Week 3- Post 2

Wednesday 29th of October 2008

Sandy**

Thoughts and feelings in the presenting situation…

Sandy is 15 months old and has been diagnosed with down syndrome. Sandy is a beautiful little girl who has such a gorgeous and gentle temperament. She had clearly visible low muscle tone and this was the first time I have seen Sandy. She was a pleasure to work with and to move around into the crawling position and did not complain once. Although she fatigues after half an hour, so she began crying at half an hour when all her muscles were getting tired.

How I managed the patient…

This was my first time seeing Sandy. Lots of positive reinforcement was given when she would succeed in tasks. She had a much curved spine in the beginning of the therapy session, as this is an indicator of low spinal muscle tone. We got Sandy doing assisted bottom bouncing to increase her spinal muscle tone. We also placed a tall giraffe musical toy in front of her to encourage her to further straighten her spine. This worked incredibly well, and her back was very straight. This also allowed her to play with and manipulate the blocks that went in the toy with correct body position and posture. She needed help getting into the crawling position. We would get behind her; tuck her legs underneath her chest so she was on her knees. We would then rock her backwards using the hips as the stabilising point, to encourage head extension and arm propping forward. She began to get a feel for synchronised crawling with her hands moving forward. She was also beginning to bare weight on her legs which is a fantastic progression and improvement.


What I did well…

I jumped in and corrected her positioning whenever I got the chance, and made conversation with the mother. I always had a smile on my face and am now getting the hang of positioning the children using key points.

What I could have done better…

Be more forward and asked Jenny If I can take control more. But this was the first time I saw Sandy so in the beginning observing was to my advantage to begin with.

Forward plan…

Prepare some progressions for her therapy and some challenges for Sandy.

Changes for next time…

I will immediately get into improving her sitting posture and increasing her spinal muscle tone. This will allow immediate correction before play and activities begin.

Overall thoughts and feelings of how today has gone…

Today was interesting as it was my first time seeing some of the patients. It was great to meet the children and work with them. In the afternoon after Jenny had left I was writing up a report for a client to be sent to a paediatrician. I am proud of the quality of the work and it was interesting writing it as my understanding of the child’s improvements since day one has increased. I also know where he is at, and it helps with planning progressions and challenges for my next therapy session with him.

Strategies to improve my performance…

I’m still a little reserved with new clients, but I think that’s normal. I need to just keep putting hands on to gain experience.

Questions…

**Name changed

Week 3- Post 1

Tuesday 28th of October 2008

Jasmine**

Thoughts and feelings in the presenting situation…

Jasmine was a 4 year and 8 month young girl who came to us with a turned in foot. This was the mothers concern. She is very tall and bright. She appeared to have slightly protracted shoulders but, this was not a concern at this stage. Her hips were not in any way oblique and her femurs were not ante or retro verted in any way. This girl displayed general hypermobility and therefore she needs stronger muscles to support her joints. Jasmine had weak abdominal muscles, strong back muscles, grade 5 quads and tight hamstrings. Her tight hamstrings were interesting because this was all related in her foot positioning.

How I managed the patient…

This was the first musculoskeletal assessment I have done since beginning my prac. Jenny did not use a goniometer but another device which was much easier to manoeuvre and made for a quick and simple objective assessment. I tested for general muscle tone and Jasmine displayed slightly low muscle tone. We would always say what nice work she was doing, and comment about her beautiful toe walking right on her tip toes and say she should start ballet dancing! I would observed everything and tried to pick up as many things as possible to add to our assessment. I believe I was easy going and we created a nice friendly environment for her and her family.

What I did well…

I think I was very friendly, and I was just myself. I think I noted important observable features that were important to know, and was friendly with mum, talking about Jasmines interests and hobbies. I also came up with the appropriate exercise for strengthening peronii for toe walking.

What I could have done better…

If I had more preparation time I would have been more ready to undertake the assessment. I could have positioned myself more appropriately whilst watching Jasmine walk down the room, to watch her gait.

