Everybody has different things that they have to deal with in life such as living conditions, socioeconomic status, employment, access to healthcare and the list could go on and on. As we evaluate clients and try to figure out the best treatment options for them we need to keep these factors in mind that are referred to as social determinants of health. Social determinants of health are anything in our social environment that could affect our health in some way which could be good or bad. It's things that are going on outside of our bodies that are affecting our body functions, organ functions, or occupational performance. As occupational therapist's, this goes right along with the concept of client-centered, holistic practice of looking at the person as a whole and not just at the problem they are having. A client profile is so important when considering their social determinants of health because we will be able to ask questions to help us get to know the client better personally and any special circumstances that they might be dealing/living with that is causing an observable effect. These social determinants of health could affect our nervous system by adding on excessive stress or altering our sleep wake cycles to where we're not getting the rest that we need to function. Also, the excessive stress could also cause sleep problems, headaches, anxiety disorders, etc.
I believe that the OT program at UTHSC really does a great job at allowing and encouraging us to see and interact with people that are different than us that might have things under the surface that are affecting their health. Through the hours that we have to acquire of service/professional development we get to interact with people that may have very different social determinants of health compared to our own. Whether they are homeless, live in unsafe conditions, deal with abuse, are health illiterate, have a very physically demanding job, are unemployed, have a disability/take care of someone with a disability, etc., we get to talk with people that come from all walks of life and might have to deal with things that I would never dream of that will consequently affect their health. I'm thankful to be pursuing this career that encourages me to get out of my comfort zone and interact with people that are different than me that I can hopefully help and maybe learn something from in the end.
Tuesday, June 16, 2020
Monday, June 8, 2020
Biomechanics Blog 7 - Locomotion and Adaptive Devices
There are many situations where a person might need adaptive equipment to help with their ambulation and mobility. When picking what kind of AE the person needs, many factors need to be taken into account to make sure the most efficient and safe option is chosen for the client. Things such as disability, weight bearing status, strength, ROM, balance, and coordination will need to be assessed to make sure the correct assistive device is being chosen and if they need any added on equipment to the device. Other factors should also be looked at like age, endurance, and psychological condition. As an OT, we need to make sure that the device is comfortable for the client and doesn't cause any pain or breakdown of the skin, puts the client in a position to use correct body mechanics, and is practical and usable for the client in their day to day life.
Some devices that can be used to help with ambulation and mobility include canes, crutches (axillary and Lofstrand), and walkers (platform and rolling). A cane would be used when the least amount of stability needs to be added to the client. To fit a cane to the person, we need to make sure that the hand grip is at the level of the client's wrist crease and that their elbow is slightly flexed to hold on to the cane. There are also different types of canes that can be chosen from, for example, a standard or straight cane with one leg or a quad cane that has a wider base and 4 prongs to increase stability (base can be wide or narrow).
Crutches can give more added stability than canes. To fit crutches to a client, we would need to take the same measures as for a cane and add that the crutches, if axillary, should be around 5 cm below the floor of the axilla with the shoulder relaxed. This is for comfort and correct alignment of the shoulders while using the crutches. For Lofstrand crutches, these have an arm cuff that goes around the proximal forearm of the client. We would still need to make sure they are the right height and that the arm cuffs were a correct fit for the client. They provide less stability than axillary crutches, but are for long-term disabilities.
Finally, walkers are more stable than either canes of crutches. The same measures should be taken when fitting a walker to a client as with a cane. A platform or rolling walker will have 4 points of contact to the ground, but the rolling will be less stable than the platform. A platform or standard walker should be given to someone with fair balance that needs a large amount of added stability. A rolling walker is more efficient for a person that cannot lift a walker up to move.
Some devices that can be used to help with ambulation and mobility include canes, crutches (axillary and Lofstrand), and walkers (platform and rolling). A cane would be used when the least amount of stability needs to be added to the client. To fit a cane to the person, we need to make sure that the hand grip is at the level of the client's wrist crease and that their elbow is slightly flexed to hold on to the cane. There are also different types of canes that can be chosen from, for example, a standard or straight cane with one leg or a quad cane that has a wider base and 4 prongs to increase stability (base can be wide or narrow).
Crutches can give more added stability than canes. To fit crutches to a client, we would need to take the same measures as for a cane and add that the crutches, if axillary, should be around 5 cm below the floor of the axilla with the shoulder relaxed. This is for comfort and correct alignment of the shoulders while using the crutches. For Lofstrand crutches, these have an arm cuff that goes around the proximal forearm of the client. We would still need to make sure they are the right height and that the arm cuffs were a correct fit for the client. They provide less stability than axillary crutches, but are for long-term disabilities.
Finally, walkers are more stable than either canes of crutches. The same measures should be taken when fitting a walker to a client as with a cane. A platform or rolling walker will have 4 points of contact to the ground, but the rolling will be less stable than the platform. A platform or standard walker should be given to someone with fair balance that needs a large amount of added stability. A rolling walker is more efficient for a person that cannot lift a walker up to move.
Wednesday, June 3, 2020
Biomechanics Blog 6 - Transfers and Mobility
Mobility is a very important part of people's lives. We like to be able to get where we want to go without much resistance or problems. When a person loses that ability of moving themselves around, it in most cases becomes a goal of restoring that mobility as quickly and efficiently as possible. There is a hierarchy of mobility skills that can be followed in this kind of situation. The steps include bed mobility, mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADLs, toilet and tub transfer, car transfer, functional ambulation for community mobility, and community mobility and driving. These steps set up a system that can be used to gradually restore the person's mobility in the most safe and efficient way possible and helps to also gradually restore the person's confidence in their mobility skills.
During high school I received my CNA license and during the time I spent in different facilities, I saw some of these steps, but not all and sometimes not in the same order. I think that the hierarchy was put in this order because it is the most functional and safe process to use for the patient, but sometimes people will progress differently causing the hierarchy to maybe be changed for some. This hierarchy of mobility skills I believe is effective in treatment of others because it goes from the basic needs of mobility and self care and proceeds to more difficult tasks that should be implemented at a later time when some/most mobility has been restored. As an OT, it will be my job to make sure that whenever someone of trying to restore their mobility that we are doing it in the safest, most efficient, and personally accepted way for the patient or client. This hierarchy seems to be a good guide to go by.
During high school I received my CNA license and during the time I spent in different facilities, I saw some of these steps, but not all and sometimes not in the same order. I think that the hierarchy was put in this order because it is the most functional and safe process to use for the patient, but sometimes people will progress differently causing the hierarchy to maybe be changed for some. This hierarchy of mobility skills I believe is effective in treatment of others because it goes from the basic needs of mobility and self care and proceeds to more difficult tasks that should be implemented at a later time when some/most mobility has been restored. As an OT, it will be my job to make sure that whenever someone of trying to restore their mobility that we are doing it in the safest, most efficient, and personally accepted way for the patient or client. This hierarchy seems to be a good guide to go by.
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