To kick off this new blog series, I have Emily from @OTandEmily giving us the scoop on Inpatient Rehab! She shares about her experiences, what diagnoses she saw, assessments she used, and the ups and downs of her experience in inpatient rehab.
Let’s get started!
Hey! Can you tell us a little about yourself?
Hello, my name is Emily! I graduated from University of Wisconsin-Madison in December 2020 and passed the NBCOT in February 2021. I recently accepted a dual position working 20 hours/week in inpatient psychiatric and 20 hours/week in outpatient pediatrics. It’s an unusual combo, but both part time positions were at the same hospital and they were willing to work together so I could be hired for both!
What setting are you sharing about today and can you give a brief description of it? What qualifies a person to receive therapy in this setting?
Inpatient rehab! Inpatient rehab is generally where an individual will go following an acute care or ICU setting but only if they are:
- Medically stable
- Able to handle 3 hours of therapy daily
- Have functional deficits that need to be addressed/are not safe to return home.
What is OT’s role in this setting?
OT’s role is to help the individual relearn ADLs, IADLs, and transfers/general mobility or learn compensation techniques for the first time. Additionally we utilized therapeutic exercise and neuromuscular re-education. The patient is often staying for a week or more so there is a lot of time to see progress!
Did you feel prepared going into this setting based off of your classes? And how did you prepare before starting?
I felt prepared going into this setting based on my background of exercise science and my OT program’s anatomy and adult classes. Before going into the setting I looked into common diagnoses, reviewed how to use my goniometer, and studied stroke symptoms based on location.
What resources were the most helpful during your time there?
My CI was an incredible resource, she has been in the field for over 20 years! In addition to my CI, I liked the free handouts from Seniors Flourish, AOTA’s condition specific TIP sheets, and notes from my MSOT adults class. I also made my own resource of skilled phrases so that I could copy and paste them to speed up documentation.
BALANCE: Sitting/standing balance addressed at table/edge of mat/edge of bed with focus on (static balance, dynamic, pelvic positioning, posture?) How long for standing balance? Why did they need to sit?
EXAMPLE BALANCE: Patient stood for 1:30 minute requiring SBA to complete clothes pin activity focused on L side lateral leaning. No LOB or instability noted. Patient completed activity with final stand lasting 1:30 requiring SBA.
THER EX: Where is the patient? Ex: (supine in bed, sitting at EOM, sitting at edge of bed, standing) Pt utilized (blue theraband, yellow weighted ball, 5# dumbbell) to complete ___________x NUMBER, utilized _____ to complete ______ x number. Required VC for positioning? Fatigue?
EXAMPLE THER EX: Ther ex performed to address UE and core strength. Pt utilized red theraband to complete external rotation x15, shoulder abduction x15. #3lb dowel utilized to complete chest press x15, and shoulder flexion x15. Triceps extension performed x15 utilizing 2lb weight. Bicep curls completed x15 alternating arms utilizing 3# weight. Pt noted lower back tension completing toe touches with hold to address.
Upper Body: Dressing completed in (sitting/standing)…where? Shirt assist? Don/doff. Limiting factor?
Lower Body: Dressing/undressing completed in (sitting/standing)…where? Pants/underwear/socks/shoes + assist level with all. Donned shoes using figure 4 method? Any adaptive equipment used? Don/Doff. Limiting factor?
EXAMPLE DRESSING: Pt doffed/donned shirt in sitting. Doffed pants/underwear/socks in sitting utilizing lateral lean and dressing stick w/o assist. Donned underwear with min assist to hike over hips during lateral lean. Donned and pants utilizing min assist and reacher to lace and hike in sitting with lateral lean. Donned socks with use of sock aid. Required set up assist to don shoes.
How did you stay organized and manage your time?
I always brought a notebook with me. I would write the first initial of the patient and their time slots that day, the diagnosis, level of assistance required, specific treatment ideas, and any fun facts I learned about them from previous sessions so I could bring it up again or ask more questions. In this setting my time was strictly scheduled out each day and the patient would know what time I was coming.
