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Hunter Mercier

EXS : 496

Field Work

2022

Reflection #1

Today I started shadowing at Northern Light AR Gould Hospital in Presque Isle. When I

arrived, I was assigned to a man named Bradley who is a physical therapy assistant at the

hospital. Bradley introduced me to his first patient who was a sixty two year old male. The

patient told me that he had been suffering from lower back disc pain. Without knowing any of

the patient's medical history, I concluded on my own that his back pain could be due to all of the

extra weight that he carries in his abdominal area. Bradley described the patient's past medical

history to me and I learned that the patient has type 2 diabetes. The patient also has hypertension

that could eventually cause health problems, such as heart disease. Over time, diabetes damages

the small blood vessels in the body, causing the walls of the blood vessels to stiffen. This

increases pressure, and can lead to hypertension like it has in this specific patient.

On top of that, the patient has short term memory loss, and Lymphedema. I learned that

Lymphedema is the build-up of fluid in soft body tissues when the lymph system is damaged or

blocked. Lymphedema occurs when lymph is not able to flow through the body the way that it

should. The patient wears compression stockings on both legs to improve his physical

functioning and overall quality of life. Bradley explained to me that Lymphedema is a condition

that often gets misdiagnosed or goes undiagnosed. When this happens, it can be extremely

detrimental to the person, ultimately affecting their ability to move their limbs, increase the risks

of skin infections and sepsis, and can lead to skin changes and breakdown.
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Bradley took the patient and I into a separate room from the physical therapy gym. The

room had a single treatment table in it. Just from observing and hearing about the patient's

background, I knew most of his treatment today would be done while he was off his feet. Bradley

started by leaning the patient back on the table until he felt some discomfort in his back. Once

the patient was ready, Bradley began doing range of motion with both legs by lifting them up and

holding them in a minute stretch two times each. Bradley did this same stretch again but moved

the patient's legs away from his body. After that, Bradley took a band and wrapped it around his

waist while the other part of the band was wrapped around the patient's ankle. From there,

Bradley proceeded to lean back and slightly pull on the patient's ankle. This exercise was done

two times on each ankle for two minutes.

Core strengthening exercises were next on the list for the patient. Bradley told the patient

that working on his core strength is extremely important because it will help protect his back.

The patient was instructed to draw his belly button down towards his spine, take a deep breath in,

hold for a second, exhale, and then relax his stomach. Because the patient has short term memory

loss, Bradley had to repeat this process several times. Bradley also demonstrated the exercise and

explained each step to him while doing so. After that, Bradley moved the table all the way down

so it was completely flat and asked the patient to bend both of his legs as much as he could. The

patient performed the same stomach exercise in this position and then added the lifting of each

leg while doing it. The patient finished his appointment on the NuStep T5xr machine for ten

minutes. The NuStep T5xr machine provides a low impact, inclusive, total-body cardiovascular

and strengthening workout as well as accessibility through its step-through design, resistance

levels, and workout programs.

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After I graduate from UMPI, I plan on pursuing a career in occupational therapy but it

was still beneficial for me to observe a PTA today. Even though physical therapy and

occupational therapy are two completely different professions, they share a lot of similarities in

the way that they practice. Both occupational therapists and physical therapists work hand in

hand with each other and can co-treat some of the same patients.The primary difference between

the two fields is that physical therapy helps patients cope with pain, increase range of motion,

improve endurance, and develop gross motor skills whereas occupational therapy focuses more

on how patients perform activities and roles that are most important to their daily lives, including

assessing and treating physical, psychosocial, behavioral, cognitive, or sensory skills.

My only experience around physical therapy has been through a patient's perspective so it

was very interesting to see an appointment from the outside. I had the opportunity to not only

conversate with the PTA but the patient as well. This particular patient had a great sense of

humor and was a joy to talk with. I believe that figuring out how to communicate with each

patient is the most important skill that a physical therapist and occupational therapist needs to

have. Bradleys specific philosophy as a PTA for this patient is to educate him on proper posture

techniques to help preserve the spine and manage his pain, accelerate healing through

strengthening and stretching, restore muscle flexibility and joint mobility, and ways to prevent

further injury. Knowing this patient had a short term memory, I thought Bradley did a great job

with explaining and demonstrating the exercises in a way that he would comprehend.

My philosophy as an occupational therapist will primarily focus on effective

communication with the patients that I have. Because occupational therapists often work with

patients that are non verbal, it was very beneficial for me to see how Bradley communicated with

his patient. I know that there has to be a big sense of trust between the therapist and patient.
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Communication is key in gaining trust from the patient so that they feel comfortable with what

they are doing and get the most out of every appointment as possible.

Reflection #2

Today I started shadowing at Northern Light AR Gould Hospital in Presque Isle. After

shadowing a PTA, I got the opportunity to observe a pediatric occupational therapist named

Amanda. When I met Amanda, she gave me a tour of the occupational therapy department in the

hospital and I got to see all of the different sensory gyms. She also introduced me to the other

occupational therapists that were there at the time as well as a speech pathologist named Robbie.

