Post-Interview Reflection

 After reflecting on my interview, I believe it went quite well. Overall, I had a great time discussing the potential job opportunity with the hiring manager. I was a little bit nervous at first because I didn’t know what to expect or how I would respond to tough questions, but I feel that it went very well. I prepared for the interview by using resources on BB that Dr. Lancaster provided. This included researching tough interview questions and writing down some personal experiences and my strengths and weaknesses. I feel that writing out some thoughts before the interview really helped me mentally prepare for questions, even though I didn’t know what questions she would ask me. I believe if you are somewhat prepared for “typical” interview questions then the rest of them will naturally flow. Only one question went differently than I expected. That question was, “What was the most difficult part of your fieldwork?” I think this question tripped me up because we haven’t gone on our level II fieldwork rotations yet, so I was basing my answer solely on the 1 level I fieldwork we had, but other than that everything went as expected. I think something I would change is that I would do in-depth research about the facility where I am interviewing. This could include looking up their mission, standards, beliefs, etc. I have found great success in performing some preliminary research about a company prior to the interview so that they can say, “wow, he is already looking into what we are all about!” For example, if I am interviewing for a travel therapy OT job, I may reach out to some current employees in the company and see if they can provide any insight into what the company looks for or likes in their employees. I feel this can give you a significant upper hand when interviewing. In conclusion, I feel that I learned how to properly interview for an entry-level OT job, and I feel better prepared in knowing what I am worth and the value I can bring to the company. I believe that is one of the main things a company is looking for; what value are you going to bring to their company. This process also taught me that we are interviewing the company just as much as they are interviewing us. We need to feel at home and comfortable accepting the position from the company and believe it is a right fit. All in all, I thoroughly enjoyed the process and I feel much more prepared for conquering my first, real-job interview in the future!

Glyph 2020

Glyph Key for Drawing A Self-Portrait of a Leader

Face Shape: If you believe that leadership is an inborn trait, draw a triangle-shaped head.  If you think that leadership stems from nurture over nature, draw a square-shaped head.

Eyes: If you think the vast majority of OTs are leaders, make big circles for the eyes.  If you think there is a fairly equal mixture of leaders and non-leaders in the field of OT, draw small circles for the eyes.  Fill in the pupils.  Add glasses if you feel that you have had more experience in leadership roles than most other people your age at this point in life.

Eyelashes: Draw one eyelash on each of the eyes for each of the five themes you can name based on your personal Clifton StrengthsFinder assessment from earlier in the curriculum.

Eyebrows: If you like to take the role of the leader in an out-in-front way, make curved eyebrows.  If your leadership style is more behind the scenes, make pointy eyebrows.

Nose: Draw a triangle nose if you think that seeing yourself as a leader is necessary to being a leader.  Draw a rounded nose if you believe that a person can be a leader without seeing himself or herself as a leader.

Skin:  Add a freckle anywhere on the skin of the face if you believe that self-awareness is vital to effective leadership.  Leave the skin clear if you don’t think it’s an essential trait.

Mouth: Draw a smiling mouth if you can think of at least one leader who has had a positive impact on you.  Draw a frown if you can’t think of a good example of a leader.

Ears: Draw round ears if you think technology is an important part of effective leadership in many situations. Draw pointy ears if don’t think so.

Hair: Draw the hair based on a continuum, based on your personal viewpoint in two areas: 

What’s more important in leadership:             Curly hair  <------------------------->  Straight hair 

          creativity or organization?                   Creativity  <-------------------------->  Organization

                        AND

Can an introvert be an effective leader?         Short hair <-------------------------> Long hair

                                                                           No way  <------ I’m unsure -----> Definitely yes

Accessories: Add at least one accessory (example: a piece of jewelry) if you see yourself as a leader.  Add a hat if the way you think about or approach leadership has changed as a result of what you have learned since beginning in OT school.

Finishing Touch: Label your paper with your name, writing in cursive if you have a written plan or goal about to serving in leadership roles in the future; write in print if you do not yet have a written plan. 

Above is a picture of my newly completed Glyph from Fall 2020. After completing this glyph, I realized several things had changed since I completed one last year. My belief of being a leader and becoming a leader has stayed somewhat consistent; although, I do believe I have taken more leadership roles since entering OT school than I have in previous years. I believe anyone can become a leader, yes, there are natural born leaders and people who are born into leadership through their familial connections; however, I believe anyone can make applicable decisions and adjust their mindset in order to become a leader. I hope to continue to invest time and effort into developing leadership skills and taking on leadership roles as a new practitioner and down the road as well-established OT.

