Thomas' Tourette's

I watched a Ted Talk about a guy named Thomas White who has Tourette's Syndrome. I highly recommend anyone to watch this video as he explains what he has gone through with Tourette's, and how he is still dealing with it. He explains that Tourette's Syndrome is due to multiple motor and vocal tics that can include repetition and involuntary cursing. He in fact has to deal with both. Although throughout the video you can tell he is struggling with the Tourette's, he manages to make light of the condition and his obvious tics, and make the audience feel enlightened and educated about his neurological condition without bringing negative connotations to it as the world can be cruel and do that very thing. I really like the fact that Thomas does not let it hold him back, or let it control his every day life. He is independent, he went through school, the only thing different is that occasionally he told it like it was (unconsciously). Although, he said that the tics and outburst of comments or words are not exactly what he is thinking and often apologizes. He does not let this control him and his life/lifestyle, and I admire that because most people think Tourette's syndrome is very strange, and hard to be around without laughing or getting offended. This is where becoming educated with the neurological condition and having compassion for those who suffer from it come to play. I especially enjoyed the way he ended his speech with how the Tourette's does not define who he is and that instead of the condition speaking for him, he speaks his own words. 

https://www.youtube.com/watch?v=0szLOMIt9SQ

Breea's Story with Multiple Sclerosis

 Imagine... it's senior year. You're looking forward to the next football game because cheerleaders get front and center to support their fellow classmates against a rival team. You have so many friends, and everything is blissful. Until. You're on the floor, partially paralyzed, and blind in one eye. This is Breea's story. You could say she has a normal life, until this tragedy struck. It happened on December 8th, 2011. Her life changed in an instant, even though her original symptom began with a little coordination imbalance, by 24 hours she experienced all of the aforementioned affects from what was soon diagnosed as multiple sclerosis (MS). A quick definition of what MS is the attack of the myelin around nerve fibers in the central nervous system. Breea was diagnosed with severe MS so it was imperative to act fast. At this point she could not talk or swallow as well. She spent 6 weeks in the hospital relearning the basics, and then began the journey to walk again with the help of therapy services. In the video, even though this seems like such a catastrophic event to happen to a vibrant, and active 18 year old (which I am sure there were ups and downs throughout the journey), all you see is so much support from family and friends, and laughter/smiles, and encouragement/motivation. She decided to stay focused on the positive, and laughed through the triumphs. By day 46, she was discharged and began in home therapy, and there was only more improvement to be made from there. Through her good attitude and determination, 8 months later she was performing assisted back walk overs! She ended up going to prom, getting in to college, and has hopes in becoming a cheerleader again. With her kind of grit, I personally think she could do it. 

In watching Breea's story, and the amount of support that she had throughout her journey made me reflect on how blessed she was, but how unfortunate others are who do not have that. Which brings me to my point about how health care professionals should remember that and take that into consideration especially in therapy. As a future OT, I remind myself how much of an impact encouraging and motivating a client has on them and their progression. Even though therapy is in sessions, it is important that they feel supported within the few hours that you are with them a week. OT's to me have a reputation of being impactful, and I can only hope that I have a client like Breea one day, so I could experience the impact that is not only made on that individual, but the impact that it would make on my life. All experiences teach us life lessons whether they happen directly or indirectly to us. It is important I think to remain humble, kind, and focused just as Breea did. 

