Situation: For this placement at Osborne Park Hospital I am on a stroke and general rehabilitation ward and have a mixture of both stroke patients and other rehabilitation type patients under my case load. On Monday I was given a handover sheet for the general rehab patients that I would be seeing that day and continuing on with their physiotherapy treatment. One of the patients was an elderly male who had a high anterior resection surgery performed approximately 3 weeks previous and had been on the ward at Osborne Park for about a week. From the handover and reading the notes I deduced that the man lived at home with his supportive wife, in a home with 2 sets of stairs, both with rails and that previously he was independent with all ADL’s and ambulating with a walking stick. Currently he was independent with all transfers and ambulating on the ward with a standby assist for both a wheeled zimmer frame (WZF) and with a walking stick for up to 60m. His treatment plan was to manage his chest, increase ambulation endurance, improve balance, be safe and independent with transfers and to increase strength. These were previously being targeted through deep breathing exercises, ambulation with both the WZF and walking stick, static and dynamic balance exercises, transfer education and practice and strength exercises including sit to stands and squats.
Task: My task was to take over the physiotherapy care of this patient and progress his treatment to get him to a functional level where he was confident and safe to be discharged back home.
Action: For the first day of the week I continued the treatment in a very similar fashion to what had previously been done, particularly with the ambulation practice, which consisted of a half and half mix of walking with the WZF and the walking stick. On reflection, I agreed with the standby assist status for ambulation with both aids as the man was having trouble with the steering and direction of the WZF and was generally a bit unsteady with his use of the walking stick. It wasn’t until a quick chat with the man after that first session that I realised that the current course of treatment was a bit odd, in terms of progressing to independent ambulation status by doing equal amounts of practice with each aid. This method was clearly showing some progress with both aids, but certainly very slowly for each and for a man who was crying out to be independent as he told me he was at home, this wasn’t targeting his immediate goals. I decided to change my plan of attack for this man’s ambulation, to focus more heavily on the WZF, whilst still practising with the walking stick, just not to the same degree. I ran this idea past my supervisor to get her thoughts first before implementing this plan and she agreed that it was a much better way of going about things for this man. In the subsequent sessions this week, I had the man walking to and from the physio gym with his WZF, each day taking a different route to get there to get him walking further and for longer. Once in the gym, the ambulation practice focused more on the walking stick along with his other exercises, but the spotlight was now definitely more focused on the WZF for ambulation.
Result: The result was a dramatic increase in the man’s ability to manoeuvre and manage ambulation with his WZF, whilst still maintaining progression and carry over with the walking stick. On Wednesday after our treatment session I granted the man independent status for going to and from his bed to the bathroom using his WZF, which he was very pleased about. I felt this was a good place to start by making him independent to the bathroom, but kept him with a standby assist for ambulation on the ward as I wasn’t yet confident he could handle longer distances on his own. By Friday however, after 2 extra days of practice with me, with even more focus on the longer distances I was confident that the man was now safe and capable of independent ambulation on the ward with the WZF. The patient was also more confident in his ability to manage on his own with the WZF, so I granted him full independent status for ambulation with the WZF.
Now that the man has achieved independent ambulation status with the WZF which was his short term goal, I can now focus more on progressing to the longer term goal of becoming independent with the walking stick and preparing for discharge. I had a discussion with my supervisor and the ward OT about a home visit for the man to prepare for discharge and the OT explained to me that now he has achieved this independent status with his WZF, that a home visit can now be arranged, whereas it previously could not because of his ambulation. This was another great positive to come out of the situation.
Evaluation: I feel I analysed the situation well and consequently a favourable outcome followed. I believe it was important to get the man who was previously so independent with all his daily activities back to a level where he at least had some level of independency and progressing his use of the WZF has enabled that. I hope that now the man has seen the excellent result he has achieved with the WZF, that he will be motivated to do the same with his ambulation with the walking stick. I also feel that it was a good idea to check with my supervisor at the time about my idea to progress the work with the WZF because I was only new to the facility and didn’t know what kind of protocols they had for ambulation aids. I believe that checking with my different supervisors throughout the year before acting is very important because of the fact that we know different facilities have different beliefs and systems in place for all sorts of treatment and assessment methods, so this is definitely something I will continue to do for the rest of the year and for years to come when I am at a new facility. After I had the discussion with my supervisor and got the all clear then the rest of the treatment progression seemed to fall into place very nicely, to the point where the man in now independent with all ambulation with the WZF.
