I am ABSOLUTELY an Imposter....

What is imposter syndrome? "Doubting your abilities and feeling like a fraud," according to a quick google search. AKA, story of my life. I rarely have ever been given praise and actually believed that I deserve it. Everything that I have accomplished I blow off and say that I was lucky or something along those lines. I completely have imposter syndrome, let's talk about it. 

I took this "Impostor Phenomenon Rating Scale" test and scored a whopping 80. Now most would think "wow an 80 what a high score, she's awesome!" well I am kind of cool, but in this situation you actually want to have a low score. I scored around the area of frequent imposter syndrome feelings and intense feelings of imposter syndrome.... Sadly I would say that this is very accurate for me. I struggle everyday to think that I actually have a brain and that anything I do is actually worth anything. I can't compliment myself, I hate being complimented because I feel like the other person is lying to me or pities me or wants a compliment in return. Basically anything positive that happens in my life I just wait for the other shoe to drop/ say that I am lucky. For the past year and a half at this point I have been waiting for Ashton Kutcher to run out from behind a corner and say "You just got Punk'd!" To my surprise, this has not happened yet. I'm about to walk across a stage to get my OT white coat and then during my level 2 fieldwork rotation I am expected to manage a case load by myself?! I am terrified! As someone that doesn't believe that she belongs in the program, I'm stressed. I believe that everything happens for a reason, so I'll just go with the flow and see what happens. So far, I have been to therapy (like actively attending a session weekly for a few months) twice because of my racing thoughts/anxiety/self-esteem/depression and unfortunately I quit before we can get to the part of addressing my actual issues. I know this is a problem for me, but I don't believe that I am worth fixing my issues. Which is an issue in itself haha. I have problems. Hopefully I don't misrepresent my school's program by being an idiot because this truly keeps me up at night. I'm so scared..... To end on a happy note, I am very excited for this rotation too. I'm pumped to learn and see so much! I allowed myself to have a fun selection and a not so fun selection when selecting fieldwork sites. This is my "fun" rotation so deep down I am very pumped, but man I'm scared. Excited and scared and an 80 on the imposter rating scale. That's me. The end. 

Locus of Control

Locus of Control- OT 630

    Upon getting my results back I don't really agree with them. It says that I am a person who has a score of an 18 believes more on the side of external locus of control. I think this exam is based on perspective in a way... Let me try to explain...

    Me personally, I believe that in my own world my actions reflect me and my successes/failures but when looking at a global scale it's more on the people in charge. The video we watched about this kept using the example that a person more on the external locus of control side would blame everyone else if they failed to graduate or get a promotion. This person would blame the teachers for failing to teach him/her or that the boss promoted someone else just because of favoritism. I don't think this way all. On the contrary while I was failing my anatomy course I put the blame on myself because I clearly didn't put in enough hard work to accomplish better grades. I do try to be gentle with myself and remember that I had just moved into a new city not knowing anyone so I lacked any emotional support and that I leaped back into school after having a year and a half off. I did have other factors going on in my personal life but at the end of each day I knew that only my daily actions could change anything. So maybe this example is somewhere in the middle?

    I do believe that we the general public people have zero say in government policies and that people in positions of power stepped on anyone and everyone they could to get to where they are. To try to build off of this I'm going to refer to the options in #3 "a.) One of the major reasons why we have wars is because people don't take enough interest in politics. b.) There will always be wars, no matter how hard people try to prevent them." I selected option b because war is a money maker for our nation, so in my opinion/view I believe we will always and forever be in some type of war. *spoiler* A movie recently released called "Without Remorse" and basically at the end of this movie a politician says that he was trying to create a fake war with (I think I remember correctly) Russia to instill fear in our nation as a way to unite us together and help the economy. Obviously there is more to it but that's the gist of it. I point this out because this movie had nothing to do with people caring about politics at all. It was just one corrupted human in a position of power deciding we weren't doing enough for our nation and so we need war. People can care about politics all-day, everyday but that does not mean change will happen. Let's quickly reflect on 2020 with all the political chaos.... Has the police been defunded yet? Nope. Was there a ton of care and interest during that time and into the future? Heck yea. So I have a hard time trusting those in power. Another example that could be debated would be #8 "a.) Heredity plays the major role in determining one's personality b.) It is one's experiences in life which determine what they're like." I selected b that one's experiences in life determine what they are like. I think this is true yes but also I know through science that genetics and heredity can play a role in someone's personality when considering schizophrenia, bipolar disorder, depression, etc..