Forward plan…

I don’t think Jasmine will return, because if she focuses on the exercises we gave her I think she will strengthen her muscles to support her joints more. We have filed away a SOAPIER of the assessment and the stretches and activities we gave them as a home exercise program.

Changes for next time…

I would prepare myself more for the musculoskeletal assessment

Overall thoughts and feelings of how today has gone…

Today was a very busy day, but a very interesting one. It was interesting to see a musculoskeletal assessment for children because we have to distract them so they walk or move the way they normally do, not the way they want us to think they walk. Also you have to make it fun and not boring. We incorporated the ball pit when we wanted to ask mum questions to make the assessment age appropriate for Jasmine.

Strategies to improve my performance…

I definitely discovered that conducting assessments on children is quite different to adults. Children will often start to get agitated if they are in one place for too long. You have to make it fun and engage with them at their level. You have to ask questions about likes, dislikes and hobbies to keep them interested.

Questions…

I asked Jenny about the ROM device she used. I had never seen one before. It does take practice to use but I think I will invest in one later on!

**Name changed

end of week 2

Thursday 23nd of October 2008

Michael**

Thoughts and feelings in the presenting situation…

Michael is a 17 year old boy with left hemiplegia. It has been four years since his Motor vehicle accident. Michael also suffers from some memory loss due to the damage to his right side of his brain. He has left side weakness and has a foot drop on bhis left side. He is always friendly and remembered my name after only 2 days, and it took him over a year to remember Jenny’s name. He is very happy and loves hanging out with his mates. Jenny and I see him twice a week at the gym for over an hour for an intensive workout. He is very strong emotionally and his strength is improving from therapy. He also receives speech therapy aswell.

How I managed the patient…

I think because I am young I get along with Michael really well. Also I’m a girl so that helps, apparently he chooses equipment which is located near girls. I always pushed him to continue with words like ‘keep it up’ ‘almost there’. I just treat him normally, and speak completely normal. I think Michael and I get along well. We do 25 minutes of cardio on the treadmill running, watching his heart rate, which rises and falls very quickly. He then has an element of control out of two machines for the next task. On the treadmill we watch his gait and make sure he does not get more than 3 toe catches. We will stop him because he could be fatiguing and may fall.

What I did well…

I think I was very friendly, and I am just myself. He enjoys conversation and humour/jokes. I think I also prompted him when necessary to correct his motion on the machines or his technique. I used tactile response with tapping his muscles when I wanted him to correct his posture or use different muscles.

What I could have done better…

I could have asked him questions in between sets about how he is going to use the machine this time round, and what things he needs to remember.

Forward plan…

We want to organise with his dad to pick up his new orthosis to use in therapy.

Changes for next time…

Manage time a bit better, and less chatting before getting into exercises.

Overall thoughts and feelings of how today has gone…

Today was a very long day. I was involved in a group class and we had one little boy with down syndrome. He was very hard to control and was not very well behaved. That was very enhauasting but a giant learning curve, because at times you have to be strict and be a little forceful. It’s a little awkward when the mum is there, but she understood that he was being a difficult. It was very interesting watching how Jenny approached the situation, however she has worked with this boy before and this was my first time.

Strategies to improve my performance…

Don’t be afraid to have a stern voice at times to control the children. I think I just don’t want to sound mean, but towards the end of the class I was a little less nice because it was exhausting him not listening to everyone.

Questions…

I had a few questions about the little down syndrome boy and other members of the group and asked whether they were making any progress in therapy.