Strategies: I feel the biggest things that I have learnt from this situation are the importance of viewing the patient holistically and of appropriate goal setting. By having the different goals in place to work towards, it meant that there was a logical progression and treatment outline for this man’s ambulation. In this instance it was the short term goal of independent ambulation, which was modified to purely relate to ambulation with the WZF which was identified and subsequently worked towards and achieved with effective treatment and practice of ambulation with this aid. Now that the short term ambulation goal has been achieved, we can begin working towards the longer term goals of independent ambulation with the walking stick and also towards getting this man home again, where he will be safe and manage on his own. The other point I make about viewing the person holistically was important in this case because I could see how desperate the man was to restore some independent function back to his life and by fast-tracking the use of the WZF we were able to achieve this. Thirdly, another point I have learnt about goals is that you can be working on and towards multiple goals at the same time. In this situation I had prioritised the time more towards the WZF ambulation, but didn’t completely discard the use of the walking stick, as it was used around the gym. In doing this, the short term goal was at the forefront of the treatment session aims, but I was still very much working towards the ultimate goal of home discharge, which could be achieved when the man is deemed safe and independent ambulating with his walking stick.
Sunday, March 28, 2010
Sunday, March 21, 2010
Initial Entry (21/03/2010)
On the eve of the first day at my second 4th year clinical placement I feel nervous and a bit uneasy about what I’m about to face over the next 5 weeks. I do feel more relaxed than this time 6 weeks ago, which is probably due to my confidence still being pretty high following my previous placement, which I think is a good thing. My self-imposed nervous feelings are probably a bit of an overreaction to this being my neuro placement and being situated on a stroke ward because I found the 3rd year PHTY 314 neuro unit to be one of, if not the hardest of the course. My grade for this unit however wasn’t too bad, so I’m hoping that I won’t have as much trouble putting the theory of this unit into practice as I’m telling myself I will. From all accounts so far though, this seems to be a very enjoyable and beneficial placement, so I am really looking forward to getting the most out of it as I possibly can.
I expect that the nature of this placement will be similar to that of previous ones, but just with slightly inflated expectations of me because of it being a 4th year placement. I believe I will be expected to progress and grow as a therapist as each week passes and as my confidence and skills improve I will be expected to take on more responsibility and varied roles. I have heard that my facility is very realistic with its expectations of students and what they can successfully manage and I very much hope this is the case. In terms of structure, I expect to have a supervisor who I will be working in tandem with and as time goes by I will progressively have less and less supervision and guidance from my supervisor. I am hoping though, that my supervisor will initially take the time to introduce me to how the facility is run and how they go about their business, because I do know that each facility does things differently, so the earlier I can become familiar with this particular format the better and easier things will be for me. The facility information on blackboard has also been very beneficial in my preparation thus far and has informed me well as to the structure and expectations of me. For example, in week 1, I will be performing the “assessment of patients, subjective, objective and use of outcome measures –COVS, TUG, BERG Balance scale, Stroke Outcome measures,” followed by more treatment based objectives in my second week and then really focusing on “consolidation of independence in these areas,” by my third week. I realise that this has been provided more as a guide, but it is still very encouraging to see how well the facility appears to treat the students there on placement. On my role as a student, I expect that as time progresses I will be seen as less and less of a student there on placement and more and more as part of the team, which will also reflect my increasing degree of independence with my case load.
