Impostor Phenomenon

     Impostor Syndrome is a feeling where people believe that they are not as intelligent, competent, or knowledgable as they truly are. Individuals experiencing Impostor Syndrome often accredit their success to luck and have feelings of being a fraud. These individuals often feel a lack of confidence in their abilities to succeed. This phenomenon has affected over 70% of individuals at some point in their lives and careers. It is very common among individuals in the healthcare field as jobs in healthcare appeal to high-achieving personalities. 

    The Impostor Phenomenon is something that I am all too familiar with experiencing. I have a high-achieving personality that puts me at risk for feelings of Impostor Syndrome. My results from the Impostor Phenomenon Rating Scale indicate that I frequently have imposter feelings as I scored a 75. Common traits of individuals with Imposter Syndrome include: perfectionism, anxiety, doubt, shame, and fear of both failure and success. Personally, I have noticed all of these traits within myself especially during my schooling. These traits intensified when I began college as I became hyper-focused on succeeding to ultimately get accepted into occupational therapy school. Once I began OT school, these traits became even more prevalent in my life. During my time at UTHSC, my professors have repeatedly discussed this phenomenon and ways to combat these feelings. 

    When an individual is experiencing feelings of Impostor Syndrome, it is important to self-reflect. Self-reflection is a great way to "justify" one's personal success. For example, when you get an exceptional grade on an assignment but do not feel worthy of that grade, you can reflect back on the amount of time and effort put into that assignment. This practice will allow you to become more confident in your work and success. It is important for people with Imposter Syndrome to practice receiving praise and compliments as this can be difficult. Engaging in a mentorship program also helps combat feelings of Impostor Syndrome as a mentor could provide constructive feedback and praise in your successes. 

    It is important for individuals with feelings of Impostor Syndrome to find ways to release their perfectionism. Perfectionism causes one to feel a lack of confidence due to their overly high expectations. To release this perfectionism, it is important to reframe your thinking. By changing your thinking to more positive thoughts, you can become more confident in yourself and your abilities. Also, creating a healthy work-life balance will help relieve feelings of perfectionism. Prioritizing activities you enjoy in addition to your work will relieve stress and anxiety. Finally, engaging in mindfulness can combat feelings of perfectionism that are associated with Imposter Syndrome. Being more mindful will help relieve stress and anxiety and increase positivity within one's life. 

Albanese, S. (2019). Facing imposter syndrome as a new grad. Eyes on Eye Care. https://eyesoneyecare.com/resources/facing-impostor-syndrome-new-grad/

Lancaster, S. (2017). Imposter Phenomenon (No. 7). [Audio podcast episode]. In On the Air. http://www.ontheair.us/podcast1/episode-7-impostor-phenomenon

Locus of Control

     As a future practitioner, it is important to understand the role that one's locus of control plays on their performance. Individuals that place a heavy importance on their internal locus of control may have personalities that are harder on themselves, and those that view circumstances with an external locus of control may blame the world for their struggles. In the future, it is important for me to evaluate my personal views on locus of control to understand my thinking patterns. After taking the quiz, I found that I am right in between internal and external loci of control. This means that I believe there is a balance between internal and external circumstances affecting my life. This can help me understand how I view my control in all situations. 

    When working with clients in the future, I need to understand their viewpoints on this topic. Some clients will believe that they have full control over their recovery, and other clients may believe that they have absolutely no control over the recovery or their diagnosis. Understanding how each client views their locus of control will help me gear my strategies and interventions to fit their views. This will allow me to adapt to each client and find the best ways to motivate them to achieve their highest potential. Understanding how a client views their control over their circumstances will provide the best outcomes to treatment. 

Neuro Aspects Media Project: Pipe Cleaners

    Through completing the Media Project, I gained insight on client-centered intervention and the benefits of purposeful activities. Initially, I was focused on creating a piece of adaptive equipment (AE) to help Dennis engaged in his passion for gardening, but I quickly realized how important it was to first address the deficits that are restricting Dennis from getting back into gardening. Due to his CVA, Dennis showed problems with left neglect, right/left discrimination, dynamic sitting and standing balance, object release, spatial relations, fine motor coordination, and many other deficits. By first working on his deficits instead of immediately prescribing AE, Dennis will have an opportunity to improve skills that will carry over into his other contexts and occupations. My "ah-ha" moment was realizing that it is important to first attempt to address these deficits instead of immediately moving to compensatory strategies by giving AE. A client may be able to bypass using certain adaptive equipment by improving deficit areas first. 

