Imposter Syndrome

    After taking the Imposter Phenomenon Rating Scale test, I scored in the "moderate IP experiences" category. I feel that this is pretty accurate because it does not seem like imposter syndrome affects me daily, but it does come up sometimes in my life. At this point in my career, I can see imposter syndrome possibly becoming more of a problem, since I am about to start Level II Fieldwork. It could be easy to fall into a mindset of seeing myself as an imposter once I develop my own caseload and start planning my own treatment sessions. But, I plan to utilize what we have learned about ways to combat imposter syndrome so that I do not develop thoughts about if I am competent enough or not.

    

    Firstly, I plan to do a lot of self-reflection and preparation during this next week prior to starting Level II Fieldwork. By assessing myself and studying up on common diagnoses/treatments/etc. that I may see in my setting, I will feel better prepared and be more confident coming into my first day. And if I don't feel confident, I'll fake it until I make it. I will remind myself of how hard I worked to make it to this point in my life and career. By reminding myself of all that I have accomplished to get here, my negative and untrue thoughts stemming from imposter syndrome will fade. I have also started trying to expand my network and stay in touch with OTs I have been on fieldwork with, met at the job fair, etc. This will not only aid in my search for a job as a new grad but also for mentorship once I do get a job. 

    It is important to realize that imposter syndrome is normal and happens to everyone. By remembering this, we will feel more confident in ourselves even when these thoughts do creep into our minds. We belong here, and we will do amazing on Level II Fieldwork. No imposters here!

Locus of Control

     After completing the locus of control questionnaire, I scored sort of in the middle of having an internal and external locus of control. I lean more toward external locus of control. I think this is accurate as I share some of the qualities of both sides but have my faults when it comes to not always taking the blame for things. But in the same sense, I feel that I demonstrate the positives of the external locus of control as well, as I am more easy-going and won't let myself get stuck on thinking about the past and what I could have done differently. 

    Learning about locus of control especially in a healthcare aspect is very important for us as future occupational therapists. We will have clients coming in from all different kinds of situations. Some will have an internal locus of control and will put the responsibility of working to achieve their goals completely on themselves. These are the ideal clients, but obviously we are not always going to have those. It is inevitable that we will have clients come in that find every person/situation/etc. to blame for what happened to them or why they are not achieving their goals. It is important we find ways to stay patient with these clients and help them work past this mentality.

    Helping these clients achieve an internal locus of control will make a huge difference in how they perceive their situations. It is important for us to talk with them and help them focus on what they can do now and not what happened in the past. It can be easy for us to grow impatient and less sympathetic to those who constantly find someone to blame or something to complain about. But, it is our job not to give up on them and to remind them that they are the ultimate decision maker when it comes to achieving their goals. This can make a difference in how they participate in their therapy sessions and especially their home exercise programs. We as OTs need to work to encourage an internal locus of control in our clients so that they know they can achieve success in their lives.

Media Project

For my media project material, I had buttons. I turned this simple item into a "button garden" complete with a cookie sheet full of soil, button "seeds," and plastic gardening tools. I did this because my client Dennis has suffered a stroke and now has left neglect. He wants to return to one of his favorite activities (gardening), so doing activities with this button garden can be enjoyable while also benefitting him in many ways. It can improve his finger and wrist flexibility, bilateral coordination, object release, dexterity, safety awareness, strength, balance, ROM, and more. 

The most significant thing I learned from this project is that you can make anything into something meaningful. Having something as simple as buttons but making it into a whole setup that is meaningful to the client just shows how much you can do when you really put thought into your interventions. I feel that one way I have changed is by realizing I can be creative. Before now, I have always said I'm not creative. But, now I believe that everyone is creative in their own way. We shouldn't belittle our abilities just because they're different from someone else's. 

Completing this assignment has impacted me in a way that I will remember for future courses and in clinical work. It has made me realize even more how important it is to make our interventions and activities occupation-based. This concept became more real for me as I was working with my materials. I thought about how boring it would be if I just asked Dennis to count and pick up buttons. Adding in a simulation of one of his favorite hobbies (working in his garden) was something so simple yet I know would be so affective and meaningful to him. 

