Rolling Grizz, Neuro Note 4

As a class we went out to watch The Rolling Grizzlies, a wheelchair basketball team in Memphis. The environment was extremely inviting and welcoming. The coach came over and introduced himself to us and then shared some of the rules with us; such as, they are allowed to push the wheelchair twice before they have to dribble or pass, the height of the basket and the number of players is the same as in a running game. We also got to see many transfer as many of the players had to transfer into their playing wheelchair. The players participated in about an hour scrimmage with minimal breaks, which was impressive because it seemed like hard work! 

After their practice, we were able to talk to the players and have hands on experience of what it felt like to be in their shoes. Probably, the most meaningful experience of this outing was running into my friend, Jake Wigg, one of the players. When he walked in I was so excited because I had not seen him in a while, and my first thought was "Oh, he must help coach the team.", but the next thing I knew he was putting himself in a chair. To say I was confused was an understatement! I had known Jake for a few years now, and I had no idea he had a spinal cord injury! I went up to him after the practice and asked him what qualified him for wheelchair basketball. He told me that in high school he was diagnosed with a disease that compresses his spinal cord which disqualified him for any kind of contact sport. During this time, his friend introduced him to wheelchair basketball and Jake went on to get a full ride scholarship to play wheelchair basketball at Missouri. I definitely learned something new, not only about my friend, but also that you do not have to be paralyzed to play wheelchair basketball!

I thought the most encouraging aspect of this experience was seeing how diverse the team was with a 1;1 ratio of African Americans to Caucasians. I think it is pretty safe to say that you will not be able to find a team that diverse anywhere else in Memphis. It was so eye-opening that even though a SCI can be so debilitating, it does in a way put everyone on a level playing field with better a perspective on life. This team has so much influence to help bridge racial gaps in our society and I think that is really exciting! Everyone on the team clearly had a sense of community and inclusion and it was refreshing to be in an atmosphere like that. 

My take away from this experience is to remember to be including of all people, because at the core we all bleed the same, and that is what the wheelchair basketball team help me see. They also showed me how important community is and how it helps in the rehabilitation process. I hope to share this knowledge when I practice so that people feel fulfilled with their lives.

Media Project, Client: Craig

At the beginning I was really intimated by this project. I did not see how I was going to make a meaningful activity from a sponge for a man who had a complete spinal cord injury at a C5 level. The client's goal was to go to a rehabilitation hospital, and he was completely dependent in all ADLs. Therefore, I was challenged as to what intervention to make for him because of his diagnosis leaving him so greatly immobilized.   

After some research I found that the client could only use his biceps and some wrist extensors. I also knew that he would need to work on withstanding upright sitting in order to succeed at a rehab hospital. Therefore, I wanted to incorporate sitting up while doing the activity. After much brainstorming I landed on a pre-feeding activity. This activity would use the same motion and muscles for feeding except in a gravity eliminated position. 

This activity is client centered because it will simulate an ADL that my client can work towards, which is feeding. This will also help him reach his goal of a rehab facility if he is able to sit upright without getting dizzy. During this activity, he will be sitting upright with his forearm rested on the table, his elbow at a 90 degree angle, and shoulder adducted. The client might want to use a towel under his forearm to help reduce friction and  one under his axillary to reduce pressure. The client will work on pushing the pieces of sponges off the table. The goal of reaching the table edge gives him motivation and reward.  I learned I have to break down the anatomy involved to know what barriers must be considered in creating a solution.

After working this out, I realized that an activity does not always have to be exciting and extravagant, but rather it has to be meaningful and geared to the client. I worked so hard to try to think of something fun, but in this case this is the activity that the client needs to work on in order to reach his goal. So looking forward, I want my ideas to be client-centered, even if they do not seem flashy. I think it is imperative to remember why we are doing what we are doing as OTs, and I think that was my biggest take-away from this assignment.  Going forward, I will gear my ideas and tailor my ideas towards the client and where the client is on their journey. 

