SIM Experience: Sensory Processing Disorder

Overall, I believe the SIM encounter went well! I say that because this SIM encounter felt the most “natural” out of all of the ones I’ve had. I didn’t have anxiety going into the room, and I felt like I was just having a normal conversation with a parent. Because of this, I think it was easier for me to pay attention to the parent’s body language and use active listening techniques. However, there are still many things I thought I could have done better. I realized that the parent I was talking to was very anxious and overwhelmed. However, I also knew I was running out of time with her and, therefore, didn’t stop to ask her if she was okay.  This made me realize that I not only need to learn how to explain things in layman’s terms but also in a concise way. If I did this, I wouldn’t run into the issue of running of out of time and would have not thought twice about stopping and asking the parent how she was doing. I also believe that learning to explain things in a concise manner would have given me more time to listen to the parent’s questions towards the end of the simulation as well as have more time to explain some techniques she can use with her son more in depth. I realize that in a real clinical scenario I’m going to have to learn how to manage my time better so that my client can understand the information I’m giving her and feel heard and understood while I’m still able to get to the next client for their scheduled time.  I’m still trying to figure out how to manage my time appropriately, but one technique I could use is timing myself while practicing and having someone else provide me with feedback on what I could say to simplify my explanations before the next our next SIM.

During this simulation, I did try to provide encouragement through smiling and nodding my head as well as explain to the parent that her son’s difficulties are not due to her parenting style or him not trying hard enough. I also sat close to the parent (without invading her privacy) and maintained eye contact when talking to her.  These are few examples of how I tried to show an attitude of caring. Another thing I could have done to show an attitude of caring is to give my client more time to explain her concerns without cutting her off. I realized that during the simulation, I was quick to say no whenever the parent was expressing concerns about her child not being able to be successful in life. I was quick to do this because I wanted to quickly ease her fears; however, I didn’t give her a chance to finish what she was saying before interjecting.

*I realize when reflecting on my experience, I tend to focus on the things I did wrong instead of talking more about what went well. However, I do believe this SIM experience went well and that I’m improving each time I have a simulation experience. 

Living with ADHD

This is What It's Really Like to Live with ADHD-Jessica McCabe

I chose this assignment because we learned about Executive Function Disorder (EFD) in my Neuroaspects class. During the lecture, I realized that a lot of what I thought I knew about ADD/ADHD, a type of EFD, was false and I wanted to correct and further my learning about the diagnosis.

In this Tedtalk, Jessica McCabe explains one of the darkest times in her life. She was having trouble being organized, making friends, turning in assignments on time, focusing, signing up for classes on time, etc. This was very confusing considering Jessica could perform very well on tests. Growing up her teachers said she had a lot of potential. However, once it was up to her to get to a place on time, submit assignments on time, or organize her materials herself, she felt overwhelmed. She had a skewed sense of time; this resulted in her dropping out of college. She explained that she aced a statistics class that she never got credit for because she missed the sign-up deadline. Not only was she having trouble in school, but also in her relationships. She was trying so hard to keep up with everything that she wasn’t able to make her friends a priority and she also ended up having a divorce at the time. Jessica explained that she knew she had ADHD and that her ADHD medicine helped her a lot. She explained it as someone wearing glasses for the first time. However, it wasn’t all she needed to help manage her life. 

In our Neuroaspects class, we learned that the diagnostic criteria for ADD/ADHD. It requires that the client show several specific signs to a degree that is maladaptive (not providing adequate or appropriate adjustment to the environment or situations). We also learned that some people diagnosed with ADD are inattentive, hyperactive, or a combination of both. A few examples of diagnostic criteria for ADD-Inattention are: unorganized, fails to follow instructions or finish work, forgetful about daily activities. A few examples for ADD with Hyperactivity are: Fidgety, doesn’t stay seated, difficulty playing or working, difficulty waiting in lines or waiting turns. This makes perfect sense to why Jessica McCabe was having so many problems in her life. While I had learned these about these ADD/ADHD symptoms in my class, this talk helped me understand what these symptoms look like in a person’s day-to-day life. It also made me more aware that having ADHD does not mean that someone can’t excel in school. It just means that they need to use different strategies to adapt to their environment. One thing that really stood out to me was when Jessica said that people with ADD/ADHD are 300% more likely to start their own business. She explained some people say, “You need to think outside the box”; however, people with ADD/ADHD don’t really know that the box exists. This is why people with ADD/ADHD are great at thinking creatively and initiating projects/ideas. 