My overwhelming feeling right now though is that I am very nervous about going on a neuro prac, which is my main concern. As I mentioned previously, I found the neuro unit in third year quite challenging and despite reviewing all my resources from this and other units I still don’t feel confident that I know enough about this very complex area of physiotherapy work. Particularly neuroanatomy continues to puzzle me and I’m not sure if I have the capabilities to draw on the required knowledge at the appropriate time to be a really effective therapist in this field. I am hoping however, that with more exposure to this side of things, that it will become easier and make a bit more sense. My fingers are crossed about this one!
I also worry about my ability to handle a large case load under time restraints because on my previous placement this was one aspect I really identified as being something I need to improve. I am hoping that with issues such as this my supervisor will be able to offer strategies about aspects such as time management and patient prioritisation that will assist me to manage my case load on the ward. At this point in time, I definitely feel I need to become faster with my interactions with patients to increase my efficiency and effectiveness, but this should come with experience and exposure to different situations.
Another issue I have is that on my previous placements I have always been quite heavily supervised or had someone very nearby who was available to assist or provide suggestions whenever I felt I needed it. I’m not sure if I will have this ‘luxury’ so much on this placement as I expect to be much more independent, particularly in my final weeks than I have been previously. At this point in time, this is a concern for me because it will be up to me to control the situations that come my way and I just hope that I can handle it. The other way of looking at this though, is that it will be a good thing and will enable me to grow and develop my own methods and techniques of dealing with different scenarios to some extent, which as I said will be good for my development as a therapist. I will have to see how I feel about this one after the 5 weeks are up.
I am definitely a mixture of emotions at this point in time, I only hope that I can put these feelings aside and focus my energy to being an effective therapist and getting as much out of this placement as I can. I am sure I will learn plenty of new things over the 5 weeks and if I can enjoy myself as much as possible at the same time then that will be a bonus!
I expect that the nature of this placement will be similar to that of previous ones, but just with slightly inflated expectations of me because of it being a 4th year placement. I believe I will be expected to progress and grow as a therapist as each week passes and as my confidence and skills improve I will be expected to take on more responsibility and varied roles. I have heard that my facility is very realistic with its expectations of students and what they can successfully manage and I very much hope this is the case. In terms of structure, I expect to have a supervisor who I will be working in tandem with and as time goes by I will progressively have less and less supervision and guidance from my supervisor. I am hoping though, that my supervisor will initially take the time to introduce me to how the facility is run and how they go about their business, because I do know that each facility does things differently, so the earlier I can become familiar with this particular format the better and easier things will be for me. The facility information on blackboard has also been very beneficial in my preparation thus far and has informed me well as to the structure and expectations of me. For example, in week 1, I will be performing the “assessment of patients, subjective, objective and use of outcome measures –COVS, TUG, BERG Balance scale, Stroke Outcome measures,” followed by more treatment based objectives in my second week and then really focusing on “consolidation of independence in these areas,” by my third week. I realise that this has been provided more as a guide, but it is still very encouraging to see how well the facility appears to treat the students there on placement. On my role as a student, I expect that as time progresses I will be seen as less and less of a student there on placement and more and more as part of the team, which will also reflect my increasing degree of independence with my case load.
My overwhelming feeling right now though is that I am very nervous about going on a neuro prac, which is my main concern. As I mentioned previously, I found the neuro unit in third year quite challenging and despite reviewing all my resources from this and other units I still don’t feel confident that I know enough about this very complex area of physiotherapy work. Particularly neuroanatomy continues to puzzle me and I’m not sure if I have the capabilities to draw on the required knowledge at the appropriate time to be a really effective therapist in this field. I am hoping however, that with more exposure to this side of things, that it will become easier and make a bit more sense. My fingers are crossed about this one!
I also worry about my ability to handle a large case load under time restraints because on my previous placement this was one aspect I really identified as being something I need to improve. I am hoping that with issues such as this my supervisor will be able to offer strategies about aspects such as time management and patient prioritisation that will assist me to manage my case load on the ward. At this point in time, I definitely feel I need to become faster with my interactions with patients to increase my efficiency and effectiveness, but this should come with experience and exposure to different situations.
