Neuro Note #2 ALS

For this neuro note, I decided to look into a blog about someone who has been fighting ALS since they were diagnosed in 2015, at the age of 28. Her blog is titled "How I Live Now: Life with ALS" and she has been willing to be open and transparent about her journey living with a progressive disease. It took her almost a year until she started a blog in late May of 2016. She talks about the struggles having ALS (Amyotrophic Lateral Sclerosis aka Lou Gehrig's disease), like not being able to teach, the symptoms that occur, relying on others to help take care of her, not having the same chances to travel and not being able to start a family. However, she also mentions how this disease has changed her outlook on life and is grateful and humble for what she has and having the opportunity to share such a story that is unique and special to her. Being able to read about a personal story of someone with this neurological disease was so eye-opening and allowed me to encounter such an inspiring story. From reading her blogs, she discusses her symptoms and the challenges she has dealt with, but she always seems to stay positive and have the best outlook and mindset on life. She definitely has her days when it is hard, but she also finds joy knowing she has a great support system, especially her husband, Evan and her medical team. I learned that ALS affects upper and lower motor neurons, which Rachel mentioned she has the disease that affected the upper motor neurons, so her prognosis is better than those who have the lower motor neuron type. Also, she is having to use a catheter to help with bowel and bladder function, she has lost her ability to speak, as well as move her limbs, she gets fatigue easily, and has spasms. She also talks about the different surgeries, treatments, adaptive equipment, and medications she is on and has been through and using. Her lungs are starting to dysfunction, and she may only have up to 3 years to live, but she still presses on and lives life to the fullest and most potential that she can. I am glad I chose to do this specific type of note for this assignment because it gave me an insight on how ALS can affect someone, but even more how reading and learning about someone's experience with a disease like this helps advocate and raise awareness about it. In addition, her letting us get a glimpse into her life, allows us to be in her shoes and have empathy for her, as well as support her. I would highly recommend reading her blog and experience what I did!

Below is a link to access Rachel's blog:
https://howilivewithals.com/

Doboga, Rachel. “How I Live Now: Life with ALS.” How I Live with ALS, 21 May 2016, howilivewithals.com.

Neuro Note #1: OT Interventions used in Multiple Sclerosis

For this neuro note, I decided to read and review a systematic review about occupational therapy interventions used for multiple sclerosis. This article particularly looked at activity and participation as the intervention that was given by a multidisciplinary team. Multiple Sclerosis affects the central nervous system and impairs people's abilities to functionally engage in occupations. The three main categories or types of interventions given were rehabilitation programs, including inpatient and outpatient, fatigue management programs, which were either long-distance or face-to-face, and health promotion programs, that really align with occupational therapy philosophy. Having the multidisciplinary effort, it was beneficial in improving functional status, motor function, and self-perceived quality of life. Occupational therapists being a part of this team, they were able to help with ADL functioning, as well as stress and fatigue management. Being able to see the different aspects brought to the table with the multidisciplinary approach was beneficial for my learning, because it really is a team effort to help someone get back to their meaningful and purposeful everyday life. I chose this article and this neurological condition because we have not yet fully discussed MS in class, so I wanted to dive deeper into it. Also throughout my experience doing observations and an internship, I was not able to see a lot of cases of multiple sclerosis, so being able to learn in detail about what occupational therapists do for this condition was helpful. Occupational therapists play such a vital role in helping people recover and to be able to research and find articles like this are so beneficial to know on how to become a client-centered, evidence-based practitioner.

Below you will find the link to the article for access.

https://www.researchgate.net/profile/Virgil_Mathiowetz/publication/259461986_Systematic_Review_of_Occupational_Therapy_Related_Interventions_for_People_With_Multiple_Sclerosis_Part_1_Activity_and_Participation/links/55ff2a8508aeba1d9f840470/Systematic-Review-of-Occupational-Therapy-Related-Interventions-for-People-With-Multiple-Sclerosis-Part-1-Activity-and-Participation.pdf

Yu, C., & Mathiowetz, V. (2014, January 01). Systematic Review of Occupational Therapy–Related Interventions for People With Multiple Sclerosis: Part 1. Activity and Participation. Retrieved July 16, 2019, from https://ajot.aota.org/article.aspx?articleid=1863111

Hierarchy of Mobility Skills

In order to increase someone's confidence when it comes to mobility, it is important that the client is educated on the steps it takes to carry out the action, as well as it pertaining to the client's goals, needs, values and that it is relevant. In addition, we want the client to be able to move and function in a safe and correct way, so risks can be minimized. For the body to be mobile, there are some ways to make it easier, which includes making sure the center of gravity is moving, the line of gravity is near the outer edge of the base of support, outside joint motion is controlled, and the base of support is small. As for the order of the hierarchy of mobility skills the first mobility that is done is bed mobility, then mat transfer to wheelchair transfer, bed transfer, functional ambulation for ADL, toilet and tub transfer, car transfer, functional ambulation for community mobility, and last community mobility and driving. It makes sense that it is done in this sequence so it is expected, and I believe it is in this order because the level of cognition needed starts out less complex and easier to understand. As you go up the pyramid, there are more steps and movements to follow and carry out to remember. Also, the base of support is wider and more stable starting with bed mobility, but as you go up the BoS gets smaller, which makes it more difficult. I have observed in the past that it is done in this order, but not with every client depending on their level of independency (level of assistance) along with comprehension and functional body control. I think it depends on the status of the client and what they can do that determines which mobility skill needs to be worked on or started off with. I do agree with this approach because there is not only room for improvement and progress, but it is also putting the client in a safe environment and builds their self-efficacy. 

