3 Letters - ALS

TEDTalk | Scott Matzka | How 3 Letters Changed My Life

https://www.youtube.com/watch?v=NOK83OHmTbE

I have only had very superficial exposure to Amyotrophic Lateral Sclerosis (ALS) through the Ice Bucket Challenge, learning about it in class, and knowing about iconic people with the disease such as Lou Gehrig and Stephen Hawking. So, I chose to watch this TEDTalk in order to gain insight into someone's personal experience with ALS. 

Scott Matzka is a University of Michigan alumni, and played hockey for 11 years at the collegiate and professional level. He has been married to his wife for 7 years and is a father of two children. The initial signs and symptoms of ALS he experienced were forearm cramps, stiffness in his fingers, and muscle spasticity in his hands. After seeing a general doctor and after months of MRIs, blood tests, and examinations, he was referred to a neurologist and diagnosed with ALS. Five years prior to his diagnoses, Scott was in peak athletic condition, being able to run a 6-minute mile and hit a golf ball 300 yards. From then to 2017, there was a stark contrast. His day to day life was significantly impacted and he was faced with new challenges, including walking to the mailbox, dressing himself, holding utensils, and getting out of a car or up from a chair. 

When Scott was diagnosed, he knew he had to make a choice - to lie down or stand up. He resonated with other people who have been faced with a similar choice on how to proceed with life when they have had a life-changing event such as losing a loved one or having a career-ending injury. Although he knew he would never walk his daughter down the aisle or hold his future grandchildren, he chose to live life to the fullest. He considered keeping his diagnoses personal in fear of making others sad or upset. Instead, he chose to be vulnerable, and as a result, he strengthened his current relationships with his family, friends, and former teammates, and created new bonds with people he has never met from places he has never visit. With such a strong rapport for emotional support, they were able to build a bucket list and Scott found a new meaning to his life.

Through this encouragement, Scott founded "My Turn" which is a campaign to raise awareness and aid to the ALS cause. This turned into his life's purpose and reason for getting up every morning. Scott shared 2 lessons with his audience. Lesson 1: Vulnerability. If he had not shared his diagnoses with others, he would not have received such love and compassion from his loved ones, or have raised the extent of awareness he had. This leads to Lesson 2: Perspective. As a result of his vulnerability, he was able to change how others looked at and approached their own lives. This prompts the question - what would our life be like if we knew death was close, inevitable, and could occur at any given moment? Maybe we would see less of our daily exposure to terrorism and shootings, and maybe, instead, we would be kinder, more compassionate, and more generous toward others.

This video was so touching and deepened my empathy as an OT student and future practitioner to those with ALS, as well as others who may be experiencing a life-altering disease or injury. Upon being diagnosed, Scott was not informed by any medical professional or website on how to approach life after his diagnoses. No one told him "...that life goes on. They don't tell you that you have to keep on going... even that very same day." With our holistic approach, we as OT's can help and guide others through these emotions so that they can continue to live life to their fullest, possible potential. This gives our role a profound meaning and purpose that others cannot fulfill. By sharing his experience, Scott introduced a ripple effect so that we may continue to advocate for the ALS cause. Although Scott passed away in December of 2018, his legacy thrives and lives on through the lives of those he impacted. 

~ Pam ♡

Picture retrieved from: Google Images
TEDx Talks. (2017, March). How 3 Letters Changed My Life [Video file]. Retrieved from https://www.youtube.com/watch?v=NOK83OHmTbE

