Scapulohumeral Rhythm

The scapulohumeral rhythm is the ratio of movement between the scapula and the humerus. This movement must be be synchronous in order to maintain optimal congruency between the glenoid fossa and humeral head. This rhythm is important clinically in order to properly measure shoulder range of motion. For every 3° of shoulder movement, there is 1° of movement at the ST joint and 2° of motion at the GH joint. This means at full 180° of motion, there will be 60° from the ST joint and 120° from the GH joint. It is important to know these ratios in order to determine the cause of the problem if a client does not have full shoulder ROM. If the scapula doesn't move, there would be decreased ROM as well as friction in the joints. This mechanism also helps to maintain the subacromial space in order to avoid impingement. With proper joint congruency, shear forces are decreased as well. Without the scapulohumeral rhythm, we would not be able to participate in many of our activities of daily living such as brushing our hair or reaching up into a high cabinet to grab something.

Implicit Bias

Implicit bias is an automatic subconscious way of thinking we all have about people. This bias can influence how we act as well. Implicit bias is something that we as people could develop over time because of many factors -- where we live, how we were raised, our religion, the media, etc. Subconscious is the key word here. Many of us may think of ourselves as fair and accepting of all people. But chances are, we all have some sort of implicit bias -- good or bad. 

It's important for OT students and practitioners to learn about implicit bias because it's crucial for our practice of being client-centered and respectful. Implicit bias can affect our interactions with clients without us even knowing. We don't want to treat some of our clients better/worse than others. Some ways we can examine and address our own implicit bias is to take the Project Implicit survey, take continuing education courses, educate ourselves by reading up on how to override implicit bias, and just doing some self reflection.

My big take-away from this session is to not think we are excluded from having implicit bias. If we subconsciously think a certain way, couldn't this cause us to subconsciously act a certain way as well? We want to bring our implicit bias to light so we can eliminate it from our minds in order to treat our clients well. They all deserve equal opportunity. Like we always say, everyone deserves the right to participate in the activities that are meaningful to them.

Test Positioning: ROM and MMT

It's important to use bony landmarks as reference points in order to orient yourself on the body when measuring. Palpating bony landmarks is also important for correct goniometer placement. If you don't position the patient correctly, the ROM measurement will be unreliable. The purpose of the "test position" for MMT is to ensure that the muscle is placed in a position for optimal muscle contraction. The gravity eliminated position is for those who do not have full ROM or are too weak. This position is always parallel to the ground. When using the gravity eliminated position, it is important to make sure the limb being tested is still positioned in a way that enables the most optimal contraction.

Activity Analysis

Each day when I wake up I eat breakfast, usually cereal. My right arm starts in a relaxed extended position down by my side. To eat the cereal, I start by performing shoulder flexion until my arm sticks straight out in front of me. I extend my right arm out at the elbow joint to grab the spoon and flex my fingers around the spoon to hold it. Then, I flex my arm while also medially rotating my arm to bring the spoon to the bowl. I slightly extend my wrist in order to scoop the cereal out of the bowl. I then flex my arm even more to get the spoon to my mouth. The motions of flexion and extension at the elbow joint occur in the sagittal plane around the frontal axis. The osteokinematics of the elbow joint are extension to flexion in an open kinematic chain. In regards to arthrokinematics, the concave ulna is the moving segment when decreasing the angle between the humerus and the ulna. The concave ulnar surface rolls and glides anteriorly on the convex surface of the humerus. The prime mover for elbow flexion is the biceps brachii, which performs a concentric contraction.

Health Literacy & Social Determinants of Health - Session 28

Throughout this session, I learned what social determinants of health really are. I had heard this term before but have never had a full understanding. I feel like the "social" aspects that are important to one's health are often overlooked as they are not the first things that come to mind when we hear "health." Social determinants include affordable housing, quality of education, availability of resources, public safety, and much more. I know these are all things that would have an extreme effect on my mental health and quality of life, so it is important for us to remember this as practitioners in regards to our clients. 
With Professor Flick's lecture on health promotion, I gained a better understanding of "wellness" as well. I loved the example she used of the patient with diabetes who has recently had a toe amputated. It could be easy for us as OTs to think, "why does this patient need me for just an amputated toe?" But with our holistic approach, we should remember that we need to look at this client's health and wellness as a whole. Maybe this client had to have their toe amputated because he/she struggled with taking care of his/herself and participating in his/her ADLs which in turn put him/her in this position. Is there a barrier that we need to identify and decrease in order to improve this client's quality of life? Well we are the perfect people for the job!