What was your schedule like?
|8:00AM-8:30AM||Review the day’s schedule and patient information (generally 4 patients with 2 90 minute sessions), if there was an 8:30am shower I would make sure the room was set up with towels and had the correct assistive devices needed.|
|8:30AM-9:15AM||Patient #1 (session 1) **Generally we completed showers 2-3 days of the week. Showers would be completed during the morning session. We would complete showers in the same bathroom type they would be using at home (ie: tub shower, walk in shower with appropriate transfer equipment if needed)|
|9:15AM-10:00AM||Patient #2 (session 1) **If the patient was not showering I would see if I could help them complete their morning routine: brushing teeth, hair, getting dressed, using the restroom etc.|
|10:00AM-10:45AM||Patient #3 (session 1)|
|10:45AM-11:30AM||Patient #4 (session 1)|
|11:30AM-12:00PM||Lunch and documentation (unfortunately at the same time)|
|12:00PM-12:45PM||Patient #1 (session 2) *session 2 would focus on something different than session 1. For example if I worked on kitchen mobility in session 1 i may work on therapeutic exercises and sitting balance|
|12:45PM-1:30PM||Patient #2 (session 2)|
|1:30PM-2:15PM||Patient #3 (session 2)|
|2:15PM-3:00PM||Patient #4 (session 2)|
|3:00PM-4:30PM||Documentation, discuss day with CI|
What assessments did you use most?
During admission and discharge we would typically use: goniometer measurements of the upper extremities, 9 hole peg test, MMT, an informal mental status check with orientation questions (day, year, time, what brings you here, remember these 3 words etc), and IRF-PAI (Inpatient Rehabilitation Facility Patient Assessment Instrument) scores. Another common assessment we used was the Cognitive Performance Test (CPT) which includes a series of tasks including: purchasing an item, medication management, making toast, washing hands, following a simple map.
What conditions/diagnoses did you see most often?
I often saw limb amputation, myocardial infarction, SCI, TBI, MVA caused injuries, and various neurological disorders including MS, brain tumors, and strokes. Our most unique diagnosis was Guillain-Barre – which has an interesting progression and recovery process!
What did a typical session look like?
Usually OT and PT would see the patient for two 45 minute sessions each day, if the patient also required speech that would sometimes bring us down to one 45 minute session and one 30 minute session depending on the needs of speech.
Typically a morning session would include bathing or dressing. If the patient was not bathing that day their AM or PM session could include any of the following: family training, laundry task, cooking/kitchen tasks, functional standing/sitting balance tasks (standing while playing a board game, sorting items, or folding laundry), therapeutic exercise, transfer training/functional mobility, dressing, oral care, practicing with adaptive equipment, and/or utilizing the dynavision to assess reaction time if driving was a concern.
How did you stay client-centered and occupation-based?
My inpatient rehab facility had access to a full kitchen, laundry room, and shower/bath facilities which made it easy to complete the daily living tasks that individuals would complete in their own homes. There were lots of options for creativity as well, for example if a person liked hunting I would have them aim bean bags at various targets. If they were a game person we would play their favorite board or dice game, but in standing to work on balance!
Did you have to do a project or in-service? Could you share what topic you chose?
I chose to give a presentation on managing anxiety/depression and finding new coping skills during the COVID pandemic. The audience of my presentation was our hospital’s Stroke Support Group at their monthly meeting.
What was your favorite part of this fieldwork experience?
One of my favorite moments in fieldwork was being able to help a young woman take her first REAL shower in over a month following a debilitating stroke. She was globally aphasic, had a lot of ataxia as well as poor sitting balance leading her to require bed baths for over 4 weeks. During her shower she was smiling and laughing to express her joy. That night when I went home to shower I thought about how meaningful such a seemingly insignificant occupation can be when you are forced to go without it.
What was your least favorite part of this fieldwork experience?
My least favorite part would be the days I went from a really high level patient (modified independence or independent) to a session with a lower level patient (Total assist) or vice versa. This took some getting used to because I had to completely change my approach, language, and activities.
What is something you learned that you will take with you for the rest of your career?
CONNECT with your patients, always! By the time a patient gets to inpatient rehab they have often been in the hospital for a while. During this pandemic they are missing their families, friends, and independence more than ever. As an OT a patient’s hobbies and passions are important for us and can often be incorporated into the session. It’s our job to connect with people and find out their interests, goals, and how we can help them make it happen.
What advice do you have for a student about to start in this setting?
Be confident in your abilities, but know that some ideas won’t go as well as others. It’s okay (and recommended) to grade activities throughout the session based on your observations or to completely change it up if it really isn’t working out. Also- SAFETY FIRST. If something doesn’t seem safe it probably isn’t!