Fieldwork experience at a specialized school for brain injuries

I have always been interested in the neurological population, but could only see myself working with adults. That was until my Level II fieldwork experience allowed me to dive deeply into the complexities of pediatric occupational therapy, particularly working with children and young adults ages 5 to 22 years with brain injuries and brain-based disorders. This 12-week journey was quite different from my first Level II fieldwork site at an inpatient/skilled nursing facility that worked largely with undomiciled adults. It was crucial in shaping my clinical skills, broadening my understanding of diverse diagnoses, and pushing me to apply creative solutions to support children’s functional skills and strengths. While working with children with these conditions, I learned that progress is often non-linear and that every breakthrough, no matter how small, can have a significant impact on a student’s quality of life. At the school, we worked primarily on three goals: ADLs, academics, and social/emotional well-being. Working at a specialized school for those with brain injuries not only deepened my understanding of occupational therapy’s impact on individuals, but also reshaped my perspective on resilience, collaboration, and therapeutic interventions.

At this fieldwork site, I was able to collaborate alongside an incredible multidisciplinary team including physical therapists, speech-language pathologists, music therapists, hearing educators, vision educators, assistive technology specialists, yoga instructors, teachers, nurses, and paraprofessionals. Most students were seen by the three allied health therapies once a day, for 1-hour sessions, 4 to 5 days a week. In addition, each student in a classroom of five to eight students, had a 1:1 paraprofessional, a teacher, and a teacher’s assistant to support them throughout their school day. Depending on the child’s diagnosis and needs, if they required a G-Tube or tracheostomy, they would have a 1:1 nurse as well. Here, I was able to observe how each student had unique needs and dealt with their diverse cognitive, emotional, and physical challenges. This variability taught me the importance of flexibility in my approach and made me appreciate the core values of occupational therapy: individualized care, empathy, and creativity.

This fieldwork exposed me to a variety of therapeutic approaches, each requiring unique adaptations to suit the needs of the children I worked with, including my own therapeutic use of self. Learning the involvement of posture and positioning; helping with transfers of children to and from a wheelchair, swing, mat, or pool; and working with orthotics and adaptive equipment became essential parts of my daily tasks. I also learned to integrate assistive technology including adaptive scissors, easy holds, communications devices (switches, eye and head gazes, iPads), and so much more into therapy to enhance functional outcomes for children facing a range of challenges. I was able to learn so much about what I read in my textbooks, like types of wheelchairs and their specific parts, casting to mold custom-fit braces, and sensory tools and techniques. One of the most exciting aspects of my experience was exploring aquatic therapy. The pool became a place of transformation, where the students gained confidence and improved their motor and social skills in a soothing and supportive environment.

One of the most rewarding challenges was figuring out how to modify the activities to fit each child’s needs and learning the therapeutic use of self. I had to think critically and adjust my approach based on the child’s goals, abilities, and personalities. One of the children I worked with burst into tears the moment my clinical instructor asked me to participate in one of their sessions. Even just performing passive range of motion to their arms would cause them to get emotional due to their uncertainty about who I was. For the first week or two I was thinking that I would never get through to them and asking myself what I was going to do to get them to feel comfortable. How would I ever get this student to participate on my caseload for the full hour each day? I simply remembered that effective treatment and collaboration are built on rapport and the child’s trust. Whenever they did get emotional, it offered a chance to work on their emotional regulation goal to identify their feelings through the emotions buttons (characters of the emotions from the movie Inside Out), identify why they were feeling that way, and then identify a coping mechanism. Over time, as we learned more about each other and I gained more confidence through the help of my clinical instructors, the child became more receptive, and I could then bring in new ideas for sessions to target their goals.

During my fieldwork experience in a new setting, I gained many insights that I will take with me as I continue my journey and become an occupational therapist. I learned that it’s normal to experience feelings of self-doubt and to be overwhelmed. It is important to share these concerns with your clinical instructor, your fellow cohort members, and your fieldwork coordinator to connect and receive advice from others in similar positions. Be open to trying new things, learn new strategies, research the techniques used, and if you come across anything you are uncertain about, always ask the questions. You never know what you might enjoy until you put yourself out there. By developing relationships with your instructors, the other occupational therapy practitioners, and the rest of the interdisciplinary team, you not only enhance the client’s overall care, you can learn the unique perspectives of others, exchange strategies and techniques, and advocate for our profession.

Mya-Ann Tschopp is an OTD student at New York Institute of Technology where she will be graduating in May 2025. She is currently completing her doctoral capstone on educating and advocating for college students on the return to the education process post-concussion. She has occupational therapy areas of interest in neurology and physical rehabilitation.