Neurodegenerative Diseases

An OTR® in home health care is seeing a client who has Stage III Alzheimer's disease. The client lives with an adult daughter and likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. To prevent the client from getting out of bed unnoticed at night, what would the OTR® MOST likely recommend? A. A nightlight in the room B. Full bedrails on both sides of the bed C. A video room monitor D. A bed alarm system

A bed alarm system will alert the daughter when the client is attempting to leave the bed and is more suitable for use when the daughter is not able to stay in the same room as the client for surveillance.

A client with a recent diagnosis of dementia is receiving occupational therapy. The caregivers are most distressed about significant behavioral changes that have occurred since the client was diagnosed. The client has become increasingly impulsive and difficult to redirect. What type of dementia does this client MOST LIKELY have? A. Frontotemporal dementia B. Alzheimer's dementia C. Vascular dementia D. Dementia with Lewy bodies

A. Frontotemporal dementia The distinguishing feature of frontotemporal dementia is behavioral changes with an increase in disinhibited behavior, decreased social tact, lack of empathy, and lack of interest.

On an inpatient rehabilitation unit, the OTR® and the evaluating physical therapist observe a new patient with Parkinson's disease eating breakfast seated in a bedside chair. The OTR® observes a fork on the floor and milk spilled on the patient's gown and tray. The patient begins coughing, spitting up pieces of pancake, and then says hello with unswallowed food in the mouth. What action would be MOST appropriate for the OTR® to take while evaluating the patient? A. Consult with the patient to propose adaptive feeding equipment to minimize spilling and dropping food. B. Educate the patient on the role of occupational therapy for feeding and speech therapy for swallowing, and make an appropriate referral. C. Collaborate with the patient and the physical therapist to create the optimal seating and positioning of the patient to the tray for proximal stability. D. Discuss with the patient and the nutritionist an immediate need to switch to a mechanical soft diet.

B is the most important immediate action, because a speech therapist is a critical interdisciplinary team member who can evaluate for dysphagia and advise on appropriate diet changes or recommend further testing such as a video swallow. It is appropriate to discuss with the client whether the client wants increased independence with feeding via adaptive techniques or equipment, and providing education on the role of occupational therapy with feeding would help initiate this part of the intervention planning process.

At what stage of Alzheimer's disease (AD) does nerve cell damage cause significant motor impairments that limit the ability to complete life tasks? A. Mild cognitive impairment B. Early stage C. Middle stage D. Late stage

By the late stage of AD, nerve cell damage has become so significant that not only are cognitive processes impaired, but motor skills are also affected.

A client is able to say only "yes," "no," or "hello." This client is also incontinent of bladder and bowel and is unable to walk. In which stage of Alzheimer's disease (AD) is this client? A. Early B. Middle C. Late D. Mild cognitive impairment

C. Late Late-stage AD is characterized by limited speech, decreased ambulation, and incontinence.

Vascular Dementia

Cerebrovascular disease (often a series of small strokes) leading to focal lesions on the brain and neurotransmitter disruption

Alzheimer's Disease (AD)

Cortical atrophy of the frontal, parietal, and temporal lobes as well as the hippocampal region caused by an accumulation of amyloid-beta senile plaques and tau protein neurofibrillary tangles

A client presents with decreased memory resulting from dementia. What is the MOST EFFECTIVE strategy for an OTR® to implement to intervene with this cognitive impairment? A. Chunking or grouping similar items together B. Repeating information over and over again to oneself C. Rhymes to recall information D. Cue cards or signs in key places

D. Cue cards or signs in key places Adaptations, as opposed to targeted interventions, are the most effective strategy for decreased memory in clients with dementia.

At what stage of Alzheimer's disease (AD) will procedural memory impairments FIRST be noticed? A. Mild cognitive impairment B. Early stage C. Middle stage D. Late stage

During the middle stage, all memory worsens, including procedural memory.

What is an effective strategy to facilitate maximal independence in self-feeding with a client who has middle- to late-stage dementia? A. Change the client's diet to foods that are palatable and easy to chew. B. Change the consistency of foods to allow for easier chewing and swallowing. C. Provide hand-over-hand guidance for food retrieval and utensil-to-mouth motions. D. Provide constant verbal cues throughout feeding to improve attention to the self-feeding task.

Hand-over-hand guidance is an effective strategy to encourage maximal independence through participation in daily living tasks, including self-feeding.

Multiple Sclerosis Contraindications to Intervention

Hot temperatures Heat modalities such as moist heat or fluidotherapy Increased emotional or physical stress Excessive physical activity or overexertion Also use increases balance deficits and can be dangerous when mixed with medications used to treat the symptoms of MS

A client with middle-stage Parkinson's disease demonstrates tremor and rigidity bilaterally in upper extremities, mild difficulties with executive functioning, and increased fatigue during ADL and IADL performance. Which is the BEST occupational therapy intervention for a client in the middle stages of Parkinson's disease? A. Splinting to minimize tremor during fine motor coordination tasks B. Progressive resistive exercises to improve fine motor control function C. Training in the use of power mobility to maximize functional mobility independence D. Modification of clothing with minimal fasteners or hook-and-loop closures to reduce fine motor control demands

Modifying or eliminating clothing fasteners decreases the demand on fine motor coordination for a client experiencing tremors.

Frontotemporal dementia

Neuronal, intranuclear inclusions

Both standardized and nonstandardized assessments are included as part of an evaluation for a client with multiple sclerosis. Which standardized assessment would be MOST effective in assessing a client's endurance? A. Nine-Hole Peg Test B. Sleep Questionnaire C. Modified Fatigue Scale D. Multiple Sclerosis Functional Composite

The National Multiple Sclerosis Society recommends use of the Modified Fatigue Scale as a fatigue assessment.

A client with amyotrophic lateral sclerosis reports functional limitations when completing his daily routine. The OTR® has completed ADL and IADL assessments as part of the evaluation and is considering how the client's upper-extremity motor control is affecting his functional ability. Which assessment would be MOST effective for assessing this client's upper-extremity ability? A. Modified Ashworth Scale B. Trigger point evaluation C. FIM™ D. Purdue Pegboard test

The Purdue Pegboard test is a timed test of upper-extremity function and is useful in determining a client's functional limitations.

An OTR® has received a referral to evaluate a client with dementia who lives alone in the community. When the OTR® arrives at the client's home, the OTR® notices that the client is well groomed but appears to have forgotten that the OTR® had called earlier in the day to set up the appointment. Which area of occupation would be a priority to assess during the initial occupational therapy assessment? A. Bathing and showering B. Sleep C. Emergency system access D. Personal device care

The client has early-stage dementia as evidenced by short-term memory deficits but maintains the ability to complete routine ADLs. Other ADLs are likely intact, but IADLs, in particular those that require higher level executive function, would be affected at this stage. In addition, the client lives alone so understanding the client's safety in the community would be important.

Sundowning

an increase in activity and often agitation that begins in the late afternoon and extends into the evening or night.

Akinesia

delayed initiation of movement, caused by changes to the functioning of the basal ganglia

An OTR® in home health care is seeing a client who has Stage III Alzheimer's disease. The client lives with an adult daughter and likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. The client requires close supervision on the stairs and seems to be very fearful when putting the foot down on each step. To further ensure the client's safety in getting up and down the stairs at the back door, what would the OTR® MOST likely recommend? A. Yellow contrasting tapes on the edge of each step B. Installing a ramp with handrails over the steps C. Teaching the client to use a cane on the stairs D. Referring the client to physical therapy for stair training

A client with Stage III Alzheimer's disease often begins to experience changes in vision and perception. Having yellow tape on the edge of each step helps to differentiate each step and prevent the client from missing one.