Another issue I have is that on my previous placements I have always been quite heavily supervised or had someone very nearby who was available to assist or provide suggestions whenever I felt I needed it. I’m not sure if I will have this ‘luxury’ so much on this placement as I expect to be much more independent, particularly in my final weeks than I have been previously. At this point in time, this is a concern for me because it will be up to me to control the situations that come my way and I just hope that I can handle it. The other way of looking at this though, is that it will be a good thing and will enable me to grow and develop my own methods and techniques of dealing with different scenarios to some extent, which as I said will be good for my development as a therapist. I will have to see how I feel about this one after the 5 weeks are up.
I am definitely a mixture of emotions at this point in time, I only hope that I can put these feelings aside and focus my energy to being an effective therapist and getting as much out of this placement as I can. I am sure I will learn plenty of new things over the 5 weeks and if I can enjoy myself as much as possible at the same time then that will be a bonus!
Sunday, March 14, 2010
Final Entry
Well, my rural placement is over and I had an absolutely fantastic time. I was exposed to many, many new situations and learnt so much from my supervisor and all the other health care professionals that I associated with over the 5 weeks. My initial feelings about being nervous continued well into my first week, but by about my fourth day I had found my feet and these feelings eased off considerably. This was my musculoskeletal placement, but being in a rural setting meant that I gained exposure to many different aspects of life as a physiotherapist, including in-patient hospital treatment, neurological disorders, cardiorespiratory disorders, women’s health, orthopaedic conditions, home visits, group exercise classes, paediatric and plenty of gerontology patient experience as well as musculoskeletal conditions. I also treated a cat, which was interesting to say the least!
My main concern in my initial entry was that of the perceived heightened expectation of me as a 4th year student, which turned out not to be much of an issue at all. On my first morning I asked my supervisor if he would mind if I just observed him when taking the first few patients of the morning so that I could get an understanding of how he goes about his business in the musculoskeletal setting, because I had very little experience in this setting. He did not have a problem with this, but insisted that once I feel comfortable and ready that I let him know so that I may take over. This worked very well and by the third patient of the morning I gave my supervisor the nod and I was away. My other concern about my supervisor not making an allowance for my feeling of being a ‘slow starter’ also proved to be incorrect as he was more than happy to facilitate my initial style of learning and any other learning styles that I requested throughout the placement.
From this point onwards I was relatively independent with my patients, but my supervisor was always around to provide support and suggestions if ever I needed it. As time progressed I got more and more exposure to different patients and scenarios and required less and less input from my supervisor. The initial thoughts about not currently having the capabilities of a new graduate we correct during my early days and my supervisor admitted this at my end of placement assessment, but I feel I progressed and continually challenged myself to grow to point where I feel I would now be working at a new graduate level in musculoskeletal physiotherapy.
My final concern was that I initially viewed the musculoskeletal as 4 very different entities and this was still evident in my mind until the end of my first week when I treated a patient and it all seemed to ‘click’ for me. The concept of remote mechanical problems became very clear from a practical perspective in my mind, not just from a theoretical perspective. I treated a patient who had definite median nerve compromise symptoms in one arm, showing sensory changes in the median nerve distribution in the hand and weakness of the thenar muscles. The nerve was very sensitised on palpation of the nerve in the cubital fossa in the forearm, but the patient was complaining of symptoms in the shoulder on upper limb neurodynamic testing as well. This finding led me to assess the shoulder and in turn the cervical spine, which produced the exact same symptomatic findings in the shoulder and hand upon PAIVM assessment of the lower cervical spine. I was sure there was compromise occurring at the intervertebal foramen at this level, which was causing the problems, which did end up being correct. I also assessed the thoracic spine to see if it was a further contributing factor and sure enough it was incredibly stiff, so I concluded that the apparent lack of movement here was being compensated for in the cervical spine with increased movement and causing compromise of the nerve root. My diagnosis was proven correct when I mobilised the thoracic spine and mobilised the cervical spine into the opposite the direction and gave the patient a stretch to open up the IVF on that side as a home exercise program and he returned the following week virtually symptom free. This piece of the jig-saw had fallen into place and from here I didn’t look back.
