"Approach every day as if it's a new world because it is."


This is the way that I would like to deal with every day, because every day is full of opportunities to make a difference in someone’s life, even be it your own. Every day is a time to start on new page and try to become the person you want to grow to be. It's all about the approach. Similarly, in OT, you need to use an approach when treating your client, but it’s all about the right approach (see what I did there.)


But before you can think about an approach, you need to look at applied frames of reference (AFR). A frame of reference is a “reference that is developed from synthesis and interpretation of knowledge.” So in normal English language, it is a reference that is developed using different sources of (e.g. anatomy, physiology) and understanding and making sense of this knowledge to be able to use it as a guide for treatment. It is important to choose an AFR based on your client and their assessment findings.

 After choosing an AFR, you THEN move onto choosing different approaches. Approaches are the way the therapist implements the AFR. When choosing an approach, you need to be very clear in your reasoning of choosing a certain approach.
With regards to my Spinal Cord Injured client, I am using a Biomechanical Applied Frame of reference. What does this entail? This means I am focussing on the body’s muscles and their capacity to produce movement to participate in functional activities. The theoretical basis of this AFR is motion and forces that cause motion. An example of such a force would be gravity. Why did I choose this AFR? I chose this AFR as it specifically looks at muscle strength and joint range of motion and this is where I discovered my client’s problems lie after assessing him. There needs to be a link. Without a link, you might as well be talking gibberish (some of you reading this might aleady think I am.)

Next, the approaches. I am using various approaches to implement this AFR. The first one is a client centred approach. This means that I take the clients goals and opinions into account when planning intervention sessions as this will motivate him to participate as he is improving a specific skill or movement he finds important.

My second approach is a graded approach. No, this does not mean I grade the client on his session like a teacher would a test. It means upgrades or downgrades (sounds like I’m talking about a PlayStation or Xbox game, but not that either.) I use this in my sessions by making specific aspects more difficult if the client is coping well with the task he has been giving, OR, making it easier if he is not coping.

My third approach is a compensatory approach. This means I am going to help the client compensate for his decreased function in his lower limbs. This was done by using a transfer board to help the client transfer. This is used by placing one end of the board under the clients bum, and then the other will be put on the surface he is transferring to. This way, he can shift himself along the board until he is on the desired surface. Another example of compensation is teaching the client different methods of doing every day activities so he can still participate in these activities. As you can imagine, it would be quite difficult to get out of bed in the morning if you can’t move both your legs. As a result, I am teaching him a new method to sit on the edge of the bed so he can be mostly independent in his morning routine.

My last approach is activity as a means. This approach is basically using an activity that has the desired aspects to work on certain performance skills (performance skills are muscle strength, joint range of motion, sensation etc.) so an example of this would be using an activity like painting to improve upper limb strength. The aim of the session is not to have a wonderful picture at the end (although the promise of a good end product does motivate your clients) but rather to have improved the upper limb strength as the upper limb need to maintain position to allow for the client to paint.

This AFR and approaches definitely help in directing treatment sessions and ensuring you target the most important areas before your client is discharged. This is especially important in an acute facility as clients are often discharged after only one or two sessions.

Speaking… actually typing of discharging… my client that has aphasia got discharged on Friday, so I was not able to put my communication board to the test. However, I know I am prepared for the next time I have a client with aphasia, so that’s a positive.

I have gotten a new client whom I have not yet met. He is also classified as a spinal cord injury as his paralysis of the lower limbs occurred because of a tumour on his T2 and T3 vertebra (see picture below for where these vertebra are situated.) He is in his 7th week of therapy and will likely only be there for 3 more weeks, which means looking into caregiver training and home programmes to ensure he stays active and maintains the function he has. I am very excited about this because I have never done therapy with a client in his final stages of rehab and never had to do caregiver training or home programmes as all my clients have been in chronic facilities – meaning they are there for extended periods of time. Learning new things = growth, and growth = a better OT.
My spinal Cord client is doing exceptionally well in therapy sessions. The physiotherapist says he is making quite a lot of improvement with gravity eliminated movement. The next step is movement against gravity. His static and dynamic sitting balance has also improved quite a lot from the time I assessed him. He does not fall over as easily, and he is able to stabilise himself if he feels he is going too.

He is a wonderful reminder that there is always something to smile about. He jokes and laughs even when he is tired or in pain or both. He perseveres through the difficult times because he knows in the end, it will all be worth it. It’s something so many people, including myself, lose sight of when times are tough. Things will get better in the end, and if it’s not better, it’s not the end.


I have had a lot of guidance from various people over the last week with various things that have helped make those tough times a little less tough.

My supervisor has taught me various ways to interact with clients and colleagues to be able to change schedules or how to ask clients questions to ensure full participation. My supervisor has also taught me that it is okay to feel like you are battling, because everyone battles with something or the other in their lives at some point. As long as you ask for help and take the help that is provided so you can help yourself.

My fellow student therapists have shown me that we are all in the same boat when it comes to stress. We are all stressed for some or other reason, and while I don’t wish it upon anyone, it is nice to know you are not the only one feeling like your brain is going to explode from everything going on inside it.


From my friends, I learnt that an ear and support is a phone call or Whatsapp message away. If you are sad, they will cheer you up. If you are angry, they will be angry with you… and then calm you down. If you have had great day and need to tell someone about it, they are there to be happy that you had a successful day or session. They even stay at campus longer to give you advice on how to write SMART aims, because mine are anything but smart.

From my family, I learnt to make the most of every opportunity you are given, and I have been given the most amazing opportunity to make a difference in peoples lives with what I have chosen to do with my life. 

So to end off, I am going to share a quote that I feel is a great reminder when things get tough on the path you have chosen to take.

"It's not about what it is, it's about what it will become."
- Dr Seuss

And I refuse to let it become anything but spectacular.


References:

Spinal cord injury and how it affects people | Back Up. (2019). Retrieved from https://www.backuptrust.org.uk/spinal-cord-injury/what-is-spinal-cord-injury

Mesothelioma Law Firm - LowGif. (2019). Retrieved from http://www.lowgif.com/abab2367-law-firm.html

New Approach Quotes | Picture Quotes. (2019). Retrieved from http://www.picturequotes.com/new-approach-quotes

G. Kielhofner, u.d.; Cole & Tufano, 2008; D. Clarke, 1986 (acknowledging lecture notes)

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