Which behavioral symptom might a client with early-stage dementia have? A. Pacing B. Difficulty choosing appropriate clothing C. Vulgar or rude language D. Suspicion

A client with early-stage dementia might become suspicious; it is common for clients to think misplaced items have been stolen or that their spouse may be unfaithful.

An inpatient is in the recovery phase of Guillain-Barré syndrome. Currently, the patient uses a wheelchair for mobility and has Fair Plus (3+/5) strength of the upper and lower extremities, and Good (4/5) trunk control. The patient wants to be able to return home to care for a preschool-age child. What should be the PRIMARY focus of the patient's intervention during this phase of recovery? A. Gross motor movements and energy conservation for completion of PADL B. Fine motor activities and moderate resistance putty exercises to improve BADL C. Functional splinting and caregiver training for participation in routine ADL D. Compensatory strategies and assistive devices for childcare activities

A. Gross motor movements and energy conservation for completion of PADL Addressing gross motor movements and energy conservation will allow the client to meet goals while addressing the primary needs of improving mobility, maximizing energy available for preferred activities, and increasing strength throughout upper and lower extremities.

An OTR® is planning intervention approaches for a client in the recovery stage of Guillain-Barré syndrome (GBS). According to the biomechanical frame of reference, which preparatory method is the BEST for addressing upper-body dressing? A. Instruct the client in hand-strengthening exercises using therapy putty to increase strength for manipulating fasteners on shirts. B. Measure the client for resting hand splints to wear at night to prevent contractures while ROM returns to bilateral hands. C. Teach the client how to use a dressing stick and button hook to don a formal shirt independently. D. Develop a home exercise program for the client for upper-body ROM and light strengthening and provide education on energy conservation and the importance of rest breaks.

A. Instruct the client in hand-strengthening exercises using therapy putty to increase strength for manipulating fasteners on shirts. A correctly addresses hand weakness and its effects on fine motor tasks of dressing. The biomechanical frame of reference is a common theory used in practice and focuses on restoring or remediating skills to enhance occupational performance. A hand-strengthening program would restore needed ROM and muscle power to adequately perform fine motor tasks.

A client with multiple sclerosis (MS) presents with balance deficits and impaired lower-body ADL resulting from increased spasticity in the bilateral lower extremities. The OTR® wants to promote safety during bathing tasks, particularly the parts of the task that require standing. What might the OTR® FIRST suggest? A. That the client maintain at least 90° of hip flexion on a shower chair B. That the client use a long-handled bath sponge to reach the lower legs and feet C. That the caregiver be instructed in stretches to the lower extremities D. That the client place one foot at a time on a small stool while washing

A. That the client maintain at least 90° of hip flexion on a shower chair A addresses both the balance deficits and the spasticity that interfere with lower-body ADLs. By sitting down to wash, the client reduces the risk of falls, and flexed hips may lessen spasticity in the lower extremities.

A client presents with decreased orientation. What is the most effective strategy for an OTR® to implement to assist with this cognitive impairment? A. Use an orientation poster in a common area with personal and day-time information listed. B. Provide auditory reminders throughout the day that provide basic personal and day-time information. C. Provide the client with orientation information only when requested to prevent undue anxiety. D. Allow the client to establish his or her own routine, even if that means allowing the client to dress for the day in the middle of the night.

A. Use an orientation poster in a common area with personal and day-time information listed. Visual reminders are an effective strategy for deficits in orientation.

An OTR® has completed an evaluation of an inpatient who has acute Guillain-Barré syndrome. The patient scored a "3" on all subtests of the Functional Independence Measure. Based on this information, which outcome would be realistic for this patient to achieve prior to transitioning to a skilled nursing facility? A. Uses energy conservation techniques during daily self-care tasks B. Completes three sets of a progressive resistive upper-extremity exercise program C. Independently completes wheelchair transfers using proper body mechanics D. Demonstrates controlled dynamic trunk movements during IADL activities

A. Uses energy conservation techniques during daily self-care tasks According to the FIM score, the patient requires moderate assistance for performing activities. In the acute phase of Guillain-Barré syndrome, the patient may be experiencing muscle belly tenderness and overall fatigue; energy conservation techniques will allow the patient to engage more productively in daily self-care tasks.

A client who has Parkinson's disease reports increased tremors, problems knocking items over while eating, and poor articulation, leading to recent social isolation. Which intervention strategy would be MOST effective for this client? A. Educate about timing social activities when medication is most effective. B. Train in facial exercises to improve speech quality and communication. C. Provide utensils with built-up handles during mealtimes to decrease spills. D. Suggest a community support group to provide a social outlet.

Activities should be timed during medication "on" times. Determining a client's optimal time of day for activities promotes increased success in occupational performance.

An OTR® in home health care is seeing a client who has Stage III Alzheimer's disease. The client lives with an adult daughter and likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. To provide a defined, safe environment for the client to wander in the house, what will the OTR® MOST likely recommend? A. A deadbolt at the front door B. A side bolt high on the front door C. A gated area in the living room, using child safety gates D. A walk with the client several times a day

B. A side bolt high on the front door A side bolt that is not within reach of the client is one strategy to prevent the client from opening the front door and wandering away from the house without the daughter's awareness. Explanations of Incorrect Answers A: A deadbolt should not be used in case the client locks the daughter out when she steps out of the house. C: A gated area can be too confining for the client and increase the risk of a fall if the client attempts to climb out of it. D: Taking a client for a walk several times a day may or may not decrease wandering behavior. If the client is overexhausted from the walks, the risk of a fall when wandering in the house may increase.

A client with dementia presents with decreased attention. What is the most effective strategy for an OTR® to implement to assist with this cognitive impairment? A. Encourage the client to persist in the task despite fading concentration. B. Break the task into manageable steps and provide them one by one to the client. C. Provide the client with self-talk strategies that allow the client to maintain attention to the task. D. Provide contrasting visual cues to enhance interest in the environment to improve attention.

B. Break the task into manageable steps and provide them one by one to the client. Breaking the task into manageable steps allows the OTR® to control the task and provide the "just-right" challenge to the client to maximize attention to the task and to reduce frustration.

Why should fall prevention strategies be implemented with clients with middle-stage dementia? A. Declines in temporal orientation may cause anxiety and confusion, leading to falls. B. Declines in judgment of distance, direction, and ground surfaces may increase risk of falls. C. Declines in sequencing cause disturbed gait patterns, leading to an increased risk of falls. D. Hallucinations or delusions coupled with overall motor decline may lead to an increased risk of falls.

B. Declines in judgment of distance, direction, and ground surfaces may increase risk of falls. A client with middle-stage dementia will have decreased judgment along with decreased performance skills that may lead to falls.

What is the most important safety recommendation for clients with middle-stage Alzheimer's disease (AD)? A. Do not allow this client to complete ADLs independently because the client might not dress appropriately for the weather. B. Do not leave this client alone because the client might get lost, even in a familiar environment. C. Provide this client with activity to engage the client throughout the day to minimize behavioral disturbances. D. Provide this client with redirection to minimize behavioral outbursts and prevent self-injurious behaviors.

B. Do not leave this client alone because the client might get lost, even in a familiar environment. The most important safety issue would be leaving a client with AD alone, because the client might become lost or confused, even in familiar environments.