Locus of Control

Locus of Control

After taking the LOC questionnaire, I calculated my score to be a 15. I found this somewhat surprising, because I am usually internally locus and believe individuals’ decisions play a MAJOR role in the outcomes of their life. In the past, I listened to a podcast on Spotify called “How I Built This.” The podcast interviewed different entrepreneurs about how they founded their businesses, how the scaled it from 1 to 100 million dollars, and so on. One thing that stuck out to me listening to this podcast was how every entrepreneur stated they worked harder than anyone they knew AND they had a tremendous amount of luck along the way. I think this speaks volumes of how success can come about in mysterious ways and I find this to be true in my own life as well. All in all, my score of 15 was weighted more towards externally locus; which I think can eb and flow depending on a multitude of different factors. I do believe that there are things in this world that are out of our control; however, I wholeheartedly believe the decisions we make will influence the outcomes of our life. 

After reading the supplemental income, I believe we should fully understand LOC for patients and other therapists. It is important to understand a patient’s LOC to know how to properly decision their intervention plan and know what would challenge them. If a patient is internally locus then we could understand they are motivated and will work strenuously to regain their abilities. However, the externally locus patient could play the victim during therapy, work, and other areas of their life. This is so important to understand even during our basic, everyday interactions with our patients. 

In conclusion, I believe it will help us become better therapists to understand locus of control in our patients and fellow employees. I think designing a patient’s intervention/plan of care will be impacted by understanding this. A patient that is externally locus will not respond well if we are blaming them for a slower progression in rehab. This may require us to be creative in our treatment design and responses to their comments.

OCP Peds Simulation

Overall, I believe the simulation went very well. Personally, I feel that this simulation was much more calming than the previous ones, or maybe it could be the "practice effect." It also could be just becoming more comfortable with speaking to clients. Just before entering the room there I became anxious, but once I walked in and introduced myself most of the nerves went away. In preparation for the SIM, there were copious amounts of information that we had to read, interpret, and deliver to our simulated client. I think spending ample amount of time preparing notes, reading over Libby's information, and practicing with classmates helped me be better prepared for my delivery of the information. I believe this SIM went well and I delivered the information I needed to with empathy and understanding.

If I could do something differently, I would have tried to get to know her more and understand what she is going through. I think probing more with questions about Libby, asking how her behavior impacts their daily life, and just try to get a full perspective about Libby and their family dynamic would have been great. I think this is the one thing I would have done differently.

1. One example of how an attitude of caring can be communicated to a client/caregiver is body positioning/language whenever speaking to the client. I believe body positioning is an integral part to being on the same level/playing field as the client. In our simulation, the client was seated near the hospital bed. I had to roll the stool over and sit close to the client, but not too much in her personal space. I think being close to the client shows that you care and you are available to them, and I also think it allows you to explain paperwork or documents "together" instead of being all the way across the room on a computer screen. 

2. Another example of how an attitude of caring can be communicated to a client/caregiver is practicing active/emphatic listening skills. This can be done by giving the client your sole attention, making eye contact with them while your speaking, and using facial expressions to express and openness to what they are saying. We know that listening is just as, if not more important than speaking, so as OT students we need to listen to our clients. We have to listen to understand.

I will incorporate this SIM lab into an actual clinical situation by using emphatic listening skills we have learned. I will take time during the clinical situation to sit down and actually get to know my clients on a personal level. Also, in a clinical situation I will take time to find things/interventions/activities that are truly meaningful to the client and help them work on those things. Overall, I think the SIM labs help us to develop a confidence to convey information and speak to clients in a professional and emphatic manner, and I am grateful for these opportunities to help us become better practitioners in the future.

Neuro Note 4

Parkinson's disease

A test for Parkinson’s with a phone call

Max Little— June 2012

Little, M. (2012, June 1). A test for Parkinson's with a phone call. Retrieved from https:// www.ted.com/talks/max_little_a_test_for_parkinson_s_with_a_phone_call?language=en#t-238655

Max Little is an applied mathematician. He has a friend, Jan, who has Parkinson’s and it destroyed her ballet career. 6.3 million people worldwide who have the disease and have to live with weakness, tremor, and rigidity. Max believes we need objective tools that will diagnosis and detect the disease earlier and more accurately. Unfortunately there are no biomarkers that show Parkinson’s disease. The most accurate current test is a 20 minute neurological test that is costly and will require the patient to come into a doctors office to receive the test. The test in the neurologist clinic is around $300. The vocal folds are affected in patients with Parkinson’s and Max is tracking those differentiations to diagnosis Parkinson’s with a phone call. Max’s goals are reducing logistical difficulties, high-frequency monitoring, and low-cost mass recruitment. He has developed a non-expert test to diagnosis Parkinson’s. Parkinson’s Voice Initiative is a way that everyone can call into the hotline and leave small voice recordings in order for Max and his team to collect data and see if individuals are showing early signs of Parkinson’s through their voice recordings. The more data Max receives the more advanced his machine learning will become and the better detection rate will be for his diagnostic tool. He also will be using the voice call in service for patients with Parkinson’s disease to call in and their doctor will receive the recording in order to check up on their progress. The doctor will be able to tell the progression of their disease solely based on the voice recording. 

