Media Project

 

    The client I focused on for our Media Project was Barbara, a 64-year-old woman who was diagnosed with Relapsing Remitting Multiple Sclerosis about 30 years prior. She lives at home with her husband and adult son, enjoys crafting and sewing, has decreased memory, increased fatigue, and has experienced a significant loss of upper and lower body strength. Her doctor advised her to continue an exercise program when she gets home from her hospital visit, but she gets bored with ordinary exercise programs easily. For her case, I created a therapeutic activity that she can do when she is feeling fatigued and needing to sit down which will allow for an enjoyable task outside of her exercises. It is a lacing activity since she likes sewing and crafts. The materials I used were a paper folder, yarn, and a piece of tape. I chose this activity because it can be used to channel her creative side which could enhance her quality of life and mental health. She can punch holes in the folder wherever she wants, lace them in any direction she prefers, have multiple folders for different options, and pick some that are her favorite designs or colors. The activity can be adapted by cutting the folder in half or not (to make easier or a little more challenging to manipulate), punching more or few holes, and doing certain lacing techniques that may be easier or considered to be more difficult. This assignment supported my learning in this course because it required me to think from a holistic perspective for clients’ sakes and offer the best options for them. Neuro Aspects includes a huge emphasis on occupational performance. 

Neuro Note #6 - Guillain-Barre Syndrome (GBS)

 

For my final neuro note of Neurological Aspects of Occupational Performance, I read a self-reflection by Lori Basiege, a woman who is an administrative assistant at “GBS|CIDP Foundation International” who was diagnosed with Guillain-Barré syndrome (GBS) during her time in undergraduate school. GBS is an autoimmune disorder that results from one’s immune system attacking the nerves that carry signals to the brain, causing myelin sheath degeneration and affecting the peripheral nervous system. The first symptom Lori noticed was fatigue even after trying to combat it with vitamins and change in diet. Eventually, she began noticing muscle weakness, so she called her mom who demanded she go to the E.R. It wasn’t until her second visit to a different hospital that she was immediately diagnosed with GBS by a neurologist almost immediately. After 18 days of plasmapheresis, an intervention that exchanges blood plasma, she was released from the hospital. Years later, Lori decided to leave corporate America and pursue work with a nonprofit for GBS, which is her current position (Basiege, 2022).

In this course, I have learned that there isn’t a set age range for people to be diagnosed with GBS. Lori was diagnosed at a relatively early age, but some can be as early as four-years-old, unfortunately. I can only imagine how she felt as a college student, finally feeling the independence of being away from home and then learning that she would lose it, to some degree, for the rest of her life. As we learned in class, her lower extremity could be most affected, causing difficulty with dressing and toileting. She didn’t mention how her experiences with ADLs have been affected, but she gives the energy in her writing that she is not struggling with quality of life. She states she wants to remain positive, which is the phrase that helped her get through treatments. I would consider Lori to be inspirational and a role model because of this.

References

Basiege, Lori. (2022, April 22). Patient stories: Lori Basiege. GBS/CIDP Foundation International. https://www.gbs-cidp.org/patient-stories/lori-basiege/

Neuro Note 5 - Amyotrophic Lateral Sclerosis (ALS)

     

    I’m back with another Neuro Note, and this week’s topic is Amyotrophic Lateral Sclerosis (ALS), most commonly known as Lous Gehrig’s disease, which is a progressive neurodegenerative condition that affects one’s motor abilities. I read the story of Lauren “Lolo” Spencer, a rambunctious woman who was diagnosed with this condition at the age of 14 (Bergeron, 2019). The typical prognosis for ALS is 2-5 years but because she was diagnosed at such an early age, she had been living with it for 18 years in 2019 when the article was written, so it’s been 22 years now! Lolo was a very energetic girl who loved running, dancing, and street hockey, but she noticed she was a lot more fatigued and felt like her muscles were weakening despite being so active. She started using a wheelchair to get around at 19, five years after her diagnosis. At the age of 32, she said “My body has changed very slowly, thankfully, I just made a decision that I was going to live my life to the fullest. [ALS] was not going to be my story” (Bergeron, 2019).

    Although Lolo is thriving, she shared that accessibility to buildings, the street, and public transportation are a constant challenge for her and others who use a wheelchair to get around. She soon realized that there weren’t many online resources of people with disabilities telling their first-hand daily experiences, so she decided to create her own platform to share her own “real deal”. Her Instagram account is @itslololove and her YouTube is Sitting Pretty. Her goal was to become a positive influence on the disability community, doing product reviews, life hacks, giving dating and relationship advice, and general life advice for dealing with the harsh ways of society. She shares a lot of bright moments in her life like traveling with friends, clubbing, and doing fashion shoots, but also wants to avoid creating “inspiration porn”, which is a term used to describe how others view people with disabilities’ every move as being inspirational. Spencer states, “we’re able to live our lives as fruitfully as we can in spite of having some level of limitation” (Bergeron, 2019).