Which of the following symptoms is characteristic of the early stage of Alzheimer's disease (AD)? A. Visual hallucinations B. Forgetfulness C. Confusion D. Elation

B. Forgetfulness Forgetfulness is characteristic of the early stage of AD. Explanations of Incorrect Answers A: Hallucinations are not usually associated with dementia. C: Confusion over directions and recall of events is common in the middle stage of Alzheimer's disease. D. Elation is not typically a symptom of dementia.

A client with middle-stage Alzheimer's disease (AD) presents with new behavioral concerns in a long-term care facility. The OTR® is asked to evaluate the client and make recommendations. The OTR® observes the client during routine activities in the facility. What should the OTR® do next? A. Use the Assessment of Motor and Process Skills (AMPS) to assess motor and praxis skills in the client's current context. B. Interview family members to complete the client's occupational profile. C. Establish rapport with the client by assisting the client in activities run by the recreational therapist. D. Provide the client a challenging activity to assess attention and emotional regulation skills.

B. Interview family members to complete the client's occupational profile. Observation and interview are the primary methods of assessment recommended for clients with AD. After observation, it would be important to interview family and caregivers to complete the assessment.

A client was recently diagnosed with multiple sclerosis and has been referred to occupational therapy for evaluation. When assessing the client's occupational performance, which information should the OTR® consider? A. ADL assessments completed on the first visit B. Observations of the client's performance over a period of time C. Results of specific measures, such as the manual muscle test D. Observation of the client's routine early in the morning

B. Observations of the client's performance over a period of time Observing the client over a period of time allows the OTR® to identify variability in endurance and fatigue a client with MS may experience.

A client with multiple sclerosis (MS) presents with extensor tone in the bilateral lower extremities, which interferes with work tasks completed at a desk. The OTR® performs a worksite evaluation. What would the OTR® recommend to decrease spasticity? A. Trialing moist heat pads B. Positioning the hips into 90° or more of flexion. C. Taking frequent rest breaks to stretch D. Using a reclining chair to open the hips

B. Positioning the hips into 90° or more of flexion. Maintaining at least 90° of hip flexion will help reduce spasticity and can be achieved by adjusting the height of the chair or using a small stool for the feet.

A client with early-stage amyotrophic lateral sclerosis (ALS) wants to remain physically active and continue to go to the local gym. Which action would the OTR® take? A. Advise against exercise, which would exacerbate symptoms and accelerate muscle loss; instead, educate the client on fatigue management. B. Recommend modified workouts that consist of endurance and light strengthening with education on how to prevent overexertion. C. Agree that the client would benefit from continued physical exercise at the gym. D. Suggest instead a home exercise program of light calisthenics and stretching.

B. Recommend modified workouts that consist of endurance and light strengthening with education on how to prevent overexertion. In the early stages of ALS, smaller distal muscles are weak, but gross proximal muscles have not yet been affected. ROM exercises, light strengthening, and endurance training are all effective at this point. It is important for the OTR® to advise on precautions such as avoiding overexertion, stopping if a client experiences muscle cramps or spasms, and monitoring fatigue. Moreover, the client states a goal is to continue frequenting the gym, which likely also offers social benefits.

An OTR® is performing caregiver training for a client with Stage 3 Parkinson's disease (PD) and family members because of the client's emerging need for increased assistance with ADLs and mobility. Which instruction would MOST appropriately help family members deal with a freezing episode? A. Educate the family to have the client silently count each step while walking. B. Recommend that the family use a rhythmic beat to each step as they walk with the client. C. Advise the family to place vertical strips on the floor where freezing episodes are likely to occur at home. D. Encourage the family to give the client tactile cues to promote weight shifting to resume walking.

B. Recommend that the family use a rhythmic beat to each step as they walk with the client. External cueing and feedback from caregivers is an important strategy to improve safety and in this case reduce freezing episodes. The rhythmic nature of counting out loud or using a beat helps promote smoother movements that are more coordinated. Explanations of Incorrect Answers A: People with PD perform well with external auditory cues; therefore, silently counting each step, would not be the best option. C: Strips on the floor or carpet where freezing occurs is one intervention approach, but the strips should be horizontal, not vertical. D: A person with Stage 3 PD likely has balance deficits, and forcing weight shifting may increase the client's risk of fall.

A client in the late stage of Parkinson's disease presents for an occupational therapy evaluation. Which of the following symptoms can the OTR® expect to see? A. Resting tremor, spasticity, tingling sensations B. Resting tremor, rigidity, oral motor deficits C. Spasticity, paralysis, decorticate posture D. Spasticity, rigidity, impaired respiratory muscles

B. Resting tremor, rigidity, oral motor deficits Swallowing difficulties become apparent in the late stage of the disease because of impairments in the oral motor muscles as motor control becomes further compromised. Resting tremor is a symptom that manifests in the early stage of Parkinson's disease and continues throughout the disease course. Rigidity often onsets in the early stage of Parkinson's disease and progresses in severity in later stages.

A client has severe intention tremors secondary to multiple sclerosis. Which adaptive strategy would be MOST BENEFICIAL for this client to use when eating? A. Placing plastic eating utensils in a universal cuff B. Stabilizing both arms on a counter or table top C. Using a mobile arm support or suspended sling D. Fastening a 5-lb (2.27-kg) weight on each forearm

B. Stabilizing both arms on a counter or table top Intention tremors occur during voluntary movement, and providing proximal stabilization may be effective in decreasing the intensity of the tremor with eating.

An OTR® receives a referral to evaluate a client who has early-stage Huntington's disease (HD) at the client's home. The OTR® begins by asking the client basic questions. What should the OTR® remember about communicating with clients who have HD? A. Use open-ended questions to allow the client to give rich detail about the client's needs. B. Use close-ended questions to prevent frustration caused by difficulty in word retrieval. C. Use observation as a primary source of information from the client. D. Use the caregivers to provide the majority of the client's history.

B. Use close-ended questions to prevent frustration caused by difficulty in word retrieval With a client with early-stage HD, it is important to use close-ended questions that require yes-no responses or use a list of choices to prevent frustration associated with word retrieval problems.

The caregiver of a client with middle-stage dementia requests assistance from the OTR®. The caregiver wants to ease the client's morning personal care routine. What is the BEST recommendation related to the bathroom environment that the OTR® can provide to the caregiver? A. Paint the bathroom a bright yellow. B. Use labels for hot and cold on the faucets in the bathroom. C. Use low levels of light to reduce eyestrain. D. Keep all bathroom items clearly visible to the client.

B. Use labels for hot and cold on the faucets in the bathroom. Labeling physical structures with symbols, such as arrows for direction, is helpful to people with dementia.

Which task might a person with early-stage dementia have difficulty performing, in light of typical psychosocial and cognitive abilities present during this stage? A. Completing the morning ADL routine consistently B. Balancing a checkbook C. Maintaining social interaction with family D. Cooking a simple meal

Balancing a checkbook is a higher level cognitive task that will most likely be difficult for a client with early-stage dementia. Typically, people with early-stage dementia have the most difficulty with IADLs that require executive function, such as money management and driving. Other IADLs and ADLs become impaired as the disease progresses.