I chose this Ted Talk because of the technology used to detect/track progress of Parkinson’s disease. I believe technology can make our lives better, more convenient, and more accessible in terms of healthcare opportunities. I was very intrigued by Max’s talk about machine learning and how collecting more and more data will increase the accuracy of detection and progression. It is something that will be paramount in the coming years especially in the healthcare sector. 

In addition to above, I believe I learned how technology can not only help us as healthcare practitioners, but it can completely mold how we care for our patients. I know as occupational therapist we will use our therapeutic use of self every single day with our clients, and we will build lifelong bonds with them as well. However, in today’s world we can communicate with individuals through the internet we never would have had the chance to meet in our entire lives. This is a special time and we can take advantage of the technology we have to enhance and benefit our lives. I believe there will always be a special place for face to face, physical communication, but I do believe technology, machine learning, AI, Virtual reality will better our lives and the health of our world. 

Below is Max’s website:

www.parkinsonsvoice.org

Media Project

Innovator’s Statement

One of the most useful things I learned from this assignment was finding the right innovation that fit perfectly with my client. Once I figured out what activities my client could complete with his upper and lower extremities, I was able to use my materials to create something meaningful and therapeutic for him. Craig used to work 70 hours per week owning his own music store, so I wanted to incorporate music and business into his therapeutic innovation. I took the brown paper bag and created CD and DVD pouches that Craig would be able to slide or push CDs into. This is where the “ah-ha” moment came into play.

From this assignment, I learned how to take an ordinary item and transform it into a therapeutic medium that is useful and meaningful to my client. I believe having prior knowledge of spinal cord injuries and deficits at those specific injuries helped me tremendously. I was able to find what Craig could perform and areas he would need assistance. Also from this project I have learned that most items we have within arms reach can be adapted and used for a therapeutic purpose. I believe creating the CD pouches and sleeves are a simple solution that is easily teachable. Lastly, completing this assignment will help me become a more adaptable occupational therapist. I know looking back to this assignment will help me when I am working with clients and need to think on my feet about a quick, adaptable intervention. When you have a client that needs a simple solution specifically catered to their occupations and wants, sometimes you have to be able to create something out of nothing.

Neuro Note 3

ALS

Nancy Frates—October 2014

“Meet the mom who started the Ice Bucket Challenge”

Frates, N. (2014, October 1). Meet the mom who started the Ice Bucket Challenge. Retrieved August 18, 2019, from https://www.ted.com/talks/nancy_frates_why_my_family_started_the_als_ice_bucket_challenge_the_rest_is_history

Nancy talks about how in the Summer of 2011 her 27 year old son, Pete, was playing minor league baseball and got hit in the wrist while batting. His wrist went completely limb and was like this for several weeks. He went from doctor to doctor with no diagnosis but ended up at a neurologist and they clinically diagnosed him with ALS. Her son Pete was extremely passionate and strong after his diagnosis and decided he wanted to change the face of ALS and help find a cure for such an awful disease. They created “Team Frate Train” to help spread the word about ALS.  After a few years, Pete was put on a compassionate drug that was in trial runs; however, the drug came back with no efficacy. Two and a half years after his diagnosis he is completely paralyzed. He has a feeding tube, cannot speak, he uses a motorized wheelchair, he also uses an eye-gaze communication device. At the 75th year anniversary of the ALS disease BleacherReport.com asked Pete to write an article about the disease and his mother said he wrote the entire article using his eye gaze technology. July 27th was the first “ALS Ice Bucket Challenge.” The word spread like wildfire! After the Ice Bucket Challenge began, the media got ahold of Pete’s story and his website. First it was in Boston, second was National media attention, then it was celebrities, and lastly it was global news coverage. Pete’s favorite Ice Bucket Challenge video was Bill Gates, because he knew philanthropists like him would provide necessary funding to help find a cure for the disease. 3 pieces of advice Nancy wanted to give was: 

• Choose every morning to live your day in positivity and proactiveness
• Person in the middle of the challenge has to have mental toughness to put themselves out there
• If you ever find yourself in a situation that is so unacceptable that you cannot live with it any longer, dig as deep down as possible and GO AFTER IT!