Spinal Cord Injury Lesions

There are many effects and ways to categorize the effects of spinal cord injury (SCI) lesions. For example, there are different syndromes that may stem as a result of an SCI lesion, such as Central Cord Syndrome, Brown-Sequard Syndrome, Anterior Cord Syndrome, Cauda Equina Syndrome, and Conus Medullaris. In order to assess the differing degrees and residual function after SCI, the American Spinal cord Injury Association (ASIA) Impairment Scale is utilized. It ranges from Level A to Level E with Level A being the most severe, indicating a complete SCI and no motor or sensory function in the lowest sacral segment of the spinal cord, and Level E indicates normal sensory and motor function with no spinal cord lesion. Depending on where the lesion occurs, upper and lower motor neuron (U/LMN) signs may be present. UPN originate from the brain and are responsible forsending signals to LMN. LMN are also known as spinal nerves and send the received signals directly to the desired target (e.g. muscle). If an UPN lesion occurs, one may experience spasticity below the level of the lesion and paralysis. On the other hand, one may experience hypotonicity (low muscle tone), muscle atrophy, and partial to no motor reflexes if the LMN is affected. A couple other hallmark conditions associated with SCI include neurogenic shock and autonomic dysreflexia. One may experience neurogenic (or spinal) shock immediately following a SCI leading to a loss of motor pathways, tendon reflexes, autonomic function, as well as causing flaccid paralysis. Neurogenic shock may last for hours, days, or weeks before spinal activity returns. Upon the return of this activity and usually at a SCI at T6 or above, autonomic reflexes return and may result in exaggerated sympathetic reflex responses known as autonomic dysreflexia. Signs associated with this include severe hypertension, profuse sweating, bradycardia, and vasodilation. Autonomic dysreflexia is considered to a clinical emergency that can result in death - when it occurs, it is crucial to immediately stop the individual’s activity, elevate his/her head to avoid excessive blood pressure to the brain, and loosen clothing and other constrictions.

~ Pam ♡

Image retrieved from: https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Spinal-Cord-Injury

The Cure to Alzheimer's

The TED Talk by Samuel Cohen, “Alzheimer’s is not normal aging – and we can cure it,” caught my attention due to its bold title. I chose to watch this in hopes that I could make connections to our neuroscience class as well as apply any learnings as an occupational therapy student and future practitioner. As a major medical epidemic, it is inevitable as a future occupational therapist that I will connect with others diagnosed with this particular condition. However, Cohen states that by the year 2050, the number of people Alzheimer’s will affect compared to present-day will almost quadruple and the chance of developing this disease will be 1 in 2. 

Over a century ago, a medical case kindled the origins of Alzheimer’s disease. From a woman named Auguste’s experience, Dr. Alois Alzheimer discovered plaques and tangles – both contributing components involved in AD. Since then, there has been virtually no progress in the treatment of Alzheimer’s. To this day, it is one of the top 10 causes of death worldwide and the only one in this category that is still not preventable, curable, or able to be slowed down in its progression. In this TED Talk, Samuel Cohen argues that there is a cure that could come into existence but cannot be reached due to a lack of awareness, compared to other prevalent medical diagnoses such as cancer and HIV. This has been due to the misunderstanding and belief that the signs and symptomology of Alzheimer’s were merely indicative of someone becoming senile. It was not until the brain of a patient with Alzheimer’s and a brain of one without were compared that there is an observable physical difference between the two.

Cohen revealed for the very first time a new drug that he and his research team had developed which applied to worms at an early age, live a normal, healthy lifespan. He demonstrated this in order to illustrate that Alzheimer’s is a disease we are all able to understand and one day cure. Because we as practitioners are involved in the field of medicine and directly interact with others who may be diagnosed with Alzheimer’s, it is important to actively educate ourselves and play a key role in raising awareness. Today, there is such a diverse group of people contributing to this goal in order to transform it into a reality, including our very own occupational therapists.

Here is a link to the TED Talk if you would like to know more! https://www.ted.com/talks/samuel_cohen_alzheimer_s_is_not_normal_aging_and_we_can_cure_it/transcript?language=en

~ Pam ♡

Image retrieved from: https://www.williamsburglanding.org/article/10/6/2015/samuel-cohen-alzheimers-not-normal-aging-%E2%80%94-and-we-can-cure-it

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 ♡