Mobility

The hierarchy of mobility skills 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 lastly community mobility and driving. This order is somewhat what I expected it to be because you always have to start with the simplest step first. If someone tries to go to the restroom but can't successfully transfer into their wheelchair, there is no way this would work. The least important occupation in the list is driving, so that is why it is listed last. I think this sequence is beneficial because if a person is not able to do bed mobility tasks, then there is no way they would be able to do anything else. The first step to independence is bed mobility. 
Although I observed in a rehab hospital, I never got to witness transfers of any kind. I would have to stay in the therapy room while the OT went to get the client. I wish I could have gotten to see more of the bed mobility skills and transfers. 
I definitely agree with this approach. It is always better to start with something simple and work your way up. You do not want your client to get discouraged because he/she can't complete a task. I think you should always make the task achievable and then increase in difficulty each session. The simulation labs definitely helped me grasp the concept of transfers since I had never seen them done before. I think it is way easier to learn by doing rather than just watching. 

Assistive Devices

The correct fitting of an assistive device is crucial when working with clients. There are many reasons why a client would need an assistive device but the 2 main reasons are decreased balance, strength, and ability and to increase safety and security. For a client with decreased strength, a correct fitting assistive device would be crucial in helping them gain their independence back. Instead of using a wheelchair, the client could use a walker, crutches, or even a cane. All of these options are easier and less bulky than a wheelchair. If the devices are not fitted to your client properly, this could cause them danger, and even result in an injury. Also, if you do not properly fit the devices to your client, they will be difficult and awkward to use. If a walker or a cane is not fitted directly to a client, they will not get the full benefit from them, and in return, decrease mobility and confidence with the devices.
To fit your client for a cane or a walker, the hand grips should be at the level of the ulnar styloid, wrist crease, or the greater trochanter, The elbows should be relaxed and flexed 20-30 degrees to get the right measurements. A platform walker would be used for a client who has a fracture or something wrong with their arm but also need support while walking. A rolling walker would be used for clients who fatigue easily, but have good balance. To fit your client for crutches, the hand grips should be at the level of the ulnar styloid, wrist crease, or greater trochanter, and the axillary rest should be approximately 5 cm below the floor of the axilla to prevent putting pressure on the brachial plexus. When your client is using Lofstrand crutches. you fit them the same way, but make sure the hand rests are facing forward when the client is moving to prevent an awkward angle of their arms.

Posture and Body Mechanics

It is very important to be aware of your posture and body mechanics throughout your day. There are many things that could go wrong for a person who does not have proper posture or body mechanics. Proper posture will reduce the risk or injury or progressive deformity, because having your body in the proper alignment allows everything to work as it should. Having correct posture allows muscles and all of your organs to function properly and optimally. Also, incorrect posture can cause nerve compression in the spine, which would later cause even more problems. Correct body mechanics is a huge part in preventing back injury. 80% of adults will have back pain sometime in their life. If they were taught correct body mechanics at a younger age, that number could be reduced. There are many ways to prevent back pain dealing with body mechanics. One of the most important ways is to never twist your trunk while lifting objects. This puts strain on your thoracic and lumbar vertebra causing back pain. 
While working with a client with poor body mechanics, I would instruct the client, family, or caregivers the correct way to lift and carry a load. If the client is independent, I would educate them on how to do all of their ADLs with little to no strain on their body. If the client is dependent, I would educate the caregiver on the correct body mechanics and posture needed to successfully perform a transfer without injury to themselves or the client. Another thing I would work with the client and caregivers on would be that pushing a heavy object is always more effective and more safe. Pushing and object causes way less strain and stress on the back than pulling an object does. With making just this one little change, it could make a huge difference in the health of the client or caregiver. 

