Restoring confidence in mobility

The hierarchy of mobility skills begins with bed mobility then goes to mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADL, toilet and tub transfer, car transfer, functional ambulation for community mobility, and finally community mobility and driving.  This is very close to what I expected the "stages" of mobility skills to be like because each one builds on the other. I have seen this used when working with clients and I agree that it is the correct way to work with individuals on mobility.
From class and labs, I have learned that you start working with clients on tasks that are not as complex and then grade the individual up or down based on their performance.  This is why the hierarchy of mobility skills is in the correct order in my eyes because each one builds up to being able to perform the next. 

Fitting Assistive Devices

Fitting assistive devices to clients is very important and specialized to each person.  It is crucial to fit the device to the person so that they are able to use it for a long period of time.  As discussed in class, insurance companies expect a device to be used for a certain length of time before they will pay for another.  This is especially for children who may outgrow the device.  Another reason it is important to appropriately fit assistive devices is so that the client can use it safely. If a walker is too low when a person is using it, it could cause them to be flexed at their back and cause additional injuries to that person.  Another example would be a cane being too short cause the person to lean further to one side and could also cause them to fall when supporting themselves on it.

To fit an individual for a cane, they should be wearing shoes and the cane should be adjusted to the height of their greater trochanter.  They should use the cane on their uninvolved side as well.  To fit a person for axillary crutches, the axilla rest should be approximately 5 cm below the person's axilla. The handgrips also need to be adjusted to the height of the greater trochanter of the person with their shoes on.  The lofstrand crutches should attach the arm band approximately 2/3 up the forearm with the handgrips at the height of the greater trochanter and facing forward. 
A platform walker should have the handgrips adjusted to the height of the greater trochanter of the individual with shoes on. The platform should be set with the individual's elbow flexed at 90 degrees to allow weight bearing through their forearms.  The proximal forearm should be 1-2 inches off the platform to avoid compressing nerves.  The handgrip of the platform should be slightly medial for comfort of the individual.  Finally, a rolling walker should have the height adjusted to the person's greater trochanter while wearing shoes.  The front and back legs should be at the same height allowing the handgrips to be level as well.

Body Mechanics

Having good posture and body mechanics is very important for every individual.  If someone has bad posture, their spine could become more kyphotic which puts more pressure on the disks in between the vertebrae.  Having good posture also helps keep back muscles strengthened by keeping them engaged.  Back injuries are very common in the work place which is why teaching proper body mechanics when lifting stuff is crucial.  Keeping the back straight when lifting from the floor keeps from having bulging or herniated disks or even straining back muscles.  The large thigh and glut muscles should be used when lifting objects.  Teaching proper body mechanics would also allow a person to have more power and strength when trying to lift or move objects. 

One way you might teach body mechanics is as a prevention method to a company for their employees.  Teaching them proper lifting, pushing or pulling techniques would be an effective intervention for this population.  This could be from an ergonomic standpoint in a factory.  Another way you may teach proper posture or body mechanics is for transfers in patients in a hospital.  You would want to inform them on positioning of their feet when going from a wheelchair to a bed or vice versa.  Moving around in the bed would also require good body mechanics in order for the patient to become independent. 

Man from the south

Like the soldier in the story and many others think, the pinky finger does not play a crucial role in ever day activities, but this is incorrect.  If the soldier would have lost the bet and had his pinky finger cut off, he would have lost a lot of his grip strength.  The pinky finger is a huge contributor to the power grip and his ability to open a door with a flat handle would be greatly affected.  Many military doors have this style of handle, so it would be important for him to be able to perform this activity.  One strategy that would be beneficial in the soldier regaining the ability to do this would be simply teaching him to grab the door handle towards the end, where not as much pressure needs to be applied in order to open it. If he grabs the handle closer to the point where it rotates, more force will need to be applied as well as more grip strength will be needed. This simple modification could get him back to being able to perform this activity.

Health Promotion

One big take away I got from listening to professor Flick was the vision change for healthy people from 2020 to 2030.  The focus for the new 2030 vision puts an emphasis on health and well being across the lifespan instead of where people are at a certain point in their life. By putting the focus on health starting at birth, preventative measures can be put in place to improve the quality of life for people.  Screening for things before they happen is another way this can be implemented in this vision statement.

A big key in health promotion is prevention.  Prevention is the absolute best way to improve health among any population.  There are three types of interventions that aim to reduce health risks.  The first is primary which prevents injury or disease before it occurs.  The second is secondary when the injury/disease has already occurred, but it is detected early to keep it from getting worse. The final one is called tertiary which is where you work to improve the quality of life for someone who has a chronic illness or injury.

Blog 3 Shoulder

The scapulohumeral rhythm is the movement of the scapula with the humerus. It is important for these two bones to move together in order for the human body to achieve full range of motion. These structures move in a 2:1 ratio meaning for every two degrees the humerus moves, the scapula moves one degree. The muscles producing this movement help to stabilize the head of the humerus in the glenoid fossa by not allowing it to come out of the "socket". If a person does not have scapulohumeral rhythm, then they will not be able to have full range of motion which would decrease you measurements in the shoulder.  The humerus could hit the acromion from being pulled up too far also not allowing full 180 degrees ROM. Movement of the scapula provides the sliding motion of the humerus to allow this much motion. 

Foundations Podcast

One thing I learned from the assignment was that universal design is an important aspect that we as a society need to seek out.  Universal design helps eliminate any issues that may arise from anyone with a disability. Something as simple as a modification of a door knob design can help millions of people.  When universal design begins to take place, it becomes a downhill affect and it continues to happen with everything being designed.  It is important to think of how every single person can use something when it is being designed.  Every single person has some sort of disability regardless of if it is temporary or permanent.
Another thing I learned from this assignment was about working with different people throughout OT services.  From listening to the podcasts, it seems like every individual client has something unique about them that either helps or hinders their participation in an activity.  As an OT, you have to come up ways to get your client to participate in an activity that they may be scared of or not want to do at all.  Similar to the Au-Some swimmers podcast, they had to sprinkle the water on this child's head to get them use to having water on their head because they did not want to put their head under the water when swimming.  Small steps such as this can lead to success when working with clients in OT.