Level 1 Fieldwork: Inpatient Rehabilitation

Hey readers! This week I had an incredible experience completing my third level 1 fieldwork placement. I was placed at an inpatient rehabilitation facility where I observed an occupational therapist for three days. Level 1 fieldwork is comprised of 24 hours of observation in various settings, so that’s why I was only there for 3 days. In those three days, I had the opportunity to observe individual OT sessions, group therapy, a support group, and aquatic therapy. To protect the confidentiality of the patients and therapists that I observed as well as the location itself, I will be pretty vague about what I saw, but I hope this post gives you some insight into what OT is like in the inpatient rehab setting! Enjoy 🙂

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What is Inpatient Rehab?

In inpatient rehab, all patients must tolerate and receive 3 hours of therapy per day. This includes occupational, physical, and/or speech therapy. The length of stay is typically a few weeks, and OT usually sees each patient for an hour per day. Patients come to this setting after leaving an acute care hospital, and here they work on improving function and independence to either return home or to another facility, such as a skilled nursing facility. Typically, patients are in inpatient rehab because they need therapy services to strengthen them before returning home. For example, patients may need to be strengthened physically to be able to walk independently, learn adaptive strategies to be able to functional tasks such as dressing or cooking with their injury (ie. one-sided weakness after a stroke), or practice cognitive skills such as memory.

Populations Served

The populations served include individuals who have experienced stroke, spinal cord injury, traumatic brain injury, amputation, neurological condition, and/or musculoskeletal/orthopedic conditions. There was also a pediatric floor at the facility that I was in, which I wish I had gotten to see! My experience was mostly observing patients who had experienced a stroke or other neurological condition, such as multiple sclerosis.

One-On-One OT Sessions

The focus of occupational therapy in inpatient rehab is function. The sessions that I observed worked on functional mobility (ie. bed, wheelchair, toilet, and tub transfers), facilitation of the upper extremity through neurodevelopmental treatment (in other words, getting the arm to work again after a stroke), caregiver education, ADLs (ie. dressing, toileting, hygiene), IADLs (sorting groceries), cognition, coordination, balance, and more!

OT Group Sessions

I also observed group OT/Therapeutic Recreation sessions. This was basically an extra hour of therapy for any patient who was recommended by an OT. In this group, we worked on short-term and long-term memory, working memory, and social participation. We did this by playing name and “get to know you” games, facilitating relationships between patients so they had social support during their time in the hospital, and with current events. We ended each group with a fun activity that worked on various skills. Some of them worked on coordination and fine motor skills, and another was music therapy!

Support Group

I was lucky enough that my fieldwork placement fell during the same week as the monthly Stroke Survivor Support Group. This was a really fun experience. I observed as stroke survivors from the community created connections with other survivors. This is really important because it provides the participants a support network of people who understand what they are going through or have gone through. We also played a fun activity that worked on skills such as teamwork, memory, and information processing!

Aquatic Therapy

One of the patients that I was observing asked for extra therapy via aquatic therapy. (This person was AMAZING. His intrinsic motivation and desire to improve his function was incredible. I would love to see more patients who love therapy this much!) I was able to go down to the pool with him and observe the session, which was really cool. I believe the aquatic therapist was a physical therapist, and they did one-on-one pool sessions by request or recommendation. From my observation, they did a lot of passive ROM, strengthening with weights and a step, and walking in the water.

My Experience

I had an amazing experience observing OT in inpatient rehab. This is a little bit shocking to me after I did not love my first inpatient experience. The difference between the two settings was that the first was more short term (I like the longer term setting where you get to know your patients and see them grow), and in the first setting I observed way more ADLs (I think I spent half of my day in the bathroom). I really appreciated that in this inpatient rehab setting, I got to do more than ADLs. While those were still important, we also got to do IADLs, UE facilitation, functional mobility, and more occupation-based activities that were meaningful to the patients. If you haven’t read my post about my first inpatient setting, you can check it out here!

I learned in this experience that OT can look very different in various inpatient settings. Acute care is very different than sub-acute, which is very different than inpatient rehab, which is also very different from long-term acute care. Just because I did not love my sub-acute experience doesn’t mean I will not like any other inpatient setting! I actually really wish I had gotten a chance to observe the pediatric inpatient rehab floor at this setting, which I may look into doing in the future.

Question of the Week: I would love to hear from anyone who is an OT or did a fieldwork placement in inpatient rehab! What was your experience like? Comment below!

Thanks for reading!

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