Post Mock Interview

    Overall, I feel like the mock interview went well. The person interviewing me said she thought that I sounded confident and that I was able to give detailed answers without giving too long of answers. The questions asked were similar to ones that I have been asked in the past, so that made me feel a little more at ease. I also enjoyed her asking if I have had coworkers in the past that I did not get along with, and if so, how did I handle it? I thought that was a good way to evaluate my professionalism. 

    To prepare for this interview, I role played questions and answers in my head. It always seems to calm my nerves when I verbally practice my answers, so I would think of a hypothetical question and then answer it out loud. I considered role playing with a friend, but I always seem to get more anxious when I do that. I feel like I do best when I can just talk to myself and rehearse my responses until they are smooth and efficient. 

    For the most part, everything during the interview went as expected. However, at the beginning of the interview, the person interviewing me told me that she has had some internet connection problems today then all a sudden, she froze. She ended up turning her video off and just had her voice playing. It was a little weird talking to a screen with only my face, but it was not the worse thing that could have happened. 

    No matter how much I rehearse, I feel like I always say the word "umm" throughout an interview. I am actively working on being more aware of my words and expressions, so eventually, I would like to go into an interview and not use the word "umm" at all. Also, sometimes my mind starts to wonder mid sentence because I am nervous that I will forget what to say --> ironic because that is what makes me end up losing track of thought. So, I would like to be more confident and relaxed during an interview, so that I will stop being so anxious and avoid my mind wandering off. 

    One thing I learned during this interview is that no matter how much you rehearse, you will still probably be asked a question you did not think of. Therefore, it is important to be able to "think on your feet." I found that when I took a second to breathe and gather my thoughts before answering, I was able to give a more coherent answer. Just like during the interview, unexpected things will happen in the workforce and I will have to think fast for a solution. This interview helped me work on "thinking and acting on the spot." 

Leadership

At the beginning of OT school, we drew ourselves the way we view leadership according to these rules: 

Glyph Key for Drawing A Self-Portrait of a Leader

 

Face Shape: If you believe that leadership is an inborn trait, draw a triangle-shaped head.  If you think that leadership stems from nurture over nature, draw a square-shaped head.

Eyes: If you think the vast majority of OTs are leaders, make big circles for the eyes.  If you think there is a fairly equal mixture of leaders and non-leaders in the field of OT, draw small circles for the eyes.  Fill in the pupils.  Add glasses if you feel that you have had more experience in leadership roles than most other people your age at this point in life.

Eyelashes: Draw one eyelash on each of the eyes for each of the five themes you can name based on your personal Clifton StrengthsFinder assessment from earlier in the curriculum.

Eyebrows: If you like to take the role of the leader in an out-in-front way, make curved eyebrows.  If your leadership style is more behind the scenes, make pointy eyebrows.

Nose: Draw a triangle nose if you think that seeing yourself as a leader is necessary to being a leader.  Draw a rounded nose if you believe that a person can be a leader without seeing himself or herself as a leader.

Skin:  Add a freckle anywhere on the skin of the face if you believe that self-awareness is vital to effective leadership.  Leave the skin clear if you don’t think it’s an essential trait.

Mouth: Draw a smiling mouth if you can think of at least one leader who has had a positive impact on you.  Draw a frown if you can’t think of a good example of a leader.

Ears: Draw round ears if you think technology is an important part of effective leadership in many situations. Draw pointy ears if don’t think so.

Hair: Draw the hair based on a continuum, based on your personal viewpoint in two areas:

What’s more important in leadership:             Curly hair  <------------------------->  Straight hair 

          creativity or organization?                  Creativity  <-------------------------->  Organization

                        AND

Can an introvert be an effective leader?         Short hair <-------------------------> Long hair

                                                                           No way  <------ I’m unsure -----> Definitely yes

Accessories: Add at least one accessory (example: a piece of jewelry) if you see yourself as a leader.  Add a hat if the way you think about or approach leadership has changed as a result of what you have learned since beginning in OT school.

Finishing Touch: Label your paper with your name, writing in cursive if you have a written plan or goal about to serving in leadership roles in the future; write in print if you do not yet have a written plan.