https://www.youtube.com/watch?v=hfD9s1_TN0s

CSI for SCI

I watched a Ted Talk on a guy named Janne Kouri who endured a spinal cord injury (SCI). He is a courageous and hopeful guy, whose identity was changed (or so the doctors thought). Before his injury, he was very active and athletic until the unfortunate event that left him instantly paralyzed, leaving him worried about his future. Doctors were so unbelievably discouraging and again leaving Janne with no hope for his future, saying that he should get used to playing games like he was a vegetable who was incapable of ever doing anything ever again. However, with the persistence and help of his girlfriend, and Janne's positive attitude, they were able to find a perfect fitting rehabilitation center that could actually help him. Even after battling an extremely high fever, severe pneumonia, and coding twice in the intensive care unit at the hospital for two months. Here's the kicker. This rehab center was across the country, in Kentucky. They lived in California, and decided to leave everything behind in order to provide him with the best care possible. Not only that, but with the ONLY doctor that said there is hope. So, they went. Through a therapy called locomotive training, he was able to regain some function, and improve his overall health while training there eight hours a day. After a while, a health care worker asked him to try and walk. A couple times of doing so, he began to wiggle his toe, which was something that the previous doctors said he would never be able to do much less regain function to live and lead an independent life. During his whole journey, he got to thinking why did he have to travel this far to have access to this training and rehab facility, and why are the others who are here not able to receive these benefits? Well, even though he was going through his journey, he soon discovered that his mission was to make a difference and correct this issue in the health care system. He was determined to make this locomotive training available to everyone. If you have never heard of locomotive training, it is where a client is strapped into a harness and trainers/therapist assist in helping you simulate movement such as walking. Because of this awesome innovation, he was able to walk a little bit with a walker, and give his wife there first dance. A special moment indeed, all thanks to the people who had hope and passion to strive for better than playing board games for the rest of their lives, and to actually live life instead. I think as a future OT, this reminds me to never give up hope on a client, even if I am not the one who could help them, but even pointing them in the right direction. It is our duty as (future) health care providers to have their best interests at heart, and do good because that is simply the right thing. In doing all of this, we should be more like Janne even through the toughest moments of his life. Keep smiling, keep laughing, and find a reason to be happy every day no matter what it is or what you are going through.

https://www.youtube.com/watch?v=xCxCFjmruSg

Mentioning Dementia

I watched this Ted Talk by a woman named Beth Malone. A very sincere, and real talk about her father’s dementia. She explained that her father was in the later stages of dementia (a neuro degenerative disease) and was no longer able to care for himself as he needed anymore. So, he was brought into a care facility that would help him daily. Beth said that this was not a place where he would have delighted in with a sound mind, or a lack of better words that he would normally reside in prior to his dementia. Because of this, she felt compelled to take him from his misery, however, she knew she really could not do this for him. Instead she decided to keep her father/daughter dynamic and roles and just be there for him. During this video, you’ll notice she holds back tears on several occasions, and I remind myself that even though we treat client last specifically, these personal family accounts or perspectives of their loved ones remind me that empathy is such a huge part of this profession, not only for the client but their loved ones. Each person may be affected differently as well, and it is important to remain mindful of everyone’s feelings in a situation as sad as dementia is in any state or form, early or late. I am so passionate about the importance of considering others feelings in what you are doing, and I believe that is why I am meant for OT. Dementia is a very tough journey not just for a client but to anyone who is involved and especially has a close relationship with them. Empathy is just about everything.








https://www.ted.com/talks/beth_malone_how_my_dad_s_dementia_changed_my_idea_of_death_and_life

Let's Talk Neuro!

Have you ever experienced a person having a seizure? If so, what did you do? More importantly what were you thinking at that moment of that person? Well, after watching a Ted Talk about a specific chronic neural disease, I definitely learned a little more than I already knew. What I mean by that is, not only did I gain knowledge while watching and listening, but I gained an outlook, a perspective if you will about the subject because I think some of the best educational experiences come from testimonies. So, with that being said, the speaker in this Ted Talk was Claire Koster. In this video, she was 17 years young, and battling a chronic neural disorder called epilepsy. What I learned was that there are two different categories which are petit mal, and grand mal seizures. Petit mal was described as a "loss of control over the nervous system", while grand mal was defined as a "loss of control over the muscles" (Claire Koster, 2015, 0:33). Claire was diagnosed at the age of 2 years old, and experienced petit mal seizures whenever triggered. Another thing that I learned was that sugar can affect if someone is triggered into a seizure. Interesting. Other things that she must keep in moderation is alcohol consumption, and of course "party" lights or strobes. Other than this, because of her medicine, she can live and lead an independent life. I refrain from saying a normal life because the word normal is such a construct and has a different meaning to everyone. She further explained that like other disorders, there is a spectrum for this one as well. She observed other individuals who have the same diagnosis but were wheelchair bound and were not able to live as independently as her (which I am sure humbles her deeply, even at such a young age). So, when you hear that someone suffers from epilepsy, don't assume the worst. In fact, in her speech she gave out some astounding percentages of what people think about epilepsy. I won't name all of them because it is quite a lot but when it comes to children and love, it hits me the most. So, Claire brought to mine and the audience's attention that " 12% of people thought they should be isolated from other children, 23% of people would not let their future children integrate with them, 14% of people say they should not be allowed to marry/have children themselves, and 64% of people would not marry someone who suffers from epilepsy" (Claire Koster, 2015, 1:15). How should these percentages and statements make a person feel? Especially someone who suffers from it. My biggest take away from this Ted Talk, is the perspective that I gained because in OT I believe that as our main goal. Empathize with how someone feels and try to create a better standard an outlook for them to provide them with the best quality of care that you can. Claire explained that a lot of people think that their boundaries are considered a negative thing, but she says because of her boundaries, she actually has none. At the bottom, if you are interested, there is the link to her video which I recommend. Her confidence and courage are inspiring. 