Jessica talked about how she uses timers. alarms, and checklists to help her understand deadlines and help her get organized. She started her own Youtube Chanel, called HowtoADHD, where she shares her knowledge about the diagnosis and  what helps her tackle problems and adapt to her environment. She explains that learning more about her diagnosis and how to deal with situations has helped her become successful in her in business and in her relationships. I  believe that everyone should watch her TedTalk to better understand what this diagnosis entails.  I also believe that watching both her Youtube channel and Tedtalk will help bring awareness to how to better love those with ADD/ADHD. 

**Here is her link to her Youtube Channel:

https://www.youtube.com/channel/UC-nPM1_kSZf91ZGkcgy_95Q 

**Here is the link to her TedTalk: https://www.ted.com/talks/jessica_mccabe_failing_at_normal_an_adhd_success_story

APA Citation: 

McCabe, J. (2017, July). This is what it's really like to live with ADHD [Video file]. Retrieved from https://www.ted.com/talks/    

     jessica_mccabe_failing_at_normal_an_adhd_success_story

Media Project Reflection

Background:  In our Neuroaspects class, we were given a media project assignment. In this project, we were given a low-cost item that most people can find around their house and told to create a therapeutic, OT intervention for a hypothetical client that was assigned to us. The media I was assigned was buttons. 

Reflection:     

When I first started this project, I felt excited!  I felt like there were so many therapeutic activities that could be created with buttons. I went home and made a list of interventions. However, when I received my hypothetical client and realized that my client has a Complete C5 Spinal Cord Injury (SCI), I struggled with coming up with a creative, client-centered idea. 


This assignment was definitely out of my comfort zone. Something I have to fight against is wanting to stay in my comfort zone all the time. This is not because I don'tt want to learn, but rather because the thought of failure is sometimes terrifying. OT school has helped change my perspective. Still, it's a process and I have to remind myself to have the right perspective. Because I know this about myself, I decided to try something different when starting this project. Instead of sitting in one place and thinking about this project for hours at a time, I decided to spend fifteen to twenty mins every day or couple of days just thinking about the assignment and trying to come up with ideas. This was sometimes done on my drives home from UTHSC.   If I didn't think my ideas were good enough, I would continue to try to make it better. If I still couldn't get it, I would just revisit the topic another time. This made this assignment a lot less stressful and a lot more enjoyable. When there's not as much pressure, it's so much easier to be creative!  While I realize that I'm not always going to have the same amount of time I had for this project to complete other OT-related assignments, I learned to just take everything one step at a time and to continue to work on things through the process of trial and error. 

Not only did I learn how to have more of a grit mindset throughout this process, but I also learned how to think more like an OT. I loved the process of learning about the client's interests and then comparing it to what he needs to get better physically, mentally, and emotionally. This project made me use the same type of creative thinking OTs use in the field. This made me feel more competent in my abilities as a future OT and even more excited to learn more about how to be a good practitioner! 

These are my final products:

A couple challenges I experienced throughout this project (aka. trial and error): 

• In the beginning, I couldn't figure out how to create something out of buttons that appealed to my client's Korean culture. I searched the internet several times for arts and crafts or games that I could modify by sliding the buttons. However, I wasn't able to find anything. It wasn't until a week ago that I remembered that elephants are admired in Asian cultures for their intelligence and good memory; elephants tend to symbolize wisdom. This led me to create the magnetic elephant puzzle. Just a few days later, I realized that music is also part of one's culture. Since my client owned a music retail store, I realized I could make a magnetic music board for him so that he can slide the notes onto the staff to compose music. It all started coming together when I realized this would help motivate him to sit up for longer periods of time and help him gain the strength and endurance necessary to withstand therapy in a rehabilitation center. 