    I don't like quizzes like this that try to put your entire view on things down to an A or B option because it's perspective and could depend on your current mood when reviewing it. What if someone took this right after being declined a promotion, I'm sure that person would have a bit of a chip on his/her shoulder and would have a different selection of answers if they did get the promotion. If I were to take this during a depressive period my answers would be completely different rather than when I passed my anatomy class. (YAY). I don't know if I did a fantastic job explaining my thoughts and feelings regarding this topic. It's a tricky topic to explain through just typing out words. But hopefully I gave some thought provoking points to think about over time. Thanks for reading. :)

Media Project- Maurice- Gloves

My client is an 83 year old man diagnosed with Parkinson's disease.

I wouldn't really say that during this assignment I had specifically an "Ah-Ha" moment. There was never a light bulb that went off in my head. I think that might have been because of my chosen object. I looked through the list of all the students and had better ideas for some other objects but maybe I just had a mental block because I was overthinking for my personal assignment. You know like sometimes it is easier to help someone else out like the answer is so simple through your eyes but when it comes to your life/perspective you have "blinders" on and can't see past what the object is. I mulled over gloves for a long time, thinking to myself that there is no other possible use of gloves than to wear them when it's cold. Well that's not really true, my mom wears them when she's cutting up jalapeños cause she doesn't want the "juices" to get in her finger creases and then possibly in her eye; doctors wear them during exams; and even my dentist when I was younger would blow gloves up and draw faces on them as a "gift" to take home. Gloves have multiple purposes. Who knew?

A take away from this assignment is for me to take off my "blinders" I need to stop seeing everyday basic objects as their single given purpose. I don't have a very creative mind, I would say that I am a very "in the box" thinker. So after this assignment I need to start seeing objects as things as more than the given reason. I think this is a valuable assignment because it proves that you do not have to spend a lot of money for assistive technology or therapy intervention. This will stay with me as an OT because I know I will have a budget and will need to be creative and crafty coming up with simple solutions using everyday items.

https://www.youtube.com/watch?v=KkepXS2j-F4

The Theory of Everything- Neuro Note #5

Marsh, J. (2014). The Theory of everything. United States: Universal Pictures.

So this movie is about the late Stephen Hawking. It has its ups and downs. It starts off with him as a student at the University of Cambridge. He meets this woman that will soon become his wife, Jane Wilde. It ends years later after he meet the queen of England with his ex-wife and kids. Shortly after meeting Jane at the age of 21 he gets diagnosed with amyotrophic lateral sclerosis (ALS). This disease effects your motor neurons that control voluntary muscle movements. Stephen asked the doctors how his body would change and his doctor made it clear that his muscles would deteriorate but that his mind will stay the same. He also was told that he would only live about 2 more years.... Wow, two more years to live at the age of 21... Yep I cried. All wasn't lost for Stephen though, after some time I suppose he came to peace with this diagnosis and he kept working on his physicist work about "the theory of everything", the beginning of time, the theory of how everything was created. Spoiler, Stephen become a very famous physicist and lived much longer than the 2 years he was given. Screw time huh Stephen.

There was a specific moment in the movie that made me think, "Yep I want to help someone have that moment right there." It was after his second child was born. Jane had Stephen's arms up on a table in the shape of a circle and she laid his daughter in his arms. That was how he had to hold his child. Broke my heart but also made me feel warm and fuzzy on the inside. To help someone hold their newborn child, yea that seems pretty rewarding.

There was another moment, when Elaine walked in and blew him away. She had a letter board that was supposed to help Stephen communicate since he could no longer talk. She memorized where all the letters were located on the board and Stephen was able to communicate with her without having to use the board, he could just move his eyes around. She also didn't treat him as a victim which I'm sure was a welcomed feeling for Stephen. Everyone around him seemed to treat him as if he was made of glass since his diagnosis and beating the 2 year time limit he was given. This is something I think OTs and other health care providers should remember. Their client/patient was someone before their diagnosis and want to be treated the same as before. Always remember to look past the diagnosis and see the person you're caring for. Should we call that "The Theory of Caregiving"??