    I thoroughly enjoyed reading Lolo Spencer’s story and her experiences with ALS. This helped further my learning by providing a positive insight into what people with this condition can experience with the right mindset, although other factors like age and cognition before diagnosis are important to consider. I admire that she refused to let ALS define who she is and wanted to help others who may be experiencing the same or similar obstacles by setting an example that may inspire them to make the most out of their life. I chose this source to read among the others because of that reason. It’s important for me as a future OT practitioner to gain this insight to better assist my clients with their needs as well as advocate for them when it comes to accessibility, for example. Something I learned from the reading is that a prognosis of 2-5 years is not a guarantee for everyone who is diagnosed with ALS and that it is super helpful and important for people to be a little transparent at times so others can know they’re not alone and hopefully benefit from seeing it. The link to Lolo’s story is included in the reference below!

References

Bergeron, Ryan. (2019, June 8). Diagnosed with ALS at 14, she’s now a disability lifestyle influencer. CNN. https://www.cnn.com/2019/05/31/health/turning-points-lauren-lolo-spencer-als-disability-lifestyle-influencer/index.html

Neuro Note #4 - Spinal Cord Injury

 

For this week’s neuro note, I chose to read an article titled, “Jocelyn’s Gender-Neutral Nursery Renovation” written by a blogger who has a 10-month-old child and wanted to share Jocelyn "Jos" Franciscus' inspiring story. Jocelyn has a Spinal Cord Injury (SCI) which resulted in quadriplegia and her being paralyzed from the torso down without finger function. She coordinated and designed her daughter, Myla’s, nursery with her cell phone prior to Myla’s birth. Jos and her husband, Michael, bought a home that, fortunately, was equipped with a ramp and was very wheelchair accessible. It was important to them that the nursery be gender neutral to avoid gender stereotypes as well as the consideration that Michael would be spending a lot of time there caring for Myla. Jos said the most challenging part of the entire process was coordinating tradespeople with all their different schedules, especially being that this was her first time needing to do so. She is a very organized person and found it difficult rely on others so heavily for something she once did with ease. After finishing her daughter’s nursery, she now consults for children’s interiors giving her best advice. A few of her recommendations include “have fun with it!” and “with a bit of forethought and preparation, a nursery can become a haven that grows with them for many years to come” (Anderson, 2016). I think this is great advice.

I chose this resource among all the choices because I was curious about how a person with a SCI can complete home renovations like a nursery and I also love to see nursey designs! Fun fact: I looked Jocelyn Franciscus up on Google and it turns out, she's an Occupational Therapist! Anyways, what I took away from the reading is that a SCI should not hold someone back from their passions in life and they can do what they love with a few modifications. I believed this prior to the reading, but I learned more about how that can be achieved specifically. She made use of today’s technology, her support system, and professionals who could get the job done physically because she had the resources. I would recommend this reading to others because it is insightful for anyone who wants to learn more about SCI’s and nurseries!

References

Anderson, M. (2016, April 17). Jocelyn’s gender-neutral nursery renovation. House Nerd. https://www.house-nerd.com/blog/articles/jocelyns-gender-neutral-nursery-renovation  

Neuro Note #3 - Huntington's Disease

 

In order to further enhance my learning about Huntington’s disease (HD) outside of the Neuro Aspects course I’m taking in OT school, I watched a brief video titled, “Huntington’s disease: I’m taking a test that will reveal my future”, about a family from the UK who have been affected by this disease. In the film, two sisters, Danielle and Sophie, have a mom, Lisa, in the late stage of Huntington’s and have opposite opinions on if they want to do the genetic testing that will determine if they have the gene from their mother. They understand that there is a 50/50 chance that either of them could have inherited it, which is also what we have learned in class. Sophie doesn’t want to know if she has it because she feels like there will be a “dark cloud over [her] for years to come” while Danielle prefers to know as she is a newlywed and would love to have children. In the end, we learned that Danielle did have the gene for HD and she may not show symptoms for at least 10 years. She went on a honeymoon cruise shortly after (Wright & Beale, 2020).

Danielle mentioned that in the beginning, her mom often walked like she was drunk and broke her arm and hit her head around this time, too. This relates to our course content because knowing that she had trouble with balance and coordination lets us know that it involves the functioning of her cerebellum and basal ganglia. As she progressed to the late stage, she needed full-time care, was tube fed, and was unable to complete ADLs on her own. It was shown in the video that Lisa had caregivers outside of her family who helped her with these activities like putting on makeup and getting dressed to go out.

I chose to watch this BBC interview because I wanted more insight on how HD effects families and to see firsthand how people who have any relation to it, whether they are experiencing it or providing care, feel daily and/or overall. As of now, there is no cure for this disease and clinical trials are taking place to see if new agents might slow down the progress or prevent it from developing in the future (Wright and Beale, 2020). 

References

Wright, A. & Beal, T. (2020, February 1). Huntington’s disease: I’m taking a test that will reveal my future. BBC News. https://www.bbc.com/news/av/stories-51310996

SLUMS Assessment Simulation Report

 

    As part of the Neuro Aspects course I'm taking in OT school, I participated in a clinical simulation encounter today during which I administered a cognitive screening to a person with a recent history of stroke. This assessment is called the St. Louis University Mental Status exam (SLUMS). The purpose of this exam is to assess a person’s cognitive state and be used as a screening tool over periods of time. Cognition can be described as a mental process that requires input from one’s thoughts, senses, and experiences (“What is”, 2015). Occupational therapists’ role when assisting clients with cognitive deficits is to give them the best opportunity to do their occupations by playing to their strengths, considering assistive devices, and/or modifying their environment so it is safe and accessible.

