Mobility Skill Progression

It is important to take the Hierarchy of Mobility Skills into consideration when working with a client in order to ensure safe and efficient treatment progress. The order from most basic to complex 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 community mobility and driving. From a personal and practical perspective, this sequence is understandable. Not only is bed mobility the most basic skill, but it also supplies the foundation on which other mobility skills can expound on. As the hierarchy ascends, the client's base of support decreases, which allows for increased mobility, however, consequently reducing stability as well. Namely, the ability to effectively and safely perform one mobility skill is dependent upon the mastery of the skill(s) associated with the tiers beneath it. 

It was eye-opening to have been able to better understand different mobility skills in simulated labs. The exposure to how debilitating even a simulated disability can be placed a lot into a different perspective. This order of attaining mobility skills is a very gradual progression in which levels could overlap. This helps to facilitate the fluid and natural development of said skills, and as a result, promotes the efficacy of treatment. Fortunately, in terms of personal observed clinical experiences, practitioners have done well to abide by this sequence. As future practitioners, it is imperative that we have a full, clear understanding of this hierarchy so that we may efficiently and holistically treat our clients.

~ Pam ♡

Image retrieved from: https://www.canstockphoto.com/disabled-wheelchair-kids-27985992.html

Finding Your Fit

Appropriate fitting of assistive devices is essential for a variety of reasons, such as increasing safety, comfort, and balance for the client. An assistive device that is well-suited for a client will more easily allow him/her to access and engage in meaningful activities. If not properly measured, an assistive device may make the client more susceptible to injury and potentially endanger him/her. Each device is unique to the individual. It is important to consider the client's physical, as well as cognitive, limitations and capabilities, and adjust accordingly. 

In order to properly fit clients for canes and walkers, a few things should be taken into consideration and are as follows: the grip of the hand should be level with the ulnar styloid process, the wrist crease or greater trochanter; elbow should relax at a flexed state of roughly 20-30 degrees; and the device should be adjusted in a way that permits shoulder relaxation as opposed to sustained shoulder elevation. When differentiating a platform versus a rolling walker, as well as a wide-based Quad Cane versus a narrow-based Quad Cane, it is important to consider a client's balance and upper extremity strength. A platform walker and narrow-based Quad Cane need less support and necessitate less balance as well as more upper extremity strength, respectively. On the other hand, a rolling walker and a wide-based Quad Cane are better suited for those with less balance and who experience upper extremity weakness and/or fatigue.

In addition to canes and walkers, standard/axillary crutches are fitted in a comparable manner, supplemented with an axillary (armpit region) rest positioned approximately 5 centimeters below the floor of the axilla. Lofstrand crutches bear less stability than the aforementioned axillary crutches, however, provide more support and stability than a cane, and are better suited for those with long-term disabilities. 

There are a variety of factors to account for when selecting an assistive device that may serve to maximize a client's potential to engage in meaningful activities.

~ Pam ♡

Image retrieved from: https://www.123rf.com/stock-photo/old_woman_cartoon.html?sti=le7jt8thlux10srjtw|&mediapopup=52882621

Mind Your Posture

Conscious practice of proper posture and body mechanics may not only contribute to optimal body function but may also subserve preventative benefits and effects to the body. The ideal body alignment is one in which an individual's center of gravity is centered over the base of support. This aids in the promotion of balance equalization and body stability. As previously mentioned, proper posture is a key contributor in preventative physical care. It reduces the risk of deformity and/or injuries such as kyphosis, lordosis, or scoliosis. Additionally, proper posture allows the body to perform at an ideal functional level with minimal energy expenditure. 

As an occupational therapy student or practitioner, it is important to inform and educate clients on ideal posture along with its benefits. A few options for a client who spends most of the day in sedentary conditions (e.g. sitting) may include an unsupported chair that helps to modify one's posture, a standing desk, or encouraging the client to take short breaks to stretch, stand, and/or walk. Alternatively, if a client spends most of the day on his/her feet, one may suggest imagining a string on the top of one's head and standing as if someone is pulling directly upward on the string. This supports the body in maintaining proper alignment, alleviating pressure on the vertebral column, and attenuating potential deformities and/or injuries, while simultaneously engaging and strengthening the muscles necessary for proper posture. 

~ Pam ♡

Image retrieved from: https://www.georgecorbett.net/?page_id=195

Common posture mistakes and fixes. (2016, January 7). Retrieved from https://www.nhs.uk/live-well/exercise/common-posture-mistakes-and-fixes/

Impact of Digital Absence

In Roald Dahl's story, "Man From the South", he shares a tale of a soldier who makes a bet with a perceivably wealthy man. The stakes are high with the potential loss of the wealthy man's vehicle or the loss of the soldier's pinky finger. To the soldier's fortune, the wealthy man's partner walks in and interrupts just before the challenge ends, and the soldier notices that she has lost all but a thumb and one finger on her hand. This could cause her to face potential challenges in her daily life such as self-care and navigating activities outside of herself, such as driving her partner's vehicle. 

