Nursing

Non-standardized is ______ and often has no specific instructions for administration of items

subjective

Clients with sensory dysfunction will ______ for all task in order to prevent injury

supervision

Augmentative communication

supplement device

The model of human occupation is a

system model

During Bilateral Integration increase_____ and _____ input will encourage development of movement sense

tactile and visual

Any degree of paralysis of the four limbs and trunk musculature

teraplegia

Education of the caregivers begins at ______

the first meeting

Static progressive splint

type of dynamic splint incorporate the use of inelastic components such as hook and loop tapes, outrigger line, progressive hinges Allows CLIENT to adjust the line of tension

This term refers to the 5th digit

ulnar

Interactive Reasoning

understand impact of the hand condition on the person useful to determine proper splint for each person

Adolescence ages

10-19

Transfers of Learning

Skills experiences need to be presented in logical progression Simple, foundational skills should be practiced before more complex skills Skills practice should include real life and simulated settings Skills with similar components are more likely to show transfer effect

Clients can perform movement and achieve functional goals

Skills retention stage

Issues equality and inequality

Socioeconomic status, gender, and age are factors to consider when assessing how decision making occurs for the client

High muscle tone

Spasicity

Nongenetic theory

Wear and tear theory Cumulative damage to vital parts of the body leads to death of cells, tissues, organs, and finally the organism.

Narrative reasoning

Consider the persons occupational story Consider roles/activities/habits

Skills retention stage _______ is most effective at this stage

random practice schedule

Repression mechanism may be necessary in the ______ of some PWDs.

readjustment

Is a deficit in the ability to copy, draw, or construct a design , whether on command or spontaneously

Constructional Apraxia

The ____ component is one's understanding of one's relationship to other and the world

Contextual

Represents reception of complete information in the environment in all vision area

Visual field

Tasks are taught in a relevant environment and

context

Logrolling is more difficult toward the ____ side because the ____ may not be able to initiate the roll

stronger weaker

Symptoms of Postpolio syndrome

fatigue slowly progressing muscle weakness muscle atrophy

Static Splint-

maintain a position to hold anatomical structures at the END of available ROM, thus exterting a mobilizing effect on a joint

CVA an important goal early in treatment is

maintenance of full joint range of motion (ROM) and prevention of deformity

Acne is more common in males or females

males because of testosterone

security rule

mandates facility has policies/procedures to protect PHI

privacy rule

mandates protection of clients identifying information

The aim of treatment for peripheral nerve injuries is to assist the pt in regaining the

max level of motor function and independence in performance areas.

When engaging pt in treatment activities using the NDT approach the OTA should offer

meaningful and practical tasks to enhance carry-over from selected normal movement patterns to functional performance. Pt can more easily attend to and be motivated by activities that relate to real-life situations

A FCE usually comprises review of

medical records interview musculoskeletal screening evaluation or physical performance formation or recommendation report generation

HIPAA Transaction Rule

mndates uniforms terminology/uniform billing codes

Nerve fiber damage usually results from reduced circulation and is the mildest and

most temporary form of PNI

The desire outcome of motor learning is permanent change in

motor behavior or skill as a result of practice and experience

Treatment sessions should be ______ so that the client performs tasks in various contexts to allow training for generalization

structured

The brain must be able to create and retain a mental image of the observed object in the mind's eye and store the visual image temporarily in short term memory

Visual memory

Avoid a protective attitude that prevents elders from active

participation in their care and decisions

This shape of thermoplastic material is stronger and better able to handle externally applied forces

curved or contoured

Ovulation typically starts about 12 to 18 months after menche and at the

peek of physical growth

Health

". . . the absence of disease or other abnormal condition" (Potter & Perry 2002) Optimal level of functioning for a person's age and condition

Medicare is divided into four parts

(A,B,C and D)

Avoid thinking that all elders have

. cognitive impairments.

Forearm-based

..

There are __ carpal bones arranged in 2 rows

8

If scapula does not protract ( abduct) and rotate upward and outward with shoulder movement, ROM exercises past _____ of shoulder flexion are contraindicated because of risk of injury

90 degree

overhead pully exercises past _____ should be avoided for clients with subluxation

90 degrees

COTA's role in fall prevention

: Inspect the client's living environment for hazards that may lead to a fall.

The cortical senses- somatosensory

two point discrimination stereognosis

Example of compensation

A PWD may excel in academics to compensate for the inability to excel in sports

Ensuring client access to resources such as transportation, housing, education

Advocating

Inflammatory Stage

After trauma last 3-6 days Vasoconstriction begins during 5-10 mins

PMH

Age Date of injury Hand Dominance Avocation interest Subjective complaints Vocation How injury occurred Functional ability Family/social history treatment received to date Prior injuries habits

Patient's History includes

Age Gender Diagnosis PMH (Past Medical History)

Factors influencing Splint Approach

Age Occupation Expected Environment ADL Responsibilities Personal motivation/compliance Cognitive status

CVA- when there is minimal active movement,______- exercises are performed

AAROM- active assisted ROM

Functional causes of falls

ADLs become challenging Functional mobility problems Transferring from bed to chair or toilet, tub, or shower Reaching, sitting, standing, and walking unsupported Lack of assistive aids for ambulation or an inability to use them Carrying a walker instead of using it to walk Old, lost, borrowed, or smudged glasses impair vision Poorly fitting shoes, loose pants that drag, and flimsy sandals affect balance

The pt with persistent _____ may have difficulty maintaining the head mid-line while moving the eyes toward or past midline

ATNR

Pedestrian Safety Tips (Box 14-6)

Always use a crosswalk. Use the pedestrian push button and wait for the WALK sign to appear. Before stepping into the roadway, search for turning vehicles and look left and right before crossing. Wear bright (fluorescent) colors during daylight and wear retroreflective material and carry a flashlight if walking at night.

Medicare Part D

An optional benefit

Complete loss of pain sensation

Analgesia

Is a combination of impairments occurring in individuals who have experienced poliomyelitis many years ago and have functioned quite satisfactorily in the interim

Postpolio syndromelio

The skill by which a person identifies something seen or encountered in the past

Recognition

Keeping Elders Active

Exercise programs Research supports the need for some form of exercise for all individuals. Can help reduce falls by increasing endurance, improving balance, and improving confidence. Muscle strength decreases 15% per decade after age 50 years and 30% per decade after age 70 years. Resistance training can result in 25% to 100% strength gains in older people.

in general ____ splints are recommended for CTS because the provide better support. postioning and more constant allocation of pressure over the capal tunnel

custom

Driver Rehabilitation Professionals

Assist elders needing scooters that are transported in a van. This professional takes into account the type of wheelchair or scooter, whether the person needing the equipment will be a driver or passenger, and the length of time the equipment will be needed.

This grasp is used to hold soda cans, pan handles

cylindrical grasp

Benefits of Correct Positioning in a Wheelchair

Assists breathing, swallowing, digestion Improves socialization by changing elder's eye gaze Promotes comfort (reduces pain, sliding, leaning) Provides easy rolls for the client Insurance restrictions sometimes lead to use of sling upholstered wheelchairs really meant for short-term use only Insert a solid seat or back. Add padded cushions. Adjust the wheelchair if able. Make sure elders can reach the brakes and wheels.

When the person with TBI begins mobility training, the OTA start with _____ skills of rolling, moving up and down, bridging, moving from supine to a sitting position and the reverse

bed mobility

is often used to place the hand in such a fashion as to maintain a tension/distraction of anatomic structures to avoid contracture

Antideformity Position

Uneasiness and concerns about the future are common responses to recent physical dysfunctions

Anxiety

Cognitive Disabilities Model

Applies to OT services designed for clients with cognitive impairments. Cognitive impairments can result from psychiatric illness, medical disease, brain traumas, or developmental disorders. In this model, "occupation" is synonymous with voluntary motor action (e.g., dressing, crafting, preparing a meal). Observing a cognitively impaired client's voluntary motor action gives insight into the relationships among the three domains.

The modified ________________________ provides a uniform way to measure muscle tone in adults

Ashworth Tone Scale

This refers to severe loss of body scheme

Asomatognosia

Treatment precautions for RA

Avoid fatigue Respect pain Avoid static, stressful or resistive activities Limit application of heat to 20 minutes Use resistive exercises with caution and never with unstable joints Beware of sensory impairments

_____ or transfer of learning occurs more reliably wit practice in different contexts

Gerneralization

___ show an increase in motor performance ealier around age 14

Girls

According to the OT practice framework client factors related to cognitive perdormance skills

Global mental functions( orientation, energy, motivation, emotional stability) Attention Memory Thought Functions Higher level cognitive functions

Professional Thinking is done

before, during and after pt treatment

PRWHE

Condition specific tool Clients rate pain/function in 15 preselected areas Obtains info about client's functional abilities Broader functional areas than DASH Closed ended questions Should use interview to ID details of function/context

ADLs

Bathing/showering Bowel and Bladder management Dressing Eating Feeding Functional mobility Personal device care Personal hygiene and grooming Sexual Activity Toilet hygiene

Steps to success- Restraint Program

Begins with a multidisciplinary team Family members should be included because they may continue to ask for a restraint to prevent falls. The family needs to sign a consent for a restraint. Family education is critical to success. Policies and procedures for applying a restraint and removing restraints should be developed. Alternatives to restraints should be available in the facility. After removal, follow-up and assessment of patient safety is needed. Additional alternatives may need to be tried.

Ex of form 3 of rationalization

Being blind I can no longer judge other by external factors

Preventing orthostatic hypotension

Occurs when an elder goes from a lying to a sitting position or a sitting to a standing position. It is a drop in blood pressure enough to cause dizziness or passing out. Prevention Educate elders to sit up slowly and sit for a few minutes before standing. Elders can dress while seated. Physician should be informed about this form of hypotension.

Occupational deprivation

Occurs when factors beyond themselves limit the individual's choice or opportunity

Paralysis of the LE with some involvement of the trunk and hips depending on the level of the lesion

Paraplegia

Measure all wounds in

Cm

Typical Characteristics of Psycho-social Development- Middle Adolescence

Continuation of movement towards psychological and social independence from parents Increased involvement in peer group culture, displayed in adopting peer value system, codes of behavior, style of dress and appearance Involvement in formal and informal peer groups such as sport teams, clubs or gangs Acceptance of developing body; sexual expression and experimentation Exploring and reflecting on the expression of own feelings and those of other people Increased creative and intellectual ability Risk taking behaviors underscored by feelings of omnipotence ( sense of being powerful) Experimenting with drugs

______ fantasy can be a sign of serious problems, and health care provider must be careful about encouraging patients to abandon the actual world for fantasy

Continuous

Strategies for limited endurance

Place chairs strategically around the home. Sit while performing ADLs. Have a commode chair near the bed. Perform general strengthening exercises. Try community exercise programs such as swimming, dance, or walking clubs.

Procedural reasoning

best splinting approach to improve functional performance pt diagnostically related performance areas

An assessment tool was needed;

Minimum Data Set (MDS) created.

Physical development is the result of significant

biological changes

Splints and Orthoses are not only to immobilize but to

Mobilize position protect a joint project a specific body part

Teaching and educating, instructing and sharing information, explaining research finding and possible outcomes

Instructing

Arises from sensory stimulation to tactile receptors, propriocepters, and visual and vestibular systems while performing the task

Intrinsic feedback

This grasp is helpful in holding flat objects such as books or snadwichers, is NOt present with median and ulnar nerve injuries

Intrinsic plus grip

Occupation-based splinting

Is an approach that promotes the ability of the individual with hand dysfunction to engage in desired life tasks and occupations.

Maintaining Independence in Community Mobility

Driving is an important factor in elders' independence and mental health. By 2030, 20% of drivers will be 65 years old or older. Elders account for a large number of traffic fatalities. In the past decade, highway traffic fatalities increased by 33% in the elderly population. Causes: Age-related vision, mobility changes; medications, decreased reaction time, and decreased decision-making skills

Persons with poor sensation have little urge to move; those with _____ sensation have even less urge to move

Dull

This disease is characterized by the formation of finger flexion contractures with thickened band of

Dupuytren's disease

Which splint employs elastics, springs, and wire, as well as multipart splints

Dynamic splints

Intervention Strategies-Environmental concerns

Eating is part of socialization and quality of life. The eating experience should be as aesthetically pleasing as possible. Ensure good lighting with no distracting noises. Allow plenty of time to eat. Make sure the table is at the appropriate height. Provide comfortable positioning. Sit with pleasant table mates if the elder lives in a residential community or nursing home.

Due to the thin, supple nature of the skin on the dorsal surface of the hand, it is often the location for this common ailment

Edema

When present, friction is increased, joint motion is limited, and tissue has less ability to elongate and compress. Significant exposure to this diagnosis can result in permanent deformity

Edema

The term ANTECUBITAL FOSSA refers to the following body part?

Elbow Pit

The humeroulnar joint is responsible for the following movement

Elbow flexion and extension

Terminology for older adults

Elders Older adults Elder population Aged

Procedure for seizures

Place pt in a safe location Assist in keeping airway open If pt mouth is open-place soft object between teeth to prevent accidentally biting of tongue When convulsion subsides, turn pt head to side incase of vomit After convulsions cease pt should rest

Wheelchair positioning begins with ______because poor hip positioning causes poor head and trunk alignment and influences tone throughout the body, especially the extremities

pelvic alignmenta

Signs and Symptoms of Aspiration

Coughing, gagging, or choking during mealtimes and immediately afterward Rapid breathing, fatigue, or bubbly respirations during and immediately after meals Intermittent elevated temperatures Vomiting small amounts after meals and at night (spitting up) Needing to take multiple swallows to clear food from the mouth Drooling or having food fall out of the mouth Eating or drinking rapidly and stuffing food in the mouth Appearing fearful and reluctant to eat Unexplained weight loss or being underweight

Medicare Part A

Covers "inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities" (not custodial or long-term care) Also covers hospice care and some home health care Beneficiaries must meet certain conditions

Continuity theory

Elders adapt to changes by using strategies to maintain continuity in their lives.

Obesity has become a major health concern for

people of all ages. 1 in every 3 adults and nearly 1 in every 5 young people aged 6-19 are obese.

Fall prevention-limit reach

Limited reach Use reachers, extended handles on bath brushes, shoe horns, carts, walker trays or bags, or sock aids. COTAs can determine the best way to attach the reacher to a walker or wheelchair. Rearranging an elder's environment is inexpensive and effective in fall prevention.

Listening to clients, paying attention to feelings conveyed, observing nuances of nonverbal expression, validating and reflecting back client perceptions

Empathizing

Instilling hope and confidence by praising efforts and achievements, selecting activities that clients value, using feedback and positive reinforcement using playfulness and humor

Encouraging

Causes of falls

Environmental Biological Cognitive or psychosocial Functional

Different use of time, monochronic and polychronic

Monochronic: "One thing at a time" Adherence to schedules is important May be offended if kept waiting Polychronic: Organize their lives around social relationships May be late to appointments Enjoy conversation Want to know the COTA personally

Causes of Falls

Environmental causes Poorly kept home or yard Poor lighting or glare Uneven stairs, lack of handrails on stairs Uneven and unsafe surfaces (frayed rug edges, slippery floors in showers and tubs, polished floors, cracks in cement) Unstable or low furniture (chairs, beds, toilets) Pets, young children, clutter or electric cords in walkways Inaccessible items Limited space for ADLs

Dominant American culture value system

Equality of all people Informality in interactions with others Emphasis on the future Change Progress Punctuality Materialism Achievement

Which laws and institutional rules apply?

Ethical action = making morally good choices Legal action = right and wrong as a principle of justice Ethics can be said to hold practitioners to a higher standard than the law. Laws and institutional rules both help clarify the role of COTAs in a given ethics problem.