I chose this Ted Talk because I participated in the Ice Bucket Challenge in 2014 and did not truly know the impact it was having. I think watching the video really opened my eyes to the progress Pete and his family are having in achieving a cure for ALS. I believe if finances are provided to help try to find a cure that we will find one during our lifetime. I believe it takes people like Pete, who has the disease, to reach out to individuals like Bill Gates, who has the financial means, to help put their strengths together and find a cure.

I learned more of the advocacy side of ALS from watching this video. I also learned that if you truly believe in something and want to get information, answers, or a cure then you have to FIGHT for it. Pete went from begin diagnosed with ALS at 27 years old to spreading news so rapidly that the richest man in the world did an Ice Bucket Challenge to raise money and awareness. If that doesn’t pump someone up to stand up for what their passionate about, then I don’t know what will. I truly have respect and courage from watching this Ted Talk. 

Here is the link to watch Bill Gates’s Ice Bucket Challenge. Enjoy.

https://www.gatesnotes.com/About-Bill-Gates/Bill-Gates-ALS-Ice-Bucket-Challenge

Neuro Note 2

Title: “Navigating Genetic Disease Testing: A Personal Story”—Seth Rotberg

Date: January 2018

Citation: Talks, T. (2018, March 06). "Navigating Genetic Disease Testing: A Personal Story" | Seth Rotberg | TEDxNatick. Retrieved August 11, 2019, from https://www.youtube.com/watch?v=5_O5TfMVqD8

Description of the material/experience and what I did to further his/her learning:

Seth describes the day he was clinically diagnosed with HD. He describes how HD can resemble ALS, Alzheimers, Parkinson’s all at once. He also states how patients with HD have a 10 to 20 year lifespan after first symptoms show. Seth also describes watching his mother go through HD with wobbly/uncoordinated gait, slurred speech, etc. While Seth was in college he was contemplating if he wants to get tested for HD. He described the process as "mentally draining" on whether or not he would test positive for HD. He did test positive, but he was reluctant to tell his family and friends. 

He joined a few HD organizations and people thought he was raising awareness because his mom has the disease, while all along he knew deep down he was positive. During his senior year of college, his friend Jake passed away unexpectedly in an accident. This shifted Seth's perspective on life and his friend's death changed his mind about keeping his HD a secret. One quote his friend Jake always said was, “Live as if you are to die tomorrow, and learn as if you are to live forever." He ended up losing another friend from a version of HD at the age of 26. Then Seth decided he was going to tell his dad and sister that he tested positive for HD. He vividly recalls telling his dad about his positive test. While his dad was upset with his positive test, he tells him they are making great progress in a cure for the disease. Telling his sister was different because his sister was upset he kept it a secret for 2 years. Later in the Ted Talk, Seth tells how his mom passed away from a 17 year battle with HD. He gave three pieces of advice to anyone looking to get genetically tested for a life altering disease. They are:

1. Work with a genetic counselor/neurologist in the field

2. Talk with your family/friends first

3. Things get tough. Each day is a new day!

Explanation of why I chose that as part of this assignment

I chose this because Ted Talks are always dynamic and interesting. Also, this was a personal story of someone battling HD. My sister-in-law recently was positively tested for HD and this Ted Talk paralleled her story almost identically. Watching it was almost like a movie that you have watched a thousand times but you still watch it again because it is so impactful. Since HD has such an impact on my immediate family I feel that I will always be drawn to learning more and more about the disease and how to help these individuals.

Reflection of what was learned/gained by the student in relation to this course content, including a recommendation for others to access the material/experience too

From this assignment I learned there are more individuals battling the fight to go through with genetic testing for HD. I know firsthand my sister-in-law and my brother were in a mental tug of war on whether or not to be genetically tested; however, knowing they want to have children one day motivated them to go through with the testing to hopefully prevent passing down the HD gene. I also learned that how every family dynamic is different and some individuals handle the genetic testing differently. Seth's account of learning you tested positive for a disease that will ultimately kill you was so eye opening. It just changes your life in the blink of an eye. All in all, this Ted Talk helped open my eyes to a different point of view of someone battling HD.
Below is a link to a webpage where you can find out additional information and also donate to help find a cure for hereditary diseases.
http://www.hdfoundation.org

A photo/link to a document/website/etc.

https://hdsa.org

This is a link to the Huntington’s Disease Society of America. There are many resources on this website to support/advocate for HD and hopefully find a cure one day!

Neuro Note 1

TED Talk by David Camarillo—Why helmets don’t prevent concussions—and what might.

