Posture and Body Mechanics

        Posture is defined as the relative alignment of body parts. It is ongoing and changing as the body moves throughout space.  It is important to remind clients what correct posture looks like and explain to them the reasons why it is important. Keeping ideal posture maintains skeletal and muscular balance and minimize the risk of injury. For example, a person with forward head posture, is putting stress on the hyoid bone and neck extensors, and increasing the rsik of strain and injury. Posture is also important because it requires less effort and energy expenditure to stand and move when you are properly aligned. An individual with a spine curving inward (Lordosis), will have tight and shortened chest muscles which leads to impaired respiration and greater exertion. 
        Body mechanics is the way that one moves the body during daily activities. Proper body mechanics can protect the body from pain, especially the back.  It is important to maintain proper body mechanics because faulty mechanics are often the cause of back pain. 80% of the adult population will have low back pain at some point. Improper mechanics can cause disk herniation, muscle strain, or stiffness. Proper body mechanics are not only important to protecting ourselves, but also important in protecting the clients that we are helping. If we dot stabilize and assist in the correct areas while stabilizing our own bodies, it can be harmful to the client.
           As a therapist, I would suggest that clients who spend much of their time sitting, use an unsupported desk chair or standing desk. I would teach clients proper form when typing at a computer and provide resources to adaptive mouse pads and keyboards.  I would teach individuals to stand from their desk using their core and leg muscles and not pulling themselves up on a desk or chair. If the individual is in a job that requires lifting or picking items up, I would instruct the client to use a broomstick to practice keeping the spine erect and feet flat.

Don't Cry Over Spilled Milk- A Man Without a Pinky

         In this story, the poor soldier did not know where his confidence would lead him when boasting about a fine and trustee lighter. Thankfully, the wife stepped in before her husband could take a whack at the soldier's little finger and add another victim to his list. Had the wife not stepped in, the soldier might have lost the finger. Although it is called the "baby finger", its' job is large and mighty.
         The pinky finger is a key player in gripping. Every finger is involved in gripping but the pinky finger has the greatest range of motion in the aspect of flexion. Each finger converges toward the scaphoid as they flex into a fist, allowing for a firmer grip. A task that requires gripping that would become difficult for the soldier is pouring a bottle of milk. Considering the time period of this story, 1948, we know that milk at that time was delivered in glass bottles. Milk in the 1940s was not purchased in gallons and cartons that we know today. The soldier might have enjoyed a cold glass of milk or a bowl of cereal, and without a pinky finger, this treat would be difficult. The type of grip necessary for is a cylindrical grip. During prehension, the soldier would open the hand and position his fingers and thumb around the milk bottle. This initial grip would not be firm and the action of pouring a heavy and full jug by pronation would be unstable because of the grip.
         The soldier could modify this task of pouring milk by adding pumps to the bottle. You can picture the mechanics of this pump by thinking about pumping sauce or ketchup from a container at a fast food restaurant or soap from a bottle of sanitizer. By adding a pump, he could use one hand to stabilize the bottle and push down on the pump with the other hand. Pushing down on a pump would not require gripping and allow him to easily transfer milk to a bowl for cereal. Don't cry over spilled milk, Mr. Soldier. With modifications and OT think, there is a way!

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.

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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.  

 

Therapeutic Relationship

Therapeutic Relationship is the relationship between a client and occupational therapist. Building a strong therapeutic relationship is important because it allows a trust to be formed. If a client trusts their therapist, enjoys going to therapy, and feels comfortable, the OT process will be a more positive experience.
The greatest take away for me, in class, was the distinction Dr. Lancaster made between sympathy and empathy. Empathy is an extremely important quality in a therapist and it is not just placing yourself in your client's shoes. If a client has experienced a spinal cord injury from a car wreck, you do not just imagine how you would feel if you were in a car wreck. Empathy is understanding that what has brought them to OT, might be the hardest event or experience of their lifetime. Knowing that, you think about how you felt during the hardest experience in your life and use that perspective to help your client. I would like to spend more time reflecting on my own experience to strengthen my sense of empathy. I would also like to improve my ability to ask questions and actively listen. It is so important to ask questions without judgement or assumption before beginning treatment and this is something that I would like to strengthen.
I enjoyed learning about therapeutic relationship because this is the "bread and butter" of the occupational therapy experience. I think that this unique aspect of OT sets our job as healthcare practitioners apart and keeps the heart in what we do.

Rhythm of Life

Today’s lecture by Dr. Keisling was extremely enlightening about how we have evolved in America in response and inclusion of individuals with disabilities. Hearing the stories, examples, and legislation (well, lack there of) that has painted the footprints of the journey of disabilities gave me new perspective. Hearing Dr. Keisling’s lecture was so important because it gave us background into population that will be an integral focus of our career as occupational therapists.

            A main point that resonated today is that individuals with disabilities should be afforded and supported in participating in the rhythm of life. This word, rhythm made me dwell a little deeper. What is rhythm and what does mine look like? The rhythm across my lifespan would include attending church, playing team sports, taking piano lessons, and attending college. Smaller pieces of my rhythm of life might include having lemonade stands, trick or treating, or shopping for a prom dress. Being homesick at college, losing my grandfather, and breaking my arm also play into that rhythm. Do the individuals with disabilities that I know have a right to that rhythm? Judith Heumann was most definitely kept from the rhythm of life when denied her right to education and teaching. Death and grieving are a part of the rhythm and the children of institutions were merely buried with a number as a headstone. Moodiness and anger would are definitely part of adolescent rhythm but resulted in extreme consequences for Rosemary Kennedy.

Perhaps this mention of rhythm resonated with me because that is exactly what we are learning to be the aim of our practice. We, as therapists, strive to help individuals successfully perform purposeful activities that allow them to fulfill their roles. In essence, OT aims to facilitate rhythm of life. This lecture inspired me to advocate for the rhythm of life for all humans. I was stirred to reflect on capability rather than disability. I think about a certain song I used to hear in middle school, “If God is a dj, life is a dance floor, love is the rhythm, and you are the music.” Let’s shed light and give love so that rhythm is found, no matter the music or dance floor.

The Occupational Therapy Practice Framework (OTPF)

The Occupational Therapy Practice Framework, the OTPF for short, is a summary of ideas and values that guide the OT Profession. The OTPF provides a positive perspective that focuses on a holistic approach of health and wellness of individuals. It is a go-to document for occupational therapists to seek guidance in the OT Process of evaluating, creating interventions, and assessing individuals. The OTPF is important because it has created a common language among therapists and establishes a scope of practice. By using the OTPF across all settings and states, we create a better sense of a community and expectations among all occupational therapists. This can ensure efficiency in billing, quality treatment across the board, and better communication the network of occupational therapists.

My Role- Knowledge Check 2/19

In this phase of life, my role is an occupational therapy student. Occupations are meaningful activities involved in fulfilling that role. An obvious but important occupation that is associated with being a student is studying. Whether it be Anatomy, Foundations, EBP, or Leadership, there is almost always something that I can be reviewing and studying after class. One activity that I frequently use to in studying is quizing myself on a whiteboard. There are several tasks involved in this review activity. I need to be able to grip the expo marker, visually shift my focus from my textbooks to whiteboard,  tear off paper towels to clean the board, and wipe the board clean for a new topic.