Man of the South

Although many people think of the pinky fingers as useless, they are much needed for grip strength. I can think of 2 activities of daily living that would greatly be affected with the loss of one pinky, and even more affected with the loss of 3 fingers. The first one would be dressing yourself. Although the soldier would have a hard time dressing himself with only 4 fingers, I can only imagine the trouble that the man’s wife would have. There will always be buttons, zippers, and many other objects to manipulate when you are trying to dress yourself.

The main activity that I will focus on is brushing your teeth. I can’t imagine trying to brush my teeth with only my thumb and my index finger. One modification that could be made would be to use an electric toothbrush to really be able to focus on your grip on the toothbrush rather than the actual brushing motion. Another modification that could be added to the wife’s toothbrush would be the use of Velcro. Since she does only have 2 fingers, I think the easiest way to modify her toothbrush would be to have a custom glove made for her with Velcro on the palmar side. Also, have Velcro attached to the toothbrush so whenever she grabs the toothbrush with the glove, it automatically sticks. This would be a good way for her to gain her independence after the traumatic experience of loosing her fingers.

Knowledge Check Public Health

One of the things that I learned from Professor Flick's lecture was that there are 3 types of negative outcomes to occupations. The first one is Occupational deprivation which is the lack of access to engagement in an array of self-selected occupations with meaning to the individual, family, or community. For example, a child living in a neighborhood with gang violence so the family is afraid for them to interact with the children in that neighborhood. The second one is  Occupational apartheid which is different individuals, groups, communities can be deprived of meaningful and purposeful activity through segregation due to social, political, economical factors and for social status reasons. An example if this is segregation and slavery. The third one is Occupational alienation which is experiencing devoid of meaning or purpose, a sense of isolation, and powerlessness, frustration, loss of control, or estrangement from society of self that results from engagement in occupations that do not satisfy inner needs related to meaning or purpose. An example of this is a person or persons who are struggling with addiction. 

Another thing I learned are the 3 different types of interventions. The type of intervention that OTs use mostly is the tertiary intervention. tertiary intervention limits the impact of an ongoing illness, injury, or disability that has lasting effects and helps improve the quality of life. 

Reflection 3 - Scapulohumeral Rhythm

The scapulohumeral rhythm is the ratio of movement between the scapula and the humerus. It is a kinematic interaction between the scapula and the humerus. This states that for full 180 degrees of motion, the scapulothoracic joint produces 60 degrees of movement, while the humerus produces 120 degrees of motion. Scapulohumeral rhythm is important because it allows muscles to be in an optimal length-tension relationship. It helps maintain subacromial space. Another reason that scapulohumeral rhythm is important is because it helps prevent active insufficiency of the glenohumeral joint. In terms of range of motion, the humeral head must always rotate laterally. For the body to have scapulohumeral rhythm, motion must be distributed between 2 joints. With scapulohumeral rhythm, joint congruency results in decreased shear forces. 

Foundations Knowledge Check

While listening to the podcast "Can OT Help with ADHD" I learned that it actually can. I knew that OT helped many disabilities, but I never knew that ADHD was one of them. Something called the sensory diet, or sensory schedule, is a common term used between pediatric OTs. This means that children with ADHD or any sensory problem need to have a 2-3 minute break every 1 1/2-2 hours. This break helps the child get back into a learning and participation mode. This technique is used not only to help the child become more focused, but it changes the thought of them being a bad kid or from the child hating school. I worked in a Pre-K class before I came to OT school, and I wish I would have known about this technique sooner. There were 2-3 children that really would have benefitted from this technique. ADHD can be improved with just changing the environment and routines. If the OT team, child, and parents all work together, problems can be minimized before they get too out of hand.

Another thing I learned is that assistive technology can improve the balance of time between and individual and the environment. There are 3 different levels of assistive technology: low tech, medium tech, and high tech. Low tech is the easiest to be set up and used. The person using the technology can figure out how to use it without any prior training. Medium tech calls for additional training or set up time. Medium tech assistive technology might need batteries or have an on/off switch. High tech is the most complicated and be challenging to program and maintain.