Costa !

Helen Rosas Costa

PTA 1010-301

Professor Taunya Garrett

30 July 2017

Clinical Observation Reflection

The clinic I observed at was Avalon Valley Rehabilitation Center which classifies as a

Skilled Nursing Facility (SNF) but is occupied by the therapists from Brighton Rehabilitation.

My observation normally centered around the PTA I chose, Robyn Moore and the patients she

was seeing that day. Although I mostly dealt with physical therapy I was able to get experience

with occupational therapy as well, and fairly often. My overall impression of the facility and of

the profession in general enhanced my notion of having physical therapy as a requirement. I

observed that patients with almost complete function to almost no function at all would benefit

from physical therapy. Also enhancing the fact that anyone, any age, could use physical therapy.

It helps the community to regain a family member or a friend that can be part of the

neighborhood and contribute but will also help the individual get back to their everyday lives.

While in the SNF I mostly dealt with older adults, but there were younger adults that also

required physical therapy due to injury or other life choices that required medical attention. From

the days I observed I did not see anyone doing something out of their scope of practice, which is

sometimes rare with a large workload and not very many staff. Many times when patients are not

physically capable of doing an hour of physical therapy and an hour of occupational therapy, the

therapist would co-treat the patient so they will only have to exert themselves once but still

attempt to meet their goals in each area of therapy. This also assisted in having the therapists to
 Costa !2

use their time as efficiently as possible. The state practice act was adhered at all times with

having all physical therapist assistants (PTA) and occupational therapist assistant (COTA) be in

direct supervision with their physical therapist (PT) or occupational therapist (OT). Because of

the patients being older in age we did get to help a few with showering and dressing, but at all

times ethics were kept to make sure the patient was taken care of and comfortable but also kept

modest when possible. With having patients needing help dressing, bathing, and even having

clothing/blankets that get in the way of exercises, the therapy staff had to be very professional in

dealing with those situations of having to dress and undress patients. Their professionalism was

outstanding, even when patients would be rude, curse, or push them away, they would stay calm

and professional and continue attempting to do their job.

Based on my experience observing the PTA profession, I am more excited to join this

career. While physically it is demanding, I would need to do stretching or other things to keep

myself from injury, it feels like the time goes by so quickly. Although I do not believe I would

want to work in a SNF environment, mostly because it upsets me to have to try and force

someone to do physical therapy. Especially when they do not want to but are required to because

of the insurance they have. My preferred clinic would be in an outpatient setting to where if the

patient has already driven there, they have already done half the work and have at least half of

the motivation. Although, working in an inpatient facility you are able to speak directly with

their nurses and figure out what might be going on if they are not feeling well or if there are

other issues, such as falling before physical therapists and PTA go to see them. Both have their

pros and cons but I believe I would work best in an outpatient setting.
 Costa !3

The experience I had that stuck out to me the most was in class, days before one of my

clinical visits, we were learning about the cardiopulmonary systems and learning about strokes

(CVA). I met a patient that was wheelchair bound and was prescribed physical therapy because

of a hip replacement and other circulatory issues. Just looking at the patient and seeing that they

favored their left side and seeing that their face was partially paralyzed on the right side made me

believe this patient had a history of CVAs. I asked my PTA later if that patient had a history of

CVA, she didnt believe they had, but when she checked the medical history of the patient she

saw that they had multiple CVAs. Although the CVAs were years ago and the patient may have

regained partial function to a point where she did not notice they were partially paralyzed. Also,

after learning about the cardiopulmonary systems and risk factors of having issues in the future, I

was asked why we try to stretch patients who are bed bound or even try to move them partially. I

answered with preventing having the patients living a sedentary lifestyle that may cause more

issues in the future not only in their muscles but internally as well. There was a patient that was

completely paralyzed due to having serotonin syndrome that we attempted to do active range of

motion (AROM) with. The OT asked me to attempt the AROM and see if I could feel the

patients rigidity. After getting verbal permission that I could, I attempted the AROM with the

patient and very slowly lifted their arm. Even going slowly I could feel major rigidity in the arm.

We also did AROM with the patients feet, but what was amazing was that we started slowly

doing dorsiflexion on her foot and it became less rigid as time went on and we were able to get

the patients foot to 0 degrees. We also attempted to try to challenge various other patients

mentally by seeing if they could remember what we had done with them in the previous visit and

to gauge how their memory is doing. Their memory stayed steady or worsened since we had seen
 Costa !4

them last. I was also able to experience assisting patients transferring from their bed to their

wheelchair and vice versa and also assisting with hoyer lifts.

The best aspect of having this clinical experience was getting to know the patients, seeing

their progress, and motivating them to try their best. One patient stuck out to me the most, this

patient was always ready and willing to do their therapy even when not feeling their best. I was

able to motivate the patient to complete 15 minutes on an omnicycle (which worked out the

patients arms, legs, and activity endurance) just by having them talk about their pets at home and

things they were interested in. Distracting the patient enough to where they do their exercise but

still are engaged in the conversation really boosts their activity endurance and puts a smile on

their face. I personally loved seeing those patients that gave me their 110% and I gave them my

effort in return and it made it for a happier, more enjoyable experience for everyone involved.

There was difficulty with the clinical experience, most of it being in the attitudes of patients.

Being rejected for any type of therapy or seeing the misery in someone when they rejected

physical therapy, but if they did not get their allotted therapy time in their insurance would no

longer cover them. Having the anger of a patient aimed towards you when attempting to have

them follow safety procedures and bothering them multiple times to come to the gym to do

therapy. Or even attempting to preserve the privacy and modesty of one patient by having to

close curtains on another patient and having the second patient feel claustrophobic made me feel

awful. Lastly, one experience that was not comfortable was having a patient yelling at me to help

the nurse and physical therapist change the dressing on their wounds and move the patients bed,

which had safety precautions in regards to the bed listed on the wall. I felt bad that I was not able
 Costa !5

to assist but also trying not to anger the patient further by telling the patient I cannot do anything.

Overall it was a positive experience but there were uncomfortable situations that were faced.