Myasthenia Gravis- Neuro Note #4

Carter, B. (2014, October 23). Sheryl and myasthenia gravis: how I cope! YouTube. https://www.youtube.com/watch?v=UZU2nTf6_cc

This video was about Sherly, a 16 year old girl with myasthenia gravis. Myasthenia gravis is a chronic autoimmune neuromuscular disease that weakens the voluntary skeletal muscles over time. She talks about medications that can help her disease and other medications that might help someone else. She also talks about how she can stay in communication with her friends in school like through social media, text, FaceTime, etc. She makes it known that she can still do normal everyday things like taking her little sister for short walks. It just takes her a while to recover from the activity. She even gets involved with her staff members with paintings.

This video taught me a little bit about what myasthenia gravis is and even showed me that someone with this disease can still live a complete and fulfilling life. She is still involved with her sports team by cheering them on, she gets to go on vacations and she has a successful social life. Although her life doesn't look the exact same as the "average" 16 year old in high school she still gets to experience pretty much everything that all the 16 year old girls get to do.

20 Year Old in a Nursing Home- Huntington's Disease_ Neuro Note #3

Butz, D. (2018, March 29). From high school to nursing home: 20-year-old learns to cope with fatal disease. Sioux City Journal. https://siouxcityjournal.com/lifestyles/health-med-fit/from-high-school-to-nursing-home--year-old-learns/article_06dd5b66-dd55-52ee-864d-c54b7be8d324.html

Huntington's disease is something that isn't new to Desiree's family. This disease has taken her mother's and grandmother's life. At the age of 18 Desiree started to experience pains and weakness in her limbs. In 2016 she was moved to a skilled nursing facility when daily activities became an everyday struggle for her. She spent some of her time playing PlayStation to help maintain hand and finger movement. Desiree had a wonderful staff on her side that did whatever they could to give her a childhood she never had by taking her on trips around the city. The staff and townspeople held fundraisers in her honor, so that Desiree could complete her number one bucket list item. Although the number one dream couldn't be achieved, they were able to schedule and raise money to let Desiree go to Disney. Desiree was able to go see the beach for the first time and was able to ride the rides while also seeing the Disney princesses. 

I picked this article because I don't know much about Huntington's Disease so I was hoping this would tell me more about this disease itself. Also I am 24 years old so the title and the thought of being a 20 year old in a nursing facility caught my eye. Although I did not learn much about Huntington's Disease itself this is a story that I will forget about anytime soon. The take away will be to appreciate the little things in life to enjoy the small things. I'm sure it was a hard experience for the staff having to take care of someone who's time will be cut short and definitely hard for her family having to watch this disease take another loved one from them. Do what you can to make to those you care for happy.

"Deny, Cope, or Thrive"- TEDTalk: MS- Neuro Note 2

Buxhoeveden, S. (2015, April 3). Thriving in the face of adversity. TEDTalk.

Stephanie was 25 years old, a neurosurgical intensive care nurse and enrolled in a program to become a nurse anesthetist (the person that injects you with anesthesia). One day while she was working out she noticed her foot go numb and it progressed up her leg as time went on. Being a driven person focused on her end goal and not current problems she ignored this and carried on with her day to day life (I probably would have done the same thing honestly.) As time went on she finally got her moment in school. She was going to get to be in an operating room and was going to administer anesthesia. (Woot-Woot! Big day!) That morning she was getting dressed and still couldn't feel her legs, she got to work and before things got too busy at the hospital she noticed that one of her arms went numb and her vision started to go away. So she finally called her instructor and told her what was going on with her body. Her instructor told Stephanie to go to the ER which was very close to her. She got admitted and stayed for a week... She was then diagnosed with multiple sclerosis (MS). Lucky for her though it's relapsing remitting MS and not progressive. She takes medicine and has adaptive equipment to help her with pain management and daily struggles. One day while she was in the hospital her nurse mentioned not liking neurology, which Stephanie loves neurology. So Stephanie chatted with her for a while and showed the nurse some cool stuff. The next day the nurse came back with a new fire within her about neurology. Seeing that change in a person lit a fire within her. Stephanie changed careers and became a nurse practitioner working with other MS patients. After some time went by she noticed that a lot of her patients had the same questions about what to do after being diagnosed. So she started a website about answering the questions and sharing her story as a fighter as a way to help educate those who do not have access to specialists or those that could be in the dark about their own personal care.... Wow what a woman! 

