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Showing posts from June, 2020

Social Determinants of Health

Social determinants of health are the circumstances in which people are born, live and work in that influence their health status. This includes a person’s socioeconomic status, employment, education, friend/family support, neighborhood, housing, physical environment, and access to healthcare. Social determinants of health are very relevant to health conditions involving the nervous system. Some examples could be carpal tunnel syndrome, traumatic brain injury (TBI), spinal cord injury (SCI), stroke, etc. These conditions may be experienced as a result of a person’s social, behavioral and biobehavioral factors. Social factors could be income, education, culture, family/friend support. Behavioral factors might be diet, tobacco/alcohol use, physical activity, sexual practices, etc. Lastly, biobehavioral factors could be stress, psychological health, allostatic load, etc. For example, a person may have a stroke due to years of unhealthy behavioral choices. As Dr. Rishi Manchanda noted in ...

Adaptive Devices

Comfort and independence are two of the most important reasons for ensuring the appropriate "fitting" for patients using assistive devices. If the assistive devices are not appropriately fitted they can cause pain or discomfort and may do more harm than good. The goal of using assistive devices would be to enhance independence in ADL's. The appropriate fit is necessary to accomplish this goal.  Here are a few examples of how adaptive devices should be fitted for patients to achieve optimal success in ADL's: To fit a patient with a cane the handle should be in line with the wrist crease, ulnar styloid or greater trochanter. Adjustments can be made by releasing the locking mechanism and pushing the button to move the cane to the correct height. The correct height will correspond to 20-30 degrees of elbow flexion.  For axillary crutches the length should be approximately the same length as the distance from the patients forearm to the finger-tips of the opposite h...

Mobility Skills

The order for restoring confidence in mobility skills based on increasing activity demands is a concept that therapists can use to determine where to start with a client who has decreased mobility. The base of the hierarchy is bed mobility, then mat transfers, wheelchair transfers, ADL bed transfer, functional ambulation for ADL, toilet and tub transfer, car transfer, functional ambulation for community mobility, and lastly community mobility and driving. The order of the sequence allows for the completion of one skill to be followed by a more difficult skill. As OT's we want to promote independence. This hierarchy sets the client up to achieve several goals on the road to recovery.  I like this approach because it can be useful for any level of mobility skill. If a client's baseline is ADL bed transfer we assume that bed mobility, mat and wheelchair transfers (if needed) have already been accomplished. I did most of my observation hours in a pediatric outpatient clinic wher...