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.