Start Position                                          

End Position - Pushing sponge off table

Activity material needed                                            

Neuro Note 3, Simple hacks for life with Parkinson's

I watched a Ted Talk titled "Simple hacks for life with Parkinson's" by Mileha Soneji. She begins her talk by noting that one of her favorite memories of going to family gatherings was hanging out and playing with her uncle who was always energized and the life of the party. Sadly, he was diagnosed with Parkinson's disease, a disease that causes degeneration of the nervous system. This was a confident, powerful, and independent man whose body started to deteriorate after the onset of this disease. She notes that just to make a turn with his walker, he had to shuffle and take multiple steps to turn himself around. She touches on how his personality changed because of this disease, he did not feel like himself and was less likely to engage because of how different his demeanor was with the disease (i.e. tremors). 

She then goes on to say that her aim is not to cure Parkinson's, because she realizes that she is not capable of doing that on her own, but to help  make their everyday tasks easier. First, she invented a no spill cup for people that are uncomfortable with drinking tea or coffee in public, her design was able to keep the liquid inside of the cup despite a person having a tremor. This was very important to her uncle because he stop drinking anything in public because he was too embarrassed with his tremors.

Next, she decided to observe him in his home and try to see what he struggled with the most. It struck her that her uncle was having trouble walking on flat ground but had no problem walking up stairs. She found that this was the case because it was a continuous motion. She then created a stair case solution that allowed her uncle to walk quicker on flat ground. She notes that what people need to be focused on are human-centered solutions. 

This Ted Talk is so on point with OT values! I loved how client-centered her approach was. Sometime I am intimated by the amount of technology out there and I feel like I will not be able to help people to the best of my abilities; but, this reminded me that as long as we are client centered it can be low tech and still be beneficial to the client as long as we keep them in mind. I also loved that the way she figured out this problem was by observing her uncle. She took the time to slow down and watch. This is something that I sometimes forget to do but is so vital in our career. Going forward, I want to remember to keep the client first, observe the client, and be bold enough to create something that will help them. 

Reference: Soneji, M. (n.d.). Simple hacks for life with Parkinson's. Retrieved from https://www.ted.com/talks/mileha_soneji_simple_hacks_for_life_with_parkinson_s#t-366783

Conceptual Model of OT

Running the Race Towards Independence
By Ashlyn Dixon, OTS

Inside the O'Briens Summary and OP Report

Inside the O' Briens

by Lisa Genova

Huntington's Disease is a genetic disease where nerve cells break down over time and there is no cure for this disease, eventually this diagnoses will lead to death. This is a cruel disease, and Genova uncovers the pain and reality of this disease in her book. This book stretches the reader to face the reality of Huntington's Disease and walk alongside a family that is faced with this genetic nightmare. I think what surprised me the most was the mind games that HD played on the family members. Before reading this book I would have just assumed that most people would get the tested to see if they were HD positive or negative. However, this booked showed a different side, we know that two of the four kids , JJ and Megan were HD positive. Katie, the younger daughter really struggles throughout the book to know if she has HD. By the end, the author leaves us in suspense to whether she has it or not. At first I was annoyed that the author left the end like that, but after thinking about it I think I understood why. This book aimed to shed a light on the struggle of HD, and the fact that the end result is death. Joe said in the book that everyone was going to die eventually " that was the price of playing poker". 

As OTs, it is imperative that we are able to step out of our own shows and put ourselves in the position of someone else. This book helped me step outside of myself and into Joe's shoes for just a moment. By reading this book I have such a greater understanding of what HD is and how it can affect family dynamics. When practicing, I will keep this in mind with clients that I will see. I do not want to be ignorant of the reality of this disease or any other disease for that matter. I would recommend this book to anyone because it paints such a beautiful picture of the realities of life and how we can better come alongside people and help them in their times of need.  