A client with advanced amyotrophic lateral sclerosis (ALS) presents with a stiff forward-flexed neck that is at risk for developing a contracture and impairing social participation. Which intervention would the OTR® use to BEST prevent a contracture? A. A physical agent modality such as diathermy or ultrasound B. Caregiver training on gentle neck stretching and how to help don a soft cervical collar C. A home exercise program of isometric neck exercises in all planes D. Education on proper positioning at rest and during functional tasks

Because of ALS's progressive nature, many of the interventions for clients with ALS focus on patient and caregiver education to address the increasing symptoms and preventing secondary complications such as contractures. Caregiver training on gentle neck stretching and how to help don a soft cervical collar is the most appropriate because using the collar will help maintain the neck in a neutral position, and gentle stretches to the neck will lessen stiffness and discomfort.

A client with middle-stage Huntington's disease (HD) is displaying fatigue during lower body dressing tasks. What would be an appropriate intervention strategy for the OTR® to use with this client? A. The OTR® should engage the client in an intense cardiovascular exercise routine. B. The OTR® should encourage the client to take frequent breaks during lower body ADL tasks. C. The OTR® should train the client in the use of lower body adaptive equipment such as a sock aid. D. The OTR® should educate the client's caregivers on appropriate assistance to provide to the client during dressing.

Because the client's primary complaint is fatigue, taking rest breaks would be appropriate.

What is an effective way to assist a client who has early- to middle-stage dementia with a complex task? A. Suggest that the caregiver complete difficult components of the task. B. Break the task into manageable steps and provide verbal or visual cueing. C. Remove the materials necessary for the task until the client forgets about it. D. Change the location where the task is performed so that the client can relearn the task.

Breaking a complex task into manageable steps while providing some type of cueing (whether simple verbal or visual cueing) allows a client with dementia to perform a task more independently and with less frustration.

Results from a manual muscle test indicate that a client who is in Stage II of amyotrophic lateral sclerosis has Good Minus (4/5) strength of the intrinsic muscles. The client reports that by the end of a meal, it becomes extremely difficult to hold and manipulate eating utensils. Which assistive device will be MOST EFFECTIVE for the client to use during self-feeding at this stage of the disease process? A. Foam tubing to build up handles of eating utensils B. Standard universal cuff with elasticized strap C. Lightweight plastic eating utensils with contoured grip D. Wrist support with palmar pocket for inserting utensils

Built-up utensils will allow the client to use less grasp strength throughout the meal and will be effective in compensating for the decreased intrinsic muscle strength.

During the OTR®'s initial interview, a client with Stage 2 Parkinson's disease (PD) explains the importance of the client's role as head of household and expresses a fear of being dependent on his or her children. The client's chief complaints are tremors and fatigue, which are starting to affect the client's performance of higher level ADL and IADL tasks. Which intervention should be the OTR®'s focus? A. Energy conservation education, such as delegating tasks to family members to reduce fatigue B. Stress management skills, because stress tends to exacerbate symptoms such as tremors C. Activity and environmental modifications for home management skills to successfully maintain the client's role D. Therapeutic exercise to improve balance, which will enhance the client's participation in higher level tasks

C. Activity and environmental modifications for home management skills to successfully maintain the client's role The client has identified independence in managing the home as a treatment priority; therefore, interventions should be aimed at ensuring participation by means of environmental modifications, adaptive equipment where necessary, adaptive techniques, or positioning.

Which of the following goals would be appropriate for an client with mild dementia? A. Client will improve money management skills to independent as evidenced by paying five of five bills on time in 30 days. B. Client will verbalize with 100% accuracy the names of at least four family members once cued when looking at family photos. C. Client will maintain good safety during independent light meal preparation while using visual cues for sequencing as needed. D. Client will improve bathing to independent while using adaptive equipment for safety.

C. Client will maintain good safety during independent light meal preparation while using visual cues for sequencing as needed. The primary goals for clients with dementia are related to maintaining functional capacity.

An OTR® has completed the Allen Diagnostic Module with a client who has dementia. Results indicate that the client is functioning at a 4.6 level (Goal-Directed Actions). Based on this information, which strategy would MOST effectively promote the client's success during a grooming task? A. Demonstrate and ask the client to imitate the OTR®'s movements. B. Guide the client through the physical movements of the task. C. Lay out the items needed for the task prior to the start of the session. D. Use verbal praise during each task to encourage on-task behavior.

C. Lay out the items needed for the task prior to the start of the session. Visual cues are significant at Level 4. Keeping items in plain view and minimizing clutter in the environment will facilitate this client's performance of self-care tasks.

What skills might a client with middle-stage dementia have difficulty performing on the basis of typical psychosocial or cognitive abilities present during this stage of dementia? A. Speaking B. Swallowing and chewing C. Managing finances D. Posture and balance

C. Managing finances In middle-stage dementia, a person will begin having moderate impairment in IADLs, such as finances, shopping, medication management, and complex meal preparation.

A client with Alzheimer's disease (AD) perseverates on having to pick up children from daycare. At which stage of the disease process is this client likely at? A. Mild cognitive impairment B. Early C. Middle D. Late

C. Middle The middle stage of AD is characterized by clients' thinking that they are back in an earlier stage of life.

An OTR® is providing intervention in the home of a client who is recovering from Guillain-Barré syndrome. The client ambulates independently using a walker, but becomes unsteady when tired. What should the OTR® include as part of the intervention for supporting the client's safety at home? A. Talk with family members about providing contact-guard assistance whenever the client is engaged in daily tasks. B. Advise the client to complete self-care tasks while seated in a wheelchair in the home bathroom. C. Problem-solve with the client to identify and eliminate existing fall risks within the home. D. Teach the client diaphragmatic breathing techniques to use during functional ambulation at home.

C. Problem-solve with the client to identify and eliminate existing fall risks within the home. Providing safety strategies for proper use of a walker within the home is the most effective intervention strategy because it allows the client to identify situations that could be modified for better safety.

A client with middle-stage dementia has maintained the ability to complete repetitive tasks common in middle adulthood. For example, if given a basket of socks, the client will reflexively fold them until the task is complete. Given this information, what recommendation would be appropriate for the OTR® to give caregivers? A. Provide challenge to the client by placing the laundry basket at various heights to improve trunk stability and balance. B. Provide challenge to the client by putting various types of clothing into the laundry basket, which will aid in maintaining this skill. C. Provide the client with a basket of socks at a set time each day, determined by the client's arousal level, to give structure to the client's day. D. Provide the caregivers with information about how they can use a basket of socks to decrease agitation in the client.

C. Provide the client with a basket of socks at a set time each day, determined by the client's arousal level, to give structure to the client's day. Interventions to control the daily structure of a person with dementia have been documented to provide balance between the times the person is in high arousal versus low arousal. Explanations of Incorrect Answers A, B: Providing too much challenge to a client with dementia might increase agitation; providing structure to the client's day is the best option to decrease agitation and promote better balance. D: Engaging a client in a task once the client is agitated might be difficult; providing structure to the client's day is the best option to decrease overall agitation and promote better balance.

Which recommendation should an OTR® make to the caregiver of a client with dementia who is suffering from caregiver stress? A. Recommend that the caregiver inquire about medication to reduce the caregiver's stress. B. Recommend that the caregiver inquire about additional sleep medication for the client. C. Recommend that the caregiver contact a local adult day care to inquire about its services. D. Recommend that the caregiver find a teenager in the neighborhood who can watch the client.

C. Recommend that the caregiver contact a local adult day care to inquire about its services. OTR®s have a responsibility to provide caregivers with information related to local resources to reduce caregiver burden.

