PLACEMENT REPORT

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PLACEMENT REPORT

Berufsgenossenschaftliches Unfallklinikum Hamburg

Lea Griemens S3800733

University of Groningen

Faculty of Arts

Master Neurolinguistics

Internship

Dr. Dörte de Kok

March 10, 2020

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Introduction

About Placement Providing Organization

The Berufsgenossenschaftliche Unfallklinikum Hamburg is an accident hospital that specializes in acute care and rehabilitation of seriously injured and occupationally ill people. It is specially equipped for the care of fresh and old trauma consequences and multiple injuries. The focus is on rehabilitation in order to accompany the patients back to a self-determined and independent life with the help of comprehensive therapy.

My workplaces

During my clinical internship I worked at the following hospital departments: (list goes from most to least amount of time working at this department)

- Neurotraumatological center

o The neurotraumatological center takes over the complete care of neurologically and psychologically traumatized people. Multiple injuries often occur in accidents, some of which are life-threatening. These include severe traumatic brain injuries, brain hemorrhages and nerve injuries. These often lead to impairment of consciousness up to coma, speech disorders, balance problems, changes in behaviors and paralysis. Here, I focused on speech disorders especially.

- Interdisciplinary neurological early rehabilitation phase A and B

o Phase A includes initial treatment in an acute care clinic, often in the normal or intensive care unit. This is where acute care, diagnostics and therapy take place. In this phase, early rehabilitation begins. If there is no longer any danger to life, the patient is transferred from the acute clinic to a clinic for early neurological rehabilitation (B).

o The main goal in phase B is to bring the patient back to "conscious" life. Most of the time the patient is still in a stage of unconsciousness or severe impaired consciousness, which means that the ability of the patient to cooperate is severely limited. The early rehabilitation measures are intended to improve the state of consciousness and encourage the patient to cooperate. In this phase, intensive care treatment options still have to be provided.

- Intensive care unit

o The intensive care unit includes a traumatological operative intensive care unit and an intensive care unit for burn victims. The entire spectrum of modern, non-invasive and invasive monitoring is used here. The patient is always cared to in close cooperation with all departments involved in the hospital.

- Paraplegic center

o Here, people with spinal cord damage are treated. The damage to the spinal cord leaves permanent failures. These are expressed depending on the amount and extent of spinal cord damage. Failures can occur in the form of paralysis and sensitivity disorders on the extremities and trunk or as functional disorders of the digestive- and urinary tract.

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My tasks during the internship

Clinical (neuro-)linguist and speech- and language therapist

As a clinical (neuro-) linguist, it is essential to investigate the connection between language processing (understanding and production) and the underlying neuronal structures. Neurolinguistics explicitly refers to the anatomical and physiological aspects of the brain. My tasks during the internship included:

- Observing the work of other therapists, treating patients by myself (including supervision and evaluation talks)

- Treating patients with speech-, voice-, swallowing- and communication disorders

o Traumatic brain injury, critical illness polyneurpathy, stroke, cerebral hemorrhage, etc. resulting in mild to severe aphasia, cognitive dysphasia, dysarthria, apraxia dysphagia, etc.

- Making diagnoses

o After the patient was introduced, it was my task to find out which form of the disorder is present. In order to get to the right diagnosis, several factors had to be included: access to and working through existing patient file, anamnesis interview with patient (if possible), talking to family members, carry out diagnostic procedures. Combining all of this is important to see how the patient speaks as well as to see which psycho-social factors favor the patient’s disorder (for example: whether the patient shows developmental delays or has difficulties due to a stroke or accident).

- Developing individual therapy plans and implementing them with the patient

o My job as a clinical (neuro-) linguist was then creating a therapy plan (including short-term and long-short-term goals), which I explained to the patient and, if necessary, to doctors, other therapists, nurses and relatives. The patient got 30 minutes therapy 5 days a week, including documentation of each session.

- Combining knowledge from different disciplines

o On some days I was able to attend therapies of other disciplines such as doctors, physiotherapists, occupational therapists, music therapists, neuropsychologists, respiratory therapists, caregivers. This was beneficial in many ways. One the one hand, I got an idea of the work of the other disciplines and on the other hand, I was able to see the patient in a different setting and got to know him better and his holistic problems.

Professions in linguistics offer a wide variety of fields of activity that coincide with those of speech- and language therapists. Since I have a bachelor degree in speech- and language therapy, I was able to combine both professions during my internship.

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Goals and Experiences

Learning Outcomes

1. At the end of my clinical internship I am competent in taking and interpreting diagnostic tools that are used by clinical (neuro-)linguists (such as Aachener Aphasie Test (AAT), Aphasie Checkliste (ACL) or Lexikon Modellorientierte Einzelfalldiagnostik (LEMO)).