    This assignment improved my client-centered practice. Before completing this assignment, I read Dennis' case study and saw several areas that I felt were important to address, however, I stopped to consider his personal goals of getting back to his hobbies. I focused on finding his "clinical carrot", in this case, gardening. I improved my understanding of the importance of incorporating Dennis' passions when his case study mentioned that he struggles to understand why he is in therapy. When treating Dennis, I have learned that it is important to explain why this activity is beneficial to his goals and even other occupations he values. As a future practitioner, I sometimes forget the importance of explaining why a specific intervention was chosen. As mentioned earlier, I began this assignment focusing on compensatory strategies to improve his engagement in gardening, however, I quickly learned that it is important to give Dennis the opportunity to improve his areas of deficit before providing compensation. The areas he is struggling with post-CVA influence more occupations and ADLs than just those pertaining to gardening. Culturally, within his family, Dennis is expected to do all home maintenance which will be improved by addressing his deficit areas. By addressing the client's goals and considering the importance of remediating skills impacted by the stroke, Dennis' engagement in all occupations will be improved. As a future practitioner, I will continue to think "outside the box" to find economically-friendly intervention ideas to engage my clients. I learned that interventions do not have to be expensive or manufactured by a medical company to be effective. This project has influenced my outlook on client-centered practice and prioritizing remediation of skills before jumping to give AE. Because of this assignment, I will remember how creativity can produce efficient, client-centered interventions that are driven by the client's volition. When completing observation hours, I often saw practitioners having clients engage in monotonous interventions that did not showcase their personal goals in relation to occupation. This assignment reminded me of the importance of always putting the client's goals ahead of my own. I will always remember how a few minutes of brainstorming led me to creating an intervention that addresses both my client's goals and also his areas of need due to his diagnosis. Taking the extra time to consider your client can lead to impactful interventions. 

link to the YouTube video: https://www.youtube.com/watch?v=U27b0aKqOy0

Neuro Note #5: Breea's Journey with Multiple Sclerosis

     For my Neuro Note assignment, I watched "Breea's Story" on YouTube. In the fall semester of 2011, Breea was your average high school senior. She was on the cheer team and was looking forward to graduation and starting college. All of her plans changed on December 8, 2011. On this morning, she woke up feeling a little off balance and strange but went about her day as usual. However, by 6:00pm, Breea found herself unable to move the left side of her body and went to the emergency room. She was diagnosed with Multiple Sclerosis, and she was blind in the left eye and could not swallow. 

    Breea's diagnosis began a long, difficult journey for her and her family. She was in the hospital for six weeks receiving medical treatment for her MS including 7 plasma transfusions and monthly Tyasbri infusions. On her second day of therapy, Breea began to walk using the parallel bars and assistance from her therapists. She slowly was able to learn to feed herself again. Throughout her entire stay at the hospital, Breea was surrounded by supportive friends and family that pushed her each day to work hard. On New Years Day, Breea's friends conducted "Operation Ocean View" where they "snuck" her out of the hospital to take her to see the beach. On this day, she also set her goals for 2012 which included graduating, going to college, and walking again. 

    While she was in the hospital, Breea wrote her college entrance essay in her wheelchair. She slowly saw the progress she was making. Finally, she was able to tighten her fingers to make a small fist and flex her left leg voluntarily. These little victories pushed her to continue working to beat MS. By her 40th day in the hospital, Breea was able to balance on her left leg for a short period of time and continued seeing progress in her previous victories from therapy. Soon, she graduated from inpatient therapy and went home from the hospital to resume therapy at home. 

    After she returned home, Breea began feeding herself with her left hand and documenting her improvements through video recordings. She began attending her high school basketball games wearing her cheer uniform again. She continued seeing improvements in her fine motor skills and gross motor skills that were once seemingly impossible for her. 

    In the spring, Breea attended prom with her friends and her date, graduated from high school, and was accepted into NAU for college. In the following weeks, Breea regained the ability to jump off of her left foot and make a scissor motion with her feet before returning to the ground. She could also do this motion and spin at the end. These movements were so exciting for her to regain because when she started her journey, Breea was unsure if she would ever be able to do something so seemingly simple. 

