Neuro Note #2

Huntington's Disease Film:     

      The material I chose was a short film titled Her Mother’s Daughter. This film followed the O’Donnell family and their experiences with Huntington’s Disease. In the film we see how Huntington’s is affecting the family. Kathi O’Donnell has two children diagnosed with Huntington’s, her daughter and son. Kathi is the care-giver of both her daughter and her grand-daughter. In the film, we learn more about Kathi’s daughter, Meghan. Meghan was diagnosed with Huntington’s Disease when she was only 20 years. When she was diagnosed, she was pregnant with her daughter, Alyson. Meghan and Kathi had Alyson tested before she was born, and it was determined that Alyson would also develop Huntington’s Disease. Throughout the film, we learn many things about Kathi’s family. As far as HD goes, we know that the more CAG repeats, the faster the progression of the disease. Kathi’s son had 51 CAG repeats, Meghan had 68 CAG repeats, and Alyson has 80 CAG repeats. Throughout the film, we see Meghan a couple of times. It shows Meghan is in a nursing home and is fully reliant on the workers to take care of her. Kathi explains that Meghan is cognitively all there, but her body has given up on her. She is in a wheelchair and cannot speak. Meghan was tested for Huntington’s because she started noticing changes in her gait. Since being diagnosed, Meghan’s HD progressed quickly. We also see a focus on Alyson throughout the film. Alyson has Juvenile Huntington’s Disease. She developed symptoms for Huntington’s at the age of 9 and is now 11. We learn from Kathi that Alyson has an incredibly hard time making friends. Alyson attends a medical facility with a school included to make it easier on her. Overall, the film gives a good insight into Huntington’s Disease and not only what it does to the person, but also the caregiver.

         

      I chose to watch a documentary on Huntington’s Disease because I realized that it was one of the topics in class that I had known the least about. I wanted a chance to see Huntington’s Disease and how it affects a family. By watching the film, I aimed to learn more about the disease. I also wanted to compare and apply it to what I have already learned in class. 

      Even after our class on Huntington’s Disease, I still had a hard time picturing what all the symptoms and stages would look like. The film allowed me to primarily learn about the middle and late stages of Huntington’s Disease. Meghan being in the late stage and Alyson being in the middle stage. I was able to look at our study chart on Huntington’s Disease and pull things out that Meghan and Alyson displayed that placed them in those particular stages. In class, we learned that in the late stage, that the person will generally require help in all aspects. We also saw that they would often be in a nursing home. I was able to place Meghan into this stage based on what I saw in the film. In class we learned that the middle stage involved eating, speech, and walking difficulties. Alyson was hard to understand. We also saw that she had difficulty walking and wore a leg brace. By watching this film, I learned a lot about what falls into each of the stages. It is important as an Occupational therapist to know what stage each individual is in so that you can provide the best intervention approaches possible. I also learned a lot about the symptoms of Huntington’s Disease. I saw a lot of motor symptoms including the loss of coordination. I learned what adaptive equipment is often used including leg braces, wheelchairs, and 4-wheeled walkers. I also learned about involuntary movement and noticed Alyson’s arms would go up in the air quite a bit. I learned about the psychiatric aspects of the disease, especially agitation and depression. I saw both of these with Alyson throughout the film. One of the most important things I learned from watching the film was the caregiver’s role. Kathi O’Donnell was an amazing caregiver, who made sure that Meghan and Alyson’s quality of life was maintained as much as possible. Alyson was able to go to conventions about Huntington’s Disease, where she could meet new friends, participate in talent shows, and other events. Even though Meghan was in a nursing home, Kathi still made sure to read cards out loud to her, talk to her, and entertain her. I enjoyed learning more about Huntington’s Disease by watching this sweet and inspiring film. 

Her Mother's Daughter. (n.d.). Retrieved from https://hdsa.org/hmdfilm/

Neuro Note #1

TBI due to MVC: 

      In 2017, my family received a knock on our door from a police officer. The officer asked if we knew of any relatives or had any contact information for our next door neighbor. The officer could only tell us that there had been a bad wreck and that our neighbor would be transferred to a hospital. Since that night, we have been keeping up with the caring bridge website, that her sister has been updating. We soon learned that she was hit by two vehicles that were drag racing. The updates on our neighbor from the hospital were as follows: GCS score of 5, diffuse axonal injury, subarachnoid hemorrhage, intraparenchymal hemorrhage, and TP fractures of C6, C7, and L3. They monitored her vital signs and started therapy five days later. There was no change in her GCS until 17 days later and it only improved to a 6 but even the slightest improvement was good news. They recommended that the family keep her stimulated so that it would help increase brain activity. They were able to get insurance to approve a switch from Memphis to one of the best rehabilitation hospitals in the nation. As far as the rehab went, they were able to get her to support herself and stand by her for balance. She was also able to do fully supported squats. She started remembering things again like what a cellphone is, how to use it and respond to yes or no questions by moving her head. After she was finished with the first rehab center (due to insurance), she was able to get into one of the best rehab centers in Memphis. This was all such great news but unfortunately many things put her back into the hospital and she was regressing. Now, just two years later, she has lost the ability to move her arms and legs. Recently, there has not been many posts about her treatment, etc. so we are not quite sure how or if she is improving. 

