Imposter Syndrome

     I was first introduced to Imposter Syndrome in Foundations of Occupational Therapy which was the second class I ever took in OT school! Even though I remember learning about it, I never really applied it to myself, because I did not think it was relevant to me. It seemed as if all the examples were regarding individuals like famous lawyers or Olympic athletes. However, that is not the case at all. Every single person can be a victim of Imposter Syndrome to some degree, and unfortunately, I am one of those victims. 

            I have been a perfectionist ever since I can remember. I have always wanted to be the best and never make any mistakes. I would not be satisfied until my performance was “perfect”. This mentality led me to become a starter and captain of my D1 collegiate soccer team, graduate with a perfect 4.0 GPA, and hold a position in my sorority, Delta Gamma. However, even after reaching these amazing accomplishments, and seeing how able and capable I was of facing challenges and being successful, I still felt anxious and afraid of failure and not being enough. I felt like I could do more, even though I was giving me all every single day.

            Fast forward to OT school, I have made straight A’s, held numerous leadership positions, and have stayed extremity organized and motivated throughout challenging COVID times. Yet, before every test I take or every new class I start I am convinced that it will be the one I fail or the test that I will struggle more than everyone else. However, I can usually compartmentalize these thoughts well and remember that I am capable, and I will succeed because I have been prepared. So, when I took the Imposter Phenomenon Rating Scale Test and scored a 56, which is close to the cut off between moderate and high Imposter Syndrome experiences, I was not surprised. 

From podcasts and other outside resources, I have learned that this syndrome has a higher prevalence among healthcare professionals because healthcare professionals are surrounded by other high achieving individuals, so you are comparing yourself with the best of the best and it is easy to feel like you fall short. I also have learned that comparison is one of the worst things you can do if you are struggling with this syndrome because you are likely comparing one of your weaknesses to another’s strong points. However, there is hope! First, it is imperative that you are self-aware and have confidence in yourself! Think back to all the times that you felt stress and had success or any accomplishments you have made so far and never forget these things! It is also important to have a healthy work life or school life balance. You will never be your best version if you are not taking care of yourself first, like it has always been said, you can’t pour from and empty glass. Finally, release yourself from that perfect standard. Every single person makes mistakes, needs breaks, and has bad days, but you will bounce back, learn from mistakes and you can be the best version of yourself the next day! I am thankful that this syndrome has been brought to my attention prior to beginning my Level 2 fieldworks. I have learned symptoms of this syndrome and strategies that I can use to help combat it when I start to feel over whelmed and anxious! 

UTHSC Honor Code & Fieldwork

 When I began my OT didactic work in January 2020, UTHSC required all students to sign the Honor Code Pledge. The Honor Code Pledge says that as a UTHSC student, you have read through the entire Honor Code, understand its meaning and significance, and agree to uphold it the entire time you are a student at UTHSC. Before I signed the Honor Code Pledge, I thought it was just going to be a promise to not cheat, plagiarize or share information with others. However, after taking time to read through each part of the Honor Code, I realized it was much more than that. 

The Honor Code states that all students are required to “exemplify personal integrity and responsibility in the classroom, laboratory, clinics, and other academic endeavors”.  For the past 21 months of my didactic work exemplifying integrity and responsibilities in the classroom and lab settings has been my main concern. Our professors have had to rely heavily on UTHSC’s Honor Code considering majority of assignments, quizzes, and tests were administered virtually due to COVID. However, this unique situation gave me, and all my classmates, a chance to show that we are trustworthy, respectable and will uphold the Honor Code in all situations. As our didactic portion of school ends and we prepare to move into 6 months of clinicals, it is important to understand that this Honor Code is not something that just goes away because we are not working on full class assignments. 

