Health Promotion

As a future occupational therapist, it is important to start looking ahead and learn about how to promote health and address health literacy. Part of AOTA's Vision 2025 is to maximize health and quality of life for all people in everyday living. Health can be seen as the complete state of physical, mental, and social well-being. People feel their best and are happiest when they are healthy. In this context, being healthy does not mean having a six-pack and running 10 miles a day. Being healthy consists of obtaining the physical and mental abilities to perform activities of daily living and able to carry out a role that relates to a person's identity. However, not many people understand the importance of health for well-being. Occupational therapists can promote health by education clients and help clients make adaptations or alterations to maximize health and quality of life.

Along with health promotion, health literacy is a huge crisis in the United States. Many times, clients see their primary care doctor (or any type of doctor) and do not understand their diagnosis. Doctors usually prescribe various medications that have complex names. Sadly, a lot of clients do not know which medications they are taking, and they do not know why they are taking certain medications. As a future health care provider, it is important to make sure clients understand diagnoses and treatment plans. Most people who do not work in the healthcare field do not understand medical terminology. To increase health literacy, health care providers can do simple things with clients like using audio-visual aids, using plain language, highlighting take-home points, and encouraging the clients to "teach back."

This picture is of Occupational Therapy Departmental Chair and current occupational therapy students currently enrolled in a course titled "Serving the Underserved." The course teaches healthcare providers how to serve clients who may not have the situational or monetary means of getting health care. It also teaches healthcare providers how to promote health and increase health literacy in less resourceful environments. 

Scapulohumeral Rhythm

The Scapulohumeral Rhythm is the ratio of movement between the scapula and the humerus. It helps to make sure movement between the scapula and the humerus remain even. For every 3 degrees of shoulder movement, the scapulothoracic joint moves 1 degree, and the glenohumeral joint moves 2 degrees.

The Scapulohumeral Rhythm helps maintain the subacromial space, which helps avoid impingements of the supraspinatus. It also aligns the glenoid fossa with the head of the humerus for proper shoulder function.

Motion during the Scapulohumeral Rhythm is distributed between two joints. This allows joint congruency, which results in decreased shear forces. The Scapulohumeral Rhythm is also important in muscle function. It helps to prevent active insufficiency of the glenoidhumeral muscles by allowing optimal length-tension relationships. Therefore, those muscles are still able to produce force.

When testing range of motion, if the shoulder abducts 180 degrees, the humerus abducts 120 degrees while the scapula upwardly rotates 60 degrees. For the humerus to fully flex or abduct, the humeral head must laterally rotate and the scapula must upwardly rotate and posteriorly tilt. Limited range of motion at the scapulothoracic joint will result in limited motion at the glenohumeral joint and vise versa.  If the scapular muscles are weak, then the range of motion of the humerus may be limited and vise versa.

OT Outside

Occupational therapy takes place in various settings. Usually, the settings are indoors like inside an outpatient clinic, inside a hospital, inside a rehabilitation facility, etc. However, some occupational therapists have started practicing outside.

By doing occupational therapy outdoors, clients get a natural simulation. An indoor clinic is very controlled, and unwanted noise or distractions can usually be eliminated. Nature based therapy provides natural sensory and "natural distractions." For example, rather than having a client play with sand in a contained area, an occupational therapist may choose to take the client to the beach for natural simulation activities. For clients with attention deficit hyperactivity disorders, clients learn to adapt with daily distractions from the environment.

One of the concerns of nature based therapy is safety. Since a natural environment is not as controlled as an indoor environment, safety precautions are higher. However, nature based therapy teaches clients every-day skills that an indoor environment cannot provide. For example, a client is able to learn visual perception skills in order to cross the street when a car is approaching. The client will learn how far away the car is, how fast the car is going, and whether or not there is enough time to cross the street before the car passes.

Even though not all therapists choose nature based therapy, many therapists have had successful outcomes with nature based therapy. In nature based therapy, clients still have goals, and therapists evaluate the clients the same way as indoor therapy. Nature based therapy can be very beneficial for many clients, especially those with sensory processing disorders or attention deficit hyperactivity disorders.

