OTS3 Chapter 32(Degenerative Diseases) & Chapter 27(Bariatric Factors) &tidbits

1) thalamotomy 2) pallidotomy 3) deep brain stimulation

3 surgical procedures that may be performed on clients with PD:

U-step brand walker

A ____ has a laser light that shines on the ground to give the client who frequently "freezes" something to step over to restart ambulation. This walker type also has the brakes always locked, and the client squeezes the brakes to make the walker intentionally move. (this is safer than a standard rollator walker bc the combination of small steps and stooped posture means that the rollator or rolling walker can get away from the client.)

malabsorptive

A ____ operation does not limit food intake, but bypasses the intestines. By avoiding the intestines, the surgery allows for less caloric absorption and increased weight loss. However, one must be mindful that this also limits absorption of nutrients as well.

large-handled utensil; straw with a lid

A _____ may keep the spoon or fork more securely in the hand during self-feeding, and a _____ will help keep a drink from spilling due to movement challenges.

bariatric stand assist lift

A ______ allows the caregiver to safely lift and transfer the client from one seated surface to another with minimal physical effort.

sundowning (fun fact it is found to not be as much about the sun going down, but is more about brain fatigue)

A common effect from the symptoms that occur in the mid to late stages of dementia is called ____, characterized by increased anxiety, agitation, confusion, disorientation, and is generally seen later in the day.

1) performing only submaximal resistive exercise, with a focus on lighter weights, versus heavy weights 2) aerobic exercise, such as swimming, walking, or biking (good for heart health, general fitness, and ROM) **generally aerobic exercise is to tolerance, the exercise should not tire the clients to the point where functionality or balance is compromised or they risk a fall due to fatigue. ***fatigue can be a major problem for clients with ALS

A general guideline for exercise early in the ALS disease process would include:

decreasing pain and increasing ROM in a sore shoulder

A patient with ALS might go to an outpatient clinic to work on:

significant discrimination (Workers who were obese were considered to be less suitable for employment.)

A study from 2015 looked at the hiring and employment practices in relation to the obese and found _____ of this population.

1) perform in a seated position with UEs supported on counter (if possible) 2) client should utilize an electric razor and toothbrush, unless he or she uses oxygen

A technique for energy conservation while performing grooming activities would be to:

(Vbloc) Vagal nerve block

A type of RGB operation in which a rechargable neuroregulator device is implanted under the skin. Flexible leads are placed around the vagus nerve that intermittently blocks signals, reducing hunger and increasing feelings of fullness. side effects: complaints are rare, but do include tingling of the throat, pain, heartburn, nausea, difficulty swallowing, belching, and/or abdominal cramping

Gastric balloon

A type of RGB operation in which either one or two balloons are inserted into the stomach to cause the client to feel full sooner and eat less food. The balloons are usually left in for 6 months to jumpstart a weight-loss program.

Gastric bypass

A type of RGB operation which is the most common bariatric procedure performed. The procedure takes the top portion of the stomach, creates a small pouch, then attaches it directly to the small intestine. side effects: gallstones, kidney stones, hypoglycemia, diarrhea, anemia, dumping syndrome, nutritional deficiencies

•2 week goals •See simple goals •Work closely w/ caregivers •Recognize pt will likely be d/c'd to some form of rehab (inpt, subacute)

ACUTE CARE P. 973:

dyspnea (SOB) or orthopnea (SOB while lying flat)

ALS clients may have difficulty with _____ or ______ which will require the use of respiratory support to sleep and eventually to use full time as well.

1) bilevel positive airway pressure (BiPAP); 2) volume ventilation with a mask (BiPAP-like settings on a ventilator) 3) nasal pillows (interface that covers only the nostrils) 4) ventilator with tracheostomy

ALS clients with respiratory weakness usually use __(1)__, __(2)__, or __(3)___, and some later in the progression also choose to get a __(4)___ (a surgically created hole in the trachea with a tube connecting it to a ventilator to provide alternate method for breathing.)

hypermetabolic

ALS is known to be _____ (increased metabolism and speed of processing food) in most people, and so maintaining a high-calorie diet can be important as well. When combined with decreased ability to self-feed due to arm or hand weakness and slow or poor swallow, it can be difficult to consume enough calories; clients often lose weight quickly.

