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

Knowledge Check: Universal Design; Cancer-Related Cognitive Dysfunction

Universal Design-Ted Talk 

"Everyone has a disability to some extent and everyone has to figure out a way to cope around their disability." This was something that stood out to me in Michael Nesmith's Ted Talk. It's true. We do have to find ways around our problems, whether we have a disability like Rheumatoid Arthritis (RA) or something like a sprained wrist. I learned that this is why Universal Design is important. Universal Design is defined by the National Disability Authority as "the design and composition of an environment so that it can be accessed, understood, and used to the greatest extent possible by all people regardless of their age, size, ability, or disability."  This is why things like automatic doors were created. The automatic door allows people with a number of "disabilities" or circumstances to enter a place. This includes (but doesn't limit to) people in wheelchairs, mother's with strollers, people who have difficulty turning a doorknob, etc. The invention of one universal design usually ends up in a snowball effect. It inspires people to either improve on the design or create more designs that help people in various ways. What a great way to serve people in all stages of life and all circumstances!

Link to the Ted Talk -Why We Need Universal Design:
Picture from: https://people.utm.my/azarimy/2016/10/universal-design-for-all/

Cancer-Related Cognitive Dysfunction: 

"Chemo-Fog"–I'd heard of that term before. However, I'd never heard of  Cancer-Related Cognitive Dysfunction. I learned through this podcast that the term "Chemo-Fog" is misleading. When a person hears the words Chemo-fog, they usually think about a patient with cancer who has undergone chemo treatment and has cognitive problems due to the chemo treatment. However, leading research has shown that the chemo treatment isn't the only cause of cognitive dysfunction among cancer patients. The research shows that specifically with breast cancer, cancer itself or other therapies such as radiation can cause cognitive dysfunction even after being cured of cancer. I also learned that Cancer-Related Cognitive Dysfunction can last for many years. It is important for cancer patients and cancer survivors to know that this is a factor so that they are aware of the changes that they can make to their daily lives in order to help their quality of life and their ability to complete daily tasks.

Link to the podcast: Cancer-Related Cognitive Dysfunction 
Picture from: https://www.pacificneuroscienceinstitute.org/blog/brain-tumor/chemobrain-cognitive-dysfunction/

Biomechanics-Everyday Activity-Opening/Closing the Blinds

*quick summary about what is happening at the elbow is posted underneath; main points about the elbow joint are also in bold

When I’m home and it is sunny outside, I open my blinds. When the sun starts to go down, I make sure to close my blinds so people can’t see inside my apartment. In order to open or close the blinds, I start by standing in front of my window.  My knees, elbows, and fingers are extended. My shoulders and forearms are in a neutral position beside me.  When I reach to open or close the blinds, I flex my right shoulder and elbow, extend my right wrist, and flex my fingers at the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints to grasp the string.  My forearm remains in a neutral position.  I then go from that position to extending my elbow and shoulder while continuing to extend my wrist and flex my fingers. This enables me to open or close the blinds by pulling the string. This is my ending position. 

Shoulder flexion/extension, elbow flexion/extension, wrist flexion/extension, and finger flexion/extension all occur in the sagittal plane around the mediolateral axis.  All of this happens in an open kinematic chain because the distal segments of my body are free while the more proximal segments of my body are stabilized/ fixed.  The prime movers that flex the elbow are the Biceps Brachi (main agonist), Brachialis, and Brachioradialis. In the scenario given above, flexing my elbow is a concentric movement because the muscles are shortening while producing and a force and the movement is acting against the force of gravity. In the scenario above, the same prime movers are used to extend my elbow. However, the extension is an eccentric movement because the muscles are lengthening while producing a force and the movement is lowering the ulna and radius towards gravity. The antagonist is the Triceps Brachii. 

The elbow joint (humeroulnar joint) is a hinge joint that has 1 degree of freedom and allows for flexion and extension. The joints consist of the concave portion of the ulna (olecranon) coming together with the convex surface of the humerus. When the elbow flexes and extends in this activity, both the concave surface of the ulna and the convex surface of the humerus roll and glide in the same direction.  During elbow flexion, the proximal end of the ulna glides along the distal humerus anteriorly. During elbow extension, the proximal end of the ulna glides along the distal humerus posteriorly. 

Quick summary: 

:

• Task: Opening and closing the blinds by pulling the string 
• Reaching to open the blinds: flexes my elbow 
• To close the blinds: extends my elbow 
• Both are an open kinematic chain 
• Flexion/extension of elbow-sagittal plane/mediolateral axis
• Prime movers in both flexion and extension: Biceps Brachii, Brachialis, and Brachioradialis; main agonist we’ve talked about-Biceps Brachii
• Antagonist-Triceps Brachii 
• Flexing elbow to open blinds-concentric….extending elbow to close blinds-eccentric 
• Elbow (humeroulnar joint): hinge-1 degree of freedom. Flexion/extension 
• Concave ulna (olecranon) comes together with convex humerus
• Elbow flexes-both convex and concave surface of humerus roll and glides in the same direction-ulna glides along distal humerus anteriorly
• Elbow extension-proximal end of ulna glides along distal humerus posteriorly  

Extra information: 

The normal range of motion (ROM) for elbow flexion is 0-145 degrees while normal ROM for extension is 0 degrees. The normal end-feel for flexing the elbow is soft while the normal end-feel of extending the elbow is hard. 

