Over preparing

I am currently on my neuro outpatients placement and encountered a situation of over prepared- ness. I have been treating patients in 90 min time slots and as i am roughly half way through my placement i have got to a stage where i am quite comfortable with my patients and familar with their current treatment plans, goals and responses to certain treatments. To make myself more efficient i decided for a short while the night before to run through my notes on each patient i would be seeing the following day; i.e. impairements, problem list and my treatment plan for the next session.

One of my patient's i was going to treat was the patient that had been chosen for me to review. Keeping this in mind i had accommodated in my treatment plan enough time to get a thorough assessment of the patient; joint rom, mms length, tone, functional status, sensation and a berg balance ax. I had planned exactly what assessments i was going to do on this patient over the next 5 times i would see her so i had a lot of assessment measures to work with on my soapier report and objective measures i could reax each treatment session to monitor this particular patient's progress.

This particular patient had suffered a right MCA infarct roughly 2 years ago and has had a lengthy rehab regime with her response to treatment being up and down. Functionally the patient can sit with good posture when prompted, has abnormal standing balance and weight bears more through her unaffected side, and can ambulate with 2 x A with a very antalgic gait pattern. Upon reading her notes at times in the last 2 years this patient has progressed to gait retraining then lost motivation so much so that getting from sitting to standing has been a struggle. My intentions for this patient was to get her in standing, work on her standing balance, and functionally carry over this thru to gait re training.

This particular morning the patient was very uncompliant that transfering from her wheelchair was difficult. All i managed to achieve in a 90 min session was some lower limb stretches, foot mobs, and 30 mins on a tilt table. Post session once this patient had left i was so disappointed in myself that i just burst into tears as i felt completely hopeless and felt that the patient also thought i was useless. My supervisor sensed my frustration and pulled me aside. It was very comforting to know that even after 20-30 years of experience in neuro that some days patients have bad days which is by no means a reflection of the therapist's skill. My supervisor then told me that there a certain ways of getting this patient to "do what you want them to do" and that he would be happy in the next session to guide me through my treatment.

I have found that in a lot of placements i have been reluctant to ask my supervisor for help, guidance and feedback on my performance as i have been scared that they may think i am not capable of fullfilling the placement expectations. On this particular occasion my supervisor really put my mind at ease. No question, query or doubt is stupid. Supervisors are there to help us learn and the time to make mistakes is now as students. Now i feel more confident speaking directly to a supervisor specifically on feedback of my performance. Also no matter how prepared you may be, things presented to you on the day can be quite a different story. So rather than being so set in your ways on how you will achieve your treatment goals it is a good idea to be accomodating and consider many external factors.