Social Determinants of Health

Social determinants of health (SDoH) are factors that include socioeconomic status, money, employment, education, social support, physical environment, and access to healthcare. SDoH are influenced by where people are born, live, and work. Some people are born into situations at a disadvantage and don’t have access to these factors. When these factors are linked to a lack of opportunity, health risks can occur. SDoH affects the nervous system by development and the ability to function. When a person has stress, they experience allostasis; a process of adapting to stress. As the body adapts, one may experience an increase of blood pressure, headaches, and GI problems. Additionally, the allostatic load influences the nervous system, which influences biobehavioral factors. Next, behavioral factors include things like physical activity, diet, and alcohol use. For example, a poor diet leads to the development of blood pressure problems, which leads to long-term consequences and an increased risk of stroke. Lastly, a social factor is no access to the gym, which leads to risky behaviors.

When someone is stressed, their adrenal glands produce high levels of cortisol, which leads to health issues. These health issues could include high blood pressure, obesity, or diabetes. Specifically, high levels of cortisol diminishes the function of the PFC and reduces the number of connections in the hippocampus, causes memory problems. UTHSC’s OT program requires students to complete service and professional development hours, which serves to facilitate career preparedness. UTHSC prepares students to think from an upstream approach, one that considers a client’s living and working conditions, instead of just the diagnosis. Moreover, students learn how to ask important questions, break barriers, work together, and contribute to building health in the community. Now, I understand the importance of the context of a client’s life and can provide the best standard of care.

Transfers

The hierarchy of mobility skills goes in the following order: bed mobility, mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADLs, toilet and tub transfer, car transfer, functional ambulation for community mobility, and community mobility and driving. I think that this hierarchy is in this particular sequence because skills are built sequentially. Moreover, it is important that the client is able to perform the steps that are at the bottom of the hierarchy and then progress to the more challenging skills at the next level. The order of the hierarchy is mostly what I would expect because of my observations at Covington Care Nursing and Rehabilitation. Here at this skilled nursing facility, I observed occupational therapists help clients move up the hierarchy order from wheelchair transfers to bed transfers. I agree to the order of this hierarchy, but I do think that all clients are unique. Thus, not all clients progress at the same rate or order. I believe that occupational therapists are great at adapting to the situation and should encourage clients based on their unique improvements. Furthermore, I believe that safety should be of the highest importance at all times, especially if the client is progressing in a different order.

Posture and Body Mechanics

It is important to teach proper posture and body mechanics to a client who has faulty posture for several reasons. Most back pain is a result of faulty posture and poor body mechanics. By teaching proper posture and body mechanics, the therapist is educating the client on preventing back pain. Clients need to understand proper posture and body mechanics to avoid possible injury, thus, hindering their careers, increasing the time that the client is away from work, and pain. In 2016, the back was reported as being the most frequent injury. Therefore, work related injuries can be costly, leading to expensive medical and lawyers bills. If the client understands proper posture and body mechanics, they are less likely to face injury, miss work, and face expensive medical costs. Back pain could also be from lack of exercise, poor nutrition, stressful situations, smoking, and lack of proper rest. Thus, it is important for occupational therapists to teach their clients on proper posture and body mechanics before injury occurs. An example of a way that I might teach proper posture and body mechanics in an intervention would be teaching my client the slouch-overcorrect technique. This technique is used to improve someone’s posture while sitting. After learning the procedure, the client can practice the slouch-overcorrect technique in the comfort of their own home. Another way that I would teach my client would be instructing them on the golfer’s lift. The golfer’s lift reduces strain on the back and allows the spine to stay straight. The golfer’s lift is used to pick up light objects off of the floor, while still maintaining correct posture and preventing injury.

