Media Project: Aluminum Foil

 

   While completing this project, one of the things I learned is that if you use some creativity, you do not need expensive equipment to create an intervention that can benefit the client. This assignment also emphasized the importance of the interview with a client so that the OT can get all the necessary information to create an intervention that is catered to the client. After reading through the case study I realized just how much you have to consider when creating an intervention. Initially seeing that the client was having trouble gardening I wanted to find a way to use the aluminum foil to help her with her big grades, but after seeing she can only do things for about 15 min and that her husband is gone most of the day for work, I quickly realized that having her garden outside alone was not the safest idea so I found a way for her to participate in gardening while sitting down inside her home.

   One thing that I learned from this assignment is that it really is important to always be working on creative and cheap interventions that can be used. Creativity is something that I definitely struggle with at times, but there will be times that I may not have access to the intervention tool that I would traditionally use, or the traditional intervention tool may not match the client's interests. This is another major advantage to creating an original intervention, it can be designed specifically to match the client's needs and interests. Hopefully this assignment will help me in the future to think outside the box when I do not have a clear answer or approach to a problem. 

Neuro Note #5: Dementia

    I listened to Beth Malone's TED talk titled "How my dad's dementia changed my idea of death (and life)". In this TED talk Beth discusses the mental challenges she endured while her father was dealing with frontotemporal lobe dementia. She talks about how hard it was to watch him be trapped in a body that took away his ability to interact with the world the way that he wants to and should be able to. She described it as him being tortured in that body and wanting to get him out of it. Essentially she wanted to kill her dad to free him from the disease. Beth talks about how death no longer seemed like the worst fate and she wished they had talked more about each other's "best death" when the whole family was still healthy. At the end of her TED talk she discusses her realization that she is his daughter, she is not his doctor and therefore the big decisions should not fall on her; her only role should be to be his daughter.

   I chose to do my assignment on this TED talk because the concept was intriguing to me. We live in a society that assumes life is always better than death and we do everything in our power to preserve life. However, this TED talk raises the concern of quality of life versus life. I think this TED talk brings up a really important conversation that people should have about what kind of care they want to receive in situations like this. As Beth mentions, no one wants to have the "death" conversation while everyone is healthy, but knowing how a loved one feels about this topic will help others not feel guilty or confused when decisions need to be made. As a future OT I think it is important to try to help clients and their families open up about these kinds of conversations while the client is still healthy enough to convey his or her opinions and preferences so that everyone can feel confident when making decisions in the future. It is certainly not an easy conversation to have, but it is an important one. I also think it is important to see how much pressure Beth felt to "save" her dad, even though she was his daughter and therefore that kind of responsibility should not have fallen on her. This is somewhere that OTs can help with the family and helping them realize that there is a team of physicians and healthcare professionals that can help guide them in the process. I would recommend other's to listen to this TED talk to better understand the challenges that loved ones of the client might be facing to help them become more aware of how to assist the client and their family. 

Malone, B. (2017). Transcript of "How my dad's dementia changed my idea of death (and life)". TED. https://www.ted.com/talks/beth_malone_how_my_dad_s_dementia_changed_my_idea_of_death_and_life/transcript.

Neuro Note #4: Spinal Cord Injury

   I read a blog post by Elizabeth Forst, "Anything is possible", where she talks about her experience chasing her dreams after a spinal cord injury. In August of 2014 she had a swimming pool diving accident that resulted in C4/C5 injury that led to her having complete quadriplegia. Before the accident she was just weeks away from obtaining her advanced diving certification. While she realized this dream was probably not in the cards anymore, she refused to give up her passion for diving. Just 2 years later in May 2016 she was preparing for her first dive since her injury. Unfortunately, without the use of her arms and legs she cannot dive independently, however she has found ways to adapt the situation to meet her needs and has decided to dive with two trained “buddy divers” who will help her to dive safely. Also, since she cannot use hand signals to indicate distress or to signal “okay”, she has created some of her own signals using her head, eyes and shoulders. 

