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

Rehabilitative Frame of Reference

This FOR is based on clients whose underlying impairments might be considered permanent. This FOR includes concepts of adaptation, compensation, and environmental modifications. The method of teaching clients through this FOR included compensatory or functional methods, and makes use of assistive equipment and environmental modifications to restore function. The population for this FOR is  Child, Adolescent,  Adult, and Elderly. It is important to considering when using this method the client's motivation, ability, strengths, and evaluation of  client's environmental and social context. The ultimate goal of this FOR is to maximize independence despite the presence of persistent impairments.

3 key terms for this FOR:

- rehabilitative: working on enhancing function
- impairments (persistent): something that is an obstacle in finishing a task
-adaptation : changing the environment in order to achieve tasks more efficient

References:
Rehabilitative Frame of Reference. (n.d.). Retrieved April 05, 2018, from http://ottheory.com/therapy-model/rehabilitative-frame-reference

Knowledge Check 17

Two thing that I learned today:

• Cost effectiveness of OT- people who had OT were less likely to be readmitted to the hospital. 
•  Health People 2020 mission is to identify health improvement priorities, increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress