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.