   I chose to read this because I thought it was really inspiring to see someone has quadriplegia chase such an adventurous dream that even I am terrified to do. Diving can be a dangerous and taxing on a fully able-bodied person and for her to choose to tackle this challenge is truly incredible. I think there is a lot to be learned from Elizabeth’s mentality; she decided to be positive and find new ways to pursue her passions. I would recommend other’s read this because it just goes to show how important to not write people’s abilities off simply due to their diagnosis. Based on what I have learned in my neuro class about C4/C5 spinal cord injuries with complete quadriplegia, I would not typically expect to see that person take a dive into the depths of the ocean, but as she says “anything is possible if you put your mind to it”. As a future OT, I think this is a great example of the importance of the Occupational Profile and the general importance of getting to know your client. Even if two clients have the same diagnosis there abilities, needs, and wants will all be different and it is important to take note of this to help a person feel fulfillment with their life. 

Forst, E. (2016). Anything is possible - Blog. Reeve Foundation. https://www.christopherreeve.org/blog/daily-dose/anything-is-possible-by-elizabeth-forst.

Neuro Note #3: "The Theory of Everything"

   I watched the film "The Theory of Everything" which is about Stephen Hawking, a famous physicist, and his diagnosis of ALS, Amyotrophic Lateral Sclerosis, more commonly known as Lou Gehrig's disease. The film shows what his life was like after he was diagnosed with ALS, along with his wife's experience. Shortly after his diagnosis he married Jane Wilde, with the expectation that caring for Stephen Hawking would be hard, but also only last for a couple of years due to the short life expectancy associated with ALS. Stephen Hawking however far surpassed the average life expectancy of 2 years and lived for over 50 years with ALS. This story gives an interesting perspective on how it can be just as much of a hardship for someone to live so long with ALS as it is for them to die quickly of ALS. Throughout the film the viewer can see how difficult it is for Jane to be a full-time caregiver to her husband as well as her children. I think this film also does a great job of showing how tragic it is for someone to suffer with such a debilitating physical disease and to still have the mind so intact. Overall the film greatly displays the trials ALS can place on a family and really show how devastating the effects of the disease are.

   I chose to look at this film because I have watched it before in the context of entertainment and now that I am taking a neuro class I thought it would be interesting to watch it with a greater emphasis on understanding the disease. As a future occupational therapist I think it is important to watch films and documentaries about people with these various diseases that we may see in our practice because it helps to see what a person's life is like outside of the walls of the clinic. It helps to give insight into their daily world and the world of the families as well, which is sometimes hard to fully grasp and understand through just a series of questions. I would recommend others watch this film because it shows a unique side of ALS where you can see a longterm struggle with a disease which typically comes to a fairly rapid end. I also think it is a good film because it does provide some background information about ALS which helps with the general understanding of what the progression of the disease looks like. Overall "The Theory of Everything" is a heartbreaking film to watch, but Stephen Hawking's story is definitely one worth knowing.

Neuro Note #2: "My Beautiful Broken Brain"

   I watched the documentary "My Beautiful Broken Brain" which is about a 34 year old woman named Lotje Sodderland and her journey of recovery following a hemorrhagic stroke, which was later found to be due to a pre-birth abnormality in her blood vessels. This documentary follows her journey returning home from the hospital, to going to an inpatient rehabilitation facility for people who have suffered a stroke, and even trying a new experimental treatment (which may have been the cause of a seizure that she later experienced). The beginning of this documentary was heart breaking as she showed her everyday struggles with communicating. The hardest part was to see her frustration with herself, knowing that these were things she should know how to do and knowing that she used to be able to. At about 7 months since the stroke, her language was noticeably better and she seemed to be a little happier with herself. She then heard about an experimental non-invasive brain stimulation study which gave her hope for more improvement in her language comprehension. Unfortunately, either from the experiment or from her increased risk following her stroke, Lotje had a seizure which caused a regression in her progress. Seeing both her and her family's experience throughout the whole recovery progress shows just how important it is to have that support system backing someone in the recovery process.
   I have always found documentaries like this are so important because they remind us that the clients and patients we deal with are real people and so are their family members. I also think it is nice to see the reactions in "real-time" since the footage was taken throughout her recovery. I think her story is also very inspirational, because despite her roadblocks along the way, and her frustrations, she shows that after a brain injury like this not everyone will be able to get back to their "old self" but they can still have goals and strive to be successful in other ways in their new life. At one point in the documentary she talks about her new outlook on her life and how she has different goals in life now but that doesn't mean she has failed. I think this is important for all OT's to remember as well as any person dealing with a neurological or physical condition, sometimes one will have to change things about his or her old life, but it does not have to be a bad thing. In my neurological course we have been learning about CVAs (aka strokes) and to see the deficits that commonly follow a stroke through a documentary like this really helps to put into perspective how serious and devastating these effects can be.  I definitely think that others should watch this film to see how Lotje and her family/ friends helped her overcome so much in a single year following her stroke.  Overall I loved Lotje's positivity and courage throughout this whole film and I think there is a lot to learn from her perseverance.