1) External fixators 2) Lines, tubes and drains 3) Meds: Sedative (calm and increase comfort); Analgesics (pain mgt); Vasopressors (manage low BP)

ATTACHMENTS:

lists, medication reminders, and a call bell

Adaptation for cognitive and memory tasks is often needed such as:

the medical benefit would outweigh the side effects of the medication

Although there are weight-loss medications, they should only be used by clients who present with an increased medical risk from the obesity and are under the care of a physician because of their side effects. The assumption is that:

extra wide walker (Weight limit is 400 lbs)

An ____ can be utilized for standing transfers.

3

An acute patient typically transferred to inpatient if the patient can tolerate ___ hours of therapy per day.

"EC"

Assistive devices, transfer equipment, and mat tables have weight limits. Specialized equipment for the bariatric client is often labeled _____.

biomechanical

At times with relapsing/remitting MS, the client can improve after the relapse to close to the PLOF, and the OTP may use a _____ model instead of focusing strictly compensatory methods. Generally with primary and secondary progressive MS, once the strength is lost due to steady disease progression, it cannot be regained.

600 lbs

Bariatric stand assist lifts have weight limits up to ____ pounds, however the OTA must also be aware of girth limits.

bariatric= up to 600 lbs standard= 250-300 lbs

Bariatric transfer boards have weight limits up to _____ pounds, while standard transfer boards can hold _____ pounds, depending on the brand.

family members and friends can inadvertently become food "enablers" to the obese client by providing nonhealthy foods, encouraging unhealthy eating, and offering comfort verbal responses ("You look fine the way you are!")

Behavioral strategies provide techniques to help the client comply with the new diet and physical activity. This is a very important part of the treatment not only for the client but for the family and friends. Why is this?

not only "pushes" the air, but "pulls" it as well

BiPAP differs from a continuous positive airway pressure (CPAP) machine used for sleep apnea in that the BiPAP device:

AD

Bright light therapy is most useful for which diagnoses?

moderate stage

"freezing" episodes happen with mild, moderate, or severe PD?

•Compartment syndrome- connective tissues "compartments" cannot handle swelling and it causes circulation/oxygenation issues •Fat embolism syndrome- fat enters blood stream and creates emboli

COMPLICATIONS:

1. Hypothyroidism (under active thyroid with decreased metabolism, weakness, and feeling tired) 2. Cushing's syndrome (the body's adrenal glands make too much of the hormone cortisol) 3. Polycystic ovary syndrome (PCOS) (affects about 5-10% of women of child bearing age and 40-80% are overweight or obese)

Certain hormone problems that can cause obesity and are not necessarily linked to overeating are:

autoregulate

Clients in moderate to advanced stages of dementia cannot _____ body temperatures, so make sure they are wearing multiple layers of clothing, such as a thermal undershirt, shirt, and sweater to maintain body heat. Pay attention to temperature, noise level, and lighting in the environment.

1) maceration within the skin folds that can develop a fissure (narrow opening or slit in the skin) 2) intertrigo (yeast infection within skin folds) 3) dermatitis (inflammation of the skin) 4) pressure injuries **It is very important to assist and educate clients who are obese in hygiene and moisture management.

Clients who are obese may experience what as related to skin integrity?

1) catheter tubing placement 2) take precautions with the use of bedpans 3) monitor ill-fitting seating devices as prolonged pressure can initiate skin breakdown 4) educate the client to be aware of these risks and consistently monitor for excessive redness and skin breakdown

Clients who are wheelchair users or bed-bound can present with decreased sensation and may become unaware of lines and tubes under their bodies and in their skin folds. Therefore, the OTA must be aware of:

consistent daily routine incorporating the use of lists, calendars, and notes

Clients with HD need a ______ to assist with organization.

initiation

Clients with HD often lack ______, therefore caregivers who are helping the client during the midstage of the disease may suggest a task or activity and offer help to get started, as well as make lists for daily hygiene tasks. The caregiver may also want to pair items, such as a shirt and pants that match, for easier dressing.

BIG

Clients with PD tend to make smaller and smaller movements with walking and writing, as well as quieter/faster sounds with less mouth movement when speaking. ______ focuses on making larger movements, as well as balance and motor control, and is often run by OTPs or physical therapists.

