What Would You Choose?

APA Citation for Ted Talk video:

Rotberg, S. [TEDx Talks]. (2018, March 6). Navigating Genetic Disease Testing: A Personal Story [Video File]. Retrieved from: https://www.youtube.com/watch?v=5_O5TfMVqD8

I chose to my last Neuro Note on Huntington's Disease.  The reason I chose this particular disease is because I honestly wasn't aware of the condition before taking this class.  I think I had heard it briefly mentioned before in another class I took in undergrad, but other than that, I knew nothing about Huntington's.  I find it both fascinating and saddening that such a condition exists, but I'm hoping that with further advancement in research, a cure, or at least a way to lengthen the life expectancy of those with HD, can be found.

I ended up watching a Ted Talk on YouTube and the guest speaker was Seth Rotberg.  He was a younger man, and he opened up his talk by explaining that he had been tested positive for Huntington's Disease, since his mother had the illness as well.  He goes on to tell his story about how as he was growing up, he never really wanted to be around his mom due to the physical impairments she had because of HD.  He was 15 when he learned the name of her condition, and was a sophomore in college when he made the decision to get tested for the disease, since a parent with HD has a 50% chance of passing it down to their child(ren).  Once he had found out he tested positive, he didn't tell his family for over two years.  He discussed that once he had told them, there was immediate relief and he regretted not telling them sooner.  He goes on to discuss that he continues to live each day to the fullest and hopes that a cure for HD is found soon.

I do recommend people watch this video, because it follows the journey of a young man who is roughly our age and we see how he copes with knowing what his condition is and still tries to live life and find happiness in it, despite knowing what he has.  I also do hope that a cure for HD becomes available, and I do hope to see that cure within my lifetime. 

Brain Injuries: A Prismatic Experience

APA Citation for Ted Talk Video:

Barrett, A. M. [Tedx Talks]. (2016, August 1). A Vision of Brain Injury Rehabilitation [Video File]. Retrieved from https://www.youtube.com/watch?v=QJ-OBXTA5AE

I chose to do my 3rd Neuro Note on this Ted Talk video because the lecturer talks about TBIs and strokes, and how such injuries to the brain can lead to spatial neglect, which can cause serious complications in the rehabilitation period for a person who has suffered an injury to their brain.  I chose to do this because one of my good friends in high school was a competitive lacrosse and field hockey player.  Despite physical contact being prohibited, she still suffered multiple hits to the head in both sports.  Because of this, she was left was permanent eyesight problems.  One of my other good friends received a concussion and was taking out of the our rowing program for months because her brain was healing fast enough to allow her to get back into the sport.  In all this, I watched and saw what how intimately a person's life can be effected by brain injuries.

In this video, A.M. Barrett, a cognitive neurologist, gives a talk on brain injuries, specifically TBIs and strokes and how both can cause spatial neglect in a person who has suffered from either.  She pulls up pictures of patients who cannot complete things on their left side, as the injury was to their right hemisphere, therefore everything on their left side has been effected.  She goes on to explain how such spatial neglect can cause serious delay on a person's rehabilitation, as well as dramatically increase their risk of falls.  She then proceeds to discuss a new, innovative, yet cheap method in rehabilitation for those with spatial neglect.  She called it the prism adaptation, which is a pair of goggles with prisms in each lens, with the left side of each lens being higher than the right sides.  This treatment, as she explained in the video, has been shown to increase a patient's independence by helping them regain the spatial awareness that they had lost post-injury.  She talked about how not many hospitals or rehab clinics use this type of treatment, but hopes that they will in the future.

As future occupational therapists, I think this video is important because we will eventually work with clients who have suffered from TBIs or strokes, and with this treatment because affordable, as well as easy to use and train other therapists with, I think advocating for this will become a necessity if we want to see clients have more independence in the long run.

ALS: A Theory

APA Citation for Movie:

Bevan, T. et. al (Producers), & Marsh, J. (Director). (2014). The Theory of Everything [Motion Picture].  United Kingdom: Universal Pictures.

I chose to do my second Neuro Note on Amyotrophic Lateral Sclerosis, or ALS, because it is a condition that I am very much interested in.  As we have been learning more about the disease in class, I realize my interest for it grows.  Also, my media project revolves around a case about a woman with ALS, so I wanted to learn more about the condition and how I can do better for my future project.

The movie I decided to watch for my neuro note was The Theory of Everything, which follows the famous physicist, Stephen Hawking, and his journey through his diagnosis of ALS in his early 20s, to pursuing a long-term relationship with Jane Wilde, who he would eventually marry and have three children with.  The movie follows Stephen's journey as he moves further in his career, not allowing his progressively disabling condition to stop him from continuing his work on the well known "Black Hole Theory".  It also follows how Jane, his wife, dealt with the hardships of being both a caregiver, and a loving spouse and mother to their children.  It shows how she has to put her own thesis on hold to care for him and the kids, and becomes frustrated with the circumstances.