My uncle passed away when I was (I believe) in 8th grade (maybe 7th grade). My family seemed to have 3 back to back to back deaths around that time. They were all unfortunately kind of expected, one simply from old age, one from Alzheimers, and one from MS. My uncle had been diagnosed with  MS years before (again I was young during this time and I don't remember the timeline very well). I do remember clearly my family speaking so incredibly highly of my uncle I can't even describe the amazing things they would say about this man. He was an incredibly hard worker and didn't ask for anything in return- life is cruel sometimes. At the time (I was like 13 so forgive me for not cherishing moments more) I didn't really paid close attention to the words people said, but they never left my brain. He always seems to come to mind when I think life is getting hard for me or if there is a task that needs to be done. He just pops up in my head randomly, I think I have modeled my work ethics after him and my father (two very driven/hardworking men that you could count on). As I got older and became more interested in the medical field MS became a topic that just never seemed to go away no matter how much I wanted to ignore it because I don't want to think about the pain he felt or other struggles he dealt with within his body. And once I learned that it's an autoimmune disease that attacks the sheath around your nerves disabling communication within your body, and your body slowly just kind of quits on you. My heart broke in half because I cannot imagine the amount of pain my uncle probably experienced for years, and he probably never really complained either. What a man!

I wanted to hear the story from someone else. I wanted to hear someone else's experience. I need to learn that not every story is going to be like my uncle's and that people do indeed have successful lives after this diagnosis.

What I am taking away/ gained from this content is that it is time for me to grow up. I picked this topic simply because I need to start facing MS and other diseases that have affected my family head on and to stop being a child and ignoring them. I honestly did not know that there were two types of MS one being progressive and one being relapsing remitting. I kind of thought that they were all what my uncle experienced. Learning about relapsing remitting MS has given me hope for those out there battling with this disease. I gained more internal "strength" and maybe not as much knowledge after this but both will be carried on with me through my journey.

https://www.youtube.com/watch?v=zuLOT6GsAxw

The Mother of Dragons Had a Brain Aneurysm After Season 1?!

Clarke, E. (2019, March 21.) A battle for my life. The New Yorker.

I honestly picked this story because I was a huge fan of "Game of Thrones" (up until the last few season/ I named my car after Arya Stark's direwolf Nymeria but we aren't talking about that). I do a pretty alright job of keeping up with what is going on in the pop culture world, but I had never heard about any of this happening. So I was pretty surprised and captivated simply by the title, I had to know more.
The Mother of Dragons had two brain aneurysms. Wild. She obviously has made a complete full recovery from them. For the first one in 2011, she just had an endovascular coiling which just means that they took a wire through her femoral artery all the way up her body and to her brain to stop the bleeding. (How wild a wire can go from your groin all the way to your brain! Medicine is cool.) Her second procedure in 2013 did not go as planned. It was supposed to be another simple operation but she has a massive brain bleed so the surgeons had to cut her skull open and fix the problem "the old fashion way". She dealt with aphasia for a while but after a few weeks she was back to normal learning her lines for upcoming "Game of Thrones" season 4.
A personal take away from Emilia's story is just that you never know what it going on internally, so always be on your toes for any changes within yourself and those around you. No matter how healthy you are, something could easily go wrong within you and bam that could be it. She spoke about possible warning signs she and her family might have ignored like migraines and fainting as a child. Maybe if she would have gone to the doctor sooner and spoke about these things she wouldn't had to have two operations or they could have done something sooner before her first aneurysm. I feel like people need to know the signs and symptoms of when someone else is having a brain injury whether it's traumatic or non-traumatic.

https://www.newyorker.com/culture/personal-history/emilia-clarke-a-battle-for-my-life-brain-aneurysm-surgery-game-of-thrones?source=EDT_NYR_EDIT_NEWSLETTER_0_imagenewsletter_Daily_ZZ&utm_campaign=aud-dev&utm_source=nl&utm_brand=tny&utm_mailing=TNY_Daily_123119_TopTen&utm_medium=email&bxid=5c323320639ec86e604a6ea6&cndid=48059106&esrc=&mbid=&utm_term=TNY_Daily

Social Determinants of Health

So how do you define social determinants of health? To me it is when your "social status" affects your health in a way that might not be completely in your control. Yes we can all go outside and walk for 15 minutes everyday. But that becomes challenging when your town doesn't have safe sidewalks or even a small park. Or what if you simply live in an area with a bunch of factories and there air filter system isn't very efficient or what if you don't have proper plumbing on a trip to a third world country? I took a trip to London when I was in high school with my mom and the air is so polluted there that our mucus turned black. Social determinant of health automatically put your health at a disadvantage without you even doing anything. 

