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.