    Eight months after her hospitalization and diagnosis, Breea did a back walkover with a spot. This was a huge victory for her as her goal was to return to cheerleading one day. She began college and joined Alpha Phi sorority. For long distance walking, Breea relied on a leg brace, but for all other walking, she was able to do so without any adaptive equipment. She continued working on strengthening her muscles and committing to a lifestyle that would support her in her journey with MS. 

    I found Breea's Facebook page "Help Breea Beat MS" and found that she still documents her journey with MS for all to see. She has continued to post updates in her diagnosis and details about the progression of it. Breea's page mentions that she has a rare form of MS called Tumefactive MS. This type of MS is difficult to diagnose because it often mimics the symptoms of stroke, brain tumor, or brain abscess. Tumefactive MS is one of the most aggressive forms of MS, however, it can go into remission for months or years at a time. Eventually, this form of MS usually turns into Relapsing-Remitting or Primary Progressive MS. According to her Facebook page, Breea is living an active and healthy life. She promotes eating a diet that reduces inflammation to keep her symptoms from flaring up. 

    I chose to watch this video because I wanted to see a first-hand account of someone's journey with MS. This particular story stuck out to me because of how young Breea was at the time of her diagnosis. In class, we learned that MS is typically diagnosed between 20-40 years old, and Breea was an 18 year old senior in high school. Even though 18 years is not much younger than 20, it was eye-opening that she was still in high school when the symptoms first flared up. 

    Watching this video showed me what MS can look like. When learning about MS in class, I memorized the symptoms and information necessary for OT intervention about MS, but I struggled to picture exactly what it would look like in a clinical setting. This Neuro Note assignment showed me exactly what one individual's journey with MS looked like. I saw the importance of each "small"victory such as closing a fist, flexing a knee, or moving an ankle. I also saw the importance of having a great support system. One video in her account showed someone asking Breea if she could feed herself, and she quickly said no. One of the boys in the room quickly corrected her by saying "not yet", and Breea changed her answer to "not yet". Seeing the involvement of her friends from high school showed how valuable a support system can be in treatment. They pushed her to work hard even when she may have been frustrated or felt too weak. As a future OT practitioner, I need to remember the affect Breea's friends had on her recovery. I am sure there will be times when having too many people in the room with a client will become overwhelming, but if it contributes to the client's success, confidence, or comfort, I need to be understanding and encourage the participation.

    Following the video, I looked up Breea's Facebook page and found her specific diagnosis. I had not learned about Tumefactive MS prior to learning about Breea's story. Through looking at her Facebook page, I was able to learn more about her most recent updates on her health, wellness, and life. I recommend watching the YouTube video to learn the story of Breea's beginning with MS and then looking at her Facebook page to see how she is doing now. It showed how devastating MS can be for a young person, but also, the miraculous comeback possible with some forms of MS. 

Neuro Note #4: Miss You CAN Do It!

     For this week's Neuro Note assignment, I watched Miss You Can Do It, a documentary detailing the Miss You Can Do It pageant. This pageant was founded by former Miss Iowa 2008, Abbey Curran. Abbey was diagnosed with cerebral palsy at two years old, and despite her challenges, she was the first woman with a disability to compete in the Miss USA pageant. Abbey was told that every victory is meant to inspire the next person, and she wanted to use her victory in the pageant world to inspire other women with disabilities. 

    Abbey Curran founded the Miss You Can Do It pageant to create a safe environment for girls with disabilities to feel beautiful and meet other people with disabilities. Several of the contestants came from small towns and did not have many friends that could relate to them, so competing in the pageant exposed the contestants to other individuals with similar challenges. 

    This documentary shared the accounts of several families and children with disabilities. One of the most highlighted disabilities was cerebral palsy. Cerebral Palsy is an acquired brain injury that affects individuals on a spectrum with some more involved than others. Abbey's CP is relatively mild compared to some of the other contestants in the pageant. She has been able to walk independently since the age of four. One contestant, who ended up winning the pageant, was diagnosed with cerebral palsy and walked using a posterior walker and mentioned her dream of walking independently without the use of adaptive equipment. This little girl's family said that seeing Abbey Curran walk without a device inspired their daughter and showed her that people with CP CAN walk without devices. For this particular girl, the mother discussed her hypertonicity which caused her daughter to constantly cross midline with her arms and legs especially in ambulation.

