Social Determinants of Health

I really enjoyed this TED talk. I think he made great points that describe how the field of occupational therapy is. I would define social determinants of health as the things in a person’s life such as where they live, where they work, where they socialize, and where they participate in daily activities, that affect their health in a negative way or positive way. As occupational therapist students, we have learned that it is always person first and not the medical problem. To fully help someone get better, you must know what happens in their daily routine to figure out how to help them. I loved that in the TED talk, the speaker said, “zip code matters more than our gene code”. He couldn’t have said it any better than that! As we have learned in class, the limbic system controls our emotions. SDoH can cause our limbic system to produce emotions like happiness for when someone enjoys walking through the park every day on their way home from work. They relate the park or environment that they see every day as something happy. That shows how the SDoH can have a positive effect to our nervous system. SDoH can also have plenty of negative affects to our health. As we heard in the TED talk, there was a lady that had awful headaches because of the place she was living it. It wasn’t her genes that caused the pain, it was her own apartment that caused it. I feel like the lady could have also been stressed because there was mold and roaches in her apartment. We know that the neurotransmitter norepinephrine is a stress hormone in the body. SDoH can cause a person to produce a lot of norepinephrine because of their environment.

I think that the program's requirements for service and professional development hours facilitate preparedness in us by having us informed in all aspects of occupational therapy. It is good to know the concrete facts, but it is also just as important to know how to work with clients. It shows us how to be personable and not medical. 

Locomotion and Adaptive Devices

As occupational therapist, it is so important for us to know why we need to appropriately fit each client for an assistive device. It is important to make sure each device is fitted for each individual because you want to make sure the device doesn't do more harm than good to the person. Sometimes if they are not fitted correctly it can cause poor or improper body mechanics and cause injury to the client. Assistive devices are prescribed to help client improve their base of support and stability so it is important that you don't do further damage to the client. We also need to make sure each device is comfortable to the client. The clients will be using the assistive device a lot so we need to make sure it fits comfortably so the client does not receive pain from the device.  It is so important to fit each need for the client so that they can be as comfortable as possible in their condition. 

To fit for a cane, you need to make sure that the hand gip is at the level of the ulnar styloid, wrist crease, or greater trochanter for the best support. When testing, the clients elbow should be relaxed and flexed at about 20-30 degrees. Their shoulders should be relaxed and not elevated. A cane does not proved great stability for clients so you need to make sure the client has is stable enough to use it before the fitting process takes place. 

To fit for an axillary crutch, you need to make sure the client is stable enough for the crutches just like the cane. Axillary crutches provide a little more support for the client than a cane, but you need to make sure the client has enough upper body strength to use them. To fit them for a client, you would use the same method as you did for the cane. The handgrip should be level with the ulnar styloid, wrist crease, or greater trochanter. The elbow should be relaxed and flexed 20-30 degrees and shoulders should be relaxed instead of elevated. The difference with the axillary crutches is that the axillary rest should be about 5cm below the floor of the axilla with the shoulders relaxed. It is also important to make sure the hight of the crutches matches the hight of the client. 

To fit for a Loftstrand crutch, you would use the same method as the axillary and cane, but this type has an armcuff that wraps around the proximal forearm. It is important to make sure that the armcuff is about 2/3 of the way up the forearm. This is used with clients that have long term disabilities. It provides more support than a regular cane but less support than the axillary crutches. 

To fit for a platform walker, the client is typically someone who cannot bear weight through their wrists or hands. The platform surface should be positioned to allow weight bearing through the forearm when the elbow is bent to 90 degrees. Make sure that the client is standing tall with the scapula relaxed. The proximal ulna should be positioned 1 to 2 inches off of the platform surface. This helps to prevent nerve compression. Make sure the forearms and hands are in a neutral and supported position. The handle fo the platform should be positioned slightly medially to allow for a comfortable grip for the client. 

To fit for a rolling walker, the client is someone who cannot lift a regular walker due to UE weakness. This assistive device allows for a large base of support for the client. It is important to adjust the walker to the hight of the client to provide the best support and comfort. Again, you would use the same method as the cane when fitting. Make sure the hand grip is level with the ulnar styloid, wrist crease, or greater trochanter when the arms are at the sides. The elbow needs to be relaxed and flexed at 20-30 degrees. Shoulders need to be relaxed and not elevated. 

It is so important that each occupational therapist follows each of these steps for each assistive device so that they can provide the best support for each client. 

Transfers

The order of hierarchy of mobility skills 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. I think that this hierarchy is in this specific order because you start out with simple task of transfer and then work your way up to more complex tasks. I agree with the order because I believe it is easier to complete the simple task before trying to master harder tasks. I have seen this work in my experience as a physical therapist technician. I have seen clients start out trying to get off the mat by themselves to being able to get into a wheelchair by themselves after surgery. I think every client is different though. Sometimes I would see clients be able to transfer from the wheelchair to the mat with no problem, then struggle to get from the mat to the chair. I believe that as occupational therapist, we can adapt to any different situations that may arise. Even though a client may not follow the exact steps in the hierarchy of mobility, we need to be flexible to each specific client. I have also had the experience of seeing someone fall down the hierarchy of mobility. My grandmother was diagnosed with Alzheimer's Disease about 13 years ago. I have seen here be functional enough to drive to know she cannot get out of the bed by herself anymore. Even though she went backwards down the hierarchy, she did progress through each level of mobility skill. Overall, I think this approach to the hierarchy is well because it allows you to start from an easy level or level that if comfortable to the individual and build up from that point.