Week 3- Post 3

Thursday 30th of October 2008

Josh**

Thoughts and feelings in the presenting situation…

Josh is 3 years and 2 months old who has been diagnosed marked global development delay. Josh is a well behaved boy and is beginning to get involved in make believe play and role playing. He is now instructing ‘Candy’ (our Velcro handed doll) to hang and get down the monkey bars, and recently has now directed her to jump off the plank. Since beginning therapy Josh has improved in muscle strength, coordination, motor planning and confidence. He was very reluctant to be involved in any gross motor activities at the beginning of therapy earlier in the year and has now got age appropriate climbing skills. Josh still cannot jump and is still displaying low muscle tone. Josh is a pleasant boy and follows the program each physio session. I have put together an updated plan to challenge him further for future therapy sessions.

How I managed the patient…

I was very friendly with Josh and wasn’t afraid to get down to his level, even if it meant waddling around and quacking like a duck, or hopping like a bunny. I gave lots of positive feedback and would put hands on when necessary to assist him on the trampoline or with his jumping.

What I did well…

I remained at his level, and always gave positive feedback and corrected his technique when he would be performing the tasks incorrectly. I think I also had good time management and I finished on the half hour block,

What I could have done better…

Josh is improving but is still unaware of his head position in space. He still hits his head and does not see obstacles in his way. Sometimes I think he just rushes activities and does not perform them to the best of his abilities. I could remove any obstacles like the hanging monkey bars before directing him outside to ride the tricycle. He accidentally walked into the ladder, but was ok once he mounted and dismounted the bike independently.

Forward plan…

I am in the process of re-writing his activity sheet, to include more challenging tasks for Josh. This will make the session more interesting and give him something to work towards.

Changes for next time…

Next time I am going to remember to tell Josh to slow down especially towards the end of the session, or if we need to go outside for an activity such as tricycle riding. This will hopefully make him perform better and not be as rushed, and not have as many silly accidents. I will also put the monkey bars on the ground before taking him outside. This will prevent him from also bumping into it. However, I think it is also worth keeping it up there sometimes when he becomes a bit more aware of his head position because it will allow him to make decisions about going under or around objects, or playground equipment to dodge obstacles and prevent injury.

Overall thoughts and feelings of how today has gone…

All patients today did very well, and all were happy. This in turn makes us happy. We noticed good progress in most patients and were pleased with this. The gym visit in the afternoon was cut short, however, due to the fact that he was late. Jenny and I had a really nice and interesting chat about her life in physiotherapy.

Strategies to improve my performance…

Especially when doing the animal walks task, remember if they are having trouble with it, before they start to get frustrated and give up, jump in, put hands on and help facilitate the movement. This will help them understand the process they have to go through to perform the task successfully.

Questions…

**Name changed