Articles Utilized in Level II Fieldwork

My first level II fieldwork experience was in an acute care setting. In this fast paced
setting, I had the opportunity to work with patients of various diagnoses such as stroke and
orthopedics. In order to successfully implement interventions for my patients, I did a bit of
homework by finding evidence based research to support my interventions. Due to the nature of
my facility, I worked with many older adults who suffered from falls. One article discussed the
importance of the trunk for providing proximal stability that is necessary for distal mobility
which is required for activities of daily living (Granacher, Gollhofer, Hortobagyi, Kressig, &
Muehlbauer, 2013). I incorporated core stability and strength while performing ADLs such as
eating and dressing at the edge of the bed while progressing the activities from proximal to
distal. In addition to falls, I came across many different types of patient post stroke and wanted
to incorporate interventions Ive learned in school. Looking back to the five implementation
strategies of task-specific training, I focused on making sure the task was relevant to the patient
and the context, repetitive, aimed towards reconstruction of the whole task, and reinforced with
positive feedback (Hubbard, Parsons, Neilson, and Carey, 2009). I spent a good amount of time
during a patients lunch to help develop skills using his affected upper extremity to grasp
different shaped objects. This was motivating to the patient because she was high functioning
and had difficulty with fine motor skills. Incorporating this activity during lunch allows her to
work on picking up different items such as utensils, cups, and a variety of fruit. Lastly, I spent
several weeks in the orthopedic unit working with elective surgeries for total hip replacements
and knee replacements. I noticed there wasnt a demand for utilizing adaptive equipment. One
article concluded that occupational therapist need to provide client centered care and include the
patient in the decision-making process to increase compliance when recommending adaptive

equipment (Thomas, Pinkelman, & Gardine, 2010). I implemented this concept during
interventions; however, I found most patient preferred to rely on their significant others help.
The best I could do is educate patients about the importance of their precautions and how each
device may be helpful when they eventually are discharged back home. Overall, these research
articles helped me as an occupational therapy student justify my strategies for implementing
interventions during treatment.

References
Granacher, U., Gollhofer, A., Hortobagyi, T., Kressig, R. W., & Muehlbauer, T. (2013). The
importance of trunk muscle strength for balance, functional performance, and fall
prevention in seniors: A systematic review. Sports Medicine, 43, 627-641. doi:
10.1007/s40279-013-0041-1
Hubbard, I., Parsons, M., Neilson, C., & Carey, L. (2009). Task-specific training: evidence for
and translation to clinical practice. Occupational Therapy International, 16(3/4), 175-189
15p. doi:10.1002/oti.275
Thomas, W., Pinkelman, L., & Gardine, C. (2010). The reasons for noncompliance with adaptive
equipment in patients returning home after a total hip replacement. Physical &
Occupational Therapy in Geriatrics, 28(2), 170-180. doi:10.3109/02703181003698593