    Watching this documentary solidified my knowledge of neurological disorders covered in this class. I was able to gain a deeper understanding of several disorders including cerebral palsy. It showed people with differing levels of involvement of cerebral palsy and gave me more insight on how different this acquired brain injury can look on several individuals. The families of these young girls with cerebral palsy advocated for the abilities of their daughters. They continuously stressed that their children were very intelligent and mainly struggled with motor skills. A common challenge among these children with CP was a lack of independence in daily activities. One mother discussed how her daughter struggled the most with accepting that she may need help in activities due to her diagnosis. Her daughter understands the demands of tying her shoes, however, most times, she needs help due to her motor challenges. 

    I have met people with cerebral palsy through my involvement with organizations like Best Buddies, however, this was a disorder that I did not have much knowledge on. This documentary reinforced what I have read and learned about CP in OT school and gave personal accounts of what life is like with this disorder. I chose to watch this documentary for several reasons. The main reason I chose to watch it was to gain more insight on cerebral palsy, but I also volunteered at a pageant designed for individuals with disabilities while in college. I felt personally connected to the message of the documentary through my involvement with organizations that support individuals with disabilities. 

    I highly recommend that others watch this documentary! It was recommended to me by a classmate that also used this documentary for a Neuro Note assignment. It was a sweet, uplifting, and enjoyable way to learn more about several disabilities including acquired brain injuries. 

Davis, R., Anderson, J., Westervelt, C. (Producers) & Davis, R. (2013). Miss You Can Do It [Motion Picture]. United States: HBO. 

Neuro Note #3: The Cory Weissman Story

            For my Neuro Note, I chose to watch 1,000 to 100: The Cory Weissman Story. This movie tells the true story of a college freshman, Cory Weissman, who plays basketball for Gettysburg College. In high school, Cory scored over 1,000 points playing basketball and worked diligently to earn the starting point guard position. While training one day, Cory began to feel disoriented and dizzy. His best friend, Brandon, noticed something was wrong and almost carried him to the team’s athletic training. She soon realized that he was exhibiting signs of a cerebrovascular accident, or a stroke.

            Cory was rushed to the hospital where he remained unconscious for several days. The doctors found that Cory had an arteriovenous malformation (AVM), which is a tangle of vessels in the brain that can eventually burst. The physician found that the AVM was the cause of Cory’s stroke, and for several days after the stroke, the AVM in Cory’s brain continued to bleed. During his first night in the hospital, Cory’s doctor was unsure whether he would survive the night or pass away from this stroke. After several days of unresponsiveness, Cory smiled and responded when his older brother spoke to him.

            Soon after Cory regained consciousness, he began intense therapy in hopes to regain his abilities. His main goal was to return to playing basketball at the collegiate level. During his rehabilitation, Cory had a great support system. His mom was incredibly involved in his therapy as well as his best friend, Brandon, and the rest of his family. Despite the circumstances, Cory often reminded himself that other people had it worse than him, so he should continue fighting through the difficulties from the stroke.

            After his discharge from the rehabilitation facility, Cory found that he was often unable to participate in activities with his friends and felt like he was missing out. His girlfriend at the time broke up with him because she could not handle the challenges of dating someone with a disability. Although he was disappointed in losing his girlfriend, Cory continued to work hard to overcome the obstacles he was faced with. He began driving again and was planning on returning to school. Soon, however, Cory began to have seizures, and his family and doctors feared that returning to school would only increase the likelihood of him having more seizures. Eventually, Cory convinced his family to let him return to school, and he began working towards his goal of returning to team.

            As Cory progressed, his coach warned him that he was unsure if he would play ever again. The coach feared that Cory could get hurt or suffer another seizure while playing. Instead, Cory was given a position on the team to help with practices, games, and keeping statistics. As he continued to make progress through therapy, Cory was able to run lines with the team and participate in practices with the team. During his senior year, Cory was voted as one of the team captains, and at the end of the season, his coach allowed him to start his Senior Night game. Cory was on the court for tip-off, but his coach did not want him to play anymore during the game for his own protection. However, with twenty seconds left in the game, Cory’s coach allowed him to play. The other team purposely fouled Cory so that he could go to the free-throw line and shoot. Cory missed his first shot, but he made the second free-throw.