 

Roughly 2 years later, we were asked to draw ourselves again according to the same rules:

After looking back at my first drawing, my perspective on leadership has not changed much. For the face shape, I was torn between the two shapes. I feel like leadership is a mixture of an inborn trait and nurture. I feel like some individuals are born with a more leadership personality compared to other individuals. However, I think that leadership skills can be nurtured and developed overtime. 

I only know a handful of occupational therapists, but all the ones I know show exceptional leadership qualities. Personally, I have not held that many leadership roles, but I think I tend to be more of a "behind the scenes" kind of person, especially when there are other people who want to be a more "out-in-front" leader. This has definitely changed since starting occupational therapy (OT) school. Before OT school,  most of my peers were not trying to get into graduate school, so they did not have the "drive" to work hard in most situations. Therefore, I tended to take the leadership role in many group projects in undergrad. However, since starting OT school, I am surrounded by like-minded peers, so I have learned to step back a little from being "front and center." This has really helped me grow as a future healthcare practitioner by teaching me to adapt to group dynamics. 

As for the nose, skin, mouth, ears, hair, and accessories, I view leadership the same as my previous drawing. Leadership entails various qualities, and I think it can change person to person and group to group. Some people/groups do better with a more dominant leader, and some people/groups do better with a more flexible leader. As a leader, it is very important to be aware of the group dynamics and adapt accordingly to be successful. 

Locus of Control

    In the 1950's, Julian Rotter introduced the term "locus of control," which refers to a person's belief about who or what controls what happens in life. An internal locus of control entails that an individual plays a large part in shaping his/her future. Whereas, a person with an external locus of control believes that his/her happiness depends on external events. 

    As a future occupational therapist, I believe that it is important to have more of an internal locus of control. I believe that hard works pays off, and if you are a hard working, you will reap what you sow. I also believe that there are things out of our control, and we have to accept that, i.e., not getting to go on fieldwork because of a pandemic. However, a person with an internal locus of control understands that even though external events can bring challenges, his/her reaction to the external event can either impede or benefit his/her future. An internal locus of control also contributes to a more positive mindset. People with an external locus of control tend to dwell on the negative instead of thinking of ways to adapt to an unfortunate situation. 

    When treating clients in the future, I believe it is important to nourish an internal locus of control. In many cases, the clients will be discouraged since they are no longer as independent as they once were. We often talk about how important motivation is for a successful recovery. I feel like motivation goes hand-in-hand with an internal locus of control because if an individual believes that he/she has control over his/her rehab outcome, then he/she will be more motivated to work hard in therapy.

Sensory Processing SIM Lab

Today, I had the opportunity to explain sensory processing disorder to an actor who played the role of a parent with a child who showed symptoms of sensory processing disorder. Overall, I think the SIM encounter went decently well. I tried my best to use layman's terms when explaining everything, but sensory processing is a very complicated concept and it can be quite challenging to simply it. When talking about possible interventions, I think I did well explaining the different types of inputs. I tried my best to make the parent feel comfortable and that it is okay that John struggles with certain things. I wanted her to understand the John was not a "problem child," but rather, people process things differently and some people take more sensory input to regulate emotions and behaviors compared to other people.

If I could redo the SIM lab, I would try to get more input from the parent. With there being a time limit, I felt a little rushed to get all the information in. I tried my best to ask her her thoughts and feelings throughout the encounter, but it was difficult making time to talk about everything. I also would explain deep pressure a little more; I did not get the chance to explain that deep pressure is not restraining the child. Rather, it is providing just enough pressure (like a deep hug) to help relax the nervous system. 

Two ways an attitude of caring can be communicated to a client/caregiver by an OT student could be active listening and establishing rapport. With active listening, you make the client/caregiver feel important and like you truly care. There are many instances that professionals "half-way" listen to patients, and that professional may come off as superior to the patient. Often times when that happens, the patients are not completely happy and may even show some resistance. With active listening, the client/caregiver feels likes their needs and wants are being heard, and he/she will probably feel like they have some kind of say in treatment. By having an input, people are usually more receptive and cooperative. Second, establishing rapport can be very important with treatment outcomes. Establishing rapport will make the client/caregiver feel comfortable and be more likely to "open up" about things that may be a sensitive topic that needs to be addressed. Along with active listening, establishing rapport will hopefully lead to better participation and carry-over to other environments. If the client/caregiver trusts you, then he/she will more likely be willing to try things you recommend and practice skills outside of therapy sessions. 

