I recently encountered a child who had been diagnosed with arnold-chiari malformation (structural defect of cerebellum, may force cerebellar tonsils and brainstem downwards, often progressive, symptoms include balance/co-ordination problems, muscle weakness which all obviously affect motor development). She also has some other undiagnosed behavioural/social problems. This 3 yo client had really struggled to achieve every motor skill she had acquired and through much support of her very patient mother she was now walking; which is what we were hoping to assess.
Unfortunately, upon seeing the physio (whom I think probably represents a lot of hard work in the mind of the child), the child starting screaming. Mum carried her into our treatment room where she continued to scream and cry. Being able to actually treat the child was an idea written off early in the session, but we tried to console/ distract/ bribe her in order to achieve some sort of assessment to guide our advice to mum. Eventually it seemed we were not going to be able to assess the child who continued to cling to mum and scream until she was hoarse, for 40 minutes. The physio indicated that we were giving up and I assumed this would be the end of the session. Instead though, the physio asked mum to read an entire book to the child before they could go. Mum calmly read the book and the therapist addressed the child, saying “now that you’ve finished reading it’s time to go home”. We arranged a home visit for our next session, where Mum suggested we hide in the next room and observe through the window while mum played with the child!
Anyway after this first session I asked about the book reading and I soon realised that whilst this session was obviously non-productive, the therapist was preparing the child for next time, trying to change her negative associations with the physio and with therapy. By allowing the child to read with mum then go home, her association to the centre might be with something more fun like reading. I realised I would not have thought of this very simple idea. We have all had patients who for some reason are non-compliant on particular days and we want only for the session to be over so we can start afresh next time. I now appreciate how important it is to think about not only the individual session aims but your long term goals and remember that your actions have the potential to influence not only the current session, but future sessions as well.
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I'm on my paediatric placement at the moment as well Amber and I have noticed that the physio, the ot and the speech therapist really time when they see their patients to avoid the child linking them to a negative experience. For example on the wards at the moment there is a patient with a severe head injury. He is in the early stages of recovery. The patient can become very agitated and aggressive when we are stretching him. This patient will be on the wards for a long time so the allied health professionals are very flexible about seeing this patient and choose times when he is less agitated and more relaxed so they can provide optimal treatment and so that the patient stays positive about these health professionals.
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