**Name changed

During the 2nd week

Wednesday 22^nd of October 2008

Erin**

Thoughts and feelings in the presenting situation…

Erin is a 5 year old little girl who has severe dyspraxia. I have never seen Erin before but I was aware that she needs a high tech augmentative communication system. Jenny did not give me prior warning that I would be running the whole session. I pretty much ran this session solo and Jenny only joined in the session twice. I set up the whole area and made up the chart on the Velcro board. Erin is a very nice girl, who was very compliant and completed the whole program without any real dramas. She required assistance with hopping on the ground and also needed prompting and physical hands on help with duck walking. Jenny was talking to mum about issues as well as her 6 week old baby boy (who mum was a little concerned about) while I was running the session. When I met Erin I thought I may have some focus problems but she performed excellently in the session. I was very happy with how focussed and compliant she was in the therapy, especially as she had speech therapy prior to my session.

How I managed the patient…

I think I managed Erin quite well and I stayed focused and was confident throughout the session. I demonstrated some tasks to Erin to get her understanding more what she was to be doing. I gave her assistance when she needed it, but I tried not to help her when I knew she was capable of performing the task as this made her more proud of her efforts when she successfully completed a task. I gave her positive feedback throughout the session such as ‘goodwork’ and ‘well done’. At the end of the session I gave her the choice of a task she wanted to do. She chose the ball pit.

What I did well…

I believed I displayed confidence and was not afraid to get down and be on Erin’s level. I think being on their level really helps as this is less intimidating than standing up and being much taller than the children. I always kept Erin on task and believe I worked well with her and made the activities fun and friendly. I never got cross, instead I merely encouraged her to stay on track.

What I could have done better…

At the beginning of the session I should have got Erin to take off her thongs so they were not in the playground area. I found she got distracted by her thongs and would go to them in between tasks and put them on when she needed them off for the next task. She would listen and take them off when I or mum would ask her. I could have done more hanging with her, she was quite strong at this, but I don’t think she enjoyed it much. I could have done some singing with her to make her repeat the task and make it fun.

Forward plan…

Try some trycyle riding with Erin and have a look at her balance on both feet in one leg stance.

Changes for next time…

I think this program may be a little easy for Erin. I might have a chat to Jenny about making it a little bit more challenging so we can get Erin to work at a more advanced, higher level.

Overall thoughts and feelings of how today has gone…

Today was overall a good day. We saw three clients in the morning, one had cancelled due to the chicken pox. Two of these client’s I had not seen before so it was a very interesting morning working with them and learning what they were capable of. I had to create a list of the current clients that needed equipment in the future. This included their diagnosis, DOB, full name, gross motor functional score, health care card number and a table which included equipment they currently use and predicted equipment. I also divided them into low, medium and high care depending on their needs.

Strategies to improve my performance…

Don’t push the child to the extreme, especially little ones who are struggling with some tasks, are fatigued and when things are just a little too hard for them. Sometimes if they have a little fall, the whole therapy can be disturbed. Also when the child is sick, this severely affects their mood and participation/ ability level.

Questions…

I had a conversation with the Speech pathologist about Erin’s behaviour in her session. Julia had said that Erin was very focussed and well behaved in her session today. This was great as this focus continued right through into my physio session.

**Name changed

Beginning of week 2

Tuesday 21^st of October 2008

Liam**

Thoughts and feelings in the presenting situation…

Liam turns four in December and has been diagnosed with autism. He originally had global developmental delay which then turned into autism. Liam is a bright boy, but is starting to show his independence by not doing what we want him to do. His compliance was very low today and Jenny has always been so used to him doing everything she has ever asked him to do. It was hard managing him today as he would respond with comments such as ‘no hang’ for example. He was finding it hard to understand that he had to hang first before he did an activity he wanted to do. We tried to limit his element of control to make him understand he was to do what was asked of him. He completed the tramp program, went on the beam and jumped off, went up the slide and into the ball pit, hanging and the incentive for completing hanging was spinning in the orange top ( for vestibular) He was not being compliant as we were challenging him and taking him out of his comfort zone opposed to letting him do what he wanted to do.

