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