Occupational imbalance include

Occurs when a person engages in to much of the same activities

Support: With whom do I need to talk for ethical conflicts?

Ethical commitments are shaped by social influences; outcomes of ethical decisions also have social effects. Before acting according to moral convictions, COTAs should solicit the support of others who will be affected by the issue. Involved parties generally include: The client, the client's family, other staff members, and possibly the organization's ethics committee

What kind of ethical problem is it?

Ethical dilemma = a situation in which there are two or more ethically correct options for action Ethical distress = a situation in which the COTA knows which course of action to take but feels constrained to not carry it out Distributive justice = a situation in which there is not enough of something that is valued

OT process consists of three dynamic and interactive phases:

Evaluation Intervention Outcome

Higher order reasoning and planning functions such as goal formation, planning, implementing the plan and effective performance

Executive Functioning

De Quervains tenosynovitis

Long forearm-based or radial gutter splint

This arch of the hand allows the DIP, PIP and MCP joints to flex

Longitudinal arch

Communication and Social Skills

Looking Gesturing Maintaining acceptable space Initiating and answering Taking turns Acknowledging

Contact Transmission

Place pt in an isolation room and limit access Wear glove during contact Reinforce handwashing Wear 2 layers of protective clothing Limit pt movement form isolation room to other areas Avoid sharing equipment between pts-

Disuse Syndrome

Loss in the ability to perform ADL functions as a result of a sedentary lifestyle disability Approximately 14.2% of elders living in the community experience difficulty completing one or more ADLs because of health-related problems. Approximately 21.6% of elders report difficulties with instrumental ADLs (IADLs). The need for assistance in ADLs and IADLs increases with age.

The primary function of this muscle group is to flex the MCP joints

Lumbricals

Joints of Digits 2-5

MCP PIP DIP

Droplet Transmission

Place pt in isolation room Wear a respirator Limit pt movement from the room to other areas- place surgical mask on pts

MDS relevant to COTAs: tool identifies strengths and deficits for further assessment

MDS are also used to determine Medicare payment for eligible residents. Even if no intervention has taken place, data collection and resident interview may help COTAs give the necessary information to others on the interdisciplinary team.

Therapist should fabricate this splint only on hands that have a healthy

MP joint

Hypertoncity is often found in pts with upper motor neuron disorders such as

MS CVA Head injury brain tumors or infections spinal cord injuries or disease

Airborne Transmission

Place the pt in airborne infection isolation room (air no circulated to the rest of the health facility) Wear a respirator Limit pts movement from the room to other areas- Place surgical mask on pt who must be moved Wash hands thoroughly upon entering and leaving room

The treatment plan including the frequency and duration of treatment

Plan

Play

Play exploration Play participation

Myth #5: Elders become more conservative as they age.

Many elders are receptive to new ideas and accept fresh roles. Adults learn continuously from their life experiences and may pursue new interests and goals. Their habits and preferences contribute to consistency in personality, but personality may be influenced as individuals deal with crisis points in each phase of life.

If the person copes well and develops a ________ , then psychic energy may be freed for new activity including OT efforts

compromise body image (combining disabled body image with preinjury body image)

General treatment goals for those living with progressive neurologic diseases

Maximize clients ability to engage in meaningful occupations despite disease progression Prevent secondary complications-DU, contractures, pain injury, anxiety and depression Maximize quality of life Teach client strategies to self- manage the effects of the disease Teach caregivers safe and effective ways to provide assistance to the client while not undermining the client's ability

Outcome

Measuring the client's progress toward meeting the treatment goals

Herberden nodes-

DIP joint

In _____, energy associated with one object or person is directed to a secondary target

D__isplacement

Avoid condescending references:

Dear, darling, sweetie, grandma, honey, and so on Call the person by Mr., Mrs., and so on until the person gives you permission to use his or her first name. Be respectful.

DECIDE

Decide to get going Evaluate options Create new options Investigating options Discuss potential choices Evaluating your feeling

Physical or chemical process of removing or inactivating pathogens on a surface or item to the point where they will not transmit infectious particles

Decontamination

Secondary Prevention

Definition: "Identification and treatment of persons with early, minimally symptomatic disease to improve outcomes and maintain health" (p. 57).

Tertiary Prevention

Definition: Prevention of the progression of existing conditions Relates to the functional assessment and rehabilitation both to reverse and prevent the progression of the burden of illness

Feedback about performance from an outside source such as an OT practitioner or external device

Extrinsic feedback

T/F The ligaments on the dorsal aspect of the wrist are thick and strong, which provide stability

F- the volar

FoF

Fear of Falling

_____ an activity means pacing it appropriately and modifying it to obtain the pt's max performance

Grading

Nontraditional roles for elders

Grandparents in the parenting role Across all socioeconomic and ethnic groups Grandmothers raising grandchildren are more likely to be living in poverty. Causes: drug and alcohol abuse, teen pregnancy, divorce Increasing numbers of elderly in the workforce Increasing use of computer technology Challenges include low vision, arthritis in hands and joints, and expense.

The ability allows humans to recognize numbers, letters or forms written in the skin

Graphesthesia

Sources of anxiety reduction

How does the elder handle stress? COTAs should know who supports the elders in times of stress when decisions need to be made.

Cognitive Style

How information is organized by the client—not an assessment of cognitive function for brain dysfunction Open-mindedness or closed-mindedness

Also called spasticity refers to increased muscle tone

Hypertoncity

Clients with ______ are at a high risk for injury because protective sensation is lacking

Hyposensitivity

Dysphagia

Inability to swallow

Ex of form 2 of rationalization

Its ok that I lost my job it was too low paying anyhow

_____ may result from lack of movement

Joint contractures

Cognitive

Judging Selecting Sequencing Organizing Prioritizing Creating Multitasking

The typical posture in the adult with hemiplegia-Head

Lateral flexion is toward the involved side with rotation away from the involved side

Takes place within the learner and can be defined as the acquisition of skills or information that changes a person's behavior, attitudes , insights, or perceptions

Learning

Leisure

Leisure exploration Leisure participation

Typical Characteristics of Psycho-social Development- Late Adolescence

More stable sense of self Strengthened relationship with parents Increased independence in decision making and ability to express ideas and opinions Increase interest in the future, consideration of consequences of current actions Resolution of earlier angst at puberty about physical appearance and attractiveness Diminished peer influences; increased confidence in personal values and sense of self Preference for one to one relationship; starting to select intimate partner Becoming realistic in vocational choice or employment Definition of an increasingly stable value system

Bouchard nodes

PIP joint

The ability to identify the important features of objects and the environment and to use these features to distinguish an object from its surrounding

Pattern recognition

Illness

The presence of disease

Somatic mutation theory

Unexpected chromosomal changes occur and result in replication mistakes. Mistakes result in progressive loss of function.

Disadvantages of Prefab Splints

Unique fit is compromised Little control over therapeutic positing of joints Expensive Prefab made for a few specific targets made need to be order time frame

A comprehensive process systematically uses work, real or simulated

Work evaluation or vocational evaluations

Refers to formal, multidisciplinary programs for rehabilitation the injured worker

Work hardening

Medicaid

a combined federal and state insurance program that addresses the health care needs of the indigent, was enacted in 1966.

This dramatic increase in height, weight and changes in body portion occur as a result of

a complex regulatory process, involving pituitary gland initiation of the release of growth and sex-related hormones from thyroid, adrenal gland, and ovaries and testes

Occupational Disruption-

a temporary and less severe condition in which a client is unable to engage in meaningful occupation due to unexpected factors

Pts displaying displacement should be _____ about their behavior and made aware of its negative effects on significant others and those engaged in their therapy efforts

confronted

Habituation

activities that have been performed enough times to become routine and customary

Training should occur in the environment most

appropriate and most realistic

Pragmatic reasoning

consider reimbursement, documentation, equipment etc Public Policy Expected discharge

PD pts often develop a monotone, low-volume speech. OTA can increase the benefits of speech therapy by providing

breathing and postural exercises

An AAC device should allow the user to

construct, preview and edit communication utterances before they become apparent to the communication partner`

In OT, anger and aggression should be channeled into

constructive activities

NDT-approach

emphasizes .relearning normal movement while avoiding abnormal movement patterns. Principles include the normalization of muscle tone, avoidance of synergistic movement and incorporation of the affected side into purposeful activities.

The adaptive approach, which focuses on adapting the task/environment to

enhance occupational performance

Those who have ideomotor apraxia may do better attempting the ______ task

entire

Clients with apraxia can learn a task using

environmental cues or tactile cues from others to assist them through familiar basic functional tasks until performance becomes more automatic

The core idea of the model of human occupation is that the umans have an inborn drive to

explore and master their surrounding

Bilateral Reciprocal patterns

extremities perform in opposite directions at the same time. Ex; pitching in baseball or walking on a balance beam with one extremity in a diagonal flexion pattern

Bony spurs, may form in the fingers or at the base of the thumb

osteophytes

Medicare Part D

outpatient prescription drug coverage

ROM

p. 118

Specific Techniques for ADL

p. 250-274

Compensatory Techniques for ADLS

p. 446-447

Retention of information improves when

the person repeats and manipulates it

When making health care decisions, some clients make ___?

their own decisions, others need the collective consensus of a group (family or extended community).

Physical maturation and psychocial development shape an adolescent's capacities to

think, relate and act as a future adult

Volition

three key elements- causation, values and interest

Hypertonicity

thumb loop splint or figure 8 wrap splint

Rates are paid based on

time, case, or episode patient classification systems:

T/F Clinicians should guard against preconceived notions and conclusions about the pts's capacities

true

Cohort

"A collection or sampling of individuals who share a common characteristic such as age group" (Potter & Perry, 2002)

Client Centered Splinting

"An approach to service which embraces a philosophy of respect for, and partnership with, people receiving services" (Law et al.)

Ageism

"An attitude that discriminates, separates, stigmatizes, or otherwise disadvantages older adults on the basis of chronological age"

Definition of health promotion

"Any planned combination of educational, political, regulatory, environmental, and organizational supports for actions and conditions of living conducive to the health of persons, groups, or communities" (p. 54).

Assessments are influenced by

attitude pain response coping mechanism locust of control

Ace wrap in lieu of strapping is common applied in figure 8 pattern, and

distal to proximally

Therapist often provide resting hand splints for people with RA

during periods of acute inflammation and pain

The volar wrist immobilization splint depends on a ___ wrist strap to hold the wrist in extension in the splint

dorsal

A deficit in the ability to perform simple calculations

dyscalculia

Palpate muscle on _____ for comparison

each extremity/ Promixal and Distal

In limb synergies- the muscles acting in synergy are linked and cannot act alone. If one muscle in the synergy is activated

each muscle in the synergy responds partially or completely. As a result, the pt cannot perform isolated movements when bound by these synergies.

______ can be directed inward and to self or outward to others

Aggression

Motor and praxis

Bending and reaching Pacing Coordinating Maintaining balance Anticipating or adjusting posture and body position Manipulating

As adults age, we typically require corrective lenses to read because of

presbyopia

Edema is a normal consequence of trauma but must be quickly and aggressively treated to

prevent permanent stiffness and disability

To effectively plan treatment to maximize learning the OTA must understand

previous and current learning styles

Most clients who require OT after TBI will exhibit deficits in one or more of the following areas

primitive reflexes muscle tone postural stability motor control ROM strength sensation endurance

Factors that contribute to increased risk for subluxations

severe sensory loss poor UE support poor alignment of GH joint during ROM exercises arthritic shoulder joint incorrect handling of the involved UE by staff or untrained family members

This type of stress happens when parallel forces are applied in an equal and opposite faces of a structure

shear

_________ of the UEs is an early and important goal in stroke rehabilitation , even if the affected arm is nonfunctional

Bilateral Intergration

The person with a disability must first learn to ___, then regain essential _____, and finally to resume ____

Survive physical skills meaningful life

The ability to detect ____ also contributes to the enjoyment of food

Thermal

Thumb immobilization splint prevents motion of

one, two or all thumbs

This approach helped a person who had a tendon repair that resulted in flexor contractures of the MCP joint regain full range of motion

Bio-mechanical Approach

The treatment of physical dysfunction considers the human body as a living machine. Techniques in this approach derive from kinetics

Biomechanical Approach

Clinical Reasoning Includes therapist knowledge

Biomechanics Anatomy Kinesiology Psychology Conceptual models Pathology Splinting techniques/protocols Clinical experience Awareness of pt

Involves repeated performance of the same motor skill

Blocked (massed) practice

The who has hypotonicity ______hold a position once the limb is placed and released by the therapist

cannot

Is described as an intense burning sensation so excruciating that the pt holds affected limb immobile for fear of stimulating the pain

causalgia

PNI may affect the nerve

cell body, the myelin sheath, axons or neuromuscular junctions

Passing requires constant vigilance; denying the disability becomes a

central focus of life

Hypertonicity is associated with _____ as occurs with stroke or head injury, is often seen in combination with other motor deficits such as rigidity or ataxia

cerebral damage

Signs of visual field deficits

changing head position- consistently bumping into objects placing objects into one field making consistent errors in reading

Changes to Swallowing Structures

Occur naturally as we age Compensations : Adaptations to swallow Smaller bits, more chewing time, softer food May need soft diets, liquid diets, and so on to prevent choking or aspiration

Community Mobility

Pedestrian safety Alternative transportation Safe driving

Crepitation

characterized by joint degenerate, grating, crunching or popping sensation that occurs during joint or tendon motion.

Secondary prevention strategies

Blood pressure screening, cancer screening. Educate elders about the importance of having annual screenings done. Minority groups are especially at risk for lack of screenings. Increasing access to health care when needed, even for those with mobility problems.

Health may be defined as the

"ability to live and function effectively in society and to exercise self-reliance and autonomy to maximum extent feasible, but not necessarily as total freedom from disease" (p. 51). .

Occupations

(activities) permit the patient to participate in desired roles and life situations in the home, school, workplace, and community.

Strategies for working with adolescents with cognitive impairments

* Identify how each teen learns best. Ask the teen, family, or teachers * Identify strengths and build from existing skills *Offer specific choices *Select activities that match the teens abilities, needs, and interest. Offer activities that are age related but within performance level *Break down activities into simple steps that are achievable, but a challenge *Keep instruction simple *Present only one instruction or step at a time *Increase instruction only if the client consistently follows current instruction *Present directions systematically * use any methods of instruction (verbal or visual, demonstration, visual cues, step by step diagrams) *Help client develop and learn a new skill in a familiar setting before using the skill in novel setting *Give specific feedback with concrete examples * Be consistent and use repetition * Do not introduce variety without reason

Is formed from multiple perceptions of the body based on experience, current sensations, and attitudes and values of culture

Body image

Some signs of adverse/negative reactions to pts

1. failure to keep points 2. offering less treatment time 3 regularly arranging for the pt to be treated by an aide, student or other therapist 4. unnatural and excessive politeness and service to pt 5. feeling of boredom 6. a tendency to ignore the pt when other our present 7. unrealistic optimism or pr pessimism about pt prognosis or potential 8. giving the pts inadequate answers and instrctions

Orthosis

-"a force system designed to control, correct, or compensate for a bone deformity, deforming forces, or forces absent from the body" (Mosby's Medical Dictionary

In the ___ approach, the therapist focuses on identifying problems with specfic performance skills

Bottom-down

This condition is common after a carpal tunnel release, or when the flexor reinaculum is absent

Bowstringing

______ and ______ may be used to cover helplessness and dependency and to hide deep feras and anxieties

Bravado and Aggressiveness

Intervention Strategies for Dysphagia

Establish a therapeutic relationship with the elder. Focus attention on every aspect of the mealtime experience. Position the elder, use his or her assistive devices, address his or her dietary concerns, and take necessary precautions.