How I managed the patient…

Liam was very difficult to manage because he was not compliant today. We just needed to be patient, but at some points in the therapy, Jenny used some force to keep him focussed, for example pulling him out of the ball pit, which all kids love playing in! We had to repeat ourselves a lot and ended up edited the scheduled program as he would not hang unless something more enjoyable was to follow. Liam’s mum and younger sister (2 ½ years) were also present as well as Jenny and myself. We made it more into a group session rather than just asking Liam to perform tasks. We asked his younger sister to hang, then I would hang, then mum would hang. It took a while for him to listen and do the required tasks. We also used ‘Candy’ the doll to hang as well.

What I did well…

I believe the tramp program was the most successful. I got on the tramp as well and showed him how to do things and used the chart to recognise what position we were doing. I also assisted him with puppy dog jumps by stabilising his legs between mine and jumping with him. I used a lot of positive encouragement only when he would attempt something or complete a task successfully, not when he was being difficult.

What I could have done better…

This was only the second time I have seen Liam and this time was a lot more difficult than the last session. I tended to have a voice that was a little too loud, so I lowered my volume. Also I think I need to learn how to be firmer when he loses his focus, I’m too nice!! But keeping them on track is benefiting them more than just letting them wonder and do their own thing.

Forward plan…

For next time we want to focus on riding a tricycle and also running on toes using the pumping arms as well.

Changes for next time…

Keep challenging him but change the program slightly so he shows more interest in the activities.

Overall thoughts and feelings of how today has gone…

Today was a very full on day, we had 4 clients in a row and I think the change in weather may be contributing to a few of the child’s moods. Good day today. In the afternoon, Jenny and myself went in did a gym visit with a 17yr old post MVA male who trains in a gym. That was such a fantastic experience, and I will definitely be talking about one of those sessions in my reflections.

Strategies to improve my performance…

Be strong and keep your voice at their level not great volume levels higher, as this just adds to the chaos of the session. Lowering the volume of your voice may also relax the child.

Questions…

I only asked the mum if Liam was tired, and if this was affecting his performance in therapy today. Was it making Liam feel like he was not performing up to standard because his younger sister was performing tasks he was struggling with. Jenny replied with that he doesn’t have the cognitive ability to think that way, we were simply making the therapy into a friendly ‘everybody is doing it’ session.

**Name changed

End of the 1st week

Friday 17^th of October 2008

Leah

Thoughts and feelings in the presenting situation…

Leah is a 5 year old little girl with Tubular Sclerosis, autism and due to this has a delay in her development. Leah also suffers from seizures daily but has a very loving and supportive family to support her all of the way. Leah is a gorgeous, smiley little girl who warms to friendly, familiar voices and liked the vibrating space ship very much, This was her favourite toy, as it vibrated and had flashing lights. The vibrations stimulate nerve endings in her muscle which is great to activate her muscles and is fantastic for her proprioception. Leah was very comfortable in her own house, more so than in the therapy room. I do a home visit to Leah’s hose every Friday by myself to work with Leah. Mum was very welcoming and was very lovely.

How I managed the patient…

When I had arrived, Leah had just awoken and had just had a very bad seizure, so we let her sleep and wake up in her own time so she was comfortable with the therapy session and wasn’t too sleepy. Leah is a very happy little girl so I just gave lots of positive reionforcement and kept a big smile on my face and always communicated at her level. While she was still a little sleepy I worked her in the walker first of all, so she could work at her own pace. I would encourage walking and try and get her to hold the rail in front of her to connect that if she pushes with her arms she can take a step forward. We used the vibrating space ship as a trick to help stimulate the muscles in her hands to hold on to the rails. As soon as she would let go I would immediately put them on again I then walked Leah without her walking supporting her by her arms with a loose but stable grip and then transferring her weight to assist her in taking a step. I also worked on sit to stand and stand to sit, and always had a toy on the wall to grasp her attention then I would help her up. I also worked on her one point kneel to stand, but this is tricky because Leah wears AFO’s. Worked on her propping and balance aswell.

