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.

Man From The South Post

In the story of the American boy who placed a bet on his left pinkie finger and somehow won, let's flip the script and see what would have happened if he had actually lost.  If he had lost, he would have had the pinkie finger on his left hand chopped off.  Now, some of us might think that is not that bad, and losing your thumb or index finger would be much worse.  However, in reality, if someone were to lose their pinkie finger, on either hand, they would lose up to 50% of their grip strength.  Yes, you heard me right...50. Percent.  That's a large percentage for such a small finger!  We unknowingly rely on the pinkie more than we think we do.  So if this American boy, who is also a soldier in training, were to have lost the bet and had his left pinkie finger chopped off, he would more than likely struggle through basic training camp when he returned.  His grip strength on his rifle would be severely depleted, as well as his ability to perform well in the mandatory PT tests conducted during the training process.  Due to this, he might flunk out of basic and would have to return to civilian life, which he might not want to do, since during this time period, men were mandated and drafted to serve in the military.  One major thing that the boy could do to hopefully get back to his daily occupations of being a soldier, would be to work on grip strength exercises without the use of his left pinkie.  It is not at all impossible to live a fulfilling life without a pinkie, it will just take time and patience to get back to full usage.

What I learned about Health Promotion

Being able to sit in on Professor Flick's presentation/lecture on Health Promotion was really amazing.  Firstly, I could tell just how excited/passionate she was about presenting the information to us, which made it more interesting and fun to learn about.  I learned a great deal in the presentation, things I believe will stick with me years down the road, especially once I start practicing as an occupational therapist.  The social determinants of health were some of the major takeaways from the presentation. Some of the things that we learned about that are considered social determinants were a little surprising, but after Professor Flick went over them, they all made sense.  And none felt more important than others.  One of the other major takeaways I had from the presentation was the difference between occupational deprivation, apartheid, and alienation, and how they are often not seen separately, but happen almost simultaneously, especially depending on the situation. 

Scapulohumeral Rhythm

The clinical relevance of the scapulohumeral rhythm is that it plays a major role in the function of the shoulder.  Due to the complexity of this rhythm, it can greatly affect ROM measurements/movements of the shoulder.  Firstly, the ratio of movement between the scapula and humerus must be addressed.  For full 180 degrees of motion, the scapula moves 60 degrees, and the humerus moves 120 degrees.  When dysfunction occurs, abduction of the glenohumeral joint can be affected.  This is prevalent in when someone tries to lift their shoulder and there is a large substitution in trunk flexion to try and lift the arm up into the air.  The scapula is controlled greatly by the serratus anterior muscle, and if the muscle is not working properly, the scapula may wing, which would cause the shoulder to not be able to lift and may cause impingement or rotator cuff problems.  The scapulohumeral rhythm also allows for good length-tension relationship, so if a problem occurs with the rhythm, such relationship may be affected as well.