Measurements

Occupational therapists often measure client's range of motion (ROM) and strength in order to assess joint and muscle function. ROM is the amount of motion available at a joint and can either be measured with active range of motion (AROM) or passive rang of motion (PROM). AROM involves the client using his or her own muscle strength, and PROM is achieved with an external force, like a therapist stretching the client. Strength is usually evaluated with a manual muscle test (MMT).

A client's ROM tells the therapist the client's available motion at a joint. ROM at particular joints can affect a client's functionality when engaging in activities of daily living (ADLs). Proper body position and palpating bony landmarks is important to ensure accurate results and provides intrarater and interrater reliability. A client's progress or regression can also be measured when using the same body positions and bony landmarks.

MMT helps determine weak muscles and data collection. "Test position" in MMT is the position in which the muscle is placed in for optimal muscle contraction. "Test position" will give the therapist the best score of a client's muscle strength. In most cases, mid ROM is the optimal position for MMT. Using the same "test position" also helps intrarater and interrater reliability.

Gravity eliminated position eliminates the resistance of gravity when measuring strength. This position is used when a client is too weak to perform against gravity, but allows the therapist to still get a MMT score.

By keeping these concepts in mind, a therapist is able to evaluate a client and create a treatment plan individualized for each client. It also allows consistency when more than one therapist treats the same client.

Running

Every day, I go for a run. Running involves many joint and muscle actions. When broken down to a single leg working, there are three basic phases: initial swing, terminal swing, and stance.

During the initial swing, the foot plantarflexes to push off the ground. The knee swings from extension into flexion. The hip goes into slight extension in order to get the leg behind the torso.  Plantarflexion of the ankle, flexion of the knee, and extension of the hip move in the sagittal plane about the frontal axis. While the knee flexes, the hamstrings act as the agonist to concentrically contract, and the quadriceps act as the antagonist. The osteokinematics of the knee is extension to flexion in an open kinematic chain. In terms of arthrokinematics, the concave tibial plateau rolls and glides posteriorly on the stable convex femur.

In order to get to the terminal swing, the hip must flex in the sagittal plane about the frontal axis. The hip swings from behind the torso to in front of the torso.

Terminal swing begins with the knee flexed in the air and the hip slightly flexed. The knee extends from flexion, and the foot dorsiflexes to plant the foot on the ground. Knee and hip flexion, ankle dorsiflexion, and knee extension act in the sagittal plane about the frontal axis in an open kinematic chain. (The distal foot is lowering to the ground) Once the foot is on the ground, the leg is in the stance phase. The foot then pushes off the ground again to begin the initial swing.

Therapeutic Relationships in the Work-field

A therapeutic relationship is the relationship between an occupational practitioner and the client. Therapeutic relationships involve many characteristics, but empathy is a major component of a successful therapeutic relationship. The occupational practitioner needs to be able to relate to the client and be understanding rather than be dominating and judgemental. An occupational practitioner should truly get to know the patient's life like family, interests, work, etc. A successful therapeutic relationship also involves trust. A client is more likely to be motivated to work with the occupational practitioner when he or she trusts the practitioner. Just like in everyday life, respect and kindness goes a long way in a therapeutic relationship.

Making a Community Whole

Around the mid 1900's, people with intellectual disabilities were basically not seen as a person. Many families institutionalized other family members with disabilities. By institutionalizing people with intellectual disabilities allowed the families to pretend the person did not exist. The institutions took care of the people with intellectual disabilities, and the families had no responsibilities.

On the contrary, the institutions were poorly kept, and the people living there did not have a decent quality of life. The people living there were abused, physically and mentally. They were not getting fed the proper nutrition or receiving the appropriate amount of physical activity. Most people were basically left to die in the institutions without anyone caring for them.

More recently, progress has been made to keep people with intellectual disabilities at home and active in the community. Even though some people have disabilities, they are still human and deserve a good quality of life. Luckily, most institutions have closed down, and more people with intellectual disabilities are living at home with family.