What I did well…

I believed I engaged with little Leah well and did not push her so she got agitated. I would also get her to work to get something or go to mum. I would get her up and walking.I was giving lots of positive reinforcement and praise to make Leah feel good about what she just did. I always gave her a rest after a little seizure and would always talk to her and keep her awake so she was ready to do some more work.

What I could have done better…

For my first solo flight I was fairly happy with how the therapy session went. I need to learn how to use the mum more to help me out because I didn’t have Jenny there. It was a fantastic experience. I need to also just practice my handling skills better, but overall I was happy and I think mum and Leah were too.

Forward plan…

Ensure that mum has new batteries in the space ship toy, because Leah loves this. I might also write down a few things for mum to remember, little tips for her to help Leah’s developmental progression.

Changes for next time…

I may let Leah do slightly more of the work to make sure she is strengthening her muscles and joints.

Overall thoughts and feelings of how today has gone…

It was very interesting being the sole therapist there, and I was very happy and comfortable working with the mum and Leah. I get along with mum well and always tell her what I’m doing and why I’m doing it so she has a good understanding of how the therapy is going to help Leah.

Strategies to improve my performance…

Don’t be afraid to get the child focused again, and don’t let the child control your therapy treatment. But don’t ever push the child beyond what they are capable of.

Questions…

I may ask Jenny, for a few tips on handling and hand placement in particular exercises just so I am 100% confident for my next visit.

During week 1

Wednesday 15^th of October 2008

Lilly*

Thoughts and feelings in the presenting situation…

Lilly is a 3 ½ year old little girl who has a condition called microcephaly. Microcephaly is a rare neurological condition with the circumference of the head being smaller than normal because the brain has not developed properly or has stopped growing. It is a very broad condition ranging from mild to very severe. Lilly is significantly intellectually impaired and is very behind in her developmental milestones. Lilly also has joint hypermobility and wears customised non-articulated ankle foot orthosis as she has pes planus or rocker bottom feet. Lilly is a happy cheerful little girl, who cannot articulate any words or understand words, and cannot signal to her parents/therapist and carers. She is struggling to weight bear through her legs causing her to be delayed in her walking. She is transferring weight more so on her right side and leaning to her right and her hips are tilted to the right side in supported standing. Lilly’s mum was very lovely and loved Lilly very much, always involving herself in the therapy. Lilly was fatigued and sick today so she was very hesitant in walking in the k-walker which she was successfully walking in three weeks ago. Lilly just had a session with one of our speech therapists and was learning feeding, so she was a little distressed and tired for our upcoming very challenging and tiring physio session. Lilly coped very well and by the end wanted mum and wanted to go home to sleep. Lilly was very trusting and tolerated handling and initiating interaction with Jenny, mum and myself.

How I managed the patient…

I had to really engage with little Lilly and get her attention with musical toys or doing the tigger voice with the tigger doll. All three of us were giving Lilly lots and lots of positive reinforcement and she was clapping her hands, smiling and making lots of sounds, which indicated she was happy with what she was doing. When I would see little Lilly’s face becoming a little distressed or scrunched up I would give her lots of praise and engage with her and make lots of high pitched sounds to distract her when Jenny was assisting her moderately with pull to stand from sitting and also when Jenny was helping Lilly from stand to sit. She loved the toys and loved a smily happy face from all of us.

What I did well…

I believed I engaged with little Lilly well and gained her trust and made her familiar with my face. I think I was giving lots and lots and lots of positive reinforcement and praise to make Lilly feel good about what she just did. I was also being a great distraction by speaking to her constantly and engaging with her. I also picked up on her hypermobility in her left arm especially which I wasn’t aware of before I saw her.

What I could have done better…

When little Lilly was using the k-walker I could have jumped in a little more and took control of the situation and leading the walking, but she was just tolerating Jenny helping her to walk, so this progress was fantastic (considering her state) and not worth messing with, although I think I should have maybe taken over at some point. I need to learn to just ask Jenny if I can have a go, but it is a little awkward with the parents watching.