During our Fieldwork rotations, it is more important than ever for us as UTHSC students to uphold and implement the Honor Code when working with our clients and in our facilities. The Honor Code expects us to always interact with our patients and coordinators professionally and ethically. As an occupational therapy student, this means exercising our AOTA Code of Ethics throughout the entire fieldwork experience and always doing what is just and right for the client and facility. This is not only what is expected by UTHSC, but also what is expected to be an ethically grounded OT with a strong OT identify. That it is why it is important to periodically familiarize ourselves with not only our Honor Code, the AOTA Code of Ethics, and the facility’s expectations and regulations to ensure we are upholding a pledge we took at the beginning of our school and becoming the most professionally and ethically grounded practitioner. 

Locus of Control

 Locus of control is a term that is used to describe a person’s beliefs about who or what controls what happens in their life. To break this down even further, control is defined as the power to determine outcomes by directly influencing actions, people and events and locus is defined as a position, point or place. This means that you can have different positions of where you put your control. Overall, locus of control can be looked at as a continuum that has two extreme points, which are internal and external, and everything in between! 

            Someone with an internal locus of control believes that they have a large part in controlling their future, however, someone with an external locus of control will believe that things happen to them, and external events determines their future. Most people will shift back and forth between internal and external but will have a dominant style that they fall back to in most cases. 

            Understanding Locus of Control is important for future occupational therapy practitioners because it allows you to become self-aware of how you approach situations, friendships, and different circumstances in your own life. In addition, it is important to have a strong understanding to be able to work with and treat your future clients most effectively. For example, clients who are workman’s compensation and MVA patients tend to have more of an external locus of control. This means they blame others for what happened to them, and they feel like the only way for them to be “fixed” is with therapy physically helping them. However, this is not true. We as occupational therapists can teach them ways to reorganize their thoughts and help them to think in a more positive way, so that they can make improvements during the therapy session and at home! Some strategies that can help with improving a patient’s internal locus of control include, forming HEP with materials they have in their home, minimizing passive treatments and have the patient come in less often so that you can track their personal progress on their own (Meira, 2021). Overall, it is our goal as ethical providers to encourage our clients and teach them strategies to use an internal locus of control in their day to day lives. 

 

 

Meira, E. (2015, May 28). Are your patients out of control? The Science PT. https://thesciencept.com/are-your-patients-out-of-control. 

 

Media Project: Ice Cube Tray Dressing

     For my media project, my client's name was Harris. Harris is a 22 year old who was in a car accident which left him with a complete SCI at the T3 level. He is now a paraplegic and has troubles with his sitting balance in his wheelchair, maximum assistance in dressing and troubles propelling his wheelchair with the arm cast. He is a student within 4 months of graduating and enjoys golfing and going to the movies with his fiancé and friends. His goals included returning home, graduating on time with a computer science degree and getting out of rehab and getting on with his life. The media I was assigned to use with Harris was an ice cube tray. It took me multiple days and numerous different ideas before I finally settled on my ice cube tray dressing idea! I wanted to focus on his goals, struggles and help make the activities he enjoyed the most easier to do! My "ah-ha" moment was when it finally clicked that he was maximum assistance on dressing, an ADL important to be able to return home, go to school and get on with his life! He is right hand dominant yet his right arm and hand are in a cast, so this is why dressing is so difficult for him now! My dressing ice cube tray will allow Harris to practice doing multiple dressing actives like buttons, zippers and velcro with his weaker hand! This will also help him strengthen his hand, and increase fine motor skills which can transfer over into his school work and having to work on a computer and manipulate items like his backpack and his golf bag. This activity will help make reaching his goals easier and also help with leisure activities he enjoys! 