Koster, C. (2015, December 9). Living with a Chronic Neural Disorder. YouTube.

https://www.youtube.com/watch?v=WYcuvtdvD88 

Social Determinants of Health

I watched a Ted Talk by Rishi Manchanda who spoke about social determinants of health (SDoH), and how this knowledge can change lives in healthcare. Well, what are social determinants of health you may ask? These are everyday factors that can impact your health such as where you live, where you work, accessibility to resources, and transportation to and from these places. Not only that, but more specifically the conditions in which someone surrounds themselves in whether it have to do with living, working, education, economic status, or leisure. These factors or determinants if you will, can all play a role in a person’s health, or expected health behaviors, a big role actually. Because social determinants are so influential to a person’s health, you can believe that it can impact one’s nervous system and overall being. Take stress for instance. We can experience stress at any age depending on someone’s circumstances, especially a child who grows up in an abusive home, or maybe just a low economic status and lacks simple resources that are beneficial to their well-being. Stress can affect your whole body, most importantly your brain. When a person is stressed, they are most likely feeling an overload of emotions. But when a kid who lives in a home or is in an environment that is constantly stimulated by the same stress because of some type of instability or lack of necessities (love, food, clothes, stability, consistency, etc.) that can and will play a role in their emotional states, and behaviors which in turn affects their nervous system. For example, stress is can have an effect on decreasing gray matter in the prefrontal cortex, which is a region of the brain linked to such things as self-control and emotions. This is just one example of many.

Lastly, UTHSC’s OT program requires so many hours of service and professional development hours and I think this helps prepare us OT students for the future in our profession because it is teaching us early on the skills necessary to become outstanding OT practitioners. It teaches us to take responsibility and pride in our work and I think most importantly becoming independent in self-awareness and self-motivation in anything that we do. I am extremely thankful to be in a program that is not only concerned about our education, but also the necessary skills for when we interact with coworkers and clients.

Assistive Devices

Assistive devices have come such a long way from how they have been made in the past, today, and for the future because technology is an ever-growing field along with healthcare. The great thing about assistive devices are that they are made to be adjusted to each patient and fit them appropriately to produce only productive outcomes. One of the reasons that assistive devices need to fit appropriately to a patient/client is for their safety. Safety is always our main concern with anything to do with a patient. Let’s say someone is on crutches, but they are not adjusted to the right height, whether it be too short or too tall, this is a situation that puts the client at a fall risk. Another reason to fit a client for an assistive device is for comfort. Again, let’s say someone is being fitted for a wheelchair. Now, not everybody has the same body type (long legs, short legs, long torso, short torso, etc.). If the width of the chair or the height of the chair does not fit, it could cause rubbing behind the legs, or create uncomfortable posture/hip flexion.  

One assistive device that you can be fitted for is a cane. This can be accomplished by telling the client to stand while look straight ahead with arms relaxed at their side. The handle should be in line with the wrist crease, ulnar styloid, or greater trochanter. If need be, you can adjust this by releasing the locking mechanism, pushing the button, and moving the cane base to the correct height. Another, assistive device that you can be fitted for are axillary crutches. The crutch length should be about the same length as the distance from the client’s forearm to the fingertips of the opposite hand, and the length of the crutches should be based on the height of the client. The arm pad should be 1 to 1.5 inches under the axilla or armpit area or 2 to 3 finger widths. The handgrips should be in line with the wrist crease when hands are resting at their sides. Along with those crutches, there are some called loftstrand crutches that allow for more dynamic movement and control in small spaces. To fit a person to them, the cuff of the forearm crutch should be three fingers width from the elbow and then lock the buttons in place. The handgrip should be adjusted to the height of the wrist and show a slight bend ion the client’s arm. Lastly, walkers are a very popular assistive device used for all kinds of injuries or the elderly. To get fitted for the platform walker, the platform surface should be positioned to allow weightbearing through the forearm when the elbow is bent 90 degrees and the client is standing tall and relaxed. An important note to avoid nerve damage, the proximal ulna should be positioned about 2 inches off of the platform surface, while the handle of the platform should be positioned medially to allow for a comfortable grip. For the rolling walker, the height of the walker handles should be at the hip joints of the client and their elbows should be bent at about 20 degrees give or take because everyone is a little different.  

