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.

Posture and Body Mechanics

Proper posture and good body mechanics are extremely important to an individual's wellbeing. One reason it is good to teach this is because poor posture can contribute to abnormal development of bones and muscles. Poor posture can also lead to decreased awareness of body positions due to sensory loss. Proper body mechanics can help with decreasing injury risks and back pain. Good posture promotes comfort and alignment, along with optimizing your vision and breathing.

One way I would teach proper posture and body mechanics is to use the broomstick demonstration. I would have the client place the broomstick behind their back and to make sure that it is touching their head, back, and bottom at all times as they perform various movements. This will ensure that everything is in good alignment. Another way I would do so is by providing modification to tasks such as reaching, pulling and pushing and turning to promote good body mechanics and avoid injury. 

My Favorite Advertisement

An advertisement that really sticks out to me would definitely have to be the Doritos commercial of the 2010 Super Bowl. It is my all time favorite!! It was so funny and entertaining to me. I think that I love it so much because Doritos are my favorite chips and I felt where the kid was coming from. It is about a little boy's mom boyfriend coming over. The little boy was already giving the man the evil eye. The man compliments the woman followed by getting one of the little boy's Doritos. The little boy slaps him and says, "Put it back. Keep your hands off my mama, and keep your hands off my Doritos.

The part of my nervous system primarily involved would be my temporal lobe, but more specifically my hippocampus. The hippocampus is responsible for your long term memory. It is a commercial that I remember from over 10 years ago. It has been stuck with me ever since. I believe that my amygdala is also involved due to how overprotective I was over my mom as a kid. Your amygdala is responsible for your emotions. I did not like when my dad would try to hold her hand. I would get upset and cry when I couldn't hold her hand, haha. It was very interesting thinking about my favorite advertisement and linking it back to my nervous system, with the information I have learned from our Neurobiology course. Now I feel like I have to watch the video a million times more, because it was so funny but yet so relatable.

Here is a link to the commercial:
https://www.youtube.com/watch?v=dYZoOyo5alY

Neurotransmitter: Serotonin

"Man from the South"

I thoroughly enjoyed reading the short story about "Man from the South". The story was very intriguing, and I even found myself reading in the accent the older man was portrayed to have. The elderly man decided to bet a young sailor who was hanging out at the pool. He told the young sailor if he could light his lighter 10 times in a row that he would give him his green Cadillac car. But, if the sailor couldn't, he would chop off his little finger. The older man felt as if it was a little thing he could afford.

If the sailor lost the bet, it would in fact be a big deal if he no longer had his little finger. This could impact the sailor's daily life engagements. It would cause impairment to the ulnar nerve, which innervates the pinky and half of the ring finger. I believe that this will affect the sailor's ability to properly hold a gun, or his occupation of work. Due to his pinky being gone, it would cause him to lose a significant amount of his grip strength.

A strategy that might help the soldier regain independence in operating a gun would be to work on strengthening his remaining fingers. This can be through using grip strength tools such as pinch blocks or squeezing putty with various resistances. A modification that could be made for his gun is to consider him using one that does not have to be held, but could rest on his shoulders for more mobility.You could also add something to the gun that would take place of his little finger to where his knuckle could rest and hold the gun up.