2. At the end of my clinical internship I know what therapy material is used for neurolinguistic aphasia therapy (such as materials from the NAT publishing company).

3. At the end of my clinical internship I elaborate test results based on the Ellis & Young model and based on this I diagnose the disorder.

4. At the end of my clinical internship, I draw up an individual and suitable treatment plan for each patient based on speech therapy- and linguistic examinations.

5. At the end of my clinical internship I know how to combine my therapeutic skills as speech- and language therapist and clinical (neuro-)linguist effectively.

6. At the end of my clinical internship, I attended a number of interdisciplinary team meetings and consultations where the treatment plan of each patient was discussed to get an idea of the role that a clinical (neuro-)linguist plays within a treatment team.

7. At the end of my clinical internship, I looked into the work of other disciplines (doctors, physiotherapists, occupational therapists, music therapists, neuropsychologists, respiratory therapists, caregivers) to get an idea of their work and to understand the patient as a whole. 8. At the end of my clinical internship I communicate adequately with patients, and the adapted

communication with people with neurological disorders is effective.

Additional experiences

Besides all the working experience on the patient and in a multidisciplinary team, I was able to undergo extra training on the following topics:

- Induction training in equipment (e.g. tubes, measurements, drips/lines inserted into blood vessels, feeding, medication), reading monitors/machines correctly (e.g. heart rate, oxygen level in blood, blood pressure, temperature), ventilation, change of position of patients - Cough aid (paraplegic center)

- Electrostimulation on vocal cord level

- Structure of tracheostomy tubes and dealing with patients with tracheostomy tubes

- Fixation of patients, because they are confused, endangering themselves or because of their age there is an acute risk of falling

- Documentation of content of therapy sessions

During my internship, I was also able to see the following procedures: - Fiber endoscopic swallowing examination

- Surgery for placing a percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy

- Electroencephalogram used to evaluate the electrical activity in the patient’s brain - Providing patient with nasogastric tube/intravenous feeding

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Evaluation

Right from the start of my studies I had been interested in an internship in a neurological clinic and was therefore happy to have received a confirmation from the Berufsgenossenschaftliche

Unfallklinikum Hamburg. So, the last two months I did an internship in a clinic in Hamburg looking into

neurolinguistic disorders especially. The team consisted of 9 therapists working at different departments. In order to get a precise insight into the everyday working life, I, at first, observed and witnessed the activities of the therapist. At the beginning I tried to get to know the therapists and their patients, mostly by observing the work. After a short period of familiarization, I was ready to actively participate in the activities. I got to know different patients with different problems and looked into the different treatments of the therapists. Next to that, I was also able to learn more about German diagnostic tools and German therapy material.

During my internship, I had the opportunity to gain new experiences and to deepen and further expand my previously acquired skills. I was able to get my first professional experiences as a clinical (neuro-)linguist and deepen my experiences in interprofessional collaboration. For some diseases, the need for interdisciplinary therapy is particularly evident. It is possible that an illness affects different body functions and the patient has to make use of several disciplines. The therapy goals are then individually tailored to the patient and deal with restoration, improvement or preservation. Each discipline has a different focus.

In the clinic, these different disciplines not only work side by side, but also with each other. This form of therapy is called co-therapy. Not only the patients themselves benefit from this form of therapy, but also the therapists.

During the internship I had the opportunity to combine both professions, clinical (neuro-)linguist and speech- and language therapist. Combining the skills of both professions resulted in more intensive and goal-oriented therapy on different levels.

Next to my usual daily therapeutic activities, the clinic offered additional training on different fields of activity (see ‘additional experiences’). I can now use all this information and my new gained experiences during my job as clinical (neuro-)linguist and speech-and language therapist.

I noticed that each patient must always be considered as a human, instead of only treating a certain disease. This is essential in order to create a basis for the relationship between therapist and patient that is based on trust and appreciation. In addition to professional knowledge in theory and practice, this basis is fundamental to ensure successful therapy. A good therapist not only needs his professional knowledge, but also humaneness. Therefore, in addition to good therapy skills, communication skills, such as empathy, active listening, etc. are also important components for a well-functioning relationship between the therapist and the patient. Furthermore, communication is of great importance when working and interacting in a team. However, it is important to always be and remain professional. In this regard, I have succeeded in acquiring new and relevant therapy skills, but also in developing myself personally.

The versatile work as a clinical (neuro-)linguist impresses me and will always present me with new challenges in my later professional life.

PLACEMENT REPORT