    While working on this project, I had to learn a little more in depth about the different levels of SCI and what function each level had! I have never worked with a SCI patient in the past so it is definitely an area that I need more practice in, so this assignment allowed me to learn more about a topic that I do not have much experience in. I also learned how important it is to look at your client's specific client factors and make your intervention and approach client centered. This makes thinking of ideas a little bit harder, but in order for OT to be successful you want the client to feel that they are doing their therapy for reasons important for them! Another thing I learned from reading Harris' case study is that as an OT, it extremely important to educate the client and the family. One of his goals is to "walk out of here and get on with my life" and as much as I want that goal for him too, with the injury he sustained he will not be walking out. This is something that I would want to explain to him, but not in a way to make him sad or depressed but just to inform him and let hime know that we can help him get better and work with his injuries while they are healing and help him get on with his NEW life! While making my dressing ice cube tray I also had to reach out to my mom who started to teach me how to sew, which was important for sewing on the buttons to the front of the shirt! I am excited about this new skill I am learning because I know I will be able to use it with my future clients! This media project assignment will help me when I am working on other assignments and while working with clients in the future by making me be more creative and think outside of the box. If I am working with a client and am having trouble thinking of an intervention that is client centered and still works on their goals and struggles, I will think back to this assignment and remember that ANY material can be transformed into a fun intervention or adaptive equipment with creativity and some thought!  I am now more confident in my ability to be client centered and to make meaningful activities for a client. I feel better prepared for future assignments because of my ability to apply my knowledge of client factors to an intervention.  It also helped me work with an area that I do not have a lot of experience but want to learn more and get more experience with patients interventions related to SCI! At first this assignment was very overwhelming to think about and I was nervous that I would not be able to think of something good enough. However, I am extremely happy we were challenged by this assignment and forced to use our creativity to help expand and apply our knowledge and participate in this awesome experience!   

Follow this link for my video presentation about Harris' Ice Cube Tray Dressing 

https://youtu.be/Vg3-KB9oM3Y 

                

TransFatty Lives (Neuro Note 5)

     For my 5th, and final, neuro note I decided to watch a movie titled TransFatty Lives. This movie follows a filmmaker named Patrick O'Brien, also known as DJ TransFatty, through his life after being diagnosed with Amyotrophic Lateral Sclerosis (ALS). ALS is a progressive neurodegenerative disease that affects motor neurons. This means that as the disease progresses your muscles will start to waste away and you will no longer be able to move or control your body. However, your mind and cognition will stay completely intact. Patrick describes this as having your brain "unplugged" from your body. 

    In TransFatty Lives, Patrick was diagnosed with ALS in the spring of 2005 when he was 30 years old. He reached out to a doctor when he noticed his leg was trembling and he couldn't make it stop and when he fell backwards out of a chair for no reason at all. In a room full of Patrick's family and loved one's, the doctor confirmed that he did indeed have ALS and he would have between 2 and 5 years left to live. After this diagnosis, Patrick and his production team began documenting his story and how he was living with ALS. It showed in very real detail the many struggles he faced with doing his ADL's and how even with help like his friends and father activities like taking a shower could become extremely dangerous and even impossible. It starts with us seeing Patrick walking with a walker and having to take frequent breaks all the way to him being completely reliant on others and machines for survival. The film gives you a very real look into what happens as ALS progresses including doctors visits, adaptive machines and equipment and the role of caregivers. 

    Something that I found so unique about this story was that in 2006, a year after his diagnosis, Patrick starting dating a women who eventually became pregnant with his child. The baby, Sean, was the reason that Patrick wanted to fight for so long. Through the struggles of needed constant care, a G-tube for feeding, a tracheotomy for breathing, and only being able to communicate through typing with his eyes he wanted to live to see his son grow and answer any questions he may have while growing up! Patrick spent all of his money to stay in nursing homes full time and to stay alive for his son even though him and his mother ended up breaking up and he was unable to see Sean much. ALS is a debilitating disease that affects not only the patient and their loved ones physically but also mentally, emotionally and spiritually. Patrick had many people support him in the early stages of ALS and then walk out of his life throughout the film which left a sad, lonely hole in him. This movie does an amazing job of showing the realness of ALS and the stress that it puts on everyone involved but also the importance of loving and ALWAYS supporting the patient. Thankfully, in Patrick's case there is a happy ending. Patrick was offered at spot The Leonard Florence Center For Living in Boston, which was a specialized facility only for patients with ALS. Through his films, blogs and Facebook posts he raised enough money to be flown to Boston and afford to stay at this facility. During this time, he also got to spend time with his son and family! When Patrick finally arrives at the facility and is surrounded by people who are dealing with similar struggles to him he types with his eyes that he feels "humbled" and starts to cry. 