            Cory constantly contemplated the reason for him having a stroke. At the end of the story, Cory reflects on the obstacles he overcame and how strong he became due to his circumstances. Cory meets a young boy who had an AVM that led to a stroke and played soccer with him. The little boy’s mom discussed how inspired her son was because of Cory’s story. He realized that his stroke allowed him to reach people on a different level and become an inspiration for all.

            I chose to watch this movie for my Neuro Note assignment after hearing a classmate discuss it for her Case Study. I am aware that young people suffer strokes, however, I had never heard a story of someone close to my age having a stroke. I found out that this was a true story and found it very fascinating that a college athlete in the best shape of his life could have a stroke.

            Through witnessing this depiction of Cory Weissman’s story, I was able to understand the struggles and obstacles he faced. This movie used a lot of terminology that has been covered in this class, and I was able to apply my knowledge from Neuro Aspects to this movie. It gave me a real-life look into how people adapt to life following a stroke, and the impact that positivity and hard work can have on therapy. I also saw the impact of family and friend support on one’s therapy. Cory was able to overcome so many obstacles with the help of his family and friends to motivate his recovery. This story really provided me with a raw perspective on strokes in young, healthy individuals. I recommend this movie to anyone who is looking to learn more about strokes and gain a real perspective on the reality of a stroke in a young person.

 

Burris, B. & Gordon, B. (Producers), & Levine, M. (Director). (2014). 1000 to 1: The Cory Weissman Story [Motion Picture]. United States: Cinedigm.

Neuro Note #2: The Next Steps Following Spinal Cord Injury

     I watched a TedTalk by Janne Kouri. August 5, 2006 changed Janne Kouri's life forever. Prior, he was a very athletic man who once played college football. On this day in 2006, Kouri was playing beach volleyball with some of his friends when he decided to go into the water. He was diving into the waves, something that many beachgoers enjoy, when he hit his head on the sandbar. Instantly, he was paralyzed. Immediately following his paralyzation, he was left floating in the water, and fortunately, a man witnessed this and rescued him. 

    Janne Kouri recounts his experience in the hospital and shared an upsetting incidence in which his doctor told him that there was no hope that he would recover. He was told to "get used to playing board games" for the rest of his life. Kouri discussed his determination to be happy so that his loved ones would be happy as well. Each day, he made the decision to find the happiness in something he did, and some days, this happiness could only come from something as small as a smile. He knew one thing about his life after his spinal cord injury, and that was that he wanted to be happy. 

    Shortly after his injury, it came time to find a rehabilitation facility to cater to his needs. Kouri's girlfriend began flying to different states to visit facilities, but unfortunately, most of these facilities told her that there was no hope for him. Finally, she visited Dr. Susan Harkema at the Frazier Rehabilitation Center in Lousiville, Kentucky. Dr. Harkema founded a training program for people with spinal cord injuries called Locomotor Training and approved Kouri for the treatment. Locomotor Training involves a patient weight-bearing and walking on a treadmill in a harness. Therapists simulate human ambulation by moving his arms and legs while a client is on a treadmill. The focus of this intervention is to regain function. Janne Kouri mentioned how fortunate he was to have the financial means to leave California with his girlfriend and leave behind their family, house, and jobs. Most people would not have the same opportunities that he had. He began to notice that he was the only patient on his floor at the facility that received the Locomotor Training and learned that most people could not participate due to a lack of insurance coverage or room in the schedule. He found this very disheartening as he claimed this treatment saved his life. 

    About a month before he was discharged from the rehab facility, Kouri was able to wiggle his toes again. He claims that this was the best moment of his entire life because it proved that there was hope for him. Following his discharge, Kouri remained in Kentucky for about 6 months and spent eight hours a day in therapy. Prior to his move back to California, Kouri and his girlfriend researched the next steps for his recovery when he returned home. They quickly found that his options were minimal to say the least. This sparked an idea for him to make a difference in the lives of spinal cord injury survivors. 

