her a log to write
down the times in which she completes the exercises to serve
as a reminder. I also made a change to our treatment sessions.
Instead of having her complete the usual 8-10 exercises, I
Reflections on Practice, continued from Page 14
decided to create a game. I found an inflatable dice and selected
varying combinations of 6 exercises that she would complete if
the dice were to land on a given number. If she were to complete
her exercises at home and brought in her log to prove it, she was
allowed to pick an exercise of her choice. Each of these exercises
I selected required active engagement from the client and were
to be completed in different areas of the gym, using different
equipment. She loved it! It wasn’t long before she began to come
up with her own twists for the game I created (like all kids do).
For example, instead of just rolling the dice, we would toss it
back and forth like a volleyball until one of us messed up and
the dice hit the floor landing on a number. She also decided that
if she were to roll a 6 and then a 1, she could do a cartwheel.
(Surprisingly, that combination of numbers occurred way more
than I expected!) Lastly, floor push-ups were one of the exercises
I had her complete, which were her least favorite. She somehow
talked her way into making me complete the pushups with
her…so that exercise quickly became one my least favorite too!
Once adjustments had been made to her home exercise
program with a log to reinforce the consistency of completing
her exercises, and treatment sessions were centered more towards
the client’s age and interests - her progress was significant! She
came to therapy motivated to participate in treatment and I
could see how proud she was to show me her completed exercise
log. Needless to say, she is well on her way to making a full
recovery.
Although I have a few regrets regarding the structure of my
initial treatment sessions with this client, I am beyond thankful
to have had this learning experience so early-on in my career.
As a new practitioner, it is easy to fixate on the diagnosis the
client presents with and treat based on what our textbooks say.
However, as OT practitioners, we have a unique skill set which
allows us to treat clients from evidence-based research, but also
have the knowledge and creativity to make adjustments and
structure treatment to fit the needs of each individual client.
While I learned a tremendous amount about upper
extremity anatomy, different surgical procedures and protocols,
and an array of interventions for various diagnoses and injuries,
the lesson that this one client taught me is invaluable. I am very
thankful to have had an outpatient hand therapy placement and
am excited to take this experience with me to my next rotation.
I consider myself very blessed to be entering such an amazing
profession!
About the Author
Katie Estey is a recent graduate of the MOT program at
Elmhurst College. She is originally from Spokane, Washington
and relocated to Chicago to study OT after completing a BS
Degree in Psychology from Carroll College located in Helena,
Montana.
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