This placement far exceeded all my initial expectations and I really cannot believe how much I got out of it. My supervisor was amazing with every interaction that I had with him, which made me so much more confident that all my actions were becoming better and better. As I said previously, I feel that in the space of 5 weeks I have gone from below par in the field of musculoskeletal physiotherapy to the expected or even above expected level for a new graduate therapist.
My main concern in my initial entry was that of the perceived heightened expectation of me as a 4th year student, which turned out not to be much of an issue at all. On my first morning I asked my supervisor if he would mind if I just observed him when taking the first few patients of the morning so that I could get an understanding of how he goes about his business in the musculoskeletal setting, because I had very little experience in this setting. He did not have a problem with this, but insisted that once I feel comfortable and ready that I let him know so that I may take over. This worked very well and by the third patient of the morning I gave my supervisor the nod and I was away. My other concern about my supervisor not making an allowance for my feeling of being a ‘slow starter’ also proved to be incorrect as he was more than happy to facilitate my initial style of learning and any other learning styles that I requested throughout the placement.
From this point onwards I was relatively independent with my patients, but my supervisor was always around to provide support and suggestions if ever I needed it. As time progressed I got more and more exposure to different patients and scenarios and required less and less input from my supervisor. The initial thoughts about not currently having the capabilities of a new graduate we correct during my early days and my supervisor admitted this at my end of placement assessment, but I feel I progressed and continually challenged myself to grow to point where I feel I would now be working at a new graduate level in musculoskeletal physiotherapy.
My final concern was that I initially viewed the musculoskeletal as 4 very different entities and this was still evident in my mind until the end of my first week when I treated a patient and it all seemed to ‘click’ for me. The concept of remote mechanical problems became very clear from a practical perspective in my mind, not just from a theoretical perspective. I treated a patient who had definite median nerve compromise symptoms in one arm, showing sensory changes in the median nerve distribution in the hand and weakness of the thenar muscles. The nerve was very sensitised on palpation of the nerve in the cubital fossa in the forearm, but the patient was complaining of symptoms in the shoulder on upper limb neurodynamic testing as well. This finding led me to assess the shoulder and in turn the cervical spine, which produced the exact same symptomatic findings in the shoulder and hand upon PAIVM assessment of the lower cervical spine. I was sure there was compromise occurring at the intervertebal foramen at this level, which was causing the problems, which did end up being correct. I also assessed the thoracic spine to see if it was a further contributing factor and sure enough it was incredibly stiff, so I concluded that the apparent lack of movement here was being compensated for in the cervical spine with increased movement and causing compromise of the nerve root. My diagnosis was proven correct when I mobilised the thoracic spine and mobilised the cervical spine into the opposite the direction and gave the patient a stretch to open up the IVF on that side as a home exercise program and he returned the following week virtually symptom free. This piece of the jig-saw had fallen into place and from here I didn’t look back.
This placement far exceeded all my initial expectations and I really cannot believe how much I got out of it. My supervisor was amazing with every interaction that I had with him, which made me so much more confident that all my actions were becoming better and better. As I said previously, I feel that in the space of 5 weeks I have gone from below par in the field of musculoskeletal physiotherapy to the expected or even above expected level for a new graduate therapist.
Entry 3: Evidence-Based Practice
Situation: During the second week of my placement I was told by my supervisor that in my final week I would be conducting a home visit on a gentleman with Parkinson’s Disease. The purpose of the visit would be to conduct a bi-annual assessment on his condition state. At this initial point in time I wasn’t provided with any more information than this.
It was at the start of my fourth week when I noticed the home visit in the appointment book again and I asked my supervisor if I could view the gentleman’s file at the practice so that I may begin preparing for the following week. I was granted this access and over the week took time to read his history and the results of the previous two assessments that had been conducted on this man. The assessment was an outcome measure designed especially for Parkinson’s Disease, the Unified Parkinson’s Disease Rating Scale (UPDRS).