Below is a photo of the button garden and a link to my media project video:

https://www.youtube.com/watch?v=8JUdo3YKLJE

Neuro Note #5 - Huntington's Disease

For this neuro note, I decided to choose Huntington's Disease (HD). We just learned about this disease recently in class, but I wanted to dive deeper in order to gain a better understanding of what HD is like. I wanted to gain knowledge from someone's personal experience with this disease, so I chose to watch a Ted Talk called "Facing Death Full of Life" by Danielle Valenti. Danielle shares about how her mother's diagnosis of HD impacted her life. Her mother found out she had HD but chose to keep it a secret from her daughter to protect her. Danielle explains how horrible this disease is by describing the sad reality of how it took her mother's life. She describes her mother as eventually being "the shell of the woman that raised her." Danielle's mother eventually chose to take her own life by refusing food every day. Danielle decided to let her mother choose her destiny rather than forcing her to do something she did not want to do. Her mother died 67 days after refusing her last bite of food. This was shocking to me as I was thinking the process might have happened faster than that. Danielle decided she wanted to get the genetic test to see if she would eventually develop this disease. Most people that could have HD do not get the test because they know there is nothing they can do about it. Danielle had a different perspective - she didn't feel she could mourn her mother properly unless she got tested because HD will always have an impact on her life no matter what. Danielle tested positive but has no way of knowing when she will develop symptoms. She admits she has bad days living with the knowledge of how her life will end, but she also states that she decided she is going to commit to happiness and knows she will get there because she is investing in it every day. 

I admire Danielle's bravery. She is selfless and cared for her mom in a way that allowed her to make her own choices even though Danielle may not have agreed with or liked how things would turn out because of it. I think it's also so brave of Danielle to get the genetic testing done. I have no idea what choice I would make, but I tend to think I would rather not know since it won't make a difference. But until you are put in that kind of position of having the option to know your destiny, I don't think anyone truly knows what they would do. Through watching this video, I have learned a little about what it's like to have a loved one die of HD and know you will have the same results. It is so difficult to imagine, but it is important that we know how to empathize with and care for these people. I have a hard time learning about these awful, life-altering diseases, but I learn a lot when I watch people's personal testimonies. So many of them choose to stay happy during the rest of their time on Earth, and I think that's so inspiring and should drive all of us to choose to be happy in our own lives every day. 

References:

[TEDx Talks]. (2015, December 4). Facing Death Full of Life | Danielle Valenti | TEDxBerkshires. Youtube. https://www.youtube.com/watch?v=6JRwCdmewl0

Neuro Note #4 - Guillain-Barré Syndrome

For this neuro note, I wanted to learn about Guillain-Barré Syndrome (GBS). I chose this topic because I honestly don't think I have ever heard of this disease, much less know what it is. I wanted to broaden my horizons and learn about GBS by watching a Youtube video entitled "Andrew's Story: Guillain-Barré Syndrome." This video is all about Andrew Franek's testimony to his diagnosis of GBS in 2016. Andrew had just started his career as a firefighter when he suddenly got sick with a very high fever, weakness, and a rash. He went to the doctor and was diagnosed with strep. Some of his symptoms resolved, but then his feet became numb. After a few days he could no longer walk because of weakness and tightness. A spinal tap revealed that he had GBS. The video shows the progression of the disease including all the treatments and therapy he received. Andrew had to have an NG tube and was even placed on a BPAP machine. Things got so bad with Andrew struggling to breathe that he requested to be intubated and put on life support. He was paralyzed but had horrible symptoms like his body was burning or being crushed, migraines, and blurred vision. Andrew eventually made major improvements and was able to eat and breathe on his own. After his time at Shepherd Center having lots of therapy, Andrew got his normal life back. He is fully recovered and back at his job of being a firefighter - all of this in less than a year!

By watching this Youtube video about Andrew, I learned a lot about GBS, considering I knew nothing about this disease before. I liked how Andrew talked about all of his symptoms leading up to the disease since they were common and he was misdiagnosed at first. Showing the full details in how this disease manifested in Andrew was very eye-opening. This was such an inspiring story of how miraculously Andrew recovered after the extreme lows he had. He also mentioned how great some staff were but how terrible others were. Some completely disregarded him or treated him like he was part of a checklist. This was yet another reminder of how much it matters that we as OTs get to know our patients and genuinely show that we care about them. 