On the FIM scale

1 indicates complete dependence 7 indicates complete independence

Peripheral nerve regeneration begins about

1 month after the injury

Therapists must apply knowledge of items when considering a splint

-occupation -pathology -physiology -anatomy -psychology -reimbursement -bio-mechanics -aesthetic

Splinting

..."an orthopedic device for immobilization, restraint, or support of any part of the body". (Mosby's Medical Dictionary

Each of the 10 leading health indicators has one or more objectives from Healthy People 2010 associated with it. As a group, the leading health indicators reflect the major health concerns in the United States at the beginning of the 21st century

.1.Physical activity 2. Overweight and obesity 3.Tobacco use 4. Substance abuse 5..Responsible sexual behavior 6. Mental health 7. Injury and violence 8. Environmental quality 9. Immunization 10.Access to health care

Rote exercise is not as meaningful or as productive for elders as personally meaningful occupations because

.Personally meaningful occupations are intrinsically motivating. Picking up 10-lb grandchild versus a 10-lb weight Using an actual task versus an exercise may be more beneficial to elderly clients.

No muscle contraction

0

For CTS. splinting the wrist close as possible to _____ helps avoid added pressure on the median nerve

0 degree or neutral

Contraction can be felt, but there is no motion

1

Stages of Motor Learning

1. Skill acquisition 2. Skill refinement 3. Skill retention

Three interrelated components of human occupation

1. Volition 2. Habituation 3. Performance capacity

Two categories of thumb immobilization splints

1) forearm based 2) hand based

Self- identity has two components

1)- Individual component-who am I as person 2) Contextual component- where and how do I fit into my world

Standard Precautions

1. Wash hands 2. Wear clean, ordinary thin gloves- contact with fluids 3. Wear mask, protective eye-wear and gown during any pts- splashes or spray body fluids 4. Handle needles with care- do not recap needles 5. Routinely clean and disinfect frequently touched surfaces 6. Clean and disinfect soiled linens

Kitchen modifications- Fall prevention

Avoid step stools. Keep objects within reach. Provide simple meal preparation guidance. Use a microwave instead of the stove.

According to the ASHT classification - 6 splints

1. Identification of articular or nonarticular 2. Location 3. Direction 4. Purpose 5. Type 6. total number of joints

# stages of wound healing

1. Inflammatory 2. Proliferative 3. Maturation

Levels of cognitive functioning

1. No response- total assist 2. Generalized response- total assist 3. Localized response- total assist 4. Confused/agitated- max assist 5.Confused/inappropriate, non-agitated- Max assist 6. Confused/Appropriate- Mod assist 7. Automatic/Appropriate- Min assist for Daily living skills 8. Purposeful/Appropriate- Standby assist 9. Purposeful/Appropriate- Standby assist on request

Principal of PNF treatmenst

1. Normal motor development proceeds in cervicocaudal and proximodistal direction ( head to tailbone) 2. Early motor behavior is dominated by reflex activity 3. Motor behavior is exposed in an orderly sequence of total patterns of movement and posture 4. The growth of motor behavior has a rhythmic and cyclical tend, as evidenced by shifts between flexor and extensor dominance 5.Normal motor development has an orderly sequence but lacks step by step quality 6. Establishing a balance between antagonists is a main objective of PNF 7. Improvement of motor ability depends on motor learning 8. Goal directed activities coupled with techniques of facilitation are used to hasten learning of total patterns of walking and self care activities

The Basic assumptions of the Rood approach

1. Normal muscle tone is a prerequisite to movement 2. Treatment begins at the developmental level of functioning 3. Motivation is necessary for the reeducation of muscular responses. 4. Repetition is necessary for reeducation of muscle responses.

The Rood Sequence of Motor Development

1. Reciprocal inhibition-early mobility phase that serves a protective function- 2. Co-contraction-when opposing muscles contract simultaneously 3. Heavy work-mobility on stability-proximal muscles move and distal segments are fixed 4. Skill-highest level of control and combines efforts of mobility and stability

The principle treatment of the Rood approach

1. Reflexes can be used to assist or retard the effects of sensory stimulation 2.Sensory stimulation of receptors can produce predictable responses 3. Muscles have different duties 4. Heavy work muscles should be integrated before light work muscles

The four neurotherapeutic treatment approaches most commonly used are

1. Rood approach 2. Brunnstrom (movement therapy) 3. Proprioceptive neuromuscular facilitation (PNF) 4. Neurodevelopmental treatment approach (NDT)

The 4 basic elements of teaching/learning process

1. assessment 2. design of the plan 3. instruction 4. feedback/evaluation

4 Forms of Rationalizations

1. blaming incidental causes for problems 2. devaluing unobtainable goals 3. finding an advantage in an undesirable traits 4. mentally balancing negative and positive traits

Goal of Biomechanical Approach

1. evaluate specific physical limitations in ROM, strenght, and endurance 2. Restore these functions 3. Prevent or reduce deformity

Stages to ethical problem solving:

Awareness: What is going on? What kind of ethical problem is it? Who is involved? Which laws and institutional rules apply? What guidance does the AOTA provide? What are my options? Reflection: What do I think should happen? Support: With whom do I need to talk? Action: What will I do?

The 4 purposes of splints

1. mobilization 2. immobilization 3. restrictions 4. torque transmission

Role of COTA in Dysphagia

1.Collect data to identify the strengths and weaknesses of elders in feeding and drinking. 2.Provide quality care to elders with swallowing problems. 3.Activities 4.Meal preparation, money management, shopping, oral-facial exercises, assistive devices

Splint Fabrication Process

1.Referral- 2.Evaluation- use assestment, COPM, DASH, PRWHE 3.Consider Treatment Options-Biology, cause, course, traditonal treatment 4. Analyze Assessment Findings-pathology and protocols Determine Splint Design 5. Design-desired activities, functions within splint

Strength increases ___ months after and adolescent height and and weight have peaked

12

Boys the typical time of peak growth is

13 years

Girls usually reach full height ___ years after they begin menstruating

2

Part moves through incomplete ROM with gravity decreased

2-

Proliferative stage

2-3 day after injury last 2-6 weeks Epithelial Cells migrate to the wound

The forearm through of a splint should measure approx ___ of the forearm

2/3

______ after SCI is the typical point at which the aging problems begin to increase

20 years

Transition to adulthood

20-24

Occupation-based splinting is defined as

Is defined as "attention to the occupational desires and needs of the individual paired with the knowledge of the effects of pathological conditions of the hand, and managed through client centered splint design and provision.

What would be the total number of joint for this splint-Elbow flexion immobilization splint type 2 (3)

3 joints as indicated by (3)

____ is an approach associated with sensorimotor approach that focuses on the acquisition of motor skills through practice and feedback

Motor leraning

The natural tension within a muscle

Muscle tone

Hearing

37% of people older than 65 years of age experience some hearing loss. Hearing is needed for horns, sirens, train whistles, ambulances, fire trucks, police vehicles, and so on. Elders may need hearing aids to assist with this problem.

General Problems to Avoid-Dysphagia

Food too hot or too cold Ill-fitting dentures Not allowing enough time for chewing and swallowing Not monitoring a patient at risk for aspiration while he or she is eating Stopping the feeding before the elder has had time to consume the nutrition needed

The goal of splint wearing is to tolerate stress to the end range of the joint comfortably for

4 hours

Average growth period last about

4 years

The radius and ulna are included in this upper extremity

Forearm

The ability to group and to differentiated various forms of the same type of items

Form discrimination

Education

Formal Educational participation Informal personal educational needs or interest exploration Informal personal education participation

Ischemia that last ______ or more will result in permanent deformity of the forearm

48 hours

Adolescents gain approx ____ of their adult weight and ___ of their adult height

50 % weight 20% height

Mind-brain-body performance

Musculoskeletal, neurologic, cardiopulmonary, symbolic images

Medicare Part B

= doctors' services, outpatient care, services not covered by part A (including some OT, PT, HHC)

Medicare Part C

= managed care, fee for service, and medical savings accounts (private plans approved by Medicare)

Contemporary Task-Oriented Approach

?

Model of Human Occupation and Adaptation

?

Occupational performance

?? Examples: Playing golf (occupational form) Golf course available (physical characteristic) Socialization while playing (sociocultural)

What guidance do the Occupational Therapy Ethics Standards provide?

A philosophical and practical translation of how to maintain professionalism in practice. A regulatory code: guidelines for conduct are stated, and sanctions are provided for failure to comply with the code Sanctions are stated in the Enforcement Procedures for the Code of Ethics.

Occupational Therapy Practice Framework Purpose

Framework is intended to help OTRs and COTAs analyze their current practice and consider new applications in emerging areas. Developed to help the external healthcare professionals (e.g., physicians, payors, community) understand the profession's emphasis on function and participation in social life.

_________ refers to the pts ability to walk to complete all activities

Functional ambulation

The part of ADL, includes movement in bed, transfers or moving the body from one surface to another, wheelchair mobility, and ambulation with or without walking aids

Functional mobility

A person's perception of and identification with being either masculine or feminine

Gender Identity

Ideas for Managing a Feeding Program

Get elders out of bed at mealtimes. Ensure a pleasant dining environment without loud noise and distraction. Set up each resident's trays, dishes, and assistive devices so they are within easy reach. The program should address all meals and include members of the interdisciplinary team. Safety first!

Principles of activity Analysis

Goal directed meaningful to pt match to individual needs to social roles capable of eliciting the mental and physical participation designed to prevent or reverse dysfunction and develop skills related to pt interest adaptable, gradable, and age appropriate selected through knowledge and professional judgement selected in cooperation with the pt

Health promotion programs

Goal is for elders to prevent the progression of disease and decrease risks of disability and death. Health promotion should help maintain functional independence and autonomy.

The 4 most common optical defects reducing acuity are

Myopia (nearsightedness) Hyperopia (Farsightedness) Presbyopia (farsightedness associated with aging) astigmatism ( variations in curvature of the cornea)

One important element of a driving evaluation is

direct observation of driving behavior

COTA's Role in Determining Activities

OTRs and COTAs must match the activities with the characteristics of the matter, mind, and behavior domains appropriate to the client's cognitive level.

Observable and measure data derived from evaluation and treatment results

Objective

Arthritis, the most common cause of

disability, limits activity for 19 million U.S. adults

Myth #6: Elders prefer quiet and tranquil daily lives.

This varies with the individual. Don't make assumptions that all older adults want a quiet lifestyle. Continuing a vibrant lifestyle and staying active are key to healthy psychological aging.

T/F OTA can contribute to treatment plan

True

T/F Orthosis and Splints are used interchangeably

True

T/F Shorter, more frequent practice sessions are preferable to longer, less frequent practice

True

T/F Splints must address all muscles involved in motion

True

OT Intervention Goals for Cognitively Impaired

Purpose of OT intervention is to document alterations and improvements in functional abilities, sustain current performance, and reduce pain and stress associated with the symptoms. Goals do not aim to improve cognitive level. Goals aim to ensure consistency of performance at the safest and least restrictive level.

T/F Splints that focus on client factors alone do not always treat the functional deficits

True

T/F The OTA may carry out elements of the evaluation, the OT analyses the evaluation data to identify the clients specific strengths and deficits

True

T/F The use of fantasy can be channeled constructively in role playing situations

True

T/F When a disability is visible, passing is impossible

True

T/F For person who have hand burns, therapist do not splint in the functional position

True- they splint in the intrinistic plus or antideformity position

T/F A red wound is a healthy wound

True-presense of granulation tissue and is normal

Herberden nodes- and Bouchard nodes can lead to

loss of motion in the fingers, which can limit grasping and hand dexterity

Procedure for Bleeding

Wash hands and don protective gloves Place clean towel or sterile dressing Elevate the wound Consider cleaning the wound Encourage the pt to remain calm and quiet

Example of Cognitive learning

Adult learning to dance; older person who had a stroke learning to brush his teeth again Person with LE amputation learning to move around the house

Examples of associative learning

Adult remembering similar movement in previous dance routine; Older person picking up familiar toothbrush Person with LE amputation noticing how nice it feels to be back home

Taylor interaction styles-therapeutic mode

Advocating Collaborating Empathizing Encouraging Instructing Problem Solving

The original program covered most people 65 years of age and older. The program now covers those:

Age 65 years and older Entitled to disability benefits for at least 24 months With end-stage renal disease Who buy into the program

PD pt requires a daily home exercise program for

AROM and stretching, as well as clinic appointments in which exercise programs can be closely supervised by the OTA

Common reflexes exhibited in severely brain injured adults are

ATNR STNR

_____ can lead to a diabetic coma and eventual death if not treated

Acidosis

_______ enhances learning and enables the client to control the process, as the director of action

Active participation

OT's premise has been to promote a healthy balance of activities for persons who seek treatment. Why?

Activities perceived by an individual to be meaningful occupations are believed to influence the state of actual or possible health and well-being. Humans find meaning in what they do.

Social Theories of Aging

Activity theory Continuity theory External continuity Lifespan or life course theory Erickson's theory of human Peck's stages of psychological development in the second half of lifel Exchange theory Thriving: a holistic lifespan theory

What Is Accepted as "Truth"

Acts on faith Acts on fact Acts on feelings

Silent aspiration:

Aspirating food or fluids without coughing or choking and later developing pneumonia or other conditions

COTA's Role

Assess the client's developmental stage and potential disruptions in each adaptive skills area. Analyze the collected data for effects on age-appropriate occupational performance in the areas of work, education, self-care, and play and leisure. Devise intervention strategies that facilitate development of a specific skill needed for successful occupational performance. Sensory, developmental, symbolic, and daily life tasks Interventions continue until the client reaches sufficient competence in performing the skills and activities described as developmentally appropriate. Continue to monitor and reevaluate the client's progress in improving, maintaining, or restoring areas of occupational performance.

Allen Cognitive Levels (ACL) Test

Assesses cognitive level by assessing response to verbal instructions and problem-solving techniques when a client is presented with a leather lacing project.

The opinion, interpretation, or assessment of the results of the client functional performance and anticipated outcomes including problem list and long and short term goals

Assessment

COTA's Role- Driver Rehabilitation

Assist elders in applying for disabled parking placard issues by the Department of Motor Vehicles. Help the elder determine the requirements for the disabled parking placard. Paperwork usually needs to be signed by a licensed physician.

Role of COTAs in Elder Community Mobility

Assist elders in being as independent as safely possible. Help elders identify realistic goals and treatment plans for moving around the community. Provide resources for transportation when they can no longer drive. Groceries, pharmacy, medical appointments, activities

Exchange theory

Assumes people attempt to maximize their rewards and minimize their costs in interactions with others. Continuing interaction is based on what the elder perceives as rewarding or costly. Elders continue with interactions that are beneficial and withdraw from those perceived as having no benefit.

Guidelines for clients with CNS or PNS impairment

Avoid or limit exposure of the involved body part(s) to hot,cold, and sharp objects Avoid task that require use of one tool for extended periods of time Be conscious not to apply more force that necessary Distribute force evenly when using tools or objects Use the uninvolved hand or less involved hand to perform household mgt task such as testing the bath water Use vision to observe movement and positioning of body parts- looking behind to find toilet seat Observe the skin for signs of stress Avoid wearing restrictive clothing, jewelry, braces etc Enlist help from caregivers to check pressure sores in places that the client cannot see or feel Follow daily routine of skin care as recommended

An important goal in rehabilitation is helping pts to ______ their feelings and to accept ______ for them so that they can gain control of their rehabilitation

acknowledge responsibility

Typical Characteristics of Psycho-social Development- Early Adolescence

Being engrossed with self Emotional Separation from parents Decrease in compliance with parents rules or limits Challenging the authority of others Questioning adults opinions Changing mood and behaviors Mostly same-sex friendships with strong feelings toward these peers Demonstration of abstract thinking Idealistic fantasizing about careers Importance of privacy Interest in experiences related to personal sexual development and exploring sexual feelings Self-consciousness display of modesty, blushing, awkwardness about self and body Ability to self-regulate emotional expression Experimenting with drugs

Ageism:

Belief that one age group is superior to another Avoid stereotyping or assumptions about inferiority.

