No longer faking it

One of the things I've enjoyed in the past few weeks is getting to put fundamental skills into practice on patients who actually need them rather than a classmate who is trying to fake it. For example, one basic skill for an OT is doing passive range of motion on a patient who can't move their arm or hand on their own. This may be because of a stroke or because the patient is sedated in the ICU. Either way, it's a very different experience lifting the dead weight of a completely flaccid arm compared to lifting the arm of a classmate who can't fake dead weight no matter how hard she tries. For the last several weeks I've been regularly seeing a patient who's been in and out of the ICU. One of the dangers of being in bed for so long is that joints get stiff or hands begin to swell because there hasn't been any movement to help pump fluid back out. Some days this patient has been able to assist me as I've moved her arm. Other days I've been moving the dead weight. Her joints have remained supple except for her hands. This morning I was delighted to see her out of ICU and alert. She agreed that her hands were stiff and she was finding it hard to hold a cup or feed herself. One of the OTs will continue working with her twice a day to relieve that stiffness and help her build back up her strength.

Another skill one of our professors tried to drill into our heads was manual muscle testing (MMT). We had a practical exam for this with a classmate as our patient trying to fake an injury. As part of every evaluation, I test the patient's strength for their shoulders, biceps and hands. For patients on rehab it gets a little more in-depth but for the vast majority of people I can write "within functional limits" on the form. Basically that means that the person has the strength to do simple daily things such as showering, getting dressed, getting dishes from the top shelf, or carrying a bag of groceries. This past week however, I saw a patient with a brachial plexus injury. All the nerves that go to the arm leave the spinal cord and pass under the collar bone. For this particular patient, the nerves had been compressed and as a result she couldn't move her arm or hand at all. By the time I saw her (with one of the experienced OTs), she had regained a little bit of movement. When we asked her to bend her wrist, she couldn't do it, but if we turned her forearm so her thumb was up she could move her wrist in both directions. She didn't have the strength to bend her wrist against the force of gravity but she could move it once gravity was no longer a factor. Cool. I even remembered how to rate that on the MMT scale without having to look it up.    

Low census

The past two weeks have been quiet at the hospital where I'm working. That is a good thing in one sense because it means most people in the area are staying healthy. On the other hand, it isn't the best thing for my education since fewer patients mean fewer opportunities to learn. There were 10 people on the inpatient rehab unit when I arrived, each needing 2 occupational therapy sessions a day. On Thursday this past week we were down to 1 patient. Thankfully for the therapists, 3 new patients came onto the unit on Friday so there will be more things to do this week. One of these patients is still recovering from the effects of a neurological condition that began last May. He is eager to improve so he can finally return to his own home. I look forward to the challenge of helping him progress.

Last week I experienced one of the frustrations of working as an OT (and in all of health care). I arrived at work one morning and looked at the list of patients in the hospital and recognized two of the names from their stay on the rehab floor. My thought was, "They just left. What happened?!" Then a few days later, a patient who had been on the medical floor for 3 weeks was back after less than a week at home. The reasons vary but it is hard to see people who were doing well and making progress return even if it is for a short stay. I'd like to see them go home and stay healthy.