Entry 2 – Assessment

Situation: School holidays are the busiest times of the year at Rocky Bay as it is when all the school-aged clients are booked in for their annual assessments. The annual assessment is conducted to determine how the individual is progressing or regressing with their condition from the previous year. It involves a detailed subjective questioning on things such as mobility and transfers, school, physical activities, general comfort and goals. The objective assessment includes photographs of sitting and standing postures, functional assessments, respiratory assessment, joint ranges and muscle strength assessment. It’s a lengthy process that usually takes about one and half hours to complete in its entirety.

Last week I was scheduled to perform my second annual assessment with one of my supervisors and it was actually a double assessment on 2 brothers, both with Friederich’s Ataxia. From previous assessments I was able to ascertain that the younger brother was more severely affected and was wheelchair bound, only standing out of his chair to transfer, while the older brother had maintained his ability to walk, unless severely fatigued. Both boys had recently been for their regular check-ups at the PMH spinal clinic and the feedback from this was that there was no noteworthy change with the younger brother, but that the older brother would soon be fitted with a spinal brace but first needed his physio assessment including gait analysis. Because of this, my supervisor and I decided that we would make the older brother the priority in this session if we began to run short on time.

Task: My task was to perform the annual physio assessment on the 2 brothers with the assistance of my supervisor. I only had 2 hours to perform both assessments and after a quick discussion with my supervisor prior to starting she told me that she wasn’t expecting me to get through both in the allotted time slot. We agreed that realistically it would be a good effort on my behalf to get through both boys subjective assessments and the objective assessment on the older brother. This became my modified task and goal for the session.

Action: As it turned out the whole family came into Rocky Bay for the assessments, being the 2 boys and their younger brother, plus their mother and father. When I was initially introduced to the family the boy’s father seemed very nice and friendly, however I didn’t get the same response from the mother, who didn’t seem too happy that I would be performing the assessment. When we had all made our way into the private assessment room in the therapy area I got started with the assessment. I began with subjective questioning by asking the younger brother, who seemed the quieter of the 2, if he was enjoying the start of his holidays and this quickly lead to his school life. From this platform I was able to ask about physical activities in and out of school, mobility and his ability to transfer. It was at this point I realised that the older brother had been sitting patiently, but hadn’t actually been involved for close to 15 minutes. I quickly swapped over and began asking him a few questions. I again found that one topic of questions easily flowed into the next and this time got carried away with the older brother. From this point I was able to complete my subjective questioning, switching from brother to brother fairly frequently.

With the subjective assessment over I decided to perform the respiratory assessments on the boys one after the other. This involved measurements of vital capacity and forced vital capacity using a vitalograph. Once completed, I took the photographs of the boys sitting and standing postures, again one after the other. As time was beginning to run short, I turned the individual focus onto the older brother as previously discussed. We went outside to begin his functional assessment and returned back to the assessment room to complete it. I was then able to perform a full range of motion assessment of the upper and lower limbs before time was unfortunately up.

Result: The result was that I didn’t really have a full subjective assessment for either boy when I reviewed my notes after the session had ended. I attributed this to the swapping over between each brother during my questioning. This aside, I was nearly able to complete the entire assessment for the older brother, having only needed to assess muscle strength for it to be complete. I was also able to begin the objective assessment on the younger brother and finish taking his posture photographs, which is one of the more time consuming aspects of the assessment. As I wasn’t able to finish both assessments, we were able to book a return appointment for after the school holidays so that they can be completed. After the session my supervisor and I both took a file and the notes so that we could begin writing up one set of assessments each.

Evaluation: Even though I initially felt a bit uncomfortable because of the mother’s attitude towards me, I feel that overall I performed well during this double assessment. I believe that in my attempts to make my subjective questions flow from one topic to the next, it actually made the initial part of the assessment not flow so well. By asking long series of questions to each boy when I started it actually got me out of place a bit and I feel that this was the reason there was some parts missing to my subjective assessment. Despite this, I feel that the questions that I did manage to ask were appropriate and worked well, which also helped with the boy’s mother who became much more cooperative as the assessment progressed. I feel that doing the respiratory and posture photograph aspects of the objective assessment on each of the boys at the same time also worked well. It meant that I didn’t have to explain the process to each boy individually which saved me time in the end. I also feel that I was able to complete the other parts of the assessment in an effective, but time efficient manner. Although the session turned out different to what we had initially planned, I believe that I was actually able to accomplish more than originally anticipated, which was a positive. The problem with the actual outcome was that I wasn’t able to complete the full assessment for either boy, but they are booked in to return soon, so they should both be completed in the next few weeks.

Strategies: One thing I have learnt from this experience is that in the future it would be advisable not to conduct double assessments where possible, especially when under time constraints. By doing the double assessment it unfortunately meant that neither boy’s assessment was able to be completed in the time available. If performing both is unavoidable, I learnt that it works best if each part of the subjective assessment is asked individually and in turn. When I adopted this method at the end of the subjective questioning I didn’t miss any sections or important parts. This is definitely a strategy I would use in the future to ensure I got a thorough and complete subjective history. The other thing I learnt from both my supervisor and my own actions in this scenario was the importance of planning a session before you begin. By having the plan in place to make the older brother the priority in this assessment, it meant that even though we strayed from this plan, I was still well prepared with how the session would run. Also the planning involved with having all the relevant equipment and resources available, such as cameras, stopwatches, goniometers and stickers for spinal assessment in the photographs. It wasn’t a big issue in this instance because there was 2 of us and 1 could just leave the room to gather the forgotten equipment while the other continued, but if you were on your own this would be a time wasting action at a point where time is of the essence. The other thing that was further cemented in my mind was the importance of time efficient positioning and testing everything possible when the client is in their current position, which I was glad to be commended on by my supervisor at the end of the session.