Physical Rehabilitation Journey Reflection

I always knew I would want to go into adult rehabilitation so to no surprise, I was very excited to attend my coursework preparing me for that journey. Being a kinesthetic and visual learner I was very excited about learning about human movement because I finally would have a class taught in my learning style. A goal of mine is to become a certified yoga teacher and found that human movement coursework would also help me achieve that goal. In regards to this class, the professor made it enjoyable to learn as she made the information easy to remember and gave practical examples of her experience which helped me root my work back to how I can use this information to help my clients. I remember some key phrases this professor told us “always look at the pelvis” and “proximal stability leads to distal mobility”. These concepts were ingrained into my mind and were reinforced further into the program. I was often amazed at how many movements it takes to complete one action and how one condition can change someone’s movement drastically. Like if you slouch in a chair it can cause hip and back complications. This was later better understood as to how those movements would affect occupations. At this point in my physical rehabilitation journey, I was focused on getting the basics right so that I could explain to my client how they move and how to best use the abilities they have to complete their meaningful occupations. I also knew that human movement analysis would be a building block for me to understand and thrive in the Fundamentals course.

Coming into Fundamentals, I thought this class would be a glimpse into who we are as future OTs. I was excited to prepare for practical lessons but I don’t think I realized the pressure I had placed on my shoulders. I learn best from a demonstration and then me trying the skill, which the skills checks aim to do, it became difficult for me to perform when my client was difficult. Though I later found out that a standardized patient was fired but nonetheless it taught me that not all people want to take the help I can give. Additionally, in a skills check, I had experienced a patient dependent for transfers, or so I thought, but then was told I just had to put my foot down and be more assertive. This dependent transfer, stress, and anxiety in the situation led to me not maintaining proper body mechanics and ended up hurting my back. I learned a few lessons that day. I learned I should be more assertive, test my patient’s abilities before I put physical effort to help them, to maintain body mechanics, and not give my everything to a patient as they won’t always have me around. My OAS 2 coursework further informed this notion of addressing what will still be a problem once I leave the patient’s room. Additionally, I think I do give a lot of care for my patients and I hope that with more practice in fieldwork I will be better at setting boundaries of how much of myself I give. Additionally, these skills check experiences shifting my mindset on how to address a patient in contrast to what I learned in psychosocial coursework. I learned that in a medical model world, we do have an advantage for assertiveness because we have medical charts and a whole team to help detect what lab work tells us, what imaging tells us and the condition doesn’t only come from what the patient’s experience. This differed from what we had previously been taught in psychosocial about giving the client the power of choosing to disclose information and is much more of a collaborative intervention process. Adult rehabilitation does encompass collaborative interventions but I think OT is the main driver in holistic care and collaborative care in what is meaningful to the client in comparison to other health professionals in the medical model. This course also allowed me to shine bright at my first skills check where I got to bond with the standardized patient and perform an assessment and it gave me confidence that I am good at OT, I can do this and I am learning a lot in this program that I can apply. Overall, my take away from fundamentals was that we have to find the balance between our informed knowledge on conditions and treatments and still have bedside manners, communicate genuinely with the patient and that there is such a thing as giving too much care.

The Occupations of Adults and Seniors (OAS) series of three courses build upon each other to first gain knowledge on conditions we would encounter as well as interventions appropriate for them. OAS 2 and 3 also taught us clinical reasoning and critical knowledge or not only for the NBCOT but for fieldwork and practice. Those two classes, though intense, offer an unimaginable wealth of knowledge to prepare us for our future. First, we had to understand the conditions in OAS 1. This class reignited my love for physical rehabilitation after coursework in pediatrics that though I gain important skills and insight in that practice, I think my strength lies in adult rehabilitation. Learning all the conditions and the ways OTs are skilled in helping people who experience those conditions, made me feel like I can make a difference in the world. A pivotal moment was when a guest speaker came to our class to discuss spinal cord injuries. I vividly remember a video he showed us of him getting into his sports wheelchair when on a hike with rough terrain. I was amazed by the complexity and the tragedy people may go through but seeing the resilience and the strength they gain after a traumatic experience is something I can relate to and share that it’s very rewarding to see happening. I realized I would be the one helping patients regain independence in their meaningful occupations, like this man and hiking.

As OAS 2 came along, I knew it would be a challenge but with every lecture, assignment, and lab I got more and more excited for the times in the future where I could implement what I’ve learned in practice. In this class, you learn to analyze what it meant for someone to experience a symptom, and how it would affect their day-to-day life. This class pushed my clinical reasoning skills to be well informed by the literature as well as developing more knowledge on conditions and how they can present. Various labs and assignments that truly help to understand the material effectively. But the main lesson I learned was to not just know the information but to know how to apply it in practice. This came very apparent in tests as the questions were asked in an NBCOT manner. I am thankful for the opportunity to practice that during my program before taking the NBCOT exam. I do not consider myself a good test taker and I will continue to seek out test-taking strategies, accommodations as I can and I always study best I can for a test. Another lesson this program reinforced was that though we have education in conditions and interventions, that every patient we meet has a unique story, lifestyle, and meaningful occupations. If we meet someone with a stroke, though we can address the effects of a stroke, we have only met one person with a stroke. This class, and the program as a whole, reinforced the importance of OTs to be person-centered, occupation-based, and evidence-based.