Let's Get Moving!

The order for restoring confidence in mobility as activity demands increase are these listed in order: bed mobility, mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADL, toilet & tub transfer, car transfer, functional ambulation for community mobility, and community mobility & driving. I think the hierarchy is in this specific sequence because it allows a client to work and build on more basic and lower level skills (but imperative) in order to achieve higher level and more complex skills for everyday life for them to become more independent in their daily living. Their quality of life depends on it, so I agree with the lay order. I think of it as building blocks, and the more basic skills and activities, like taking care of yourself are the foundation, and like a house you build off the foundation. When you are able to take care of yourself it not only allows for independence, but as well as giving a person the ability to take care of others, or (like driving) being aware of yourself and others.

In my past observations, I never got to see this progression in mobility although I think that is the best part of therapy almost. I saw progress in different clients, but not to the degree of this type of regaining of confidence and independence in mobility. I do think that every person is different, and when you have one client who may not be in any worse of a medical situation but is more emotional or emotionally stable I do think that can impact progression in these steps.

I would love to see this type of progression in a client in the future, and honestly it is this type of impact on a client that I am eager to assist with in my profession as an OT.

Body Mechanics

Reasons to teach people/clients about proper body mechanics and posture are very important and include:

1.       Prevent injuries to the body such as muscle, joints, etc.

2.       Protect your body from back pain and or other parts from strain  

3.       Promote ideal balance and coordination

4.       Encourage safety for yourself and others

One way that I would teach a client on how to use proper body mechanics is by using something straight like a yard stick or something, and aligning it on my back along my spine, back of my head, and tail bone (to show them, and later allow them to try), and I will demonstrate how to properly pick a package up from the ground without bending over like most people do which is not proper body mechanics. The idea is that the stick stays on all those areas that I explained, and you lift with your legs when you grab the object from the ground.

Another way that I could show a client how to use proper body mechanics is informing on how to improve posture when sitting in a chair especially for long periods of time if that is your job. So, first adjust the height of the chair where your feet are nicely planted on the floor, and your knees are either in line or slightly lower than your hips (comfortably). Obviously sit straight up in the chair, and your hips all the way back in the chair as well. Lastly, the back of the chair needs to be slightly inclined also. This will reduce back pain, and promote good posture!

Interesting, Might I Ad!

So, I was trying to think of a popular ad, and it seems like every time I purposely try to think of something like a song, or anything specific, nothing comes to mind. So, I decided to look up popular ads, but then I thought they were too popular, so I went for something that I was wanting to connect with personally. A certain emotion I wanted to feel, and so that is what I searched and came up with... an ad that fit me. At the bottom I will post a link if you would like to watch it. In the ad, there are three individuals that are feeling stressed about just everyday life, and one trying to fall asleep. All three were wanting to experience some relaxation. This is something that I can relate to on a daily basis, and I may even get the app that they were advertising! Anyhow, in the nervous system you have your CNS and your PNS. The PNS (peripheral nervous system) connects the CNS (central nervous system) to the rest of the body. The PNS divides into the somatic (voluntary movement) and autonomic system (involuntary movement). The autonomic nervous system further divides into the sympathetic and parasympathetic nervous systems. I believe that this specific ad kicks both subdivisions into work. In the beginning there is immediate over stimulation, which quickly made my heart rate race a little because I could easily relate to the stressors given which is the sympathetic nervous system at play. It is your fight or flight response. Now, quickly into the ad they switch gears and advertise this app on the phone to help you relax and get away from all those stressors and connect with yourself again. This is where your parasympathetic nervous system comes into play. It is responsible for lowering your heart rate and blood pressure and bringing your body back down from a stress induced state. It is your rest and digest response. Both are very important and imperative. I hope this "Ads" to your knowledge!

https://www.ispot.tv/ad/dEi1/calm-reduce-your-stress

"Man from the South"

The daily routine of the soldier (with all fingers intact) would be normal in doing the very things he enjoyed. Now, had he taken the bet and lost, certain occupations would certainly be affected like specific sailor duties possibly pulling up a rope, or simply even grabbing a drink. His sense of gripping things would be decreased because that is a big function of the pinky finger. The wife of the of man betting against the soldier, I am sure that her daily routines are very difficult with only having a couple fingers, such as washing dishes, or even driving. I believe most of everything would be difficult and need to be modified in some way to improve function. Depending on what fingers were still intact, which I know the thumb was but I am unsure of the other one that was left, a way that washing dishes could be modified would be wearing a special glove that fit her hand with scrubbers/grippers on them to sufficiently grip the dishes and wash them as well.

