Research

What I Need to Know:

From the first day of my internship I have had a lot of freedom to choose which patients' sessions I would like to be involved in. After being introduced to nearly 20 different therapists I chose a young lady to shadow for the first hour while my official mentor is on her lunch break. Primarily by chance, I chose to spend 3:00-4:00 every Tuesday with a young boy struggling from intense seizures. I typically also see two other children with cerebral palsy, but I have always been captivated by the treatment offered to seizure patients. Even before I began formulating my essential question, I was researching and asking tons of questions about seizures in general, how to treat or manage them, and what an occupational therapist can do to aid those suffering from seizures. After a few weeks spent determining how I wanted to phrase my essential question I decided to research "How can I, as an occupational therapist, collaborate with teachers, doctors, families, and patients themselves to determine the best ways to treat patients suffering from seizures? What do successful plans often look like?"

What I Know Or Assume

I initially was introduced to occupational therapy by a young girl I met in middle school. She was diagnosed with cerebral palsy and after approximately a week of middle school, I had been asked to be her student aid. I never treated this as a job or truly hard work and instead chose to accept this girl as one of my best friends and as an effect I learned so much. Because of my friend, I considered myself to be fairly well introduced to occupational therapy, but I found that I knew very little about diagnoses outside of cerebral palsy. I knew nothing about seizures as a neurological condition and very little about how they could be managed. Although I knew a lot about how occupational therapists typically conduct a session and deal with their patients, I knew very little about how this treatment varied from patient to patient and diagnosis to diagnosis.

The Story of My Search

Even before I began my internship, I consistently read various blogs by parents and therapists to familiarize myself with the occupational therapy field. When I began to research my essential question I started to read more scientific articles to learn more in depth information about seizures and how they are related to other diagnoses. This research was punctuated by frequent conversations with my mentor and other therapists when I felt free to ask any questions about occupational therapy as a career, the various sessions I observed, or anything else I was curious about. This information culminated in an interview with one of the occupational therapists I typically serve under. By compiling this information, I was able to come to a sufficient answer to my essential question.

What I Discovered in the End

Through all of my research I have learned so much about my future career. For one I have confirmed that occupational therapy is my passion and I will be pursuing that. Because of the structure of my internship, I was able to shadow a speech language pathologist and a physical therapist in addition to my mentor and the two other occupational therapists I regularly shadowed. This truly opened my eyes to the differences between each type of therapy and confirmed that occupational therapy is my passion.

To answer my essential question, I learned that the vast majority of a therapist's information comes through the parents (in the case of private clinics specifically). Although therapists always have the option to ask the teachers or doctors for their diagnosis, using the parent as a major source of information constantly keeps them informed and doesn't allow the parent to feel talked about behind their back. In the case of seizure patients, it is not possible to therapeutically prevent seizures. Medicine can be used for this purpose, but therapy is primarily used to introduce patients to coping mechanisms and increase their muscle tone as most seizure patients suffer from extremely low muscle tone.

More than anything this internship allowed me the opportunity to make amazing connections with therapists in my future career. I am extremely excited to begin my education so that I can begin making a difference in children's lives and serve my community as an occupational therapist.

Interview:

(Note) One Tuesday, after my normal internship time, I conducted an Interview with Alivia, an occupational therapist at Essential Therapy Services. Tina, my mentor, was out of the office this week, so I chose to interview Alivia instead because I work with her at least an hour a week. Below the questions are printed in bold text, Alivia's answers are typed normally, and my reflections to these answers are in italics. All answers have been paraphrased or abbreviated for this context.

What originally encouraged you to become an occupational therapist?

After high school I planned to be a news reporter. While in college, I taught a gymnastics class, and was approached by a mom asking if I knew of a special needs gymnastics class for her son. Although I didn't know of one, I offered to teach the class if she would assist me. The class quickly filled and one of the moms offered to take me along to one of her son's occupational therapy sessions. I went and quickly fell in love with the playful nature of occupational therapy. I changed my major the next day and never looked back.

First of all I think it is amazing that Alivia had the courage to offer to begin a special needs gymnastics class simply because she saw an unfulfilled need. I hope to apply that to my own future. Second of all I love how the moms were willing to teach and even allow her to visit OT session. That truly speaks to the amazing parents of special needs children.

Have you worked or shadowed therapists in any settings other than private clinics? How did these experiences contribute to how you have developed as a therapist?