If the Assistive Device Fits

When fitting a client for assistive devices, it is important that the equipment allows the client to have the most stability and functionality needed depending on their physical condition (ROM, balance/coordination, strength, etc) to be able to carry out ADL's as independent as possible in the safest manner. For example, if a client does not have very much strength in their upper extremities, then a standard walker would not be the best option, because there is lifting needed to be done to maneuver the walker. However, in this case the best option would be a rolling walker because there are wheels and the arms do not have to lift the device. Something else to consider when fitting assistive devices, is the cognitive status of the client. If the client does not understand how to use the device, then this will be difficult for the client to use the device confidently and without problems. Also, if the client does not comprehend how to use the device, like locking the brakes when needed or keeping the device close to the body when in motion, then there can be an increased risk of a fall or something happening that is not in the best interest of the client.

As for actually fitting these devices, for a cane and walker, the hand grip should be placed at the bony landmarks of the ulnar styloid, wrist crease, and greater trochanter. In addition, the elbow should be relaxed and flexed 20-30 degrees, as well as the shoulders not elevated, but relaxed. Furthermore, for a cane, depending on the physical and psychological status of the patient, this will determine if a wide based quad cane or a narrow based quad cane will need to be used. As for a rolling walker, a client with impaired balance or upper extremity weakness, this would be best suited for them. For a platform walker, these are used if the person cannot weight bear through the wrist and hand. The platform needs to support the forearm and that it is in neutral. Fitting for crutches, the bony landmarks are the same as the walker and cane. In addition, the armpit region rest should be about 5 centimeters below the floor of the armpit (axilla) with the shoulders relaxed. In more detail, for Lofstrand crutches the cuffs are wrapped around the proximal arm and are for people with long term disabilities and who are not as stable for use of axillary crutches. Axillary crutches are situated in the client's axillary region and less stable than other types of crutches.

As you can see, it is important that these devices are appropriately fitted to the client and that it meets the needs of the client, so if the assistive device fits, there is likely a higher chance of there being a happily ever after!

Proper Posture and Body Mechanics

Having the proper posture and body mechanics can help prevent and protect the body from resulting in pain and injury. Also, it can help to efficiently and effectively carry out functional tasks in daily activities without having problems. Some things to take into consideration with having good posture and body mechanics is having a good base of support which contributes to stability and balance and allows the body to stay in equilibrium. In addition, if a client has poor posture it can cause tightening and loosening in muscles and cause the spine to become kyphotic or lordotic. Educating a client who has faulty posture and body mechanics can help with restoring or help with injury or pain from reoccurring or happening in the first place. Simply by letting them know the correct way to sit, stand, bend/lift, reach, turning, pushing/pulling and even modifications that could be done.

An intervention example I would use for my client in order for them to have the right body mechanics and posture, is to work on trunk and core exercises to strengthen these areas. Having a strong and stable trunk and core can take a lot of stress and load off the body. Another intervention I would teach is to make sure when the client is performing tasks, especially when repeating a motion, that they are not overworking or fatigued when doing an activity, as this increases the risk of pain and injury. Furthermore, this would include taking rest breaks when needed and not doing an activity that is strenuous to the body.

"Man from the South"

If the soldier were to lose the bet, an occupation that could be impacted is his ability to get dressed and put his uniform and shoes on everyday for duty. This occupation would be greatly affected because the pinky deals a lot with grip, function, power, and opposability, so upper and lower body dressing would be more difficult to perform. Getting dressed requires having to grasp the clothing to put on bilaterally. Also, if there are buttons, zippers, or shoelaces then pinching and gripping could be hard to do. A strategy that I would recommend to help with putting his shirt on in particularly, is for the man to sit down and have the shirt in his lap with the collar facing away from him, then he would thread his bad hand first through the sleeve using his good hand to help and bring it up to his shoulder. Next, he would thread his good hand through the other sleeve and pull it up to his shoulder, then take the opening for the head with his good hand and pull it over his head. If it were a jacket he was wearing, then the same steps would occur except for bringing the head opening over the head, the back of the jacket would go around to the other side and thread that way. In addition, if the jacket had buttons, then the soldier could put an elastic band and loop it through the where the button hole is and then around the button to bring it together. The strategy and modification described would help the soldier be more independent in this specific ADL.

Health Literacy and Health Promotion

After going through and listening to the lecture about health literacy, health promotion, and the social determinants of health, I learned that there is progress still to be made in the United States. As for example, the mission for Healthy People 2020 was to make sure that health was a priority and that it needs to be improved. Also, it said to make sure the public is aware and understands what the social determinants of health are and making progress with them. The social determinants of health are food, education, social justice and equity, stable ecosystem, income, peace, sustainable resources and shelter. However, our country has come in last when it comes to public health and to these determinants. Something else we need to take into consideration is that we are still experiencing occupational alienation, apartheid, and deprivation. All of these can occur simultaneously or can be isolated. It is important as a country and worldwide to make sure that everyone has the same rights, accessibility, engagement and meaning and purposeful activities in life.
What was a huge eye opener to me, were the videos on health literacy and how the medical and healthcare professionals need to do a better job explaining and comprehending medical terminology to clients and patients. It is important that we ask to make sure that the client's understand what they are reading or hearing so health and well-being can be optimized, instead of them feeling incompetent, afraid, insecure, uncertain, etc. We do not need to assume that everyone has the same level of education and be sure to use simple, nontechnical language. When this is achieved, there is a better sense of acceptance, relationship, rapport and support. We need to be better as a country and worldwide to make strides in advocating and educating about health literacy and promotion. We need to improve the patient experience of care, improve the health of populations, and reduce the per capita cost of health care. (IHI Triple AIM)