      I chose to use the caring bridge blog for my neighbor for this assignment because it was a very real and traumatic event. It was very sad to see something like this happen to someone who I saw almost every day. I also wanted to enhance my learning on her condition and see how it compared to what we have learned in class thus far. 

      When reading the website ,when it initially happened, I honestly had no clue what half of the diagnoses were. I learned a lot by re-reading the caring bridge website and actually looking at the terms and realizing just how bad it was for her. For example, I did not know what a GCS score of 5 meant or even what the GCS was. Each of the terms in the blog were terms that we had learned in class. I learned just how important OT/PT services were to her recovery and that they were responsible for most of her improvements. Also, seeing the impact of what the improvements meant to the family was amazing. This is why Occupational therapy plays such an important role. Even though most of the rehab they discussed on the website was very general, it made her happy and put a smile on her face. Overall, the website helped me use my knowledge learned in class and apply it to her situation. It also gave me an idea on what activities are important to focus on in rehab and at what time. For example, the brain stimulation that was recommended probably played a huge role in her improvement. I thoroughly enjoyed enhancing my learning through this. 

The website is as follows: https://www.caringbridge.org/visit/lisamsloan/journal/index/0/0/asc

Hierarchy of Mobility Skills

The hierarchy of mobility skills is as follows: bed mobility->mat transfer->wheelchair transfer->bed transfer->functional ambulation for ADL->toilet and tub transfer->car transfer->functional ambulation for community mobility->community mobility and driving

This is similar to what I had expected. All of these are arranged in a logical sense, in that you need to accomplish one in order to successfully move onto the next. For example, if you have your client practice ambulation for ADLs after a toilet and tub transfer, it would be very unsafe. Each step needs to be taught and mastered before moving on in order to maximize client safety. I also think that is in this particular sequence because you have to be able to get out of the bed in order to go use the bathroom and so on. Every step is essential for performance in the next step. In the past, I never got to see the full hierarchy of mobility skills. When I was shadowing, it was normally for a day or a couple of days and rarely would I get to see the client progress unless I came back months later. However, I was always informed by the OTs at the centers of the mobility skills and how they typically went about them. Mainly what I saw was that we would do some in bed activity and then try to get them to walk to the bathroom (with a gait belt) or sit in the wheelchair and go to the bathroom. Then we would transfer them to a shower chair or the toilet. This was how I typically saw an initial evaluation performed. Most of the clients that I observed were still able to ambulate but since it was right after a surgery, it became more difficult. I agree with this approach in the sense that is in a logical order that will help promote client safety overall. During our simulations and labs, we always talk about how the main goal is client safety. As a therapist, you never want your client to be at risk for a fall or injury. By teaching and following the hierarchy of mobility skills, you are minimizing the risk of a fall or injury tremendously. The client will also have more confidence in each of the following steps as they are able to successfully perform them in a safe manner. Overall, the hierarchy of mobility skills is a great tool to have to ensure that you are doing everything you can to keep your client's safe and progressing further. 

Assistive Devices

“Fitting” your patient for an assistive device is very important to ensure proper use of the device. Fitting each patient for an assistive device ensures comfort and also helps with confidence. If an assistive device is too high or low for an individual they would have troubles with ambulating. It is important to take in consideration each individual’s comprehension of how to work each device and also teaching them how to use it. If a patient is weak in their wrist or has fractured/broken a bone, then you will need to put this into consideration. In summary, the needs of the patient are the top priority. Enhancing the comfort of the assistive device and taking into the needs of the patient will allow them to ambulating safely and confidently. 

Cane- First, you will have the patient stand up straight and looking forward with their hands relaxed at their side. You will then line up the handle of the cane with one of the following: wrist crease, ulnar styloid, or greater trochanter. Make sure that when they are holding the cane that their elbows are slightly flexed 20-30 degrees. 

Axillary Crutches- First, you will have the patient stand up straight and looking forward with their hands relaxed at their side. The arm pad will need to be 1 to 1.5 inches under the armpit (axilla) or 2/3 finger widths. The handgrips will need to be in line with the wrist crease, ulnar styloid, or greater trochanter. 

