Odd Man Out

Odd Man Out

Background:  This is my first fieldwork experience in the OTA department at Durham Tech.  I am assigned to a traumatic brain injury (TBI) center for people who are mildly/moderately affected by their injury.   All of the clients are mobile and can communicate to varying degrees.

Looking back, I was a little anxious about the experience.  The only real exposure I've had to the mentally ill has been the case studies that I'd read in Psychology class or the movies that I'd seen.  To say that the movies were stereotypical is an understatement, and the Psychology textbook only gives you the worst case scenarios.   I'd known some people with developmental delays, but the exposure had been limited.  I had questions about fieldwork.  What would it be like to interact with "real" people? What if I got there and it was too much for me to handle or it was unsafe?  What if it was like the movies???!!!

Let me back up.  Before we went out to the field site, some representatives from the center gave the OTA-180 class a briefing.  They wanted to establish expectations and allay our fears.  The main thing that I took from that session is that behavior is just a means to communicate.  (Keep that thought in the back of your mind when you go on fieldwork.)  They said that in order to better communicate, we needed to establish a connection to our clients so that we could better understand what motivates them.  This connection might enable to us prevent some frustrations which the clients feel, and, in turn, prevent behavioral extremes.

When I got to the fieldsite I was pleasantly surprised.  The center was nothing like what I'd seen on TV.  It was a beautiful place with large spacious rooms, nice/new furniture, and lots of windows to let in the natural light.  Everyone one was friendly.  They came up and shook my hand and introduced themselves.  They were willing to participate in whatever activities my classmates and I came up with.  They came to the table with a refreshing sense of openness and willingness to try new things.  They "jumped in with both feet," and they seemed to genuinely enjoy the activities.  Each time I left there with a feeling like it was a positive experience for both the clients and the OTA students.
 
There are 8 clients that we work with who have suffered from various types of head trauma.  Depending on the location of trauma, they range widely in their degree of difficulties.  A couple are almost completely aphasic, some have dysarticula, a couple have low vision, and a couple have flat affect.  I found myself wanting to communicate with all of them, but those that were expressive aphasic had difficulty talking to me.  I was unsure how much of my words they understood.

[Check out this link to learn more about the symptoms of TBI.
http://www.traumaticbraininjury.com/content/symptoms/severetbisymptoms.html  ]

It occured to me after I left, that the interactions that a client receives in rehab are somewhat affected by the location of  their brain injury.  Humans communicate with both their words and their facial expressions, but after a TBI that capability can be diminished in one or both areas.  I found myself talking more to those people who could understand me and who could express themselves.  I was a little embarrassed to talk to people when I couldn't understand the words coming out of their mouths.  Several times I had to ask them to repeat themselves.  Also, I tried to talk enthusiastically to all the clients, but those with a flat affect couldn't smile at me when we talked, and I didn't find the conversation with them rewarding.  I sometimes broke away from them to go do something else.  For those that could talk, I spent more time with them finding out about their likes and dislikes, establishing a rapport.  It dawned on me that those with better communication capabilities received a "richer" therapeutic experience.  I connected with them.  I came back to check on them more often to see how they were doing.  Since I had a rapport with them, I could make the activity more client-centered or ask them more pertinent questions. 

This realization makes me want to try harder to communicate with the aphasic clients.  They need my attention just as much as those who can communicate well.  Maybe I'll linger a little longer the next time there's awkward pause in the conversation.  And maybe I'll be enriched by the experience.  :-)