Visual Acuity

By age 70 years, most elders have poor acuity without corrective lenses or glasses. This makes driving more hazardous for them. With aging, changes in the lenses of the eye occur, and the eye muscles weaken. Pupil size decreases, which results in not being able to see well at night. Field of vision decreases with age, and this contributes to collisions. Special mirrors on the car can be used to improve vision. Glare occurs when too much light or light from the wrong direction is present. Elders' eyes recover more slowly when glare is present. Color of traffic lights can be a problem because elders require additional time to read road signs.

Unless it is medically contraindicated, _____ is usually measure first, to assess the available ROM at the joints

active ROM

The joint of the first digit

CMC, MP, IP

The Biomechanical Approach is most appropriate for pt whose ____ is intact but who have lower motor neurons or orthopedic dsorders

CNS (Central Nervous System)

Reflection: What do I think should happen?

COTAs must decide what they want to happen and must be able to explain their position. Ethical reflection involves careful and critical examination of feelings and values, a rational estimate of benefits and burdens, and a sense of professional duty. Free writing for reflection

Ethical conflicts Action: What will I do?

COTAs will need to take action; doing nothing can also be perceived as an action. COTAs may retain uncertainty but take comfort in knowing they gave deep thought to their position.

Maturation Stage

Can last up to 2 years Tensile strength increase Scar tissue softens

Client Centered Assessments

Canadian Occupational Performance Measure (COPM) Disabilities of the Arm, Shoulder, and Hand (DASH) Patient-Rated Wrist Hand Evaluation (PRWHE)

IADLs

Care of others Care of pets Child rearing Communication device use Community mobility Financial management Health management and maintenance Home establishment and management meal pre and cleanup Religious observance Safety and emergency maintenance Shopping

The term carpus refers to the wrist. Provide another term to refer to wrist?

Carpal

The CALMER approach

Catalyst for change- pt is responsible Alter thought to change feelings- reflect on why Listen- to determine what the problem is Make and agreement-reinstatement of the established plan Educate the client Reach out and discuss your feelings

This allows us to chunk information ( place it into groups)

Categorization

This approach was used on a child who has Cerebral palsy, the goal of the splint was to decrease the amount of tone present

Central nervous system- Sensorimotor approach

Environment- Restraint Reduction

Chair selection: Reclining chairs Alarms for chairs and beds Low beds that rest on or very near the floor Fall mats Moving furniture away from beds so that rolling out of a low bed to the floor is safer Wrap-around walkers Nursery intercoms that can help monitor safe ambulators Families can help decorate elders' rooms so they appear familiar and safe.

Neurologic or musculoskeletal causes of falls

Changes in the center of gravity, gait, stride, strength, and joint stability increase the risk for falls. Changes in posture control include decreased proprioception, slower righting reflexes, decreased muscle tone, and increased postural sway. Decreased height in stepping Medical conditions that contribute to instability include degenerative joint disease, deconditioning, neuropathy, stroke, Parkinson's disease, and dementia. Musculoskeletal conditions include osteoarthritis and decreased range of motion.

Cybernetic theory

Changes in the neuroendocrine system (endocrine and hypothalamus) result in organ changes.

Canadian Model of Occupational Performance (CMOP)

Client Centered Interview-based valid

Other Splint Considerations

Client motivation Clients ability to follow directions Client may require more than one splint

During the beginning stages of learning, individuals rely on ___ to guide movement

Cognition

_____ informs occupational performance

Cognition

______ is ALWAYS a factor in OT intervention

Cognition

Principles of Cognitive Evaluation

Cognition should always be seen in relation to to other potential deficit areas Discussion of the OT evaluation results with other health profession The testing environment also influences the results The optimal test involves a selection of test Avoid condescending attitude

Involving the clients in making decisions, in setting goals, in choosing priorities for treatment

Collaborating

Preparation Checklist for Dysphagia and Self-feeding Interventions

Collect information and review the chart. Inform the elder of the treatment goals. Create the right environment for eating. Ensure proper fit of dentures, glasses, and so on. Asses the patient for readiness to eat. Position the elder safely. Complete oral preparation exercises. Check the food tray for the correct diet.

Document Skin

Color Temp Texture Muscle atrophy Scarring Edema Skin Thickness Allergies Wounds/sutures

This part of the IADL includes all aspect of sending and receiving information, specifically the ability to use tools to write, and to operate a personal computer, read, type, text, or use a telephone, tape recorder, or special communication device

Communication management

Social participation

Community Family Peer, friend

This part of IADL refers to the skills used to move around the neighborhood or community

Community Mobility

____ is a way of making up for a deficit in one area by capitalizing on strengths in another area

Compensation

DASH

Condition specific Measures client's perception of how current disability of upper extremity has impacted function Measures client's functional abilities 30 set questions about function within performance areas Clients rate on 1 to 5 scale current ability level Should be coupled with interview Re-administration post splint fabrication measures client change in functional abilities

What are my options for conflicts of ethics ?

Conflicts of conscience = conflicts between personal and professional duties in which the ethical course of action is not clear Ethicists suggest estimating the consequences of a given option weighed against the consequences of other options. Ethically preferable course of action = action that carries the greatest probability of a good outcome (benefits) and the least amount of damage (burdens)

Diversity

Conformity An individual or cultural group forsakes values, beliefs, and customs to eliminate differences with another culture. Examples: Americanizing first or last names, speaking only English, abandoning religious practices or social rituals, not wearing a particular ethnic dress Bias: "a personal and sometimes unreasoned judgment" Prejudice: "an irrational attitude of hostility directed against an individual, a group, a race, or their supposed characteristics" Discrimination: "prejudiced or prejudicial outlook, action, or treatment" Definitions are from Merriam-Webster's Online Dictionary at http://www.merriam-webster.com/

The rehabilitation approach assumes that the pt is an

active, involved, contributing member of the rehabilitation team

in Peripheral nerve regeneration-flaccidity will decrease and muscle tone will increase. An important principle is that paralyzed muscles must first

sense pressure before tone and movement can be realized

Brunnstrom believed that traditional passive exercises may actually ______ to pain in pt with hemplegia

actually contribute- instead the shoulder joint should be mobilized through guided trunk motion WITHOUT forceful stretching

Wellness Program for Elders

Goals Enhance awareness of the positive effect of wellness on health at any age. Promote awareness of the sensory changes that occur as aging progresses. Improve knowledge of food consumption and effects on health. Improve decision-making skills. Encourage self-responsibility for health. Maximize a positive focus. Heighten awareness of behaviors that inhibit health and perpetuate disease. Encourage independence in self-care.

The role of the OT with ALS pts is to enable the pt to

adapt and maintain maximal level of functioning through out the course of the disease, as well as to assist care providers with the necessary skills to effectively assist with daily care issues

Tasks to Assess with Expanded Routine Task Inventory (RTI)

Grooming, dressing, bathing Walking, exercising Feeding, toileting Taking medications, use of adaptive equipment Housekeeping and doing laundry Food preparation Spending and managing money Communication such as reading, writing, speaking Following instructions, safety, responding to emergencies

The Oldest of Old: Centenarians (>100 years old)

Growing in numbers worldwide Lifestyle Genes Socioeconomic state 30% have minimal functional limitations

Acts on faith

Has a belief system based on religion or political ideology and uses it to determine "good" or "bad" Screen for faith-based beliefs before planning care

Code of Ethics outlines principles for OT practitioners.

They must: Demonstrate concern for the well-being of their clients and respect their clients' rights. Be competent. Comply with laws and rules that apply to their practice. Provide accurate information about services. Be fair and discreet and demonstrate integrity with colleagues and other professionals.

Fluid Consistencies-Dysphagia

Thin - regular consistency with no alterations Nectar - slightly thicker than water Honey - consistency of honey; trickles slowly off spoon Spoon-thick - consistency of pudding

The ability of the hand to function, explore and interact with the environment depends on

sensibility

Psychosocial approaches-Restraint Reduction

Have a written plan of interventions for cognitively impaired elders who may wander. The elder may have an agenda behavior that is repeated and can be expected and planned for. Keys to responding successfully to agenda behavior are to allow elders to act on their plan, find a point at which they will accept a suggestion or guidance, and allow them to keep their dignity.

Throughout childhood and across adult life , a person's sense of self continues to evolve, but the process is most intense in

adolescence

Bed Mobility- turning toward the

affected side is easier than turning toward the unaffected side

Consequences of Using Restraints-Physical

Hazards of immobility, incontinence, constipation Loss of balance, falls, pressure ulcers Pneumonia, infection, dehydration, impaired circulation, respiratory problems Abrasions, cuts, loss of freedom Death by suffocation or strangulation

De Quervains tenosynovitis

affects APL affects EPB most common diagnosed wrist in athletes

Clients with _____ are at a much higher risk for injury, especially if they have cognitive deficits such as impulsivity

sensory dysfunction

Value Systems

separates wrong and good from evil.

OT working with a patient with a board and fastener, the pt ask why is she/he doing this ? The OT should answer

This is a preliminary task that will lead up to buttoning your own shirt

Precautions-Dysphagia

Observe the patient's level of alertness, orientation, cognitive status, positioning, general endurance, and ability to self-feed. Observe the presence of delayed swallowing, food pocketing (food retained between the gums and cheeks), choking, and a wet-sounding voice. Be prepared to assist with choking using the American Heart Association methods for a choking person and CPR.

Evaluation

Obtaining the client's occupational profile Analyzing the client's occupational performance

Abnormal postures associated with severe to moderate brain injury

Head/Neck- forward flexion or hyper-extension Scapula- humeral depression with protraction, retraction or downward rotation UEs- possible bilateral or unilateral involvement- typical to have elbow flex, humeral adduction or internal rotation forearm pronation and flexion of wrist and fingers, Trunk- kyphosis, scoliosis, loss of lordosis Pelvis- posterior pelvic tilt, pelvic obliquity LE- hip adduction, knee flexion, plantar flexion, inversion

Key Chronic Diseases: The Facts (from the CDC)

Heart disease and stroke are the first and third leading causes of death, accounting for more than 30% of all U.S. deaths each year. Cancer, the second leading cause of death, claims more than half a million lives each year. .

Furniture-Fall prevention

Height of seats can be increased with firm cushions. Chairs with armrests are helpful. Chairs with wheels should be avoided. Elder's feet should be flat on the floor when seated.

New OTA should undertake independent service provision in evaluation and treatment planning only when

service competency is ensured after careful training

Culture Is Learned?

Culture is learned or acquired through socialization. Not genetic Environment is central to culture. Shared with others Cultural beliefs can change over time. Culture can be subconscious. Essentially, every belief and value that humans acquire as members of a society can be included in their culture, thus explaining the broadness of the concept of culture.

Different communication styles -culture

Cultures differ in the amount of information communicated. Cultures differ in verbal and nonverbal language. High-context cultures have understanding through shared experiences and history. Low-context cultures focus on precise, direct, and logical verbal communication. Depending on which context culture you are from and which the client or family is from, communication needs to be adjusted so that understanding occurs.

Consists of asking the client or family members questions relating to occupational habits and life roles, family situations, home setup, interests, values, and or therapy goals

Occupation Centered Interview

Splinting to Facilitate Therapeutic Outcomes

Occupational Performance Client Satisfaction Role Competence Adaptation Health & Wellness Prevention Quality of Life

__________________________can have a positive effect on the lives of elders in any living environment

Occupational engagement

Alternative Transportation

Help the elder navigate the public transportation system if one exists. Call the local senior center. Independent living centers in the community may also have resources for elders. Title II of the Americans with Disabilities Act (ADA) addresses elders with disabilities. Public transportation services are designed to be usable by individuals with disabilities (physical or mental) who need assistance of another to board, ride, or disembark.

Risk factors for Falls

History of falls, neurologic illness Multiple medications Poor eyesight, deconditioning Environmental hazards, poor lighting, loose carpets, no clear walking pathway in the home or room

Individualism

Degree to which a person considers only himself or herself when making a decision

Collectivism

Degree to which a person must abide with the consensus of the collective group

Function Assestments

Dellon Modification of Moberg Pick up test COPM AMPS DASH

____ as discussed here is an unwillingness to take action for oneself and an unnecessary reliance on others

Dependency

The feeling of sadness often accompanied by changes in behavior such as sleeplessness or excessive sleeping and disinterest in previously enjoyed activities

Depression

Consequences of Using Restraints-Psychosocial

Depression, withdrawal, anxiety, fear, panic, and so on Less social contact, humiliation, decreases in dignity and self-esteem

Model of Human Occupation

Designed for use with any individual experiencing difficulties in performing occupation. Explains for the way occupation is motivated, organized, and performed. Input Throughput Output (behavior) Model emphasizes the importance of the external environment to the performance of expected behaviors. The internal environment consists of subsystems. See Figure 7-2 and 7-3.

Procedure for Shock

Determine the cause of shock and correct if possible place pt in supine position Do not add heat, but prevent loss of body heat Keep pt quit

Memory for episodes or events in one's life

Episodic

____ ____was the first development theorist to propose that acquiring a sense of identity was the foremost psycho-social task of adolescent development

Erik Erikson

Successful aging

Disease prevention, health maintenance, and health promotion

Social Theories of Aging

Disengagement theory Activity theory Continuity theory Lifespan or life course theory Erickson's theory of human development Peck's stages of psychological development Exchange theory Thriving: a holistic lifespan theory

This crease is the landmark for the distal edge of the palmar portion of splint intended to immobilize the wrist while allowing motion of the MCPS

Distal palmar Crease

Assessment-Restraint Reduction

Documented need for an intervention should be completed first. Assess posture, alignment, balance, strength, and visual acuity. Examine head control, trunk stability, upper extremity support, and ability to self-propel if in a wheelchair. Perform a cognitive assessment.

Questions a Therapist should ask client

Does the splint feel secure do the straps irritate you anywhere does you skin feel hot What activities will you be doing When you move do you experience pain Does the splint feel comfortable after 20-30 minutes

______ or task specific training may be used for the client who has global memory deficits

Domain-specfic

This term refers to the back or the posterior aspect of the hand and forearm in relationship to the anatomical postiiton

Dorsal

5 Splint approaches

Dorsal Palmar Radial Ulnar Circumfrential

The degree of ease with which a material conforms to the underlying shape without manual assistance

Drapability

_____ requires continuous integration of visual , perceptual, cognitive and motor skills

Driving

Overview of Cultural Diversity

Each client has his or her own culture with his or her own blend of values and beliefs. Clients are unique in race, gender, age, ethnicity, physical ability, and sexual orientation. Their families, place of birth, religion, levels of education, and work experiences are also diverse. COTAs contribute to the creation of a therapeutic environment where diversity and differences are valued and where elders can work to reach their diverse goals.

How COTAs Influence Health Promotion in Elders

Educate elders who can benefit from assistance in making positive choices to improve the quality of their lives. Influence their clients' considerations of healthy lifestyles and assist them in improving the quality of their lives. Encourage elders to explore health-promoting activities and provide them with education. Motivate elders to take actions that promote health and limit potential for occupational deprivation, alienation, or imbalance.

Material resistance to stretch and its tendency to return to its original shape after stretch

Elasticity

Pedestrian Safety

Elders account for approximately 17% of all pedestrian fatalities. Wheelchairs, walkers, and scooters require more time for crosswalks and may overturn when going down ramps. A mobility expert should evaluate the type of equipment needed by the elder. Safety training on the equipment an elder uses is critical for the COTA.