• When I finally decided I was going to create a magnetic button puzzle, I couldn't find magnets that would work-either the magnets were too strong or they didn't fit the button properly. This made the puzzle look awkward. The solution was to use the magnets that were very strong and place several sheets of paper between the magnet and the cookie sheet to decrease the strength of the bond. 

Overall, I think this has been my favorite project in OT school. While it took a lot of work, it challenged me in the best ways possible! My biggest take away from this project  was learning how to go through the process of figuring out a unique intervention for my client and learning to have a grit mindset throughout the process. 

Three Letters That Changed His Life–ALS

Scott Matzka and family

Scott Matzka was a professional hockey player for 11 years. Once he retired from hockey, he was still physically active. He'd run six-minute miles and hit golf balls well over 300 yards. He had two kids and was married for seven years before something unexpected happened. He started to have cramps in his arms, stiffness in his fingers, and he wasn't able to unclench his fist easily. It started getting worse over time. For several months, several blood tests and MRIs were taken. Afterwards, he was referred to a neurologist. Matzka had researched his symptoms and prayed that his neurologist wouldn't say 3 specific letters. After his neurologist performed several tests, he had a meeting with Matzka and asked him to sit down. Matzka's fears were realized; he was diagnosed with ALS (Amyotrophic Lateral Sclerosis). He knew it was a neurodegenerative, progressive disease that was fatal and that he only had about 3-5 years to live.

It's interesting to me how Matzka decided to carry on with his life knowing this information. We've all watched movies like The Bucketlist and have thought about what would we do if we knew we only had a few weeks or years to live, but sometimes I wonder how much we truly consider that. When faced with a situation like Matzka's, we don't have a choice but to really think about what are the most meaningful things in our lives. It gives you perspective.  I don't know if Matzka had an occupational therapist, but if he did, I imagine the therapist helping him create a bucket list and finding ways for him to travel and get around to places while he can.  I also imagine the OT giving him options for different kinds of adaptive equipment so he can be as independent as he can for as long as he can.

While he was able, Matzka decided he was going to travel with his family and friends and soak up every moment he could. He also decided that he was going to raise awareness and try to help those with ALS financially. When I looked up his site, MyTurn, I read a few of the statistics that surprised me. The most surprising thing I read was that it costs around $250,000 a year for a person with ALS to have what he needs and insurance doesn't cover the majority of it.  I can't imagine being part of a  family that not only has to deal with the hardships and heartaches of losing a loved one and watching him progressively lose function, but also be in so much debt because they can't pay the medical bills. This is why it is so important for us to help raise awareness about ALS and help support those with ALS as much as we can.

The reason I decided to watch the Tedtalk, How 3 Letters Changed My Life,  is because one of my friends recommended it since we are learning about ALS in our neuroaspects class. She told me how heartbreaking it was to listen to him speak about the reality of being diagnosed with ALS. She was right. The most heartbreaking part of the Tedtalk was when Matzka spoke about the fact that he wouldn't be able to watch his children grow up, he wouldn't be able to walk his daughter down the aisle, and he wouldn't be able to see his grandchildren one day. He said that it was really easy to see the darkness of the world and see how unforgiving it could be; however, the unwavering support and compassion people showed him helped him push through. It reminded him to make the most of the present and look at the diagnosis of ALS as an opportunity instead of an end.

 Matzka ended his Tedtalk by stating that one does not need an illness to gain perspective and I a hundred percent agree. We should think about what is meaningful to us and live our lives as fully as we can-having compassion for others and loving one another. We should especially be there for those who are going through the hardest of times. I pray and hope that as a future occupational therapist, I will have perspective and remember the reality of what my patients are dealing with. I pray and hope that I continue to remember that being an OT is so much more than a day job. It's a chance to love and serve others.

