The plan, implemented

I was assigned to teach a client a pair of balance exercises. But as it turned out, the other one that I prepared was already part of her treatment program with the intern. Eventually, I showed her how to perform tandem walking. It was a chance to experience instructing a client first hand. I was glad to have had this experience. It feels very different to teaching my classmates in laboratory sessions or simulated patients in exams. I realized that being a therapist need a lot more interest and compassion with the client and not just teaching them for the sake of it. You must have a true intention of helping the client with whatever you can to improve the condition.

I only took a few minutes of the client's session with the intern as there are other exercises and activities they will perform. She was jolly and always smiling. As I observed, she really is doing her best to perform the movements as instructed by the intern although some are difficult for her, At the start of the session, I introduced myself to her and told her what we are going to do. I thought to myself, "This is it. I hope, wish and pray that I do well.". I learned that it is important to speak clearly and loud enough so the client can understand the instructions better. It is also important that your voice or the way you speak tells that you are really interested in what you are doing. Also, the way you talk should be appropriate to the patient's demeanor during the session. I was able to explain what the activity is, the rationale behind it and how it will affect her in everyday activities. I then demonstrated the activity by doing the tandem walk in front of her. How the placement of the foot should be, the distance she needs to cover, the line she needs to follow and how one foot should be placed in front of the other. I reminded her that the goal of the activity is not to cover the distance in a short time but for her to concentrate on maintaining her balance as she is walking and place her feet in a controlled manner. She was very cooperative and understood what she needs to do with no difficulty. I then asked her if she has any questions before we start and said there was none. The activity was done just outside the parallel bars, I told her that if ever she cannot maintain balance, she could hold on it using one hand. When she stood up and placed one foot in front of the other, I made sure that I was close to her if ever she cannot maintain her balance. She did okay in the first to and from the starting point. She is having difficulties placing the right foot in front of the left as it is rotated a little internally and she ca not sometimes control the placement. I asked her if she wants to sit first and rest before we continue but said she was okay. Actually, she did not sit at all during the activity after doing 4 or 5 laps. I think she was challenged by the activity as evident from her lively expressions. I constantly gave her instructions on properly placing the right foot in front of the other and placed it correctly and pointed to the front more often than not. I also noticed that the movement of her  hip was more of flexion than circumduction which is one of the problems of the client. Together with the instructions, I constantly commended her for doing better and asked her to refine movements that are still not correct. At the end of the session, I said that she did very well on the activity and mentioned all the things that I observed. I reminded her that she should always point the feet forward in walking and that the movement of her right leg should be forward and not towards the side.

One of the mistakes I made was not to highlight the line that she needs to follow as she performs tandem walking. We used the lines on the tiles of the clinic which may be difficult for her to see as she was an older adult. Finding the line while walking could have gotten some of her attention instead of just focusing it entirely on doing the activity. I could have used a material which color is very discernible from the floor to help facilitate the activity more. I should watch out for this every time because things such as these could affect the client's learning. Also, I need to be careful in giving the progressions of activities. After I saw that she can maintain the tandem position, I immediately told her to walk with that pattern which made it a lot difficult for her at the beginning, although she was able to do it towards the end. It is important that learning is translated clearly to her so she can do it even by herself. I could have told her to walk with the feet closer to the middle before placing it entirely towards the front of the other. When she masters it by herself, then maybe we can do it closer and closer until she can do tandem walking. Although this may be difficult to achieve in one session, and also this is the first time she did the activity, this is what I would suggest if she will continue doing the activity in her future sessions. This shows the importance of continuously assessing the client and the situation to make sure that nothing is too difficult or too easy.

All in all, I believe I was able to help the client achieve the goal for the session we had. I hope to apply the things I learned from this activity to my clients in the future.