Although the hand's digits (i.e. fingers) are small, they are constantly utilized and contribute a great deal to everyday life due to their intricate and delicate nature. The complexity of the digits allows for elaborate actions and manipulation of objects, and they must function in harmony in order to optimize strength, as well as stability. In regards to the woman in the story, she likely experiences difficulties with activities such as driving her partner's due to the absence of most of her digits, causing a deficiency in hand motor function. Grasping and guiding the steering wheel in addition to adjusting the gear could prove to be complicated without the assistance of her digits. In order to amend these circumstances, a steering wheel knob with a textured surface may be implemented. As opposed to grasping the entire steering wheel, a knob will allow her to wrap her two fingers around it, and as she maneuvers the vehicle, the knob will simultaneously rotate to accommodate for her motions. She may also place her palm on top of the knob, and the textured surface will provide extra traction so her hand does not slip. Because our digits are used incessantly, it is easy to dismiss the importance of their function and how impactful they are on our activities of daily living.

~ Pam ♡

State and Trajectory of Public Health

Public health is the overarching source of the population’s current knowledge, approach, and applicability of living a healthy lifestyle (or lack thereof).  In the past, medical fields such as psychology were condemned for the fixated attention to solely the individual’s prognosis or diagnosis (Seligman, 2004). However, on a global scale, the practice and approach of medicine and healthcare have progressed. As opposed to an exclusive concentration on the identification of a problem, public health has propelled the maximization of universal health, as well as the optimization of current well-being and health in order to endorse a preventative approach.

Within our realm of practice, the inclusive nature of occupational therapy necessitates an appropriate approach to public health in order to adhere to the needs of different populations in their entirety. To advocate for positive public health, it is essential for occupational therapy practitioners to consider all aspects of a population such as education, food, income, ecosystem, and resources. Through involvement in community-based practice, inter-professional education, and strong therapeutic relationships with clients, occupational therapists make an impact on aspects of public health such as health literacy and cost of healthcare to ultimately increase the quality of life across populations (Flick, 2019). Additionally, there is evidence to indicate and support an inverse relationship of hospital spending on occupational therapy and readmission rates. According to Rogers, et al., “higher hospital spending on occupational therapy [was] associated with lower readmission rates” (2016). Due to the prioritization of a holistic approach, occupational therapists make a significant contribution to the positive trajectory of universal public health.  

~ Pam ♡

Citations:

Flick, J. (2019). OT 425 Health Promotion and Health Literacy [PowerPoint Presentation].

Rogers, A. T., Bai, G., Lavin, R. A., & Anderson, G. F. (2016, September 2). Higher hospital spending on occupational therapy is associated with lower readmission rates. Medical Care Research and Review, 1-19. Retrieved from https://doi.org/10.1177/1077558716666981

Seligman, M. (2004). The new era of positive psychology [Video file]. Retrieved from https://www.ted.com/talks/martin_seligman_on_the_state_of_psychology/up-next?language=en

Image retrieved from: http://healthchanging.com/time-get-serious-grip-level-health/

Scapulohumeral Rhythm

Scapulohumeral rhythm allows the scapulothoracic (ST) and glenohumeral (GH) joints to work in concert in order to increase shoulder range of motion (ROM). The degree ratio for the shoulder, GH joint, and ST joint are 3:2:1, respectively. It is clinically important because proper functioning of the humeras and scapula as a unit permits the client to perform full shoulder ROM at an optimal level. It also allows for a favoral length-tension relationship thus preventing active insufficiency of GH muscles. Additionally, a discrepancy in scapulohumeral rhythm could lead to decreased scapulohumeral space yielding impingment. Another consequence of disparity is joint incongruency potentially causing a risk of shearing. Ultimately, this biomechanical property improves efficiency of movement. A client’s ability to perform full shoulder ROM is dependent on the synchronization of scapulohumeral rhythm.

~ Pam ♡

picture derived from: http://www.geocities.ws/ptexas9/scap-rhythm.html

Unity by Personal Disability

The advancement of modern technology has allowed for the implementation of assistive technology (AT) in the therapeutic setting. The purpose of AT is to facilitate the engagement of activities and occupations of individuals with disabilities who may otherwise experience difficulties. AT ranges from no/low-tech to medium-tech to high-tech. No/low-tech is considered to be the most intuitive in that it is the easiest to utilize and has a very clear understanding in terms of usage. Medium-tech AT may require a small extent of training and set-up. High-tech AT is the most complex and may prove to be challenging to program and maintain. When deciding which form of AT to implement, it is important to consider multiple aspects of the client such as strengths, weaknesses, and goals, as well as the availability of AT (Lancaster, 2018).

Assistive technology is simply one component of the countless that exist within the concept of universal design. The extent of a disability is not exclusive to those who have been branded with that label; every individual experiences challenge due to personal and potentially innate shortcomings that may not be considered a “disability” by society, such as height while playing for a basketball team or limited creativity on an art project. “Disability” is only a manifestation of the imperfect nature of man and unifies us as humans. If seen as a drawback instead, there is a strong implication that a step can be made forward toward one’s improvement of health and autonomy as opposed to being a quality of permanence. Because there is a need to cultivate a myriad of solutions to account for each blemish of man, universal design is essential to create “products and environments accessible to all people, to the greatest extent possible, without the need for adaptation or specialized design” (Nesmith, 2016).

~ Pam ♡

Citations

Lancaster, S. Introduction to Assistive Technology. 5 April, 2018. Prezi.

Nesmith, M. (2016). Why We Need Universal Design. Retrieved from https://www.youtube.com/watch?v=bVdPNWMGyZY&app=desktop.