An OTR® is reviewing the medical chart of a client who has Parkinson's disease. The neurologist has indicated that the client has a festinating gait. What does the client's gait look like? A. The client's steps are stiff and slow. B. The client's steps are halting and unsteady. C. The client's steps are small and rapid. D. The client's steps are marked by pauses.

C. The client's steps are small and rapid. Festinating gait is marked by small, rapid steps resulting from a forward-tilted posture of the head and trunk.

An OTR® is completing a wheelchair assessment for an adult client who has progressive cerebellar degeneration and requires the use of a power wheelchair for mobility. What type of control switch would be MOST BENEFICIAL for enabling this client to independently operate the wheelchair? A. Sip and puff B. Joystick C. Chin-activated toggle D. Proximity-sensing microswitch

Cerebellar degeneration results in loss of balance and coordination. A sip-and-puff control switch would allow control of the power wheelchair without the client needing to use coordination.

A client in the early stage of Huntington's disease (HD) displays difficulty with initiation and completion of the morning grooming routine. What might be a good approach for the OTR® to use to assist the client to become more independent in this activity? A. Train the client in the use of checklists for completion of daily living tasks, including the morning grooming routine. B. Remove any barriers from the bathroom because they may impair the client's mobility and prevent the client from using the bathroom for grooming. C. Recommend that the client's caregiver offer as much physical assistance as possible to decrease frustration during the task. D. Suggest that the client move through the steps of the task as naturally as possible, not worrying about the quality of each step.

Checklists for completion are an effective strategy that OTR®s might use with clients with HD who are having difficulty initiating and completing multistep tasks.

An OTR® is completing an initial evaluation with a client who has relapsing and remitting multiple sclerosis. Sensorimotor skills assessment indicates that the client's daily activities are limited by low endurance and decreased upper-extremity coordination. In addition, the client has been unable to remain in a job as a clerical worker. What additional information is MOST important to gather before developing an intervention plan? A. Medical test results, including neurological and imaging exams B. Availability of home care services to support the client in the home and recommend modifications C. Reports of other health professionals involved in the client's care D. Contextual and environmental factors that support the client's ability to adapt to the diagnosis

Contextual and environmental factors provide information about a client's available support systems, which can influence his or her ability to adapt to the diagnosis.

An OTR® is evaluating a client with Stage 4 Parkinson's disease (PD). During ROM and manual muscle testing, the client presents with cogwheel motions and is mostly quiet with an occasional moan. What would be the BEST action for the OTR® to take? A. Continue testing, then apply heat or ice (to the client's preference) to reduce pain associated with stiffness. B. Study the client's facial expressions and body language to determine which specific movements elicit a pain response. C. Discontinue the manual muscle testing and assess at a later time. D. Continue with gentle stretching, and determine pain by asking clear questions that require a one- or two-word response.

D. Continue with gentle stretching, and determine pain by asking clear questions that require a one- or two-word response. A client with advanced PD would likely experience common symptoms such as muscle rigidity, which may be exacerbated by ROM or manual muscle testing. "Cogwheeling, common in clients with Parkinson's disease, is identified by jerky movements and is considered rigidity superimposed on tremor. Rigidity often is associated with musculoskeletal pain" (Cooper, 2008, p. 477). The client may not be able to tell the OTR® that he or she is experiencing pain; it is critical that the OTR® help the client feel comfortable with hands-on techniques and assess verbally in clear, concise language, with close-ended questions.

A client with secondary progressive multiple sclerosis (MS) is recovering from a recent relapse and seeks occupational therapy to manage anxiety associated with the disease and its effect on occupational performance. What strategy might the OTR® suggest? A. Participation in a cognitive retraining group B. Implementation of a home exercise plan that incorporates deep breathing C. Relaxation, such as taking a hot bath and yoga D. Using coping strategies for self-identified difficult tasks or situations

D. Using coping strategies for self-identified difficult tasks or situations Emotional stress may exacerbate symptoms in clients with MS, especially relapse-related anxiety. This strategy is client centered and will empower the client with MS to problem solve and handle difficult tasks.

A client with a diagnosis of dementia has memory loss. The OTR® observes that the client has visual hallucinations. In addition, the client has decreased spontaneous motor movements and rigidity. What type of dementia does this client MOST LIKELY have? A. Frontotemporal dementia B. Alzheimer's disease C. Vascular dementia D. Dementia with Lewy bodies

Distinguishing features of dementia with Lewy bodies are visual hallucinations and Parkinson-like motor symptoms.

The caregiver of a client with Alzheimer's disease questions the home health OTR® about a recent increase in the client's dosage of donepezil (Aricept) prescribed by the physician. The caregiver is particularly concerned about potential consequences of the increased dosage. What is the OTR®'s most appropriate suggestion for the caregiver? A. Observe the client for signs of dizziness, which increases potential for falls. B. Because the medication can cause photosensitivity, keep the client out of direct sunlight. C. The physician will probably monitor the client closely for potential drug toxicity. D. Monitor the client's hydration carefully because the drug can cause dry mouth and constipation.

Donepezil is a cholinergic-modulating drug that may improve memory and cognition and reduce negative mood, anxiety, and hallucinations; however, dizziness is a side effect.

What strategy might an OTR® appropriately recommend to caregivers of a client with Alzheimer's disease to assist with fall prevention? A. Engage the client in daily, structured activity. B. Provide visual reminders in the home environment. C. Install grab bars in the bathroom. D. Engage the client in an exercise program.

Engagement in activity-based interventions, along with daily structure, has been documented to assist in fall prevention.

A client with Parkinson's disease complains of difficulty with bed mobility resulting in difficulty changing position during the night. Which environmental modification BEST addresses this client's difficulties with bed mobility? A. Put pillows on one side of client to position in side lying. B. Place a nightlight in the bedroom to improve ability to see during bed mobility. C. Change to lighter bedding to decrease resistance during bed mobility. D. Move the bed closer to the wall to provide stability during bed mobility.

Environmental modifications for improving bed mobility include using light bedding (e.g., changing from flannel to satin sheets), using a firm mattress, lowering the height of the bed, and using a bed rail for support.

An OTR® in home health care is seeing a client who has Stage III Alzheimer's disease. The client lives with an adult daughter and likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. The daughter has expressed fear that the client might fall down the stairs at the back door while wandering. To prevent the client from using the back door, what would the OTR® MOST likely recommend? A. Painting a big "STOP" sign on the back door B. Painting the door yellow to contrast with the environment C. Using a poster to camouflage the back door and the door knob D. Installing a motion-detecting light at the stairs to the garage

Evidence has shown that camouflaging a door and its doorknob can decrease way-finding behavior when an client with Alzheimer's disease wanders.

An outpatient has a medical history of having multiple transient ischemic attacks and is in the early stages of Alzheimer's disease. During an initial ADL assessment, the OTR® observes that the patient puts on eyeglasses upside down, attempts to stir before coffee is poured in a cup, and uses a spoon to cut meat. Based on these observations, which performance skill is MOST IMPORTANT to address as part of the intervention plan? A. Spatial relations B. Sequencing abilities C. Ideational praxis D. Body scheme awareness

Ideational praxis involves knowing which objects are used and how to use them to complete tasks. The observations in this scenario indicate the client has ideational apraxia.

A client with Huntington's disease presents with decreased motor planning. What is the most effective intervention for an OTR® to implement with this cognitive impairment? A. Provide alternative suggestions for safe mobility, including use of a wheelchair for community mobility. B. Provide the client with strategies to self-assess performance on tasks. C. Suggest that the client reduce participation in tasks that are difficult. D. Have the client imagine performing the task in a smooth, coordinated manner.

