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.