Neurotransmitter Project: Acetylcholine

Implicit Bias

    A bias is defined by dictionary.com as a tendency, inclination or opinion especially one that is preconceived or unreasoned. When our brain does this automatically and unconsciously it is then considered an implicit bias. Implicit bias is your brain's automatic processing and grouping of stereotypes, attitudes and beliefs unconsciously. As humans, we all would describe ourselves as being fair, or at least believing in things that promote fairness. Every person should have an equal and fair shot to get a certain job, to buy a car and to really do anything! With fairness being a characteristic that we as humans strive for, how do we know if we actually are fair? Or if we are letting implicit biases shape our actions and ways of thinking? In order to get answers there are multiple resources and techniques to put implicit bias to the test. This includes things like a self-analysis survey, implicate associations test and understanding when implicit biases are more likely to come through. With self-analysis surveys and association tests, an online test will see how you naturally group things or how you associate certain words and generate specific results. This will help you identify your specific beliefs and feelings and hopefully encourage you to open up and try to break these stereotypes apart. It is also an important tool to realize that implicit biases are more likely to arise in situations when you are stressed and under pressure. It is important to focus on identifying these times and focusing on slowing down and breathing to make the most fair and open-minded decision.

     As OT practitioners and students, it is a very useful and important to learn about implicit bias. We are taught through our education and career that we need to be life-long learners about the field of OT, but it is no different with implicit bias. Teaching yourself to not have these automatic groupings and thoughts is not something that can be learned in an afternoon, it is a life-long process. It is especially important for us as OT's to act in this way because of our strong belief in occupational justice and that every single person has the right to therapy! If we are having implicit bias, we would not be providing the most fair and just services to our clients. The biggest take away I had from learning about this topic is that implicit bias is not something to be ashamed of. It is an automatic unconscious thought of your brain that you need to be aware of and not hide. However, once you are aware of this, it is imperative that you are striving to break the bias and train your brain to not automatically group these beliefs together. 

Scapulohumeral Rhythm

     The scapulohumeral rhythm is important in movement and to obtain  full ROM at the shoulder. This rhythm is present in shoulder elevation, flexion and abduction and really whenever you are reaching to grab something in a tall cabinet at work or for a snack on the top shelf of the pantry. In order to perform this movement the scapula, humerus and glenoid fossa must move and work together. As the scapula moves upward, the glenoid fossa will tilt up to maintain contact with the humerus that is rolling superiorly. It is imperative that they all work together because each part  contributes to total ROM and if one part of this chain is not functioning properly, there will be a decrease in ROM. The scapulohumeral rhythm also helps maintain the subacromial space which will result in impingement and pain if not maintained. This impingement can also lead to rotator cuff muscle weakness and scapulthoracic muscle weakness which will negatively effect the dynamic stabilization of the shoulder. The scapulohumeral rhythm collaborative motion is caused by the shoulder being classified into two joints: scapulothoracic (ST) and the glenohumeral (GH) joints. These joints have a 1:2 ratio for shoulder movement. This means that for every 3° of shoulder movement there will be 1° at the ST joint and 2° at the GH joint. So for a full ROM at the shoulder of 180°, 60° will come from the ST joint and 120° will come from the GH joint. These joints working together will allow for joint congruency which will result in decrease shear forces and will permit optimal length tension relationships for the abductors muscles. Without scapulohumeral rhythm, full shoulder ROM will not be achieved and pain and impingement are likely to occur.

Test Positioning: ROM & MMT

     As an OT, it is imperative that you use bony landmarks and proper positioning when measuring a clients range of motion (ROM). By finding the bony landmarks, it ensures the therapist has the correct placement of the axis, stationary arm and moveable arm on the goniometer to get a precise and accurate reading. The correct placement is also important because with every therapist using the same landmarks and positions the inter-rater reliability will be higher and it will not become an issue if different therapists work with a client. Palpating bony landmarks will also identify any bony or soft tissue irregularities. Along with correct placement of the goniometer, proper positioning of the client is important to ensure that the client is in a comfortable position that allows for full ROM of the joint being measured. This will allow for the most accurate and precise measurements.
     When working with manual muscle testing (MMT), the "test position" is also a very important component. An optimal test position would be in mid-range position of the movement which is where the highest number of cross-bridges are formed and the ideal length-tension relationship is. Another component of MMT is a testing positioned that is gravity eliminated. This is when the client can not resist the force of gravity so the position of the client will be moved so that the movement is done parallel to the ground. With client being in a gravity eliminated position, it allows the therapist to be able to palpate small muscle contractions that may be happening.

Biomechanics AA for Drinking Coffee

     Each morning I wake up and I drink a cup of coffee. My starting position for this is my elbow fully extended, shoulders adducted as my arms are hanging to my side and I am standing at the counter. In order to grab my coffee cup from the counter my major joint will be my elbow joint. My elbow joint will move in the sagittal plane and frontal axis to produce flexion of the elbow to not only grab the cup but also to bring it to my mouth. The digits of my hand will also be in flexion to grasp the cup and my wrist slightly extended. My end position will be my elbow in full flexion or WFL to be able to drink and the digits of the hand in flexion and wrist slightly extended. The osteokinematics of the elbow from extension to flexion is an open kinematic chain because the distal end of the chain, the forearm and hand, are the segments that are moving. In terms of arthokinematics, the moving segment, the ulna, is concave and will roll and glide in the same direction anteriorly on the convex surface of the humerus. The prime mover for elbow flexion is the brachialis which performs a concentric contraction.

Health Literacy Takeaways

     The term health literacy is something that I thought I knew and understood but when asked what exactly it was and what it meant I found myself at a loss for words. I learned that health literacy is basically the level that a client obtains, processes and understands information and knowledge about their health. This concept is extremely important and gets looked over way too often because of assumptions made by medical professionals. As a current student in OT school I have a basic understanding of numerous medical terms, however there are many times that I have gone to a doctors appointment and left with medicine that I didn't know what is was for or even how to take it properly. I knew that I should ask for help or clarification but it seems embarrassing and just scary, so I do not. This exact situation is what happens with too many clients because they are scared or embarrassed to ask for help. In order to have the healthiest population possible, it is imperative that health services not seem scary to people who may need a little extra assistance. I have learned numerous techniques to help to ensure the best care and information is given to the client. OT's and all other medical professionals and medical offices should offer to help with paperwork and offer to read or explain anything, use pictures and symbols, use bulleted lists instead of paragraphs, highlight main points and even check for understanding by allowing the client to summarize their visit. These are simply steps that can really make a difference in the health and wellness of our clients not only in OT but in every medical profession.
     Another concept that I learned about were the different determinants of health and they levels that OT's help reduce potential threats of them. Determinants of health are basically what makes up you including your genetic make up, individual behaviors, social and physical environment and available health services. These determinants can positively or negatively influence your life and if they are a negative to your well being there are 3 different types of intervention that OT's are able to use to try to combat it. The type of interventions are primary, secondary and tertiary. Primary is having preventative measures in intervention to try to stop a future problem from occurring. Secondary intervention is when a barrier or illness has already occurred but still in the early stages and can easily be controlled; basically a screening stage. The last intervention is tertiary which is when there is an ongoing barrier or illness with lasting effects but we still try to improve quality of life as best as possible. These interventions are simple but extremely important to be aware of and understand the basic principles so that as future OT practitioners we can be well informed and integrate them into our practice while also being able to effectively inform our clients.