Knowledge Check- April 18

Professor Flick gave us a new perspective and insight into the world of health. Professor Flick began her presentation to explain the shift in Vision 2025 to describe OT as "an inclusive" profession that "maximizes health, well-being, and quality of life for all people." The shift propmts the question, what is health and what is occupational therapy's role in that? Health encompasses a balance in mental, physical, social, and emotional state and may look different for every individual. Determinants of health might include stress, sleep, habits, routines, exercise, mindfulness, and responsibility. Why does this sound familiar? It sounds very similar to something we call the Occupational Profile. That is where we made an "aha" moment bridging a connection in health and promotion of wellness and occupational therapy.
Professor Flick explained the Institute of Healthcare Improvement's push for OT in primary care, population health, and community based programs. By using a client-centered approach with each individual, we can identify specific concerns and problems rather than using a temporary band-aid or medication that may lead to re admittance. Professor Flick explained the negative impacts on promoting occupation such as food deserts, segregation, crime, and financial status. This reality of a need for fulfillment but a lack of resources made me think about where OT may fit into the picture. What if Occupational Therapists promoted community gardens in a food deserts or offered parenting classes for single mothers? What if we created playgrounds that are fun for children of every ability or self-care classes for those that may read on a lower level? Professor Flick explained the difficulty in filling out paperwork, reading prescriptions, or even understanding a diagnosis for individuals with low health literacy. The thought of walking into a healthcare setting, unable to read the paperwork, understand questions that are asked, or navigating through a hospital reading signs and directions is disheartening and scary. This lecture allowed me to place myself in those indivudals shoes for just a moment and try to understand the fear and anxiety it may bring.
This lecture was eye-opening and made me think about the role of OT in health differently. I would like to learn more about how we, as occupational therapists, can play a part in advocating for individuals and improving healthcare. I would also like to learn more about how these topics relate to pediatric needs and the job of occupational therapist to promote health and well-being for children.

Scapulohumeral Rhythm

Scapulohumeral rhythm desccribes the ratio of movement between the scapula and and humerus. For every one degree that the scapula moves, the humerus moves two degrees. This rhythm is very important because it allows the muscles involved to be in optimal length tension relationship. If you know that full range of motion in abduction is 180 degrees, the scapula should move 60 degrees and the humerus 120 degrees.  Knowing this can help you in detecting abnormal measurements for range of motion. The motion is distributed between two joints- the scapulothoracic and the glenohumeral joint. This helps to prevent active insufficiency in muscles of the glenohumeral joint. It also allows for full range of motion. If the scapula did not move, there would be friction in the subacromial space. The rhythm also keeps impingement from occurring in the subacromial space that could result in tearing the supraspinatous.

• 
  

Test Positioning- Biomechanics Blog #2

When performing Manual Muscle Testing or Range of motion testing, it is important to follow certain procedures. In ROM testing bony landmarks is necessary because it gives the therapist a point of reference for positioning the goniometer. A goniometer has a stationary arm, a moving arm, and an axis. By placing the axis or stationary of the goniometer at a particular bony landmark, you can measure precise angles. Having landmarks allows testing range of motion to be universal and precise. Proper positioning is also important because you could be putting the client at a disadvantage, by placing them in an incorrect position. The client may not be able to move as freely or their movements may be less controlled if they were not specifically positioned. If landmarks and proper positioning were not established, there would be ambiguity in measuring change over time. Following the protocol for range of motion allows precise and accurate results. This is important for billing and charting improvement. It also allows for interrater reliability among therapists if a client sees a different therapist in the course of therapy.
Manual muscle testing measures muscle strength and function. Test position is crucial for MMT because certain muscle groups should be activated when performing a particular test. It is also important to be sure that the client is in mid-range of motion for a particular muscle group because the muscles should be at the greatest mechanical advantage. The therapist should also be mindful of their own positioning in testing. The therapist should be in a position to apply a great amount of force in the correct direction.
Gravity eliminated positioning is used for weaker muscle groups or when the grade is below 2+. Gravity eliminated positioning allows a muscle to move parallel to the floor. This eleminated the perpendicular force of gravity. It is important to use accuracy in MMT to best decide a grade. If a client is graded inaccurately, it could be dangerous for them to remain moving against gravity instead of gravity eliminated. 

Compassion and Communication- Session 25

The textbook describes emerging areas of practice in the world of occupational therapy such as aging in place, youth and children, and assistive technology. Each of these areas of specialization involve one-on-one interaction and listening to the specific needs of individuals. In forming relationships of trust and paying careful attention, aiding is really quite simple. In the TED Talk “Why we need Universal Design,” Michael Nesmith explains,through sign language, the desperate and necessary call for universal design. Universal design means carefully assessing products, spaces, places of work, and communities so that all individuals, no matter what their disability may keep them from doing, have full access. He uses the example of his mother, a woman who is deaf, longing to attend a movie at the theaters. We have the technology and resources to address this problem, but what are we missing? Compassion and consideration for individuals with a disability can quickly resolve a problem.  

After reading and listening to these resources,  I listened and reflected on the podcast "Au" some Swimmers: The Role of OT in Swim Lessons for Kids with Autism. In this podcast, a group of OT students worked with lifeguards that teach children with autism swimming lessons. The seemingly daunting task of teaching  the life skill of swimming, was made quite simple with a few changes. The students helped the lifeguards keep a log for each child, allowing them to track progress, feelings, and milestones so that each teacher and lesson went smoothly. The community center made changes in schedule so that children who were overstimulated by the business of a crowd, could attend classes during quiet hours. One child who was fearful of putting his head underwater, was guided by the therapist to sprinkle water on the lifeguard’s head. By slowly integrating the concept and being aware of this need, the lifeguard soon watched the child confidently pursue the new task.  

The underlying pattern in each of these examples is being receptive, open, and compassionate to each and every individual. If we, as therapists and humans, listen to the struggles, fears, and needs of those around us, we can create solutions. I believe that we are all wonderfully made and by building relationships of trust and opening our ears, we can help every client to feel so. 

Biomechanics of Sipping Coffee

An action that I do everyday, several times a day is taking a sip from my cup of coffee. As I hold my coffee mug and pull it toward my mouth, my shoulder flexes, elbow flexes, and fingers flex. The motions of flexing my shoulder, elbow, and fingers occur in the sagittal plane about the frontal axis. The osteokinematics of all of of these motions are open chain kinematics because the distal segments are moving. Regarding arthrokinematics as you flex the shoulder to take a sip, the convex humeral head rolls superiorly and glides inferiorly in the concave glenohumeral fossa of the scapula. At the elbow, the concave head of the ulna rolls and slides along the convex trochlea of the humerus. In flexion, the concave ulna rolls superiorly and glides superiorly along the convex humerus. The primary mover of shoulder flexion is the anterior fibers of deltoid that works concentrically to flex the shoulder.  The primary mover in elbow flexion is the biceps working concentrically to move the forearm. The primary mover in finger flexion is the flexor digitorum profundus which is performing a concentric action to keep the fingers flexed around the mug.