Neuro Note #4: ALS

 Amyotrophic lateral sclerosis (ALS) is one of those terrible diseases that we still do not have a cure for. ALS is a condition that affects the nervous system in the brain that causes loss of muscle control. I read a blog post called "One Year" by a man named Ray. He gave a personal perspective of how ALS affects ones life. He had a whole blog about his journey of living with ALS, but his blog post tells about his first year living with ALS. He talks about the process of telling everyone close to him that he had ALS. He said it was the hardest thing he had to do and that it was draining. He felt that way because he didn't know what to say and the people he told didn't know what to say either. I can only imagine being diagnosed with an incurable disease and having to tell everyone I know that I was dying and there is nothing that can be done about it. It is hard to process the thought of dying yourself, but knowing that you are telling people awful news cannot be easy at all. With this disease, there is no specific time line of how fast the muscles will start loosing their function. Ray thought that in a year he would still be pretty much the same as he was when he was diagnosed. He found that it wouldn't be true. He was getting tired very easily. He had trouble eating independently, and it took him a long time to finish each meal. I feel as he felt that he was a bother to those around him because he stated that people usually were cleaning dishes around him and he felt bad that he couldn't help. He also stated that it took him a while to get dressed with help and it was even harder to do it by himself. He had to have a whole new wardrobe since being diagnosed with ALS so that it would be easier for him to get dressed by himself. Reading through his experience should make anyone feel blessed that they can do simple things as dressing themselves independently and to not take anything for granted because it can be gone so soon. I wanted to read this blog post to see what life was like at the initial start for someone who has been diagnosed with ALS. This is the perfect blog to read for someone to get the perspective on the person diagnosed. We can read all about the diagnoses and symptoms of ALS, but knowing how a person diagnosed with it lives helps me understand the disease better. I learned that the best thing you can do for a person diagnosed with this disease is to be there for them and help them learn how to adapt to the new living situation. It is important that they know all the effect of the disease and how to properly prepare their current living environment. It is important for them to know that there is no specific time line for when the muscles will lose function. It is also important for them to have a support system. They will need someone to help them function independently in their daily life. I strongly recommend reading the whole blog by Ray. It give a great perspective on how he found joy through this trial in his life and what to expect of someone who is diagnosed with ALS. 

Photo & Blog from: 

Rays Little Ride. (2016, May 24). One Year. Retrieved from https://rayslittleride.com/2015/12/16/one-year/  

Neuro Note #3: Traumatic Brain Injury

Concussions are classified as a serious type of traumatic brain injury. Concussions happen all the time, but most of the time to children. A concussion happens when a person has a serious blow or impact to the head. It takes a lot of force to hit the head for a person to sustain a concussion. I decided to watch the TEDtalk "Protecting the Brain Against Concussion" by Kim Gorgens. I think she did an outstanding job presenting information on this subject. I decided to watch this TEDtalk because I have always been curious about the effects concussions have on children who play sports. Both my brothers and my fiancé have played football and sustained a concussion from the sport. It is a very serious and scary situation to be in. Depending on the level of severity of the concussion, the person can be a little light headed and have a headache or they can be completely disoriented and nauseous. My younger brother didn't get completely disoriented, but he got nauseous and had a headache for a week. Thankfully, the coaching staff contacted my parents right away and they were able to take him to the hospital to get an MRI to see if there was any permeant damage. We were relieved when the scans came back and there was no damage. We were worried because this was his second concussion. He had one before when he was little at his daycare. They were riding kids around on four-wheelers and they ran over a bump and he fell off and hit his head on the ground. Kim Gorgens stated in her talk that once you first sustain a head injury, the chances of getting a second injury is higher and it keeps getting higher the more times you injure your head. She also said that high school athletes are three times more likely to have serious injuries to the head and it usually takes them longer to be symptom free. The second time my brother had a concussion, he was a senior in high school and it happened during practice after school one day. Since his headache lasted for a full week, they required him to sit out that week plus a full week after the last day his head hurt. I am thankful that there are rules and guidelines in place like that to protect these children. I feel like there should be some rule put in place that makes the schools record how many times a child sustains a concussion and that after three times they shouldn't be allowed to play the sport anymore.  Having multiple traumatic brain injuries can have a negative affect to the brain in the long run. Kim Gorgens talked about a research study that was conducted on retired NFL players. It was actually the wives of the players who wanted the study done. They were all concerned because their husbands were young and seemed very forgetful all the time. This research study showed that NFL players who have had three or more traumatic brain injuries to the head or concussions had a higher chance of getting demented diseases at a young age. Kim stated that there are three things people must to do to try and prevent concussions. They need to study and be educated on the subject, they need to do something about it, and they need to make sure there is protection in place. I loved those three steps that she talked about. There needs to be more guideline put into action to protect these children and athletes from sustaining so many brain injuries. It should be a top priority to protect the minds of our youth. If everyone cared a little more about the affects concussions had, I strongly believe would could come up with a solution to lower the statistic of people who sustain brain injuries. I strongly recommend parents, teachers, coaches, athletic departments, and even athletes to watch this TEDtalk and educate themselves on how to protect the brain. Kim Gorgens did a fantastic job of explaining how you can start to protect the brain from injury.