Mental imagery is an effective strategy to improve motor abilities for clients with decreased motor planning. evidence supports use of mental imagery as an intervention with Huntington's disease.

When dealing with clients who have dementia, what would be the primary role of the OTR® in addressing caregiver burden? A. Provide recommendations about community resources. B. Provide recommendations about medication management. C. Provide recommendations related to home modifications. D. Provide recommendations related to safe transfers.

OTR®s have specific skill in providing recommendations about home modifications. Home modifications can benefit clients with dementia and their caregivers by providing a safe environment that prevents unsafe wandering and provides optimal occupational engagement for reduced caregiver burden.

An OTR® in an outpatient facility is working with a client with Guillain-Barré syndrome (GBS) who is in the recovery phase. During ADL and IADL tasks, on what is education primarily focused? A. Skin integrity techniques B. Energy conservation C. Adaptive techniques and equipment D. Caregiver training

People who recover from GBS typically report fatigue as the most common residual symptom. Managing daily life after discharge from the hospital will likely require significant education on energy conservation and fatigue management to ensure resumption of important roles, rituals, and routines.

Which suggestion that an OTR® might provide to a caregiver who is living with a client who has Alzheimer's disease (AD) is the BEST? A. Suggest appropriate activities that can engage the client during unoccupied time and improve daily structure. B. Suggest that the caregiver allow the client to continue cooking independently with adapted cooking utensils to improve safety. C. Suggest that the caregiver provide challenge to the client's daily routine by maintaining distance during routine tasks. D. Suggest modifications to the home environment to include arrows that lead to the bedroom and bathroom.

Providing structure to unoccupied time is an important consideration for clients with AD to prevent behavior problems and maintain quality of life. In addition, structure promotes an increase in goal-directed activity and may aid in more regular sleep patterns.

A client with multiple sclerosis (MS) experiences ataxic movements when performing fine motor self-care tasks. During treatment addressing oral hygiene, what might the OTR® FIRST do? A. Instruct the client in weighted adaptive equipment to reduce tremors B. Have the client trial a static wrist splint to reduce the number of joints needed to stabilize and perform motor tasks C. Position the client's trunk and upper extremities to provide proximal support for the shoulders and elbows D. Massage the client's trigger points to release muscular tension

Proximal support of the trunk, shoulder, and elbow may help increase distal control of the hands and fingers. This client may be positioned to lean against a table and prop the elbows on it, which may provide enough support to allow for improved control of the hands while performing oral hygiene.

An OTR® is performing a home evaluation for a client with Stage IV amyotrophic lateral sclerosis (ALS). On what will the OTR®'s recommendations MOST LIKELY focus? A. Modifications to keep the client's lifestyle as close as possible to occupations preferred before diagnosis B. Environmental adaptations such as moving frequently used items to easy-to-reach and nearby areas C. Creation of a first-floor setup and increased accessibility to a wheelchair or durable medical equipment D. Technology changes such as a motorized stair lift

Someone with Stage IV ALS is likely to have severe weakness in the lower extremities, causing an inability to ambulate. Working with a client and his or her family to create a safe, accessible first-floor setup is the best option; the patient and family will need recommendations for moving furniture, creating spaces that a wheelchair or power chair can navigate, and the most appropriate durable medical equipment such as a hospital bed and specialized mattresses to prevent pressure sores.

To facilitate participation in familiar daily living tasks by clients with dementia, what would be an appropriate INITIAL stage of intervention? A. Recommend home modifications. B. Provide caregiver education. C. Develop strategies to simplify familiar tasks. D. Establish appropriate daily routines.

Task simplification is a primary intervention used with clients with dementia to maintain independence in daily living tasks.

An OTR® and a client with multiple sclerosis (MS) collaborate to set client-centered goals; the client expresses interest in developing an exercise program but states that weakness and fatigue are barriers. What program should the OTR® FIRST recommend? A. A home program including bike riding, walking, and free weights with careful monitoring of fatigue B. A strengthening program to reduce weakness associated with the disease's deconditioning process C. Aquatic therapy to reduce the effects of weakness while promoting gentle exercise D. Progressive resistive exercises under the supervision of the OTR® to avoid overexertion

The buoyancy of water helps reduce the effects of weakness; aquatic exercise programs for clients with MS should be in room-temperature or cooler waters because of heat sensitivity. Explanations of Incorrect Answers A: A home exercise program may be intimidating to someone new to exercise, although it is important to educate people with MS in how to monitor their fatigue and prevent overexertion. B, D: Strengthening would likely not be a first approach to introducing an exercise program. Evidence shows that fatigue can be reduced by participating in a structured aerobic program. Further, strengthening will not reverse the neurological weakness from MS, but it can reduce the weakness from being deconditioned.

Why might a client with early-stage dementia appear rigid in routines? A. The client may be compensating for memory loss. B. The client may be compensating for decreased orientation. C. The client may be compensating for decreased spatial orientation. D. The client may be compensating for decreased temporal organization.

The client may be aware of memory loss at this stage and compensate by becoming rigid in routines so that the client still appears intact to others.

An OTR® is working with a client with Alzheimer's disease (AD) in a skilled nursing facility. The client's adult child, who is the client's primary caregiver, appears to be stressed and fatigued and has asked the OTR® for advice about how to best manage the parent's progressive decline in function. What would be the BEST approach the OTR® could use? A. Refer the caregiver to a physician for treatment. B. Refer the caregiver to the social worker for community resources. C. Provide the caregiver with education about the progression of AD. D. Suggest that the caregiver use the massage services at the facility.

The most appropriate approach for an OTR® when dealing with caregivers of clients with AD is to provide education about the progression of AD along with strategies to improve the caregiver's self-efficacy in caring for the client.

A client will initiate dressing at the appropriate time of the day but will not attend to the day, temperature, or season. The client is able to don clothing slowly but has difficulty with fasteners or fails to see errors in the back (i.e., not tucking in the shirt). At what stage of the Allen Cognitive Level Screen is this client? A. 4.4 B. 4.0 C. 3.6 D. 3.2

The question describes typical dressing behaviors of clients at Mode 4.0; a client would attend to visible sensory cues and ignore what is not in plain sight (e.g., not tucking in the back of the shirt). Explanations of Incorrect Answers A: Clients at Mode 4.4 will be able to locate clothing and initiate dressing at a customary time of the day and dress in sequence. Clients may wear the same clothing over and over again because they like it and have worn it before. C: At Mode 3.6, clients must be trained to initiate dressing at the customary time of day. D: At Mode 3.2, clients will need cues to sequence through a dressing routine.

An OTR® is assessing bed mobility with a client with Guillain-Barré syndrome (GBS) 2 weeks into the plateau phase. The patient reports dizziness on performing supine to sit at the edge of the bed and begins to lie back down. What step is MOST appropriate for the OTR® to take? A. Encourage the patient to remain upright and allow for the dizziness to subside by performing simple ROM exercises to promote circulation. B. Assist the patient back to bed safely, lower the head of the bed, and monitor vitals, comparing the current blood pressure with the resting blood pressure. C. Assist the patient back to bed slowly, elevate the lower extremities, and immediately search for the nurse to assess the patient. D. Educate the patient on the importance of sitting upright and out of bed to help regulate the nervous system and prevent secondary complications.