    The actor client, Harper Henshaw, got a score of 21 on the SLUMS. This score indicates a “mild cognitive impairment” for clients with a high school education. People who are in this stage experience memory loss and problems with judgement. In a home setting, they will most likely have trouble remembering tasks and events but will be able to live functionally overall. In my explanation of OT to the client, I feel as though I did a decent job of making it understandable and pointing out that we can help them work to their strengths and/or modify their environment. I adapted the “elevator speech” by including occupations that the client might like to do like completing puzzles and explained that we help with things they want and need to do.

    I feel like I did a good job of keeping the experience subjective rather than telling the client she did great or saying “perfect” which can be misleading. I let her know that it wasn’t a pass or fail test and it would be a tool used to see where she is with her memory. If given the opportunity for a re-do, I would use hand sanitizer when I walked in the door and think of some better topics for small talk once the assessment was over. My big take-away of this whole process was that sometimes the encounter will not go as expected or the client may think of a question differently than we intend but we should always be adaptable and document anything worth noting. Going forward, I will use what I learned by applying it to future sessions and especially fieldwork opportunities so I can learn even more before I become an official Occupational Therapist!

References

What is cognition? (2015, August 19) Cambridge Cognition. https://cambridgecognition.com/what-is-cognition/#:~:text=Cognition%20is%20defined%20as%20'the,used%20to%20guide%20your%20behavior.

Neuro Note #2 - Traumatic Brain Injury

 

I took the time to read the article titled, “When A Prisoner Returns Home with A Brain Injury, Freedom Isn't So Free” written by Christie Thompson and Joseph Shapiro about a man, Chuck Coma, who sustained an anoxic TBI during his time in federal prison after being assaulted by his cellmate. Chuck was a war veteran who suffered from PTSD after witnessing a grenade kill to men in his unit shortly after they arrived in Iraq. He experienced great discomfort from his disorder and eventually turned to alcohol and cocaine to self-medicate and bury his memories. His life took a turn as he obtained more and more criminal charges such as DUIs, drug possession, and assault. Eventually, he turned to armed bank robbery and suggested that maybe he found romance in the idea of being a bandit (it is suggested because the interview was gathered after his TBI).

Before the incident, Chuck had a sweet spot for his mother and was always very affectionate towards her. But when he returned home, he had outbursts of frustration and would often swear at and threaten her which was very unlike him. He also experienced confusion and would take off, requiring his mother to come after him. Once, she found him walking on the side of the road and then took a fall. As she tried to help him into the car, he screamed that he was being kidnapped by a woman, which resulted in him being admitted into a psychiatric hospital. Overall, Chuck’s symptoms following his TBI included tremors, lack of balance, intense irritability and frustration, and amnesia.

I chose this reading to further my learning because it pertains to the prison system, which I am usually interested to know more about since my dad was incarcerated for seven years. The reading opened my eyes even more to people’s experiences in federal prison, solitary confinement, and more importantly the effects a TBI can have on someone both long and short term. This relates to our course content because we have learned about the symptoms of his injury such as amnesia as well as decreased balance and tremors which can relate to the cerebellum’s functioning. Additionally, Chuck displayed the common symptoms of a TBI that relate to behavior which were combativeness and agitation. Lastly, as future OT practitioners, we may have a client who spent time in prison and it’s important get an understanding of their mental health and experiences from being there so we can offer the best care for every individual. I would recommend this reading to others because it is informative and offers the perspective of someone who had these experiences firsthand.  

References 

Thompson, C., & Shapiro, J. (2019, December 17). When a prisoner returns home with a brain injury, freedom isn't so free. National Public Radio. https://www.npr.org/2019/12/17/788824775/when-a-prisoner-returns-home-with-a-brain-injury-freedom-isnt-so-free

Neuro Note #1 - Alzheimer's Dementia

 

    In order to enhance my learning in my Neuro Aspects of Occupational Therapy course, I decided to read an article written by Carol Bradley Bursack titled, “Should You Play Along with Dementia Patients’ Realities?”. She wrote about her experiences caring for her dad with Alzheimer’s Dementia. She mentioned he would wait endlessly (she waited it out to be sure) for his medical degree from the University of Minnesota which would never come because he didn’t get to finish his studies. While he was in school, he took a break to pursue archaeology and while he was working on that he was drafted into World War II. There he suffered a closed head injury as a result from collapsing of heat exhaustion and hitting his head on the hard earth floor of the Mojave Desert. Over time, fluid began to build up behind the scar tissue in his brain which required him to get surgery to drain it. The surgery backfired and caused him to enter a severe stage of dementia.

    When her dad expected a degree or acknowledgement to come in the mail, Carol took it upon herself to create documents that seemed like the real thing to go along with his perceived reality. When he had delusions of war going on around them, she would play along with the idea by saying “we are in a safe zone” after the tactic of trying to convince him that there was no war at all didn’t work. She didn’t play into every delusion but if they were harmless to him and others, she thought to herself “why should I make his life miserable by continually telling him he is wrong? Going with the flow is not hurting anyone else and it makes his life with Dementia a little more bearable”. She found out later on after being scolded by a psychiatrist that her tactic was actually supported by a theory called validation therapy.