April 2016— Stanford University

Camarillo, D. (2016, April 1). Why helmets don't prevent concussions -- and what might.Retrieved July 21, 2019, from               https://www.ted.com/talks/    david_camarillo_why_helmets_don_t_prevent_concussions_and_what_might? utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare

This TED Talk described how a concussion happens and several assumptions we have about concussions. David describes how some visuals do not show the impact of concussive impacts that are happening deep within our brain, permanently destroying our brain tissues. He also explains how research is still needed to understand how to better prevent and decrease concussions. During the TED Talk, David spoke about a company called Hovding in Sweden that has a current inflatable bike helmet that fills with air on impact, thus preventing the rider from sustaining a traumatic brain injury. I believe with cutting edge technology like Hovding is developing, we should be able to help decrease the number of concussions that are occurring today.

I chose this topic because I played football from the time I was 8 years old until Junior year of high school. I have always been interested in how repetitive hits to the head can affect the brain later in life and what routes we can take to help prevent these devastating injuries from happening. 

From this TED Talk I learned how sometimes information can be misconstrued and presented in a confusing manner. David explained the neuropathology of a concussion and the complexities of the injury. I researched further into the chronic traumatic encephalopathy (CTE) that David mentioned during his talk, and it seems that CTE is VERY common among NFL players. The Journal of American Medical Association performed a study in 2017 and found that 110 of 111 deceased NFL players had been neuropathologically diagnosed with CTE. These numbers are staggering and the need for further research is evident! I also believe that further education should be presented to individuals, players, coaches, etc. in order to explain the risks involved with receiving repetitive hits to the head, like experienced in a typical football career. Some NFL players have recently been bold enough to speak out about the physical implications from playing in the NFL for numerous years, causing some players to retire after a couple of years to prevent further physical and psychological damage.

https://hovding.com

Restoring Confidence in Mobility

The hierarchy of mobility skills, increasing in independence, are as follows: bed mobility, mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADL, toilet and tub transfer, car transfer, functional ambulation for community mobility, and community mobility and driving. 

    After initially reading the hierarchy, I did not expect there to be this many skills. The list is much longer than I expected. I believe the hierarchy is in this particular order because it builds upon the skills of the level below. Once the patient can successfully complete one level of the hierarchy then they will move on to the next level. For example, after successfully completing a toilet or tub transfer the patient would then move onto a car transfer. Each skill is more complex than the preceding one. After rereading the skills, I believe I have observed this in some of my shadowing prior to OT school. I do agree with this methodology for moving onto more complex tasks and skills. If a patient can complete a toilet or tub transfer they should move on to a car transfer to increase their independence and active participation in their ADLs. I believe this hierarchy is formatted in such a way that the patient will increase their independence and promote self sufficiency.

    After reflecting on what we have learned in labs and simulations, I believe we have been taught the most efficient ways to perform transfers and mobility. We will use these skills everyday at our jobs and I look forward to putting them to work. I am thankful for our simulation experiences and the resources UTHSC provides to enhance our education. We have used wheelchairs, hospital beds, Hoyer lifts, and many more tools to hone in our skills as future therapists. 

Assistive Devices

The proper fitting of assistive devices for clients is crucial for their safety. Safety is the first reason you want to properly fit a person for an assistive device. If their device is not fit according to their specific height, weight, etc. then they will more than likely compensate with poor body mechanics and posture to use the device. For example, if you incorrectly fit a client with a walker and the individual is very tall then they will be bent over for the majority of the time they are using the walker. This compensatory method would create more problems for the individual and we would be at fault for the incorrect fitting. The second reason proper fitting of assistive devices is crucial is to ensure their insurance will pay for the device they NEED. If we improperly fit a child/client for a wheelchair they will outgrow in the next year or two then insurance may not cover the cost of their next wheelchair. This is incredibly valuable for the client and the insurance companies so that they will get the most of their device the maximum amount of time. We, as healthcare professionals, also do not need to be advocating for our clients for additional devices when we were the ones who improperly fitted the client in the first place. This will ensure the client gets the most for their dollar!

The correct fitting for a cane is the handle should be at the same level of the ulnar styloid, the wrist crease, or the greater trochanter. The elbows should be relaxed and flexed at 20-30 degrees. (Also, we must ensure the client places the cane on the opposite side of the injured limb.) The same fitting will apply to a rolling walker. The hand grips will be at the same level as stated above. To properly fit axillary crutches the axillary rest must be 2 and 1/2 inches below the floor of the axilla. The hand grips should also be at the same level of the greater trochanter. For Loftstrand crutches, the arm band should be 2/3 of the way up the client's forearm. This provides the greatest stability for the client when using their crutches. Lastly, for the platform walker, the client should be standing upright with their scapula relaxed. The client should place their elbow at a 90 degree angle and their weight should be applied through their forearm and not their wrist. Also, the platform should be placed 1 to 2 inches away from the elbow to prevent ulnar nerve compression. The handle attached to the platform should be placed medially to allow the client to have a comforting grip when using the platform walker. All of these should be taken into consideration when fitting an individual with a walker, cane, or crutches. We must take extra precautions to ensure the client is receiving properly fitted equipment and by doing this it will prevent further injuries.