There have been many laws passed to make sure people with intellectual disabilities receive an appropriate education. Many companies are looking past disabilities and hiring people with intellectual disabilities. People of different backgrounds volunteer to help advocate for programs for people with intellectual disabilities. Communities are finally becoming whole, including people with and without intellectual disabilities.

The OTPF

OTPF stands for Occupational Therapy Practice Framework, and it is the foundation/guidelines for occupational therapists while working in different settings, and it highlights an occupational therapist's scope of practice. OTPF helps occupational therapists identify certain aspects of a client, and it helps the therapists progress towards a treatment plan. It focuses on occupation, health, and wellness. Even though each therapist has different educational backgrounds, experiences, and opinions, the OTPF is constant throughout the entire field and contains useful information to put into practice.

Role, Occupation, Activity, and Task

One of my favorite roles is being a "dog mom." Being a dog mom involves many aspects. One of my occupations of being a dog mom is taking care of my dog and making sure all his needs are met. Some of the activities included in caring for him are feeding/watering him, taking him for walks/runs, and playing with him. One of the main tasks associated with being a dog mom is buying his food, so he gets the proper nutrition and has energy to play. Being a dog mom involves many activities and tasks in order to properly take care of him.

Occupations throughout the Decades

Over the decades, occupational therapy has changed in many aspects. It started out with volunteers taking the role of occupational therapists and transitioned into a masters and doctorates program. Many pieces of legislation have been passed that affected the career and required changes/adaptations (both negatively and positively). In the occupational therapy world, there are multiple models like the reductionistic vs. holistic approach and the top-down vs. bottom-down approach that change the treatment style of a client.

However, the term "occupation" has remained constant since the beginning of occupational therapy in 1917, despite all the other changes and variations in the career. Occupation refers to any activity in which a person engages. An occupation has meaning, a goal, and a purpose that links directly to a role. Occupation is anything that occupies one's time, and it can be done alone or with others. Some occupations are required, but some occupations are a choice.

There are multiple treatment methods. For example, in the early decades of the occupational therapy career, many therapists used a reductionistic approach when treating clients. They isolated injuries/disabilities from the whole body and only treated the "problem." Recently, a holistic approach is preferred when treating clients. A holistic approach emphasizes treating the client as a whole and not only treating the specific injury/disability. Rather, the whole body is treated. A top-down treatment method starts with a client's occupations associated with his or her role. It then addresses the barriers the client is having with achieving/participating in those occupations. A bottom-down approach looks at a client's disability first and basically cuts straight to the point of the therapy treatment.

Whichever treatment method an occupation therapist decides to use, the ultimate goal of occupational therapy is to rehab clients back to doing occupations that helps them maintain their role/identity. Even though different methods may be used during the treatment, the ultimate goal of getting back to doing occupations remains constant. Whether the disability/injury is isolated or addressed last in the treatment session, the client will eventually get back to doing occupations. No matter what other changes may come to the therapy world, occupations will always be activities in which a person engages that provides meaning and purpose.

OT as a Lifelong Career

As a child, I always enjoyed serving others, and I thought I wanted to be a school teacher when I grew up. However, as college came closer, I started getting into health and fitness. As a result, I wanted a career that involved serving others while improving one's quality of life.

While deciding on a major in undergraduate school, I talked to many adults in various careers that they did not enjoy. Since "work" would be a majority of my adult life, I wanted a career that I would truly enjoy. The human body, people's health, and fitness interested me, so I wanted to a career that allowed me to work with people by improving body strength and function. I also try to live an active lifestyle, so I wanted my career to reflect that. As a result, I did not want a desk job. I decided I wanted to work in the medical field because it is very hands on and active. It may sound silly, but many medical jobs like doctors and nurses did not appeal to me because I did not like the idea of giving people shots. Therefore, I wanted a career in the medical field but with as minimal blood and needles as possible.

After researching many medical field careers, I came across occupational therapy. Occupational therapy allows me to serve others by working on functional activities to improve one's quality of life and retain one's identity. With this career, I can work in different settings and with different people. There is always something to learn, so I will constantly be gaining knowledge throughout my career. There are many areas to specialize in if I want to indulge in one specific concentration. With occupational therapy, the sky is the limit.