SDoH and UT Preparedness

Social determinants of health (SDoH) are  factors that impact an individual’s day to day life and health. They can be either positive or negative. The community in which you live in affects your health. Your socioeconomic status affects your health. If you do not have access to health insurance, you may be limited in being able to go to the doctor. SDoH can honestly make or break an individual. In a TEDx Talk by Rishi Manchanda, he discussed how making changes to one of his client’s home, removing mold and roaches, caused the client’s symptoms improved by 90%. I really enjoyed when he said, “one’s zip code matters more than your genetic code”. This highlights that all of the things that makes up a person’s environment affects their health.

Social determinants of health can lead to various health conditions. SDoH like access to shelter, food, money, and education can cause an individual to become stressed. With stress comes increased levels of the cortisol hormone, which decreases the function of the prefrontal cortex that is responsible for the body’s executive function. Another example would be if your neighborhood is not safe and you cannot go for a walk or play outside, this can lead to a decrease in the neurotransmitter dopamine. Decreased levels of dopamine could lead to major depressive disorder.

On another note, I am extremely grateful for the UTHSC OT program’s requirement for our service/professional development hours. It is helping us in learning how to be responsible, efficient, and continuing learners. It is preparing us for when we have to complete continuing education courses as future OT practitioners. I believe that it is aiding my classmates and I on how to balance/prioritize and continue to give back to the community, while also growing as a unique individual.

Assistive Devices

Fitting your patient for use of an assistive device is very important for many reasons. It is something that an individual will depend on for their day to day functions. No single individual is the same and their device needs to be customized for them specifically. You have to consider the person's physical conditions such as, disability, weight bearing status, strength, and ROM. Client's may also have unique limitations and capabilities and that also needs to be taken into consideration, along with their environment as well. Lastly, you need to consider the person's stability, rather they have high or low stability, to determine which assistive device will suit them best.

The cane would be the least stable of assistive devices. Therefore, the individual would need pretty good upper and lower body strength. In order to fit a cane properly, the hand grip should be at the level of the wrist crease, ulnar styloid, or greater trochanter. The person's elbows should be relaxed, flexed to 20-30°, and shoulders should be relaxed and not elevated.

The next assistive device I will discuss are axillary crutches. They are more stable than a cane. You fit crutches with the same criteria for a came, but with an additional step. Axillary crutches have an axillary rest that should be about 5 cm, or 4 fingers, below floor of the axilla with shoulders relaxed.

Lofstrand crutches are more stable than canes but less stable than axillary crutches. You use the same steps that are required for fitting axillary crutches with an additional step. There is an arm cuff that should go around the client's forearm.

A platform walker would be the most stable device due to it having four points of contact with the ground. Client's that use this typically cannot bear weight through wrist or hand. You would fit a platform walker the same as you do for canes. But, the client's elbow would need to be flexed to about 90° in order to rest comfortably on the platform.

The last assistive device I am going to discuss is a rolling walker. Rolling walkers are used for individuals that cannot lift the walker due to upper extremity weakness. They provide more stability than crutches but less stability than walkers without wheels. You fit rollings walkers the same way as you do for canes.

Transfers

The order for restoring confidence in mobility based on activity demands is:
bed mobility > mat transfer > wheelchair transfer > bed transfer > functional ambulation for ADL > toilet and tub transfer > car transfer > functional ambulation for community mobility > community mobility and driving
This is kind of what I expected. I think this hierarchy is in this particular sequence because it starts with where the client may spend most of their time. It then works toward getting the patient mobile and functional. The furthest level I have seen in my observation is toilet and tub transfer. I agree with this approach. I believe that it builds the client's endurance, strength, and confidence to complete activities. It builds up from the least energy required to the most. I believe it will help prevent injuries.