This related to your nervous system in a few ways. When I blew my nose in London and saw black snot... It kind of freaked me out. I remember thinking pretty often that this is what was going into my lungs and inside my body, but I couldn't do anything about it. The TED Talk we listened to started off with a doctor talking about one his patients in the past. She suffered from migraines. None of her previous doctors could come up with a solution to her problem but he figured out that her home had mold, a water leak and rats. Her poor living conditions were causing her health problem. She took action and had her landlord fix her home and bam, recovered. 

The UTHSC OT program requires us to have a certain amount of service/ professional development hours during our time as student's here. I think this is an excellent way to go ahead and get upcoming 

OT's in a mindset of helping the community in different/creative ways. To go ahead and form good habits of observing our community and finding ways to improve it as we grow within ourselves and as a whole.

Locomotion and Adaptive Devices

As life progresses or after a traumatic event, you or someone you know will need an assistive device. It is very important to make sure that you are properly fitted for your assistive device. Say you were playing basketball with some friends and you sprained your ankle. You go to the nurse, the ankle gets wrapped up and you leave with axillary crutches. This is just your standard crutch that goes under the armpit and has one surface toughing the floor. You want to make sure that it is not too close under your armpit because this will increase the amount of pressure there and possibly damage your brachial plexus. Then you really will have a much bigger problem than a sprained ankle. So preventing other possible injuries is one reason. Another reason would be to prevent fatigue, this device is supposed to assist, not make the client's life a little harder. Say for example grandpa is having leg pain. His therapist orders him a cane but doesn't measure everything correctly and the cane comes in a little too short. The therapist blows this off and says eh you'll be fine. Well as grandpa is using the cane he is hunched over to one side and not standing up tall with good posture. Over time grandpa's back is going to start to hurt and he is probably not going to want to walk much since it causes him pain. A few inches off could really make or break an assistive device. You want to carefully measure everything because again, these devices are to "assist" and make life a little easier/ mobile not cause other problems and make you become more sedentary. Life is too short to watch it blow by from sitting on the couch.

In the following sentences I will explain how to measure and fit a client for a cane, axillary crutches, Lofstrand crutches, platform walker and a rolling walker.

• A cane you want the hand grip to be at the level of the ulnar styloid process, wrist crease, or greater trochanter so that the elbow is flexed at a 20-30°. Also decide which type of cane the client wants. There is a standard cane and also a wide based quad cane (WBQC) with 4 prongs touching the floor. The 4 prongs increases the stability for clients with a decrease in balance. There is also a narrow based quad cane that is the same as the WBQC but the 4 prongs are just closer together.

• Axillary crutches are the normal standard crutch that goes under your armpit. You want the axillary rest (the top) to be about 5 centimeters (or about 4 finger widths) below the floor of the axilla (armpit) with shoulders relaxed, so that there is no increased pressure on the axilla.

• Lofstrand crutches are the type of crutches you would see used by someone with Cerebral Palsy (think of the son from Breaking Bad). There is an arm cuff that wraps around the proximal arm (about 2/3 up the forearm) and hand grips for the client to hold onto. You want the hand grips close for a resting neutral position.

• Platform walker is a standard walker with a platform to support a forearm. You want the walker hand grips to be level with the ulnar styloid process, wrist crease, or greater trochanter and the elbows flexed at 20-30° like for a cane.

• Rolling walker is a walker with 4 wheels and the hand grips have brake pulls to help with stopping. These are for clients that can't lift a walker so you can just push them. Normally they come with a basket and also a place to sit in case client becomes fatigued while walking. Keep in mind that this is the least stable assistive device. 

Hierarchy of Mobility Skills

After a traumatic event and a client is stuck in bed there is a certain hierarchy of mobility skills that much be met for them to successfully and safely walk on their on once again. The hierarchy is as follows: 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. In my mind this process makes perfect sense like the saying you gotta walk before you can run. Well you must be able to move around in your own bed before you can be expected to get up in a wheelchair. I think it was planned out this way because if you were to make an assumption that your client can complete a task, you might want them to fall back on pillows instead of possibly the floor. It just seems like the logical and safest way for movements to progress. I can't really say that I have seen this in my past to my knowledge. When I worked at an assisted living faculty our residents there were relatively mobile when they wanted to be (that was the key). I feel like I would see more of this in an ICU unit or maybe even a nursing home. I completely agree with this process you start small (like sitting up in bed) and work your way up (like to transfer into the tub). I also think accomplishing multiple "small goals" builds confidence for much larger goals and makes things feel easier when taking everything slow and steady.