References:

Andrew J. Franek (2017, August 1) Andrew's Story: Guillain-Barré Syndrome. Youtube. https://www.youtube.com/watch?v=VWvrHhs2jps

Neuro Note #3 - Parkinson's Disease

For this neuro note, I decided to learn a little more about Parkinson's Disease. I chose this because I have never been around anyone with this specific disease until last year when I started dating my boyfriend whose grandmother has Parkinson's. I became interested in how Parkinson's affects people after this. The article I'm writing about is also about a service dog, and since I am obsessed with dogs, the article caught my eye.
To further my learning, I read an article entitled "The biggest compliment I get is when people don't notice my dog is here" by Aurore Groult. The author interviews Renee La Verrier about her diagnosis and how her dog assists her in her daily life. Renee has lived with Parkinson's for 13 years and has had her service dog Tommy for six years.

Reading this article helped me learn the benefits of having a service dog for someone with Parkinson's. Tommy helps Renee have confidence enough to go out in public places each day. Renee states that not only does Tommy help her physically but he also helps build a bridge between her and other people because people look at her and don't just see a disease. But with the benefits of having Tommy also comes challenges. Tommy requires a lot of attention and care, and Renee frequently worries about something happening to him. There are also many fraudulent dog services in the U.S. which means just about anyone can fake a dog's service, and that can be very dangerous in certain places. She talks about how some dogs run all over the place while people comment on not even noticing her dog. This is how it should be because dogs that are not properly trained can cause a lot of problems. In conclusion, service dogs can be beneficial to those with Parkinson's, but a lot of research should be done first in regards to the right organizations and proper training for the dog.


Reference List:

Groult, A. (2018). The biggest compliment I get is when people don't notice my dog is here. Parkinson's Life. http://parkinsonslife.eu/renee-le-verrier-service-dogs/

Neuro Note #2 - Multiple Sclerosis

For this neuro note, I wanted to learn more about multiple sclerosis because I feel like I just don't know a lot about it. I had always thought of it as a disease that impacted everyone severely and was debilitating until I met one of my best friend's college friends who has MS. I would've never been able to tell she had it if she hadn't told me. She said she just has some vision trouble and pain sometimes. This was the start of my interest in learning more about multiple sclerosis.

To further my learning, I watched "Breea's Story," a youtube video about an 18-year-old girl who was diagnosed with severe onset of multiple sclerosis. She suddenly became blind in her left eye, could not talk or swallow, and had paralysis on her left side. After months of therapy, treatments, and encouragement, she made major improvements and gained her independence and a lot of her strength back. She was very determined and overcame huge obstacles to get her life back.

From this video I learned how severe multiple sclerosis can be but also the improvements that can be made with the right support and determination. I highly recommend watching this video because it gives insight on the struggles of multiple sclerosis but also is very inspiring because it shows how Breea overcame those struggles.


References:

[breeareneebeatsms]. (2012, September 8). Multiple Sclerosis - Breea's Story. Youtube. https://www.blogger.com/blogger.g?blogID=5819044671474784522#editor/target=post;postID=5619129910520304250

Neuro Note #1 - Dementia

For my first Neuro Note, I wanted to dive deeper into dementia. I chose this because of its relevance as we just turned in a diagnosis snapshot about dementia last week. I also haven't known anyone personally with dementia, so I wanted to learn more and become more comfortable by familiarizing myself with these types of life-altering diagnoses. They are saddening, but as OTs we could be dealing with these diagnoses often, so it's important to know the best ways to interact with these clients.

To further my learning, I chose to read the article "Playing Along with A Dementia Patient's Realities" by Carol Bradley Bursack. In this article, Bursack talks about her father's experience with dementia. After undergoing surgery to remove some fluid in his brain, Bursack's father awoke in a severe stage of dementia. She discusses how she was the only member of their family to play into her father's delusions rather than trying to bring him back to reality. For example, she created fake degrees and awards he believed he had earned and hung them in his room. She later learned that this is actually a technique used with patients with dementia called "validation therapy." She compares this to that of when a child dreams of what they will be when they grow up and they pretend to be a "firefighting hero or a prima ballerina," which I think is a perfect illustration.