*You can watch his Tedtalk, How 3 Letters Changed My Life, here: https://www.youtube.com/watch?v=NOK83OHmTbE
*His website: https://scottmatzka.com/take-a-turn (This website is helpful in understanding how much everything costs for a person with ALS)

Citations (APA):

Take a Turn. (n.d.). Retrieved from https://scottmatzka.com/take-a-turn

        Talks, T. (2017, March 16). How 3 Letters Changed My Life | Scott Matzka | TEDxUofM. Retrieved from https://www.   
            youtube.com/watch?v=NOK83OHmTbE

The Theory of Everything

Personal reason why I wanted to watch the movie, The Theory of Everything:

I believe that it is important for every person to understand or at least seek to understand what they believe in and why they believe it. In a world where it is so easy to just “go with the flow,” it becomes even easier to fall into traditions and routines. Traditions and routines in of itself are not bad; however, the danger is when one refuses to think for him/herself. Like most, I have read about Stephen Hawking before watching this movie. I’ve read about his philosophy or “lack of philosophy” that the world doesn’t need a Creator because it has physics. However, I've found that to be contradictory since the law of gravity still needs a creator. Hawkin’s later in his last book stated that in order to know how or why we need to know the mind of God. I’m not sure whether Hawkins truly believed that towards the end of his life or if his publisher pushed him to write a surprise ending. Either way, it made me interested to learn more about him.

Relation to OT:

Another reason why I wanted to watch The Theory of Everything is because we are currently learning about Amyotrophic Lateral Sclerosis (ALS), a motor neuron disease, in our Neuro-Aspects class. While The Theory of Everything does touch on Hawkin’s thoughts about physics and how the world came to be, it focuses more on how ALS affected his life.  Throughout this movie, it was interesting to see the little signs, such as Hawkins dropping a glass or stumbling over nothing,  before it was clear that his body wasn’t functioning typically. Once he realized his gait was affected, the audience sees him having a lumbar puncture. (In our class we learned that this is one test that is used to eliminate the possibility of Hawkins having a different diagnosis; the diagnosis of ALS is one by process of elimination).  Once he received his diagnosis and the doctor tells him he only has a few years to live, he tried to isolate himself but his girlfriend, Jane, wouldn’t allow it.  Overtime Jane sees how much the disease impacts his ability to walk, feed himself, dress himself, swallow, and talk. Throughout the movie, it is hard to watch Jane struggling and trying to hide her emotions so she can be strong for husband. It is also hard to watch Hawkins losing function over his body yet having the cognitive ability to understand and feel everything going on around him. However, it is also inspiring to see Hawkin's determination and positivity through all the hardships.

I believe this movie did a great job in showing the progression of the disease as well as the assistive technology Hawkins used, such as the spelling board and an adaptive switch with a speech-generating device. Since having a lecture on assistive technology, it is even more amazing to know that Hawkins used assistive technology to write books. While the device is helpful, it usually takes a person a long time to select the correct categories before picking out the word they are trying to say (usually about four words a minute). Through more research, I found that many people worked on Hawkins assistive technology and added predictive messaging to help him work at a faster speed. Whether Hawkins knew it or not, he became a huge advocator for assistive technology and an inspiration to those who have disabilities and feel unable to accomplish tasks that are meaningful to them

While I do not agree with Hawkin's "Theory of Everything," I do believe that Hawkin's determination was inspiring. This movie brings awareness to not only what ALS is, but also what the lifestyle for someone with ALS looks like. I recommend watching this movie if you want to learn more about Stephen Hawking's personal life and what the progression of ALS looks like.

*This movie is found on Netflix (for free if you have a subscription). It is also on Amazon Prime and Youtube for $4.