After that, I got the chance to sit in her office while she gave me an insight on what her days as a

pediatric occupational therapist normally look like. She told me that as of right now she sees

around fifty six kids from zero to eighteen years old. She not only sees children at the hospital

but also has a contract with Washburn high school. She explained to me that most of the kids she

treats have some sort of autism. Other kids she treats either have cerebral palsy, sensory

processing disorders, developmental delays, and mental health or behavioral problems.

Amanda told me about her route to becoming a pediatric occupational therapist. She

described her time in graduate school and how she decided to work in the pediatric field. She

even mentioned the not so ‘glamorous’ parts of her job that most people don't see. I got a

glimpse of her process in completing paperwork, the software that the occupational therapists

use, how to write an eval, and her calendar on how she stays organized. I have done a lot of

research and watched many videos on occupational therapists but it was very astonishing to see

one work right in front of me.

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After Amanda finished some notes, she told me about the telehealth appointment she was

going to have with a patient while I was there. This patient was a five year old boy who was

autistic and actually the most severe case of autism she has dealt with in her career. When she

saw him for the first few times in person, he was not cooperative and would cry the entire time

that he was there. Amanda and the other occupational therapists all tried to get him to calm down

and nothing worked. As a whole, they decided having a telehealth appointment once a week

from home would be the most effective way of treatment for him. Amanda admitted that trying

to give therapy to this particular patient over the computer was difficult in various ways. Not

only is the patient nonverbal, he also has an extremely hard time focusing on one thing at a time.

Because he is nonverbal, Robbie (the speech pathologist) was going to be on the telehealth call

as well.

When Amanda made the call, she started off by talking to the parents of the child first.

The mother mentioned that he was pointing to things he wanted more often and getting better

with going to new places and environments. The first thing that I noticed on the telehealth

appointment was that there was an overload of stimulation in the home. The tv was on and the

patient was playing with loud light up toys. It was even hard for me to focus on what Amanda

was saying to the parents of the patient. Once she was done talking to the parents, Amanda and

Robbie had a difficult time getting the patient's attention. I actually got to see the messages

between Amanda and Robbie and both of them said there was way too much stimulation for the

patient to focus.

Robbie then asked the mother nicely if she could turn the tv off and get the patient to

separate from his toys. The mother turned the tv off but was unable to get her son to stop playing

with his toys. Amanda pulled up a personal document she made specifically for the patient that
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had pictures of his favorite tv shows and songs. She came up with this technique so that the

patient could point to what picture he wanted and it would play automatically. Once Amanda put

it on the screen, the patient became intrigued. He pointed to a picture and a song came onto the

screen.

We listened to the same song probably twenty five times but it was what made the patient

happy. Amanda and Robbie sang along and did the dance alongside the patient. Little things like

the patient clapping, jumping, and dancing was a form of therapy for him. By doing those things,

he was learning what words went with what body movements. Because the patient is nonverbal,

when the song was over, Amanda and Robbie would sign to him. Some words they signed to the

patient included: “something different”, “more”, and “again”. It was cool to see them both

signing to the patient because at Pine Tree Camp this past summer, I had the opportunity to learn

sign language during a training. We often worked with campers that were deaf or nonverbal so it

was important for me to know the basics of sign language.

After about thirty minutes, it was clear that the patient's attention was focused on

everything but the telehealth appointment. Amanda and Robbie said their goodbyes and let the

patient go a little earlier than normal. Once the call was over, Amanda and Robbie came together

to debrief the therapy session. They talked about what they planned to do for the next telehealth

appointment. Robbie explained that in order for the patient to grow in all areas of

communication, he needed a communication device. Amanda also discussed some other games

and songs that she believed would force the patient to participate more in the next telehealth

appointment.

Pediatric occupational therapists evaluate the current developmental levels of children,

aiming to improve their ability to self-regulate emotions and participate in social interactions.
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Through interventions, occupational therapists can help children build on their areas of strength

and overcome their limitations. I could tell Amanda's philosophy as a pediatric occupational

therapist was to enhance and enable her patient's participation in any way possible. The reason I

am so interested in pediatric occupational therapy is because I would get the chance to be

extremely creative when working with patients every day.

Each patient that I will have will be different in their own way and I will get to use my

problem solving skills on a daily basis. Pediatric occupational therapists are often labeled as

people that just play with children all day. However, pediatric occupational therapists input their

therapy by disguising it through play. In order to help children, they need to make the

appointments as fun as possible so that the child does not even realize that they are in therapy.

Finding different techniques and games to help a patient get stronger in an area they needed, will

be really fun for me. I would say my philosophy as a pediatric occupational therapist will look a

lot similar to Amandas. I will spend a frequent amount of my time thinking of and brainstorming

new interventions specifically for each of my patients.