    I original chose this movie because I wanted to learn more about ALS since I had very little previous knowledge about the disease. I wanted an opportunity to learn more and get a different perspective! I would highly recommend this movie because it shows you what ALS does to not only the patient but the one's around the the patient and also gives you a new perspective of what the patient is going through! I really enjoyed this movie!  

TransFatty Lives. (2015). https://www.imdb.com/tv/watch/tt4221762?ref_=tt_wbr_fdv. 

 

The Jordan Hand Challenge (Neuro Note 4)

I recently participated in The Jordan Hand Challenge, which was created by Jordan Bone. Jordan is beauty blogger on YouTube and has over 200,000 followers. She also is paralyzed from the chest down (tetraplegic) from a car accident when she was 15 years old. She shares the uniques struggles that she faces not only physically but emotionally and mentally on her website, vlog, and on her many social medias. She also has made it a priority to speak to schools and colleges to raise awareness for road safety and spinal cord injuries. In one of her YouTube videos she challenged her viewers to do their make-up, the way she had to. This means no use of your fingers, a small amount of use in your thumbs, and only flexion and extension of your wrists. Knowing the limits Jordan has with her hands, you wouldn't think that her makeup would flawless... but you are SO wrong. When you see Jordan your jaw will likely drop to the floor because her makeup is AMAZING, like it was done by a professional! I accepted the challenge and did my best to apply just some basic makeup to myself like Jordan has to! I opened all of my products before I started and then put a rubber band around my fingers to keep myself from cheating. My makeup does not turn out nearly as flawless as Jordan's... but it really made me view life in a different perspective. Jordan is truly an inspiration to everyone and we all can learn from her! I would definitely suggest that everyone take on this challenge just to get a first had experience on how it would be to have to live your same life... just differently! Below my full video of the Jordan Hand Challenge, as well as links to Jordan's website and instagram! I hope you enjoy! 

Watch MY Jordan Hand Challenge here!!!  

Click here for Jordan's website about her life!  

Click here for Jordan's YouTube Channel 

Me Before You (Neuro Note 3)

I recently got the chance to watch a movie titled Me Before You, which is focused around a guy named Will that has sustained a Spinal Cord Injury two years prior. He now lives very well off with his parents in a fully adapted downstairs suite. He has a nurse named Nathan that spends most of the day with him and helps with all of his daily tasks, only leaving to check on the other patients he works with in the community. A young women named Louisa (Lou), had recently been fired from her restaurant job and needed another job desperately to help her family pay the bills. While she was searching, she found an add that was posted by Will's mom for a caregiver and companionship for a disabled man. She applied right away, got the job, and then spent 8 AM-5 PM Monday thru Saturday with Will. At first, Will was extremely rude and did not want anything to do with Lou because of his severe depression about no longer being able to live his old, amazing life he loved so much. However, their relationships starts to grow and they begin to get closer. However, one day Lou found out that Will had given his parents 6 months and then he was going to check in to a place called Dignitas in Switzerland for assisted suicide. Lou is so upset and his determined to show Will that his life is worth living. They got to a horse race, a Mozart concert, Will's ex-girlfriend's wedding and an all inclusive beach vacation. But in the end, Will still decides that assisted suicide is the best decision for him. He had fallen in love with Lou but he did not want her to miss out on life, regret her decision, or miss out on things in her life that someone else could give her. In the end, Will loved his old life too much, and did not want to live the new one he had.