Bevan, T.,  Bruce, L., Brown, J., Fellner, E., & McCarten, A.(Producers). (2014). The Theory of Everything[Video file]. Working Titles Films. 
     Retrieved August 14, 2019, from https://www.netflix.com/watch/80000644?trackId=14170286&tctx=1%2C5%2C7df97aa5-8b9f-4659-8b72-   
     24bb4db2fbac-18125042%2C80527623-7f17-4655-be81-09ddc47fe8d5_178698277X3XX1565838594120%2C80527623-7f17-4655-be81-
     09ddc47fe8d5_ROOT

Alzheimer’s disease

Still Alice-movie

Alzheimer’s disease has been on my mind lately due to a video I watched a few weeks ago. It was about an invention called Jelly Drops. These are pods of colorful and edible water created to help those with dementia stay hydrated. I learned through that video that those with dementia typically no longer feel thirst and forget they need to drink water; however, the colorful drops grasp their attention. Because of this video and my professor’s recommendation, I decided to watch the movie, Still Alice, in hopes of understanding more about dementia.  The fictional movie is about an award-winning linguistic’s professor,  Dr. Alice Howard, finding out she has a very rare form of dementia called early-onset Alzheimer’s.  This form of Alzheimer’s develops before the age of 65  and can have a genetic component. Towards the beginning of the movie, the audience sees how much Alice values her work, education, and family;  later, we see how Alzheimer’s strips her from the things that are most meaningful to her due to memory loss.  It’s heartbreaking. The part that stood out the most was when Alice talks about how she wished she had cancer instead. While her husband asks her not to say such things, she continues to say that people understand cancer and feel compassion towards those who have cancer. While her memory was slipping away, she still was aware of the way people judged her for something she couldn’t control. She was afraid to have dinner with her husband’s coworkers because she knew her memory could fail her and cause the dinner to be uncomfortable. This scene helped me learn that there is a huge need for people to understand the extent of this condition in order to know how to interact and love those around us. 

Not only do I believe that this movie is great at bringing awareness to what those with Alzheimer’s experience, but I also believe this movie is a fairly accurate description of the progression of the disease looks like; I recommend watching it!

**If you are wanting to watch this movie, it is available on Sony Crackle for free (no subscription is needed) Here is the link: https://www.sonycrackle.com/watch/5623/2507842

**If you would also like to learn more about the Jelly Drops, here is a link to a video about it: 
https://www.youtube.com/watch?v=eXZnTGsWSTk

APA citations: 

Glatzer, R., & Westmoreland, W. (Directors), & Lutzus, L., Brown, J., & Koffler, P.(Producers). 
        (2015). Still Alice[Video file]. Milano: Mondadori. Retrieved July 20, 2019, from  
        https://www.sonycrackle.com/still-alice

In The Know. (2018, August 23). 24-year-old invents brilliant way to help people in their fight against dementia.   
       Retrieved from https://www.youtube.com/watch?v=eXZnTGsWSTk

Hierarchy of Mobility Skills

The hierarchy of mobility skills is the order that guides the therapist in knowing what area of mobility needs to be addressed in therapy. It starts out with decreased mobility with increased stability and works its way up to increased mobility with decreased stability. One of the reasons why stability is increased in the lower levels of this chart is because the client has a larger base of support; mobility is increased when the client has a smaller base of support. However, I believe that stability vs. mobility isn’t the only reason for the placement of this order. The order is as follows: bed mobility, mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADL, toilet and tub transfer, car transfer, functional ambulation for community mobility, and community mobility and driving. 

While the order of mobility skills wouldn’t have made sense to me prior to the Biomechanics lectures and practicing transfers in lab, it is now clear to me why this order is important to follow. Not only is stability decreased as you work your way up the hierarchy, but other factors, such as slippery surfaces, small spaces, and/or items that are easier to trip on, makes it vital that the client is mentally and physically ready for the higher levels of mobility.  Without this order, it would be very easy for a therapist to overestimate the client’s ability and possibly increase the risk of a patient getting hurt. It would also pose as a frustrating task for the client since she hasn’t worked her way up to such a higher level task. This could decrease her confidence and motivation and serve as a barrier to completing her occupational goals.  