Proper Posture and Body Mechanics

There are many important reasons for clients to have proper posture. Number 1 would be for preventative measures. Standing up correctly will help to prevent disc herniation and general back pain. I have a hunch to my upper back and notice that my lower back hurts a lot. I noticed when I started working out at the gym and focused on my back muscles that the pain went away for the most part. Having a standing desk would also help strengthen a back because the client would not be leaning over it throughout most of the day. Number 2 would be to have good body awareness, with poor body posture you're more likely to lose sensation in places and not knowing where exactly they are in space. Number 3 is to prevent spinal contractures. Improper posture adds extra stress and strain on ligaments and tendons which can also lead to back pain. Lastly appearance, good standing posture has a positive affect to those around you. It makes you appear taller while also demands a certain amount of respect in the workforce.

An example that we were shown during this week was to hold a stick to your back while you squat to make sure you're bending your knees and not hunching your back is a good one because it has minimum equipment and you can do it at home. I also liked the slouch-overcorrect technique we learned about, sitting hunched over and then sitting extremely upright relaxing about 10% effort. This is a good exercise to do every once in a while especially when sitting at a desk for a long period of time. Another thing you could do for improvement is simply record the client squatting or standing and show them on camera where the problems lie and also record yourself for them to see proper form. 

How Do You Feel About M&Ms?

This M&M Christmas commercial weirdly gets me in my feelings. I think it is because they play the same one every year so it's been a consist thing since my childhood. I'm not really a big fan of normal M&Ms but I love the peanut butter, peanut, brownie fudge, minis, basically all of them except a normal chocolate one like I said. They just tap into my longterm childhood memories which is part of the hippocampus in the brain; makes me imagine Christmas and what happened years ago. Recently M&Ms are doing yearly voting where the company releases three new flavors and you can buy them, try them, and vote for it to be permanent. These really stick with me because I make it a mission to try them all just to say I did it and was a part of the process. It really taps into my declarative memory sometimes, the company released a jalapeño M&M and I remember being at the Hilton Head beach trying that with my cousins. I made a co-worker try these and she almost threw up right in front of me so that memory is probably stored in her amygdala. Family members now send me the weird ones they come across and it's a fun conversation starter sometimes. It is kind of cool to think that a little piece of chocolate can take me back to very specific times and places in my life.

I Got Chills Reading Man From the South

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Neurotransmitter Drawing, Glutamate

Implicit Bias

"Don't judge a book by its cover." We have all heard this. Whether it's consciously or unconsciously, sometimes we just can't help it. I honestly judge very quickly, I have an opinion about someone I've never met before they can even say "hi". What I believe makes this ok, is that I know everyone has as story and I try my best to give them an opportunity to show me who they are. Implicit bias is basically your unconscious judgement of a person. You don't know the first thing about them and yet you have already formed an opinion about this stranger. Judging hair, skin color, clothing, walking stance, posture, facial expression. Truth be told, they did the same to you.

This is something to be conscious of as a practitioner because you don't want your quick judgement to change how you deliver treatment. That's not fair to your client and it does not reflect well on you. You do not know what their struggles are, you don't know what kind of day they are having. Why should any of this change your treatment. Everyone deserves top notch therapy session no matter what. Think I'm wrong? Emergency room employees have to treat gun shot wounds endlessly, they do not know anything about the unconscious patient they have on the table... What if that was your best friend that happened to be in the wrong place at the wrong time involved in a drive by? You wouldn't want that surgeon to assume your best friend; a father of 2, faithful husband, loyal employee, dog lover, fellow hockey lover; was involved in something sketchy and maybe not put forth their best possible effort. A little extreme for example? Yeah you're right. But you get my point.

So how can you be aware of and improve your implicit bias? Well to start, I think it's important to know you have bias, it isn't necessarily a bad thing. There are a ton of surveys online that you can take to see where your bias lies. As a healthcare profession, you could take classes that point this out and have discussions about it. Get out of your comfort zone. Be open minded and have an open ear to those you encounter, put yourself in their shoes and be aware of how your actions might make someone else feel.

Scapulohumeral Rhythm

What is the clinical relevance of the scapulohumeral rhythm? How can it affect your ROM measurements of the shoulder? Please give at least 5 reasons in your response.

