The Scapulohumeral Rhythm

The scapulohumeral rhythm is defined as a ratio of movement between the scapula and humerus. It is the collective movement of the scapula to maintain congruency of the glenoid fossa and the head of the humerus. This rhythm consists of upward rotation, posterior tilt, and lateral rotation, and the movement between the glenoid fossa and humeral head has to be synchronous. The scapular rotation allows for the shoulder abductor muscles to maintain an ideal length-tension relationship. The upward scapular rotation helps sustain the subacromial space that is located between the subacromial arch and head of the humerus, preventing impingement. The scapulohumeral rhythm is needed for efficient arm movement, full ROM, and a good muscle length-tension between the shoulder abductor muscles, which are the deltoid and supraspinatus muscles. Additionally, the rhythm increases congruency of the glenoid fossa and the head of the humerus. For every 3° of shoulder movement, 1° is at the scapulothoracic joint, and 2° is at the glenohumeral joint. Likewise, the ratio of the scapulothoracic motion and glenohumeral motion is 1:2. For example, if the shoulder is flexed to 180°, 120° is produced at the glenohumeral joint and 60° is produced at the scapulothoracic joint. The scapulohumeral rhythm helps prevent active insufficiency of the glenohumeral joint. If there is dysfunction of the scapular movement, there will be an increase of friction at the glenohumeral joint, which will cause pain to the structures in the subacromial space. Lastly, the clavicle, scapula, and humerus all function together to produce a kinetic chain. If there is dysfunction in one joint, that could result in a loss of total motion, impingement, and pain. 

Conceptual Model of the Field

Test Positioning

It is important to use bony landmarks and proper positioning to know how to position the goniometer for measuring ROM. If a therapist uses the wrong body landmark to measure ROM, the results would be incorrect and would not reflect an accurate measurement. The next time the client is accessed, the past measurements would not be reliable. Additionally, if the positioning of the patient or goniometer is not precise, the measurement will also be unreliable. The purpose of MMT is to determine muscle weakness. When examining the purpose of the testing position, it is important to consider the plane of movement for the muscle that is being tested. The purpose of the test position is to place the muscle in a position for optimal muscle contraction, which is in mid-range. In a gravity eliminated position, the desired movement should be carried out so that it is parallel to the ground. When the patient’s muscle that is being tested is too weak, the patient should be tested in a gravity eliminated plane. MMT is most sensitive to changes in the lower grades, (0-3). Thus, a therapist will not apply resistance against gravity if the client’s MMT grade is between (0-3). Also, it is important to notice muscle compensations during testing in order to determine any lack of muscle strength. Compensatory movements may give the appearance of greater ROM. Thus, muscle compensation could lead to inappropriate movement patterns and could cause more damage. 

Biomechanics Activity Analysis

Every morning I retrieve and drink orange juice from my refrigerator.

The starting position of my right arm is elbow extension by my side and it is functioning in a sagittal plane about a frontal axis. Next, I reach forward to open the refrigerator door. My right hand grips the refrigerator door and pulls back. Here, my elbow is moving into flexion as it pulls the refrigerator door back. During this movement, my right shoulder experiences slight shoulder extension, and the end position of my right arm is elbow flexion.  

Next, I reach forward with my left arm towards the orange juice. The starting position of my left arm is elbow extension by my side, and my left shoulder is flexed, which are both functioning in a sagittal plane about a frontal axis. After I have grasped the orange juice with my left hand, I pull the orange juice towards my mouth. The end position of my left arm is flexion at the elbow, which occurs in the sagittal plane about a frontal axis.   

The osteokinematics of the left elbow is extension to flexion in an open kinematic chain. 

In terms of arthrokinematics, elbow flexion occurs at the humeroulnar and humeroradial joints. For the humeroulnar joint, the concave ulnar segment rolls and glides anteriorly on the stable, convex humerous. For the humeroradial joint, the concave radial head rolls and glides anteriorly on the stable, convex humerous.

The prime movers for elbow flexion are the biceps brachii, brachialis, and brachioradialis muscles, which perform a concentric contraction. 

