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Self Assessments for fieldwork supervisors Identifying entry-level competencies Remediating deficits in student skills Fieldwork Performance Evaluation Contact USA Fieldwork Clinical Supervisor
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The University of South Alabama Department of Occupational Therapy
Remediation Ideas for Therapeutic Handling
When a
student is having difficulty with therapeutic handling, he/she is not
effectively using his/her hands to guide the client’s motor control. The
student may not be sure of what to do with his/her hands, where to place
the hands, how to normalize the tone with the hands, or how to change
the response the client is showing to him/her. This is a skill
that requires much guided practice to comprehend and master. Most likely
the student has practiced
most of these techniques on primarily normal bodies (their classmates
and family members). This may be the first time he/she
really feels spasticity or flaccidity. There are many things the
fieldwork supervisor can do to help the student reason through the
process and practice it. 1-
Have the student write up a plan on paper with specifics about
what they need to do. Have the student list muscle groups or specific
muscles that have abnormal tone. Next identify the type of abnormal
tone. Next identify specific handling techniques to use to normalize the
tone. Lastly identify positions to do these techniques in. Review the
table with the student before the session begins and provide feedback.
2-
Have the student practice the procedure on another person with a
normal body. Have the student identify bony landmarks, palpation of
muscle bellies, place his/her hands in manner to facilitate movement.
You may have the “client” move in specific ways such as reaching in
various planes and ask the student to identify the changes he/she feels
in specific muscles when the patient actively moves. 3-
Have the student practice some techniques on you. Provide
immediate feedback during the process and identify what the student is
doing correctly and incorrectly. Factors to consider are the weight of
the hand on you, the amount of pressure, the gliding of his/her hands to
promote your movement, and the support provided proximally to help
maintain balance when needed. Some describe this process as a dance. The
student must provide the right cues to help the you gently move. 4-
Role model specific techniques on a client and ask the student
questions during the process. It’s best if you tell the student about
this activity ahead of time to ease anxiety. You can ask him/her to
identify where your hand it placed, which techniques you are
implementing, which muscles show a change in tone, why you moved your
hand to a new location or changed your technique. 5-
Refer them back to the textbooks to review the motor control
theories (Bobath, Brunnstrom, Rood, PNF) and be prepared to discuss
these as a compare and contrast question. 6-
When the student verbalizes the information correctly but seems
impatient with the techniques, he/she may be under the impression it is an
all or nothing concept. Explain that relaxation may take twenty minutes
or longer in some patients. Relaxation may occur in stages for some
patients as you work your way proximally to distally. Review the
benefits of slow steady stretching to elongate muscles to prepare them
to move. 7-
Have
the student practice with you
a
variety of clients
with various stages of recovery and different types of abnormal tone.
The more the student feels, the more he/she will understand the normal
movement process. 8-
There are some commercially available videos of therapists
demonstrating handling techniques on a client. Have the student watch
the video and describe what they see and what they learned. If you do
not have any available in your department, consider making one or call
the Academic Fieldwork Coordinator at the University of South Alabama to
request to borrow one.
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