Neuro Note #1: "The Innerkid Philosophy", Huntington's Disease

   I watched a TEDtalk called “The Innerkid Philosophy” given by Kristen Powers who is a teenager who lost her mother to Huntington’s Disease. Her mother was diagnosed with the disease in 2003. By 2005 the physical symptoms were becoming evident and eventually she was deemed emotionally unfit to stay in her home. In January 2011 her mother passed away. After her mother’s diagnosis she and her brothers realized that there was a 50% chance that they would have the disease as well, but they would have to wait until they turned 18 to be genetically tested. Kristen speaks on how she was faced with many difficult topics at the age of 12. She was faced with the thought of potentially having to care for her siblings if they had the disease as well as wondering if a future husband would have to care for her if she had the disease. Knowing the short lifespan following a Huntington’s Disease diagnosis she thought about the possibility of having her independence and life taken away so soon.

   Facing these thoughts led her to the idea of the “Innerkid Philosophy”. She remembered always hearing adults talk about their childhood being the best time of their lives and she did not want to lose that spark of childhood as she began adolescence. Kristen wanted to have fun, but also save the world in the process by making an impact. Since she could not be tested for the disease for 7 more years she decided to embrace the “power of not knowing” and make every moment matter.

   In past classes I have learned about the medical aspects of Huntington’s Disease, but have never really focused on the emotional impact it can have on the family. This TEDtalk had an interesting perspective since it came from the teenage daughter of a woman who had Huntington’s Disease. I also thought this was an interesting perspective given Kristen had yet to be tested for the disease she was able to speak on the challenges as well as the positives to not being able to find out if she will get the disease due to genetic testing laws (which I did not know you had to be 18 for). I chose to watch this video because the perspective was interesting to me. Knowing that Huntington’s Disease is genetic, hearing the daughter’s thoughts and feelings about her past experience with her mother as well as her possible future was very enlightening and something that I think is important, as a future OT practitioner, to understand. I think stories like this help remind people that often times with a client, especially clients with a neurological condition, the family is also important to think about as well so that they are not over burdened with their new roles as caretakers. After watching this TEDtalk I am going to be watching Kristen’s documentary about her journey and decision to get genetically tested for Huntington’s Disease.

Link to Kristen’s TEDtalk: https://www.youtube.com/watch?v=l6JiBiMqiI4

Kristen’s Documentary: “Twitch”

Powers, K. (2012, April 13). The Innerkid Philosophy: Kristen Powers [Video]. Youtube.                                                       

            https://www.youtube.com/watch?v=l6JiBiMqiI4

Social Determinants of Health

   Social determinants of health are essentially anything and everything that makes up your life. This can include where people live, what their job is, how old they are, socioeconomic status, and many more. These can all play a role in our health, including the health of our nervous system. 

   Strokes for example can cause many different neurological problems depending on the severity and the location in the brain where the stroke occurred. Some of the biggest risk factors for a stroke are obesity and physical inactivity which have can have a direct link to social determinants of health. For example, if a person's environment is not safe or lacks adequate access to things such as gyms or parks a person may be less inclined to exercise. Also healthy food options may be hard to acquire due to location, money, or both. These factors contribute to the risk factors for a stroke and therefore increase one's chances of suffering from a stroke.

   Another big component is stress, particularly if it is chronic stress. This stress can come from someone's job, responsibilities at home, or even from feeling unsafe in the neighborhood they live in. This chronic stress can lead to elevated levels of cortisol, which is considered the "stress hormone". Higher levels of cortisol can impact the nervous system by shutting down the prefrontal cortex, which is important for executive functioning, as well as causes the amygdala to grow, which is involved in fear and anxiety. Cortisol in high amounts is also associated with hypertension which is one of the factors that can lead to a break down of the blood brain barrier, which can lead to further problems with the nervous system.