1) increased tone and spasticity 2) increased reflexes 3) decreased balance/movement

Clients with primary lateral sclerosis or upper motor predominant ALS have increased/decreased ______ as their first symptoms?

1) weakness 2) low tone 3) atrophy 4) decreased reflexes

Clients with progressive muscular atrophy or lower motor predominant ALS have________ in all affected muscle groups.

speech and recognize loved ones

Cognitive impairments can be a significant issue, but most patients with HD will understand _____ and recognize _____.

pneumonia, heart disease, and physical injuries from falls

Complications of HD including _____, ______, and ______ reduce life expectancy to around 20 years from the point when symptoms begin.

1) genetics 2) lifestyle 3) emotions 4) lack of sleep 5) meds 6) age 7) medical conditions

Contributing factors that may lead to obesity: (Despite the stigma of obesity, overeating is not its only cause)

feeding tube

Decreased safe swallowing means a ___ will be recommended for most ALS clients at some point. Initially, clients will have difficulty with dry or crunchy type food consistencies as well as thin liquids.

2 or more injuries to physical regions or organ systems- 1 which may be life threatening... resulting in disability

Definition of polytrauma

supine position or a slight trendelenburg position (supine with feet higher than the head)

Depending on the severity of the panniculus and the client's respiratory status, have the client lie in the ____ position or a ____ position to assist with positioning the panniculus in reverse position. Doing this not only allows for thorough cleaning of the area beneath the panniculus, but also provides pressure relief.

exercise programs

Despite often unpredictable course of MS, ____ designed to increase cardiorespiratory fitness, muscle strength, and mobility provide benefits that improve a client's QOL while reducing the risk for secondary disorders such as pain and balance issues.

education on the types and the amount of food that would benefit the client's nutritional balance and weight-loss goals

Dietary treatment for obesity consists of:

No, because you can't push the fat out of the leg like you can push the lymph or swelling out. (Also, the condition is very painful and the LEs bruise easily, so pressure needs to be light.)

Does lipidema treatment include the use of pressure wraps?

fabric softener (This is important if they are relying on a terry cloth robe to assist with drying for energy conservation.)

Educate clients that utilizing ____ when washing clothes can decrease the ability of a towel or robe to absorb moisture.

as long as balance is functional enough to avoid falls, the client does not "overdo it", and potential cardiac issues are monitored (therapy and exercise are typically to prevent loss of function for as long as possible and to learn to compensate for changes in strength, balance, and coordination)

Exercise is considered a possibility for the client with HD in the early stages, as long as:

muscle group is at least 3+/5; the focus of the exercise is on: endurance, balance, and light-resistance, instead of the "feel the burn" expected with maximal effort

Exercise studies, particularly related to the correct amount of exercise that clients with ALS should perform at the various stages of weakness, are ongoing. The current exercise standard at most ALS clinics is that exercise is acceptable when the muscle group is at least ______; the focus of the exercise is on:

· Procedures are considered "cosmetic" so insurance doesn't cover it · DME more expensive · Clothing costs more · Home barriers · Chair lift and w/c more expensive · Community mobility- may not be able to drive car

Financial costs of weight loss:

positioning in bed and the w/c

For clients with advanced PD, _____ are important as the body grows more rigid and less control is evident. Padding pressure points is important to avoid pressure injuries, and ROM and stretching are needed daily as well.

regular exercise

For clients with mild PD, ____ improves and maintains mobility, flexibility, ROM, and balance, and can assist with maintaining the ability to perform functional tasks.

1) to increase dopamine production 2) to adjust the excitatory or inhibitory pathways of the brain 3) to use growth hormones to slow progression or even reverse the disease process

Gene-modifying therapy has three approaches:

immune; CD4

HIV attacks the ___ system, but it is NOT an autoimmune disease. It is a virus that attacks ____ cells.

1) organizing kitchen cabinets 2) preparing and packaging proper-portion meals (set by a dietary team) ahead of time 3) educating and assisting with organizing shopping lists and maintaining food diary logs

How can the OTA assist the obese client in dietary treatment?

educate and assist the client in keeping a daily journal for a set period of time (have clients record when they get the urge to eat, specifically, what is happening at that particular time, their mood, what they consumed, and how they felt after consumption.)