    I chose this resource to further my learning about Dementia because I was curious to know if it is considered acceptable to “go along with” the realities of people with dementia and how that can be beneficial or harmful to them. I agree with Carol and the theory of validation therapy that this can make the patient’s and their caregivers’ lives easier by validating them even if they are wrong if it doesn’t pose a threat to anyone. This ties into what we’ve learned about Occupational Therapy’s role in clients with Alzheimer’s Dementia because it can increase their quality of life by not making them feel disregarded all the time. I would recommend this article for others’ learning experiences because it introduces a different viewpoint and understanding of people with dementia and the roles of their caregivers.

References

Bursack, Carol, B. (2023). Should you play along with dementia patients’ realities? Aging Care. https://www.agingcare.com/articles/playing-along-with-dementia-realities-121365.htm

Proper Techniques for Using Assistive Devices

 

    It’s essential for therapists to fit their clients for the use of assistive devices to prevent friction, or chafing, and to ensure they are safe when using them. If their assistive device is not fitted well for their capabilities or height, there is risk of falling and/or use of improper body mechanics.

    To fit clients for a cane, platform or rolling walker, the therapist must adjust the hand grips at the same level of the client’s ulnar styloid, wrist crease, or greater trochanter for best fit. Their elbow should be relaxed and flexed about 20-30 degrees. If the fitting is done correctly, the client’s shoulders should also be relaxed with no elevation for comfort and proper body mechanics.

    A rolling walker has two wheels in the front and will be used by someone who does not have enough strength in their upper extremity to lift the walker, so it rolls for added assistance. When instructing a client to use this device from stand to sit, have them approach the surface they will be sitting on, turn, and back up until they feel the back of their legs touch the seat or bed. Have them reach back with their hands, one at a time or they can keep one hand on the walker and sit down slowly. If they have a non-weightbearing side, they should extend that leg in front and off the ground before lowering. From sit to stand, with walker in front, have them scoot to the edge of their seat or bed (or help with hip walking if necessary), place hands on that surface (one hand on walker is okay), lean forward and push up to stand using their arms and uninvolved leg. Ensure they have the involved leg off the ground when standing but both feet should be flat on the ground if they are able. Lastly, they should place both hands on the walker. For instructing a client on ambulation for this device, let them know to push the walker forward, no more than arm’s length, place the involved leg forward (if non-weightbearing keep this leg off the ground), transfer weight onto their hands, swing through with the uninvolved leg, and continue with this pattern. To help them complete a turn, have them take multiple controlled steps.  

Retrieved from: https://www.cherokeeuniforms.com/b-gait-belt.html

    

 

    In comparison, a platform walker is going to be used by clients who cannot bear weight through their wrists or hands so it will have one or two platforms attached. When instructing a client to move from sitting to standing with this device, it will be the same for the rolling walker except you’ll need to ask them not to push up with their uninvolved arm. Once they’re standing, have them place the uninvolved forearm on the platform. And when they go from standing to sitting, they must remove the uninvolved forearm from the platform prior to sitting down. If they have both, an uninvolved leg and arm, assist them with a gait belt to help them stand. Ambulation is the same as the rolling walker, and platforms will be at the height of the client’s elbow. 

    Canes are used by those who don’t need as much of the added stability that a walker provides. To instruct a client on how to go from sitting to standing with their cane, have them scoot to the edge of the surface (or assist them with hip walking), position their feet flat on the ground and toes underneath their knees. Ask them to place the cane on their uninvolved side and hold the handle loosely. Inform them to place their other hand on the seat surface, lean forward, and push up on the cane to stand using their arms and legs. When they are going from standing to sitting, have them approach the chair or bed, turn, and back up until the back of their legs touches the surface. Again, they will hold the cane handle loosely, reach back with one hand on the surface, lean forward, and slowly lower to the seat. To instruct on ambulation for this device, ask them to move the cane and involved leg forward at the same time, but if their balance is not very good, instruct them to move the cane forward first followed by the involved leg. Next, they should step through with the uninvolved leg and be sure to step beyond the involved leg. They should continue with this pattern, and to complete a turn ask them to make multiple controlled steps as they do it. If they are using a quad cane, the narrow end should be on the same side of the client for added mobility but stability on the outside.

    The fitting technique for axillary crutches is the same in regard to handgrips being level with the greater trochanter, ulnar styloid, or wrist crease with elbows relaxed and flexed about 20-30 degrees with shoulders relaxed, too. An additional precaution every therapist should be sure to include is the axillary rests being about 5cm, or 1.5 inches, below the floor of the axilla (or underarms) to prevent friction and pressure on the axilla. This should equate to the crutch being about the same length as the distance from their forearm to the fingertips of their opposite hand. To fit for Loftstrand crutches, the standard is the same, but the therapist should adjust each arm cuff 2/3 of the way up the client’s forearms so they aren’t too low and not crossing the elbow joint causing friction and lack of mobility.