Therapeutic Relationships (Take away)

I found our last lecture on therapeutic relationships helpful in understanding how to interact with clients as an OT student and future practitioner. I enjoyed learning about active listening, having empathy, and other different ways we can support and care for clients. While these are things I have learned before in some of my psychology classes in undergrad, it was helpful for me to be reminded of how intentional I need to be in the way I communicate so that that the person I am talking to feels comfortable opening up and sharing about their life. Naturally, if a client doesn't feel comfortable with me as their practitioner, they probably will withhold information and I, as a practitioner, would not be able to help them to the full extent as I could knowing more information. Throughout observing in different clinics, I met therapists that were really great at active listening and showing empathy towards their parents. I also observed some therapists who lost their patience with a client and were visibly irritated. It made a huge difference in how the client reacted back towards the practitioner and made completing ADLs or performing exercises much harder. It also took a lot more time for the tasks to be completed.

U.S. History of Neurodevelopmental Disabilites

During Dr. Keisling’s presentation, I found myself surprised about how little Americans are taught about the history of disability in our country. I believe it is important for our country to remember and learn about the past in order for us to understand the impact it has today and so that we can learn from our mistakes. It was shocking to hear about how people with disabilities were viewed in the past–as criminals and as people who couldn’t be helped. It was horrifying to hear about people being placed in institutions where they were given very little, had no say in their lives, and lived in conditions similar to prisons. It wasn’t until the Deutsch’s publication of “The Shame of the States” that Americans started to understand the harsh conditions people were living in. While it seemed like a simple choice for families to not send their loved ones to these institutions, it wasn’t that simple. The medical costs of keeping their loved ones at home and getting them the therapy they needed was enough to put them in debt. Even if money wasn’t a problem, health care professionals were telling the public that lobotomies would help their child be in a more calm state. This was the story of John F. Kennedy’s daughter, Rosemary. Without her consent, Rosemary had a lobotomy operation. While Rosemary’s circumstances were tragic, her story helped spark a fire that changed laws and legislations in America. Once people with disabilities were deinstitutionalized, they started to thrive in society. People were beginning to understand how much they underestimated their capabilities and how much they could learn from them. 

Throughout listening to this lecture, I realized I understood the context of the information better because of what we learned throughout our Era Presentations. Knowing that JFK had a daughter with a disability helps me understand  why he enforced deinstitutionalization and the Community Mental Health Act. Also, knowing that that Medicare and Medicaid took place in the 1960s, helps me understand how things started to change for people with disabilities. I believe it is important to learn about the past as a future health care profession because there are still echos of discrimination today and it helps me understand the importance of advocating for change.

The OTPF

What is the OTPF and why is it important to learn about?

The Occupational Therapy Practice Framework (OTPF) is an official document intended to identify constructs of Occupational therapy. The OTPF  uses a holistic and top down approach by looking at the domains of occupation, client factors, performance skills, and performance patterns, of the client. It also looks at the client's context and environments as well as activity and demands. The fact that the OTPF uses a holistic and top down approach makes it useful in understanding all the aspects of the client  so that the therapist can help the client perform occupations that are meaningful to them.

Knowledge check 10

My role is a graduate student. My occupation is studying for my classes. The activity I perform for my role is preparing my notes. The tasks involved in this activity are using fine motor movement to type my notes and flip the pages of my textbook.

 

Knowledge check 9

An occupation that is timeless is sleeping. Regardless of what time period you live in, sleeping is an important part of life and self-care.  Part of this occupation may include preparing for sleep or going through rituals that help you fall asleep. Without sleep, a person cannot be productive in society and his or her body can't function.
.  

Why OT?

I always thought I understood what the field of occupational therapy involved since many in my family have professions in rehab. However, it was not until my sophomore year of college that I had the opportunity to see an occupational therapist at work. It was at this moment that I began to understand the amount of creativity, perceptiveness, and compassion necessary for an OT to succeed in helping patients thrive in society. I observed as therapists used specific equipment and materials that both interested and aided patients in integrating their sensory systems, regaining upper extremity strength, and improving motor coordination to independently perform activities of daily living. I watched therapists analyze the difficulties of various patients and respond creatively to help them overcome their physical challenges and activity limitations. While some patients did not exhibit immediate progress, it astounded me to watch them accomplish some aspects of the therapists’ goals and, as a result, achieve more independence. This experience motivated me to observe several more OTs in various settings to gain a more holistic view of the field. My passion for occupational therapy grew as I continued to observe the therapists’ attention to fine motor movement, the communication and collaboration between different therapists and doctors, as well as the diversity of disciples within the field. 

My fascination with fine motor movement manifested when I began college as a piano major. My freshman year, I struggled to play the piece La fille aux cheveux de lin by Claude Debussy with the right intonation and expressivity needed to capture the essence of the piece. My professor explained that my fingers lacked force control because of my upper body posture and the tightness of my shoulder muscles. While it took several months for me to understand how to address the problem, I will never forget how drastically my performances improved once I realized how to relax my shoulder muscles. After this experience, I paid more attention to how my muscles impacted my overall performance. I was even able to identify the weaknesses in my abilities to play due to improper hand positions and find ways to alter my hand posture to eliminate noticeable difficulties throughout my performance. I credit these seemingly minor changes in the way I postured my shoulders and hands to the drastic change in my piano performance that eventually led me to win various piano awards. These experiences taught me to analyze and think creatively in order to solve difficult fine motor problems and to achieve the complex task of ultimately creating something beautiful in the form of music. It amazes me that a single muscle or muscle group can alter my ability to perform simple and complex tasks, and I desire to help others understand and achieve their potential in performing daily tasks, which will enable them to achieve significant, lifelong goals.