Gorgens, K. (May 2010). Protecting the brain against concussion [Video]. TED Conferences. 
https://www.ted.com/talks/kim_gorgens_protecting_the_brain_against_concussion#t-541603

Neuro Note #2: Alzheimer's Disease

To me, Alzheimer's Disease is the worst disease that someone can ever experience. It is awful for the person with the condition, but it's even worse on the family. I wanted to read the article "OT's Role in Helping Kids Understand a Grandparent's Dementia" because I have a grandparent who has Alzheimer's Disease. She has had this for about 15 years now. I am currently 23 so I was about 8 years old when she was diagnosed. This article was a perfect representation to me on how it was to grow up with a grandparent who has to go through this type of disease. As a kid, it is hard to understand how someone you look up to will slowly forget things and eventually forget who you are. I know for my situation, by siblings and I spent so much time with my grandmother doing fun activities because we didn't think we had much time left with her. As we got older, we have changed roles from being her playful grandchildren to her caregiver. My siblings and I love that we are able to help my grandfather take care of her because we know that it can get very hard for him to do by himself. We all learned at young ages how to correctly control a hospital bed, a wheelchair, and any other adaptive devices she needed to use before she was completely bed ridden. The article explains how Kathryn Harrison was able to come up with a book for children to explain what dementia is and how to handle it from a grandchild's perspective. It explains that the grandchildren help put the mom and the grandmother in better spirits because they would play all kinds of games together. It was a happy time and made for happy memories. They didn't let the fact that she had a disease get in the way of them making the most out of their time with their grandmother. When she eventually had to go to a nursing home, the caregivers there took the time to explain to the children what all they did so they could be there and help. They also allowed them to stay there when they would do any type of examination on her and even let them do crafts with the other people in the center. It was an important thing because it helped the grandmother be more comfortable in the center. It just helps the whole process when she starts loosing her memory. I love that she came up with this idea to make a children's book to help parents explain what will happen with this disease. I know it is extremely hard on the spouse and the children of the person who gets the disease. I cannot even begin to count the times that I found my mother crying when we all first found out that my grandmother had Alzheimer's. It has made my mom so happy to see that we all still have such a great relationship with my grandmother. Even though she cannot talk much anymore, she still recognizes us all! We know this because when we enter her room she starts smiling so much and tries to talk to us. I honestly believe that my grandmother is still with us after 15 years because we have been by her side from the beginning and have tried to make everything as comforting to her as possible. I would recommend everyone who has to go through telling small children what dementia is to get the book that Kathryn Harrison wrote. It will make things so much easier for the parents. It's hard to explain it to children when you don't really understand what is happening yourself. I am glad to know there is a book out there in case I ever need it in the future.