Posture & Body Mechanics

It is important to teach proper posture and body mechanics to clients so the client will have an understanding of the harm they are doing to their body. If the client understands the complications or injuries that can arise from poor posture and poor body mechanics they will be more self-sufficient in correcting their own faults. Another reason we should teach proper posture and body mechanics is to prevent musculoskeletal injuries. We have learned in class that improper posture and body mechanics can produce strains, disc herniations, and arthritic disorders. Instructing the client on the correct way to sit and lift can prevent these complications from arising. Another reason to teach proper body mechanics to a client is to activate their muscles when lifting. Everyone has performed a lift solely with their back and felt the repercussions the following days. If we teach our clients the proper techniques of lifting objects they will activate their muscles and gain strength for future lifting. For example, lifting a heavy box from the ground is often incorrectly performed by bending at the waist and lifting the box solely with the lumbar spine. Instead, the client should position themselves close to the box, have a wide base of support, and bend at the knees while keeping their back straight. All while keeping the box close to their body. This method will activate their quadriceps muscles and prevent a devastating injury to their lumbar spine. Lastly, teaching our client proper posture and body mechanics is important so they can teach their family and friends proper body mechanics. If they understand the benefits of proper posture and body mechanics then they will be able to help teach others and prevent more injuries from occurring. This can create a cycle of injury prevention!

One example of how to use proper posture and body mechanics is when the therapist is helping perform a transfer from the client's wheelchair to their bed. The therapist MUST have a gait belt on the client first! The therapist must have them anteriorly sitting in their wheelchair. Then the therapist will have wide base of support and bend at the knees and not at the back. The therapist will use their quadriceps to lift the client up and assist them in transferring to their bed. This is one example where a therapist can use proper body mechanics when helping with a transfer.

An example of teaching a client good posture and body mechanics is instructing them on the correct posture while driving. The positioning of the seat, steering wheel, pedals, and mirrors when driving are vital to ensuring the client will be using proper posture. The therapist can instruct the client on proper seat positioning so the client will not be slouched or leaning back too far while driving. This coincides with reaching for the steering wheel. If the client's seat is too far away from the steering wheel then they will be over extended reaching for the wheel. Teaching the client to have their seat upright and close enough to the steering wheel so they can easily reach the 10 and 2 position is important for proper posture. This is not only important for proper posture, but also vital for safety while driving!

Blog Post #4- Man from the South

In this story, Man from the South, the soldier is going to potentially lose his pinky finger. If he were to lose his pinky this would be devastating for the functional use of his hand. The pinky plays a vital role in our functional grip strength and losing that finger would wreck havoc on the solider's grip.
    In the story, if the soldier lost the bet and he lost his pinky he would have a difficult time gripping his canteen for drinking. Grasping his large canteen would be difficult without his pinky finger due to the importance of the pinky in a functional, cylindrical grasp. Some scholars say that loss of your pinky can result in a loss of 30-50% of your grip strength. While he could grip his canteen with two hands, this may require him to stop and spend valuable time he could be performing other tasks.  I even tried to grasp a large vase at home without the use of my pinky and it was incredibly unstable. After adding my pinky to the grasp again, it was a much more stable and secure.
    One modification for the soldier grasping his canteen would be adding a handle. The addition of a handle would allow the soldier to functionally grasp the canteen without the use of the lost pinky. This would also allow the soldier to only use one hand to drink and could save him time from having to use two hands for stabilization. I believe adding a handle, similar to a coffee mug, would allow the soldier to easily grip his canteen for drinking.

Knowledge Check!

During our last lecture we had Professor Flick present about health promotion, health literacy, and prevention. She was very engaging in our session and we learned many things about current health topics. One of the first things I learned was the IHI Triple Aim. This is an objective to improve healthcare quality and satisfaction for individuals. The three focuses in this aim are population health, experience of care, and lowering per capita cost. This aim also helps broaden reach of health and and wellness for all individuals!
    Another topic that I learned was about the social determinants of health. Some of these are education, food, income, shelter, and many more. I enjoyed the dialogue we had in class about some of these determinants and how if one of them were to change then it could totally change the trajectory of the person's life. Take education for example, if someone had access to a good education and was able to get a decent paying job after graduation, then the person's life would change and they  could change the next generation's lives. I think this is a paradigm that we should all take a more serious look at.
    Lastly, I also learned about the different levels of disease prevention and interventions. The levels are primary, secondary, and tertiary. Professor Flick explained in great detail the differences between the three levels. I believe there is a large push for Primary prevention in the United States today. If there are preventative methods you can take to prevent the disease from ever occurring this would drastically change our current healthcare system. I believe maintenance and improving quality of life for individuals is incredibly important; however, if primary prevention is available it should be number one.