Task: My task for the home visit was to complete the UPDRS and compare it to the previous results to assess how this man’s condition state was progressing.
Action: I read over the UPDRS a few times to familiarise myself with it, so as to enable me to conduct the assessment efficiently and effectively when the time came. To further prepare, I did some research on the UPDRS to see what additional information was available which would assist with my understanding of the scale. In my research I found that the UPDRS is one of, if not the most common assessment used by health care professionals, involving both a detailed subjective and objective assessment component to measure the severity of Parkinson’s symptoms and the stage of disease progression as well as for treatment and research strategies such as clinical trials for new treatment medications. In addition to this I found that there has recently been a series of modifications made to the scale to update it to meet the current perceptions and beliefs about Parkinson’s Disease, as opposed to what was understood when the scale was first developed over 20 years ago. The Movement Disorder Society’s new updated scale (MDS-UPDRS) has been devised to not only assess the motor aspects of Parkinson’s Disease, but to include assessment of the non-motor symptoms, such as thought and emotional processes which encompasses the new-age perception by specialists that Parkinson’s Disease is not just a movement disorder.
So I had a good read of the MDS-UPDRS and realised that the new scale was more than just the old scale with some additional questions, but it had been largely overhauled to incorporate the new changes. As a result of this, it would be difficult to infer results from the MDS-UPDRS to the original UPDRS to compare previous results for the gentleman. I presented my findings to my supervisor at the start of my last week and after a discussion we decided that for the sake of completeness that I should conduct both scales during my visit. The original UPDRS so that I could assess the disease progression by comparison to previous scores and the MDS-UPDRS so that we would have a rating using the most up to date resource, which could be used for the next assessment in six months time.
Result: I conducted both the UPDRS and the MDS-UPDRS for the gentleman on Thursday without any problems and then collated all the information to assess the results before presenting my findings to my supervisor. Comparison of the UPDRS results showed a minor increase in scores, reflecting a slight degree of disease progression compared with the last time the scale was conducted, but certainly nothing significant. With this I then compiled a letter which was sent to the man’s GP detailing the findings of my assessment.
Evaluation: On evaluation I feel that I did a very good job. I completed the task that was asked of me and feel I achieved much more than just what was asked of me by conducting additional research and implementing my findings into the task. It should also be easier for the future assessor(s) of this gentleman to perform the visit because I found the MDS-UPDRS to be a far superior scale than the original UPDRS. It was much more clear and concise with its instructions to both the examiner and the participant and the answers and scoring system was also much improved compared to the original UPDRS. I feel that conducting both assessments during my visit was the best action for me to take and was in the best interests of the whole team who is looking after this man and his condition. It took me personally more time and effort to conduct both assessments in the one visit, but it means that in future visits only the MDS-UPDRS will need to be conducted, which will serve even better than the UPDRS for identifying disease progression for the gentleman. My supervisor was also very pleased with my efforts and ability to conduct effective research which was very satisfying for me.
Strategies: What I’ve learnt from this experience is that science is always evolving and as a science-based profession we as therapists need to stay up to date with new developments and progressions. That it isn’t satisfactory when performing any assessment or treatment technique to simply say “this is the way I’ve always done it,” because it may be so, but it may not best option or method any more. For this reason we need to continually be researching and staying up to date with current best practice methods and techniques in order to provide the best possible quality of care for the people who are under our care. The other strategy that I’ll take from this is that through some self sacrifice and putting in the hard yards initially you can make things much easier for yourself in the future. In this case, it is not me that will benefit directly from my extra time and effort, but my supervisor and his future students performing the assessments on the man will reap the benefits of the MDS-UPDRS and my initial assessment using this tool. The gentleman will also benefit from this because the new scale will provide a better, more effective measure of the progression of his Parkinson’s Disease symptoms, enabling better quality of care and manageability of the condition.
It was at the start of my fourth week when I noticed the home visit in the appointment book again and I asked my supervisor if I could view the gentleman’s file at the practice so that I may begin preparing for the following week. I was granted this access and over the week took time to read his history and the results of the previous two assessments that had been conducted on this man. The assessment was an outcome measure designed especially for Parkinson’s Disease, the Unified Parkinson’s Disease Rating Scale (UPDRS).
