Ulanowski E1, Danzl M1, Loving V1
1Bellarmine University, Physical Therapy, Louisville, United States
Background: Given the rising prevalence of those over 65 in the United States, physical therapists will play a more prominent role in treating individuals with cognitive disorders. Research indicates, however, that as individuals with dementia decline cognitively, physical therapists' attitudes become more negative. Evidence supports the use of experiential learning modules in the curriculum to significantly improve student confidence and knowledge to treat individuals with dementia. Work stemming from Schön's model of reflection suggests that “reflection-onspecific action” can facilitate clinical decision-making.
Purpose: The purpose of this case report is to describe the use of this approach by students who conducted a case report with a patient with severe cognitive deficits.
Methods: A physical therapy (PT) student dyad completed a case report with an outpatient 74-year-old male veteran with severe cognitive deficits and history of post-traumatic stress disorder and traumatic brain injury. He required 24-hour caregiver assistance due to cognitive (e.g., problem-solving) and communicative (e.g., receptive and expressive language barriers) deficits. The primary goal of PT (2x/week, 60 minutes, 5 weeks) was to determine if higher intensity activity (assessed by heart rate) was feasible. Planned outcome measures (e.g., 4-square step test) were unable to be formally completed due to an inability to follow directions and high distractibility. To address their lack of confidence and the challenges with provider-patient communication, the students completed “reflection-onspecific action” journal entries post-session and used insights gained to enhance subsequent sessions
Results: Notably, the patient achieved higher intensity activity with therapists and improved participation and engagement across sessions. The journals were qualitatively analyzed for themes that contributed to the success of the intervention, fostered student confidence, and enhanced student communication with the patient. Themes included:
1) emphasizing automatic tasks,
2) family/caregiver involvement,
3) salient tasks,
4) short commands and direct communication,
5) low distraction environment, and
6) fluid transitions led by patient interest.
The faculty mentor noted that over time, the students became more adept at reflection and demonstrated behaviors typically more characteristic of expert therapists (e.g., more treatment time used for direct patient intervention and improved cues).
Conclusion(s): Individuals with severe cognitive deficits require opportunity to participate in higher intensity exercise to maintain functional mobility and decrease caregiver burden. A “reflection-on-specific action” approach to practice may combat negative attitudes toward these individuals and enhance effective communication and intervention implementation with patients.
Implications: The specific factors identified in this case may be beneficial to clinical instructors, students and therapists to develop exercise programs with individuals with severe cognitive deficits.
Keywords: Reflection on Action, cognition, Exercise
Funding acknowledgements: none
Purpose: The purpose of this case report is to describe the use of this approach by students who conducted a case report with a patient with severe cognitive deficits.
Methods: A physical therapy (PT) student dyad completed a case report with an outpatient 74-year-old male veteran with severe cognitive deficits and history of post-traumatic stress disorder and traumatic brain injury. He required 24-hour caregiver assistance due to cognitive (e.g., problem-solving) and communicative (e.g., receptive and expressive language barriers) deficits. The primary goal of PT (2x/week, 60 minutes, 5 weeks) was to determine if higher intensity activity (assessed by heart rate) was feasible. Planned outcome measures (e.g., 4-square step test) were unable to be formally completed due to an inability to follow directions and high distractibility. To address their lack of confidence and the challenges with provider-patient communication, the students completed “reflection-onspecific action” journal entries post-session and used insights gained to enhance subsequent sessions
Results: Notably, the patient achieved higher intensity activity with therapists and improved participation and engagement across sessions. The journals were qualitatively analyzed for themes that contributed to the success of the intervention, fostered student confidence, and enhanced student communication with the patient. Themes included:
1) emphasizing automatic tasks,
2) family/caregiver involvement,
3) salient tasks,
4) short commands and direct communication,
5) low distraction environment, and
6) fluid transitions led by patient interest.
The faculty mentor noted that over time, the students became more adept at reflection and demonstrated behaviors typically more characteristic of expert therapists (e.g., more treatment time used for direct patient intervention and improved cues).
Conclusion(s): Individuals with severe cognitive deficits require opportunity to participate in higher intensity exercise to maintain functional mobility and decrease caregiver burden. A “reflection-on-specific action” approach to practice may combat negative attitudes toward these individuals and enhance effective communication and intervention implementation with patients.
Implications: The specific factors identified in this case may be beneficial to clinical instructors, students and therapists to develop exercise programs with individuals with severe cognitive deficits.
Keywords: Reflection on Action, cognition, Exercise
Funding acknowledgements: none
Topic: Education: methods of teaching & learning; Education: clinical; Education: continuing professional development
Ethics approval required: Yes
Institution: Bellarmine University
Ethics committee: Bellarmine University
Ethics number: 574
All authors, affiliations and abstracts have been published as submitted.