Muscles and Joints

Elders experience back pain, making it difficult to sit for long periods of time. Arthritis may cause stiffness in the neck, making turning the head limited or painful. Reaction time is lengthened in elders, making sudden changes in traffic or sudden stops almost impossible. AARP has courses for elder drivers to improve unsafe habits. Behind-the-wheel evaluation is the best method to determine driver safety. Unsafe or questionable drivers should be reported to the DMV in each state.

Fall Statistics

Elders older than 75 years of age fall more frequently than any other age group except infants and toddlers. Accidents are the sixth leading cause of death for those older than 65 years. Leading type of accident in the home One in 40 elders who have fallen will be hospitalized, and only about half will be alive 1 year later.

Dietary Concerns-Dysphagia

Elders prefer softer, sweeter, easy-to-prepare foods. Elders often drink fewer fluids. Learn how liquid intake is measured in each health care facility so you will record the correct amounts of oral fluid intake.

Psychological Development in Adolescents

Emotional Separation from parents Expolaration of interest, ideas and roles Expermentation related to interest and preferences Formation of personal idenity Identification with a peer group Exploration of romatic relationships Development of a sense of one's ssexuality Developing sexual orientation Establishing occupational for future workers role

Work

Employment interest and pursuits Employment seeking and acquisition Job performance Retirement preparation and adjustment Volunteer exploration Volunteer participation

Occupational form

Occupational situations, including environmental context of the individual's life Physical and sociocultural characteristics

Factors contributing to successful aging:

Experiencing a sense of control over one's life Practicing healthy habits Achieving continuity with one's past Performing happy activities Participating in a social network of family and friends Exercising regularly Engaging one's mind in complex cognitive activities Stopping smoking, maintaining a healthy diet, and consuming fewer calories Taking aspirin and antioxidant vitamins

is an objective assessment of an individual ability to perform work-related activity

FCE- Functional Capacity Evaluation

T/F A pencil to write a letter to Aunt May would be an example of AAC for a person who is unable to speak

False- because able bodied correspondent would be using the same technology

T/F Advance certification is necessary to practice NDT

False- not needed

T/F Gender identity and bilogically female or male can be used interchangeable

False- they are not the smae

____substitutes imaginary activities for actual activities

Fantasy

The ability to distinguish and object from its background such as a fork in a bunch of sl=ilverware

Figure ground perception

Associative styles:

Filter new data through a screen of personal experience—only in terms of past experiences

A patient with ____ may have difficulty maintaining upright position or lifting arm or leg against gravity

Flaccid tone

A Thermoplastic material with high degree of ___- can take stresses repeatedly

Flexibility

____- allows a circumferential splint to open and close without breaking

Flexibility

The thumb can perform the following movements

Flexion extension abduction adduction opposition

During the Acute phase of an SCI _____,_____ and rotary movements of the spine and neck are contraindicated

Flexion and extension

Combined with depression ____ may severely impair the person's return to valued occupations

FoF

Procedure for Falls

Hold Gait belt Push forward against pelvis and pull back on shoulder or anterior chest Falling forward-guide the pt to reach slowly for floor Slow momentum by gently pulling back on the gait belt Step forward as pts falls forward Tell pt to bend his or her elbows to help cushion the fall when the hands contact the floor Ensure the pt's head is turned to the side to avoid face injury Backwards- rotate and widen your stance Push forward on the pts pelvis Instruct the pt to lean briefly against your body or sit Considering lowering pts into sitting position

The most common visual impairment observed after a CVA

Homonymous hemianopsia- loss of visual field in the corresponding right or left half in each eye

The _____ helps to place the hand in a neutral resting position by preventing extreme ulnar deviation

Hypothenar bar

Also called flaccidity, is a decrease in muscle tone

Hypotonicity

The inability to comprehend the concept of the required movement or to execute the act in response to a command automatically

Ideational or conceptual apraxia

6 splint classifications

Identification of articular or non articular Location Direction Purpose Type Total number of joints

Two types of apraxia that occur after a stroke

Ideomotor Ideational apraxia

The inability to plan or perform a motor skill

Ideomotor or ideokinetic apraxia

What would be the total number of joint for this splint-index-small-finger MP flexion mobilization splint, type 2

If no secondary joints are included in splint design, the joint level is type 0

Chronic Illness

Illness that cannot be cured but that can be managed through medications, diet, exercise, surgery, and technology

In a _____ SCI some of the sensory or motor nerve pathways below the level of the lesion are preserved and intact.

Incomplete- pathways must be preserved in the sacral segments to qualify as incomplete

Adolescent Cognitive Development

Increase capacity for abstract thinking-logical thinking Advance reasoning- hypothetical deductive reasoning Development of impulse control-emotional self regulation Increased ability to assess risk and consequences vs. reward Increased problem solving skills Improved used and manuipulation of working memory Improved language skills, especially girls Future-oriented plannign and goal setting Increased capacity to cognitively regulate emotional states Emergence of morla reasoning-conventional level of morlaity Greater ability to perceive other's perspectives Focus on role obligations and how one is percieved by others Questioning values of parents and institutions

Needs of the Old Old

Increased risk for disability Cardiovascular disease, vision and hearing deficits Risk for cognitive impairment High cost of health care as they use more health care resources More likely than younger persons to be institutionalized but more likely to be in the community Need support for activities of daily living (ADLs) Family provides care, transportation, food, housing Less formal education

COTA Responsibility Elders:

Influence change in the quality of lives of elders by implementation of occupation-centered care. Demonstrate leadership in helping individuals plan health-promoting engagement in meaningful occupations as the path to a long and healthy life. Assisting people of all ages to actively participate in taking responsibility for improving the quality of their health. Creating healthy environments through consultation with state, city, and institutional levels of care.

Task Assessment by the COTA

Information is obtained from the client (if possible) and caregivers regarding the client's most familiar tasks. The client is observed performing activities and tasks that are part of his or her daily routines. The OTR and COTA team can compare the performance with the characteristic behavior for each cognitive level. Knowledge of the client's optimal functioning (can also depend on the time of day) helps the team design intervention strategies that maximize the client's abilities.

IV lines

Infusion site should remain dry needle should remain secure and immobile in the vein IV support at heart level IV site same side

Aspiration pneumonia

Inhaling food or fluids into the lungs, resulting in a life-threatening form of pneumonia

Malnutrition

Insufficient amount or types of nutrients supplied to or absorbed by the body

Multifactor causes of falls/preventation

Interdisciplinary team should work together Not only ask the elders about their routines and ability to perform ADLs; also observe them doing the activities. Shoes: Wear sturdy, rubber-soled shoes that fit well; slip-on shoes should fit well. Dressing techniques should be taught.

COPM

Interview based Identifies problems in performance areas Identifies a client's perception of their ability to perform in a performance area Identifies a client's satisfaction with their current abilities Can be used with all ages/disabilities Caregivers or family members can answer questions for client if needed Provides objective documentation of splinting effects by pre-post scores

Direct Intervention-Dysphagia

Learning how to feed someone well takes practice. Provide a large napkin (not called a "bib") to catch stray food Bring food to mouth slowly and watch for cues that the person is ready to take a mouthful of food. Learn how much food the person will take in one mouthful. Watch for chewing and swallowing; wait for the patient to swallow and clear the mouth before giving another spoonful. Provides fluids to wash down the food bolus. Coordinate eating and breathing.

National Dysphagia Diet Levels

Level I: Puree consistency diet (homogenous, very cohesive, pudding-like, requiring very little chewing ability) Level 2: Mechanically Altered (cohesive, moist, semisolid foods, requiring some chewing) Level 3: Dysphagia-Advanced (soft foods that require more chewing ability) Regular (all foods allowed)

Lifespan or life course theory

Life course: "an age-graded sequence of socially defined roles and events that are enacted over historical time and place" Influenced by the age of the person and by birth cohort Life course stages are related to specific chronological ages.

20 Physical demands of work

Lifting Standing Walking Sitting Carrying Pushing Pulling Balancing Stooping Kneeling Crouching Crawling Reaching Handling Fingering Feeling Talking Hearing Seeing

Splint Compliance

Listen when client makes suggestion determine if splint is not correct for goal Does it look worn Does it smell Dirty spots Strap looks old or new

Sources of data

Medical chart Physician referral Patient Patient's caregiver

Geriatrics

Medical interventions with the elderly; clinical specialty

Education of splints include

Medical reason wearing schedule Home program Splint precautions Splint cleaning

Compliance rules for nursing facility reimbursement through

Medicare or Medicaid established through OBRA (health care law) Act of Congress effected October 1990; final rules were published in 1995

The property that describes a materials ability to return to its preheated (original shape)

Memory

Reasons for Postponing Retirement (CareerBuilder Survey 2010

More than 7 out of 10 workers over age 60 are putting off retirement due to financial inability (72 percent) Enjoy where they work and don't want to leave it (71 percent) Need for health insurance and additional benefits provided (50 percent) Fear retirement may be boring (24 percent) Enjoy feeling needed (15 percent)

Economic Demographics for Age >65 Years

Most elders are not impoverished. Elder women have greater poverty rates than elder men. Wide economic disparities exist between white elders and minority elders. Many elderly continue to work past age 65 years. Public policy (Social Security) provides retirement income. Increasing health costs are not favorable for the elderly.

The ability to regulate or direct movement

Motor Control

______ is necessary for a person to function independently during occupational performance task

Motor Control

Performance skills

Motor and praxis Sensory -perceptual Emotional Regulation Cognitive Communication and social

The acquisition of motor skills, it is a set of processes associated with practice or experience leading to relatively permanent changes in the capability for responding

Motor learning

are often easily corretced with prescription corrective lenses

Nearsightedness farsightedness astigmatism

Etiology of Dysphagia

Neurologic, structural, systemic

These are incompletely regenerated nerve endings and fibers at the site where peripheral nerve was damaged

Neuromas

Table 7-3, Characteristics of Maturity Stage of Development

Neurophysiologic and physical development Psychosocial: ego integrity and maturity Psychodynamic Sociocultural Social language development ADLs and developmental tasks Ego-adaptive skills Intellectual development

The ______ has the primary role in educating the client, family or significant others by reinforcing information provided by the physician about recovery from PNI

OT

Prevention and Health Promotion Among Elders

OT practitioners provide health-promoting activities that provide a means of preventing the unhealthy effects of inactivity.

Who can fabricate a splint?

OT practitoners PT practitioners Certified Orthotist Dentist Pedorthist

Learned Helplessness

Occurs when people perceive that they have no control over their lives and must depend on others. Elders who experience a loss of control also experience diminishing coping skills and are at risk for illness. What to do: Encourage independence and self-care. Give choices and options as much as possible. Challenge the client to work at a greater level than currently functioning. Relinquish some of the power in the relationship and empower the client to problem solve.

Occurs with effective coordination of eye movement by eye muscles

Oculomotor control

Memory

Often turns translucent good for serial splints difficult to make small adjustments

Documentation

Onset of medical condition medical necessity level of function before splint person rehab potential type of splint purpose of splint therapist commincation written schedule skin breakdown adjustment follow-up visits compliance

Well-being

Optimal level of functioning for a person's age and condition

Normal Swallowing-Phases

Oral preparatory phase Oral phase Pharyngeal phase Esophageal phase

Refers to an individuals ongoing awareness of current situations, the environment and the passage of time

Orientation

Ex of form 1 of rationalization

Others do not like me because I'm disabled

Free radical theory

Oxidation of lipids, proteins, fats, and carbohydrates Low-level free radical damage occurs over time, resulting in age-associate decline of function in major organs. Environmental contaminants increase free radical damage.

In peripheral nerve injury______ will assist in the prevention of edema by promoting venous return

PROM

__________________ exercises should be performed at least twice daily and continued indefinitely if sufficient active movement does not return

PROM

The initial phase of the evaluation for Guillian Barre Syndrome and treatment focuses on

PROM, positioning, splinting to prevent contractures and deformity as well as to protect weak muscles

Energy conservtion techniques used by pt with MS

Pacing Successful work/rest ratio Use of electronic aids Flexible home and work schedule Recognition of fatigue warning signs Successful use of compensatory strategies Acceptance of request for assistance

This allows the detection of stimuli potentially harmful skin and subcutaneous tissue

Pain

These terms are used interchangeably to refer to the front or anterior aspect of the hand and forearm in relation to the anatomical positiion

Palmar or Volar

Special Transportation Services

Paratransit services: Elders usually must be able to independently leave their home or have someone help them leave the home and enter the paratransit vehicle. COTAs help elders navigate this paratransit system to secure transportation to appointments and so on.

Ethnicity

Part of a person's identity that is derived from membership in a racial, religious, national, or linguistic group Ethnocentricity The belief held by members of a particular ethnic group that their expression of beliefs and values is superior to that of others Can be underlying, subconscious beliefs that guide a person's behavior COTAs should examine their cultural beliefs and biases.

COTAs should understand and follow specific guidelines to receive payment.

Payment claims may be denied without all guidelines addressed (e.g., not having the physician sign off on the plan of care).

Optimal seating position wheelchair

Pelvis: Neutral position with weight equally distributed between the left and right ischial tuberosities Trunk: Slight lordosis in lumbar area, slight kyphosis in thoracic area, and small amount of cervical extension Femurs: Neutral position; slight abduction of the hips; and 90 degrees of flexion at the hip, knee, and ankle Arms: Supported by armrests but without shoulder elevation

Disengagement Theory

People withdraw from roles or activities and reduce their activity levels or involvement. "Turning inward"; increased involvement with family Criticism of theory: It is a decline in opportunities to activities that cause disengagement. It may be a belief that the elder perceives other people thinking he or she is "too old."

Movement involves

Perception motor planning motor execution feedback bio-mechanics

_____ and ___ are in many cases the primary focus of OT intervention for person with physical disabilities

Performance capacity and performance skills

PNI

Peripheral nerve injury

Volition

Personal causation: Knowledge of capacity, sense of efficacy Values: Personal convictions, sense of obligation Interests: Attraction, preference

______ is emphasized as the central characteristic of occupation.

Personal meaning

Three characteristic phases of psycho-social development

Phase 1- early adolescence, middle school years 10-13 Phase 2- middle adolescence, high school- 14-17 Phase 3- late adolescence, college/work- 17-21

Establishing a Restraint Reduction Program

Philosophy Empowerment of elders and staff Elders' dignity and quality of life Elder safety and freedom within the facility Policy OBRA law requires restraints be used only in certain conditions and limitation. Each facility has its own policy that meets the OBRA law. Know your facility's policy. Know the facility's alternatives to restraints. Education Staff, clients, and families need education on the use of restraints and restraint reduction. Alternative to restraints should be investigated and selected. Teaching strategies may include having the facility staff restrained for a short period of time. Few individuals would choose restraints for themselves as a suitable intervention.

Ensure that the elder has access to emergency assistance.

Phones Phone numbers Neighbor Family members

History of restraints

Physical restraints have been used since the 1700s in the United States to manage psychotic behavior. Until the late 1980s, restraints were almost universally used in nursing homes. Restraints continue to be used today in hospitals with a physician's order. Nursing homes have almost universally eliminated restraints.

Clinical Reasoning to consider

Physicians referral surgical and rehab protocols Therapist conceptual model assessment of pt's need knowledge of reimbursement source

Cognitive or psychosocial causes of falls

Poor judgment, insight, and problem-solving skills Confusion or inattention Fatigue, depression, dementia Drug reactions, fear of falling Unfamiliarity with a new environment or caregiver Strong drive for independence

Feeding in Bed-Dysphagia

Position as close to the headboard as possible. Elevate the head of bed 45 degrees or more. Flex the knees to prevent sliding down in bed. Use pillows to position if needed. Positioning devices may be used in chairs or beds.

