How Would You Respond?

What do you do when a challenge is thrown at you, or when something doesn’t go the way you planned? Do you let it bring you down or do you turn it around and make the best out of the worst situation? We have recently learned about MS and how so many individuals have this diagnosis. I wanted to hear how it had affected a driven graduate student who was successful in her life. 

            In a recent Ted Talk, Thriving in the Face of Adversity, by Stephanie Buxhoevedem she talked about how she dealt with life when a challenge came her way. She was a graduate student who loved neurology and was pursuing a career as an anesthetist. She also loved to work out but one day while she was working out her leg had become numb. She didn’t think anything about it, maybe it was just a pinched nerve. She kept preserving and the day had finally come that she had been dreaming of, after all the hard work in the classroom it was finally time to be in the surgery room to give her first anesthesia. Before she knew it, her legs were completely numb, her arm was losing sensation and her vision became blurry. She knew something was wrong, it wasn’t just nerves. She then went to the hospital where she was admitted for numerous amounts of test. After days of being in the hospital she was given the news that no one wants to hear, she was diagnosed with relapsing-remitting multiple sclerosis. 

            She had to make a decision to keep pursuing what she wanted or let her MS determine her life. She was reading through some of her paperwork from the hospital, when she read that the doctor said, “she had a poor prognosis”. This led her to the decision of pursuing something new in life. She decided to become a multiple sclerosis nurse to help others with her clinical and own personal advice. She was able to help others with their diagnosis. She also started a website to help those with unanswered questions be aware of the diagnosis. 

            This Ted Talk shows that we never know the future and especially what our unknown is. Stephanie was faced with the most difficult, devasting news, but she had the choice to either deny, cope or thrive. She chose to thrive, and she said that this diagnosis has pushed her and gave her a purpose in life. As future practitioners we can take our own knowledge and help others and who knows we may even be able to give advice of our own. This story is touching because most people will want to deny and cope with their diagnosis, but as practitioners we want individuals to push through their challenges and be able to get the most out of their lives. 

            No matter the situation life will throw a challenge at you and it is up to you how that challenge is handled. The determination and support of others will have a great impact on how individuals can overcome challenges. There is no specific answer to the future, so making the best of the outcome can have a larger impact on your life and on others’ lives more than you think. So as future therapist we need to be holistic in all approaches. We need to let our patients know that we will support them and help them when they need it most. 

 Reference:

Talks, T. (2015, April 03). Thriving in the Face of Adversity | Stephanie Buxhoeveden | TEDxHerndon. Retrieved July 30, 2019, from https://www.youtube.com/watch?v=zuLOT6GsAxw

Sheryl's Perspective

            I was not for sure what Myasthenia Gravis was until hearing Sheryl’s touching story. She was a young girl, only 16, when diagnosed with MG. She was going about her childhood when she started noticing symptoms. She was very active in softball and had many friends. She started to experience extreme fatigue in her arms legs and hands. Then she started to notice a droop in her eye that kept getting worse. She was also having difficulty chewing foods and keeping her mouth closed when eating. She went to the doctor where they couldn’t really diagnosis her because they didn’t know for certain what was going on. She went to an eye doctor because her eyes continued to get worse. The doctor knew something was not right and wanted to do an ice test in the office to test for myasthenia gravis, it was then that he was for sure that was her diagnosis. They later sent her to the hospital to confirm her myasthenia gravis diagnosis. 

            She had to learn how to adapt to some things she was so used to doing. She had to give up playing softball because it was too much exertion on her muscles. She was not able to attend school for a few months because her body was so weak. She was so excited to finally be attending school again, it gave her a routine. She liked to stay busy and to be involved, it made her feel like a normal teenager again. Even when she had to go to the hospital for treatments, she stayed in touch with her friends to keep them updated and they gave words of encouragement. She also talked about how she still likes to go fishing, ride four-wheelers, and even take her sister for short walks because the long ones make her tired. She also has a bunny that she loves to take care of because it keeps her from thinking about her disease.

            She gave a great insight on what the disease meant to her and how to explain it to others in terms that could be understood. She talked about how her symptoms were being shown and how they would differ each day. She also talked about the different treatment plans and how one worked better for her than the other. 

Just because she was a teenager didn’t mean that she didn’t have a voice. Each story is unique in its own way and as therapist we need to observe the person as a whole, not just by their diagnosis. Each client will be involved in many occupations and all have different ways to handle things. Each client will also have different symptoms and different limitations. Listening to the whole story and giving them a sense of independence along with meeting their needs could be the most important thing in their life. 

Just like Sheryl, she knew some days were going to be better than others, but all she cared about was being able to have a meaning in life and enjoy a life like her friends. I truly encourage others to watch this video. This video explained Sheryl’s outlook on Myasthenia Gravis, and it helped to understand that each client has a story and different symptoms. Therefore, understand the person and their story and not just their disease.

Reference

Carter, B. (2014, October 23). Sheryl and Myasthenia Gravis: How I Cope! Retrieved July 31, 2019, from https://www.youtube.com/watch?v=UZU2nTf6_cc

Would You Change Your Outlook?

