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.