Sensory-perceptual

Positioning the body Hearing and locating Visually determining Locating by touch Timing Discerning flavors

The ability to base one's moral judgement on one's own moral values and moral standards

Post-conventional (Kohlberg)

COTA's Role in Seating and Positioning

Posture should be monitored continuously. Pressure relief to prevent skin breakdown Elders have very fragile skin, and pressure causes breakdown quickly. Pressures sores develop when the blood circulation to an area is decreased; sitting in one position for too long can cause this to occur. Teach elders to monitor their own skin. Look for areas of redness over bony prominences. Change positions every 1 to 2 hours. Use a mirror to inspect their skin.

The ability to plan and perform purposeful movement

Praxis

Stereotype

Preconceived ideas about how a person should act, think, or feel based on fear of the unknown or lack of contact Examples: Elders are in ill health; elders are slow; elders are too old to work; elders cannot enjoy sexual activity.

______ occurs before instruction

Preparation

Min IADL skills for independence

Prepare or retrieve a simple employ safety precautions and exhibit good judgement take medication obtain emergency aid

_____ sensation is also important in ADL because it occurs continuously in activities such as sitting, pushing drawers and doors, crossing the knees, wearing belts and collars and many other activities that stimulate pressure receptors

Pressure

Ex of form 4 of rationalization

Pretty women are dumb disabled persons have more human understanding

Prevention strategies fall into three categories

Primary Secondary Tertiary

After a CVA, because of the influence of higher centers in disturbed or destroyed motor function reverts to

Primitive state, Reflexes present in early life reappear, and normal reflexes become exaggerated

Using logic, reasoning and analysis to address obstacles to client recovery and participation. Engaging clients in problem-solving process, in generating and evaluating possible solutions

Problem-solving

______ is often retained in person who have acquired brain injury or even Alzheimer's disease

Procedural

Ability to distinctly and critically analyze reasons for actions you make as a therapist

Professional Thinking

Genetic theories

Programmed aging Somatic mutation theory Cybernetic theory Free radical theory Nongenetic theoryry

Brunnstrom principles of treatment

Proprioceptive stimuli can be used to evoke desired motion or tonal changes. To facilitate a synergy pattern, the therapist can rub skin over the muscle belly with his or her fingertips, thus producing a contraction of the muscle and eliciting the synergy patterns to which muscles belong. ex. brisk rubbing the triceps muscle while pt attempts to push arm through the sleeve of the shirt can promote extensor enegery

This memory is concerned with memory for tasks to be completed in the future

Prospective memory

Feeding Patients with Dementia

Provide finger foods if they can feed themselves. Decrease environmental stimulation. Reduce verbal communication to ease distractions. Monitor so the patient with dementia does not eat "nonfood" items on the tray.

Activity alternatives-Restraint Reductions

Provide meaningful occupations for elders. Relate activities to their past occupation if able. Provide an activity kit: Sewing basket, briefcase, fanny pack, or tackle box of items that can be manipulated by the elder

Role of COTA in Wellness and Health Promotion

Provide professional evaluation, intervention, and educational programs. Prevent the progress of disease and risks of disability or death. Help elders maintain functional autonomy as long as possible. A: Attitude B: Balancing productive activities, positive social support, emotional expression, and environmental interaction C: Controlling health through education

Intervention strategies for body scheme

Providing tactile stimulation Facilitating normal bilateral movements using NDT handling techniques Using a mirror to augment the visual awareness of the neglected parts Educating client ( and their families) about the disorder to the level they can understand

This arch is fixed and consists of the distal row of carpal bones

Proximal transverse arch

This approaches to treatment are likely to be used for upper motor neuron disorders such as CP, stroke, and head injury

Sensorimotor

The treatment for injuries for axillary nerve to OTA should maintain ________ to prevent deformity and improve circulation

ROM

This term indicates the thumb side of the palmar surface

Radial

Involves not only repetition of the same motor patterns but also formulation of plans to solve motor problems

Random practice

____ is the unconscious justification of thoughts or behaviors with reasons.

Rationalizations

______ for learning implies that the learner is prepared for the learning process and thus possesses the necessary cognitive, perceptual and physical skills to perform and master the learning task

Readiness

Helping the Elder Cope

Reduce fears about the illness through education. Listen and be sensitive to the feelings expressed verbally and nonverbally. Provide encouragement. Assist in the development of creative yet realistic ways to gain more control over the illnesses or losses. Identify ways to reduce stress and promote social support. Surround the elder with familiar objectives that may help with the sense of continuity, provide them comfort and security, and aid their memory.

Reverting to feelings, thoughts and behaviors that worked well for coping in the past is sometimes used to relive anxiety. _____ is a way of denying reality

Regression

In relation to occupation, the _____ approach focuses on the occupations themselves and on performance skills rather than body structures and functions

Rehabilitation

The ____ approach uses measures that enable a person to live as independently as possible despite residual disability

Rehabilitation

This approach allowed a person who had a stroke to grasp the walker by using splints that were adapted to assist with grasp

Rehabilitation approach

______ may be derived intrinsically from personal satisfaction of observing results of successful performance or may be extrinsically by the OT

Reinforcement

Ethical conflicts Action: Reporting

Reporting another's unethical behavior is sometimes referred to as whistle-blowing. Reporting another's unethical behavior can take courage, especially if a COTA's job is threatened. If possible, COTAs should work with the support of others, especially those in a supervisory position. COTAs should make sure to document their actions so their systematic efforts to address the problem are well established.

____ is the mechanism that removes painful memories from awareness

Repression

______ of interpersonal conflict is an important part of the OT process

Resolution

Emotional Regulation

Responding to feelings of others Persisting despite frustration Controlling anger Recovering from disappointment Displaying emotion Utilizing coping strategies

Rest and sleep

Rest Sleep Sleep Preparation Sleep Participation

_____ material is used for joint stabilization

Rigidity

Procedure for Burns

Rinse or soak the burn Cover with clean or sterile dressing DO NOT apply any cream

Part I: Restraint Reduction-COTA role

Role of COTAs in restraint reduction Assessment Consultation Environmental adaptations Psychosocial approaches Activity alternatives Treatment

Methods using the ____ were developed for treatment of pts who have CNS dysfunctions

Sensorimotor approach

Consultation-Restraint Reduction

Roles as consultant: Advocate, observer, teacher, information specialist, team problem solver, identifier of resources Formal restraint reduction training Development of alternative to restraint use e.g., splints if indicated Examine the environment for needs and psychosocial and activity-related alternatives. Teach the staff alternatives.

_____ based materials are the quickest to become brittle

Rubber

The pt with persistent _____ cannot support the body weight on hands and knees, maintain balance in quadruped and creep normally

STNR

Positioning-Dysphagia

Safe positioning prevents food from entering the trachea (airway). Proper positioning increases alertness, normalizes muscle tone, provides comfort, and helps with digestion. Preferred position is in a dining chair rather than a wheelchair. The elder should sit upright wit the feet on the floor and head and neck in alignment. The extremities should be fully supported on the table or tray. The hips and knees should be flexed 80 to 90 degrees.

Fall Prevention-Difficulty with transfers and mobility during ADLs

Safety training with a cane, walker, or wheelchair Good night lights for elders who get up to urinate at night Wider walkways by moving furniture or eliminating too much furniture

Advantages of Prefab Splints

Save time an effort Immediate feedback variety of material choices prefer sports brace appearance no waste

The typical posture in the adult with hemiplegia-UE

Scapula-depression and retraction Shoulder- adduction, internal rotation Elbow-Flexion Forearm-pronation Wrist-flexion, ulnar deviation Fingers- Flexion Trunk-Lateral Flexion is toward the involved side LE- typical extensor posture Pelvis- posterior elevation retraction Hip- internal rotation, adduction, extension Ankle- plantar flexion, supination, inversion Toes- Flexion

Closed-minded persons:

See only a narrow range of data and ignore additional information

Open-minded persons:

Seek additional information before making decisions Ask many questions, listen to alternatives

Intervention

Selection of the occupational strategies to meet improve the functioning of the client Identifying treatment goals and outcomes with the client

Rehabilitation Intervention methods techniques and modalities

Self-care evaluation and training Acquisitions and training in assistive devices Acquisitions and training in adaptive equipment Homemaking and childcare Work simplification and energy conservation work related activities leisure activities prosthetic training wheelchair management home evaluation and adaptation community transportation architectural adaptions acquisition and training in use of communication aids and environmental control

Treatment- Restraint Reductions

Self-care techniques Must be done as part of the elder's agenda and routine Upper body positioning Best support possible is needed. A full lapboard can be used if it doesn't promote agitation for the elder. Swing-away lap tray; foam wedges or bean bags Seating adaptations Correctly fitted wheelchairs with pads that support elders Drop seat chairs and reclining chairs that can prevent elders from rising or rising too quickly but do not restrict other movements Foam pads that support and position elders

Changing one's physical apperence to express individuality is an example of

Self-concept

Process of self-evaluation related to other abilities to competencies in physical activities

Self-concept

Memory of deep seated language and basic ffacts most of us know

Semantic

Myth #7: All elders become senile.

Senility: "the physical and mental infirmity of old age" (Merriam-Webster Dictionary Online at http://www.merriam-webster.com/dictionary/senility) When elders appear confused or require more time for directions, take your time. Getting older is not synonymous with feeblemindedness. Other contributing factors may be depression, grief, anxiety, or dementia.

The primary means of learning about the external world

Sensation

Biological causes of falls

Sensory Visual changes, loss of depth perception, peripheral vision, color discrimination, acuity, accommodation It becomes difficult to judge the depth of stairs. Bifocals and trifocals take time to get adjusted to. Vision Macular degeneration, cataracts, diabetic retinopathy, glaucoma, and stroke all affect vision. Spatial organization or figure ground may cause an elder to perceive a change in rug color or flooring as a stair. Misinterpreting visual information leads to falls. Cardiovascular Blood pressure changes Orthostatic hypotension, neuropathy, diabetes, medication side effects, syncope Lower cardiac output Results in lightheadedness, dizziness, impaired venous return; may occur from prolonged bed rest

_____--- techniques are based on the theory that nerve fibers that carry pain can be positively influenced through the use of pressure, rubbing, vibrations, TENS, percussion and active motions

Sensory Desensitization

Complications with SCI

Sensory loss increase skin breakdown Decrease vital capacity is problem in people who have sustained cervical and high thoracic lesions ( OT interventions- assisted cough, deep breathing exercises) A lack of muscle tone in the abdomen and LEs leads to pooling of blood in those areas, with a resultant decrease in blood pressure ( fainting- supine to sit) Autonomic dysreflexia- T6 or above Spasticity- Heterotopic ossification- ectopic bone- is a bone that develops in the abnormal anatomic locations- usually hip and knee

This refers to a person's preference pattern of physical and emotional arousal, and sexual attraction toward others of either opposite sex or same sex/gender

Sexual Orientation

Splint Referral

Should include diagnosis type of splint design

Adolescent Physical Development

Skeletal growth Growth in muscle mass and strength Growth and maturation of reproductive organs Growth of secondary sex characteristics; pubic and body hair Advance motor coordination skills Boys- Significant increase in muscle mass, onset of sperm production and ejaculation Girls- Development of female body shape, including breast development, menarche

The client understands the idea of the movement but has not learned it

Skill acquistion

The client demonstrates improved performance, fewer and less significant errors and increased consistency and efficiency of the movement achieve functional goals

Skill refinement stage

Concepts of skilled and unskilled therapy are important to Medicare reimbursement rules. Key issue is whether the skills of a therapist are needed for the required services.

Skilled services involve the therapist directly. Unskilled services involve the therapist indirectly.

Sensation is divided in to the

Somatosensory and Special Sensory Systems

Medicare Part C

Some plans have offered more benefits than the traditional Medicare plans.

Patients with ____ may decrease their movement or be unable to initiate movement

Spasicity tone

Examples of Biomechanical Approach

Standing w/ weighted sander increase shoulder ROM

Which splints place tissues in a stress-free position to enhance healing and to minimize friction

Static splints

The ability to identify an object through proprioception, cognition, and the sense of touch

Stereognosis

____ is used to destroy all forms of microbial life including highly resistant bacterial spores

Sterilization

If pain, swelling, redness occurs during ROM what do you do

Stop Document

Primary Prevention

Strategies that reduce risk for disease BEFORE its onset. Facilitation of lifestyle changes Use of necessary medications to reduce development of life-threatening conditions Immunizations, accident prevention Nutritional counseling Smoking and alcohol cessation Prevention of falls in the elderly

Assistive Devices-Dysphagia

Straws Built-up handles for silverware Universal cuff Swivel spoon or long-handled spoon Nonslip placemats or plates with suction cups Spouted lids on cups Rubber-coated spoons Rocker knives for one-handed cutting

Healthcare Systems will become even more integrated because

Stronger focus on quality, cost-efficient care. Electronic records as a result of public policy will become a reality. Increasing costs + rapidly growing population of elders = increased pressure on, and discussion of, programs such as Medicare, Medicaid, and Social Security.

Gerontology

Study of the aged and the aging process

Habituation (habits)

Style, routine, occupational behavior Internalized roles: Style of action, occupational forms of roles, temporal order of roles

What has been said subjectively by client or what has been reported by significant others

Subjective

____ is the process of channeling energy from prohibited goals to more socially acceptable ones

Sublimations

Standardized tests are considered ______ to non-standardized test

Superior

The following muscles comprise the rotator cuff

Supraspinatus Infraspinatus Teres Minor Subscapularis

_____ sensitivity is critical to the performance of all ADLs

Tactile

The primary senses- somatosensory

Tactile Deep pressure pain proprioception kinesthesia

Undernourishment

Taking in less nutrition than needed May occur in elders who need assistance feeding

Dehydration

Taking in less or excreting more fluids than needed May occur in elders who need assistance to drink or obtain fluids

Refers to the process of instructing and helping others acquire information

Teaching

Skilled service example

Teaching patient adaptive skills for dressing, eating, or going to the toilet Assisting patients in instances in which safety is an issue (e.g., after surgery)

Stress occurs when forces on an object are applied opposite each other

Tension

Conformability

The ability of a thermoplastic material to fit immediately into contoured areas the more conformed a splint to a joint, the better the pressure distribution should be

Myth #2: You can't teach an old dog new tricks.

The ability to learn does not decline with age. Elder adults learn differently than children or young adults do. Crystallized intelligence (wisdom) associated with experience or education changes less with age. Elders may take longer to learn. Physical changes that affect learning: Body aches, joints, decreased stamina Ergonomics of computers may cause neck or back stiffness. Vision and hearing deficits may slow learning. In times of stress, elders may be less flexible.

What Is Culture?

The contexts that influence performance skills and performance patterns (observable behaviors of occupations) Include physical, social, personal, spiritual, temporal, and virtual factors that influence occupation "Customs, beliefs, activity patterns, behavior standards, and expectations accepted by the society of which the individual is a member" (AOTA, 2008).

Locus of Decision Making

The extent to which a culture prizes individualism as opposed to collectivism

An example of displacement

The person with an acquired disability may project previously held negative attitudes about PWD onto the OT

Wheelchair Seating and Positioning- COTA must understand

The use of wheelchairs at home, in the community, or in institutions improves the clients' mobility, level of independence, and participation in their chosen occupations. One size does not fit all. Joint replacements, osteoarthritis, osteoporosis, CVA, Alzheimer's disease, Parkinson's disease, dementia, diabetes, heart failure, and hypertension can all influence the type, size, and fit of the wheelchair. Outcome of wheelchair fitting done by OTR Proper positioning, independence, prevention of skin breakdown, improved quality of life

Myth #1: Chronological age determines the way an elder acts and feels.

The way elders are perceived significantly affects the way they are treated. Stereotypes may affect the way you treat elders and the way they will respond to you. Treat elders as individuals within their own particular contexts, history, and circumstances.

