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