Task: My task for the home visit was to complete the UPDRS and compare it to the previous results to assess how this man’s condition state was progressing.
Action: I read over the UPDRS a few times to familiarise myself with it, so as to enable me to conduct the assessment efficiently and effectively when the time came. To further prepare, I did some research on the UPDRS to see what additional information was available which would assist with my understanding of the scale. In my research I found that the UPDRS is one of, if not the most common assessment used by health care professionals, involving both a detailed subjective and objective assessment component to measure the severity of Parkinson’s symptoms and the stage of disease progression as well as for treatment and research strategies such as clinical trials for new treatment medications. In addition to this I found that there has recently been a series of modifications made to the scale to update it to meet the current perceptions and beliefs about Parkinson’s Disease, as opposed to what was understood when the scale was first developed over 20 years ago. The Movement Disorder Society’s new updated scale (MDS-UPDRS) has been devised to not only assess the motor aspects of Parkinson’s Disease, but to include assessment of the non-motor symptoms, such as thought and emotional processes which encompasses the new-age perception by specialists that Parkinson’s Disease is not just a movement disorder.
So I had a good read of the MDS-UPDRS and realised that the new scale was more than just the old scale with some additional questions, but it had been largely overhauled to incorporate the new changes. As a result of this, it would be difficult to infer results from the MDS-UPDRS to the original UPDRS to compare previous results for the gentleman. I presented my findings to my supervisor at the start of my last week and after a discussion we decided that for the sake of completeness that I should conduct both scales during my visit. The original UPDRS so that I could assess the disease progression by comparison to previous scores and the MDS-UPDRS so that we would have a rating using the most up to date resource, which could be used for the next assessment in six months time.
Result: I conducted both the UPDRS and the MDS-UPDRS for the gentleman on Thursday without any problems and then collated all the information to assess the results before presenting my findings to my supervisor. Comparison of the UPDRS results showed a minor increase in scores, reflecting a slight degree of disease progression compared with the last time the scale was conducted, but certainly nothing significant. With this I then compiled a letter which was sent to the man’s GP detailing the findings of my assessment.
Evaluation: On evaluation I feel that I did a very good job. I completed the task that was asked of me and feel I achieved much more than just what was asked of me by conducting additional research and implementing my findings into the task. It should also be easier for the future assessor(s) of this gentleman to perform the visit because I found the MDS-UPDRS to be a far superior scale than the original UPDRS. It was much more clear and concise with its instructions to both the examiner and the participant and the answers and scoring system was also much improved compared to the original UPDRS. I feel that conducting both assessments during my visit was the best action for me to take and was in the best interests of the whole team who is looking after this man and his condition. It took me personally more time and effort to conduct both assessments in the one visit, but it means that in future visits only the MDS-UPDRS will need to be conducted, which will serve even better than the UPDRS for identifying disease progression for the gentleman. My supervisor was also very pleased with my efforts and ability to conduct effective research which was very satisfying for me.
Strategies: What I’ve learnt from this experience is that science is always evolving and as a science-based profession we as therapists need to stay up to date with new developments and progressions. That it isn’t satisfactory when performing any assessment or treatment technique to simply say “this is the way I’ve always done it,” because it may be so, but it may not best option or method any more. For this reason we need to continually be researching and staying up to date with current best practice methods and techniques in order to provide the best possible quality of care for the people who are under our care. The other strategy that I’ll take from this is that through some self sacrifice and putting in the hard yards initially you can make things much easier for yourself in the future. In this case, it is not me that will benefit directly from my extra time and effort, but my supervisor and his future students performing the assessments on the man will reap the benefits of the MDS-UPDRS and my initial assessment using this tool. The gentleman will also benefit from this because the new scale will provide a better, more effective measure of the progression of his Parkinson’s Disease symptoms, enabling better quality of care and manageability of the condition.
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