Health Literacy & Social Determinants of Health Blog Reflection

In the audio clip I listened to this for this session, I learned about the difference in connotation between the term “health disparity” versus “health equality.” They discussed how health disparity often has a negative connotation and suggests that you’re taking away from other people in order to try and “fix” a disparity. On the other hand, healthy equality is a more inclusive, positive term that suggests that all people deserve equal rights to healthcare. It’s important that people recognize the difference in a word’s connotation in order to get a more positive outcome when discussing these concepts. I also thought it was interesting to learn about Dr. Will Ross’ perspective on how to address social determinants of health. I agree with him that it would more beneficial and effective method to have healthcare students have real life exposure to the disparities that different communities have to then help them achieve the deepest understanding. 

Another thing I found interesting that professor Flick discussed was about a study done by epidemiologist that looked at the various professions offered in acute care and their impact on patient/client readmission rates. The results suggested that OTs had a statistically significant role in preventing/decreasing patient/client readmission rates. Possible reasons discussed as to why included; that OTs work to analyze the environment the patient is getting sent home to, they incorporate caregivers into the plan, they address existing disabilities with adaptive equipment (including more than just ambulation aids, like various equipment for ADLs) and they assess the client’s cognition and ability to physically manipulate medical supplies before their discharge. Considering this, it is important to keep these things in mind when developing into an occupational therapist and knowing the impact you can have! 

Scapulohumeral Rhythm

The scapulohumeral rhythm is relevant clinically for several reasons. The first reason being that it is what assists in the synchronized movement of the humerus and scapula. The scapulohumeral rhythm is also clinically significant because it allows for the glenohumeral muscles involved to be in the optimal length-tension relationship, which helps to prevent active insufficiency of these muscles. Another reason it is important to know and understand this concept for clinical purposes is that it's what assists in maintaining the subacromial space - if this space is not maintained in your client, they may have an impingement, which can be painful and lead to other problems, too. Additionally, the scapulohumeral rhythm's joint congruency works to decrease the shear forces of those joints. Without scapulohumeral rhythm, the ability to move the arm efficiently would be significantly lower, which is another reason it's so important! It helps aligns the humeral head and glenoid fossa in their proper anatomical positions to allow for the joint's full range of motion. Therefore, it can also affect range of motion measurement of the shoulder; if the scapula and/or humerus is not moving properly, it is likely that the range of motion of the joint will be lower than the average range of motion for that joint (180°). As a therapist, you should be able to consider all of these things when measuring the range of motion of the shoulder to help deduce what may be the cause of a lower than average measurement.  

Importance of Testing And Measuring Properly

Improving interrater reliability and intrarater reliability can be done by palpating the bony landmarks when using a goniometer; this is one reason why it is important to palpate them! It is also important to palpate these bony landmarks to position the goniometer at the correct point of axis and for the arm positioning to produce the most accurate results from the goniometer. It is important to use proper positioning when measuring range of motion to ensure that you are measuring the correct angle and to ensure the client’s safety and comfort.  It is important to have the Manual Muscle Testing position at the mid-range of motion to get optimal muscle contraction – if started too close to the beginning the body is at a mechanical disadvantage, if too far past the midrange of motion the body encounters active insufficiency. Test position is also important for Manual Muscle testing to make sure that the appropriate muscle is being tested. Gravity eliminated position is significant because it allows the therapist, or tester, to determine if the client’s given muscle is able to contract, and how much range of motion is possible without the resistance, or load, of gravity being a factor. 

Biomechanics of Holding Phone

Every day, I check my cellphone for notifications. I first reach for my phone on a surface like my bedside table, or kitchen table. I start with my shoulder flexed, elbow extended, forearm pronated, and wrist and fingers extended. After I bring it towards my face, so I can view it, my shoulder is extended, elbow is flexed, forearm is supinated, wrist is extended, and my digits two through four are extended, while my thumb is flexed. Flexion and extension of the shoulder, elbow, wrist, and digits two through four at the proximal and distal interphalangeal joints all occur in the sagittal plane about the frontal axis. The osteokinematics of the shoulder (glenoid fossa of the scapula and humerus head) is flexion to extension in an open kinematic chain. When considering the arthrokinematics, the moving humerus rolls posteriorly and glides anteriorly on the stable, concave glenoid fossa of the scapula. The primary movers, or agonist, for shoulder extension in this situation are the anterior deltoid and coracobrachialis; these muscles would be eccentrically activating because they are performing negative work on the load and are helping decelerate the arm and phone during this movement. 

