Clinical Posting Reflective Writing

Topics: Stroke, Mirror box, Phantom limb Pages: 6 (2226 words) Published: December 16, 2012
On the 1st of October, we had started our clinical teaching in Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM). I felt excited because I like to hand on the patient and I can gain experience through clinical teaching. On the first day of clinical teaching, I was under En Taib’s supervision. He orientated us around the Occupational Therapy department and briefly introduced the staff and rooms in the department. Due to the presence of the patients, En Taib decided to bring us to ward round at Medical Neurology department. Me and my partner, Nadiah were ordered by En Taib to interview a patient with jaundice. After interview with him, we found out that he is independent in all performance areas. We felt glad about that. In the afternoon, we had case presentation. Both groups that are Musadun and Nurul Huda, and Teong and Fatimah were presented about stroke patient. During the presentation, one of the group mention with the Mirro Box Therapy. It’s a new thing for me. So I had done some research on it. Mirror Box Therapy is part of a program called 'Graded Motor Imagery' which offers improvements in pain and disability by retraining the brain and re-mapping neural pathways, for patients who suffer from Chronic pain (Neuropathic pain, CRPS, Phantom limb pain) or for patients who have suffered a stroke or ABI (Acquired Brain Injury). (, 2012) There are few studies were done on effectiveness of Mirror Box Therapy. One of the studies investigated the effects of Mirror therapy following hemiparesis. 36 patients with severe strokes were enrolled within 8 weeks after suffering a stroke. Patients were either allocated to the Mirror therapy Group or Control Group. Results showed that patients in the Mirror therapy Group regained more hand function than the control group. They concluded that the application of Mirror therapy in the early phase after stoke resulted in functionally relevant improvements in motor sensory and attentional domains. (Dohle et al, 2008) Another study is randomised controlled trial which investigated the effects of Mirror Therapy on motor recovery and function of the lower limb in 40 patients in the subacute phase post stroke. Patients were assigned to a control group, a Mirror Therapy group or a standard therapy Group. Results found significant differences were observed at 6 months post treatment in favour of mirror therapy compared to the other two groups. (Surbeyaz, 2007) From this, I had learned the uses and effectiveness of the mirror box therapy. I also can see how the stroke patient moved his affected limb by moving his unaffected limb. I suggest that this therapy should be introduced to every hospital as its effectiveness is clearly shown because when I had my clinical observation at Sungai Buloh Hospital, I didn’t get to see this intervention.

On 2nd October, my partner and I were assigned to hand on a new case. I was very excited but nervous in the meantime. Before the patient came to the department, we were reviewed the patient’s BHT. The patient that we were going to assess is Mr T which diagnosed with right basal ganglia bleed which cause stroke. Patient came to department with his wife in wheelchair and we can see that his affected leg (left) is tied to the wheelchair. After greet with them, my partner and I were started to interview the patient. In the process of interviewing patient, I felt nervous and my mind was blanked. Because my partner can’t speak in mandarin, so I have to assess the patient myself. I forgot to ask many questions and I looked clumsy. The patient diagnosed as right basal ganglia bleed 15 months ago and had craniotomy and blood evacuation. He had delayed rehabilitation for 1 year which leads the left hemiparesis to joint contracture. When we tried to move his affected limb, he complained pain and he rated the pain with 9 over 10. (Visual Analogue Scale) When we were assessing the patient, we found out that patient got hemi-neglect...
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