While we didn’t touch on every level of the hierarchy of mobility in our Biomechanics lab, such as toilet and tub transfers, car transfers, etc., learning how to help a client with bed mobility, wheelchair transfers, and bed transfers helped me understand the level of skill needed for the client in order to be successful in completing these tasks. When helping a client with bed mobility, there was a large base of support and a decreased risk of the client falling or getting injured. In the lab, this put me more at ease because there weren't as many barriers. it became very clear that this was a task that was important for the client to achieve in order to be able to do something like a mat or wheelchair transfer due to stability, posture, physical strength, endurance, cognitive function, etc. It also made me even more aware of the fact that each client has different needs. Some just need to build their strength and endurance in order to do higher level mobility skills, some may need multiple assistive devices, and some people may not have goals that go to the top of the hierarchy of mobility skills chart.

When I worked as a rehab tech, I would assist in bed mobility and transfers. However, I had not learned about the hierarchy of mobility before my Biomechanics class and therefore didn’t think too much about the kind of mobility that was appropriate for the client. It seemed as if it was more common sense and instinctive to the therapist who had been practicing for several years. When I reflect back, the therapists I worked with did follow this model; however, it was not always clear how much the client could achieve due to their condition or motivation. It was always interesting to observe how the therapist would know when to encourage the client to increase the level of their mobility further and when to stay at the same level of mobility. I’m excited to learn more about how to help my future clients in their occupational tasks! 

Sizing for Assistive Devices

Sizing for an assistive device is very important. Without an appropriate “fit” for the patient, the assistive device can be a safety hazard and cause the patient to lose their balance and have an increased risk of falling. It can also place too much pressure on certain body parts and cause the patient to have nerve damage. An example of this is having axillary crutches that are too tall for the patient; The increased pressure in the axillary (armpit) area can cause the patient to have damage to their brachial plexus! Listed below are the appropriate ways I would select the correct sizing for a cane, axillary crutches, Lofstrand crutches, a rolling walker, and a platform walker 

• Cane: When trying to select the appropriate size, the patient should be standing and looking straight ahead with their arms relaxed by their sides. When holding the cane, the patient’s elbow should be slightly flexed to about 20 or 30 degrees.  The handles should be in line with the wrist crease with elbows slightly flexed, ulnar styloid, or greater trochanter. In order to adjust the cane, use the pushpin. 

*For a quad cane, you want the wider legs to point away from the patient. If they are not, this can be fixed by rotating the base 180 degrees. 

•Axillary crutches: Like the cane, makes sure the patient is standing tall and looking straight ahead with their arms relaxed. Sometimes the crutches will have heights listed next to each hole. This is helpful to use as an estimate, but it is still important to make sure that their arm pads are placed about 5 cm below the axilla. Like the cane, the handgrips should be in line with the wrist crease, ulnar styloid, or greater trochanter when hands are resting and elbows are slightly flexed. 

         *For Lofstrand crutches, the armband should be positioned 2/3 of the way up the forearm. The handgrips should be pointing forward. 

•Rolling Walker: 

The patient should look straight ahead with arms relaxed. The handgrip should be in line with the wrist creases, ulnar styloid, or greater trochanter. The elbow should be slightly flexed about 20 to 30 degrees when looking for these bony prominences. 

Platform Walker: The platform should be positioned to allow weight-bearing through the forearm when the elbow is bent to 90 degrees. The proximal ulna should be 1 to 2 inches off the platform; The handles of the platform should be positioned slightly medially.

Sizing for these devices should be done with the patient’s shoes on. 

Importance of Good Posture and Body Mechanics

Using improper body mechanics can cause many complications that result in lowering one’s quality of life and efficiency at completing tasks. Using proper posture and body mechanics=better balance, fewer injuries, less pain, increased mobility and stability.