My perspective was changed when I read this article and learned about validation therapy. Personally, I fully support it. Dementia is a debilitating disease with no cure and a poor prognosis. I think time with loved ones with dementia can be much better spent without arguing and redirecting. One with dementia will never be able to come back to "reality;" in fact, this new mindset IS their reality. So instead of trying to reason with that person which could in turn make them feel degraded or disrespected, much better memories can be made during the time they have left here if we just go with the flow (as long as it's safe to do so).

I recommend reading this article because it gives insight into a different way to interact with people who have dementia. Always attempting to redirect someone with dementia can be frustrating for both that patient and their family. Simply validating that person in their "new reality" is a harmless alternative that can make them feel comfortable and at peace.

Direct link for the article: https://www.agingcare.com/articles/playing-along-with-dementia-realities-121365.htm

Reference List:

Bursack, C. B. (2008). Playing Along with A Dementia Patient's Realities. Aging Care. https://www.agingcare.com/articles/playing-along-with-dementia-realities-121365.htm

Social Determinants of Health

Social determinants of health are the things that can affect a person's health and wellness due to the place where they live or work. Some examples of these things are: education, transportation, employment, housing, access to health care, etc. This is where health begins. Living and working conditions have a huge impact on one's health, though many times these factors are disregarded by practitioners. For one person, his/her social determinants of health could enable him/her to great healthcare, good education, and stable employment, whereas another person living in a different area could not have access to these things simply because of the area he/she lives.

When I think of how social determinants of health can affect your nervous system, I immediately think of stress. Stress has a huge impact on our physical and mental health. Although a little stress is needed to survive and thrive, too much stress can negatively impact our bodies. Living in an area where it is difficult to gain access to transportation, good healthcare, or proper education could cause a lot of stress. With much stress comes increased levels of cortisol. This in turn causes an enlarged amygdala, reduced number of connections in the hippocampus, and shutting down of the prefrontal cortex. With an impaired PFC, a person would have trouble with decision making, self-control, planning, problem solving, and more.

UTHSC's OT program requirements for service/professional development hours facilitates preparedness in us as students because we gain knowledge through hands-on learning and real experiences. In my opinion, that is the best way to learn. Throughout our experiences obtaining these hours, we will come into contact with people from all walks of life who we may not have ever spent time with if not for this requirement. We will see real life examples of these social determinants and their effects, good and bad. I believe this broadens our horizons on interacting with people which will in turn make us more prepared as OT practitioners.

Locomotion and Adaptive Devices

As OTs, we will be fitting clients for assistive devices often. It is important that we make sure these devices fit our clients appropriately because of safety and comfort. In regards to safety, if a device does not fit appropriately, it can be very dangerous for the client and even cause injuries. Next, we want our client to be comfortable in their assistive device. The client could be using the assistive device as much as every day, so it is important it's comfortable for him/her and will not lead to any further injuries.

In order to fit a client for a cane, the hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter. The elbow will be relaxed and flexed 20-30 degrees, and the shoulders will be relaxed with no elevation. Canes are the most unstable of assistive devices, so it is important to know if the client is strong and stable enough to only need a cane. This measurement method is also used for walkers.

For fitting axillary crutches, the same method as fitting a cane will be used. In addition to these steps, the axillary rest should be about 5 cm below the floor of the axilla with the shoulders relaxed. Axillary rests that are too high or too low for the client can be painful.

Lofstrand crutches have arm cuffs that wrap around the client's proximal forearms. These type of crutches are commonly used for those with long term disabilities. Lofstrand crutches are more stable than canes but less stable than axillary crutches. Fitting for these crutches will require following the same steps as that of the cane but with an addition of ensuring the arm cuff is situated 2/3 of the way up the forearm.

Platform walkers are for those who cannot bear any weight in their hands or wrists, so they must rely on their forearms for stability. Once again the same fitting method will be used, as canes and walkers have the same method. Also, the client's forearms need to be in a neutral position flexed at 90 degrees in order to get the proper height measurement for the platform attachments.

Lastly, we have the rolling walker. This is for clients with weak upper extremities, so much so that they would not be able lift a standard walker. We would still use the same measurements as the cane and standard walkers. This device offers very little stability as it is extremely mobile. So, we would need to ensure that the patient has good balance and will be able to keep the rolling walker under control. 

