Assignment 15: Interview

This week, I interviewed my mentor and her co-workers about my research. They were best fit to answer my questions, because they have the knowledge and experience regarding pediatric physical therapy. Below is my interview with questions, answers, and reflections.

ESSENTIAL QUESTION: How can I, as a Pediatric Physical Therapist, design the most personalized plan of care for my patients?

1. What is the first thing you do when receiving patient information?

I thoroughly read everything and look for red flags. Sometimes I receive surgical protocols that are instructed my the patient's primary doctor. With this, I try to formulate a plan or diagnosis prior to their visit.

Reflection: I was expecting this answer. Prior to the interview, we spoke about what steps she takes when treating patients

2. What vital information is needed to create the most effective plan of care?

To create the most effective plan of care, I review their history, goals, and objective measures. Typically when I look at their history, I am reviewing how they got hurt or if there are any restrictions on mobilization I need to be aware of. For objective measures, this includes range of motion and strength. To calculate these, I use rulers to measure flexion (bending) in their knee or elbow and a device to measure the torque (pressure) they can generate.

Reflection: This was another answer I was expecting. I have observed many treatments and followed patient's from the start of their plan of care to the end. Without history, goals, and objective measures, patients would not recover and receive the most effective plan of care.

3. On your first appointment with your patient, what is your main focus?

My main focus is completing the evaluation and plan of care. When evaluating them, I review their strengths and mobility.

Reflection: This was no surprise to me, because she gets new patients all the time. What she told me was exactly what I have been observing with new patients.

4. Based on your clinical judgement, how do you determine a patient's prognosis and timeline of treatment?

The evaluation process aids my prognosis and timeline of treatment. But I also try to pick up on the patient's personality, because some patients show that they want to get better and do the exercises or they want to get better and not do the exercises.

Reflection: I never took into account that you have to consider a patient's personality. Looking back at a few patients, I can pick up a few personalities where their timeline of treatment has extended, because they are not completing exercises.

5. Are goals determined by your clinical judgement or patient decision? or both? Goals are determined by both my clinical judgement and patient decision, because I want to take into consideration their feelings and thoughts on their treatment. They are more likely to work towards getting better if I get them involved.

Reflection: Prior to asking this question, I was unsure as to what the answer would be, but it makes sense that both a PT and a patient would determine goals. If a patient does not desire to work towards a certain goal, they will not be willing to do what they have been instructed.

6. If a patient is challenging to treat, how do you overcome this barrier?

I cannot force patients to complete their exercises, but if they are not complying, I must be straight forward to them or recommend them to other therapist.

Reflection: On my first day of interning, I encountered a challenging patient. This patient would always go on their phone and pretend to do the exercises. After a few treatments, my mentor told her if she does not comply and do the exercises she will never get better. The patient still did not listen to my mentor, so I tried to help my mentor by watching over the patient and ensuring they do the exercises. But still, no results were seen and the patient was referred back to the doctor and left the clinic not fully recovered.

7. A patient has a goal date, but when the date comes around, it is not met. What actions are take to evaluate this failure?

When goals are not met, I reassess my patients and make the goals more attainable. I may modify their goals and explain why I have to reassess them.

Reflection: This answer was no surprise to me. Sometimes patients have goals that will not be met until months into treatment, so their goals may have to be reevaluated. This does not meant they are never going to recover; rather so they are recovering at a slower pace.

8. You are treating two patients, with a dislocated shoulder, but they play different sports with similar mobilization. How does their plan of care differ from one another?

The first few visits are general and similar to one another. Depending on their sport and position, I later incorporate sport exercises

Reflection: Before asking this, I thought patients are secluded to exercises relating to their sport, but it turns out they are not. It makes sense that in the first few treatments, exercises will be similar, and once the road to recovery has almost ended, they start incorporating sport-specific exercises.

9. A patient has come in due to hip pain, but they later have a tibial fracture (broken leg). Do you stop hip treatment and treat both injuries or do you work around the fracture?

For this situation, I can continue treating them for the hip and modify their plan of care or treat both and do a reevaluation. It depends on what the patient wants to do.

Reflection: For the patients sake, I figured that it would be recommend that treatment be stopped until mobilization is active in both injuries, but it depends what the patient wants to do and how the plan of care is modified. If I were the patient, I would continue treatment for my hip and work around my new injury.

10. If a patient wants a certain treatment, but their parents does not consent, what measures are taken to ensure that the patient will receive the best plan of care? If my patient is a minor, I have to get parent consent. If their parents do not consent, there is nothing I can do besides treat them a different way.

Reflection: This answer was a surprise, because prior to treatment, parents sign a consent form that it is okay for their child to receive treatment. I figured with that consent form, their child could receive any type of treatment without additional consents. An example of an additional consent is dry needling. Dry needling is similar to acupuncture, but this modality -- way of treating -- is focusing on trigger points and releasing muscle tension, causing simulations and twitches of the muscle or other muscles connected to it. The procedure requires a thin, hallow needle, which can sit in the trigger point or be moved in and out. This type of modality is intensive and requires additional consent because of the needle.

11. What is your favorite type of modality to use on patients?

Dry needling is considered a modality, so I would say dry needling for sure!

Reflection: When my mentor treats patients, she always offers dry needling, so this was no surprise.

12. Are there age restrictions when it comes to using different types of modalities (not relating to parent consent)?

No there is not an age limit for using modalities, however each modality has contraindications. For example, a contraindication to using ultrasound is using it over open growth plates, so therefore since we work with mostly growing bodies, I do not necessarily use ultrasound a lot on my kids. And then, you already know that we (here at CHOA) seek parental consent for Dry Needling as well as patient consent, only if the patient is under age (under 18 years old).

Reflection: Since the start of my internship, I have never observed an ultrasound, so I never knew what it was. Once she explained why it is not used on many of their patients, I understood why I have never observed it.

13. How do you get parents involved in their child's plan of care?

Parents are usually at the evaluation, and I try to give them my assessment of their child and the injury/issue, as well as my plan of care and the home exercise program. I encourage parents to feel free to email me or call me with any questions. I also try to speak to the parents after treatment sessions to give them an update on their child’s progress so that they feel included and informed.

Reflection: Looking as to how my mentor ends a treatment session, I knew she would speak to the patient's parent(s) to follow up on their child's progress, but I never knew they were able to personally contact her with any questions or concerns.

14. How are the implications of ultra sounding and cupping different from one another and how does one greater benefit from one?

You can choose to use modalities for a variety of reasons including but not limited to pain, muscle tightness, tendinopathies, muscle strains, ligament sprains, etc. and we use our clinical judgement skills based on the patient’s age, injury, symptoms, tolerance level, body part being treated, etc to help you decide which modality to select. I would not say that one modality overall is better than the other, but one may be more APPROPRIATE to select based on the situation or patient.

Reflection: From her previous answer to no. 12, it partially answered this question. Though it was great insight when she furthered her explanation about how modalities may be more appropriate based on the situation or patient.