News from my clinical

I only have one more week of my clinical left! I haven't posted about my experience much, for two reasons. One- I am extremely tired when I get home each day. Two- I'm scared that I'll violate HIPAA. I'll describe some general cases today because neuro is really fascinating. I'm having a great experience and I like inpatient rehab much more than I thought I would! I've been bouncing back and forth between two units: the neuro/spinal cord unit and the brain injury unit, so I've gotten to see a lot of different patients. I've started guiding some sessions, planning some treatments, and writing patient notes. I love that I'm getting to do stuff instead of just standing around observing.

On right: this is what a pt with neglect would draw.

I've been working with a really interesting patient lately (disclaimer: some details have been changed). This patient had a right parieto-occipital intracranial hemorrhage, which means that he has left neglect. Left neglect is something I learned about last semester in neuroanatomy, but I didn't really understand it. It works like this: because the right side of the brain is used for spatial reasoning and attention, a lesion on the right (especially in the parietal lobe) will produce neglect of the left side.

The patient will lean toward the left and think they're standing up straight. They will "push" to the left- meaning they put pressure on the right hand and right foot to help them lean more to the left. The patient will not notice people or objects on the left and will run into things. They also won't notice where their left hand or foot is and what it's doing. You literally have to tell a patient like this "Look to your left. What's over there? Where's your left hand?" They are capable of noticing things on the left, they just don't without verbal cues.

For instance, I arranged a semicircle of eight cones in front of this patient and told him to pick them up and stack them on the right. He picked up exactly four cones, then stopped. I asked him if he got them all. He said yes, but then started looking over to the left and noticed another one. "Oh yes, there's one more over here," he said. Then he noticed one more, and another one, until he finally looked far enough over that he saw all the cones. We have to get a mirror during treatment sessions so that he'll see himself leaning to the left and be able to correct. I've come up with some ideas and activities that I want to try with him tomorrow. I'm really enjoying working with him, and I hope I get to see some progress before I leave in just one week.