Image retrieved from: https://www.google.com/search?q=clip+art+texting&rlz=1C5CHFA_enUS834US834&tbm=isch&source=iu&ictx=1&fir=9EYX_yx_5VcrkM%253A%252C5GQYChCwQa6scM%252C_&vet=1&usg=AI4_-kTTkNB4t2gfbDj7_Q4SILxnWiHzlA&sa=X&ved=2ahUKEwi06IfpyrLhAhUEPq0KHXplBz8Q9QEwCHoECAcQFA#imgrc=9EYX_yx_5VcrkM:

Session 25 Blog

The Prezi that I listened to taught me several things. Firstly, I learned that the main goal of assistive technology is to facilitate function and engagement for people with disabilities. I also learned that legally assistive technology includes the services that help people with disabilities assess and discover what assistive technology they could benefit from utilizing. In addition to this, I learned that there are three levels of assistive technology low, medium and high. Low tech is the most basic, typically the least expensive and usually easy to use. An example of low tech could be an adaptive spoon. Medium tech is a little more expensive typically and sometimes requires training to use. High tech is commonly the most difficult to use and very often the most expensive. An example of high tech could be an adapted laptop. I also learned about the assistive technology process; beginning by looking at the client’s strengths, weakness and goals; then considering the available resources. Following that, the client should then have the opportunity to try out a variety of assistive technology to see which works the best for them. Ideally the client should be able to try out a minimum of three in the natural setting they would be used in. The final step of the assistive technology is implementing that assistive technology for use. One idea that was reinforced from my existing understanding about assistive technology is that research suggests assistive technology does not typically hinder engagement, but conversely actually assists in a development. 

The TED talk that I watched was very insightful, and I appreciated getting to listen to the perspective of someone with a hearing impairment. The idea that universal design should be talked about more, and not just for the benefit of people with disabilities, but the benefit of all people is an important concept to grasp and may not be something people without disabilities typically think about. Furthermore, I think it’s even more vital to emphasize that creating and providing universal design does not“slow down”people without disabilities, but instead benefits everyone as whole and helps ignite innovation. 

Finally, the Podcast I chose to listen to was titled “Can Occupational Therapy Help with ADHD?” I learned that ADHD and sensory related diagnosis, such as Sensory Processing Disorder, are commonly associated together. One strategy that I learned about was called the sensory diet, which involves people taking “movement breaks” every hour, to hour and half, to help reduce undesired or maladaptive behaviors related to ADHD. I also learned about Dunn Sensory Profile evaluation which indicates four different types of sensory profiles ranging from sensory avoidant to sensory seeking. Because ADHD and sensory are often commonly intertwined, it is beneficial to note that often making minor changes to an individual’s environment can make a big difference! 

The Therapeutic Relationship

Before our class lecture on the therapeutic relationship, I had heard of it before. In my undergraduate major, therapeutic recreation, we discussed how important this was for your ability to be the most effective therapist possible. Some good examples I have seen in the past, have been at some of my undergraduate practicums - people who actively listened, collaborated with clients and their care team, and advocated for their clients needs demonstrated some of the best characteristics of a therapeutic relationship in my opinion. I personally worked very hard at one of my practicums to establish appropriate boundaries - the population was adolescent youth who were diagnosed with mental health and/or behavioral conditions. Because I was new to the field and very close in age to some of the residents, it was especially important to maintain professionalism. I did this by establishing boundaries from the beginning, for instance the facility required us to use our last names only, so I was Ms. Denton. It was important to me and sometimes even difficult to maintain the balance of them feeling comfortable enough with me to work on building our relationship, versus them feeling like I, their activity therapist, was a peer that they could treat with less respect, and cross boundaries that shouldn't be crossed. All of these elements are good things to consider when working on building a therapeutic relationship.

The History that People with Disabilities Have Experienced in the US

Both Dr. Keisling and the TED Talk discussed how previous generations associated disabilities with danger and were fearful of people with disabilities. Societies response to this way of thinking was to remove these people from society via institutionalization, which lasted for an extended period of time ranging from the 1900s to the 1980s. Throughout this time, and presently there have been advocates pushing for equal rights and autonomy for people with disabilities. While much progress has been made, there still is much more to build upon, improve and innovate. 

The lecture and the TED talk tied into several topics discussed during the era presentations. The lecture went much more in depth about Rosemary Kennedy and the way she was treated, which was very interesting and saddening to learn. As time went on John F Kennedy and his family eventually made strides in government to improve the rights for people with disabilities, but there was still much more improvement to come. Dr. Keisling also discussed the IDEA, which is something my group covered in our era project, as well. Furthermore, he discussed how children before the Education for All Handicapped Children could be, and were denied schooling. The woman in the TED Talk also discussed this and how she instead was offered a teacher who would come to her house for only two hours a week. 

Knowing more about the history that people with disabilities have experienced will impact my future as an OT in several ways. The first way it will is by keeping this history in mind, it will remind me to advocate for my clients and the services they deserve, in addition to the community of people with disabilities as a whole. Another way that keeping in mind this history will influence my future as an OT is to realize that there is always room for improvement and growth. I want to remind myself that just because I learned something at one point and time, doesn't mean it's going to be "correct" forever. Not only do I want to adapt and work to understand new ideas and concepts, I want to be able to contribute to them!