As a student I was interested in learning about Huntington’s disease, but I got way more than that after watching “The InnerKid Philosophy: Kristen Powers” on TedxTeen. I chose this topic because my aunt was recently diagnosed with Huntington’s disease within the last 5 years and I know the affect it has had on my family. Kristen shared her story of losing her mother to Huntington’s disease. Huntington’s is genetic, and it affects movements, speech, and even thinking. It was stated in the video that if you combine Parkinson’s, Alzheimer’s, Dementia, bipolar disorder, and ALS you will get a different type of Huntington’s disease each time. Kristen’s mother became diagnosed in 2003. She was old enough to witness the changes it caused on her mother’s health, both physically and emotionally. She watched her fall and get scrapes on her knees. She even watched her behavior change so much that it sent her to a mental hospital. Thereafter, she was sent to a nursing home since she wasn’t going to get any better. Her mother finally did not have to suffer anymore and passed away in 2011. After going through such a difficult time, it made her think about her future. And honestly who wouldn’t? Is it best to know what your future holds? Would you want to know if you only had months to years to live? When events like this happen in our life’s we can either chose to pick a path that can not only benefit us but others as well. We could take the wrong path and even turn to unhealthy behaviors. Kristen started a campaign that made people see that childhood doesn’t have to be the best time of your life. She wanted to spread the fun out and enjoy life every day and not just during her youth. After watching her mother decline, she knew that it’s not known how much time you have and being able to enjoy things throughout your life is very important. She recently turned 18 and has decided to get tested and find out if she has the disease. Through the InnerKid program she started she’s going to document her journey. Even though she didn’t want to know back then she does now, because it pushed her to enjoy life every day. Not only that, but it could help other individuals learn and even change their outlook on life and enjoy every second of everyday. The wisdom of not knowing pushes us to challenge ourselves and go for what we want in life. Kristen may or may not have the disease, but it was through the story of her mother that inspired her to try her hardest and chase her wildest dreams.

I can say with my whole heart that after losing loved ones to diseases or any other event that their story and lives have a major impact on the unknown. I would have never heard or even thought about wanting to become an occupational therapist. I would have never gone out of my way to start dating a guy that lived 1,400 miles away from me, but I did because he brought joy back to my life. I would have never left home and wanted to better myself for the future. I wouldn’t have the opportunity to grow and give encouragement to individuals that need a little extra encouraging in their life. No, we do not know the future, but we do know that each day is truly a blessing and if we can do anything to help others or even watch ourselves grow, we are living our life to the fullest.   

As future therapist I think we can help our patients apply this to their lives. That each day is full of different possibilities. Some can be good and some bad, but that it is best to take it day by day and live it to the fullest. While providing our services we can provide positivity throughout what might be the most difficult time, or even encourage them to live out their lives with the independence they have regained. So, what do you want to accomplish in your life? Would you change your outlook if you only had months to live? 

Checkout this TedTalk and see if you change your outlook on life.
https://www.youtube.com/watch?v=l6JiBiMqiI4  

Reference

Talks, T. (2012, April 13). The InnerKid Philosophy: Kristen Powers at TEDxTeen. Retrieved July 21, 2019, from https://www.youtube.com/watch?v=l6JiBiMqiI4 

Confidence and Mobility

Mobility is the constant state of instability. Therefore restoring confidence in mobility to perform occupations is an important factor in life. For an individual to be moved safely and with confidence, involves being comfortable with a small base of support, the line of gravity is outside of the base of support near the limit of stability, and the center of gravity is moving. The hierarchy of mobility skills is a great way to restore a clients confidence, no matter the level of independence they have. Based on this hierarchy the client can start at a level of functioning that is best for them, then as a therapist we can help that client build up from there to reach a state of stability and independence. The hierarchy of mobility starts with bed mobility and increases with --> mat transfers--> wheelchair transfers--> bed transfers--> functional ambulation for ADLs-->  toilet and tub transfers--> car transfer--> functional ambulation for community mobility--> community mobility and driving.

I agree with this hierarchy of mobility. My previous job in an inpatient rehab allowed me this opportunity. I have seen this hierarchy applied to many different clients, not only in occupational therapy, but physical therapy too. This approach to mobility is great for increasing trunk control as their stability becomes more unstable. It is also a great approach for a client that may have problems with orthostatic blood pressure and increase their ability to regulate BP as they increase in mobility. This hierarchy is not only helpful for the client, but also the therapist. It helps reduce fall risk, injury, and help to build confidence. 

I think this approach is very helpful because after SIM labs, it showed that transferring from the bed to the wheelchair vice versa can be very tiring and if the client is not strong enough they may need more help to transfer. Bed mobility allows them the chance to control how they move and increase strength. Even moving from the bed the a mat will allow them the ability to still build strength and confidence that they can transfer safely. Each level will get more challenging, and at each level you can strengthen the client to prepare for transfers. Even if they are not completely independent they can be safe and feel confident in whichever transfer they are performing. 

I personally never knew there was a hierarchy explaining this, I thought it was just what the therapist thought was best. I really love the fact that there is a specific chart to increase a clients stability and strength to reach a state of independence with mobility. 