My Neurotransmitter Depiction Picture: Gamma Aminobutyric Acid (GABA)

My OT Conceptual Model

https://drive.google.com/file/d/1IP-S224nurGcH1_DuMyCUcOeWIephvmK/view?usp=sharing

Implicit Bias

What is implicit bias? In my own terms I think of it as your personal experiences/attitude about things that are unknowingly influenced on our own choices and comprehensiveness on different aspects of life. With knowing what it is, do you think you have any implicit biases? Well, I think that everyone does in their own way, not even knowing it because it is an unconscious act. Maybe after recognition and reflection you then would figure out that you do. Bias has such a negative connotation to it, but these biases don’t just mean race, gender, or political standpoints. They could mean the way you feel about a simple tattoo that someone has, or their lifestyle choices. So, why is it important for students and OT practitioners to learn about this? Well, if you know and have reflected on what implicit biases that you have, or even just acknowledge that you have some, you can then decide how you will act in a certain situation with a client if they do or think a certain way that you may feel differently about.   

Not only that, but human communication is the basis of humanity, and if we are not all trying to help one another, or for the very least communicating with one another then why are we here? What is our purpose? It is about making connections and feeding off what we already know but most importantly what we learn on top of that. Being a consistent life-long learner invites a sense of diversity and a respect for the ever evolving and shifting of cultures. During a podcast interview with Dr. Lancaster she spoke about putting our implicit biases aside and unconscious assumptions on populations because if we don’t do that it could impact a client clinically and the opportunity for them to get the best and most efficient care possible. Dr Lancaster also said something that stood out to me which was, “Inclusion is not a favor, it is just the right thing to do all of the time.” We in OT, it is our duty to always make an effort to include others and the many walks of life. This does not mean we have to accept in their part, but it does mean that we should try to understand them, and use our empathetic, therapeutic self. This also means to have more cultural humility which in turn makes for a more client centered approach.  The first step to understanding your client is with asking the right open-ended questions, but more importantly understanding the importance of actively being present with your client or anybody. I learned this from a brief article that I read by Debbie Hall called “The Power of Presence.” Even in the times that you don’t have all of the right words to say, the value of being there for someone speaks volumes and it might seem like you are not doing anything, but in actuality, sometimes people just need a listening ear and a shoulder to lean on.

How can we reduce the impact of our biases? How do we even recognize that we have them? Because we all do, whether you know it or not. Well, the first thing you could do is understand what implicit biases are and recognize that you may have some. Second, if you want to know what some of them are then you could go to a website called Project Implicit. There is a test you can take, it is free, and it gives you insight on what you may have implicit biases on with certain populations or groups. Lastly, once you have examined and reflected on those biases you could look up a 7-day implicit bias cleanse to help with personal reflection. This is also free. These are just a few things to help widen our lenses and broaden our minds. 

My biggest take away from all of this is the fact that I discovered I have my own implicit biases that I never knew about. I have always tried to make inclusion such an important thing because I know what it feels like to be left out or see the effects of someone being left out or not understood. I too am going to take the steps to reduce my own implicit biases so that I can in turn become an outstanding OT practitioner for the sake of my future clients.  

Scapulohumeral Rhythm

Joints are so interesting in how they can move and how different joints work together to create certain actions, and with injury to one of those joints how it affects that motion altogether. Take the shoulder, for example. A simple ball and socket joint called the glenohumeral joint, but in order for you to reach over head for something or for an activity like volleyball you also have to have a joint in conjunction with this one in order to reach full range of motion. This joint is called the scapulothoracic joint. When these joints are paired together, this is called scapulohumeral rhythm. They work in a 2:1 ratio, where the glenohumeral (GH) joint works in 2 degrees of motion, while the scapulothoracic (SC) joint works in 1 degree of motion. When these joints are working together synchronously, it protects the contents within the subacromial space. However, if the scapula is injured or not rotating upward properly, this can cause impingement to the subacromial space resulting in pain. Also, the humeral head must rotate laterally in order to complete full ROM, along with rolling and gliding in the glenoid fossa which is a decrease in shear forces. So, it is imperative that these joints stay in conjunction with each other in order to have full functioning capacity, so… stay healthy, stay strong, and stay educated!