By biggest takeaway from this experience is to incorporate active listening skills and ask about the client/caregiver's concerns. It is important to be receptive as a professional, just like you want your client to be receptive. I feel like many professionals forget that communication involves at least 2 people. Many times, professionals want to give so much advice and recommendations that they forget what the client may need or want. As a future occupational therapist, I want to work on relating to the client/caregiver and providing interventions that will carry over and truly make a difference in someone's life. 

Executive Functioning and ADHD

In the TED talk, "Failing at Normal: An ADHD Success Story," (2018), Jessica McCabe shares her experience of living with ADHD. She begins the TED talk explaining how throughout her early life, she had trouble paying attention and completing tasks. She talks about how people around her would get frustrated with her since they did not understand individuals living with ADHD.

She talks about how she started college but could not make it to class on time. She states that she aced a statistics course, but she forgot to sign up in time for the credit to actually count. She ended up dropping out of college and moving back home with her parents. In the span of 10 years, she was hired and fired from 15 different jobs. She got married, and she got divorced within a year. All of her challenges in life stemmed from the same thing: executive functioning skills. She says she had so much potential and was constantly busy putting in effort into various activities. However, her brain was unable to process the necessary information/tasks to complete the activities.

I chose this TED talk because my sister also has ADHD and struggled majorly in grade school. She spent 3-4 hours each night working on homework and studying, but she still could barely past her tests in school. When she was first diagnosed with ADHD in kindergarten, the doctor said her brain cannot "sort information" and has multiple "activities" going through her brain at once. Since she got diagnosed, she has always been on some sort of medication to "slow down her brain activity." This has helped tremendously, but she still has executive functioning challenges that most people do not experience. In particular, she has a difficult time with critical thinking skills and visual-spatial working memory. One of the most important aspects for success with my sister is positive and encouraging support from family and friends.

McCabe talks about how one of the most difficult challenges is people not understanding the way her brain works. People around her do not understand that her brain is wired differently than people without ADHD, so her processing skills is different. She says people ask her "what is wrong with you?" or similar type questions. My sister also experiences this reaction from people who do not know her. She tries to keep a positive mindset, but sometimes it is hard to be optimistic when people tell you that you are  "stupid" or "do not know anything." As my sister started college, she has exceeded everyone's expectations, mainly because she was motivated AND had the support of family and friends.

McCabe also mentions that people with ADHD are 300 times more likely to open their own business because they do not limit themselves with "what is in the box." Ironically, my sister just got her business license and plans to open her own business after she graduates college in a year and half. She has never enjoyed being in the classroom, so she has worked hard and taken summer classes to finish her bachelors degree a semester early. My sister is not letting her diagnosis limit her goals. She is working past her deficits, even though some tasks/activities are extremely hard and may take more time to complete than normal.

After watching this TED talk, I was reminded how important education is. Many people do not understand neurological disorders, so they may treat people with neurological disorders unfairly. People with neurological disorders may have negative connotations since they are not "acting normal." However, many people with neurological disorders can independently function with some adaptations and/or modifications. As a future occupational therapist, I want to educate people  and "open up their minds" to different ways of thinking and reacting to atypical behaviors.

In the future, it is extremely important to approach everyone and every situation with an open mind. It is important to be client-centered and get to know the person, not the deficit. As a future occupational therapist, I want to help people be happy with who they are while gaining skills for occupational performance.

Reference List
TED. (2018, June). Failing at normal: an ADHD success story. Retrieved fromhttps://seeyourwayclear.com/executive-functioning-a-tedx-talk/

Getting Organized

My Media Project Experience

At the beginning of this media project, I was assigned an empty ketchup bottle to use as my intervention for someone with secondary-progressive multiple sclerosis (MS). At first, I had no idea what to do; I brainstormed many ideas but could not think of anything meaningful. I finally thought of the idea of making a home-made “check off” list to help with fine-motor coordination and executive functioning skills.