How can the OTA assist the obese client with their psychological and emotional needs?

24 hours a day (and the client may or may not be able to speak or swallow once receiving it)

How often would ventilation with a tracheostomy be worn if an ALS patient chose that option?

the moisture and the constant pressure to the area

Hygiene under the panniculus is a very important area to address due to:

1) putting deadbolts on the door high and out of reach 2) put a stop sign on the door that clients attempt to exit from 3) put a familiar restroom sign on the bathroom door, and leave the light on so that the client can locate the bathroom 4) consider alarm mats or alarmed doors or windows 5) consider registering the person with the national alzheimer's association wandering prevention program called Medic Alert/Safe return

Ideas to help keep the client safe by making the environment secure:

in a kind but firm demeanor, either redirect attention to another task, calmly state that the behavior is not appropriate, or leave the room and return at another time

If inappropriate remarks occur what should you do?

before

If possible, it is better to make accommodations ___ arrival of the client at the facility or home from the hospital to allow time to obtain the proper equipment, training, and setup.

primary lateral sclerosis (which is slower progressing) or upper motor predominant ALS

If the ALS client presents with primarily upper motor neuron signs at the time of the diagnosis, the condition can be called _____.

thalamotomy

In ___, the goal of the surgery is to permanently end tremors or other involuntary movement by placing a small lesion in the thalamus. Clients who receive the most benefit from this are usually younger adults with PD with tremors predominantly, and one-sided (or mainly one-sided) symptoms. However, the effects of this procedure on the other main symptoms of PD are much less predictable and may in some cases cause worsening of bradykinesia.

pallidotomy

In ____, the goal is to "abolish drug-induced dyskinesias, tremor, rigidity, and bradykinesia by placing a lesion in the ventral posterior globus pallidus. Only clients with treatment-resistant PD that has clearly responded to dopamine replacement therapy in the past would be considered candidates for this procedure.

car hits object, body hits protective equipment, internal organs hit body walls, debris hits body

In a MVC (Motor Vehicle Collision) there are 4 collisions that can happen:

touch

In addition to the sense of smell, the sense of ____ should be considered also. Individuals may accept a weighted baby doll, stuffed animal, or a fidget quilt (a quilt with items sewn on for touching such as buttons, keys, or ribbons), and the OTA may find that signs of restlessness or agitation decrease with these objects.

fabricate orthotics and perform PROM (the orthosis will need to be padded to maintain ROM without compromising skin integrity.)

In late stage HD, the OTA may ______ and ________ to avoid contractures, as well as education and training for the caregivers to perform PROM.

the inability to roll, position, and transfer the client who is obese due to lack of physical assist, lack of appropriate equipment, and lack of knowledge on techniques (this is why education is important)

In most settings, what is the common complaint from caregivers of obese clients?

mid stage

In this stage of HD, clients will have difficulty driving (motor as well as cognitive) and managing work and household tasks.

Moderate stage of PD

Increased issues with Tremors (liftware steady, weighted utensils) • AE • U-step laser for pts who "freeze" - something to step over • Due to stooped posture - rollator walkers can get away from the patient

No, there is only symptom management.

Is there a cure for HD?

dietician

It is beneficial for the obese client to meet with a _____ for education and counseling on the amount of caloric intake and types of foods that would be appropriate for the client's needs.

increase awareness and possibly assist with recognizing the triggers to overeating

Keeping a journal can:

•Initial inventory (make list when see pt for first time) •Maintain placements in relation to client •Q - What is connected that cannot be moved •Some tubing may limit distance pt can move •Electrical monitoring may not be able to be unplugged- or nurse may be able to detach from outlet •Do you have enough hands to manage everything-need assistance? •Lines etc. may be taped to pt's body or attached to IV pole

LINE AND TUBE MGT

voluntary

Late stage HD clients generally have the greatest difficulty with _____ movements, and often experience rigidity (tightness of muscles on both sides of the joint), dystonia (muscle contractions that cause slow repetitive movements or abnormal postures), and bradykinesia (slowness of movement).

usually affects the hips, buttocks and thighs; seldom involves the feet

Lipedema usually affects the ________, but seldom involves the _____.

Pitting edema

Lymphedema can initially appear as ____ (a soft swollen area that leaves an indentation after gentle pressure is applied and released).

