My Very First OT Shadowing!

I am happy to say that I am no longer a strictly-theoretical-only-knowing-what-I-read-on-books-and-blogs aspiring OT. I have SEEN OT! With my own two eyes! And lived to tell (you) about it!

I spent a wonderful morning with OTR/L Kay. Despite being an OT for nearly 20 years, she's not much older than I am. We got along just fine. She had a domestic emergency, so we met a bit later than originally planned.

Kay starts by showing me around the office and introducing me to everyone. She just says I'm an OT student rather than explaining, "She's two years away from even starting OT school and is only a couple of weeks into her first prereq." (Plus her option is a lot quicker.) Then she shows me the room she and her partner OT Molly work out of. It's a good thing they work mostly in patients' homes because the place is a closet. It's smaller than the bedroom I use as an office at home. The windowless space consists entirely of two desks, a table with a phone, a filing cabinet, and some wall-mounted cabinets.

Kay has to call Molly and straighten out some insurance issue (we haven't even started and insurance is already rearing its ugly head!), so I amuse myself with the MVPT, the Motor-Free Visual Perception Test. It consists of a series of placards where you are shown a shape, number or three-letter sequence, and have to find the same one among four drawings below the test item or on the next page following the test item. (I guess we're also testing ST memory a bit there.) There are also items where the "match" may be smaller, rotated, darker, etc. and a few final items of "Which one of these is not like the others?" The test seems very easy, but I guess that's just soothing reassurance that I don't have a visual impairment.

Soon, we're walking to Kay's car to go see the client. She makes a quick call on her cell phone to tell them we're coming and programs the client's address into her GPS, noting that the cell and GPS are her two best friends. She hands me the client file and pulls out of the parking lot. I am pleased that I can actually understand the file. I check a few acronyms with Kay, but my guesses are all correct.

Kay is going to do a "wheelchair eval" -- to see if the client can get a scooter or power wheelchair. The client's insurance will pay for a chair if certain conditions are met. It is Kay's job to interview the client and see if he meets those conditions. As we drive, Kay explains how several components of the client's medical history speak in favor of a powered chair.

Soon, we pull into the driveway of an older small but well-kept home and walk up a long wheelchair ramp to the front door. A lady about my mom's age opens the door, cigarette in hand, and gestures us into her living room. The client, her husband, sits at one end of a leather sectional couch, gaze fixed on the TV tuned to some morning hosts chittering and laughing about nothing in particular. Pictures of adult children and cherubic grandchildren adorn the walls and the shelf above the TV. The client has a splint and some ice over one hand.

"Oh, no, what happened?" Kay says, immediately concerned with the man's injury. His wife tells us he fell yesterday and had to go to the ER. The man had a stroke a few months ago, so his speech is slurred and sparse, yet his wife is able to interpret his grunts and mumbles. He interjects himself into her narrative as she describes what happened, and she takes it with good humor. He even allows his wife to take off and re-apply the sling (quite a painful process) so Kay can look at the injury.

Kay takes some time trying to make the client as comfortable as possible: extra pillows behind his back, replacing the hard ice pack with some frozen vegetables (they don't have peas, but soon he's sporting a bag of California Blend), and pillows to rest his lower arm on so his hand isn't hanging down. The client's wife explains that she wants him to eat before she gives him his pain meds, but he can't eat right after he wakes up. This is why he's so uncomfortable right now.

Kay opens her laptop, balancing it across her knees, and begins her interview by discovering that both the patient's first and last names have been misspelled on the file. Heh.

What really impresses me is how amazingly well Kay multi-tasks. She's typing into her laptop, she's talking to the client and trying hard to understand his replies, she's talking to his wife, she's incorporating all the extra information they are throwing in that is not directly related to the question at hand, and the evaluation doesn't even feel like an evaluation. It feels like a conversation. Meanwhile, I have the important job of holding the client's cane. :-) He does actually say that he likes me the best since I'm the only one not causing him pain. He even asks me if I'd like a cold Pepsi from the fridge, which is so sweet. I politely decline, but thank him for being a good host.

Kay gets to the part where she needs to measure the range of motion the client has in his hips, knees, elbows, shoulders, etc., so she pulls out her trusty goniometer. I've never seen one of these in action before--my inner geek is turning cartwheels. She carefully instructs him where to hold what and takes some measurements. She does a full set of measurements for his uninjured arm and shoulder, but obviously can't do a whole lot with his injured hand, so she mostly leaves that side alone.

Next, she helps him stand and sees how far he can walk. He is able to go about ten steps before turning and coming back to the couch. She makes some notes about how far he lifts his feet off the ground and the evenness of his stride, things like that, and then we take a little "field trip" with his wife to look at the bathroom doorway (wow, is it narrow) and the bedroom arrangements (tight turns required to get a chair in and out). Kay explains that a scooter requires better motor control and upper body strength because the controls are forward of the user on a handlebar-like arrangement. A scooter is also more difficult to mount and dismount and is longer than a power chair, so it has a wider turning radius. A power chair is controlled by a joystick very close to where the user's right hand would normally rest, so it doesn't require as much upper body strength or balance. Kay is leaning toward recommending a power chair for this client over a scooter.

We return to the living room. Next, the client's wife helps him get into the manual wheelchair he currently uses, and Kay asks him to wheel himself a few feet in the kitchen. He mostly uses his feet and is not able to make the chair move very effectively.

All the while, Kay is talking with the man and his wife and listening carefully to what they're saying, and the man just comes to life. His grunts and mumbles turn into words, then phrases, even a few full sentences. He enunciates clearly enough to make a joke as Kay finishes up his medical inventory. She says, "OK, so you have pain here, there, there, and there. Is there anything else giving you pain?"

"Yeah," the man says, a glint in his eyes, "that one (he points to his wife) and that one (he points to his home health aide)!" Everybody bursts out laughing.

We were there for about two hours. Kay had never laid eyes on the client or his wife before, but by the time we left, she had built a sincere rapport with them. And the client, whom the case manager had described in his file as "non-verbal," had shown himself to be a likable, charming man who could still speak fairly well. His speech improved quite a bit just while we were there.

I made sure to thank the client and his wife for allowing me to observe. It is a humbling thing to be welcomed into someone's home, and for a stranger to let you see his weaknesses and vulnerabilities--and still have the presence of mind to offer you a cold drink.

This visit: 3 hours
Total observation time thus far: 3 hours