Extending the splint borders beyond the crease will inhibit thumb opposition and palmar abduction

Thenar Crease

Thriving: a holistic lifespan theory

Three interacting factors Person Human environment Nonhuman environment Failure to thrive Sharp decline in physical health with no real physical or illness-related reason Critical elements of thriving Social connectedness Ability to find meaning in life Attachment to one's environment Adaptation to physical patterns Positive cognitive or affective function

This type of prehension is that in which the thumb pad makes contact with pads of the middle and index finger

Three jaw chuck or tripod

Ethical conflict action: What will I do professional boards

Three major bodies with jurisdiction over professional behavior: AOTA Ethics Commission Responsible for writing the profession's ethics standards and for imposing sanctions on AOTA members who do not comply National Board for Certification in Occupational Therapy (NBCOT) Responsible for certifying OTRs and COTAs Can permanently deny or revoke certification if necessary State licensing board

Internal Organization of the Human Being (Model of Human Occupation)

Three subsystems Volition Habituation (habits)

Other names for a thumb palmer abduction immobilization spllint

Thumb spica splint Short or long opponens splint thumb gauntlet splint

Erickson's theory of human development

Time Period Stage Early infancy Trust vs. distrust Later infancy Autonomy vs. shame and doubt Early childhood Initiative vs. guilt Childhood Industry vs. inferiority Adolescence Ego integrity vs. role confusion Early adulthood Intimacy vs. isolation Middle adulthood Generativity vs. stagnation Late adulthood Ego integrity vs. ego despair

Peck's stages of psychological development in the second half of life

Time Period Stage Middle age—1st Wisdom vs. physical powers Middle age—2nd Socializing vs. sexualizing Middle age—3rd Cathectic flexibility vs. impoverishment Old age—1st Ego differentiation vs. work-role preoccupation Old age—2nd Body transcendence vs. body preoccupation Old age—3rd Ego transcendence vs. ego preoccupation

Interviews include the following

Time client wakes and gets out of bed Morning activities Typical hygiene and dressing task Breakfast routine Work/leisure/home management Childcare Lunch Afternoon activities Rest Dinner Evening activities Leisure and social activities Preparation for retiring to bed Bedtime

Why Study Aging?

To clarify misperceptions of aging and elders To understand where the demographics in the United States are leading our profession To learn what is normal aging and what is not normal aging To learn strategies for working with older adults that lead them to optimal health

In the ____ approach, the therapist focuses on the client's occupational history and interest

Top- down

Cost-control strategies can create ethical challenges for practitioners.

Traditionally, services are based on clinical need. Increasingly financial constraints may impede care. Cost-driven practices may include "creative" documentation. Creative documentation refers to the practice of exaggerating a problem, altering a diagnosis, or implying better prognosis so more client visits can be approved. When fraud exists, such practices are also liable to legal inquiry and punishment. Informed consent hinges on respect for client autonomy and the practitioner's ability to effectively communicate potential outcomes. The higher the risk, the more thorough the informed consent process should be. Autonomy necessitates that they be allowed to accept or refuse the intervention. Respect for autonomy does not include offering interventions that are not clinically indicated.

Strategies in tertiary prevention

Treatment of a homebound elder who is experiencing limitations because of arthritis pain Providing education about self-care activities such as joint protection and energy conservation to prevent deterioration of arthritic joints

T/F Acidosis is consider a medical emergency

True

T/F Avoid using heat gun except to smooth edges

True

T/F Compensation may be helpful and wholesome if adjustment is personally and socially satisfying

True

T/F If motion is decreased because of joint limitation, the therapist should increase the frequency or time the person wears the splint

True

T/F It is normal to see veins on the dorsum of the hand

True

T/F OT practitioners must be careful not to think that they can replace others in the pts life

True

Bathroom modifications for Fall prevention

Tub or shower bench with armrests and back Handheld shower hose, grab bars Raised toilet Floor mats should have nonskid backing and be in good condition. Heat-sensitive safety valves should be installed to prevent scalding. Bedside commode Good handrails may need to be installed in showers, near toilets, and so on for balance.

Aging and Physical Illness

Unexpected illness is a catastrophic stressor. Unexpected illness can be debilitating in terms of independence and self-care. Chronic illness is no less stressful, but the elder may have adapted to the illness more gradually. Elders who view a physical illness as a challenge cope better than those who view it as a punishment.

Activity theory

Unless constrained by poor health or disability, elders have the same psychological and social needs as middle-aged persons. Theory excludes elders' physical well-being, past lifestyle, and personality attributes.

Myth #3: As you age, you naturally become older and wiser.

Unrealistic expectations of elders (good or bad) may cause the elder to feel like a failure. Forgetfulness or memory loss may occur. Intelligence does not decline with age; IQ scores increase until the late 20s and then level off and remain unchanged until late in life. Continued intellectual stimulation promotes successful aging.

Unskilled service examples

Use of heat as a "palliative and comfort measure" Routine assistance in dressing, eating, or going to the toilet Positioning in bed

Who is involved in ethical decision/problem solving

Usually the COTA Likely the COTA's client The client's family often needs to be involved in medical decision making. Family involvement may result in an ethical dilemma for the COTA.

Levels of Culture

Values and beliefs are shared at a variety of levels. Individual Sense of humor, personal space, coping style, role choices Family Economic factors, ethnicity, housing Community Language, geography, industry Region Shared with community and includes language, geography

Edema is caused by

Venous Thrombosis Subcutaneous fibrosis Lymphatic obstruction

Facilitating Growth and Development Model

Views the OT's role as one "concerned with facilitating or promoting optimal growth and development in all ages of man" (p. 88). Illness, disability, and trauma threaten an individual's growth and development. The COTA must understand: Developmental tasks and adaptive skills mastered at different ages Ways illness, disease, trauma, and disability threaten that development The environmental variables necessary to support the development and maintenance of adaptive skills

The special sensory system

Vision hearing smell taste balance

The highest level of hierarchy, _____, the ability to manipulate visual information mentally, understand the mental images, and integrate it with other sensory information, using all the skills described in the hierarchy

Visual Cognition

How clearly the human eye can discriminate detail and contrast- can be affected by nearsightedness, farsightedness, presbyopia, astigmatism, eye disease, trauma to eye, CNS dysfunction

Visual acuity

ensures that the visual information sent to the brain is sharp, clear, and accurate

Visual acuity

Fixating gaze on an image for as long as required and shifting to other objects as needed

Visual attention

Consists of shifting attention form one vision target to another in smooth succession so that the person continues to see the image clearly no matter how much the eyes move

Visual scanning

Scaphoid fracture

Volar forearm thumb immobilization splint

A fracture of the lower end of the humerus - this may result in a diminished supply of blood to the muscles of the forearm

Volkmann's Contracture

Medicare Part B

Voluntary benefit that is paid for by monthly premiums (beneficiaries pay 20% of their costs under Part B). Currently Part B coverage has a therapy cap. Cap is a set financial amount per year for all outpatient rehabilitation costs except hospital outpatient costs. AOTA is working to eliminate the cap.

According to the Bobaths normalization of muscle tone can be accomplished by using one or more of the following techniques

Weight bearing over the affected side Trunk rotation or diassociation of upper and lower trunk Scapular protraction Anterior pelvic tilt/forward positioning of pelvis Facilitation of slow controlled movements Proper positioning Incorporating the UE into activities

MOHO organizing questions

What skills, habits, and roles has this person lost or reduced as a result of this disability What is the person'a sense of personal causation What values and interest does the person have What is the person's social and object environment *Which interventions will assist in increasing the person's sense of personal causation and in putting the environment more within his or her control

Occupational alienation:

When people are unable to meet basic occupational needs or use their particular capacities because of intervening sociocultural factors

Ethical conflicts Action: Reporting healthcare professionals

When reporting other health care professionals, the state regulatory board should be contacted. State boards have the power to intervene if they determine the public to be at risk because of a practitioner's incompetence, lack of qualifications, or unlawful behavior. State boards can publicly reprimand a practitioner or may even prohibit someone from practicing in that state.

Padding placed in a splint to reduce pressure areas should be incorporated during this phase of the splint process

When the splint is being formed

Acts on feelings

Will go on "gut instinct"; will make a decision based on what feels right instead of facts These clients need to feel comfortable with the COTA before following therapy recommendations.

Acts on fact

Will want evidence to support the COTA's treatment recommendations Will want to know risks and benefits; will ask questions

Myth #4: Elders are not productive, especially at work.

Work assists in regulating life activities and providing meaningful life experiences associated with identity, financial security, status, and opportunities for socialization. Retirement changes this, and elders must find other activities to replace work life. Many seniors continue to work past age 65 years.

Hand Splinting became important aspect of physical rehab during

World War II

__________ should be strengthen to enhance natural tenodesis function

Wrist extensors

How free writing can be used for ethical reflection

Write for 10 minutes without stopping. Key is to suspend the usual breaks in writing and let uncensored thoughts pour onto the page. Technique is useful in uncovering deep moral and ethical feelings. Technique may reveal previously unrealized opinions or persuasive reasons for a stance.

Color classification of wounds

Yellow, Red Black

______ behavior can be productive in pursuing rehab goal

agressive

Perforations

allow air circulations reduce weight should NOT be stretched Cut pattern OUTSIDE of perforation holes

Dropout splint

allows motion in one direction while BLOCKing motion in another

Tensile strenght

amount of long axis force a muscle or tendon can withstand dictates activities and exercises

Complete loss of sensation

anethesia

The clients total inability to recognize deficits

anosognosia

The resting hand splint maintains the hand in

antideformity position

The framework can be applied to the care of

any person needing OT services.

The term usually refers to the area from shoulder to the elbow, or the hummorous

arm

Persons who require resting hand splint commonly have

arthritis

Chronic medical conditions that influence the ability to feed oneself include

arthritis, hypertension, heart disease, hearing impairment, mobility, diabetes, and visual impairments. Lack of assistance for financial support, shopping, cooking, and so on

Domain of concern:

assisting people to engage in everyday life activities that they find meaningful and purposeful

In the ____ stage of learning, the learner makes connections to previous experiences

associative

Group treatment allows persons with brain injuries to get feedback from their peers, which

can lead to increased self-awareness and problem solving in the real world, facilitating positive changes in their behavior.

Denial may be manifested by

cheerfulness and unrealistic lack of concern about the disabling condition

Medicare and Medicaid were enacted when

civil rights were a focus. The focus was reflected in government acts that passed around that time such as the Developmental Disabilities Act and the Vocational Rehabilitation Act.

Observations begins when a

client enters room

Within the OTPF cognition is classified under

client factors

The COTA can use Cognitive Disabilities model to describe

client performance and to guide selection of activities or tasks that permit the client to function consistently at the greatest possible level.

Hypertoncity is characterized by hyperactive deep tendon reflexes and ______

clonus (quick,repetitive, alternate contractions of the agonist and antagonist muscles)

The OT evaluation of the pt with AD establishes a baseline related to performance in areas of occupation in

cognitive motor sensory skills

An example of a complete task

combing hair

If pain sensation is absent or impaired, the client must learn sensory

compensations and safety awareness as part of the treatment program

In a ______ SCI total paralysis and loss of sensation result from interruption of the ascending and descending nerve tracts

complete

Palpation

completed after visual inspection -where symptoms are described-especially abnormal area Skin temperature changes

This type for force is a result of forces pressing inwardly on an object

compression

Pts with dependency , limits must be placed on regression and the staff must consistently express clear expectations for

cooperation and participation in the OT program

A person's ability to recite or reproduce information is generally taken as an indication of recall and is referred to as

declarative memory or explicit memory

Sustained contraction and posturing of both UE in flexion and both LE in extension

decorticate posturing

Brachial plexus injury have paralysis and atrophy occur in the

deltoid, brachialis, bicips and brachioradialis muscles

The person with an acquired disability may unconsciously______ its reality as a means of reducing its impact

deny

1 of FIM scale

dependent

When the pt is ____, energy is low and progress in rehabilitation is limited

depressed

Cognitive Disabilities Model- 6 cognitive levels

describe the way an individual relates matter, behavior, and mind demonstrated by his or her voluntary motor actions Level 1: greatest degree of impairment Level 6: normal performance

Remedial treatment or sensory reeducation is introduced after

desensitization treatment is complete

During the Active phase of SCI the pt can sit in a wheelchair ad should begin

developing upright tolerance

Dorsal wrist splints designed with standard strap configuration can be better tolerated by person who has ___ because of pressure distribution

edematous hands

PD benefits from learning strategies designed to increase

efficiency, safety and independence

These types of bandages have potential to apply high amounts of stress and may lead to constriction of the vascular and lymphatic system

elastic bandages

OBRA focuses on

elders' rights, quality of care, and quality of life in the nursing home setting.

Early control of edema is ideally achieved through

elevation, massage, compression and AROM

Clients who are able to recognize and discuss their mood swings and inappropriate behavior but may be unable to control them , this trait is called

emotional lability

Causalgia is exacerbated by

emotional stress

T/F Dependent persons are lazy

false- they are surrendering independent problem solving and looking for others to find a solution

Attention problems are worsened by

fatigue, depression, illness, disinterest and certain medications

Public policy develops from legislation at the

federal and state levels and represents society's values.

Sensation provides _____ to the brain

feedback

Anxiety may take the vague

feelings of tension and fears but also may manifest in physical signs of restlessness, increased perspiration, shallow and fast breathing, and pressured speech

Head, hands and ___ reach their adult size earliest

feet

Good trunk alignment and seating priority from the onset of SCI help prevent

fixed trunk and pelvic deformities such as kyphosis and scoliosis which also lead to skin problems

The _____ limb feels heavy when moved passively

flaccid

Low muscle tone

flaccidity

In clients who have a CVA and spinal cord injuries, _____ is usually present initially

flaccidity hypertonicity

Rolling and moving up and down the bed should be practiced with the bed in

flattened position

UE in a wheelchair should be positioned with shoulders in slight _____ and ______ rotation

flexion and external rotation

Rehabilitation approach

focuses on abilities rather than disabilities and facilitates returning person to maximal function using their capabilities

The hallmark of psycho-social development is the quest

for self- identity

The remedial approach , which focuses on restoring cognition to its

former level

A person with low C7 SCI or a person with paraplegia with intact UE musculature can perform a ___________

full depression weight shift off the arms or wheels of the wheel chair. Weight shifts should be performed every 30-60 minutes until skin tolerance is determined

Group programming for person with TBI is more successful if it is

functionally based

A typical sign of RA is the _______ (spindle-shaped) swelling in the PIP joints

fusiform

Frequently a hand based thumb immobilation splint is applied to a persons with ____, which involves the ulnar collateral ligament of the thumb MCP joint

gamekeeper's thumb

Challenging the client to apply skills from one task to another promotes

generalization

The OTA should demonstrate

genuineness, empathy, and concern for the patient as a unique human being

Strategies for impulsivity

giving disinfection slowly give directions in written form one step at time non distracting environment Verbal and tactile cues avoidance of repetitive task provide activities that involve choice use matter of fact approach positive reinforcement

Neuroma are managed by OTA with

graded sensory input such as tapping or vibration over the neuroma or TENS

in Peripheral nerve regeneration- the pt will be able to move the extremity first with _______ and then proceed to full ROM as strength increases. At this point graded exercises can begin

gravity eliminated

Smaller coverage areas provide for

greater movement

Limb synergies

gross pattern of limb flexion and extension that originate in primitive spinal cord patterns and primitive reflexes

The role of OT in the treatment of pt with AD varies according to the stage of the disease but aims to max I and provide

guidance and support to the family

The ____ are the sites most severely affected by RA

hand

Osteoarthritis of CMC joint of thumb

hand based thumb immobilization splint

Gamekeeper's thumb

hand-based thumb immobilization splint

Therapist must verify client's understanding of precautions

have client repeat instructions Role play with client Verify at each visit

Elastic tension dynamic splint

have self-adjusting or elastic components (wire, rubber bands, or springs)

Programmed aging

he genetic "clock" Cells may lose the ability to replicate. Segments of DNA become depleted with advancing age. 75% of variation in lifespan can be explained by nongenetic factors

Reciprocal patterns have a stabilizing effect on the

head, neck and trunk

This type of tissue can be negativity affected by mechanical stress, has decreased tensile strength and can be change the width of a scar based upon stress placed upon it

healing tissue

The primary role of the OT in Myasthenia gravis is to

help the pt regain muscle power and build activity tolerance or endurance. It is important that it does not cause fatigue

Dependency behavior symbolizes a

helpless attitude

The maintenance of painfree shoulder ROM is important with pt with

hemiplegia

This grasp uses only the fingers, and the thumb is often NOt used

hook grasp

Medicare Part A =

hospital insurance

What should you be observing

how they carry UE reciprocal arm swing Guarding postures Involuntary movemnt (tics or tremors) pt. answer a question pt follow direction pt have postural asymmetry skin color/texture changes joints -deformity/deviation

Diminished pain sensation

hypalgesia or hypoalgesia

Increased tactile sensitivity or hypersensitivity

hyperesthesia

decreased or dulled sensation or hyposensitivity

hypoesthesia

This process of thinking about possibilities without the use of concrete examples is referred to as ____ and is essential for problem solving and arguing

hypothetical deductive reasoning

Outwardly, a person's ____ is visible in his or her values, beliefs, interest, and commitments to work, and the social role he or she assumes such as daughter or parent

identity

Abstract thinkers deal with new information through ?

imagination.