    Janne Kouri wanted to take the therapy services he received and allow the community to have access to the same services. To do this, he founded Next Step Fitness, a gym dedicated to promoting physical activity and wellness in people with neurological conditions. When Next Steps Fitness was founded in June of 2008, it was the only fitness studio in Los Angeles that catered to the needs of individuals with spinal cord injuries and other neurological conditions. His vision of affordable fitness for people with these conditions came into fruition. Now, his gyms are in several cities in the United States and internationally. 

    Finally, Janne Kouri talked about how his rehabilitation has impacted his functional abilities. Kouri was able to marry his girlfriend. Later he surfed, walked with a walker, and even gave his wife a belated wedding dance. From listening to his account, I learned how impactful therapy can be on people who may feel hopeless. I saw the importance of instilling hope in clients even if their cases seem difficult. Many of the medical professionals that Kouri sought out told him that he had no hope, and this could have easily discouraged him from even trying. As a healthcare professional, I will make it my duty to provide each client with hope. Encouraging clients and working hard to lift their spirits can have such a huge impact on their therapy. I learned that even the most seemingly impossible cases can have happy endings. Kouri talked about friends that he had met through Next Step and the amazing obstacles that they have overcome and the happy lives they live today. It taught me just how important therapy is for people with a spinal cord injury and how beautiful the recovery process can be. 

    I chose this TedTalk because I am very interested in spinal cord injuries. I wanted to further my knowledge on spinal cord injuries and the outcomes of clients with these injuries. It was fascinating to learn how much progress is able to be made because most people assume that function is lost forever in these cases. Also, I was shocked to learn how Janne Kouri became paralyzed because I love diving into wave at the beach and never considered the danger that could bring. His story opened my eyes to the importance of therapy and long-term exercise in people with spinal cord injuries. As a future practitioner, I want to find resources such as Next Step Fitness for clients with spinal cord injuries and share this story with them to give them hope. 

    

For those of you who are interested in learning more, I am providing two links: one for the TedTalk and one for Next Steps Fitness. 

    TedTalk: https://www.youtube.com/watch?v=xCxCFjmruSg

    Next Step Fitness:https://www.nextstepfitness.org/

TEDx Talks. (2013, December 24). Life after paralyzation: Janne Kouri at TEDxVeniceBeach [Video]. YouTube. https://www.youtube.com/watch?v=xCxCFjmruSg

Neuro Note #1: A Real, Raw Account of Guillian-Barré Syndrome from Andrew Franek

 

            I watched Andrew’s Story: Guillain-Barré Syndrome, a YouTube video that documents a young man’s experience with Guillain-Barré Syndrome (GBS). Andrew was a young firefighter who enjoyed being active. He exercised often and spent most of his free time outdoors. Shortly after becoming a firefighter, Andrew began to feel ill and weak and developed a fever and a rash. He was diagnosed with strep throat. About ten days after his diagnosis of strep, Andrew began to experience numbness in his feet that he could not get rid of. And by August 3, he was no longer able to walk due to extreme weakness. He rushed to the hospital where a spinal tap confirmed what would become his worst nightmare, Guillain-Barré Syndrome.

            After his diagnosis, Andrew immediately began treatment for GBS. This treatment consisted of a drug called IVIG and plasmaphoresis, a medical procedure that filters blood. He was quickly admitted to the ICU and began experiencing facial paralysis. By August 12, 2016, Andrew’s vision became blurred. After about two weeks in the hospital, his symptoms had only slightly improved, but nonetheless, Andrew was sent home. He began struggling to swallow, breathe, and sit up without becoming too exhausted. Andrew became so weak that he feared falling asleep because he thought his body would just give out and stop breathing. At this point, he was taken to the hospital again and admitted into the ICU to begin his treatment again. Very quickly, Andrew lost his ability to swallow and was placed on a liquid diet, but the medical team soon realized that his body was not digesting anything he ingested. At this point, Andrew needed to be constantly suctioned in order to maintain an airway adequate for breathing. The feeding tube that had been feeding Andrew had to be removed in order to allow him to breathe better.