  The UTHSC program requires 75 hours of service/ professional development hours throughout our time as MOT students. The requirements help us to not only build on our knowledge of the profession through experience, but also help us to become more aware of the community around us and what health disparities people may be facing. By completing our hours in the three categories of public service, professional development, and leadership & advocacy, each of the students are able to get a diverse look and experience into many of the aspects of occupational therapy and hopefully help us to have a holistic view of the client.

Locomotion and Adaptive Devices

   It is very important to properly fit a client for an assistive device. Having a properly fitted device helps improve the client's function while using the device, it is important for their safety, and the client's overall comfort while using the device which will encourage the client to use the device.
   To fit a client for a cane the handle should be in line with the client's wrist crease, ulnar styloid, or greater trochanter. When the client is holding the cane, the elbow should be slightly flexed to about 20-30°.
   For axillary crutches, the crutch length should be roughly the same length as the distance from the patient's forearm to the finger tips of the opposite hand. The arm pad should be roughly 1-1.5 inches under the axilla which is about 2-3 finger widths. The handgrips should be in line with the wrist crest, ulnar styloid, or greater trochanter when the client's hands are resting at the side.
   Lofstrand crutches should have the arm band positioned 2/3 of the way up the forearm.
   The platform walker should have the platform surface should be positioned to allow weight bearing through the forearm when the elbow is bent to 90° and the client is standing tall with his or her scapula relaxed. For the client to acid nerve compression, it is important to have the proximal ulna should be positioned 1-2 inches off of the platform surface. The handle of the platform should be positioned slightly medially to allow for a comfortable grip when the forearm is resting on the platform.
   The rolling walker should have the hand grips at the level of the ulnar styloid, wrist crease, or greater trochanter. The elbow should be relaxed and flexed at 20-30°. The shoulders should also be relaxed and not elevated.

Transfers

It is important that when increasing a client's mobility, both the client and the therapist feel confident in the ability of the client to perform the task safely. The first skill in mobility that needs to be mastered is bed mobility, which involves positioning the body in bed and performing activities in these positions. The next step is to become confident in mat transfers, followed by wheelchair transfers, and then bed transfers. These transfers are all important steps in helping the client progress in their mobility. These are then followed by functional ambulation for ADLs and toilet and tub transfers. Then as we reach some of the higher levels of mobility the client will practice car transfers, functional ambulation for community mobility, and lastly once a client has mastered all of these skills they can work on community mobility and driving. To me this hierarchy of mobility skills makes sense since each step leads into the next. Each level serves as a preparatory stage for the next skill which helps the client and therapist feel comfortable moving on to the next step. This hierarchy is useful in helping space out the steps so that the client does not try to do too much too fast. I think its is also helpful for clients who may not be able to achieve the highest level of mobility to have these stages so that he or she along with the therapist can clearly see when they reach a level that may be too much. Most of my past experiences with OT have been in hand therapy and pediatrics so I do not have a lot of experience with seeing these steps in action, however from what I have learned in Biomechanics as well as with some of my other courses thus far, this hierarchy seems like it would be a good and effective option for helping a client regain mobility.

Posture and Body Mechanics

   Proper posture and body mechanics are important for everyone as it helps with balance, stability, and reduced risk of injury. If a client has a faulty posture, which can occur anytime one or more curvatures of the spine become exaggerated or decreased, this can  move his or her center of gravity out of their base of support, decreasing his or her balance. Faulty posture can also cause increased pressure on the spine and other joints as they try to compensate for the misalignment.  Poor body mechanics can also be a problem because when we use improper body mechanics for tasks such as lifting or reaching, we can cause unnecessary strain on our joints and muscles due to having an alignment that is not mechanically cohesive with the actions of the muscles. Improper body mechanics or posturing can cause discomfort and pain performing certain actions which may lead to an increase in maladaptive posture and body mechanics creating a cycle of worsening pain and alignment.
   An example of how to teach a proper lifting technique with proper body mechanics and posture would be to have the client keep their head, neck, and butt in alignment, have a wide base of support by having nice wide stance, having the clients hinge at the hips and bend at the knees for the squatting portion of the lift. For the grab and lift I would instruct the client to have the object as close to their body as possible before grabbing, then to grab the object maintaining the body alignment from the squat, by looking up, and have the client then stand and lift straight up. Another example would be to work on proper sitting position for a client who spends a lot of the day working at a computer desk. I would instruct the client to sit in the chair and to push the chair closer to the desk and get a computer stand, if possible. I would instruct the client to sit forward in their chair as if they are about to stand up to promote and anterior pelvic tilt, with their eyes facing straight forward and looking at eye level to prevent a forward head posture.