I thought coming up with a meaningful intervention with common household items was very useful and significant. Many times, people cannot afford to buy certain equipment to aid in recovery. Just like with my home made “check off” list, a person can use common household items to build interventions to address specific deficits. Luckily, with the internet, it is easy to “google” ideas/interventions and find cheaper resources/activities.

During this project, I learned that simple materials can be made into interventions that address multiple deficits. As stated before, as I was starting this project, I had no idea what to do with an empty ketchup bottle. In the therapy world, it is easy to only think of interventions using expensive, "rehab" equipment like an arm bike or thera-bands. The ketchup bottle seemed trivial and almost impossible to make into a meaningful intervention, especially for someone with MS. However, this project made me “dig deep” and really use my creative thinking skills. I am especially thankful for this project because it is the first time during occupational therapy school that required me to use my creativity skills to create an intervention that would prove meaningful to a client.

This project has helped me learn to stay open-minded. As a future occupational therapist, there will be many times when I will have to adapt and modify treatment according to the materials/equipment available. This project has taught me that even the most random objects can be turned into something very useful with a little open-mindedness and creativity.

In the future, hopefully I will be able to use other common household items to create meaningful interventions. It saddens me to see people not progress simply because of limited financial resources. This assignment helped me “open my creativity channel,” so hopefully I can carry that with me throughout my career. I am particularly interested in serving people with limited resources, so this was the perfect project to get my mind thinking. I am excited to start fieldwork to see how we can use random objects as interventions, just like this assignment required.

 

 

Living with Myasthenia Gravis

In Ted Talk "One day in the life of Pallavi Rao" (2018), Pallavi Rao explains how she lived with myasthenia gravis (MG). Currently, her biggest challenges are fatigue and slurred speech. She says she occasionally experiences diplopia, and she says some days are better than other days.

In her Ted Talk, Rao talks about 3 of the 4 Ps of Energy Conservation: Planning, Pacing, Prioritizing, and Positioning. She understands that her body only has a certain amount of energy, and she must decide how to use her energy most effectively. She uses the visual of having two circles. One circle represents "what you have control over," and the other circle represents "what matters the most to you." It is important to focus on the area where the two circles meet: "what you have control over and what means the most to you" in order to live as independent as possible. It is also important to find things in life that make things easier, in particular utilizing the 4 Ps.

Rio says she plans out her day. The day she gives the Ted Talk, she is not planning any events before or after the Ted Talk. She understands that the Ted Talk will take a lot of energy out of her, especially talking for 12 minutes. Her "talking muscles" will be weary by the end of it, so she does not want to overload herself with other activities. For prioritizing, she understands that it is important to identify what is most important and to save enough energy to complete those tasks. Rio says that her husband or son carries her handbag when they are shopping. Her handbag can be very heavy, so she lets someone else carry it so she can engage in other activities that are more important to her. She understands not to waste her energy on things that she does not have to. Rio tells the audience that it is very important to never wake up someone with MG. A person diagnosed with MG will wake up whenever he/she feels refreshed and ready to start exerting energy.

I chose this Ted Talk because despite her obstacles, Rio has learned to say "thank you." She thanks MG for helping her manage expectations and live life according to her expectations and not other people's expectations. She has also learned how to respect and love her body. She listens to her body and does not "overload" it with unrealistic expectations. I really value Rio's encouraging spirit, and as a future Occupational Therapist, I want to help my clients live with a positive mindset despite any deficits. With today's advancement in technology, it is easy to still live a "normal" life with some modifications or assistive technology. I want to help my future clients embrace their deficits and not be embarrassed or intimidated by them.

After listening to this Ted Talk, I was reminded how important energy conservation is for certain people. I also realized how important it is to educate people using the 4 Ps of energy conservation. Luckily, Rio understands the importance of energy conservation, and she knows how to apply that knowledge to her everyday lifestyle. Unfortunately, not everyone diagnosed with MG or similar diagnoses know the importance of the 4 Ps or how to apply them. Therefore, as a future occupational therapists, I can teach people how to conserve energy to improve their quality of life.