I have only worked in the private clinic setting, but in college we had to do rotations so I worked in hospitals and private clinics with kids, adults, and the elderly. I knew the smaller private setting was for me because I have the opportunity to see the same kids every week and build a relationship with them.

This answer gave me new perspective to occupational therapy. I had never considered the fact that in larger hospital type settings, I may not have the opportunity to see the same kids week to week and because I want to build a strong relationship with my kids I am now strongly considering working in a private clinic or a school.

What is the hardest part of your job?

Documentation! I see 30 kids a week and so just keeping up with weekly reports is hard, but when you add yearly progress reports on top of that it can get hard to go home and force yourself to do. Also occasionally you'll get a parent who doesn't believe you truly care about their kid and have their best interest in mind and that's really hard. I've only had one or two of those those; most of the parents are amazing.

I can imagine that the paperwork would be hard, especially because you know you are doing what is best for the kid and still have to document it with so much detail for insurance reasons and such. Also, I'm glad to hear most of the parents are really good, but honestly I would expect nothing less. All of the parents I have worked with this year have been absolutely amazing.

What can I, as a current high school student, do to prepare for a career in occupational therapy?

Keep doing what you're doing. Continue shadowing because a lot of OT schools require that to get in. I wish I would have known what I was going to grow up to do before college because I could have prepared a lot better, but it all worked out.

It's exciting to hear I'm on the right track!

Are you able to easily collaborate with a patient’s teacher, doctors, and/or family members to best determine a treatment plan?

I rarely talk directly to physicians although that is always an option if I need it. Typically most of my communication is done through the patient's parents. This keeps them involved in everything that is going on and that way they don't feel like they're being "talked about" or anything. I would love to talk to school therapists more, but unfortunately in our world we are all so competitive and territorial it is tough to keep the ultimate goal, the kid's wellbeing, in the forefront of everyone's mind.

Although I'm disappointed to hear competition sometimes overtakes some of these potential conversations, it is good to know it is always an option if needed. I love how intentional Alivia is in her parent-therapist relationships even ensuring they are the ones asking doctors questions to keep them informed.

How do you determine what goals to include in a patient’s plan?

Mainly I focus on why the parent has brought a child to therapy. From there I plan out goals to combat the underlying issues for each of these problems. For example, if a parent brings a kid in for bad handwriting in school, I'm going to find out if the bad handwriting is an effect of a vision problem or a strength problem or something entirely different. From there I create goals targeting the underlying issue, but planning to achieve the parent's goals.

That type of "backwards planning" makes a lot of sense. Alivia later mentioned that everyone could benefit from therapy in some way, so it's important to ensure you listen to parent's and their wishes so that your goals align with that. I think it is amazing that in private therapy you are able to listen to the parent's wishes and craft goals from there. In hospitals and other settings, the rules are very different and doctor's orders are often the guiding factor behind goals, not parent's wishes.

What are some of the typical treatments you use with patients suffering from seizures?

Every seizure patient is so different this is really hard to answer. I will say most kids suffering from seizures have very low strength and body control, so we work a lot on building up strength. You've seen me do a lot of that already in the session you typically observe, but I guess that would be the one common treatment I can say.

It is amazing how different seizures are and how differently they affect people. Considering that, I am amazed to even find out there is a common thing to work on in most of these kids.

Which of those treatments have you seen be the most successful?

Because every kid is so so different, it's really hard to say. The most successful kids are the ones that combine my therapies with diet and medicines to control seizures.

It amazes me that it's so hard to give an ultimatum in this case. Seizures are still not very well explored, and until further research takes place, it's going to be hard to give an generalized successful treatment.

Is it possible to completely eliminate seizures through therapeutic treatments?

Unfortunately, no. Seizures are neurological and therefore they can only be truly controlled by diet and pharmaceuticals.

This makes me sad honestly. After all of the scientific advancements, we still have not found a cure for seizures. I am glad therapy can help cope with some of the effects of seizures, but it's good to know therapy alone will not cure them.

When you begin working with a new patient, how do you determine what to work on in some of the first sessions and how do you begin to build a relationship with your patients?

I generally make an effort to involve the parents in the first sessions. It lets the kids know they can trust me because they see their mom trusts me so that begins to build the relationship. From there it just takes time. One of my kids cried every week for almost a year and that was really hard because I doubted if I was even helping at all. Eventually that relationship was built and I still see him every week.

I never would've thought about it like that, but it does make a lot of sense to let the parents sit in on the beginning sessions. I would think that would also facilitate a stronger bond between the parents and the therapist and allow both to ask the other questions when they think of them throughout the session.