Money from us (from our taxes) is passed to the government, which is passed down to the NHS to fund it. But how does the NHS department should get which money? And which departments should exist and get funded by the NHS at all? How are private companies involved if the NHS is a public organisation? The system set up to decide how the NHS’ money is spent is complicated, and it’s easiest if you just watch this video to understand:
Trends are a something (like a style of therapeutic practice) that is popular at the moment. Example:
- adult colouring books
- active ageing
- life stories
- use of Sensory Integration in settings other than paediatrics
- paternalism being challenged
- holistic approach to health
- in society, being in debt is acceptable whereas in the past it wasn’t
Contexts are the circumstances that influence or affect something (like a trend):
- Politics and the resulting government policies on access to services and funding
- the culture
- the attitudes of individual therapists
Contexts in healthcare are often influenced by political and legislation, because in the UK healthcare is funded by the government because we have the NHS. In other countries where healthcare is paid for by insurance or individuals consumers, it may be be more heavily influenced by these other factors? Anyway, in the UK the Care Act (2014) is a recent policy that supersedes the previous health-related acts such as NHS act (2006). Because of what the Care Act (2014) states, some expected trends to happen in healthcare will be
- integration of services:
- health and social care working more closely
- between hospitals and GPS (primary & secondary care)
- between mental and physical care
There are a lot of medical latin-sounding words used to describe the different stroke symptoms. Below is a list together with the way that I remember them.
In brackets is (Ph) or (M) to indicate whether the symptom is physical or mental. Physical could be movement or sensation; and Mental means cognitive processes such as perception or attention.
Around 40% of the brain is actually involved with vision, since it includes ocular motor movement, planning of these movements, receipt of the visual information, processing of it and then decisions made on the visual information – these decisions could be visuospatial, emotional etc.
Hemianopia (Ph) (hemi=half; plegia=paralysis)
Loss of vision in either L or R half of both eyes. So not loss of vision in left eye, but loss of left visual field in both eyes. The information from one side is not transmitted to the brain.
The information from eyes is being transmitted to the brain, but information for one side is ‘ignored’ or not processed by the brain.
Diplopia (Ph) (diplo=double; op=eye)
Continuous uncontrolled eye movements, seen with involuntary flickering movements of the eyes either L-R or up-down.
What is a stroke?
A stroke is similar to how a heart attack stops the blood going to the heart -but for the brain. So like a ‘brain attack’ or a sudden ‘strike’ to the brain. Depending where the blood is stopped from getting to in the brain, depends on what effect it’ll have on the person. Once deprived of blood and therefore oxygen, parts of the brain begin to die after only a few minutes and so a stroke is classed as a medical emergency.
Causes of stroke
Ischaemic– blood vessel blocked by clot, stopping flow. Most common 85% cases. Clot could be due to narrow arteries, clot in artery, or clot travelling from somewhere else to the brain. Brain area that dies is called an infarct… ‘the naughty clot “schemes” to injure the brain’
Haemorrhagic-blood vessel ruptures and blood leaks out. 15% cases. The leaking blood building up also causes extra pressure inside the skull. Leak could be due to high blood pressure or a weakened/bulging blood vessel wall (‘aneurysm’)…‘haemorrhage of blood’
Where the brain dies dictates which abilities will be lost. The right side of the brain controls the left side of the body, and vice versa.This means an injury to the left side will affect movement in the right side of the body.
The different areas of the brain control different tasks:
Frontal lobe (front)
- initiation and motivation
- voluntary movement
- appropriate socialising & interactions with others
- Broca’s area -produce spoken language
Parietal lobe (top middle strip: like saddle on a horse on the prairies, you experience a lot of unusual sensations as you ride through the desert like heat, smells, sore bum etc!)
- perception: processing sensation from touch/pressure/temp/pain
- Wernicke’s area-understand received language: spoken & written
Occipital lobe (back: why a blow to back of the head often affects vision)
- processing visual input from eyes
Temporal lobes (front either side:where your temples are located, a lot of old artefacts are stored (memory) and labelled (different things identified) in an old temple)
- distinguishing different smells & sounds apart
- visual & verbal memory (for words & names)
Cerebellum (bottom underneath, Latin for ‘little brain’)
- controls smooth (involuntary) muscles like gut or maintaining balance
Brain stem (stick at bottom, joining onto spinal cord)
- basic life support functions eg breathing, heart
The gate control theory of pain (Melzack & Wall 1965) proposes that non-painful input closes the “gates” to painful input, which prevents pain sensation from travelling to the central nervous system. Activation of nerves which do not transmit pain signals but transmit information about touch, pressure & vibration (called non-nociceptive fibres; nociception [no-see-sep-shun] is the perception of pain by beings) can interfere with signals from pain fibres, thereby inhibiting pain. Therefore, stimulation by non-harmful input is able to suppress pain.
The team in a pain clinic will typically be up of a clinical psychologist, nurse, occupational therapist, physiotherapist, an advising pharmacist, CBT therapist and counsellor. The International Association for the Study of Pain recommends the use of OTs for assessments an treatment of chronic pain (Loesler 1991). A pain clinic can be hospital (inpatient) or community (outpatient) based.
The theory of Sensory Integration (SI) proposed by Jean Ayres explains that how the senses are processed will affect other aspects of child development, such as social, emotional, physiological & neurological development. She hypothesised that motor learning was based on sequential developmental stages and could only be achieved if the necessary incoming sensations were received by the body.
There are two main sensory processing pathways in the body, the Dorsal Column Medial Lemniscal pathway (DCML) and the Anterolateral system (AL). [AL is sometimes called the Spinothalmic pathway.] These transmit the information received by the sensory systems from the body to the brain and vice versa. Read more
Occupational Therapists work with an astonishing range of clients and situations. Below is an anecdotal list of different types of OTs I have met or worked with, noting the similarities and differences between their specialisms and working environments.
Independent self-employed OT
OTs who have set up their own practice, for example one who provides assessment and treatment for children with autism or cerebral palsy. These are often in ‘role-emerging’ areas such as home adaptation consultancy for housing associations (eg http://www.viva-access.com/), or providing animal therapy services (eg www.nurture-dogs.co.uk).
Essex County Council
OTs are self-employed and work on a freelance basis. Jobs are put out by the council and OTs accept them as they wish; they are priced according to how complex or faraway the patient is. A difference here is that OTs therefore work independently which means they don’t have support of a team, must achieve their supervision needs independently, and ensure tax is paid. On the flip side it is a very flexible way of working as you can accept or decline work as you wish on a a week-to-week basis, balancing how much time you have spare vs how much money you wish to earn.