Social Determinants of Health + Nervous system

When you hear “social determinants of health” what do you think of?

   If you look at the word(s) closely, the term “social” can be defined as a society or community. The term “determinants” determines the effects our environment has on something or even someone. This condition can be based around where we were born, where we have grown up and lived, and where we have worked. Social determinants of health typically include factors such as our environment, education, socioeconomic status, and our social support systems.

   So, how does social determinants of health relate to the nervous system? Like mentioned, it consists of several factors that play into our health as we age. The nervous system monitors environmental changes in the body. What makes up the nervous system is the central nervous system (CNS) and peripheral nervous system (PNS). Throughout each one, we have receptors that respond to stimuli by sending signals, such as pain, to the CNS.

Locomotion & Adaptive Devices

When fitting a client for an adaptive device, it is very important that you fit it to match their body mechanics, mobility, and ambulation. As an OT, we should always consider how the client will progress in the months to come, rather than just focusing on the present.

It is best to make sure the client has the proper measurements, so they are stable and safe while they go about their daily activities. As their OT, it is best to be aware of the client’s limitations and capabilities. The selection of the assistive device may be considered based on the clients age, physical condition (weight bearing status, balance, ROM, etc.), endurance level, and psychological condition (whether they are confident or apprehensive).

When fitting a cane, we want to make sure that it is the right choice for our client. We want to make sure the hand grip is at the level of the ulnar styloid around the wrist or the greater trochanter of the femur. The client’s elbow should be relaxed and flexed in 20-30 degrees. The shoulders should be relaxed and not lifted/elevated. In order to use a cane, the client needs to have good stability, because a cane is the least stable assistive device for walking. It is for those clients who just need minimal assistance for certain tasks. As an OT, we need to make sure to educate our client that the cane is used on the opposite side of the weak leg and that the cane moves with the weaker leg when walking in an upright posture.

Transfers

The hierarchy of mobility skills begins in this order: bed mobility, mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADL, toilet and tub transfer, car transfer, functional ambulation for community mobility, and community mobility and driving. Each skill reminds me of a puzzle piece in which they each fit in conjunction with one another. It is best to start with the more simpler tasks and progress up the ladder. I personally worked in an outpatient PT clinic, and we had clients come in with standard, rolling, and rollator walkers as well as canes and knee scooters. We started off with the more basic mat transfer. As the client increased their mobility over time, then we would get them to the point of walking with a gait belt and cane around the clinic. That is why I feel like I would not change anything about this approach. It comes together in a sequence. Although, the length and duration of this process depends on the client.
Over the course I have learned so much about the unique body mechanics. Thus, I have really enjoyed the past few weeks of learning about posture, gait, transfers, and AD, because we were able to go more in-depth about mobility and OT. Overall I am excited to use this information in the future!