    To instruct a client with sitting to standing using an axillary crutch, let them know to extend their involved leg in front if it is non-weightbearing just like other devices mentioned. Ask them to scoot to the edge of the seat or bed if they are able (or assist them if needed), place both crutches on involved side and hold the handgrips, place their other hand on the surface, lean forward, and push up to stand using arms and uninvolved leg(s). One they are standing and balanced, they should move one crutch under the arm of the opposite side and place the other crutch under the arm of the involved side. If they are going from standing to sitting, have them approach the surface they will be sitting on, turn, and back up until their legs touch the surface. Next, ask them to place both crutches on the involved side and hold the handgrips, reach back with the opposite hand for seat surface (extending the involved leg in front if needed), and sit down slowly. For assisting with ambulation, instruct them to place the tips of the crutches in a tripod position meaning out to the sides instead of straight up and down, transfer their weight onto the handgrips (avoiding placing pressure on their underarms), swing through, and continue this pattern. Again, they will need to take multiple controlled steps to complete a turn.

    Lastly, when the therapist is helping instruct on how to sit to stand using Loftstrand crutches, it will be the same as axillary crutches except the forearm should be placed into the cuff after standing and before sitting during a stand to sit. It may be easier for the client to hold the crutches perpendicular to one another if the client is able. For ambulation, inform the client that the handgrips must be facing forward.

    Safety considerations for all devices include having gait belts on clients for sitting, standing, and ambulation to prevent harsh falls and assist with movements as needed.

References

Giles, A. K. & Kraft, S. (2019). MOBI- Mobility Aids. Available from https://itunes.apple.com/us/app/mobi-mobility-aids-id1205309397

Weisser-Pike, O. (2023, May 23). Lecture 12: Gait & Locomotion [PowerPoint Slides].

The Effects a Funny Commercial Can Have on the Brain

    An advertisement that really stood out to me was Drake’s collaboration with Apple Music in 2016. The commercial shows Drake working out with his personal trainer with rap music in the background but when the trainer leaves, he opens his Apple Music and plays “Bad Blood” by Taylor Swift and starts to sing with all his heart. By the end of the ad, he’s doing a bench press but falls over because he's distracted by his passionate singing and can’t hold the weight. This ad stood out to me because it was both comical (because it’s Drake who was trying to seem super macho in the beginning of the commercial) and relatable to me as a 17-year-old girl at the time who got about as much pleasure from the Pop song as he was. I also had a crush on Drake when I was younger so of course I loved seeing a combination of him working out and showing his goofy side to a song I liked in my teenage years.

    This advertisement had an impact on my nervous system in a few different ways. Because it was funny and I thoroughly enjoyed it, the ad affected the release of certain neurotransmitters like dopamine (reward), serotonin (mood), and norepinephrine (mood). I would say Dopamine was probably the most apparent after I laughed so hard at his dance moves. It was also nostalgic for me in a way because I had that childhood crush on Drake and it was also funny, so the region of my brain that was involved was the Limbic System, which includes the Hippocampus, Amygdala, and Hypothalamus. Specifically, this commercial had an effect on my Amygdala because memory and emotion were involved as I watched.

I've attached the ad below so please watch it for your own entertainment and I hope you enjoy it as much as I did!

Important Considerations for Patient Transfers

    There are several things healthcare professionals need to consider for an efficient transfer, or movement of a client from one surface to another, to ensure safety for everyone involved. A transfer can include a bed, tub, shower, vehicle, toilet, chair or the floor. The practitioner should thoroughly explain the steps and the client’s role before initiating the transfer. 

    First, a therapist would need to consider their client’s capabilities and medical precautions. This includes their balance, cognition, strength, endurance, body type, wheelchair style, ROM, medical instruments, and orthotics and prosthetics. Medical instruments can include a catheter bag or IV tubes. 

    Second, the therapist should consider their own capabilities, preparations, and positioning. How does one’s body size compare to their client’s? What are their physical capabilities? Do they need to ask for assistance to complete the transfer? Are they practicing safe body mechanics like staying to the front or side of the client while staying as close as possible to them, maintaining a wide base of support, and refraining from twisting their trunk as they transfer? They should use key points of control and use their own body to facilitate client stability and proper body mechanics. 

    Third, the therapist should definitely consider the environment and make sure they have all the tools needed for a safe, effective transfer. They may need a gait belt or sliding board readily available. Additionally, one will want to make sure gaps are closed, wheelchair brakes are engaged, footrests are removed and out of the way, and the castor wheels are turned and out of the way, too.

    Next, the client’s positioning is important to consider. Healthy body mechanics are important for them to use for their safety as well as the therapist’s. They also should not, under any circumstances, grab onto or place their arms around the practitioner’s neck for any reason. This is unsafe and will result in injury most times if not always.  A smaller base of support is better for mobility purposes so the client should be positioned in a way that will make it easier for them to move from one surface to another. Transferring on the client’s unaffected side and pointing their heel in the direction they’ll be going are also key components. They should also be at the edge of the surface and shift their center of gravity forward to begin the transfer. 

    Lastly, the positioning of all equipment is important to note. This can include a wheelchair, walker, sliding board, bed, etc. Wheelchairs should be placed perpendicular to the transfer surface and the armrest on the transfer side should be removed for a lateral swing and/or sliding board transfer. Gait belts should be placed tightly (but comfortably) around a client’s waist or under the breasts or underarms depending on their needs. A sliding board should be positioned with one end under the buttocks and the other end on the transfer surface with no gap between the chair and surface (Weisser-Pike, 2023). 