Advertisements and the Nervous System

   The television advertisement that has always stood out to me is the iconic ASPCA ad with Sarah McLachlan singing “Angel”. This ad is more than 10 years old and I still clearly remember it, which means it was a pretty effective advertising. In case you are not familiar with this ad here is a link to the ad:https://www.youtube.com/watch?v=6eXfvRcllV8. Between the emotional music and the images of the sad, injured animals, my pet loving heart just breaks. Most ads on T.V. are upbeat, loud and busy, so having such a stark contrast with the sad music and depressing images really catches you off guard and makes you look and take notice. Since I was a little kid when this first came out, I remember there was a shock factor to the ad with the statics and images. I could not imagine that anyone could mistreat an animal like that. This commercial uses pathos which would involve the limbic system. The limbic system is responsible for emotion and memories. The amygdala which is part of the limbic system is specifically related to emotion and linking that emotion to memories. The amygdala also plays a role in empathy, which is utilized in the ad with seeing all the helpless faces of the animals, causing you to empathize with the animals. The hippocampus, which is also part of the limbic system, is where this memory is stored since it is an emotionally driven memory. Now even just hearing that song immediately reminds me of the commercial and all the emotions it elicits. Clearly this marketing team had a good understanding of the nervous system and how to get their message imbedded in people’s memories.  

"Man from the South"

 I read "Man from the South", by Roald Dahl, which is a story about a young sailor who finds himself betting against an older man that he could get his lighter to light 10 times in a row. If he won the bet, he would have received a Cadillac and if he lost he would have had his little finger on his left hand chopped off. At the time the bet was made the sailor was unaware that the older man had done similar bets in the past with the same stakes, until the older man's wife revealed this information and it was observed that she herself had only one finger and a thumb remaining on her hand from previous bets with her husband.
   It is interesting to read this story since I am currently learning about the hand in my biomechanics class because one of the deciding factors for the sailor to go through with the bet was that he found little to no use of the little finger on his left hand. Losing the little finger severely impacts grip strength in a negative way. Such a small finger that seems to have little function actually plays a vital role in everyday activities (including gripping his lighter when he lights it). Losing this finger would make his roles as a naval sailor much more difficult, if not force him to end his naval training and pursue a new career path.
   As for the wife, who only has one finger and a thumb on her hand, most if not all her daily activities have been greatly altered. Although we are not told which finger is remaining it is safe to assume that with only one finger and a thumb her grip strength is almost entirely compromised. As we are told in the story she has to get her hair washed, indicating she probably is unable to do it herself or it is at the very least incredibly difficult. To help her achieve this on her own it may help to get touchless soap dispensers for in her shower so she would not need to hold and squeeze the shampoo bottles. She also mentions how she has a car, but it would seem difficult to grip onto the steering wheel while missing that many fingers and so I would recommend adding a spinner knob to her car so that she car drive one handed and have a safer driving experience. Driving and bathing are two very important occupations for independence and with these adaptations she may be able to regain some of that independence the loss of her fingers caused her to lose.

Norepinephrine

Implicit Bias

   Implicit bias is something that is a part of human nature; it has been imbedded in our minds throughout history to help us make quick decisions in various situations. In simple terms implicit bias is our associations or our more subconscious first impressions of people. This can apply to anything really, but in this case we are referring specifically to biases that apply to things like race, ethnicity, gender, sexual orientation, etc.. As mentioned earlier, implicit bias is a part of human nature, therefore it is normal for everyone to have these, but the important thing is to recognize these biases within oneself so that we can work to combat them and be more conscious about our impressions of people.

   Some of the ways we can work to combat these biases are through taking tests that are designed to help you identify where you might have a bias. As we now implicit biases are typically subconscious and if we do not know of a problem there is no way for us to address it. Once we discover the bias, the next step is to educate oneself against whatever the bias is to help retrain the brain to rely more on fact and less on perceptions. Lastly, probably the most effective tool for eliminating bias would be to spend time getting to know people in the demographics that you have a bias against. This will retrain associations from whatever the bias may have been to what you associate with that individual reducing the risk of stereotyping. 