            Andrew was transferred to the ICU step down unit for a short period of time before he aspirated and began to suffocate. When he was suctioned following this event, the medical team found blood, mucus, and other liquids in his airway. Due to his struggle to breathe, Andrew was intubated and put on a ventilator. In one instance, Andrew suffered cardiac arrest for about seven minutes due to a doctor giving him a medication that was contraindicated of his condition. After continuously CPR and three shocks from the AED, his heart began beating again. At this point, Andrew had been paralyzed for three weeks, and due to the ventilator, communication was extremely difficult. He used a communication board to talk to his family and medical team. After about 10 days of no change in his condition, a trach was placed in order to allow him more comfort in breathing. He was finally able to smile, mouth words, and begin to try to speak again.

            During his stay in the ICU, Andrew wanted to be admitted to the Sheperd Center in Atlanta, however, his doctor told him that he would be on the vent for another 8-10 weeks. Within days of this news, Andrew regained the strength to come off of the vent. He was sent to a rehabilitation facility for a few weeks but later was sent to the Sheperd Center. In Atlanta, Andrew received the best care for his illness. When he first became ill, Andrew weighed about 160 pounds, and when he was admitted to the Sheperd Center, he weighed only 110 pounds. Due to his intense therapy schedule, Andrew began gaining strength and eating more food. He was finally able to feed himself and began eating up to 3,000 calories a day. On October 14, Andrew took his first steps since the paralysis. Soon, he was able to walk around the facility and explore Atlanta with his family using Lofstrand crutches. He built up the endurance to complete five hours of intense therapy a day. While receiving treatment at the Sheperd Center, he received OT, PT, and respiratory therapy services. He accredits his therapy team for such a phenomenal recovery experience.

            Finally, by November 3, 2016, Andrew was back home in Smyrna, Tennessee. He was able to drive again and even voted in the presidential election. After two months of outpatient therapy, Andrew was fully recovered in less than a year and back to being a firefighter. He was determined to get better during the entire process. Outside of therapy, Andrew began working out often by doing crossfit, rock climbing, horseback riding, and jet skiing.

            I chose to do my first Neuro Note assignment on GBS because it is a neurological condition that I do not know much about. I wanted to dive deeper in my understanding of this condition. Andrew’s video was recommended as a great story on the resources page provided by my professor, and immediately, I was drawn into his story. I found myself fighting back tears throughout the video.

            I learned about the real and raw details of GBS through watching Andrew’s experience. This video provided me with a real look at this syndrome and related directly to the course content. I was able to see some of the OT interventions in Andrew’s treatment and see how OTs at the Sheperd Center addressed GBS. As this course is all about how to treat individuals with neurological conditions, I found it extremely beneficial to watch videos of his therapy. It gave me a perspective on the progression of therapy and how long treatment can take for this condition. I began to appreciate his small improvements throughout the video. I recommend that others take the time to watch this video as it details Andrew’s experience with GBS. His family showed the good, the bad, and the ugly of his journey, which provides future healthcare professionals with a real, educational account of his experience. I saw instances where the healthcare professionals on his medical team did not advocate for him or made careless mistakes in his treatment. Seeing these mistakes taught me how differently I would want to act if I were on his team. It highlighted how important I can be in the recovery of an individual with GBS in the future if I chose to advocate for my client and gear therapy to meet the needs of each individual I treat.

 

Here is a link to Andrew’s story: https://www.youtube.com/watch?v=VWvrHhs2jps

 

Franek, A.J. (2017, August 1). Andrew’s story: Guillain-Barré Syndrome [Video]. Youtube. https://www.youtube.com/watch?v=VWvrHhs2jps

Social Determinants of Health and Your Nervous System

Social determinants of health (SODoH) can be described as all the factors surrounding you that can influence your health. These determinants can be your house, job, education, social support, access to healthcare, environmental, or socioeconomic status. All of these factors impact your nervous system. If someone experiences chronic stress, they may see higher levels of cortisol. Chronic stress can lead to reduced size and number of connections in the hippocampus and enlargement of the amygdala. The PFC also is utilized less during times of stress and functioning can be impaired. 

 Education on proper diet and exercise can prevent one from becoming obese and increase one's ability to maintain balance and prevent strokes or falls that could lead to a traumatic brain injury. Another factor that can impact one's ability to exercise is their environment. Some people may not have access to a gym or a safe place to exercise. If someone lives in a food desert and does not have access to transportation, it may be extremely difficult to buy nourishing food that promotes brain health. 