    It is the role of Occupational Therapists and other healthcare professionals to remain knowledgeable about protocols, safety measures, and what is best overall for their clients.

Retrieved from: https://www.wikihow.com/Safely-Transfer-a-Patient

References 

Weisser-Pike, O. (2023) Lecture 10: Bed mobility & transfers [PowerPoint Slides]. Blackboard.

Paul Erway's race for 50 marathons, in 50 states, in 50 weeks

    After reading a small part of Paul Erway’s 50 Abilities, Unlimited Possibilities — Racing to the Final Finish Line: From Salt Lake City to the Mountains of Montana, I learned more about wheelchair users’ experiences in certain situations from maneuvering on different types of terrain to paying to park. In 2013, Erway and two friends set out to achieve a goal of completing 50 marathons in 50 states in 50 weeks. I read the chapters dedicated to their Colorado and Idaho races for this assignment.

    His 25^th marathon took place in Aspen, Colorado where he learned that 20% of the race would take place on a dirt trail and about a block would be cobblestone. The course also consisted of multiple 90-degree turns and steep downhill slopes. Initially, I thought the slopes would be beneficial to him and while they were at times, they also made it difficult for him to make the sharp turns ahead. While there were lines in the middle of the trail to indicate the sharp turns, Erway forgot what they were for and had to hold one of his wheels tightly so he wouldn’t crash. The movement was so abrupt it resulted in him getting a flat tire. He was able to replace it with a spare and complete the race.

    In the Behind-the-Scenes section of this chapter, he told us about how he came back to the rental car to find that he received a ticket for parking overnight without paying at the meter. He expressed that the meter is out of reach for wheelchair users so he would not have been able to pay anyway. Had he called the police, he wouldn’t have had to pay to park, but he was in a rush at that time. This is an issue I never thought of before reading his book and I feel like more people should be made aware of the importance of height adjustments for things like counter-tops, light switches, appliances, etc. It would even be beneficial for parking meters to have two points of accessibility: one about three feet from the ground and one at regular height. I mean come on, who wants to have to call 9-1-1 just to park overnight?

Retrieved from: https://townepost.com/kentucky/50-abilities-unlimited-possibilities/

     Next, I read the chapter for his 27^th marathon in Pocatello, Idaho. One of his friends, Grant Berthiaume, traveled to the race by airplane and was displeased to find that his wheelchair was damaged by the airline employees. His steering was damaged and made it much more difficult to complete the race. He didn’t have tools on hand to fix it, so he had to compete at a slower pace, reach further onto the steering bar for control, and take up the entire trail for the duration of the race.

    In the Behind-the-Scenes section, Erway explains that the wheelchair division of the Pocatello marathon was previously removed because of safety issues regarding wheelchair and hand cycle users, a nearby ravine and, an Interstate. Rather than making further accommodations and safety measures to ensure inclusion for these racers, organizers decided to remove the division entirely. Fortunately, Tom McCurdy, the wheelchair division coordinator, fought for the city to resolve this issue and he was successful after two years. The marathon now requires a pre-racecourse tour for all first-time racers and a bright front light for the beginning of the race as it starts just before dawn.

    Now that I’ve read these chapters, I understand more about the hardships wheelchair users face daily. They constantly face issues with terrain, accessibility, inconsiderate airline employees, and inclusion but those are only a few problems to name. As a future OT practitioner, I will work hard to reduce these issues in any way I can whether it’s day-to-day communication or a big project to accomplish the necessary improvement for the people of this community.

Retrieved from: https://townepost.com/kentucky/50-abilities-unlimited-possibilities/

                                                   Reference

Erway, P. (2019). 50 abilities, unlimited possibilities - Racing to the final finish line: From Salt Lake City to the mountains of Montana. Silver Tree Communications, LLC.

Posture and Body Mechanics

Taking a nap

Leisure

Reaching for Placemats

    I took three pictures of my best friend doing a few of her daily occupations: napping, playing on her phone while sitting on the couch, and reaching for placemats to set the dinner table. In the picture where she is reaching for placemats, she has a static posture, her head is facing upward, and in turn, the cervical and thoracic curves of her spine are extended. Her scapulae are protracted and upwardly rotated to assist with overhead reach (shoulder flexion). Her pelvis is in slight anterior tilt so her lumbar spine is in hyper-extension but her sacral spine is flexed and her pelvis did not rotate. She has equal weight distribution on each foot. Her hips are considered to be in slight flexion as her pelvis tilts anteriorly and her left and right ASIS become inferior to both PSIS. Lastly, both of her femurs are externally rotated. 

    This position is considered to be less efficient for stability because she has a smaller base of support with her feet closer together but she has more of an advantage for mobility because of this. She can quickly change out of this position with ease if she needs to. Her upper extremities are free to move a great deal as they are not supporting her body because she is not holding onto the shelf for balance. This posture is ideal for proper body alignment, for the most part, but her hips are not fully aligned with her knees and ankles as she leans forward which puts more stress and force on those lower joints. Ideally, she could remain in this position for a longer period of time but her arms would become fatigued after being held overhead for a while. She may need to shift for relaxing her arms every 20 seconds. 