Examples of why it is so important!

•  Having poor posture for extended periods of time over the years can change the alignment of your spine and cause your spinal nerves to be compressed. This can cause debilitating pain and is hard to reverse.

• Having poor posture such as protruding your neck forward for extended periods of time can eventually lead to difficulty swallowing liquids and foods. This is because protruding your neck causes the weight placed your vertebrae to increase. For example: extending your neck an extra inch increases the weight on your cervical spine from 12 lbs to 32 lbs. 

• Having poor posture can cause problems with respiration/breathing. A hunched back leaves less room for your lungs to fill up with air.  Spinal deformities can also cause weakness in muscles that help with inspiration and expiration. 

• Completing movements such as twisting at the torso when moving heavy objects,  lifting heavy objects by bending your spine and not using your legs to bear the weight, and holding the heavy object away from your body cause increased pressure on your spine. Many times this results in injury. 

Intervention with the client:

If the client’s job includes picking up heavy objects. I would:

• Show him how to bend at his knees and hips when picking up the object. I would make sure that he doesn’t bend at his back. To help him check for safe posture, I would place a pole or long stick along his spine as he bends his hips and knees and lifts the object.  If he can feel the pole against his back, he is doing a good job at not bending at his spine. 
• If he needed to move that heavy object to a different location, I would demonstrate how to move his feet instead of twisting his torso.    

Man From The South

In Man From The South by Roald Dahl, a man made a bet that if his lighter could light ten times in a row, he would be allowed to cut off a soldier’s pinky finger. However, if the soldier won the bet, he would win a Cadillac. Later on, the reader realizes that the car isn’t his to bet; it’s his wife’s car and she has made several bets in the past with the man that cost her to lose some of her fingers. All that is left on one hand is her thumb and one other finger.

This poor woman who owns the Cadillac probably has trouble driving it herself. In order to have the appropriate grip strength to drive the car, she would need more than two fingers in one hand. This is because the type of grip she is using is considered a power grip and it requires all of your fingers to be present. Thankfully, modifications can be made and she will be able to drive it again! Since the woman’s other hand is unaffected, she can use a steering ball or spinner fitted to the steering wheel to guide the wheel.  She can also have a touch screen that will allow her to change gears by tapping the screen with the hand that is affected. 

Public Health and Wellness

 In class, we've been learning how to create Occupational Profiles so that we can look at all aspects of a client/patient. However, it hadn't occurred to me that in the field of Occupational Therapy, we don't only work with individual client's/patients, but also populations of people. When looking at a population, OTs still use a holistic approach. They also look at the social determinants of health, which includes looking at the general socioeconomic, cultural, and environmental conditions. Through Professor Flick's lecture, I learned that these factors are extremely important to note because they can prevent people from getting the care that they need. One example is health literacy. If a person or population wasn't able to have the proper education (maybe due to socioeconomic reasons) to read a pamphlet, read the words on a prescription bottle, or know how to fill out paperwork at the doctor's office, they may be in danger of harming themselves by avoiding the doctor or accidentally overdosing on their medicine. Before listening to this lecture, I didn't know how common it was for people to have difficulties like this within the health care system. This reminds me that as a future OT practitioner, it is important to look for signs that a client/patient might be apprehensive about seeing a therapist or doctor because of these barriers and try to educate the population in health literacy. This also reminds me that as a future OT practitioner, it is important to be creative, diverse, and inclusive when thinking about the most effective way to help people.