The movie follows the hardships of ALS, not only for the person who is diagnosed with the disease, slowly losing their ability to control movement, but also for the person's family, both immediate and extended.  Jane and Stephen eventually divorced and married new people, but remained friends until Stephen's death in March of 2018, at the age of 76.  He holds the longest recorded time of having ALS at 55 years.  ALS is incredibly debilitating and currently there is no cure for the disease.  The average prognosis for most individuals diagnosed with it is normally 2 to 5 years.  The Theory of Everything showed how quickly the condition can worsen, how it can impact the closest of relationships, and what it takes to stay strong, even through the hardest moments.  The movie is currently available on Netflix, and if you have not seen this movie, I highly recommend you do so.  It places you in a perspective that, thankfully, not many have to go through in their lifetimes.  

UK release poster

Dementia: A Journey through Remembrance

APA Citation for Ted Talk Video:

Luciani, T. (2018, May). Tony Luciani: A mother and son's photographic journey through dementia. [Video File]. Retrieved from: https://www.ted.com/talks/tony_luciani_a_mother_and_son_s_photographic_journey_through_dementia

I chose to do my first Neuro Note on Dementia, as it's an illness that runs very close to me and my family.  My dad, who was an avid basketball player from the time he was a small child to when I was around 7 or 8 years old, is also a huge University of Tennessee Volunteers fan.  He was especially a fan of Pat Summitt, who was the coach for the women's basketball team, who was diagnosed with Alzheimer's in 2011, shortly afterwards retiring from coaching before passing away in June 2016.  My parents and I also have a family friend who has had Dementia now for the past few years, someone who I've known since I was roughly 5 years old.  I have a huge interest in neuro and just how much the brain can affect the entire body with just a few cut circuits or messed up neurotransmitter release.  Learning more about what Dementia and Alzheimer's can do to a person, and their family, is extremely important and valuable to me, especially as a future occupational therapist.

In the Ted talk I decided to watch for this Neuro Note, the speaker was Tony Luciani, who spoke about his mother who was both aging and diagnosed with Dementia.  As the title of the Ted talk explains, Tony used the art form of photography to capture moments with his mother while she was living with him, listening to her tell stories and share memories that she was able to remember.  Through sharing these moments with his mother, who continued to lose memory and function and eventually had to go living in a nursing home, Tony realized it gained more from being with her than he had first imagined.  He explained how his mother became alive again through being a model for his photography; she felt she had a purpose once again in her life.  He goes on to explain that many of those he had cared about passed away suddenly, and wanted to make sure that the goodbye he had with his mother would be long and memorable.  He ends the talk with taking a picture of the audience to eventually show his mother, along with the phrase, "Life, it's about wanting to live, and not waiting to die."

Through this Ted talk, I learned about the frustrations that can come along with a family member who is suffering from Dementia/Alzheimer's.  It can be frustrating when they forget simple things, and it can be heartbreaking when they can look you in the face and not even remember who you are or how you're related to them.  It can also be frustrating to the person who has the illness, for many of them want to say and remember things, but as soon as they want to express them, their brain makes them forget.  And what is even more frustrating is that it is a progressive illness, with no current treatment to stop it or terminate it.  From this video, I learned how important it is to be patient and understanding of the person's condition, work with what they can do and work around what they can't.  Watching this video has humbled me into realizing what could happen to me in the future, and how important it is to be there for those who have it, so as to make sure that they are not alone in that difficult journey.

Restoring Confidence in Mobility

Restoring a client's confidence in mobility is incredibly important in the therapy process, especially for an occupational therapist.  By restoring their confidence in the ability to be mobile and move around, it gives them back the independence they lost when they first become immobile, whether due to an injury or something more severe, like a stroke.  For an OT working with a client who is trying to get back to independent mobility, there is a certain method for doing so, called the Hierarchy of Mobility Skills.  It's a sequence that works from the bottom up, starting with bed mobility and going all the way up to community mobility and driving.  From a body mechanics perspective, the higher up someone goes on the ladder, the smaller their base of support becomes.  The purpose of the hierarchy is to give back independence to a client. 

