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Reflections of Holistic Clinical Reasoning

By Kayla Schulz, MA, OTR/L

As an occupational therapist (OT), I have both been taught and experienced the value of an interdisciplinary approach to working with clients. Thinking back to my time in OT school, I remember professors consistently preaching the importance of interdisciplinary teaming, yet feeling frustrated by the lack of opportunities to practice this skill in school. As a new

clinician, I had aspirations to prioritize an interdisciplinary approach in my practice and to call upon my colleagues to create holistic and interconnected care plans to best serve our clients. Yet, I was soon met with the realities of packed treatment schedules, insurance constraints, paperwork, and an overflowing inbox. My vision of being the star player on the interdisciplinary team seemed to go by the wayside. Luckily that vision and passion were recently reignited!

Earlier this month, I had the privilege of attending the first session of Integrative Education’s four-part webinar series entitled Holistic Clinical Reasoning featuring OT , Kim Barthel, and physical therapist (PT), Shelley Mannell. This course offers the unique opportunity for therapists to submit video case studies of a current client. In the series, Kim and Shelley dialogue and analyze the videos and address assessment and intervention strategies. Course participants also get in on the action as Kim and Shelley welcome observations and questions throughout the course.

In the first 2-hour session, we met a vibrant 6 year old boy named Chandler. After learning just a few things about Chandler’s diagnosis and history, we were able to gain a sneak peek into his therapy sessions with his clinician, Kelly Beins. The video was just 3 minutes long but allowed us to see Chandler during periods of transition with his therapist, engaged in gross motor activity on a playground, and participating in fine motor and visual-motor tasks in a home-based therapy session.

During my initial viewing of the video, I took notes of my observations and questions. I even “put on my PT hat” and tried to focus on aspects like gait and balance in anticipation of the analysis that Shelley would share. I enjoyed having the opportunity to view the video first, without additional dialogue, to form my thoughts and challenge my clinical brain.

Next, Kim and Shelley began their analysis of the video, starting from the beginning. I was astounded when they were able to spend over 30 minutes breaking down, discussing, and analyzing the first 12 seconds of the video! In those initial 12 seconds, we saw Chandler and his therapist, Kelly transitioning into a building. While I often catch myself not beginning “therapy” until we enter a treatment space, Kim and Shelley beautifully pointed out the value of this initial transition time. From his brief transition, they were able to make observations and assessments of postural control, body awareness, co-regulation strategies, pelvic floor function, vocal tone, breath control, proprioception, interoception, cognition, vision, sympathetic nervous system function, and body schema. Wow!

Throughout the session, Kim and Shelley worked as a team to build off each other, support one another, and accept feedback while using it to inform their clinical reasoning (a great example for all of us). They were able to pull all of these observations together and show just how interconnected they are. While this first session focused primarily on analysis, Kim and Shelley will work together to prepare an example of a treatment sequence for this client to model how to transition analysis into practical treatment strategies. They will share this treatment sequence at the beginning of the next session before moving on to the next case study.

So far, I’ve found this course to be a beautiful model for my vision of holistic, interdisciplinary care. The video analysis is a great example of what we know to be best practice and what I feel we hope to achieve for every client. While the constraints of time, money, and resources are certainly barriers, Kim and Shelley do a great job modeling the power and benefits of holistic clinical reasoning and interdisciplinary care in a way that feels attainable in our day-to-day practice. The vast wealth of knowledge that these clinicians shared left me, not with a feeling of inadequacy in my clinical skills, but instead with feelings of challenge, empowerment, and motivation.

While analyzing a client from a holistic perspective can feel a bit overwhelming, Kim and Shelley encourage you to start with what catches your eye first. They explain that if we’re looking at all areas, it doesn’t matter where you start, as long as you follow along with your clinical reasoning.

I’m excited to build what I’ve learned so far into my work. I have a fresh perspective on how to approach my analysis and treatment of clients as well as how to effectively work with my clients’ whole team. I can’t wait to follow along with Kim and Shelley’s journey in this webinar series as they continue to model a beautiful example of interdisciplinary care and holistic clinical reasoning.

For more information on the Holistic Clinical Reasoning course, click here.


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