Crash and Burn
For the majority of my first clinical, I have been doing a lot of observing during the initial evaluations. I recently started to take patient histories, but when it actually comes to hands-on strength or neurological assessments, I haven't done much. For better or worse, this is the system that my CI and I have fallen into. So the other day when I was working with a different PT at the clinic, I was caught off-guard when he asked me to complete the evaluation for a patient with a diagnosis of "gait abnormalities."
First of all, I have never even seen an eval for someone with a neurological diagnosis. All of the assessments I have been involved with have been orthopedic. If that wasn't enough to make me nervous, I realized that I had about two minutes to prepare. I fumbled through the history, not knowing what was relevant to the patient's diagnosis, and too quickly found myself on the strength screen. At that point, I realized I had never done a strength assessment on anyone other than my classmates. Next came the sensory assessment, and I somehow managed to remember the lower-extremity dermatomes. (Considering how nervous I was at that point, I'll never know how I recalled that information). I felt like the entire thing was a train wreck, and there wasn't much I could do about it.
After it was all over, I had to focus the majority of my energy on not bursting into tears - partly due to embarrassment and partly because I was disappointed that I messed up and forgot some very basic things. The PT I was working with assured me that it wasn't as bad as I thought, which I really appreciated. Either way, it was a definite eye-opener. I really need to find a way to practice the elements of a clinical assessment on people who are not in my class.