The shoulder is a fragile joint in the body. This ball and socket joint has the greatest mobility throughout the entire body, and its only connection is the sternoclavicular joint.  Scapulohumeral rhythm is the ratio of movement between the scapula and humerus. The exact ratio is every 3° of shoulder movement there is 1° of movement for the scapulothoracic joint, the joint between the scapula and the rib cage even though this joint isn't a true joint, and 2° of movement for glenohumeral joint, the joint between the glenoid fossa of the scapula and the humerus. When there is poor upward scapular rotation this can reduce the subacromial space is the shoulder joint causes pain, impingement, function of the joint and even damage the structures within the space. Check both shoulder's on your client because one side will likely be different compared to the other side. If there is weakness present there is probably a problem with one of the rotator cuff muscles, supraspinatus, infraspinatus, teres minor, and subscapularis. This is a delicate joint to work on, proceed with caution.

Conceptual Model

Test Positioning: BioM

Not all bodies are created equal, this is one of the many things I learned in my anatomy lab. The textbook may say something should be in a specific location, but that is not always the case when dealing with a plethora of human bodies. You can however rely on the probability that most everything is connected the same. Like the ulna and radius being side by side, odds are you aren't going to met someone with a femur in the arm and a fibula in their forearm. Bony landmarks are highly useful when measuring range of motion because it's going to be there, it is something most every human body will have and it will likely be in the same position for everyone. It's a solid general reference site to find. We may not all speak the same language but our bodies are the same. Sort of like math, it's the same world wide no matter where you are 2 plus 2 will still equal 4. So no matter who's body you are palpating the lateral epicondyle of the humerus will still be on the outside portion of the elbow. Using the same landmarks help improve goniometer accuracy when measuring range of motion since it will be the same placement for each client. From a client's perspective, it would be reassuring that if a different professional needed to take their measurement that the process was the same. This helps improve reliability in the measurement and simply reassure the client since the process will be the same as before.

Manual Muscle Testing positions are important because you want to maximize the cross bridges forming within the muscle. You want to give the client the best possible chance to end up successful. Some clients could be double jointed in their elbow making it harder to flex from a fully extended position which isn't fair compared to someone not double jointed. We aim for a mid range position so that there are not too few cross bridges or too many cross bridges since the majority of the human body levers are already set up at a mechanical disadvantage. Gravity itself is a form of resistance. For those that are recovering from a traumatic experience, their bodies may not be ready for the 9.8 meters per second squared (that's the force of gravity for my nerds), so we have to take gravity away by placing the client in a way so the action will be performed parallel to the ground. The client is starting back at square 1 so eliminating gravity and slowly adding in resistance is the better route to build them up to where they once were or at least close to it as best we can.

I Miss Sushi- Lets Eat!

Give me a California roll with some fried rice on the side... Uhmmm. Yum. Since this pandemic and my favorite restaurants have closed basically the only food I crave has been sushi. Yes I can make it at home... BUT it's not the same.... Rice, nori sheet, crab meat, cucumber, carrots, sesame seeds, avocado, sriracha sauce on top.... Yes please! Since it's all I want to eat, let's break down how that would happen.

Starting position would be me sitting at a table forearms resting against the table with the beautifully colorful plate in front of me, my eyes enlarge at the sight of food, mouth slightly watering. My eager right hand reaches out flexing my shoulder and turning my wrist 90° towards my midline, and digits 1 and 3 flex around the roll. Now it's time for the good stuff. My biceps brachii, brachial, and brachioradialis all together activate elbow flexion during this concentric movement along the sagittal plane on the frontal axes as the roll is brought up to my mouth. Breaking down my elbow joint a little more there is a concave on convex set up. The ulna is the concave portion while the humerus is the convex portion. The ulna moves forward while also gliding forward against the humerus. There is a slight shoulder internal rotation that occurs at the same time. Both the shoulder rotation and elbow flexion are open kinematic chains because the distal portions of my arm are moving while the proximal portions are staying relatively fixed. Once all of this is finally complete in the less than one second amount of time it takes for sushi to go from plate to my mouth, my jaw depresses, the sushi is placed, and my heart (stomach) is happy. Everything eccentrically moves back to the starting position for this route to take place about 12 more times. Wow I'm exhausted no wonder I want to take a nap after I eat, the human body is one hard worker!