Picture and Article came from:
Seniors Flourish. (2019, February 11). OT's role in helping kids understand a grandparent's dementia. Retrieved from https://seniorsflourish.com/kidsanddementia/

Neuro Note #1: Parkinson's Disease

I chose Parkinson's disease as my first note because it is a topic that I don't know much about. I have seen patients with this disease from shadowing experience and working in a therapy clinic. I know what it is but not to the full extent. I know that it is a disease that causes degeneration of the nervous system. The nerve cells in the brain start dying. I did some research and found out that many of the neurons that die are the neurotransmitter dopamine. When the levels of dopamine in your body start to die or decrease, it causes the brain to have abnormal activity. I also know that sometimes it can be a slow progression and other times it can be rapid. 

I decided to watch a TED Talk on Parkinson's disease. They have quite a few talks about this which makes me believe people need to better educated on this disease. The talk was "Simple hacks for Life with Parkinson's" given by Mileha Soneji. She started the talk out by telling a personal story. She used to have this uncle that she was so excited to see every time they had family gatherings. She stated that she was so excited because he was the "fun" uncle of the family. He was always the center of attention, would always play with the kids, and would jump around with them. She then goes to say that he was diagnosed with Parkinson's disease. He started out showing signs of developing tremors in his body. I know this is one of the most common ways to tell that individuals have Parkinson's. This is also why I mostly chose this topic to talk about and why I chose this TED talk specifically. I have an uncle who had a stroke about 8 years ago. He was left disabled as a result of the stroke. One major factor that hindered him from getting better was that he developed bad tremors a week after the stroke. I always knew tremors were signs of Parkinson's disease. When I saw that there was a TED Talk titled simple hacks for life with Parkinson's I knew I wanted to watch to see if there were any hacks that would be useful to help my uncle with his tremors.

Mileha talked about how her uncle started to hate to go out in public because he was embarrassed by the tremors and refused to even order coffee or tea when he went out because he would spill it. She wanted to help him to adapt to the environment so she developed this cup that would prevent spills. She made it to where the top of the cup was rounded so when he would shake, the liquid inside the cup would not spill out. I think that was a great invention to use for people who have tremors. My uncle has the hardest time taking a drink by himself because he shakes and spills it on him. 

She also noticed that her uncle had a hard time walking on flat surfaces. She stated that it would take him forever to get anywhere and even longer when he had to turn. He would only turn one foot at a time at a slow steady pace. He ended up having to use a walker everywhere he went. She was curious to how he went up and down stairs without his walker. She showed a video of him walking the stairs and it looked as normal as could be. She then did some research and found that others with Parkinson's do fine on stairs as well. It is because stairs are a continuous motion for them. She found a way to make walking on a flat surface look like a continuous motion for her uncle. She made a paper staircase illusion and taped it on the floor and he did so much better. It was amazing to see how if you trick your brain it does something completely different. 

I found this talk very inspirational. Mileha stated that we all need empathy and that to me is core characteristic that an occupational therapist must posses. She stated that there are about 60,000 new people diagnosed every year. There is no cure for Parkinson's disease, but there are things that we can do to make their day to day life easier and simpler. As future occupational therapist, I feel like we need to be innovative with treatment plans and make sure they fit the needs of each client. We need to make sure we know why they are having the side effects that they do. It takes time to figure things out but it will be worth the failures in the end. This talk gave me a new perspective of the life of an individual with Parkinson's. They do not have it easy at all. It is a hard thing to go from being completely healthy to very sick just because your nervous system is failing you. I will take the lessons I have learned from this video and apply them when I come in contact with people who have Parkinson's and show them empathy and understanding. 

Mayo Clinic. (2018, June 30). Parkinson's Disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055

Soneji, M. (February 2015). Simple hacks for life with parkinson's [Video]. TED Conferences. https://www.ted.com/talks/mileha_soneji_simple_hacks_for_life_with_parkinson_s 

  

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.