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.
   

Hierarchy of Mobility Skills

The order for restoring confidence follows the hierarchy of mobility of skills goes as follows: bed mobility, mat transfers, wheelchair transfers, bed transfer, functional ambulation for ADL, toilet & tub transfer, car transfer, functional ambulation for community mobility and finally community mobility and driving. This hierarchy is what I expected because each transfer has an increased activity demand compared to the step before it. This means that each transfer is building on the skills and abilities needed for the previous transfer with the ultimate goal of full community mobility and even driving. You will not be able to perform a bed transfer if you cannot first move, slide and lift your self in the bed so that makes sense why bed mobility is first and bed transfers are later on. In the time I spent shadowing, and with the new information we have gained regarding transfers, I witnessed numerous components of this hierarchy including just the basic bed mobility to slide up in bed or to roll over in order to change the sheets or place a bed pan under the patient. I also saw transfers from the bed to the walker to the toilet to perform ADL'S, but that not past that stage. However, these observations made me agree with this order and how each skill builds upon each other. This course has taught me the importance of body mechanics not only for myself but also for the success of my patients. I am excited to learn more and start to use this new knowledge soon!