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.