Final entry

The placement was reassuring, I found, as initially I felt as though being a fourth year carries so much more pressure and responsibilities and it all seemed very daunting! And even though I still feel like a little like that I know more than I thought I did thanks to the placement.

Reflecting back on these past 5 weeks, I feel I have definitely learnt many new skills and had others reinforced. Manutention is integral to protecting yourself and your patients and I had many opportunities to practice appropriate manual handling i.e. when lifting and then repositioning someone in a wheelchair with a hoist and sling. I got to do both home and school visits for children with disabilities and learnt about what goes on at the visits and the physiotherapist's role in these which I would not have otherwise known about.

Some concerns that I had prior to starting the placement included being able to problem solve in order to do assessments and treatments. I found that this was not as difficult as I expected. My supervisors helped guide me with problem solving and in a few situations (not all!) it came naturally. For example, when assessing children if they did not want to do something, I would try and make the activiy fun and age appropriate i.e. "pretend to be this animal"...etc. At times I found I was able to effectively probem solve by planning beforehand unless it was a situtaion that couldn't be predicted or planned for! I learnt from one experience and found it helped me problem solve a lot better in another. I was also worried about having to educate the families about a condition. However while on placement I learnt that it was within my role as a physiotherapist to discuss functional implications of the condition, etc but it was more the role of the neurologist to inform the family in more depth about the condition i.e. what causes it/ how the child got it and so on. My supervisors assured me that it is okay to answer families questions but to make sure I was still staying within my scope of practice.

I thought that I would have to do a lot of wheelchair and equipment (e.g. AFO's) assessment and prescription however I did not deal with this as much as I thought during my time at the placement. Many patients had already had their equipment prescribed for them. I did get to see a few patients trial new electric wheelchairs which was interesting as I needed to assess their posture and potential functional and physical implcations of how they were positioned and how their wheelchair was set up. I attended a seminar about posture and wheelchairs which was very helpful in showing how modifying things such as the tilt on a wheelchair can remarkebly change a person's posture and therefore benefit their musculoskeletal system and therefore their functional abilities, comfort and so on.

I was apprehensive about communicating with children and their families while on this placement. I did have difficulty during my placement with talking to children in an age appropriate manner now and again- I often spoke too quickly and gave instructions that at times could not easily be followed by a child! This is something I improved upon as my placement continued but also something that I will have to continue to work on. Despite this I felt I managed to build a good rapport with the children and their parents that I worked with and became more confident with talking to parents about their concerns and how to address these.

I learnt that you can either just do enough so that you are doing your job, or you can go beyond that and do your job as best you can and really want to make a difference to the quality of life of each patient (and their family's) life that comes to you. This placement was a great opportunity for me to see what a holistic approach to treatment is and how a multi-disciplinary team approach is so important especially with neurological paediatrics. For example, I went on a home visit with my supervisor to see a 7 year old boy with duchenne's muscular dystrophy. His mother had not heard of half the options that my supervisor and myself suggested were out there for her son and their family that our facility could make possible such as seeing a speech pathologist for his speech difficulties and having the OT or physio visit his school to educate his teachers about strategies to involve him in sport and other activities. The mother was so surprised that none of these options had been mentioned to her previously and was very thankful that we had informed her of them. That experience also taught me a great deal about the roles of other health professionals and how it is important to know what they are even as a physiotherapist so that you can make referrals to other professionals if needed or is asked.

Another thing that really stands out for me that I learnt from this placement was how to analyse my assessment findings and make my intervention functional/ goal directed and family centred based on these. I also learnt that it is vital to know your milestones and what is considered 'normal' in paediatrics in order to analyse your assessment findings correctly. These aspects have been driven into us at university and I thought this placement was very beneficial in reinforcing these.