Biomechanics Blog Post #3

The clinical relevance of the Scapulohumeral Rhythm is vital to understanding and measuring the motion in the shoulder joint. There is a ratio of movement between the scapula and humerus and when this ratio is disturbed it can cause implications with our clients. There is a 2:1 ratio for range of motion in the shoulder joint. If a client moves their shoulder 3 degrees, the humerus will move 2 degrees and the scapula will move 1 degree. For example, a client with full 180 degrees of shoulder abduction, the humerus would move 120 degrees and the scapula would only move 60 degrees. There is a synchronization between the movements of the humerus and scapula. One implication involved in a disrupted scapulohumeral rhythm is impingement syndrome. This is when the subacromial space in the shoulder joint is compressed and the supraspinatus tendon is trapped and cannot function like it normally would. This would cause severe pain for our client. Another relevance for the scapulohumeral rhythm is to promote an optimal length-tension relationship between muscles. The length-tension relationship ensures a muscle will be at the optimal length to produce a strong contraction. It allows for the most actin and myosin to cross-bridge to form the contraction. An impaired scapulohumeral rhythm could produce an active insufficiency between the muscles. Lastly, another relevance of the scapulohumeral rhythm is the promotion of joint congruency. The head of the humerus articulates with the glenoid fossa of the scapula in such a way to promote the greatest range of motion (ROM). If there is no rhythm between the movements of the scapula and humerus this will cause the congruency between this joint to be lost. 
    

Biomechanics Blog Post #2

It is very important to palpate bony landmarks when measuring ROM to have a high inter-rater and intra-rater reliability. This allows for multiple therapists to palpate the same bony landmark so they are measuring from the same location. It also gives the same therapist a landmark to come back to when remeasuring the joint. Doing this ensures you are measuring from the exact same position for ROM in the same joint. Also, using the proper positioning when measuring ROM makes certain you will measure the joint’s full range of motion. If body is improperly positioned then the measurement will be faulty and the client’s joint will not be measured to it’s maximum potential. For example, if you are measuring knee flexion ROM and you place your client’s leg off the table then you have the potential to improperly measure the joint’s full ROM with the leg not positioned properly.

    The purpose of the “test position” for a MMT is to ensure the muscle can reach optimal contractibility. You want to place the muscle is in the proper position so that it can reach full contraction. For example, placing an individual’s leg hanging off the treatment table is OPTIMAL for performing a MMT on quadriceps extension. This allows the greatest contraction of the muscles. If you placed the individual’s leg on the treatment table in a flexed position, the muscle would not be able to produce as great of a contraction. Another reason for “test position” is so that the therapist can be in the best position to apply pressure for the “break test.” The therapist needs to be in a good position so that he/she can apply the right amount of pressure for this test; if he/she doesn’t then the client will receive an improper reporting of their muscle strength. Also, the therapist needs to be in proper positioning to apply the pressure on the distal portion of the joint they are testing. The therapist should never apply pressure across multiple joints because this will give a faulty reading of the muscle strength of the joint being tested. If the therapist and client is in the proper position then the therapist will be able to apply pressure on the distal portion of the joint being measured.

    Lastly, the relevance of the gravity eliminated position is for clients that cannot move through the full available ROM and will be scored below a 3 on the MMT scale. Individuals needing to be tested in a gravity eliminated position do not have the muscle strength to move through the full available range of motion against gravity, so they will need to be tested without gravity in order to measure their muscle strength. Some individuals will not have any muscle activity at all.

    

Knowledge Check

I listened to the "OT's Role in Promoting Driving Independence" podcast. This was a very interesting podcast with a dialogue of two OTs and a certified driving rehabilitation specialist. They discussed many topics in regards to her role as a certified driving rehabilitation specialist. They first discussed about how the older population accounts for 8% of car crash related activity and 14% of driving fatalities. This numbers are astonishing to me because I feel that these numbers are preventable and should be lower. Another interesting fact that was mentioned was most individuals that have suffered from a TBI stop driving simply because their friends and family say they should stop driving. Many individuals could have a better quality of life if they received therapy or evaluations and were able to drive on their own. They have halted their driving because of the comfort level of another person. 