The Just Right Fit

It is very important that each client be fitted to their assistive devices. An assistive device can be something like a walker, cane, or even crutches. Each client will have different heights, cognition, endurance and stability levels which will determine the effectiveness of each assistive device. If the client does not have very good upper body strength or wrist restrictions  you do not want to fit them with a device that is going to require the majority of upper body strength and make them push weight through their wrist. Another factor that is important when finding the just right fit for assistive devices is the stability and endurance of the client. You want to allow that individual to feel safe at all times and also have a device that correctly matches their endurance levels. An individual that may have really good stability, but tires easily may need a rollator. An individual that has good endurance, but weak stability may need a standard or front wheeled walker. 

To fit a client to a rolling walker the hand grips should either be at the level of the ulnar styloid or wrist crease. The handgrips can also be placed at the same level as the greater trochanter. Make sure that the client also has relaxed shoulders and the elbows flexed about 20-30 degrees.  

For a platform walker the platform should be adjusted so that weightbearing is allow through the forearm when the elbow is flexed at 90 degrees with the scapula relaxed. the proximal surface of the ulna should be positioned 1-2 inches off of the platform to prevent compression of the nerves. The grip on the platform should be slight medial so  there is a comfortable grip when arm is supported on the platform. 

To fit a client for a cane you want to make sure the client is standing straight forward, making sure they are steady and not going to fall. Along with the walker the cane handle should also be at level with the wrist crease, ulnar styloid, or greater trochanter. The cane can be adjusted with the locking mechanism allowing the client to have 20-30 degrees of elbow flexion. If the client needs a quadcane the same rules apply, just remember that the wider legs face away from the patient. If the legs are not facing away you can adjust them. 

When fitting a client for axillary crutches the height should be based on the appropriate  height of the patient. The hand grips should be placed at the level of the greater trochanter, ulnar styloid, or the wrist crease. The axillary rest should be about 5cm below the floor of the axilla with the shoulders relaxed. This is about 2.5 inches or a palm's length distance to fit under the arm. 

To fit a client with lofstrand crutches the arm band should be placed 2/3 of the way up the forearm. An important tip to remember is that the hand grips should always face forward to promote a proper gait.

There are many different types of assistive devices that accommodate for weightbearing status, endurance, stability, and decreasing fall risk of the client. Consider the needs/goals of the client when finding the right fit in assistive devices, and ALWAYS remember to use the gait belt when transferring or walking with a client. 

Body Mechanics

Why is proper body mechanics and posture an important factor? Body mechanics and posture work together to prevent injury and illness. Having poor body mechanics when lifting/moving things increases the risk of back pain. A benefit of having proper posture and body mechanics requires less energy to maintain a state of balance. Proper posture includes keeping your body centered over the base of support in regards to line of gravity when this is disturbed the individual increases risk of falling or injuring ones self. Proper posture and movement helps the body reduce stress applied to the spine and does not strain the body's muscles and ligaments. Posture is also involved in joint function and when the alignment is off it causes stress and the degeneration of different joints. Another factor associated to poor posture is a more difficult time breathing, if the body has proper posture the chest is able to expand. It is important to teach good body mechanics and posture to individuals because they are reducing their risk of injury, illnesses, and joint and muscle damage while increasing the spines stability. 

During an intervention of teaching a client body mechanics and posture the first thing I would do would be to have the client stand against the wall if possible to explain correct body posture. While against the wall the client needs to have their heels to the back of the wall, the shoulders against the wall, with the chin tucked and head down while against the wall as well to demonstrate proper posture. I could even have the client show me what they think correct posture is to them and correct where necessary. Next to assess body mechanics I will get the client to make sure they have their feet placed shoulder width apart or large enough to have a good base of support. Reminding the client that when lowering down to grab something and lift back up to bend at the hips and knees and not at the waist which stresses the back. They also may need to be reminded that when using proper body mechanics the neck pelvis and back should all be aligned remembering not to twist at the waist, which will cause back pain and or injury. Lift with the legs and arm muscles not your back and keep the object close to was it level. The client can practice this while using a stick placed on their back to make sure their alignment is correct or they can perform an activity while the therapist observes and corrects their posture. 

Man From The South

In the story, Man From The South by Roald Dah the soldier made a bet and if he lost this bet he would lose his pinky finger. If the soldier would have lost the bet, his ability to have a strong grip strength in his pinky would not as strong as needed. Upon losing the bet the wife might have to help with taking care of the man. One way that her life may be impacted along with his is going to the restroom. After using the restroom one must be able to wipe and if the grip strength is not present it would be difficult for him to clean himself so his wife may have to help it. They could work on exercises to increase grip strength of the other digits or make adaptions to going to the restroom.  They could also use a type of assistive device to help the man go to the restroom independently. Using a long handle bottom wiper that has a grip that includes only the three jaw-chuck grasp or even the lateral grip could make cleaning the bottom easier. Another way would be to have a device installed on the toilet to clean the soldiers bottom. This type of technology may have been more difficult to come by so using therapeutic exercise along with an assistive device to clean himself may promote more independence  for both the soldier and his spouse.