Throughout the movie we learned more and more about all of the challenges that affect people who have a SCI. Will is a quadraplegic and sustained his injury about chest level, from what Nathan says, which I would say he has a C7-C8 injury. He has no use of his legs and limited movement of his arms and movement in only one index finger and thumb. He uses those fingers to steer his powered wheelchair which also has a screen attached with multiple options and commands. He is completely dependent on someone else for most all other ADL's including eating, going to the bathroom and his personal hygene. Will experiences autonomic dysreflexia and fights with pneumonia twice within the movie, and Nathan has to explain to Lou that Will does not sweat like us and it is important to monitor his temperature and vital signs regularly. The topic of SCI and this movie were interesting to me because there is so much I didn't know about SCI before our class and I think it is so interesting to learn about. I also think OT's can be a vital part of someone's life after the experience of a SCI. We could help them love their new normal and give them purpose in their new yet different life. I fully recommend this movie to everyone but especially my fellow classmates. It is extremely informative about SCI and the struggles that come with that physically, emotionally and mentally which is what OT is all about!

Rosenfelt, K. (Producer), Owen, A. (Producer), & Sharrock T. (Director). (2016). Me Before You [Motion Picture]. United Kingdom: Warner Bros. Picture 

Finding Joy in the Life You Do Have (Neuro Note 2)

A stroke, also known as Cerebrovascular Accident (CVA), is when blood flow to the brain is blocked or stopped so oxygen can't get to the brain tissue and injury or death occurs in the tissue. Strokes can be classified as ischemic, meaning a clot, or hemorrhagic, meaning bleeding out. Majority of strokes occur in people older than 65 years old and they are also the leading cause of long term disability in the United States. And even though we have all this information and knowledge about strokes, strokes will always be different for everyone and they refuse to discriminate. I watched a video titled Having a Stroke as a New Mom Changed Everything, But I am Treating it Like a Gift,  that interviewed a woman named Katherine Wolf and her husband, who know first hand about how scary and unpredictable strokes really are.  Katherine was only 26 years old when she experienced a stroke in her brain stem because of a rare congenital defect she didn't wasn't even aware that she had. The brain stem is responsible for breathing, heart rate, and motor functions and damage to it can impair any or all of these functions. Katherine was a new mom and woke up one morning feeling a little out of it, but nothing out of the ordinary when she collapsed and became unconscious. She was rushed to the hospital and underwent a 16 hour surgery and survived, but is now a little different than before. Katherine does not have use of one of her hands, she cannot walk without a walker or wheelchair, half of her face is paralyzed, her eyes have difficulty tracking which causes double vision and she is deaf in one ear. However, she did not let this define her. She has learned to love her new life and does everything she did before but just a little differently. Her and her husband had another child and started a faith based non profit camp to help connect and support families with disabilities! 

This video interested me because of our recent focus on strokes and how they can affect each individual so differently. Strokes will cause different symptoms and disabilities based on type, location and duration. I really was interested in Katherine's story because of how young she was and the type of stroke being in the brain stem was one that I was not familiar with and both of these factors were unique and interesting to me! Katherine's perspective and attitude is something we all can learn something  from, especially as OT's.  At one point she mentioned that she is finding joy in the life she has and not the life she wishes she has and the really spoke to me! As OT's we are not just there to improve occupational performance, we are there to help our patients mentally and emotionally with a new normal they may be faced with and I think this story is an awesome reminder of that! I would definitely recommend this video to anyone because it is so uplifting and inspiring and really puts life as we know it into perspective! 

Kelly Bryant July 25, & Bryant, K. (2019, July 25). 'Having a Stroke as a New Mom Changed Everything, but I'm Treating It Like a Gift'. https://www.parents.com/parenting/dynamics/having-a-stroke-as-a-new-mom-changed-everything-but-im-treating-it-like-a-gift/?utm_source=facebook.com. 

https://www.parents.com/parenting/dynamics/having-a-stroke-as-a-new-mom-changed-everything-but-im-treating-it-like-a-gift/?utm_source=facebook.com&utm_medium=social&utm_campaign=health_health&utm_content=video_internalcrosspromotion9

