Outpatient Adult Neuro with Haley

Today’s interview is with Haley (who also runs @ThatNerdyNeuroOT on Instagram!). Haley will be sharing about her experience in outpatient adult neuro rehabilitation!

My name is Haley and I run @thatnerdyneuroot. I just finished my 6 months of Level II Fieldworks and am currently studying for the NBCOT exam. I have a strong desire to work with the adult neurological population, specifically those with brain injuries and spinal cord injuries. 

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?

I completed one of my Fieldwork rotations in Adult Outpatient Neuro. This setting focused on serving clients 18 years and older with a neurological based injury, ranging from simple cervical myelopathies to traumatic brain injuries to degenerative conditions in order to increase occupational participation in meaningful activities. Typically, therapists would work with clients on foundational skills related to their condition (e.g., subluxation of shoulder) and increased participation in IADLs (e.g., meal preparation). 

What is OT’s role in this setting?

In this setting, the OT focused on providing skilled evaluation and intervention to those with neurological injuries in the areas of vision, upper extremity motor function, fine motor coordination, strength, activity tolerance, and occupational participation. With my particular fieldwork educator, we also provided aquatic therapy services weekly for the benefit of buoyancy, weightlessness, and resistance of the aquatic medium.

Did you feel prepared going into this setting based off of your classes? And how did you prepare before starting?

Due to my specific interest and personal mentorship surrounding the neurological population, I felt as prepared as a student could regarding this rotation. In my program, I felt that we were greatly prepared regarding adult physical dysfunction and the main components and tool sin order to build interventions. There were definitely areas that I had opportunities of growth and improvement (e.g., shoulder mobilizations, aquatic therapy), however, it is so important to remember that your fieldwork educator does not expect perfection, which was comforting for me.

What resources were the most helpful during your time there? 

The most helpful resources during my time were my friends, my professors, articles, and textbooks. A few of my favorite texts included topics over motor control, traditional sensorimotor approaches, and intervention ideas for neurological injuries.

How did you stay organized and manage your time?

I was able to manage my time with a printed schedule. Everyone morning I would print the schedule for my fieldwork educator and me and take about 5-10 minutes in the morning before our first session to treatment plan for the day. We also had many clocks around the clinic and utilized these and my apple watch to keep track of my timing for each client. I would then also write down my times on my sheet to help keep track of units and time with each client and activity accurately.

What was your schedule like?

Our schedule varied being in an outpatient setting, due to patient’s discretion of showing up. On a perfect day, we typically saw individuals starting at 8:00 AM and ending at 11:45 AM with 45-minute intervals. We then had a lunch break until 1:00 PM, in which we really tried to not talk about work for a true break. We would then see individuals from 1:00 PM to 4:45 PM or 4:00 PM dependent on caseload volume and availability of administration time. We would sometimes have breaks dependent on client’s availability as well, in which we could catch up on authorizations, documentation, and scheduling. We would also keep track of visits each client had for insurance purposes, updating them weekly on Friday mornings. Our Fridays were unique, including two wheelchair evaluations with a local ATP, and the afternoon included around 5 – 10 clients for aquatic therapy.

What assessments did you use most?

Our most frequent assessments included the 9-Hole Peg Test, Manual Muscling Testing, Range of Motion, Grip Testing using the dynamometer, Minnesota Rate of Manipulation, DASH, and the SPADI.

What conditions/diagnoses did you see most often?

The most common diagnoses seen during my time included CVAs, hand weakness/numbness secondary to COVID or cervical nerve involvement (e.g., myelopathies), and Parkinson’s Disease.

What did a typical session look like?

Sessions widely varied, but typically started with some sort of preparatory activity. For example, we did a lot of first rib and glenohumeral joint mobilizations for shoulder pain and shoulder stiffness. Within this, it also included gentle range of motion, massage, or kinesiotaping for muscular imbalance and pain, typically at the shoulder. After this, we would typically move into a gross motor activity, which focused on trunk and upper extremity movement. For example, this might include quadruped based activities with functional reach or I often time would do boxing with clients with Parkinson’s. Lastly, if indicated within their occupational performance deficits, I would try to focus on a fine motor activity to address the full performance for the individual. For example, this might include coin management or handwriting. At the pool, a session would typically be divided in about 4-5 differing upper extremity activities focusing on coordination, movement, muscle activation in a pain free motion, and strengthening against the resistance of the water.

How did you stay client-centered and occupation-based?

These were my two main priorities, and my two main strategies were continually re-evaluating goals established at the evaluation, when we specifically asked the client what they wanted to work on. Re-evaluating these goals helped maintain that I am addressing all components for occupational goals. This also typically took some deep thought to consider conversations I had with the client about what they missed the most or wanted to engage in and creativity with the supplies, as there were not many occupational based simulation options. For example, in order to work on household management tasks like sweeping, I might play a game of mini golf with a client to simulate the dynamic balance required.

Did you have to do a project or in-service?

I had an in-service and gave my presentation to the neurological team on occupational therapy’s position and intervention for sexuality and how we can address it. It included developing a client pamphlet for increased education, collaborative examples on how a sexuality goal can be addressed from an OT, PT, and SLP working together, and providing of resources regarding sexuality in occupational therapy.

What was your favorite part of this fieldwork experience?

My favorite part by far in this fieldwork was my fieldwork educator and my clients. First, my fieldwork educator has been taking students for 13 years and working with neurological populations for 16 years. She has true compassion for each and every client she works with and has that compassion overflow to her students as well. She never made me feel less than and really took me under her wing to learn new and exciting things she has learned. Secondly, my clients I got to work with over the 12 weeks were absolutely amazing. They each brought forth their own wisdom, experiences, and joy that made working with them so enjoyable.

What was your least favorite part of this fieldwork experience?

Something completely out of my control; a lot of our clients had Medicaid or another form of insurance that I was not allowed to treat due to defined skilled services. This limited a lot of what I could do based on insurances and the need for reimbursement from a business perspective. I also had a lot of physical pain during my rotation, which limited my abilities in a pain free motion.

What is something you learned that you will take with you for the rest of your career?

Serving others with your heart as an OT through mindful compassion is the most important component. Without caring for the humanity of each person, no matter race, gender, ethnicity, religion, socioeconomic status, or any other factor, I can serve nothing of value. When you have your heart in the people you serve, the rest you can learn and skills you can build to help you become evidence based and efficacious.

What advice do you have for a student about to start in this setting?

Take everything in and enjoy it all. You are going to learn something from every single person you interact with; every client, the administrative professionals, PTs, OTs, SLPs, your FWE, and so much more. This is the best time to learn and challenge yourself to go beyond that “entry-level” expectation. You will never have this amount of access to a seasoned professional as you have now, so take it in and enjoy it all.

Thank you so much, Haley, for sharing your experiences in this setting! I know I appreciate the time and effort into curating your responses, and I hope that my readers enjoy it as well.

You can find Haley over on Instagram: @thatnerdyneuroot


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