It would be interesting to interview people with similar diagnoses and see if they know how to conserve energy effectively. It would also be interesting to know how their daily routine looks and see if there are any modifications that can be made to make life easier.

Reference List
TED. (2018, July). One day in the life of Pallavi Rao/ myasthenia gravis. Retrieved from https://www.youtube.com/watch?v=ybhLzwBajUw

Asher, Defying the Odds

Asher Taylor is an 18-month old full of joy and inspiration. When Asher's mom Christie was 19 weeks pregnant with him, she found out that Asher had spina bifida myelomeningocele. Spina bifida meylomeningocele is a neural defect where the spinal cord does not close completely, and the spinal cord and meninges protrude from the back. Unfortunately, Christie was not able to have fetal surgery to correct Asher's spinal cord, so he had surgery to close the lesion within 48 hours after he was born.

Asher was born with hind brain and mid brain defects. At birth, he also experienced severe hydrocephalus, and his cerebellum was descended into his spinal canal. As a result, after ~4 weeks of Asher being born, he had a shunt placed to relieve pressure on his brain. About a week later, Asher began choking and aspirating. About 10 days post-shunt, all the pressure went to Asher's head, and Asher struggled to breathe. He became unresponsive, and the doctors thought it was respiratory syncytial virus, which severely affected Asher since he was immunocompromised from his birth defect. The doctors scoped Asher and found out that his vocal cords were not moving correctly and that Asher had sensory deficits. As a result, Asher underwent a tracheostomy, which inserted a tracheostomy tube to Asher's trachea to help his respiration. He also had a gastrostomy tube (G-tube) placed in his belly to get nutrients to his stomach.

However, Asher still did not improve. As a result, Asher underwent Chiari II decompression surgery. The doctors removed part of the back of his skull and his first three cervical vertebrae to provide space for his abnormally positioned brainstem.

Asher is currently diagnosed with symptomatic chiari malformation, which means that his cerebellum is still in his spinal canal. He also has two large syringes, which are large fluid sacs, on his spine. He is at risk for a spinal shunt and VP shunt, which takes excess fluid from the brain to the abdomen where it is absorbed by the body. He could potentially have more decompression surgeries in the future, but he is currently medically stable and participates in physical therapy and occupational therapy weekly.

Asher's lesion occurred around T4/T5/S1, so he experiences sensory deficits on his thigh and buttocks. As a result, Asher will probably not be able to independently walk. Asher will never have complete control of his bowel and bladder, so he is catheterized every four hours. Asher will more than likely have a tracheostomy tube throughout his lifespan to aid in breathing and swallowing. When Asher goes to sleep, his autonomic systems stops working, and he experiences central apnea (he stops breathing when he sleeps). Therefore, he his on a ventilator when he sleeps.

Despite his deficits, Asher is defying all odds. He is cognitively intact and engages with his environment. He understands the concept of being spoken to and understands the "cause-and-effect" relationship. He is a very social little boy, so when he wants his parents' attention, he knows that pulling his G-tube out will get the job done.

Asher's problem-solving skills are progressing. Unfortunately, he still experiences low tone, especially in the abdomen. However, recently, he flipped on his back from the sitting position, and he figured out how to sit back up by leaning to the side and using his hands to walk himself back up to the sitting position.. When Asher is in the car, he has a little mobile with toys hanging down. He is unable to reach the toys with his arms, so he takes his circuit off and waves it like a wand to play with the toys.

Asher loves interacting with his big brothers and parents. He recognizes people and his nurses. He is not shy and loves to socialize with people. The family recently adopted a new dog, and Asher loves playing with the dog.

The family hopes Asher will be able to eventually walk with an upper extremity walker and/or AFO braces. Sadly, insurance will not pay for a wheelchair until Asher is 4 years old. However, there is a family in New York who also has a child with spina bifida. They make adaptable wheelchairs for babies with spina bifida and give it to those children for free. Asher has been lucky enough to receive one of those specialized wheelchairs.