   Learning about implicit bias is important for OT students and practitioners because we work with a variety of people across all demographics, and yet our profession is still lacking in a widely diverse workforce. With limited diversity in our workforce, our exposure to other cultures is often limited as well making us more susceptible to implicit bias. With a more diverse client population it is important to know how to combat and eliminate our implicit biases to give each client an individualized and maximal experience with their therapy, which can be difficult if we are stuck in a stereotyping mindset. My big take-away from learning about implicit bias is that it is retrainable but you will not know what needs to be retrained if you do not take the time to explore what biases you may have. As was mentioned in the podcast "A Lesson in Implicit Bias" mentions, even though we may consciously think that we are above stereotyping and that we know better, the truth is that implicit bias is far more imbedded than we think. We must actively work to end these implicit biases to give people of all demographics a blank slate when we meet them.

Scapulohumeral Rhythm

Scapulohumeral rhythm is the interconnected systems of scapula movement at the scapulothoracic joint and the glenohumeral joint, and can be described as a ratio of movement at these two joints. The general rule of thumb is that for every 3˚ of shoulder movement performed 1˚ comes from the scapulothoracic joint and 2˚ come from the glenohumeral joint. This is important because without the contributions from both joints many shoulder movements would be inadequate for the tasks we do in our daily lives. There are anatomical limitations to the glenohumeral joint, keeping us from being able to accomplish what we would consider full range of motion of the shoulder with this joint alone. For instance, we have the glenoid fossa that serves to keep our humerus in place, however this fossa creates "walls" that the humerus cannot pass to achieve full upward rotation or abduction, and this is where the scapulothoracic joint comes into play since it can manipulate the positioning of the scapula, and more specifically the glenoid fossa, to allow the humerus a greater range of motion. Without full upward rotation, damage can occur in the subacromial space. With the joints moving together you can also reduce the shear forces that occur when pressure is being applied in opposite directions, which helps with joint preservation. The relationship between the glenohumeral and scupulothoracic joint also helps promote a more optimal length-tension relationship of the muscles. The adjustments to the position of the scapula at the various positions of the glenohumeral joint helps to keep the proper tension for muscle strength. ROM measurements can be affected due to one of these joints not properly working, since the norms we follow for the measurements are based on the combination of these joints to acquire the full range of motion expected in the movements of the shoulder.

Occupational Therapy Conceptual Model

Biomechanics Test Positioning

   It is important to use bony landmarks and proper positioning for measuring range of motion because the normative values that we use to determine if there is any deficit within the range of motion in a joint is based on specific bony landmarks and proper positioning. By following these reference points we will be able to get a more accurate assessment of the clients range of motion and the implications of the values we get in our measurement. Using landmarks and positioning can also help improve both inter-rater and intra-rater reliability. Inter-rater reliability is important because once again we want to know that the values we get are consistent with others' measurements since we use normative values to determine deficits. Intra-rater reliability is important because we tend to re-measure range of motion to determine if there has been improvement and to see if treatment is effective and following these measurement protocols, we are better able to reduce the risk of measuring differently, skewing results from measurement to measurement. The purpose of the "test position" is important because different positioning can effect the movement of a joint since there can be anatomical limitations or advantages to a joint in different positions. The effect of gravity is also important to consider and can change from position to position which is why it is important to always initially test in an against gravity position, when applicable, and only then if the gravity proves to be too great of a resistance to then use a gravity eliminated position. A gravity eliminated position is useful to test range of motion when a person lacks the strength to overcome gravity, because it is still important to note if there are other limitations to range of motion aside from a lack of strength.

Biomechanics Activity Analysis

   Everyday I fill up my water cup with a pitcher of water. My starting position is having my arms relaxed at my side with my right elbow bent around 90°, my wrist is extended and my MCP, PIP, and DIP joints are all flexed around the handle of the pitcher. The final position would have my right shoulder abducted and internally rotated, my wrist flexed and my MCP, PIP, and DIP joints still flexed. The wrist flexion and shoulder flexion occur in the sagittal plane about the frontal axis. The internal rotation of the humerus occurs in the horizontal plane about the vertical axis. The osteokinematic action at the wrist joint is flexion; it is an angular open kinematic chain motion. For the arthrokinematics, the carpal bone which is convex glides and rolls in opposite directions on the radius which is a concave surface. The prime movers are extensor carpi radialis longus, extensor carpi radialis brevis, and extensor carpi ulnaris which would be an eccentric activation acting as decelerators, since the action of pouring the water would happen in the direction of gravity.

