Observation Skills Related to Treatment

Lesson Objectives 1. Students will identify types of observations skills. 2. Students will demonstrate understanding of non- verbal communication related to patient/client interaction. Students will identify client factors related to the Practice Framework used in observation of clients for activity planning (localizing pain, attention, endurance, coordination, bp, heart rate, respirations, voice, etc.)

Types of Observation Skills Non-verbal signs Physiological signs Verbal signs

Non-verbal signs of Distress or Fatigue Slow movements Facial grimacing Closing eyes Grabbing a limb or body part

Physiological Signs Increased heart rate Increase bp Decreased oxygen saturation Sweating Limb shaking Difficulty breathing (breathing faster, harder, irregular)

Verbal Signs Voice pitch and rate change (faster or slower) Shaking voice What is actually being said

Signs during activity completion Watch the client’s: Coordination (both gross and fine motor) Speed of movements (both gross and fine motor) Apparent cognitive effort (seem to be struggling with attention, problem solving) Signs of fatigue (see physiological signs) Verbal cues (they will tell you, most of the time)

What the therapist needs to ask Are you ok? Are you tired? Are you having pain? Where? How much? Do you need to rest? Can you keep going? Get client’s feedback after activity is over, but still during session Was that hard/easy? Did it make you sore/tired? Could you feel it in your arm/hand/leg/back/etc.?

Follow up at next treatment session After our last session were you: Tired? For how long? What made it go away? Did it go away? Sore? For how long? What made it go away? Did it go away? In pain? For how long? What made it go away? Did it go away? Do you have any new goals for this session? (ask of patient, and ask of yourself as the therapist) Are there any changes that need to be made? (ask of patient, and ask of yourself as the therapist)

Suggestions for planning activity Try not to use the same activity twice in a row Find different activities that achieve the same goals Occupation-based activities can be used more often, but don’t “overuse” them Check in with the patient often; make sure their goals have not changed Is their goal “too hard”? Changed priorities? Living situation goals have changed?

If I observe these things, what do I do? Report changes to your supervisor Including: BP, Pulse, respirations, etc. that would indicate problems/trouble Note any incongruencies (the physiological not matching with the non-verbals/verbals

Pain… Pain is one of the most difficult to assess Some patients report pain to get out of having to work Physiology usually correlates to the pain reporting (BP, pulse, respirations increase) Speech often changes Be objective, but don’t ignore your intuition DON’T accuse your patient of lying, but you can ask other professionals, family, medical chart, etc. to find out more (history of injuries, anxiety, etc.) Keep your radar up, and you can usually tell when things just don’t match up