Brain Protection (Neuro Note 1)

     While studying neurobiology, we are taught about how the brain grows throughout the lifespan, the job of each specific part of the brain, potential injuries or illnesses that can happen to our brains and how all of these things affect our occupational performance. One of the injuries that our brains can sustain is an acquired brain injury (ABI), which is damage that the brain has acquired, meaning it was not present at birth. ABI's can be further divided into traumatic brain injuries (TBI) like car crashes and falls and non-traumatic brain injuries (NTBI) like tumors and strokes. TBI's, especially concussions, have always interested me because of my passion for sports and the risk that playing these sports brings. For 4 years, I was a Division 1 collegiate soccer player and for 4 years I had a ball hit my head every single day. During those years, I didn't think much of what that impact could be doing to my brain because that sport was paying for my education and I simply was not aware of the risks and the questions to ask. However, as I look back on those years with my broadened education I realize how much harm and permeant damage I was possibly bringing to myself. With this in mind, I found a TedTalk by Kim Gorgens titled "Protecting the Brain Against Concussion". Once I saw this, I knew I would have to watch and get more information about an injury that affects so many people like me.

     Kim Gorgens begins her talk by telling us that she is a mother. A mother that is a worrier, sometimes neurotic, a little crazy and really really loves her son. She is such a worrier because she is a neurobiologist and her son wants to play football. She goes on to explain her reasoning for worrying is because of the force of which a football hit can cause. A football hit can cause 103 G's compared to a punch in the face by a professional boxer, only 58 G's! Gorgen's also mentions that a concussion isn't just a loss of conciseness but a change in it, which can include headache, irritability, dizziness, confusion, slurred speech and nausea and vomiting. I also found it important that she mentioned that our brains are strong and want to repair themselves and that our brains are designed to recover from one injury. However, there is a key word in that previous sentence and it is the word "one", so in sports when the head has the potential to be repeatedly hit and damaged, is when long term issues start to arise. Once you sustain one brain injury, the likelihood of you sustaining a second increases exponentially! The last thing that she mentioned that I think is extremely important for anyone are 3 things that we should do as parents, athletes, coaches or really anyone. First, study the issues. Be informed on the risks you are putting your body in and make informed decisions. Second, speak up. Speak up to coaches and trainers about safety equipment and precautions in sports or how serious they are about concussions. And third, suit up. When participating in a sport or an activity, like riding a bike or football, and you are able to wear a helmet, do it!

     After watching this TedTalk, I wish I would have taken my brain's health more seriously when I was playing sports. This video showed me statistics regarding concussions and sports and also showed me possible risks and multiple ways that I can decrease or eliminate risks in order to keep my brain as safe as possible. I highly recommend this TedTalk for anyone interested in concussions related to sports and anyone interested in protecting their, or their kids or athletes, brain against concussions especially when playing sports! I attached the ink below in case this topic is of interest to you!

https://www.ted.com/talks/kim_gorgens_protecting_the_brain_against_concussion?language=en#t-535585

Kim Gorgens. (2010, May). Protecting the Brain Against Concussion [Video]. Ted Conferences.https://www.ted.com/talks/kim_gorgens_protecting_the_brain_against_concussion?language=en#t-535585