Having certain jobs can increase the health disparities one may experience. For example, people with very stressful jobs are at risk of hypertension, heart disease, and several other diseases. Having a low socioeconomic status can lead to an inability to adequate healthcare and necessary medications. If a person has hypertension, it is vital that they receive medication to lower their blood pressure and reduce the risk of breaking down the BBB.

The UTHSC OT program requires students to receive 75 hours of community service upon graduation for several reasons. First, several of the community service events that I have participated in have exposed me to people that grew up with different circumstances than I did. The service requirement also prepares us as future practitioners through the opportunity to advocate for OT and the clients we will be working with. OTs are typically servant leaders, so I was able to begin serving others in preparation of doing so as an OT. Finally, the requirements taught me how to best manage my time. I was able to spread out my volunteer work over the entire semester and do a little at a time. The service hour requirements for the OT students at UTHSC will better prepare us as practitioners. 

Locomotion and Adaptive Devices

It is very important to appropriately fit each assistive device that you give a client. It is important that each device be fitted in order to increase the functionality and safety of the device for the user. If something is not properly fitted, the client may struggle to use it or struggle to use it safely. Also, each device should be fitted for the comfort of the client. For example, if a wheelchair is not fitted for the client’s size, there could be issues with joint placement, posture, and uncomfortable rubbing and skin tearing.

 

To fit a cane, you should adjust it so that the hand grip is at the same level as the wrist crease, ulnar styloid, or greater trochanter. This should situate the elbow in about 20-30 degrees flexion and allow the shoulders to remain relaxed.

 

To fit axillary crutches, you should adjust the hand grip to be at the same level as the wrist crease, ulnar styloid, or greater trochanter. The axillary rest should be about 1-1.5 inches below the axilla and allow the shoulders to remain relaxed. The handgrips should be in line with the wrist crease, ulnar styloid, or greater trochanter when hands are resting at the side.

 

To fit Lofstrand crutches, the arm band should be positioned 2/3 of the way up the forearm. The length of the crutches should be about the distance from the client’s forearm to the opposite hand’s fingertips.

 

To fit a platform walker, you should position the platform surface to allow weightbearing through the forearm. The elbow should be flexed to 90 degrees and allow the client to relax their scapula. It is important to allow 1-2 inches of the proximal elbow to rest off of the platform in order to prevent nerve compression

 

To fit a rolling walker, you should use the client’s height to estimate the necessary height of the walker. The walker should be at a height that allows the client to stand with their warms relaxed. The handgrips of the walker should also be in line with the wrist crease, ulnar styloid, and greater trochanter when the hands are resting. In use, the client’s elbows should be flexed to about 20-30 degrees.

Hierarchy of Mobility

In order to restore confidence in mobility within a client, one must first achieve bed mobility. From then, the client must master a mat transfer, wheelchair transfer, and bed transfer. Next, a client will master functional ambulation to participate in activities of daily living and then toilet and tub transfers. Then, a client must perform car transfer to move onto functional ambulation for community mobility. Finally, to reach the highest level of mobility, one must master community mobility and driving. This hierarchy makes a lot of sense to me. I think it is sequenced in this particular order because it takes you from the least mobile position in bed to the most independence in mobility through driving and community mobility. In my experience as an intern and oberver, I have noticed many practitioners use this sequence when helping a client with independence. I saw a lot of practitioners work on bed mobility first and work a client’s way up to working on transfers and finally to community re-integration. When I interned at Memphis Jewish Home and Rehab, I saw therapists work with clients towards a goal of attending the bi-weekly community re-integration outings to Kroger and Walgreens. Once a client worked their way up the hierarchy of mobility and were close to a discharge date, they were able to go out to local grocery and drugstores to practice community mobility through shopping. Some clients shopped using a car with a therapist nearby, and other clients learned how to shop using a wheelchair. I agree with this approach because it really moves from least mobile to most mobile. Through my time as an OT student, I have learned that this hierarchy may not be exactly the same for everyone. There are going to be clients who may not reach the highest level of mobility, however, it is our job as future practitioners to find the “just right challenge” with each level in order to help the client reach their goals. Community mobility may look different among clients, but the goal is the same. As an OT, you may have to teach one client how to navigate public transportation while helping another client get back to driving again. Despite the differences in how the client commutes, the overall goal of mobility is the same.