    It is important to teach proper posture and body mechanics to clients who are in need of healthy alignment techniques because not knowing and applying this knowledge in everyday life situations can lead to neck and back pain, increased stress, and unsafe movements. 

Retrieved from: https://www.microfiberwholesale.com/blogs/blog/ergonomic-mopping-best-proper-mopping-techniques

    One example of how I would teach proper posture and body mechanics to a client who needs improvement in these areas would be to incorporate proper posture techniques in sessions such as keeping shoulders back with scapulae retracted, neck in slight cervical extension, and lifting/moving objects without twisting. Another example would be to teach proper sleeping habits for clients who are stomach and side sleepers by showing them where to put an extra pillow for their desired position. This would include putting the pillow in between their knees for side sleeping and underneath their knees while sleeping on their back. Additional applications would be to have the client alternate arms when using a vacuum cleaner and keep their back more extended rather than flexed when mopping.  

 References 

Weisser-Pike, O. (2023). Lecture 8: Vertebral Column, Posture, and Body         

    Mechanics [PowerPoint Slides].

Understanding the Sensory Systems of Vision and Taste

      Light waves pass through the cornea and enter our pupils, then the lens bends that light and focuses it on the retina. The retina holds millions of photoreceptors called cones and rods. Rods help us see in dim lighting and cones allow us to see color and fine details. This light is converted into electrical signals and sent through the optic nerve to be processed in the brain. The visual cortex is where these signals are processed into an image. In the article “The Science of Why No One Agrees on the Color of this dress”,  Adam Rogers talks about that infamous “black and blue” “gold and white” dress that caused such an uproar and how it is that we saw it differently. He stated that our brains determine what color light is bouncing off the object we are looking at and subtracts it from the “real” color of that object. We try to discount the chromatic bias of the daylight axis causing us to see black and blue if we discount the gold side of the axis and vice versa. Basically, our perceptions of the picture’s background can be different, so we perceive the other colors differently based on what colors are removed.  It was found that the dress is indeed blue and black after further experimenting and photoshop and Bevil Conway, a neuroscientist who studies color and vision at Wellesley College, suggested that night owls would see it this way because they typically discount gold rather than blue.

   Additionally, I listened to an audiocast “The Science of Touching and Feeling” where David Linden discusses the importance of touch and how much we still don’t know about it. Evidence shows that touch deprivation can affect our brain, GI tract, and immune system and is often irreversible after the age of two. Sensations outside of ourselves are important because we’re hardwired to suppress the stimuli we create on a day-to-day basis. This claim of irreversibility may be true but also has the potential of being changed because of neuroplasticity. 

    Neuroplasticity is an important topic we must understand because it is the brain’s ability to form and reorganize neural connections in response to changes in behavior and environment. These neural adaptations are important for learning, development, and forming memories. 

The Importance of the Little Finger

 

    In A Man from the South, an American soldier and older South American man make a bet with his Cadillac and the soldier’s little finger being the rewards. Before they could complete this bet, the old man’s wife comes back and informs them that he has taken many people’s fingers over the span of a few years. In the end, we find out it is her Cadillac and that she is missing four fingers.

    If the soldier lost the bet and, in turn, his pinky finger, many of his daily occupations would be impacted such as getting dressed, writing, tying knots, pulling rope, and lifting weights. Biomechanically, his hand function would be affected as he would lose a great bit of grip strength without all his fingers. The little finger is important for full prehension (taking hold of an object), pulling, and pushing objects and body weight. Opposition (the action of bringing the thumb to fingers) is an important movement for pinching and gripping. Without this ability, the soldier would have trouble with occupations like doing push-ups, holding a row and using it in water, writing, opening tight jars, and holding heavy dumbbells. A piece of equipment he could use for opening jars would be a rubber gripper. These are low tech devices that would require less grip strength from the user. This would address the soldier having quality of life, an outcome outlined in the OTPF-4, because if he had to have help opening jars to eat certain foods for the rest of his life he may not feel as independent and content. 

Retrieved from: https://trend-curator.com/products/qwikgrip-multi-purpose-rubber-jar-gripper-set

    Additionally, the man’s wife had to make changes to her daily life and routines after being left with only her thumb and one finger. It was mentioned that she was returning from getting her hair done, and it’s possible that she did her own hair before she lost those fingers. She would not be able to hold her hairbrush or style her hair in the way she wants without proper grasp and pinching abilities. She could attach a universal cuff to her hairbrush to help with keeping the brush held firm to her hand and completing this task independently.   

Retrieved from: https://specialneedstoys.com/usa/eazyhold-universal-cuff-youth-to-adult-5-pack.html

The Importance of Scapulohumeral Rhythm in the Shoulder Complex

When referring to scapulohumeral rhythm, it is regarding the ratio of movement between the scapula and humerus at the scapulothoracic (ST) and glenohumeral (GH) joints and how they work together to allow complete ROM of the shoulder. For every 3˚ of shoulder movement, 1˚ should take place at the ST joint and 2˚ at the glenohumeral joint, so in a full 180˚ motion of the shoulder, 60˚ will be produced at the ST joint and 120˚ will be produced at the GH joint. This is a 2:1 ratio of humeral elevation to upward rotation of the scapula. The scapula must perform upward rotation when the humerus moves upward to prevent the humeral head from colliding with the acromion process. As the scapula rotates upward, it prevents this space from getting too small and allows full ROM. This is also important for the length-tension relationship of the muscles in this area so they do not shorten too much and can sustain their force for most of the movement.

The scapulohumeral rhythm is relevant in a clinical setting because it is important to understand how the shoulder complex should function, what signs to look for if it is not functioning properly, and how to treat specific conditions of the shoulder with muscle and joint knowledge. Dynamic stabilization is an important aspect of this rhythm because the shoulder is dependent on the muscles, ligaments, and tendons to maintain integrity of the shoulder complex. The rotator cuff (RTC) muscles: supraspinatus, infraspinatus, subscapularis, and teres minor align the humeral head with the smaller glenoid fossa. Injury to these muscles or the GH labrum may compromise stability of the GH joint. Shoulder impingement syndrome is a result of RTC weakness where the humeral head becomes elevated in the glenoid fossa during shoulder elevation causing pain, weakness at the shoulder, and less than full ROM. As future OT practitioners, it is important to be knowledgeable about scapulohumeral rhythm so we can treat conditions such as shoulder impingement in the most effective way.  

Retrieved from: https://www.stacydockins.com/posture-lab/2020/1/27/the-levator-scapula-neck-amp-shoulder-pain-and-yoga

Test Positioning for MMT

 

There are specific testing protocols set in place for health professionals to follow for consistency throughout practices and so patient medical records are conducted in a format that will be the same for everyone. Goniometers are a common tool used by health professionals to measure joint angles and ROM. Testing for these are important for determining muscle functionality. One of the first steps in using this tool is being able to identify palpable bony landmarks such as styloid processes of the radius and ulna, malleoli of the tibia and fibula, the acromion processes of the scapulae, and others. It is important to know these landmarks to position the goniometer accurately. Proper positioning is important to isolate the joint that’s being assessed, all the client’s full ROM, and prevent compensatory motion of adjacent joints.

Manual muscle testing is an assessment used to determine weak muscles and to collect data. This is important for Occupational Therapists to identify if a client has difficulty completing their daily schedule and to determine a baseline for treatment. Positioning for a manual muscle test called the break test includes having the muscle that’s being evaluated placed at an angle that is midway through its ROM. For example, the normal range for elbow flexion is 0 - 145˚, so the testing position would start at about 72.5˚. This is because the muscle’s cross bridges are not too close together or far apart causing unwanted active or passive insufficiency. This would prevent proper testing because the muscle cannot perform to its best ability. For clients who do not have the capabilities to complete the break test against gravity, the body part being tested should be placed in a gravity eliminated position. This means the client will perform the movement with that body part parallel to the ground, or horizontally to assess the functionality within their limitations.

Nutshell 4 - My Why

     While Occupational Therapy and Physical Therapy have similarities like getting people on the right track to fulfill their routines and responsibilities, the types of interventions and scope of practices for these professions are very different. Physical therapists work to give patients who have experienced an injury to regain mobility and the motor skills they had before. Occupational therapists, on the other hand, work with clients who may or may not have experienced an injury to carry out their daily occupations such as dressing, house maintenance activities, health management, applying for jobs, and even playing! These are only a few examples of occupations people do for a meaningful life they can enjoy. While our focus includes mobility as well, we believe occupations are the means and the end to a successful life (American Occupational Therapy Association, 2017). You can find both types of practitioners in hospitals, skilled nusing facilities, and outpatient clinics. Additionally, Physical Therapists may have their patients use an arm bike in sessions to work on increased mobility of the shoulder, but an Occupational Therapist is going to incorporate activities that are meaningful to individuals like having them put dishes from the dishwasher into upper cabinets of their home or paint a picture of something they love while standing a certain amount of feet away from the wall. Occupational Therapists believe occupations are the means and end to therapy (American Occupational Therapy Association, 2017). I chose to pursue a career in Occupational Therapy because everyone has a human right and innate need to participate in life’s occupations regardless of the circumstances they may be under (American Occupational Therapy Association, 2017) and Occupational Therapy practitioners see clients as a whole person with wants and needs rather than by a diagnosis, so I believe their therapeutic services have the most effect on people’s quality of life and independence.

References

American Occupational Therapy Association. (2017). Philosophical base of occupational therapy. American Journal of Occupational Therapy, 71(Suppl. 2), 7112410045. https://doi.org/10.5014/ajot.

Conceptual Model of Occupational Therapy

For the Love of Occupational Therapy 

https://www.canva.com/design/DAFet1iGFpg/eSr4X8OQDZhrecIq_j-FeA/watch?utm_content=DAFet1iGFpg&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink 

An Activity Analysis of Feeding my Cat

 I feed my cat every day multiple times a day. My knees start in an extended position and end in a flexed position when I bend down to reach his bowl. The motion of extension and flexion at the knee occur in the sagittal plane about the frontal axis. The osteokinematics of the knee for this action are flexion and extension in a closed kinematic chain. Regarding arthrokinematics, the moving femurs are the convex segments which roll posteriorly and glide anteriorly on the stable concave tibial plateaus as my knees flex. The prime movers for knee flexion are the hamstrings which include the semitendinosis, semimembranosus, and biceps femoris muscles. They perform in an eccentric contraction for this movement.