The wheelchair has support for Asher's trunk, and it allows Asher to ambulate around the house. There is a bucket behind the chair and another tray attached to the back to carry all of Asher's equipment. With this awesome device, Asher can play with his brothers and parents and explore his environment as much as he wants.

Asher is the epitome of inspiration. At just 18 months, he is defying all the odds of his health deficits and still learning to live a full, active life. Despite all his challenges, Asher is such a joyful little boy who makes everyone smile. He lights up the room wherever he goes and is always the life of the party. He encourages me daily to face any obstacles thrown my way.

Support of the Community

ChurchHealth is a nonprofit organization that provides healthcare to people who do not have healthcare. The director of ChurchHealth's physical therapy department has started a stroke support group every 1st and 3rd Wednesday of the month. Each session lasts an hour and covers a topic that people who have had a stroke may experience, like challenges in nutrition, spirituality, and adapting to life post stroke.

During my first session with the Stroke Support Group, the group talked about challenges they face. Many of them are Christians, and when the stroke first happened, they were mad at God and questioned his plan for their lives. While going through rehab and relearning basic skills, they started to appreciate the little things in life. Many of them said they grew spiritually and started thanking God for things they used to take for granted, like walking and being able to dress themselves. Luckily, most of them have a supportive family and/or had access to a caregiver to help with ADLs. Through ChurchHealth, they learned the importance of exercise and healthy eating. They learned of other resources in the community like the Kroc Center, where they can swim and avoid a lot of impact on their joints. Many of the individuals have said that their stroke was a blessing in disguise.

I really enjoyed this session because I got to listen to everyone's recovery experience. Even though everyone's journey was different, they were all high-spirited and open minded to advice from each other. In the occupational therapy world, having a negative mindset can be very detrimental in the recovery process. Motivation plays a huge role in the time frame for  recovering. Before attending these sessions, I thought many of the people would be "grumpy" and still angry from life challenges. However, everyone was so encouraging to each other, sharing his or her own recovery process and what was beneficial. Almost all of them now exercise regularly and eat healthier than pre-stroke. Some of them still experience deficits like unilateral weakness or balance difficulties, but all of them are very proactive in living a happy life.

During the most recent Stroke Support Group session, we cooked a healthy meal in the ChurchHealth kitchen. The ChurchHealth kitchen staff printed chicken stir fry recipe and provided all the necessary ingredients. All the people in the group were excited to learn a new healthy meal. The ChurchHealth staff gave tips on how to cut certain vegetables and what knives to use. The director of the group let me to suggest any modifications to people struggling with certain actions, like grasping or lifting objects.

I really enjoyed this session because it "put my brain to work." I had the opportunity to observe people with a neurological deficit and offer my expertise. I thought back to biomechanics and neurobiology in order to understand the deficit and apply the appropriate intervention.

During the sessions, I take the time to individually talk to people and learn about his or her experience. Since no two cases are the same, it is interesting to hear how everyone is affected and how he or she overcame obstacles. By talking to everyone separately, I got a better understanding of the effects a stroke has on a person and his or her entire world.

I would definitely recommend volunteering at a support group in areas of interested topics. I am interested in neurological disorders and would potentially like to work in that field one day. This opportunity has helped me apply what I have learned in the classroom to real life experiences. 

Occupational Therapy and Mobility

In the occupational therapy world, each client has a different level of mobility based on individual injury/diagnosis. As clients get more stable and stronger, they slowly climb the hierarchy of mobility skills until they meet their individualized goals. The hierarchy of mobility skills from least mobility to greatest mobility is as follows:

          1. Bed Mobility

          2. Mat Transfer

          3. Wheelchair Transfer

          4. Bed Transfer

          5. Functional Ambulation for Activities of Daily Living (ADL)

          6. Toilet and Tub Transfer

          7. Car Transfer

          8. Functional Ambulation for Community Mobility

          9. Community Mobility and Driving

After studying the hierarchy of mobility skills, I think it makes sense because the lowest level requires the least amount of participation from the client, and the highest level indicates independence. The hierarchy of mobility skills is set up this way in order to progress to more independence by building upon each level. Bed mobility consists of moving in the bed, but not transferring to other surfaces. A bed transfer is harder than a wheelchair transfer because a bed mattress is not as sturdy as a wheelchair. Also, a wheelchair has chair arms that are easier to push off of compared to pushing off a bed mattress. Once a client shows the stability and strength to perform a certain level of mobility, the client can then start working on the next level of mobility.