Proper bed positioning begins

immediately when a pt is in the flaccid stage. Proper positioning promotes normal alignment and can decrease the influence of hyper-tonic muscles

Pt with MS should exercise

in the morning or after a nap or rest time

Dysphagia and Other Eating Incidences of swallowing, eating, and nutritional problems are

increasing as the elder population grows.

After survival of acute SCI, the primary goal of rehabilitation is

independence

7 on FIM scale

independent

UE strength assessment should be performed well after the

inflammatory phase of healing

If you are working with a pt who has a Volkmann's Contracture and the pt may notices a cold distal extremity with smooth, glossy or dusky appearance of the skin and if the OTA can not detcet a radial pulse- the OTA should

inform the physician immediately and the cast should be removed

The changing face of the health care economy demands

innovative and progressive responses from individuals. OTs and COTAs must be strong advocates for their profession and the clients that benefit from OT intervention by adjusting to change and adapting to new ways to deliver intervention.

Limited _____results in impulsive and unsafe behavior

insight

External continuity

interacting with familiar people. Using this theory, elders would be kept in their primary residences as long as possible.

Pain is assessd by

interview questions body diagram rating scale questionnaires

Ethical Reasoning

involves therapist values cost containment for pts payer source cost containment for therapist employer

Myasthenia gravis

is a disease of chemical transmission at the nerve-muscle synapse or neuromuscular junction. IT results in weakness of skeletal muscles and abnormal fatigue of voluntary muscles

The purpose of the thumb palmer abduction immobilization spllint

is immobilze, protect, rest and postition one or all of the thumb CMC, MCP, IP joints while allowing the other digits to be free

Visual perception

is the process by which information from vision receptors is integrated with information from other senses and interpreted by the brain

The health care industry has become fragmented. Current trend, especially for elders,

is toward comprehensive, cost-effective health care.

Potential

is written in assesment

The technique to assess or help to restore joint play is called

joint mobilization,

small passive involuntary movement must occur inside the joint at the joint surface, these movements are called

joint play or accessory or component motions

Diabetes is the leading cause of

kidney failure, nontraumatic lower extremity amputations, and new cases of blindness each year among U.S. adults aged 20-74 years.

A _____ is often used to help support the UEs on a level surface

lap tray

This the strongest pinch pattern is the contact between the thumb pad and the lateral aspect of the index finger

lateral prehension

For quadriplegia who has at least F (3) shoulder and elbow strength, _____ will relieve pressure on the buttocks

leaning forward over the feet

The OT may delegate some aspects of treatment planning to the OTA. However, the OT retains ____ and ____ responsibility for the plan and implentations

legal and supervisory

Depression often occurs with the realization of ____ imposed by the disability and may last a year or longer

limitations

When documenting crepitus

location motion caused sensation

Evidence strongly indicates that the individual's premorbid personality particularly a strong sense of ____ and social efficacy, may promote positive adjustment to physical disability

locus of control

RA

long forearm based thumb immobilizationn splint

Torque transmission splints may create motion of primary joints situated

longitudinally transversely p. 8 figure 1-2

Preferred position for lying in the bed- hemiplegia

lying on hemiplegia side back positioned parallel to the edge of the bed head placed on pillow avoid extreme flexion shoulder fully protected with at least 90 degrees of shoulder flexion forearm supinated and elbow flexed hand placed under the pillow

The Brunnstrom approach to the treatment of hemiplegia uses the

motor patterns available to the patient at any point in the recovery process. The goal is to allow progress through the stages of recovery. Brunnstrom sees synergies, reflexes and other abnormal movement patterns as normal part of the process through which an individual with CNS dysfunction must go before normal voluntary movemetn can occur

Brunnstrom Approach

movement therapy-hemiplegia based on the the theory that damaged CNS has undergone an evolution in reverse

Community mobility is defined by OTPF as

moving (oneself) in community and using private or public transportation

Manifestation of peripheral nerve injury is

muscle weakness flaccid paralysis-depending on the extent of the nerve damage because of loss of muscle innervation- atrophy will follow and deep tendons reflexes will be absent or depressed

Symptoms of PNI include

muscle weakness hyperesthesia hypoesthesia lack of sensation muscle atrophy loss of the ability to perspire changes in the quality of the skin and nails

Long-term strengthening or maintenance exercises for post-polio are recommended only for

muscles that show no EMG evidence of prior muscle involvement

Brachial plexus injury

nerve roots that innervate the UE originate in the anterior rami between C4- T1

Phantom limb pain is often the result of

neuroma formations

Sensorimotor approach use ______ mechanisms to normalize muscle tone and elicit more normal motor responses

neurophysiological mechanisms

A skilled clinicians relies heavily on structured and unstructured ____ of the client during interviews, evaluation, and treatment

observation

The framework is used by OTs as a way

of organizing and substantiating their work.

NDT

practitioners work on the restoration of normal movement patterns, through handling techniques and repetitive movement patterns

Consumers want simplified access to a range of services with

predictable costs.

Occupation is a _______________ to health.

prerequisite

The first signs of cutaneous sensation ( Peripheral nerve regeneration) will usually be gross recognition of crude

pain temperature pressure touch

Bilateral Symmetrical pattern

paired extremities perform like movements at the same time- ex: starting to take off pullover sweater, reaching to lift large item off high shelf.

Bilateral Asymmetrical patterns

paired extremities perform movement toward one side of the body at the same time...ex. putting on left earring-

abnormal sensation such as tingling or pins and needles

paresthesia

The sensations such as tingling, numbness and burning or pain, particularly at night

paresthesias

The denial of differences and attempts to conceal it are known as

passing

When muscles are flaccid, the resistance to _____ is diminished and the stretch reflex is dampened

passive movement

Person with________ require continual supervision for safety

persistent neglect

Bed mobility according to NDT pricincples

person rolls side to side putting the stronger leg under the weaker clasps hands bring the arm up to the shoulder height initiates roll

Insulin reaction can be caused by too much systemic insulin , the intake of too little food or sugar, or too much

physical activity

Poor body awareness and sensory processing difficulties include

poor kinesthesia (awareness of movement) proprioception ( awareness of muscles and joints) tactile awareness (feeling one's body)

The unconscious mechanism of _____ allows whats is unacceptable to the self be shifted onto others

projection

CVA Shoulder pain can be prevented through

proper positioning, PROM exercises, and education of client, staff and family on proper handling techniques

Medicare Part A Therapy is reimbursed under a

prospective payment system (PPS).

Resting hand splints are appropriate for

protecting tendons, joints, capsular and ligamentous structures

PROM for Guillian Barre should begin with gentle movement of the

proximal joints and should proceed only to the point of pain

Proper positioning for sitting hemiplegia

pt places both feet on the floor hips near 90 degrees of flexion knees and ankles at less than 90 degrees of flexion and trunk extended Head should be at mid-line and the arm affected fully supported when working at a table

Simple home modifications for PND

pt should be advised not to sit in deep, low chairs Preferred chair-firm cushions, straight back, and padded armrest-height to maintain feet on the floor, knees flexed at 90 degrees Kitchen- common items placed where bending and reaching are not required Fit walker with bicycle basket

To accomplish motion with shoulder ROM hemiplegia

pt sits erect, cradling the affected arm. The OTA supports the arm under the elbows while pt leans forward. The more a pt leans the greater the range shoulder flexion can be obtained. The OTA guides the arm gently and passively into flexion while pt attention is focused on the trunk motion. OTA guide the arms into abduction and adduction while pt rotates the trunk from side to side. Later, active-assistive movement of the arm in relation to the trunk can begin

Therapy in Sensorimotor approach is directed at incorporating these reflexes into ____ and at integrating them so that their power is reduced and movement becomes more controlled and voluntary

purposeful activities

For turning in bed for mobility the OTA should instruct the pt to

raise the affected arm to a position of forward shoulder flexion with elbow extension. The affected LE is then positioned in partial flexion at the knee and hip; the OTA may need to stabilize it in this position. The pt turns by swinging the arms and the affected knee across the body toward the unaffected side

To obtain a true measure of learning and skill retention, the therapist must assess performance later, outside of the intervention sessions and in as

realistic setting as possible

Never argue or debate with someone who is confused or disoriented. You can not win, and frustration will ensue. Instead,

redirect attention to another topic that is less distressing

The learner needs to understand why the activity is to be done and how it

relates to recovery and resumption of important life activities

To help with causalgia the OTA can instruct the pt in

relaxation techniques such as deep breathing, progressive relaxation and visualization

The purpose of _______________for sensory loss is to promote recovery of sensation using first preparatory methods, then purposeful activity and then progression to occupation-based activity

remedial treatment

alternative communication

replace

Serial Static Splinting

requires the remolding of static splint holds the joint or series of joints at the limit of tolerable range-thus promoting tissue remolding

Elasticity

resistance to stretch is helpful when working with high tone or multiple areas too little elasticity can stretch too easily and become too thin

Material that have a high degree___ of are strong and resistant to repeated stress

rigidity

Intervention may focus on establishing _____ to enable successful participation in daily tasks

routines

Therapy for sensory dysfunction aims to increase the client's vigilance about

safety issues

Full mobility of the _____, _____, ______ is required for pain free shoulder motion

scapula, clavicle and humerus

Splint design must be based on

scientific principles

Because this is a useful coping skill, assertive behavior and _____ should be encouraged

self-advocacy

The main FIM evaluation measures

self-care, tolieting, mobility, locomotion, communication and social cognition

For person with new disabilities cooperation and participation in the OT program, comparisons of their bodies with those of others may lead to

self-denigration

One dimension of cognition in the AOTA's practice framework is

self-regulation, the ability to control and monitor one's behavior and emotions relative to the situation and social cues

Pt tend to retain personal information longest and forget

situational information first

Generally , ___ is the tissue that least tolerates pressure

skin

Low stress, high stress and repetitive stress can all cause this injury

skin breakdown

Wet, white, macerated skin can occur when the skin under a splint holds too much moisture

skin maceration

Cell body regrowth is

slow- 8mm per day

The 2 essential characteristics of the successful interview are

solid knowledge active listening

This grasp requires an object rest against the palm of the hand and abducted five digits flex around the object

spherical grasp

Direction classification are applicable to articular

splints only

Volar thumb immobilization splint

sprains joint dislocations ligament injuries scaphoid fractures

The hand based immobilization splints provide _____ for the thumb while allowing for wrist mobility

stabilization

The treatment for injuries involving the long thoratic nerve usually involves

stabilizing the shoulder girdle to limit scapula motion- The OTA must avoid activities that promote shoulder movement

The critical task of adolescence is achieving

stable, multidimensional self-identity

Occupational Deprivation-

state in which a client is unable to engage in meaningful occupation due to factors OUTSIDE his or her control.

Sensory recovery is a slow process that may

stop at any time

For SCI pts- AROM and AAROM of all joints should be performed within

strength, ability and tolerance levels

To change this superior -inferior pattern, the OT practitioner must shed the role of ___ and ___ figure to engage authentically with patients as an equal and to assume the role of facilitator and guide

teacher and authority

Convictions of superiority are reinforced by the emergence of a

teacher-student relationship, a superior-inferior pattern

Performance capacity

the ability for doing things

Ideally the OT practitioner should evaluate ADL performance when and where

the client usually performs the activities

Develop intervention according

to resident needs relative to complexity and intensity of required intervention. Intervention plans should be based on function and must integrate the plan of care. Intervention should be reinforced by other disciplines, such as skilled nursing. Resident's prior level of function, mobility, and safety in addition to self-care deficits must be reflected in assessments.

ADL skills for independence

toileting transfers alternative plans for rest periods telephone or special call system for emergencies

Infants, toddles, and people with _____ tone may require assistance of caregiver or additonal rehab personanel for splint fabrication

tone

Helpful tactile and kinesthetic modes of instruction include

touching body parts to be moved, dressed, bathed or positioned passively moving the part through the desired gently guiding the part manually through the task

The under lying assumption is that the brain can reorganize itself and new learning can take place

transfer of training approach

T/F Exercise may not be consistently beneficial for postpolio because it may aggravate pain

true

T/F Physicians usually recommend that clients with visual field cuts cease driving

true

T/F Reheating and adjusting in 1 spot in a splint often affects other areas

true

T/F Restrict the least amount of joints possible while still accomplishing purpose

true

T/F well fitting splint/strapping can reduce edema quickly

true

t/F Tenderness/pain/firmness along vein should be documented

true

Bilateral asymmetrical patterns facilitate

trunk control and can be performed with arms in contact or not

PPS rates are based on anticipated resource

usage; rates are fixed

Diagnostic Related Groups (DRGs)

used in inpatient hospitals

Resource Utilization Groups (RUGs)

used in skilled nursing facilities

Sensorimotor approach

used to inhibit or facilitate normal motor responses whose central nervous system has been damaged

Proprioceptive Neuromuscular facilitation

uses a multisensory approach in which mass patterns of movement, usually performed in diagonals, help strengthened weak components of movement Based on normal movement and development Facilitation are super-imposed on these movement patterns and postures through manual contacts, verbal commands and visual cues

Bio-mechanical Approach

uses kinetics and forces acting on a body

Pts with spatial relations problems may learn routes in their environment by

using the same route each time and taking notice of signs to mark the way ex: recognize family member by voice not vision Labeling family photos Labeling clothes

A pt with PD should use an PT for gait training, but an OTA may supplement this training by

using verbal cues to remind the pt to stand erect, lift the feet and follow prescribed gait pattern. Bed mobility skills, transfer training, and wheelchair mobility skills should be taught by OTA if indicated

Drapability

varies among material as well as time heated Gravity Difficult for beginners require light, stroking motions low drapability-firm pressure

Splint Instructions

verbal and written phone in case of emergencies cleaning instructions precautions directions on how to handle pressure point/pain ask about wear at each visit

Persons with mild neglect can learn strategies such as

verbally cuing themselves to attend to the affected side or wearing a watch on that side

Understanding and using visual information require vision and

visual perception

The Medicare Act,

which resulted in a national health insurance plan for elders, was enacted in 1965.

Conditional reasoning

whole condition persons life before condition happen possible future life social and physical environment realizes success/failures depends on pts cooperation

When the client practices the entire task at one time he/she is performing

whole learning

Patients must be regarded as

whole person

Avoid treating elders like children

—they are not.