• Please list all of the assessment tools you use when evaluating clients at this facility

 In a typical evaluation we assess and measure edema using a tape measure for girth, ROM using a goniometer, sensation using either Semmes-Weinstein or 2-point discrimination, pain using a pain scale, and if it is not contraindicated, we test strength with a dynamometer and pinch gauge. In addition, Medicare/Medicaid requires us to administer a Quick DASH. We also do an intake interview, and ask about PMH, medications, and most importantly, functional limitations.

• Of the assessment tools utilized at this setting, name and describe one that you were not familiar with prior to this fieldwork? If there are none, please describe a challenging evaluation session you had with a client.

Because I was familiar with all of the tools we use during evals, I will describe a challenging evaluation. We had a patient come into town for four weeks, and he was to be continuing hand therapy while here. He had suffered a severe trauma to his left hand in April, a complete amputation just proximal to the distal palmar crease while using a chopsaw. He had been Medivac’d to Stanford Medical Center and had a 16-hour surgery that night, during which orthopedic, neuro, and plastic surgeons performed replantation of his distal palm and digits. My FWS asked me to lead the eval, but she would be alongside to make sure everything went smoothly. Fortunately, our patient was fit and motivated to regain function in his hand, as well as incredibly pleasant and easy to work with. To my surprise, my patient’s hand was in pretty good condition, considering the severity of the injury. Nonetheless, I was still very nervous, and unsure of how much to do with him. He, on the other hand, was accustomed to hand therapy and took the lead with giving us his expectations and concerns. In doing that, he put me at ease and facilitated a smooth eval, as we went through assessing his A/PROM, sensation, strength, and functional use of his injured hand. After that, he also shared with us that he was scheduled for a tenolysis when he returned to California, which helped us set our main goal as maintaining/improving his joint ROM as much as possible so after the tenolysis, he would have no concerns with joint contractures. Now going into our third week of treatment, his hand looks even better than we expected, and his ROM has visually improved, as well as verbally the patient reporting he feels it has increased. Evaluating and treating this patient was a big hurdle for me because it was the most traumatic injury I have seen to date as a student therapist, and I feel it has dramatically improved my comfort in  handling these types of cases.