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.