The right answer is B People with GBS are at risk for autonomic nervous system dysfunction such as postural hypotension or experiencing a significant drop in systolic blood pressure on moving from a horizontal to an upright position. Common among people who endure a prolonged time in bed, the change in position causes blood to rush to the lower extremities, resulting in feelings of lightheadedness or dizziness. The best option is to slowly and carefully assist the patient back to supine, monitor blood pressure, position the patient in Trendelenberg (lower the head of the bed and raise the lower extremities), recheck blood pressure, and then alert nursing, leaving the call bell in reach.

A client presents with decreased awareness of cognitive deficits. What is the most effective strategy for an OTR® to implement to intervene with this cognitive impairment? A. An auditory signal that cues the client when he or she is not acting in a safe manner B. Reduction of the number of choices presented to the client at any given time C. Mental rehearsal of a task before participation to increase the likelihood that all steps will be completed D. Instruction in the use of a self-evaluation checklist (i.e., "Did I complete all the steps?")

Use of self-evaluation or self-reflection before or after a task are the most effective strategies for decreased awareness.

A client with middle-stage dementia has been wandering outside the house in the middle of the night. The client's caregivers have been using monitoring devices and recently added door alarms, but by the time someone can attend to the client's wandering, the client is usually at the neighbor's driveway. The weather has become colder, and the family is concerned that the client will get frostbite if the client wanders outside again. What would be the OTR®'s next appropriate recommendation? A. Install bed rails to keep the client from climbing out of bed. B. Place the client in a nursing home C. Conceal the doorknobs so that the client cannot open the doors. D. Move the client's bed into one of the caregiver's rooms.

Visual barriers, such as concealing the doorknobs, have been found to be effective with people with dementia. The client might not attend to the doorknob because it is unseen or the client will find it difficult to open the doors and get out of the house. The concealed doorknobs might also give the family time to wake up and redirect the client.

An OTR® receives a referral to evaluate a client with dementia. What type of assessment would the OTR® likely use to evaluate this client? A. Nonstandardized assessment tool that assesses memory B. Standardized assessment tool that assesses executive function C. Observation of client and interview with caregivers D. Assessment tool that examines occupational performance and performance skills in detail

When assessing clients with dementia, observation and interview of caregivers are the primary method of assessment.

What assistive technology would be appropriate to recommend to a client who has middle-stage dementia or the client's caregivers? A. Medication dispensers B. Medication reminder boxes C. Door alarms D. Electric hospital bed

When used in middle-stage dementia, door alarms can be useful in improving safety of the client with dementia and reducing caregiver burden.

Huntington's Disease (HD)

A hereditary neurological disorder that leads to severe physical and mental disabilities. Over time, HD causes progressive loss of nerve cells in the brain, affecting movement, cognition, emotions, and behavior.

An OTR® is planning a community program for clients who have Parkinson's disease. The OTR® knows that group sessions are effective in decreasing the impact of postural instability for clients with Parkinson's disease. Which rationale would the OTR® provide when seeking funding for the program? A. Clients perceive improved quality of life when attending group sessions. B. Clients perceive tremors as having more impact on self-care tasks. C. Clients perceive community support as having a positive impact on their self-care. D. Clients perceive that they are more able to participate in social activities.

A benefit of group sessions for clients with Parkinson's disease is an improvement in their perception of their quality of life.

A client with Stage 1 Parkinson's disease (PD) identifies grocery shopping as a valued occupation but lists fatigue as a barrier and states that occasional tremors can be embarrassing. What intervention approach would be meaningful as the OTR® prepares to accompany the client to the store for an occupation-based treatment session? A. Creating a list of needed items and making a route to navigate the store efficiently B. Providing the client with psychosocial support to focus on reducing the anxiety or shame associated with symptoms C. Having the client don wrist weights to reduce tremors while reaching for items to put in the shopping cart D. Instructing the client in the use of a rollator to take seated rest breaks or one of the store's power chairs to save energy

A is the simplest approach; organizing a grocery list and planning the most efficient route through the store to obtain the needed items is an energy conservation technique that maintains dignity.

A client with dementia quits bathing routines before completing them and has difficulty measuring shampoo and lotion. The areas of the body that are usually washed are more distal (hands, arms). The client might attempt to wash the back, but not consistently. At what stage is this client, according to the Allen Cognitive Level Screen? A. 4.0 B. 3.8 C. 3.6 D. 3.4

At Level 3.6, the client will be able to wash most distal portions of the body and those that are easily seen but will not always follow the sequence thoroughly. The client may quit before completion and may have difficulty with measuring soaps, lotions, and deodorant. Explanations of Incorrect Answers A, B: At Levels 4.0 and 3.8, the client will typically recognize the need for a bath and will bathe thoroughly as long as no major problems develop during the bathing process (i.e., lack of soap). D: At Level 3.4, the client will typically wash only areas easily seen and reached. The client may wash one area repetitively and may forget to rinse or dry off.

A client with multiple sclerosis indicates in the occupational profile that cleaning the home is an important IADL. The client has good balance and fair plus (3+/5) upper-extremity strength, is independent with self-care using adaptive equipment, and needs stand-by assistance for showering due to lack of endurance. The client easily becomes fatigued when cleaning. Which intervention is MOST important to include in the intervention plan? A. Upper-extremity strengthening program B. Energy conservation strategies C. Cognitive rehabilitation techniques D. Workstation modifications

B. Energy conservation strategies Instruction in energy management strategies and activity techniques is used to address fatigue in clients with multiple sclerosis.

A client with Stage 2 Parkinson's disease (PD) is working with the OTR® on facial expressions and social skills. Which biofeedback tool would the OTR® use to appropriately address these areas? A. Instruct the client in exercises that focus on facial movement and expression. B. Advise the client to practice different facial expressions in a mirror. C. Teach caregivers how to provide cueing to enhance the client's facial expressions. D. Suggest support groups for the client to attend to receive empathy from other people with PD.

B. Advise the client to practice different facial expressions in a mirror. Biofeedback includes "procedures or techniques that are used to provide an individual with an auditory or visual cue or 'feedback' to learn and gain volitional control over a physiological response" (Radomski & Trombly, 2008, p. 543). Using a mirror offers clients real-time visual feedback to make adjustments and fine-tune facial movements. Moreover, clients with PD benefit from external cues as a treatment approach.

While assessing muscle tone in an inpatient who has multiple sclerosis, the OTR® moves the patient's upper extremity rapidly through its full range while the patient relaxes the limb. The OTR® notes a slight catch of the upper extremity in the midrange of motion. Which of the following occurred during the assessment of this movement? A. Hypertonicity B. Flaccidity C. Spasticity D. Weakness

Spasticity is indicated when a sudden catch or resistance occurs within a quick movement throughout the range of motion for the extremity

Which of the following clients is MOST likely to be a person in the middle stage of Alzheimer's disease? A. A client who sees imaginary images. B. A client who forgets how to get to a family members home. C. A client who is confused by simple directions and recall of recent events. D. A client who becomes extremely excited over mundane events.

C. A client who is confused by simple directions and recall of recent events. Confusion is commonly associated with the middle stage of dementia.

An OTR® receives a referral to evaluate an older adult client with moderate-stage dementia who resides in a long-term care facility. While the OTR® is conducting the assessment, it becomes apparent that the client is becoming agitated. The client tells the OTR® that she or he is going to make the client late to pick up the client's children from daycare. What is the BEST approach for the OTR® to take in this situation? A. Remind the client that the children are grown adults. B. Attempt to engage the client in an alternative activity. C. Leave the client alone and plan to return later in the day. D. Assure the client that the client will be able to get to the daycare on time.

