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!

Posture and Body Mechanics

How is your posture when you are lifting a box or sitting on the couch watching TV? Body mechanics is actually an important concept when it comes to posture. Several people experience back pain throughout their life and that could be due to bad posture, faulty body mechanics, lack of exercise, and stressful situations. A few statistical facts that I found interesting, are 80% of the adult population will have low back pain at some point in their life. Along with 90% of the time the low back pain will reoccur. Typically the peak age for this to happen is around 30-50 years old. One fact that stood out to me, is that 90% of the population has bulging discs. How crazy is that!? When it comes to assisting a client, it is very important they practice proper body mechanics. We want to prevent them from having disc injury (bulging/herniation), reoccurring pain, back issues that limit their ability to work (which can be costly) and that can limit them from doing their ADLs. 

There are two ways I would teach my client in an intervention, one being the slouch-overcorrect technique to correct posture. For this exercise, you lean forward by taking your arms down your legs and creating "bad posture," then slide arms back up the legs and straighten the spine into the best posture position. Secondly, I would have them stand frequently and do back extensions. I would also recommend that they place a pillow or towel roll behind them, if they don't have a ergonomic seat, to help with posture.

Advertisement + The Human Nervous System

https://www.ispot.tv/ad/7I3z/1-800-beaches-best-time-of-all-song-by-onerepublic 

I am sure you have seen the “Sandals” or “Beaches” commercials where the couples look so happy and relaxed, the beaches themselves look amazing, and the commercial itself is typically synced to some up-beat music. They even have the Sesame Street characters on there! It just makes me not only wish I was there, but it also puts me in a good mood. The reason it stands out to me, is because since I was little, I have always had the opportunity to be at the beach every summer. It is my favorite place to be, because I feel like I can just breathe easier, relax, and just watch the world go by. It is just something about that salty air that makes things better! I have never been to an all-inclusive resort such as this, but that will change one of these days! :)

I am telling you how I feel after watching this commercial, because I want to relate it to the human nervous system.

"Man from the South"

Biomechanics Blog 4:

The story "Man from the South," it based around a U.S. naval soldier that was in training, a man from South America and a local man that is from Jamaica who is narrating and watching the "bet" between the two. The man from South America was trying to get the U.S. soldier to place a bet with him, based on the boys lighter would light 10 times in a row. The thing was, if the U.S. soldier won, he would get the South American man's Cadillac. However, if the boy was to lose, then he would have his pinky finger chopped off by the South American man. On the eighth strike of the lighter, a woman comes charging in and ends the bet. She states how he has done this numerous times and they have had to move, because of people threatening to put him away. Concluding the story, it makes mention that the woman has only 2 fingers left on her hand, because she won it all from him and that Cadillac he was betting was actually hers.

I found this story to be actually interesting.

Implicit Bias

Based on what we have learned and experienced over the years, we may have developed some negative stereotypes towards groups and/or individuals. This is defined as implicit bias. In the 4 minute podcast with Alexis Johnson, she states that you can retrain your brain to see people differently. However, it takes a long period of time to actually do that.

It is interesting to see how our brains focus on certain bits of information in order to process things quicker. Like the implicit bias test I took, it wanted me to answer as fast as I could to see if my brain could keep up with the pace. Sometimes my brain would get ahead and cause my finger to hit the incorrect key. Same goes for the exercise given in the "4-Minute Listen" podcast. The start of the test administered, had phrases and to those phrases were answers that all seemed to rhyme with one another. When it came to  the phrase "the white part of the egg is called the..." Ailsa (podcaster) answered with the word yolk, when actually the answer was an egg white. Her brain didn't think about that fully, because each answer prior to had a connection and rhymed. I find it interesting that this exercise is used for implicit bias.

In the field of OT, it is important for us to challenge ourselves. We are human, but we want to train ourselves to remain open and overcome certain biases we may have.