For the hierarchy of mobility skills, I wasn't sure what to expect.  I had never really heard of this before, so learning it was an entirely new experience for me.  However, based on the sequence, and what we have learned in our Biomechanics class, as well as what I saw during my observation hours in undergrad, I see that it makes sense.  Bed mobility, the first rung on the ladder, requires almost 100% assistance from the therapist, and it goes up from there to the very top with community mobility and driving, which is near complete, or complete, independence on the side of the client, as they can move around in society and interact with others in their community.  I do agree with the hierarchy, because the higher up a client goes, the more independence they can receive from achieving those points.  What we have learned in our Biomechanics labs has also been a really great way of seeing the hierarchy in action.  I think the wheelchair lab was very beneficial in showing this, because once a client is able to functionally use a wheelchair on their own, they gain a lot of independence back that they didn't have previously.  Or even the assistive walkers, once a client is able to get off of those (if they can), it's such a rewarding feeling, both for them, and for the occupational therapist working with them. 

Proper Fitting of Assistive Devices

Assistive devices have been around for decades and though new models and versions continue to come out in the health field, the general set up for ADs is relatively the same.  As a therapist who will more than likely be working with clients who will need assistive devices, it is necessary to understand the importance of properly fitting the device to a client.  Though the set up time is short, proper fitting of the device to the client will ensure better results in the healing process down the road.  One of the reasons to appropriately fit a person to an assistive device is compression.  Let's say, for example, a client needs axillary crutches and needs to be fitted for them.  If the crutches are not properly seated underneath the axilla (armpit), it can cause compression in many of the structures in that area (blood vessels, nerves, etc.).  Another reason to proper fit a client to an AD is due prevention of additional injuries.  An example of this is if a client needs platform attachments to crutches to keep weight off of an injured wrist, the platform must be fitted properly so as not to cause compression of the nerves in the elbow.  If not fitted properly, nerve damage can happen, thus prolonging the client's recovery.  So let's look at how to properly, and appropriately, fit a few ADs to clients.

Canes are relatively easy to adjust, as long as they have proper mechanics to do so (wooden canes often to do have the right tools to adjust appropriately).  To adjust a cane to a client, make sure said client is standing and looking straight ahead with arms relaxed at their sides.  The handle of the cane should always be in line with either the wrist crease, ulnar styloid process, or the greater trochanter of the hip.  The height can be adjusted via the locking mechanism and button on the side of the cane.  Once the cane has been properly fixed, when the client is gripping the handle while standing, their elbow should be slightly flexed about 20-30'.

Axillary crutches are very common place and seen pretty much everywhere.  To properly fit this AD to a client, first make sure the crutches are the same length as the distance from client's forearm to the fingertips of their opposite hand.  From there, have the client stand up straight with arms relaxed at their sides.  The arm pad of the crutches should be around 1" to 1.5" under the armpit (or 2 to 3 finger width).  By doing this, the arm pad is not pressed up into the arm, which keep pressure off of the structures underneath the skin.  The hand grips of the crutches should be in line with either the wrist creases, ulnar styloids, or the greater trochanters.  The hand grips can be adjust via the wing nut and bolt on each crutch.  For Lofstrand crutches, the same type of fitting goes for the hand grips, while the arm bands should be positioned roughly 2/3 of the way up the client's forearms.

Walkers have also been around for decades and there are many different versions out there, all with their own unique fitting properties.  For a platform walker, make sure where the platforms attach to the standard walker (or where the hand grips usually are) are level with the greater trochanters of the hip.  The platform surface should be positioned to allow weightbearing through the client's forearms when the elbow is bent at 90'.  The client's elbow should also be positioned roughly 1 to 2" off the platform's surface, and the handles of the platforms should be positioned more medially to allow for a more comfortable grip for the client.  For a rolling walker, have the client stand up straight with their arms relaxed at their sides.  Position the height of the walker to where the hand grips are in line with either the client's wrist creases, ulnar styloids, or greater trochanters.  If properly adjusted, the client's elbows should be slightly flexed to 20-30'. 

Proper Posture and Body Mechanics

Having and maintaining both proper posture and good body mechanics are essential for completing every day activities that ask for some form of increased stress on the body.  If a client has faulty posture and poor body mechanics, there are a number of reasons why fixing both are important.  The first one is linked to posture and that having poor posture can lead to back problems, like injury or pain.  The second one is also linked to posture, and that having poor posture, like having your neck in a forward position, can increase the weight of the head on the cervical vertebrae, thus increasing the stress on certain structures, like the posterior longitudinal ligament and joint capsules.  The third reason is linked to body mechanics, and that poor positioning of the body during the act of lifting heavy objects can increase the strain on the vertebral column, possibly resulting in injury.  Increased flexion of the spine due to poor body mechanics can lead to spinal issues, like bulging, or even herniated, discs. 

In the intervention process with the client, one of the activities I would have them do is focus on core strength during sitting, so as not to develop or continue having a hunched-back while doing repetitive tasks, like typing or writing at a desk.  The other activity I would do is teach them how to properly lift a heavier object from the floor, making sure to tell, and show, them to bend on the hips and knees while keeping the back straight, as well as have the object closer to them and keeping the abdominal muscles firm and tight during the lifting process.