Making Healthcare More Client Friendly

    It is easy for healthcare professionals to use medical terminology when explaining a diagnosis, since it is the most accurate description of what is happening with a client or patient, but it is important to remember who the audience is and what their "health literacy" is.  "Health literacy" is an individuals ability to comprehend medical and health related information. In Professor Flick's lecture, she explained the importance of discovering the best delivery method of the information for the client, whether that be through audio, something visual, or through something they can read. It is important to communicate with the client about what they need so they do not feel embarrassed and withhold the fact they cannot understand what is being told to them. As we saw in a video that was presented during this lecture, it is vital that clients and patients understand paperwork and other things that are designed to inform them of their diagnosis and recommendations, because without that understanding they may be signing things away without the intention to or simply the knowledge that it had been done.

   From this Professor Flick's lecture I also learned about the institute for healthcare improvement triple aim, which looks at improving the patients experience of care, improving the health of populations as a whole, and reducing the per capita cost of health care. These are important for occupational therapists because it is important to individualize care to each patient since we have a client-centered approach and by doing this which should aim to maximize the experience as a positive experience. Occupational therapists also address the health of populations by doing community based health where we go out into the community to do screenings. I can see how occupational therapists are already working to improve the healthcare they provide to their clients to improve not only the client's health but also their experience of healthcare.

OTs in the Community

   After listening to the "Glass Half Full occupational therapy" podcast, titled "Au-some swimmers", I realized how big of a need there is for occupational therapy in the community setting, especially since  often there is a lack of funding. This podcast discussed a program that was started by OTs to help train lifeguards at a local swim lesson program to work with children with autism and other sensory processing disorders. To be honest, before listening to this podcast I overlooked many of the barriers present for a child who is on the spectrum may face when learning to swim. For example, it was brought up that even the time of day and day of the week can make a huge difference based on the number of people who may also be using the pool. The program that is discussed in the podcast helps lifeguards address these issues and helps train them to handle some of the behavioral differences in children with autism so that they can do their job effectively and teach the child to swim.
   It is easy to look at a child who is miserable and uncomfortable trying to learn to swim and figure why put them through that? However the reality is that if a child does not have basic swimming skills they are at a high risk of drowning if they ever fall in the water. This is why it is important for occupational therapists to go out into the community and help where they can. This podcast helped show me that there are so many essential programs out there that are not currently adapted for people who have a disability and we need OTs to be active in the community to help these programs interact in the necessary ways with people who have a disability for the safety and comfort of everyone involved.

SKRRT! (OT misconceptions)

"Blissful Ordinariness"

   Many people who are considered "able bodied" and "able minded" often take for granted the ease with which they go about their everyday tasks, such as, brushing their teeth, taking a shower, driving to work, etc.. For other people who may have a disability, these often considered "mindless" tasks can be a huge challenge that interrupts the flow of their daily routine. This brings us to the idea of "blissful ordinariness". This involves moving through one's day with little to no barriers and really not giving much thought into the tasks that make up one's everyday routine; in a sense someone's everyday life is rather ordinary. Not everyone experiences  "blissful ordinariness" in their everyday life due to an array of reasons and this is where occupational therapists can help.
   Occupational therapists emphasize the importance of the therapeutic relationship between themselves and the client. This means that the occupational therapist works on developing a relationship with the client that allows the OT to better understand the client as a whole rather than just for their disability, which is considered a holistic approach. Having this relationship helps build trust and understanding with the client which can help build "blissful ordinariness", because by understanding the client and their life you can better decipher what things are important for a client to be able to help them achieve a more cohesive routine to their day. No two people's daily demands are the same nor are their values; by taking a holistic approach occupational therapists are able to individualize treatment to help each individual client find and achieve their version of "blissful ordinariness".