Occupational Profile Joe O’Brein, 43

	Reason the client is seeking OT services and concerns related to engagement in occupations (may include the client’s general health status)	His wife and coworker/ friend are worried about some different personality changes/ uncharacteristic traits that he has taken on such as fidgeting and clumsiness. Joe went to the doctor and was diagnosed with HD (Huntington’s Disease)
	Occupations in which the client is successful and barriers or potential barriers to his/her success in those occupations (p. S5)	Client is a police officer and devoted husband father (of 4 kids). He has been showing signs of not being able to get work done efficiently, spending long hours at work.   Potential Barriers that could effect work with diagnoses: -          Mental function/ lack of concentration -          Abnormal walking/ involuntary movements -          Compulsive behavior
	Personal interests and values (p. S7)	Working, baseball, spending time with his wife and kids
	The client’s occupational history/life experiences	-He mother died of Huntington’s Disease (although he did not know this, he thought she was just an alcoholic) -He had some knee problems in the past -Has 4 kids, had them early in life
	Performance patterns (routines, habits, & rituals) – what are the client’s patterns of engagement in occupations and how have they changed over time? What are the client’s daily life roles? Note patterns that support and hinder occupational performance. (p. S8)	-He is working man and spends many hours on the job. He has dinner with his family on Sunday nights (wife, 4 kids, and daughter in law) -He shows signs of tripping over things and dropping items such as a pitcher of water, remotes, etc. - Roles: father, husband, police officer, friend, soon to be grandfather - with the onset of HD he unable to control some of his moods and work has become harder to stay focused - He wife (while obviously distraught by the diagnoses) stays by his side and supports his/ helps him along this journey
	Aspects of the client’s environments or contexts, as viewed by the client (p. S28)	Supports to Occupational Engagement:	Barriers to Occupational Engagement:
	Physical	He is an active police officer, has the ability to walk/work still	The symptoms are going to keep progressing which is going to not allow him to keep working
	Social	He has friends at his work who know about his disease and are looking out for him at work	He will not be able to continue to socialize/ work with the progression of this disease,
	Cultural	He is involved with his faith and God, and has a very devoted wife who is able to stand by his side during this process	This disease makes it hard to keep hope and faith, especially with his mood outbursts it makes it hard on his wife to stay strong
	Personal	He has a tough personality that will help him to push the best that he can through this diagnoses	Feels personal guilt that he brought this into his family and that some of his kids/ grandkids are at risk of HD
	Temporal	This stage in his life, he has had lot of good years, and lots of memories were made.	He and his family become very in tune to time, they are consistently wondering how much time is left and how much time is left.. this can be very draining on the family
	Virtual	Watches baseball/news in order to escape the reality of the diagnose	The internet has allowed him and his family to harsh reality of this disease, and sometimes knowing more can be harder to keep positive hope for the future
	Client’s priorities and desired target outcomes (consider occupational performance – improvement and enhancement, prevention, participation, role competence, health & wellness, quality of life, well-being, and/or occupational justice) (p. S34)	-To have as much independence/ mobility for as long as possible - try to be psychologically present as possible, I.e. keep his personality intact as much as possible —An OT could work on splinting in order to keep mobility and AROM for as long as possible, there could be preventive therapy as well to prepare Joe for what is to come with HD — Joe could keep a journal with encouraging memories and words from his family so whenever he feels as though his disease is taking over he can look back of all the good that has happened in his life

Neuro Note 2 Ted Talk

I watched a Ted Talk that was titled " Inspiring New Thinking to Restore Function after Spinal Cord Injury" (2012) by Gregoire Courtine, a neuro-scientist who works with spinal cord injures. I chose this becauseI want to expand my knowledge on SCI and better know how to most effectively treat a SCI client one day.He started out by sharing what a SCI client told him once, this friend/ client challenged the scientists to visit the rehab facilities after leaving work so that they could see people struggling to remember how to walk, and when they leave they would go home with these people on their minds and maybe they would be able to come up with something to help them.