Scapulohumeral Rhythm

What is the clinical relevance of the scapulohumeral rhythm? How can it affect your ROM measurements of the shoulder? Please give at least 5 reasons in your response

Scapulohumeral Rhythm is defined as a kinematic interaction between the scapula and the humerus. The ratio of movement among the shoulder movement, scapula, and humerus is 3:2:1. For example: if there is full range of motion for shoulder abduction (180 degrees), 120 degrees of movement should happen at the glenohumeral joint and 60 degrees of movement should happen at the Scapulothoracic joint. Because of this, it is important to stabilize the scapula when measuring true glenohumeral abduction or flexion ROM so that the ROM measurements are not skewed. (For example: the seemingly full range of motion measurements may be coming from an unstable scapula that exceeds its 60 degrees of movement while the humerus has less than 120 degrees of movement) 

In order to have full ROM for should abduction, scapulohumeral rhythm has to work to distribute the motion between the two joints and the humerus has to rotate laterally so that the scapula can upwardly rotate and posteriorly tilt. ROM at the shoulder can also be affected by other problems with scapulohumeral rhythm. The scapulohumeral rhythm distributes the motion between two joints, prevents impingement in the subacromial space and tearing of the supraspinatus muscle, permits good length-tension relationship, and helps with the alignment of the humeral head on the glenoid fossa.  It also provides joint congruency, which results in a decrease of shear forces. It is important for clinicians to understand scapulohumeral rhythm because dysfunction in the scapulohumeral rhythm can result in pain, instability, impingement, and decreased range of motion. It is also important to recognize when the client may be compensating due to scapulohumeral dysfunction and therefore may be causing more damage to their body. In addition, it is important to check for compensations when measuring range of motion so that measurements are not skewed.

ROM and MMT-Biomechanics (2)

When measuring Range of Motion (ROM), it is important to palpate bony landmarks and use proper positioning. The bony landmarks serve as a reference point for where the therapist should place the goniometer in order to have good accuracy and reliability. The goniometer has three parts: the stationary arm, the moving arm, and the axis. If the therapist changes the reference point, the values will neither be accurate nor reliable. For example: when measuring ROM for elbow flexion, the axis/fulcrum of the goniometer is placed on the lateral epicondyle, the stationary arm is placed on the lateral midline of the humerus in line with the acromion process, and the moving arm is placed on the lateral midline of the radius in line with the radial styloid process. If the therapist didn't palpate before placing the goniometer the first time measuring ROM for the patient, the measurements would be off. The next time she measured Range of motion, the numbers would not be consistent. This example shows how not palpating bony landmarks affects accuracy and intra-rater reliability.  While intra-rater reliability is higher than interrater reliability for measuring ROM, not using bony landmarks as a point of reference would affect both. In the same way, the proper positioning of the patient's body is needed for the measurements to be consistent and accurate.  In different positions, the ROM will show different measurements due to the relaxing and tightening of different muscle groups in different positions. If the patient is not placed in the proper position, they also may be at a mechanical disadvantage. Inaccurate and unreliable results would affect paperwork, billing, and insurance claims. They could also put the patient in danger if the patient is given the wrong therapy treatments based on the results.



Manual Muscle Testing (MMT)  is used to evaluate a patient's muscle(s) strength/function. When using MMT, it is important that the patient is placed in the proper test position so that the right muscles are activated during the test. It is also important so that the patient is at a mechanical advantage and can produce the most force possible from the specific isolated muscle or muscle groups. Usually, MMT is completed in against gravity position. However, in certain circumstances, the patient may need to be placed in a gravity-eliminated position. This is a resistant-free position and means that the force of gravity is no longer contributing to the resistance placed on that muscle/muscle group.  In this position, the patient's body is placed so that their action is parallel to the ground and the therapist is not applying resistance. The therapist uses a gravity-eliminated position when muscles are weaker and are unable to withstand the resistance of the four second MMT in an against gravity position with or without resistance from the therapist. The scoring for a gravity-eliminated position is less than 2+ according to the MMT grading chart. If there is almost no Range of Motion but the therapist can sense a small contraction from feeling the muscle, the patient score will be a  1 on the MMT grading scale. If there is no palpable or observable muscle contraction, the patient score will be 0.

Picture from: https://www.scranton.edu/faculty/kosmahl/courses/gonio/upper/pages/elbow-flex.shtml