From my experience, I have seen this system used, and I think it is a successful system. Rather than overloading the client, this hierarchy of mobility helps clients slowly progress without getting furthered injured and without feeling intimidated or getting discouraged. While observing occupational therapists, there were a couple of times when a client was not able to perform a mat or wheelchair transfer. So, the occupational therapists would work on bed mobility to get the client moving and using muscles. Eventually, the clients were strong enough to stand and transfer to a wheelchair. 

By slowly progressing to more and more mobility, it helps the clients not be as scared and develop a trusting relationship with their therapists. For example, if a client is extremely weak after having pneumonia for several weeks, he/she is going to be really hesitant to perform a toilet and tub transfer on the first day of therapy. However, if the therapist starts with bed mobility and works up the ladder showing the client that he/she is capable of performing those skills without injury, then the client will likely be more willing to trust the therapist and hopefully be more willing to participate in therapy treatment. 

Occupational Therapy and Assistive Devices

Assistive devices help clients with decreased balance, strength, and stability. Properly fitting assistive devices to each client is important for proper body mechanics and for safety and stability. Proper body mechanics is important so the client does not further enjoy himself/herself. For example, if a client is using a walker, the handles should be fitted properly so that the client does not hutch over or walk with elevated shoulders. Improper body mechanics can cause compensation and pain in areas that was not originally present. Assistive devices provide safety and security when fitted properly. If they are not fitted properly, the client may become less stable, weight bear when not allowed, or injure other body parts that was not originally present. For example, if a client is using axillary crutches and the handles are too high, the armpit area, which includes the brachial plexus, may become compressed. The brachial plexus contains many vital nerves, so if those nerves become compressed, new problems may arise.

When fitting clients for assistive devices, it is important to take into account the client's physical condition, age, endurance, and psychological condition. Physical conditions include the diagnosis, weight bearing status, strength, range of motion, and balance/coordination. Psychological conditions include individual degree of confidence, degree of fear/apprehension, and cognitive status.

One of the most stable assistive devices is the walker. A rolling walker, or front wheeled walker, allows for a somewhat normal gait pattern, but takes a decent amount of balance and stability. Unlike a standard walker, the client does not need to continually pick up the walker, but he/she must be stable enough to control the walker. To fit a client to a front wheeled walker, the handgrips should be in line with the wrist crease, ulnar styloid process, or the greater trochanter when the hands are resting at the side. The client's elbows should be slightly flexed 20-30 degrees. Shoulders should be relaxed and not elevated.

A platform walker can be used with clients who cannot bear weight through their wrists or hands. It can also be beneficial for clients who have a weak trunk and cannot support themselves with a front wheeled walker. To fit a platform walker, the platform surface surface should be positioned to allow weightbearing through the forearm when the elbow is flexed 90 degrees. The patient should stand tall with the scapula relaxed. The proximal ulna should be 1-2 inches off the platform surface to avoid nerve compression.

Crutches are less stable than walkers, but allows for increased variability of gait patterns and speed. Crutches require relatively good trunk and arm strength. The axillary crutch length should be approximately the same length as the distance from the patient's forearm to the finger tips of the opposite hand when the arms are open wide. To fit axillary crutches, the arm pad should be ~5 cm below the floor of the axilla with the shoulders relaxed. The hand grips should be in line with the wrist crease, ulnar styloid process, or the greater trochanter when the hands are resting at the side. Elbow should be flexed 20-30 degrees.

Lofstrand crutches have an arm cuff that wraps around the proximal arm. They allow more dynamic movement and control in small spaces. They allow the client to use their hands without dropping the crutch. Lofstrand crutches are more appropriate for long-term use since they reduce strain on the arms. However, they require more stability than axillary crutches. To fit lofstrand crutches, the arm band should be positioned 2/3 of the way up the forearm.