1. Relapsing-remitting 2. Secondary progressive 3. Primary progressive (PPMS) 4. Progressive relapsing

MS is separated into four types, and clients may move between types as the disease progresses over the years. What are the four types?

loan closet; seating clinic

Many ALS Association (ALSA) and Muscular Dystrophy Association (MDA) clinics have access to a _____, which can assist the OTA from any setting (not necessarily associated with the clinic) to provide equipment, such as bedside commode or shower seat, as required for a client with ALS. The OTA should also refer the client to a ____ for a specialized power wheelchair with flexibility in features that will meet the client's long-term needs.

cramping and fasciculations (muscle twitching)

Many ALS clients have ______, especially when the muscle is overtired or overworked.

coping strategy

Many clients who are obese use food as a defense mechanism to deflect unwanted feelings, and food can become a ____ over time. It is important to assist the client in recognizing the root problem that has brought on the condition and to assist in the method for dealing with this problem.

Many clients will receive a volume ventilator instead of a BiPAP that has settings for use with a mask, and can easily transition with tracheostomy as well.

Many clients with ALS will receive which of the devices to help with the respiratory weakness?

physicians and caregivers

Many clients with HD have difficulty thinking and communicating clearly, so decisions about end-of-life care often fall to ______ unless there are specific advanced directives already established. (advanced directives are legal documents that note who is in charge of medical decision making if the client is unable (power of attorney) as well as what treatments are desired at the end of life (living will))

cooling vest

Many clients with MS are sensitive to overheating and require a ____ or other ways to stay cool in the heat, as heat can cause an exacerbation or relapse.

Antiretroviral Therapy (ART)

Many patients with HIV go on _____ which slows the progression of the HIV disease. There are about 25 different medications that they can use to help protect the immune system. Physicians try to individualize ART cocktail to help each patient individually. Many side effects of medications (p. 771)

tracheostomy

Many surgeons will not perform the feeding tube procedure when breathing status is too low, unless performing the _____ at the same time, as there is a risk for difficulty with removal from surgical ventilator support. This means that some clients will get the feeding tube when respiration is beginning to change, but swallowing may not yet be compromised, especially bc ALS has a known course.

100# or more overweight

Morbidly obese is defined as:

sedentary

Most clients who are obese present with pain and sensitivity as well as proprioception issues. Excessive pain and sensitivity can also contribute to an increase in a ____ lifestyle.

mild stage; LSVT BIG and LSVT LOUD

Most people do not need or seek OT treatment in what stage of PD? However, programs called ____ and _____ exist that work to increase clients' motor control, fluidity, and strength with both movement and speech.

1. Physical Activity 2. Dietary Treatment 3. Behavioral Strategies 4. Pharmacological 5. Surgery

Multiple treatment strategies are available that should be considered when working with a client who is obese, including:

1) Sepsis (infection) 2) Systemic Inflammatory Response Syndrome (SIRS) (Inflammatory state affecting the whole body) (Sepsis one common cause) 3) Critical illness polyneuropathy (CIP) & Critical illness myopathy (CIM) (Disorder of nerves and muscles from prolonged ICU stay, mechanical ventilation)(~50% full recovery- can lead to long term disability or death)

NONTRAUMAT CRITICAL ILLNESSES:

dance

Numerous studies have noted that clients have shown improvements following the initiation of ____ therapy. These improvements from this therapy were seen in balance-- especially moving backward, position and awareness of self in space, rising from a chair, 6 minute walk test, and other formalized tests.

Very possible to have OT referral for client with HIV in multiple settings An assessment for HIV is the Pizzi Assessment of Productive Living for Adults with HIV Infection and AIDS (PAPL): this is specifically for people with AIDS

OT Services for HIV:

1) increasing ROM to avoid pain and contractures 2) using adaptive equipment 3) educating the client and family how to perform safe transfers 4) maintaining strength

OT goals for ALS may focus on:

suggest counseling and/or support group; encourage staying active

OT treatment for MS symptom of emotional changes:

education and training for energy conservation, work simplification, sitting to cook, and sitting to complete dressing and grooming; support to change routines to avoid fatigue

OT treatment for MS symptom of fatigue:

suggest working with a neuro-ophthalmologist for vision or OTP specializing in vision rehab; adapt for changes in acuity (e.g. with magnifiers)

OT treatment for MS symptom of visual changes:

encourage submaximal strenghtening exercises if in an exacerbation/remission cycle; encourage use of AE and compensatory techniques

OT treatment for MS symptom of weakness:

adapting ADL and IADL for performance skills, accommodating for strength, balance, pain, and safety issues, as well as cognitive/visual management, all resulting from the relapse or progression.