Social Determinants of Health and the Nervous System

     Social Determinants of Health (SDoH) are where people spend the majority of their time and include the conditions that they live, work, eat and sleep. It also includes social supports, socioeconomic status, and access to healthcare. Simply it is what makes people sick. However, when you go to the doctor, you don't get asked about your SDoH even though they can be traced back to an illness especially ones affecting you nervous system. For example, if you are having to work 2 jobs to be able to pay for food and rent every month you will be in a constant state of stress. When you are in this constant state of stress, the amount of cortisol being released will negatively affect your entire brain. Cortisol will decrease the number of neural connections in your hippocampus, enlarge your amygdala and even make your PFC completely shut down. If this state of stress become chronic it will lead to your brain not working at full capacity, having more trouble making decisions and controlling behavior.
     As it becomes more difficult to control behavior and make decisions, you will find yourself making impulsive decisions and not using logic. Impulsivity can become dangerous and lead to addiction when alcohol, drugs, and unsafe sexual practices are involved. Addiction causes you not to be able to control your body's decisions despite their negative consequences. Addiction to alcohol may result in cirrhosis of the liver and acute liver failure and even death. Addiction to marijuana may lead to abnormal neural connections that affect reward, cravings and thought control and affect thinking memory and learning. In all cases of addiction, the brain's reward system and regions that control judgment and decision-making are negativity affected.
     In the TedTalk by Rishi Manchanda, it is reported that heart disease was linked to green space. Meaning that the closer you lived to green space like parks and trails for fresh air, the lower your risk of heart disease. These numbers were collected throughout a broad spectrum of neighborhoods, so not matter how rich or poor you were it still held true. Which leads to the conclusion that zip codes matter more than genetic codes. The social determinants that you are made of are the reasons that you are who you are and why you get sick the way you do.
     Being a student in UTHSC's MOT program requires a certain amount of public service and professional development hours to be able to graduate. These hours have helped prepare me to be the best possible practicer by pushing me out of my comfort zone. Many opportunities require meeting people you do not know and who you would normally not be in contact with. This enhances my social skills and being able to adapt to any situation that is thrown my way. It has also help with my advocation of OT and perfecting my elevator speech for numerous different populations. Now I am able and confident in being able to inform members of the community or anyone I am in contact with what OT is and why I have such a passion for it.
   

Locomotion & Adaptive Devices

     Our clients will put their trust in us as OT's to do what is best for them in order to help reach their goals. So, when adaptive devices are needed, it is imperative to make sure that we know how to properly fit them for many reasons. First, each client will have unique body mechanics and measurements and the adaptive device needs to be specific to them to ensure safety at all times. Second, correct measurements will not allow additional pain or injury to prevent conditions such as pressure ulcers. Knowing the client's limitations and capabilities including their physical conditions, age, endurance and psychological condition will allow us to make the safest and most appropriate adaptive device decision.
     If the client is stable on their own but needs occasional assistance with balance, a cane would be appropriate because it provides the least stability of all the ambulation assistive devices. Different variations of canes include standard, with one leg, and wide or narrow base quad canes which provide four prongs for increased balance compared to just the one on a standard cane. To properly fit a client for a cane, the hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter. The client's elbow should be relaxed, flexed 20-30 degrees and shoulders should be relaxed and not elevated in order to grip the cane easily and most comfortably.
     Another device that a client could need to provide more stability than a cane are crutches. One of the types of crutches are Axillary crutches and, to properly fit the client, all of the same criteria of the cane are used with addition to the axillary rest being 5 cm below the floor of the axilla when the shoulders are relaxed. This is important to note because contact with the axilla area can result in increased pressure and potential damage to the Brachial Plexus. Another type of crutches are the Loftstrand crutches. These are used for clients that have long term disabilities and need more support than a cane provides, but less support than the previously mentioned axillary crutches. These crutches require the correct fit of the cuff around the proximal forearm along with the correct hand grip fit, which is the same qualifications of the cane and axially crutches.
     As the client's need for stability increases and canes and crutches are no longer provide enough, walkers are the best option. The same criteria is used when fitting walkers as it is used for canes. Walkers provide three or four contacts with the ground and vary in amount of stability based on the different types. One type of a walker is the platform walker which is used for a client that is unable to bear weight though wrist or hand because of a fracture or other injury. It is important to correctly fit where the trough or platform supports the forearm to ensure comfort and no further damage or injury to the forearm. Another type of walker that can be used is the rolling walker. Rolling walkers are the same as standard walkers however, they add wheels.The addition of wheels is ideal for a client who is lacking the UE strength to lift a standard walker but still needs multiple contact points for support.