Canes are the least stable assistive devices. They allow the most environment freedom. Canes widen the base of support for increased balance when compared to not using any assistive devices. However, canes cannot resist weight bearing like walkers and crutches. To fit a cane, the handle should be in line with the wrist crease, ulnar styloid process, or the greater trochanter when the hands are relaxed. When holding the cane, the elbow should be flexed 20-30 degrees. Canes should be placed in the opposite hand of the injury. For example, if the client had a right total knee arthroplasty, the client should hold the cane in the left hand.

The Importance of Proper Body Mechanics

Body mechanics refers to the way the body, spine, and extremities moves during activities of daily living ADLs. Teaching proper body mechanics is crucial to avoid muscle weakness, prevent injury, decrease back pain, and maximize efficiency. Poor body mechanics can cause muscles to shorten or overstretch overtime, which can cause muscle weakness. If muscles become weak, ADLs can become difficult since the necessary muscle strength is no longer there. Improper body mechanics while performing certain tasks may also lead to muscles being torn or strain. It can lead to joints, ligaments, and tendons being overused, which can cause injuries. When performing certain tasks, like lifting heavy objects, it is important to maintain proper body mechanics in order to avoid applying excess stress to certain body parts, like the lower back. Continually putting high loads of stress on the back could eventually result in chronic low back pain and lead to back disorders. Teaching proper body mechanics can also help prevent chronic malalignments of the spine from prolonged improper postures. Exaggerated spinal curves can cause muscles to overstretch, connective tissues on the convex side to weaken, and structures on the concave side to tighten. For example, when sitting at a computer desk for extended period of times, an individual may develop a forward head posture. A forward head posture lengthens the neck flexors, shortens the neck extensors, and stresses the hyoid bone. The hyoid bone is important for swallowing, so the individual will have difficulty eating and drinking. With malalignment, the body does not function optimally. For example, excess thoracic kyphosis causes the rib cage to collapse, which decreases breathing efficiency. Overtime, improper alignment can also cause "flatback." "Flatback" posture requires about 30% more energy to maintain compared to a neutral posture, which could cause more complications for individuals who already have respiratory restrictions.

If treating a client who has to lift objects often, it is important for him/her to know how to correctly lift object. Many people tend to use their backs to lift objects, which will more than likely cause low back pain. Lifting should be completed with the legs, not the back. Leg strengthening exercises may be important if a client lacks leg strength in order to properly lift. Another important body mechanics intervention is proper posture. In order to maintain proper posture, core muscles and trunk extensors need to be activated. If a client is unable to maintain proper posture, strengthening the core and back extensors could be beneficial. A tight chest could also cause improper posture by producing excessive thoracic kyphosis. Stretching the pectoralis major and strengthening the rhomboids (to keep the chest lifted) could help maintain proper posture.

The Importance of the Pinky Finger

In the story "Man from the South" by Roald Dahl, a young soldier bets his pinky finger for another man's expensive car. If the young soldier loses the bet, the other man chops off his pinky finger. While the pinky finger may not seem as important as the thumb or index finger, the pinky finger plays a huge role in power grips. According to Laurie Rogers, a hand therapist at the National Rehabilitation Hospital in Washington, losing the pinky finger will result in up to 50% decline in hand strength. The pinky finger works with the ring finger to provide hand power and to engage in activities of daily living like holding a bottle of water or picking up a bag from the handle.

In this scenario, if the young soldier loses his pinky finger, how would have a difficult time holding his gun properly, since holding a gun requires a power grip. If he is unable to hold his gun properly, he would not have an accurate shot, and his job may not let him serve active duty. By not having an accurate shot, the soldier puts himself and his fellow soldiers in danger. If the soldier is unable to serve active duty like he want to, the soldier may start to experience mental problems like depression.

In order to adapt to the situation, the soldier could work on strengthening his other digits to compensate for the loss of his fifth finger. He could also find alternative ways to hold the gun. If the soldier is completely unable to adjust to the disability, he could try finding another position in the army that does not require holding a gun.


Sources include:https://www.youtube.com/watch?v=trbzaTTzqHc