Occupational Therapy Settings: My Interests

     My first exposure to the field of occupational therapy was in a pediatric setting which led to my interest in becoming an occupational therapist. My younger cousin was diagnosed with polymicrogyria and as a result attended many forms of therapy including occupational therapy. I got to attend some of his sessions, which were in an outpatient clinic and would be classified as a private for profit agency where the funding comes from private investors. I loved getting to see him interact and learn through simple tasks and games that he had fun doing. From there I did more research and realized that being an occupational therapist that specializes in pediatrics was a perfect fit for my interests. I had the opportunity to shadow an occupational therapist at my cousin's school, which would be a public agency and founded by the government. There the main focus was on handwriting and it was with the whole class and so there was little individualized attention due to limitations of the OT's time. As of now I am pretty confident I want to work in pediatrics, however this could change throughout my time as a MOT student.

Era Presentations: My Takeaway

     After listening to different groups present on the individual decades spanning the 1940s-2010s I learned a lot about how great of an impact the outside world has on a field such as occupational therapy. Much of the current OT profession revolves around helping a client with their activities of daily living; I learned this focus came about in the 1950s when Sidney Katz developed the index of independence in activities of daily living. This index, commonly known as the Katz ADL, was the first assessment created for measuring a persons ability to complete activities to live independently, which now serves as a guiding principle for our field.
  One occupation that evolved and continues to evolve is dancing. The style of dance has changed to match the changing trends in music. In the 1940s big bands were the popular music which coincided with swing dancing which was used for leisure and entertainment. In the 1980s there was still dancing for leisure due to MTV, however the style of dance had drastically changed to match the new music styles. There was also a shift to dance based exercise with the fitness craze that occurred in the 1980s.
  I was shocked to hear that in the 1940s an 18 month occupational therapy course was packed into a 2 week course to meet the demands of Occupational Therapists during the war. I also thought it was kinda cool to see learn that USC was the first school to create an Occupational Therapy Masters program in the 1960s, since USC is both of my parents alma mater. In learning about the 1990s I found it interesting that OTs were already integrating computers and technology into their therapy modalities since I always viewed technology as an intervention as more recent and more of a novel concept. I loved seeing how much the profession of Occupational Therapy changed from decade to decade based on what was going on. Occupational therapy serves to meet the needs of the client, looking at what was going on during the decades, it is easier to see how the needs of the client changed and therefore the demands of an Occupational Therapist. This helped highlight the need for individualized approaches based on what the client wants or needs to be able to accomplish. The bottom line is Occupational Therapy is an ever evolving profession.

The History of Disability

     Dr. Kiesling gave a presentation on the history of developmental disabilities in the United States. I found it astonishing how drastically societal views on disability have changed in a relatively short period of time. I learned how in the early twentieth century people with disabilities were viewed as "feeble-minded" and disability was often associated with criminality and therefore considered a burden on the rest of the community. This lead to institutions for people with disabilities so that they could be removed from society. Learning about the conditions of the institutions that most with disabilities were subjected to was truly heartbreaking. The institutions were over-crowded and patients were treated inhumanely. I am still in disbelief that these institutions were around less than 50 years ago.Thankfully there were some legislation changes that began in the 1960s that continued to evolve and grow sparking the disability rights movement in the 1970s, mirrored after the civil rights movement the decade before.

     One thing that was discussed during this presentation was the idea of culture that can come from a disability and how many people may not view their "disability" as a disability at all. I have had the honor of being involved in the Deaf community over the last few years and one thing that came to mind was how members of the Deaf community often view their deafness as a gift. Many will decline cochlear implants because being deaf is not a negative thing, but rather just another way of defining themselves. Knowing this, I was devastated when I learned that people were institutionalized for minor developmental disabilities such as a hearing impairment.
     Learning about Ed Roberts story of how his mom, and later himself, pushed for his rights to an education no matter how many people tried to turn him away, was very moving and goes to show how far perseverance, and a little stubbornness, can get you. I definitely want to share that with my future clients, as well as myself, to help make sure people are not taken advantage of or not given what they deserve. There has been so much evolution in the views relating to individuals with developmental disabilities and while things are progressing in the right direction, from this presentation I now have a better understanding of the importance of advocacy so that people with disabilities are aware of their rights as well as society having a better understanding of the rights of those individuals. A person with a developmental disability is still a person and deserves to be treated as one.