Advertisements and the Human Nervous System

An advertisement that I have seen that really stuck out to me was one involving two patients at St. Jude. The advertisement asked for donations to help fight childhood cancer, which would contribute to helping the two children with cancer on the advertisement. In order to remember this advertisement, I used my episodic memory, which helped me identify personal illustrations of my life experiences. One aspect of the human nervous system that is primarily involved in my response to this advertisement is my amygdala. The amygdala is a small, almond-shaped part of the brain that is responsible for the emotional implication behind my memories. Additionally, located in the temporal lobe, the hippocampus is another part of the brain where long-term memories are stored and also connect with emotion. Moreover, the hippocampus is involved in the “what” implication of my episodic memory. Both the hippocampus and amygdala are a part of the limbic system, which would motivate me to donate to St. Jude. Next, I would use my prefrontal cortex (PFC), located in the frontal lobe, to make the decision to donate money towards the advertisement. The prefrontal cortex is responsible for executive functions, planning, problem solving, and decision-making. Moreover, the prefrontal cortex takes in emotional and sensory information in order to make a decision and plan of action. After I make a donation and receive a reward (receiving a letter that displayed how my donation helped fight cancer and an item from the St. Jude gift shop) the positive impact on my contribution motivates me to donate again. Dopamine influences the synapses in the reward pathway, so I anticipate a reward and continue to donate. Now, I have a reward pathway that activates the neurotransmitter, dopamine, each time I see a St. Jude advertisement.

"Man from the South"

I enjoyed reading a portion of “Man from the South” by Roald Dahl. During this literary segment, a man made a bet with an American solider. The bet was whether or not the soldier could light his lighter ten times running. The man told the solider that if the soldier won the bet, he would gain the man’s Cadillac. At the end of the story, the audience understood that the Cadillac was not really the man’s car, it was his wife’s car. However, if the soldier lost, the soldier’s little finger on his left hand would be cut off with a chopping knife. Moreover, losing the bet would change the soldier’s daily routine and occupations.

The soldier’s grasp would be negatively affected, and he would lose the majority of strength in his left hand. He would not be able to achieve intrinsic plus, and he would not have deep functioning of the ulnar nerve. More specifically, the soldier’s lateral grip would be affected when he holds a cigarette. In this case, smoking would be a leisure occupation that would be greatly affected by the loss of the little finger. Based on the reading, the soldier seemed to enjoy the leisure occupation of swimming as well. If the soldier lost the bet, swimming would also be affected. His ulnar nerve would be majorly impacted and would affect the pull and strength of his swimming strokes. The soldier would need to make modifications to his daily routine in order to compensate for the loss. Also, he may need to learn new ways to engage in the occupations that he needs or wants to do. As a solider, his daily routine may include shooting guns. In this case, his grip would also be affected by the loss of his little finger, while stabilizing and holding a gun.

After reading the article, “Occupation-based Hand Therapy and the Occupational Therapy Practice Framework” by Deborah Amini, one strategy to help the soldier regain his independence for swimming would be physical agent modalities (PAMs). The outcome that this would support would be returning to functional movement by providing pain management.

As for the wife of the man betting against the solider, she had already lost some of her fingers. In fact, she only had two fingers on one of her hands. Daily occupations that would be affected by the loss of her fingers would include driving her Cadillac, washing her hair, and preparing meals. Specifically, the occupation of driving would be affected by the loss of her fingers. Equipment that would help the wife regain independence would be adaptive driving aids such as hand controls. The outcome that this IADL would address would be the modification for functional independence.

Neurotransmitter Project: Dopamine

Implicit Bias

Implicit bias is the brain’s involuntary response that shapes our unconscious stereotypes. The brain organizes patterns based on our experiences and environment. I think that it is important for OT students and practitioners to learn about implicit bias because we can miss out on learning and growing opportunities, if we refuse to explore our implicit bias. Additionally, the decisions that healthcare workers make can be influenced by implicit bias. As an OT student, I want to understand why unnecessary sufferings can be caused by implicit bias. I know that by understanding my implicit bias, I will be able to respectfully treat my future clients with inclusiveness and generosity. 

In order to examine implicit bias, one has to be courageous enough to explore. One way to do this is by taking the Implicit Association Test (IAT). Also, one should have the willingness to be vulnerable and actively engage in conversations with a generous spirit. One should acknowledge that everyone has implicit bias because that is what makes us human. Additionally, one should challenge their current negative bias, be empathetic, and recognize that it is painful and stressful to be victimized by assumptions.

My biggest takeaway from this session was that implicit bias is not formed overnight. It is something that takes years to form and years to break. With effort and respect, stereotypes can be countered and replaced with positive perspectives. Lastly, one should not allow their ego to hinder he or she. As long as one keeps an open mind and generous heart, one can train the brain to think of more positive patterns and reshape implicit bias for the better.