    During the second portion of the podcast the OTs interviewed a certified driving rehab specialist. She gave insight into her position and how she is the only driving rehabilitation specialist in the state of Nevada. She stated there is no referral necessary from a physician and that some insurances will cover her services. With her position, she assesses the individuals home, their car, their cognitive, physical, emotional, and proprioceptive skills. Sometimes the individual will be very confident in their driving and then after the assessment she will have to inform them they should not be driving. Also, some individuals should be driving when they are not confident or comfortable with that fact. I feel that driving is such a vital part of someone's social and environmental freedom. It makes me reminisce of turning 16 years old and being able to drive by yourself for the first time. It allows for "freedom" and taking that ability away forces you to rely on another individual or system to transport you places. I think one piece I took away from the podcast and the driving rehabilitation specialist was to accept the client where they are. We must accept the client in their living situation, family situation, or mental state. Whenever we do this, we will be able to put forth the best effort to help them regain their independence and help them live the best life possible.

  

Biomechanics Blog Post #1

One movement that is a part of my morning routine is pouring a glass of milk. One of the movements after getting the milk out of the refrigerator is twisting the top off. Twisting off the cap requires grasping the cap and wrist adduction. Some tops are "pop off" and they require more supination of the forearm instead of wrist adduction. After the top is off I have to flex the elbow to lift the jug. While flexing the elbow, the shoulder is also abducting. In order to pour the milk into a glass the last movement is wrist adduction. This will instill the milk reaches the glass steadily.
    There are several joints being acted on while pouring a glass of milk. During elbow flexion, the sagittal plane, during shoulder abduction and wrist adduction, the frontal plane. There are also many axes being acted on during this movement. Elbow flexion is moving around the frontal axis, shoulder abduction and wrist adduction is occurring around the sagittal axis.
    The osteokinematics of the shoulder joint during the pouring is mainly shoulder abduction. I am abducting my shoulder to ensure the jug will be at the proper angle to pour into a glass. During shoulder abduction, it is visible that the humerus is moving further away from the midline of the body. In regards to the arthrokinematics during this movement, the head of the humerus glides inferiorly in the glenoid fossa. Because of the concave-convex rule, this allows the head of the humerus to stay in contact with the gleniod fossa.
   The prime movers of this movement are biceps brachii, brachialis, and brachioradialis during elbow flexion. Some other prime movers are the middle deltoid and supraspinatus during shoulder abduction. Lastly, during wrist adduction the prime movers are extensor carpi ulnaris and flexor carpi ulnaris. During elbow flexion, the biceps brachii, brachialis, and brachioradialis are contracting concentrically. Also, during shoulder abduction the middle deltoid is contracting concentrically because the muscle is shortening. Lastly, during wrist adduction, the extensor carpi ulnaris and the flexor carpi ulnaris are both contracting concentrically.
    Pouring a glass of milk is a vital part of my day. It has been interesting looking at all the movements involved in getting a glass of milk.
   

Therapeutic Relationship

I think therapeutic relationship is vital in being an effective OT. Learning about the different qualities in class made me think more about successful OTs I know and how they have the majority of those qualities. I also enjoyed learning about the steps in active listening. I feel that active listening is such an important quality for anyone to have so they can relate to clients, friends, and family. Active listening plays an important role in the interview process with the client because you need to really listen and pay attention to the client's story in order to correctly create the proper treatment. I enjoyed our last lecture because it allows us to reflect on qualities that we display well, and some qualities that we may need to work on.

Knowledge Check

Dr. Kiesling's presentation today was very informative and interesting regarding the history of disability in the United States. I believe my main take-away from his presentation was how we, the upcoming generation of healthcare practitioners, can pave the way for individuals with disabilities to live fulfilling and purposeful lives. He spoke genuinely about how there has been a astronomical shift in how society views individuals with disabilities, but how there is still ground to be covered when it comes to equality. We have come far in terms of accessibility and opportunity in society; however, we still need to converge on the gap of equality for individuals with disabilities. 

Earlier in the course we completed our Era presentations, and many legislative acts that Dr. Kiesling spoke about this morning we brought up during our presentations. He also spoke about how there are many legislative acts/bills that are tossed around every year that could deeply impact our profession. I think we should be more aware of what goes on involving policies, that we are normally unconcerned about, especially when they directly effect our jobs. 

As a continuation of the previous paragraph, I think information about healthcare policies and the way the United States looked at disabilities in the past deeply effects our profession. It can effect reimbursement from major insurance companies as well as whether they think our services are deemed "valid or beneficial." I also think that looking back at the history of our society and our views on disabilities can play a vital role in how we treat our clients today and in the future. We understand person-first language, but some of our clients may not recognize that. I think we, as OT practitioners, can advocate and be encouragers of equality, opportunity, and inspiration for individuals with disabilities, and further the progress America has already made.