D. Assure the client that the client will be able to get to the daycare on time. It is important to use therapeutic use of self with clients who have dementia. By acknowledging the client's issue, the OTR® is able to establish rapport and demonstrate empathy. In addition, by living in the client's reality, the OTR® will be able to observe how the client responds to stimuli and how to approach the client in the future and plan interventions.

OTR®s can assist caregivers of clients with Alzheimer's disease (AD) with reducing stress and burden by providing what type of intervention? A. Habit training to improve independence in ADLs B. Education related to the progression of AD C. Environmental modifications to the home D. Recommendations related to assistive technology

Education related to the progression of AD would be the most important intervention because such knowledge would allow the caregiver to have more control in choosing what types of intervention would be appropriate for the client and would, in turn, reduce caregiver stress. In addition, they would learn to distinguish the normal progression of AD from abnormal progression to advocate for better care of the client with AD.

Which statement BEST describes an important consideration for OTR®s working with clients with dementia and their caregivers? A. Providing a variety of new occupations creates a sense of well-being for the caregiver and care recipient. B. A brief respite from caregiving benefits the caregiver but is detrimental to the care recipient. C. Everyday occupation is central to a caregiver's sense of well-being. D. Psychologically resisting the inevitability of chronic illness improves satisfaction with caregiving.

Embracing everyday occupation has been shown to improve a sense of well-being in the caregiver and offers a suitable context for caregiving.

An OTR® is speaking to a group of nurse aides employed in a skilled nursing facility regarding dressing of residents who have Stage III Alzheimer's disease. What should the OTR® tell the aides about the expected level of dressing performance for these residents? A. Environmental aids should be used to assist the residents with completing dressing tasks. B. One-step commands are needed to start dressing and every few minutes thereafter until the task is complete. C. Total assistance is required for the residents to complete all dressing activities. D. Verbal cueing and physical assistance are needed throughout the dressing task.

In Stage III of Alzheimer's disease, an individual requires frequent physical and verbal assistance throughout ADLs as memory and physical status continue to decline.

A client with Alzheimer's disease (AD) reports getting lost when going to a daughter's apartment. The client's daughter has been living in the same apartment building for more than 10 years, but she lives 3 hours away from the client. In what stage of dementia is this client? A. Mild cognitive impairment B. Early C. Middle D. Late

In the early stage of AD, higher level executive functions that affect IADL performance are the first observed signs of the disease process.

An OTR® evaluates a client who has just entered the plateau phase of Guillain-Barré syndrome (GBS). When assessing ADLs, what would the OTR® most likely expect to see? A. Bowel and bladder incontinence, which affects skin integrity and toileting routine B. Unilateral sensory impairments, which affect fine motor tasks such as oral care C. Edema and weakness in the lower extremities, which makes bathing and dressing difficult D. Shoulder weakness, which results in decreased independence in upper-body bathing and dressing

In the plateau phase, symptoms are at their most severe: Edema and weakness are common symptoms with GBS. Because symptoms are typically symmetrical and ascend from distal to proximal, bilateral symptoms would likely affect lower-body self-care A: Bladder incontinence can be a symptom of GBS, but the bowel is not affected. Intervention with bladder incontinence may include creating a toileting schedule and frequent skin checks to avoid breakdown. B: Symptoms are typically bilateral and begin distally; clients with GBS often exhibit mild sensory loss in the feet and hands. D: Shoulder weakness may be an observed symptom; however, the most disabling symptoms are likely to be distal rather than proximal.

Dementia with Lewy bodies

Lewy body proteins present in the brain, usually predominant in the limbic or neocortical areas; overall decline in acetylcholine and dopamine levels Clinical features: Progressive deficits in attention and executive function, memory impairment, fluctuating cognition, visual hallucinations, parkinsonism, autonomic dysfunction, and falls; rapid eye movement sleep behavior disorder a possible prodromal symptom

Ataxia

Loss of full control of bodily movements

Akathisia

Motor restlessness

An OTR® receives a referral to evaluate a client with Alzheimer's disease. The client is difficult to redirect while performing the assessment. What would be the BEST approach for the OTR® to use to gather appropriate information to complete the assessment and guide intervention planning? A. Decide that it is not the appropriate time to complete the assessment; plan to return later in the day. B. Talk to the physician about the client's inability to maintain attention to the assessment. C. Explain to the family members that they should contact the OTR® when the client is able to participate more fully in the assessment. D. Observe the client's behavior and reactions to environmental stimuli to gather information for the assessment.

Observation can yield rich information about a person with dementia. It is one of the primary modes of assessment recommended for people with dementia.

A client with early-stage Alzheimer's disease has increased difficulty with spatial orientation. Which occupational performance area does this difficulty most likely affect? A. Community mobility B. Grocery shopping C. Meal preparation D. Caring for pets and others

People with early-stage dementia have difficulty with IADLs because of early memory loss and other cognitive impairment. Difficulty with spatial orientation has an impact on their community mobility.

An OTR® is providing training in cognitive compensation strategies for a client with multiple sclerosis. Which of the following modifications would facilitate cognitive function? A. Decrease time spent on an activity to conserve cognitive focus. B. Use an adaptive bath bench to conserve energy during bathing. C. Perform cognitively demanding tasks in a setting with minimal distractions. D. Use strategies to cope with changes in daily activities and routines.

Performing cognitively demanding tasks in a setting with minimal distractions is an example of a cognitive compensation strategy.

A client with advanced amyotrophic lateral sclerosis (ALS) is new to a computerized communication device. On what would the OTR® treating this patient focus? A. Positioning, to ensure proximal support on a lap tray B. ROM exercises, to enable the patient to adequately reach the device C. Trunk strengthening, to enable upright sitting during use of the device D. Adapting the device with larger buttons and controls, to enable independent use

The simplest and first approach would be to ensure positioning so that the client can see the device and having the neck and shoulder (proximal muscles) stabilized to allow the most distal control. The placement of the device is also important, with a lap tray to secure the device in bed or on the wheelchair.

An OTR® at an acute care hospital is evaluating a client in the onset stage of Guillain-Barré syndrome (GBS) who requires total assistance for most tasks. At this stage, what goals should the OTR® focus on? A. Patient and caregiver education on the progressive nature of this disease B. ADL performance, especially adaptive equipment training and other compensatory strategies C. ROM and strengthening to prevent muscles from further weakening D. Positioning to prevent skin breakdown or contractures and to allow access to needed items

The symptoms of GBS in the acute inflammatory stage—which include edema, muscle weakness or paralysis, sensory loss, bladder incontinence, and pain—increase a client's risk for skin breakdown, especially a client who is totally dependent for most tasks. This client is likely not able to reposition him- or herself or independently clean up incontinence issues. At this stage, focusing on preventing secondary complications such as skin breakdown and contractures and decreasing anxiety by having items such as a call bell, telephone, communication devices, and fresh water in easy reach will be paramount.

Secondary Parkinsonism

a condition in which people experience symptoms similar to those of PD, but the cause if related to the ingestion of drugs or other toxic chemicals.

Paratonia

involuntary resistance to passive movement of the extremities

cogwheel motions

jerky, sometimes painful movements with joint mobility, most commonly in the upper extremities

Hyperflexia

over flexion of a limb

Chorea

rapid, involuntary, irregular movements, increasing during stressful situations and lessening or absent during voluntary motor activities and sleep