Next, he dove into explaining why a lesion in the spinal cord leads to paralysis. He explained how when the brain gets affected through the spinal cord it can be dormant, which is also the same when it happens to rats (this is important to remember).His mentor encouraged him to test out his theories, because Courtine had ideas of how to redirect and restore fibers in the brain, but because of his upbringing he did not know if he could share his ideas.

He gave the metaphor that the locomotive system is a car and the spinal cord is the engine (but it is turned off). He explained that you need to restart the system so you might add fuel, next you have to press the accelerator, then you have to steer the car. So his idea was to re-program the brain in a way to redeliver information so that the brain could relearn. After 10 years of research they have what he called "pharmacological cocktails"  "that optimally repair the neuron to fire and to mimic the push on the pedal 'they' applied electrical stimulation on the dorsal aspect of the spinal cord", he called this process a "electrochemical neural prosthesis". Basically, this can reform the dormant part on the spinal cord to a highly functional state.

Interestingly, he then showed a rat with a SCI receiving this method and the rat was able to walk along with a treadmill after receiving this. The mice picked up speed with the treadmill, but then when it stopped so did the rat. I think what he was getting at is that the mice was aware of the environment that he was in and then able to go along with that sensation because of this locomotive state, he stated that brain played very little activity with the mice's movement. His next step was to move the rat away from the treadmill, so he decided to build a robot that supported the rat against the direction of gravity but does not facilitate locomotion in the forward direction. After a few weeks, the rat, who had paralyzing lesion in the spinal cord, was able to sprint up a stair case (amazing!). When this video came out currently one person was doing a clinical treatment with this method. Courtine understands that this is not a cure to SCI, he just promotes that this could be a piece to this complicated puzzle of SCI.

I think this Ted Talk was extremely eye-opening and presented a lot of new ideas that I have never thought of. When thinking about OT, this is very encouraging knowing brains out there are thinking this way and working towards a goal to improve quality of life with people who have SCI. As a future OT, I want to keep in mind the power of the locomotive system when working with SCI client's. I think this taught me to always think outside of the box, and not be afraid to share ideas.

References T. (2012, June 22). Inspiring New Thinking to Restore Function after Spinal Cord Injury: Gregoire Courtine at TEDxCHUV. Retrieved April 12, 2018, from https://www.youtube.com/watch?v=Ta4A75as7Dc

Neuro Note, Fifty First Dates

This is a movie that came out in 2004 and stared Adam Sandler (Henry) and Drew Barrymore (Lucy). Henry has a real playboy attitude at the beginning of the movie and has his eyes set on Lucy. He meets Lucy at a diner where everyone knows her. It took multiple tries for him to get Lucy's attention. For days, they both had lovely conversation at a breakfast. However, Henry starred to notice something different about Lucy.  Henry finds out  Lucy was in a car accident that lead to short-term memory loss so every night all memory of her day is erased. Her symptoms are closely related to anterograde amnesia. This is a loss of the ability to create new memories after the event that caused the amnesia, leading to a partial or complete inability to recall the recent past, while long-term memories from before the event remain intact.

Anterograde amnesia is a selective memory deficit, this can result from a brain injury, when the person is severely impaired in learning new information. Memories that occurred before the injury may be my not be regained (not always and not in Lucy's case), but events that occurred since the injury may be lost. Short-term memory is generally spared, which means that the individual may be able to carry on a conversation; but as soon as they are distracted, the memory of the conversation fades.

I chose this topic because it was fascinating because in the movie Lucy's family was trying so hard to always adjust the situation and try to live the same day over and over again. Henry, loved her so much that he wanted to adapt her situation in order for her to have a better quality of life. He came up with a movie that show would watch every morning to help her realize her accident and what has happened since that accident. I love that they did a movie on this topic, because it is something that needs to be addressed in our culture.

References

(n.d.). Retrieved April 05, 2018, from      http://www.memorylossonline.com/glossary/anterogradeamnesia.html