Week 4

Week 4 consisted of a return to Queen Nandi hospital and  visit to Thokozani clinic.

The days at Queen Nandi as always were filled with interesting cases that not only improved my knowledge of speech therapy as a field in practice but also gave me insight into medical conditions, medications  and their impact on speech, language and swallowing.

Day 1 in QNH involved seeing a variety of language disorders across the continuum in terms of severity. The key thing learned and was evident in all the cases was the importance of educational counselling not only for the wellbeing and peace of mind of the caregiver but the best care for the child. Case 1 was a male client who had a past seizure. This client presented as hyperactive and interactive, being able to communicate appropriately to adequately express his needs. In this case a host of sesnory based ASD like characteristics were evident but the clear interactive personality of the client disputed this. The need for boundaries and re-inforcement, stimulation and generalization of current communicative strengths and vocalizations was evident in this case, with progress being coloured majorly by one of the most important MDT members in this case, the caregiver! Potential and a starting point for management was identified but a key area of intervention in this case proved to be counselling, slightly changing the focus of our ‘client ‘ centred intervention .

Another case which proved not only the importance of educational counselling but assessment of strengths and capabilities was case 2 where a 2 year old female was reffered from POPD for suspected delayed milestones in all areas. This soon proved to be  untrue. The client proved to just be an overly coddled little girl that didn’t appear to be at the same level of her peers not as a result of delay or disability but because she wasn’t allowed to be a toddler!One of the dominant themes of childhood development is exploration and learning new things, something this child hadn’t experienced due to not be given opportunity to explore and try independantly. Case 2 communicated predominantly through crying and showed great attachment to her caregiver, as a result of this client 2 didn’t independantly crawl, walk or speak, which upon examination and separation from the caregiver proved to be something she can do but chooses not to when indulged.The caregiver showed great relief but also worry during the examination as she had interpreted the child cries as indications of pain. Counselling was done by the MDT for the caregiver explaining the importance of interaction with other people and children and play and stimulation or the child. General Assessment by doctors and nurses would have immediately allayed these claims by  the caregiver proving that the best source of information and assessment is the client itself.

On the otherside of the spectrum a client and family that requires a great deal of support to place and enforce boundaries for client 3. This client displayed defiant and sometimes agressive behaviour when put in structured situations or situations not in his control. It is in this session that the importance of counselling parents on boundaries to create a structured secure environment was noted. Even more the importance of boundaries within the session was glaring, as these and re-inforcement were neccessary to provide therapy.

Week 4 revealed many and new learning experiences with the most important ones being boundaries and being aware of the caregivers and family’s needs as well as the clients but most of all how the consistency in your  practice as a clinician plays a huge role in progress especially within behaviour management.