Clinical Observation Reflection

Stephanie Nielson
February 22, 2016
PTA 1010-002 sp16
Instructor: Angela Bailey

The clinical observation assignment for this class, Intro to Physical Therapy 1010 has helped
me to acquire an understanding of what a day in the life of a physical therapist and physical
therapist assistant looks like. After doing some calling around, I found two clinics that would
allow me to complete 20 hours of observation. For the first day of observation, I went to clinic
#1. I felt like I was watching a stage production with therapists, aides and patients all in a flurry
of activity. The physical therapy treatment and terminology was relatively new to me, having
never been exposed to a physical therapy clinic. I was writing as fast as I could, noting the names
of interventions, exercises and conditions. The physical therapist that I was assigned to allowed
me to observe and ask him and the patient questions regarding the patients injury/condition for
treatment. I would ask why certain interventions were being used and what the prognosis was.
Gradually, over time, I began to see some treatments were being repeated on different patients,
for example the use Astym for soft tissue therapy. This treatment creates an inflammatory
response that then breaks down scar tissue. I learned scar tissue impedes mobility and the
adhesion to nerves and underlying tissues can be painful. The therapist used this on patients with
a sports injury and subsequent surgical ACL repairs to the knee. In another case, this treatment
was used on a softball player with a surgically repaired anterior labral tear to the shoulder. On
this same patient, he also performed joint mobilization. I learned that he would push down on the
joint, release pressure and take her through some manual stretching. He would spend about 10
minutes working on improving ROM and then would use the goniometer to compare the before
and after results.
Clinic #1 didnt have any hired PTAs. I was learning in the PTA 1010 course work, there
were some ethical and legal considerations that come into question when aides are used for
carrying out interventions. I saw aides perform trigger point massage, electrotherapy and they

would teach and supervise exercise. The more I was learning, the more I felt that there were
some risk management issues at the clinic.
For example, I met a 12 year old, female patient named Nora. Nora told me she came in
twice a week to do her exercises. She told me about her condition, she called it Joint
Hypermobility Syndrome, a condition where the ligaments around the joints are excessively
loose. She said she has difficulty running without falling and to my untrained eye I could see
there were abnormalities in her gait and foot alignment. The aides would bring her Thera-bands
for doing strengthening exercises. Nora knew the sequence of her prescribed exercises.
Periodically, an aide would come by to supervise that she was doing the exercise correctly or to
perform with her the single leg ball toss. But most of the time Nora ran through her exercises
independently. I began to wonder if Nora was benefiting fully from physical therapy without
constant supervision. I felt she wasnt and that she needed someone to supervise the accuracy of
the exercise, to gain the full benefit of physical therapy.
After completing six hours with clinic #1, I decided it would be more advantageous for me
to find a clinic that used PTAs to carry out treatments. At the American Fork IHC Physical
therapy clinic, I began observing a PT and a PTA to complete a total of 14 more observation
hours. I was very impressed by this clinic. It was organized and the roles the PT, PTA and aide
were well defined. Prior to the aide escorting the patient into the clinic, he/she would touch base
with the PT or PTA to clarify the warm up treatment. The aide would supervise the patient most
often on an exercise bike, elliptical, total gym or treadmill. Then the patient would be transferred
to a therapist. I was able to observe the first three steps of the Patient/Client Management Model:
examination, evaluation and diagnosis. This was carried out by the physical therapist on three
separate occasions. I saw the PT read through the subjective information of the patients medical

history, including the results of imaging tests. Then the patient was queried and the PT would put
those responses into the electronic history.
As part of the systems review, for a 40 year old woman with a herniated disc/s, I saw the PT
conduct an examination of the overall information systems of the body. This seemed to flow into
performing tests and measures. She checked for alignment, ROM, and had the patient
demonstrate active stretching. She verbally confirmed with the patient what she was seeing
throughout this step. The diagnosis and prognosis were discussed and with the patients input,
short and long term goals for mobility and reduction of pain were discussed. The PT than left the
room to print off some exercises that would help strengthen the muscles of the back as a way to
help facilitate the disc bulge to heal itself. The patient was taught the exercises and a follow up
appointment was scheduled.
On another occasion, I observed a PTA. One of the patients she worked with was a woman
who had had surgery on her ankle and was experiencing nerve pain of the superficial
peroneal/fibular nerve. This pain was due to scar tissue adhering to the nerve. Cortisone
injections were tried but didnt give lasting relief. The patient explained to me she was
experiencing swelling, decreased ROM as result of the peroneal tendons compensating for the
nerve pain. The PTA performed the Graston soft tissue therapy as an intervention. I observed the
patients pain level evolve from high sensitivity to the slightest pressure of touch this reduced to
a bearable tolerance of the Graston intervention. At the end of the session, the patient
acknowledged an improvement in her pain level.
I was very impressed by all the therapists personal interactions with patients. I could see
evidence of professionalism that demonstrated the APTA core values. I saw compassion shown
by a PTA who was very sensitive to a patients pain level and modified her technique to allow for

the patient to adjust. From this same therapist, I saw integrity as she refrained from performing
interventions she wasnt authorized to perform. On another occasion, I saw a PT and the staff
demonstrate accountability and excellence. They provided care for a patient who although was
late for their appointment, was given his full therapy session. This happened at the end of a ten
hour shift, which the staff had already put in. These are some of the observations I made that
impressed me as to this clinics teams dedication and altruism.
This clinical exposure has given me a realistic picture of the demands that are part of
working in an outpatient physical therapy clinic that provides high quality of care. There are
ethical requirements that guarantee patients safety. These must be met, even when patient loads
for therapists are high. Thorough, accurate and detailed documentation is extremely important as
it safeguards both patient and therapist. I can now honestly say, that my decision to pursue a
career as a PTA is being tested. I see a career that has the ability to provide me with the active
occupation I seek. I definitely see the positive difference high quality care provides patients. I
have seen therapists use critical thinking and problem solving to create and carry out plans of
care.
In conclusion, I continue to ask myself- Am I ready for the challenge that a career as
physical therapist assistant would demand of me? If accepted into the SLCC PTA program, can I
handle the intense coursework load? These are questions that I am still seeking answers to. With
the help of academic counseling and further queries into the field, I hope to have my answer very
soon. I do see the work in physical therapy being rewarding for me personally. With its wide
range of specialized branches of care and the opportunities to increase my knowledge and skills
over the course of my career. I would enjoy working and helping people develop solutions to
problems that limit their functional abilities. So I will, keep moving forward towards my short

and long term goals, that will prepare me for a career in the field of physical therapy.