Little Wins, Big Progress: A Day in the Life of an ACNW Occupational Therapist

8-9 a.m.: Lacerated tendon rehabilitation 

"Your thumb was the rockstar of the day," Ashley Samuelson, MS, OTR/L, BCP, a senior occupational therapist (OT) at ACNW, says to her 11-year-old patient. Then she reminds him to use his injured middle finger, not just his thumb, as he picks up pennies and places them in a plastic container. A wound on his hand makes the normally simple task a significant challenge. "I know today was hard," she says, blending encouragement with empathy.  

It's almost 9 a.m. on a Wednesday in February. For nearly an hour, Ashley has guided her patient through a variety of exercises designed to rebuild strength and flexibility in his fingers and hand.  

Several weeks earlier, this patient cut his finger badly enough to require surgery - a lacerated tendon in medical terms - which has left a long, jagged scar along the inside of his middle finger and palm. Patrick Brannan, M.D., a pediatric orthopedic surgeon at ACNW specializing in hand, wrist and elbow surgery, operated on the patient's hand and coordinates the exercises (also called protocols) Ashley uses during weekly sessions with the patient.  

"I've worked in other places where I didn't have direct contact with the providers," Ashley said. She's been an OT for 17 years. "Here at ACNW, I can message them directly, even during a session. Yesterday, I was able to use our secure messaging to consult with the surgeon when a patient was making faster-than-expected progress." 

The surgeon's quick response enabled slightly more challenging exercises while maintaining patient safety as the top priority. 

9-10 a.m.: Volunteer training 

Most days Ashley joins a team of nurses, physicians and other care team members as they meet for rounds, reviewing patients to get updates and make recommendations. Today, she's training a new volunteer. A local college student is exploring health care careers and spending a semester in the occupational and physical therapy unit. 

Ashley walks the new volunteer through various exercise stations and machinery in the rehabilitation clinic, demonstrating how to clean every surface. Disinfecting toys, mats and exercise equipment keeps patients safe from germs spread through contact. Having volunteers help with cleaning allows Ashley and the other OTs and physical therapists time to update medical records and other paperwork between patients. 

10-11 a.m.: Dog bite requiring stitches 

Ashley's second patient of the day is another boy, 9 years old, accompanied by his mother and two younger siblings. The boy was bitten on the hand by a dog, and while the laceration didn't require surgery, it needs stitches and a hand brace to stay safe while it heals.  

"A lot of time, kids his age will avoid moving an injured finger, so he's losing motion instead of gaining motion," she explains while preparing before he arrives. "We don't want him to have a stiff finger for the rest of his life."  

The exercise protocol Ashley guides him through differs from the one she used with her first patient because the wounds differ and are at different stages of healing. She gives a masterclass in positive reinforcement as she leads him through sets of exercises. As expected, he tries doing the exercises without using his injured finger. While playfully redirecting him, she pays close attention to moments he does the activity correctly. She says some variant of "Good job!" at least 40 times during the 45-minute session. His hard work and her encouragement pay off. After the protocol is complete, she measures how far he can bend his finger and takes one last opportunity to praise his effort. 

"Nice mobility today, sir! We started at 50 degrees, and we're ending at 64." 

11 a.m.-Noon: Serial casting for cerebral palsy 

Ashley's third patient of the day, a 19-year-old girl with cerebral palsy, is eager to get her wrist cast removed. It's the girl's second cast in as many weeks, though she's not being treated for a broken bone. Cerebral palsy causes hypertonicity in one of her wrists - meaning the muscles become so tense that her wrist is nearly immovable. To increase her range of motion, the ACNW team is using a combination of Botox and serial casting. A Botox injection relaxed the flexor muscles in the girl's stiff wrist, allowing the team to gently move it closer to a neutral position. A cast holds it in the new position for a week, then the process is repeated. 

Once the cast is removed, Ashley, the girl and the girl's mother are amazed at the progress. After just two weeks in casts, and some light pressure, the girl can rest her hand, wrist and forearm flat on the table - neutral position achieved! Ashley shares the proper technique for exercises the family can do at home to continue relaxing the wrist. 

Moments like this are one reason Ashley devoted herself to pediatrics. "Kids defy the odds," she says. "Their bodies are so plastic and can make so much progress." 

Noon-1 p.m.: Lunch and feedback 

Today's lunch menu includes a side of feedback. Ashley volunteers her lunch hour to review feedback from patient families as part of the Employee Engagement and Patient Experience Committee. These meetings ensure the entire ACNW team receives praise and constructive input that guides ongoing improvements. 

1-3 p.m.: Safe sleep and new OTs 

Most days, the hour after lunch is devoted to completing paperwork and updating patient medical records. Her 2 p.m. appointment was cancelled, so she has an extra hour for additional priorities, such as recruiting the next generation of occupational therapists and ensuring babies sleep safely.  

Ashley is the point person for contacting affiliated occupational therapy schools. She emails the schools to announce the opening of this year's application process for a Level II fieldwork position - a clinical internship that allows occupational therapy students to practice under the supervision of a licensed therapist. She also puts the finishing touches on a presentation about safe sleep practices for infants, a collaborative effort with the inpatient nursing staff. Together, they've developed a plan for educating parents and fellow staff members on the most current guidelines for infant sleep practices.  

3-6 p.m.: After-school sessions 

Wednesdays are Ashley's longest days, by choice. "There was a need for true after-school availability," Ashley said, so she opts to work a longer shift in the middle of the week. Typically, she sees patients every hour. On this day, she has another pediatric orthopedic patient from 3-4 p.m., but the last two-hour block is devoted to one new patient whose family may need a medical translator. Communicating via a trained medical translator means the evaluation of her new patient will take longer. It's a worthwhile investment to ensure the family understands treatment options and baseline measurements are accurate.