Transfers

The order for restoring confidence in mobility based on increasing activity demands (easiest to hardest) is 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. I am not surprised by this hierarchy. I think the hierarchy is in this sequence because with each step, the complexity of the activities increase. For example, the steps involved with driving are going to be a lot more complex than transferring from the bed. It also would not make sense for these steps to be switched around; why learn driving if you cannot get out of bed? This hierarchy shows that mobility skills build upon each other. I witnessed many wheelchair and bed transfers with my time shadowing at assisted living facilities but would've enjoyed getting to see other types of transfers. So, I have really enjoyed learning about all the different transfer techniques and when they should be used. In conclusion, I do agree with this approach. We as occupational therapists should use this as a guide but also remember to adapt when some of our clients are progressing differently than the exact order of this hierarchy.

Posture and Body Mechanics

Did you know that 80% of people will experience back pain at some point in their life? This is largely due to improper posture and body mechanics. This is just one reason why it is crucial that we teach proper posture and body mechanics! Another reason to teach proper body mechanics is in regards to lifting heavy objects. It can be very dangerous and cause severe injury if a person is unaware of proper lifting techniques. If you already experience back pain, there is still hope for you! Not only can proper posture and body mechanics prevent back pain but they can also correct or relieve some back pain as well. These proper techniques are also important for one to maintain their independence and good quality of life.
For teaching proper body mechanics in an intervention with my client, I would of course start with finding out their ADLs and other occupations they participate in regularly. By doing this I could figure out what type of heavier objects my client might be lifting during the day. This would make it more engaging when I teach him/her proper lifting techniques: widen the base of support, bend knees, tighten stomach muscles, lift with leg muscles NOT the back muscles, keep load close, keep back straight, etc. Since everyone could benefit from learning proper sitting posture, this is another intervention I would use with my client. The easiest way to understand good posture is to see what good posture looks like and also what bad posture looks like. So, I would demonstrate examples of these to my client and get them to show me good and bad posture as well to ensure their understanding.

Neurobiology: Haribo Gold Bears Advertisement

Many people hate commercials, but in my household commercials rarely get skipped - mainly because my dad finds them all so entertaining. He has a ton of commercials memorized! With that being said, one of my and my dad's favorite commercials is one advertising Haribo Gold Bears. In this advertisement, there are adults in a conference room discussing these gummy bears - but they all have baby voices and use incorrect grammar. Some of our favorite lines are, "The red one is more gooder to me 'cause it tastes like berries!" and "And then I'm gonna flyyy it into my mouth!" We always get a laugh out of this commercial anytime it comes on. We even quote it to each other randomly lots of times!

The area of my brain primarily involved in my response to this marketing campaign is the frontal lobe. The frontal lobe has everything to do with a person's mood, personality, and behavior. I have the type of personality that thinks this type of marketing campaign is funny! I also find myself in a better mood because I end up laughing at how silly it is. The hippocampus is also involved because I have the script of the commercial stored in my long-term memories. This memory is specifically spatial memory because it is associated with what I have seen/experienced. The amygdala could also play a factor in regards to associating this memory with the emotions I feel during watching/talking about the commercial (happiness, humor/laughter, etc.)


Below is the link to this great commercial:
https://www.youtube.com/watch?v=EAnwmmPFYgU

Man from the South

In this story, a young soldier is persuaded into participating in a bet that if lost, could cost him his pinky finger. The boy talks about how he really doesn't need his pinky finger anyway, taking for granted what all his pinky does for him. Without the use of his pinky, he would lose about half of his grip strength. This young man's daily activities as a soldier would be greatly impacted if this were to happen. His ability to operate firearms, technology, and other various important things would be dramatically impaired. He would not be as accurate with his shots fired in the field which would be detrimental to his career, his life, and the lives of his comrades. 

At the end of this story, we get some insight on the life of the rich, betting man's wife. Throughout all of her betting against her husband, she is now left with only a thumb and a finger on one hand. Only having two fingers means the wife would have a lot of difficulty with daily activities such as brushing her hair or buttoning up her shirt. Something that could be done to help with hair brushing is to place a Velcro strip on the back of the brush that can stick to a Velcro strap placed around the hand. With this, the lady will not have to work as much to grip and hold the brush (since we know how much grip strength is lost without the pinky). Velcro can also be used to modify dressing for her as well. You could put Velcro spots under the buttons of a shirt so that she can just Velcro her buttons down instead of actually manipulating the button into the hole.

Acetylcholine

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!