The last portion of my physical rehabilitation coursework is OAS 3. This class taught me that I can study the information on conditions and interventions as much as I want but I need to consider it in the context of an individual, the setting and use my clinical reasoning to understand how and why we can help the person. This class continued to give me more tools on how I can help my future patients but made me think outside of their condition symptoms. I kept asking myself “how can this impact the patient’s meaningful occupations?” For example, if someone has a thoracic kyphotic posture and is wheelchair users, they will have various complications with breathing, eating, visual fields, from their posture, let alone if they use a wheelchair they could be at risk of pressure sores on their coccyx since they would be in a posterior pelvic tilt. Again, proximal stability leads to distal mobility and to look at the pelvic positioning. But on top of positioning, how will they engage in their occupations and how can we modify their positioning so that they can participate in meaningful occupations? In OAS 3, I also got to practice case studies. Not only did we have a case study from OAS 2 and 3 where we got to complete an evaluation and plan an intervention but also got to practice online simulations through Simucase in preparation for the NBCOT exam. This gave us a glimpse into what the three case studies on the licensing exam would be like. These cases brought our coursework to a life where we could interact virtually with a simulation of an assessment and an intervention with a patient. Though it had its many systemic challenges and we as the student could not explain our reasoning it gave us the simulation of being docked points if we do anything wrong and the opportunity to test our practical skills.

Additional to the coursework about physical rehabilitation, I reminisce on my experiences in practice from my volunteer hours at the Palo Alto Veteran’s Administration Hospital, my fieldwork at Rock Steady Boxing, and a Research Assistant role there as well as my certification course in LSVT BIG. These opportunities gave me practical experiences to inform my understanding of how adult rehabilitation works or offered me to practice my skills. I remember seeing patients at the Palo Alto VA with amputations, strokes, hand injuries, hip replacements, etc which helped me later understand that condition in class. I also got exposed to the interdisciplinary team when observing co-treatment with physical therapists and the dynamic between health professionals. My volunteering at the Palo Alto VA was invaluable to my understanding of acute care and acute rehabilitation and inspired me to pursue an adult inpatient fieldwork level 2 placement. My time at Rock Steady Boxing I was thankful to have part of it in person before the pandemic hit California as I got to build a therapeutic rapport with the boxers with Parkinson’s as well as practice assessing patients by conducting the Blocks and Box and 9-Hole Peg. This fieldwork allowed me to see some challenges people with neurodegenerative diseases experience and how to advocate for OT’s role. In my opportunity to be a research assistant for a study on the effectiveness of a fine motor program I furthered my love for implementing evidence-based interventions and fulfillment to aid the body of literature. These experiences have fed my love for physical rehabilitation and I look forward to my level 2 fieldwork experience.

I hope to see the OT profession have more technology use, more client-centered care, more advocacy and visibility of the need for OT and our clients, funding for our programs, and I want to see more research to inform our practice. I hope that our profession doesn't loose sight of our roots in mental health and we acknowledge that to ourselves and to our clients. I hope that our profession implements occupation based, occupation focused interventions. I hope our health care system can be more accessible and available to the people who need it. I hope our profession can become more recognized to a point where I don't need to have an elevator speech to explain what we do to every session. I want to ensure our profession is supportive of each other and collaborates not only with other OTs but interdisciplinary. We are a community working for a common goal. As a soon-to-be occupational therapist, I have various inspirations from my professors, fieldwork supervisors but I still want to develop my own identity as a practitioner. I am currently working on a few areas of improvement of mine: documentation, practicing occupational balance and self-care, setting boundaries between home and work life as well as not hurting myself when caring for patients, asserting more confidence in my knowledge and skills, asking for help earlier and to not put myself down for trying my best. As an OT I want to further advocate for OT services, be holistic, person-centered, occupation-based, and evidence-based, be a leader, contribute to the body of literature, change the world, one person at a time. I want to advocate for my client as we, as OTs, may be the only ones in their healthcare journey that asks how they are doing holistically. I want to advocate for our profession and be involved with national and international OT organizations like AOTA, OTAC, WFOT, possibly work internationally. I want to ensure my client knows I am there for them to becoming their better selves and collaborate on ways to do so in a meaningful way. I want my clients to know that I have worked hard in school, transferring my knowledge into my fieldwork, there isn't not a day that goes by were I don't think about how I am preparing to help them be their best. I want my clients to come to me because they feel comfortable, and seen and establish trust when I work with them. I want my future clients to know that I will implement intervention that have been proven effective and to not settle for uncertainty. I want my future clients to know that I am not their healthcare savior but that I am giving them tools to help themselves. I will bring compassion, active listening skills, organization, research, knowledge to educate important components of treatments and care to every patient I see. I have various goals for my career, I will describe a few here. I want to volunteer or work internationally as I love OT and am trilingual. I have the skills to serve and reach a larger population of patients. I want to specialize in adult rehabilitation and or health and wellbeing or maternal health, and assistive technology. I want to be a leader, possibly a manager, as an OT and further advocate for our profession. I want to be a mentor and give back to the OT community whether that is being a clinical supervisor or teacher or a work mentor. I want to conduct research or implement programs. I want to pass my fieldwork and NBCOT exam to be able to practice as an OTR/L and change the world!