Forward plan…

She was a little fatigued and exhausted from speech therapy, maybe a little break would be worthwhile organising for in between sessions. This may be a little tricky to organise but I could suggest it.

Changes for next time…

Next time we will get her to walk more and hopefully go back to how she was walking in the k-walker three weeks ago. Also next time, we will get the bear cushion out and get her doing squats from sit to stand, to improve her leg strength to help her with her standing balance and walking.

Overall thoughts and feelings of how today has gone…

Today was a good day and very interesting. I am constantly learning and taking in everything. I was involved in a class with two 5 year old down syndrome girls which was highly interesting. We also worked with another young down syndrome boy and I worked on organising programs for physio exercises and stretches. I feel I am settling in and getting excited about all the patients I will get to meet over the next 4 weeks.

Strategies to improve my performance…

Don’t be hesitant in jumping in and giving it a go from the start. Don’t be afraid to pull the childs attention back to the group. This is always hard as I find I don’t know how much force should be used, but it is only benefiting them with drawing their attention back. I’m learning now, as I have been seeing more patients.

Questions…

I wondered what microcephaly was and so I researched it and discovered the meaning. I also wanted to ask Jenny what the AFO’s were for on her ankles and lower leg. They are to help control Lilly's hypermobility and for her rocker bottom feet (pes planus).

* Name changed

First day reflection

Thursday 9^th of October 2008

Case one- John*

Thoughts and feelings in the presenting situation…

John is a 3 month old little boy with torticollis. He presented with a preference to looking to his right and had a flat head on his right side which indicated instantly to me it was a left torticollis with rotation to the right. He had conjunctivitis in both eyes and constipation that was being managed. John appeared to be a very bright, strong 3 month old. He appeared to interact well with the mother, Jenny and myself. Mum was very cluey and was very interested in what Jenny had to say. Mum was also a great listener and was taking in everything Jenny and I were saying. She was already using positioning strategies to facilitate little John to look to his left which means she had previously picked up on it and was acting upon it. There was no obvious side flexion to the left, maybe just a slight tightening of SCM. Knowing that the mum was interested and was coping with John very nicely, we wanted to tell her everything to make her understand little Johns condition and take home as much advice and tips as she could. Communicating with mum was very simple, as she was so compliant. John displayed many features of a typical 3 month old baby, so overall he was on track with his developmental milestones. We * marked some things for next time. We were to observe his head lag, as at 3 months there should be little to no head lag, he was lacking this. Also he didn’t follow toys with his head, so we will keep a watch on this. Also his extensor mechanism of his legs was strong but not asymmetrical. Monitoring him in prone is also something we will do, because he never lies prone at home so he has never learnt to prop himself up with his arms underneath his chest. He needs to develop his strong neck extensors to lift his head up. He didn’t bring his hands to midline so we want to observe this as well.These are a few things marked to observe next time, to make sure little John is on the right track.

How I managed the patient…

For the first assessment, I was a little hesitant at putting my hands on first, as I wasn’t sure if I should or not. In the end I interacted with little John and asked mum questions. I filled out the assessment sheet whilst Jenny was asking mum questions and primarily handling John. I was speaking to John as often as possible to engage and interact with him.

What I did well…

When I became a little more comfortable with the situation I found I was interacting with little John well. When I was holding with little John I was holding him on my left and was initiating head turning to the left towards mum to strengthen opposite muscles. Also when mum was changing Johns nappy, I spoke to him on his left and fed him the rest of his bottle so his head was turned to the left

What I could have done better…

What I could have improved on would have been to be more involved with the assessment. But as I said it was the first assessment and Johnwas a new patient, so I was a little hesitant with what I should do. I spoke to Jenny about this ,so now, whenever I find an opportunity I can jump in and put hands on and ask mum more questions.