Health Literacy

After engaging in lecture today, I learned that health is not just the lack of illness; it includes physical, mental, and social wellbeing. Occupational therapists support health in many ways, and one of those ways is prevention. In relation to healthcare, prevention involves interventions that reduce potential danger to health. A form of prevention is secondary prevention, which is inhibiting the effect of an illness or injury from getting worse by discovering it early. An example of secondary prevention used in occupational therapy is screening for development delays. 

Furthermore, I learned about health literacy and a client’s perception of health. Health literacy involves the amount of basic healthcare understanding that a client has that is also needed to make appropriate health discussions. As a future healthcare professional, it will be my responsibility to help my clients comprehend and participate in their health decisions. I thought that it was helpful to learn that occupational therapists can help clients reduce their fear and challenges by being sensitive to their vulnerability. Moreover, healthcare professionals should support clients while they navigate through a complex healthcare system. 

Lastly, it was inspiring to learn that patients who are health literate are more likely to make healthy lifestyle choices, have better communication with healthcare providers, and manage their chronic illnesses. Additionally, I learned about a couple different health literacy strategies. Providers do not always know if a patient has limited health literacy. So, healthcare providers should look for behavioral clues. These clues can be missed appointments, not taking medications, and not completing paperwork. Another strategy that I learned was using audio-visual aids instead of written words. This will help patients understand their conditions. 

Leisure Exploration and Creativity with Veterans and Service Members

I was given the opportunity to listen to the Glass Half Full podcast about “Leisure Exploration and Creativity with Veterans and Service Members.” This podcast was hosted by Natalie Barnes and Jessica Kersey, who are both occupational therapists. Natalie and Jessica talked with Rusty Noesner, a US Navy Seal veteran, about using creativity in therapeutic sessions. Rusty is the developer of War Paints, which is a non-profit program that helps service members explore artistic talents, sell artwork, and learn about creative expression. Throughout this podcast, Rusty discussed how creative practices allow service members to experience an internal reflection. Once their creativity becomes reactivated, they have the ability to grow and rediscover different aspects of themselves. 

During this podcast, Rusty offered imperative advice to occupational therapists. First, he said that service members may experience PTSD symptoms after returning from combat: prolonged stress, reliving traumatic experiences from the past, and a chronic fight or flight mentality. Second, Rusty suggested that occupational therapists should use caution with our language towards service members. Service members do not wish to be pitied; they want to be treated like normal people. Next, Rusty said that veterans benefit more from group therapy sessions rather than individual sessions. Group sessions allow the opportunity to discuss experiences and relate to one another. Lastly, Rusty suggested that occupational therapists could foster creative processes by introducing clients to different creative mediums.

 After listening to this podcast, I thought that it was interesting to discover that when creativity is involved, it can bring the brain back to life. Likewise, I thought that it was inspiring that Rusty said, “creativity is not weakness, but it is a strength.” Now, I see that creative stimulation can be used as a tool for therapeutic intervention, and creativity offers a way to process internal feelings. Additionally, creativity is not limited to artwork; it could be woodworking, photography, or music. Overall, I thought that Rusty gave important advice regarding therapeutic approaches for our service men and women.

Blissful Ordinariness

Blissful ordinariness describes the joys that are gained by the independent completion of daily tasks. As a future occupational therapist, I feel thankful to use my skills and abilities to help clients complete meaningful goals. Additionally, it is important to understand that goals are based on the client's wishes. Some goals might seem ordinary, but to the client, the goal means everything. Likewise, goals may seem small on the outside, but to certain individuals, the small goals are the biggest obstacles. Therefore, it is important to view the client holistically. By using a holistic method, occupational therapists guide and support the abilities of the client. The therapeutic relationship between an occupational therapist and the client is special because the occupational therapist looks at the whole person instead of just the injury or disability. The ordinary tasks of daily life are very important to occupational therapists. Small details in the client's story help the occupational therapist gain insight into potential treatment options. In this way, the occupational therapist is able to develop a unique plan for the particular client. Each client has a story to tell and has barriers that may not be the same as another client. Moreover, each person should be treated holistically since everyone has different goals and daily routines.