Entry 1: Intervention

Situation: I was preparing to see a long term Duchenne Muscular Dystrophy patient for the first time on the Wednesday of my first week at Rocky Bay. I was going to see the young man with my supervisor for his regular stretching and passive movement program, designed to maintain joint range of movement because he had lost his inability to perform the movements actively. I decided I would view his program before the session so that I would be better prepared for my intervention. The client comes to the Rocky Bay site twice per week for his program, but on a Wednesday does not get out of his electric wheelchair, so the program is performed while he is sitting. The program involved a warm up with general passive movements of the upper and lower limbs, followed by stretches into all directions at every joint in the upper and lower limbs.

Task: My task was to perform the client’s regular stretching and passive movement program, under the supervision of my supervisor, who would make sure I was performing things correctly so that I could do the treatments on my own in the future.

Action: After an introduction my supervisor and I started on the passive movements of the upper limb. He was performing them on one side to start off with and then I was copying on the other side once he had finished. After this I began with the upper limb stretches. At the shoulder, I performed flexion, abduction, horizontal adduction and external rotation as per the program. At the elbow I performed flexion and extension and forearm supination and pronation, again as per the program. At this point my supervisor told me I was doing well. In his wheelchair, the client rested one upper limb on each of the arm rests, with his wrists and fingers in slight flexion, which is how he stayed as he did not have the capability to actively move out of this position. At the wrist, I firstly did a passive stretch into extension and then went on to start flexion, as was written up in his program.

Result: After stretching into wrist flexion for less than 5 seconds I was told to stop the stretch by the client as he didn’t need it. I stopped and queried this with my supervisor who told me that he doesn’t usually stretch into wrist flexion as the client rests in wrist flexion anyway, so there is no need to stretch into this direction and that it is extension that we really need to be maintaining at the wrist. After this I continued on with the rest of the program on that side, then progressed to the other upper limb and then to both lower limbs without any problems. When I had finished my intervention and had a quick discussion with my supervisor I went and edited the exercise program and removed the wrist flexion stretch.

Evaluation: I feel that I performed my task well in this situation, particularly my preparation, but there was just the small part of my intervention where I fell down a bit. My supervisor commended me on the fact that I had taken the time to view the client’s program prior to treating him, saying that it would have been very easy for me just to check each part of the treatment with him as I went. He said it was actually this enthusiasm and initiative that caused the problem with the wrist flexion stretch in this instance because I had viewed the most recent exercise program on the computer, however this document had not been updated for some time. He said this was not my fault, as I was not to know it was an outdated program that I had viewed. I felt that it was a good move on my behalf to stop the stretch immediately when I was asked and then to check things over with my supervisor because he was able to point me in the right direction. However, I was still disappointed in myself for not being switched on to the fact that there really was no point in performing a stretch into the direction that the wrist is positioned in for the majority of the day anyway. The rest of the intervention went really well though and updating the exercise program was also the right thing to do as it should save people from making the same mistake as I did in the future.

Strategies: Despite what I honestly felt was a pretty good first up performance on my behalf there is a few things that I learnt from the experience that I will endeavour to incorporate into my clinical performance in the future. Firstly, I will continue to prepare for all people that I see as best as I possibly can, to try give them the best possible care. Secondly, I will know to check the publication date of all documents that I view in the future to try and give me an idea of how up to date and relevant the material contained in it really is. Thirdly, I believe this experience was a reminder that often it is the patient or in this case client who knows best. The young man knew that he didn’t usually receive the wrist flexion stretch that I was performing and was able to tell me and hence get me to stop. By listening to the client I was able to provide the usual treatment that he receives. I believe that listening to the patient/client’s thoughts and beliefs is important in any situation or setting, but also something that has to be interpreted appropriately as I’m sure people’s belief about what needs to be done in terms of treatment is often well off the mark. In this case though, it was spot on and therapeutically it was the correct move to listen to the client and act as he suggested.