Loftstrand Crutches- First, you will have the patient stand up straight and looking forward with their hands relaxed at their side. The handgrips will need to be in line with the wrist crease, ulnar styloid, or greater trochanter. Additionally, you will need the arm band to be positioned about 2/3 of way up the forearm.

Platform Walker- First, you will have the patient stand up straight and looking forward with their hands relaxed at their side. The platform surface should provide support when the elbow is bent 90 degrees (patient standing tall and scapula is relaxed). Make sure that the proximal portion of the ulna is about 1 or 2 inches off the platform surface. For the opposite hand, you will need to line the handgrip with the wrist crease, ulnar styloid, or greater trochanter. In the affected hand, position the platform handle slightly medially. 

Rolling Walker- First, you will have the patient stand up straight and looking forward with their hands relaxed at their side. The handgrips should be in line with the wrist crease, ulnar styloid, or greater trochanter. Elbows should be flexed about 20-30 degrees when holding the walker. 

Proper Posture and Body Mechanics

Proper posture is one thing that we hear about all the time but to be honest, most people will push it off (like myself) and do not actively practice it. Proper body mechanics is also something that most people have trouble with. For example, when picking something up off the floor, like a heavy box, most people will lift with their back instead of their legs. Poor posture and body mechanics can lead to a variety of issues. As Occupational therapists, we will need to learn to address these issues and help prevent our clients from developing these issues. 

4 reasons why proper posture and body mechanics are important: 

Poor posture and body mechanics can cause:

- abnormal development of structures in the body like bones, tendons, tissues, etc. 

- deterioration of bones, muscles, etc. 

- shortening and hardening of muscles, tendons, skin, etc.

- decreased proprioception 

- both poor posture and body mechanics can cause fatigue and stress on various aspects of the body

IN A SUM… poor posture and body mechanics can cause unnecessary and PREVENTABLE problems. It is essential to educate others/yourself and bring awareness to the proper posture and use of body mechanics.

Proper posture and body mechanics are all about maintaining balance of the body and providing a strong base of support for all parts. 

Ways to teach and use proper posture and body mechanics in intervention:

-      I would educate the client and use a method called the broom stick method to make sure that they are keeping their back in a neutral position, lifting objects with their legs, keeping their feet flat, and the object close to their body. Education is the first step for a client to know what it correct. 

-      I would also help my client when they deal with fatigue. For this, I would tell them to carry smaller loads if at all possible and to move their feet instead of twisting their body. I would also tell them to change positions and to take breaks in between lifts. 

Man from the South

In the story, Man From The South, an old man makes a bet with a young soldier. If the soldier loses the bet, he is to allow the old man to chop off the little finger of his left hand. The soldier makes a remark that it should be fine as he has never found much use for that finger anyhow. However, the pinky finger aids greatly in the ability to grip and grasp different things. It also showed at the end that the wife of the man betting had also bet against him in the past a long time ago. In the story, we learn that the wife has only two digits left on her hand: the thumb and one finger. Both of these characters have many occupations that would be affected by the loss of any digits. In fact, loss of the pinky can account for up to a 33% loss in overall grip-strength. If the soldier (a Navy sailor) were to lose his pinky, he would have trouble in performing occupations that normally came easy to him before. Typically a Navy sailor is responsible for steering a ship and maintenance of a ship. One of the occupations that probably would be affected most would be the ability of the soldier to anchor the ship. When anchoring a ship you have to be able to pick up and grip an anchor to throw down and land in the sand to successfully stop the ship from moving. The inability to properly grip the anchor and chain could result in injury to the soldier and/or others. I’ve seen many individuals wear gloves when working with chains and ropes, so that may allow him to maintain a better grip and grasp on the chain of the anchor to avoid dropping it. I think this would be the best way to avoid injury to himself and others. Another modification that could be made is making sure that his right hand is higher than his left when holding the objects that way his biceps of his right arm is doing the majority of the work and aiding in the gripping of the object. It would take less pressure off of his left arm and grip ability. 

Health Literacy

In Professor Flick's lecture I was really moved by the determinants of health. It was very interesting to learn about these and also the terms of occupational deprivation, occupational apartheid, and occupational alienation. When thinking about health, you think of it in a broader scheme. Often times, I take healthcare for granted. Also, health literacy is a huge issue in today's society that we got to learn about. The thing that got me the most was the video. As health professionals, it is our duty to inform our clients about everything going on and to make sure that they understand. I could not believe what I was seeing in the video where the woman got a hysterectomy and had no idea because she could not read all the papers. Especially in high school and college, I think these jobs and careers need to be pushed more since we are so in need of them. It is such a sad society that we live in where people are not able to have access to healthcare and honestly, we could do much better. Often times you just do not think about things like health literacy and determinants of health but they are so important. As a future Occupational Therapist, I will make sure to ensure that each one of my client's understands everything that we are doing since it is about them.