Forward plan…

Next time I would keep an eye on his developmental progress and make sure he is on track. Also I would find more positions mum could use to facilitate head turning to the left.I would also check to see if his ROM is improveing and to see whether his head shape is beginning to improve and grow out.

Changes for next time…

We didn’t manage to get little Johnto relax enough to feel if there was a lump in SCM. This would have been indicative of a tear and a healing process. For next time instead of going straight into ranges of motion, we could have played with little Johnmore to relax him to feel for the lump first. Also next time we would have had the doll (we couldn't find it) to demonstrate the stretches and positioning for the mum.

Overall thoughts and feelings of how today has gone…

Today has been really interesting. I learnt how to type up progress reports which are for the parents and child carers to indicate to them what their child can do and how to we are improving things. I was fairly confident today in terms of what condition the child had and how to improve it because we had covered torticollis in our paeds unit this semester. I was generally happy with the day, I spoke to Jenny about upcoming patients and what their conditions were so I could come with some knowledge to help facilitate my learning. Jenny was extremely helpful, and would answer any questions I had or offer me assistance when I needed it.

Strategies to improve my performance…

Don’t be afraid to ask questions when Jenny is not present. I should use this time as an opportunity to work on my communication with future mums and carers. Don’t be hesitant in jumping in and giving it a go from the start.

Questions…

The one question I had was why we were looking for a mass/tumour or lump in the SCM muscle. Sometimes it can be cancerous but most of the time it is indicative of a tear in the muscle, due to delivery and over stretching that muscle. This is painful and therefore the baby tends to decrease the length of SCM through positioning the head down to his left side.

* Name changed

Initial Entry

Expectations...

As this is my first placement I expect that it will be a very valuable experience and a giant learning curve on my path to becoming a physio. I'm expecting that the knowledge gained from this experience will assist me in my future placements and studies. I am expecting to learn how a paediatric private practice is managed and how the allied health professionals interact within the practice to assist and complement one another. At the end of the placement I am hoping to have grown in my understanding of paeds physio and feel more confident in interacting with children of different ages and how to conduct assessments and treatments. I am also expecting to learn about how to treat the family and their goals as well as incorporating my aims/goals of treatment for the child and the childs goals. I'm also expecting to learn alot about communication, with the child, parent/s and fellow co workers. It will be a very exciting/nervous experience that will give us great exposure to being out in the real world!!

Things I am looking forward to...

I am looking forward to getting more paeds exposure, as I absolutely loved the unit this semester. I am looking forward to bringing the knowledge I have to the table and being able to apply it to real patients with real problems. I can't wait to soak up information from my supervisor and learn their different ways of approaching patients and different situations. I guess it is also exciting being out their and being able to help children and their families cope with different disorders or impairments. I am looking forward to also being able to interact with 'real' children and see how they respond to different communication and interaction methods I have learnt. It would also be interesting to hear and see how my supervisor interacts with children, so I can pick up valuable tips to improving my professionalism and effectiveness as physio.

Concerns...

I am not too concerned at the moment with where I am going in terms of unfamiliarity because I have already worked in the practice through 4p, observing the physio and participating in a voluntary occupational therapy program for children. My only concern would most likely be how much my supervisor is expecting me to do. As 'Kids are Kids' is a private practice, I will obviously be concerned if I get thrown in the deep end and have to assess a new patient, with the parent/carer also being worried that their child may not be assessed approriately and them spending money on a student treating and assessing. I guess I am a little concerned with how it will all work out on placement and what is expected of me. I am hoping to address these concerns through discussing expectations with my supervisor.

Interrelationship of HCP's...

I see the physio, ot and speech pathologist talking to each other and helping each other out, if one of their patients needs treatment via another allied health professional. I see a professional relationship between each and every one of them and all of them showing respect of confidentiality unless they are working as multi discliplinary team, combination treatment. I have never been in the practice long enough to see just how they all interact, and if they even do at all. It will be interesting to see what happens when I start!!