OT treatment for MS will depend on specific symptoms seen, but often focuses on:

1) depression 2) eating disorders 3) poor body image 4) low self-esteem 5) hopelessness 6) guilt 7) social isolation 8) boredom 9) anger 10) sexual dysfunction 11) feelings of worthlessness

Obesity, whether primary cause or secondary, can trigger emotional responses, which include: Emotional · Depression, low self-esteem etc. · Coping mechanisms ´ Problem solving ´ Relaxation techniques ´ Physical activities (walking) ´ Hobbies ´ Support group · Counseling

skin breakdown

One goal of late stage HD is to avoid ____ by padding body parts in both the wheelchair and in the bed. Specialized w/c seating will be required for the client through a seating clinic.

•TBI •Pneumothorax (collapsed lung due to puncture wound breaking vacuum with pleural wall) •Hemothorax- blood between lungs and chest wall •Pneumohemothorax •Chest injury •Pericardial tamponade- blood trapped in pericardial sac (creates pressure on heart) •ARDS (Acute Respiratory Distress Syndrome) •Internal organ injuries •Superficial injuries •SCI •Nerve injuries

POLYTRAUMA-RELATED DIAGNOSES:

quad avoidance (quadriceps avoidance)

People who are obese tend to compensate for the joint issues when walking. Overtime, the OTA will likely notice the client walking with "stiff legs" which is called ____, with very little, if any, bend at the knee. This limits the amount of quadriceps control of the knee flexion and creates an increased amount of impact shock through the joint, which leads to damage in the joint.

poor coordination, poor balance, ataxia (lack of coordination), chorea (rapid jerky movements), decreased stamina and endurance, and dyspraxia (inability to link thought to movement)

Physical difficulty that some pts with HD may show:

1) avoid overheating which can occur both indoors and outdoors 2) perform only submaximal resistive exercise with focus on lighter weights vs heavy weights 3) aerobic exercises to tolerance 4) fatigue can be a major problem 5) avoid long hot showers (overheating)

Precautions for MS:

placing the feeding tube before the person looses excessive weight, is struggling to eat/drink, or is compromised in respiratory status

Proactive care for ALS means:

1) Negative changes in body 2) Bone demineralization 3) Tissue atrophy 4) Electrolyte and fluid imbalance

Prolonged Immobility results in:

15-24

RESEARCH ON ACTIVITIES LEADING TO INJURY: ___ years old is usually injured due to sporting activities.

>65

RESEARCH ON ACTIVITIES LEADING TO INJURY: ____ years old is usually injured due to "other"- (you can fall doing just about anything).

25-64

RESEARCH ON ACTIVITIES LEADING TO INJURY: ____ years old is usually injured due to job related activities.

<15

RESEARCH ON ACTIVITIES LEADING TO INJURY: ____ years old is usually injured due to leisure activities.

a few days to weeks or months

Relapses, also known as exacerbations or flare-ups, are periods of new or worsening symptoms of MS that generally last how long? For some clients, the remissions (improvement) mean they go back to their prior level, and others do not regain full function.

stem cell implantation; gene-modifying therapy

Researchers are looking at ____ being a possible treatment technique for PD, which are in clinical trials in humans with PD. Another one is _____.

early stage (Clients will have difficulty learning and retaining motor memories.)

Retraining a client to perform a safe transfer technique or bathing program may not be retained without cues in what stage of HD?

1) chin tuck 2) small bites and sips 3) thickening liquids 4) avoiding problem foods that can cause choking

Safe swallowing strategies include:

refer the client to a seating clinic for full eval and management

Since many insurances require 5-7 years from the purchased mobility device until they will pay for a new one, the OTA should:

encourage the client to quietly count out loud when performing tasks, which ensures proper air exchange.

Some clients hold their breath when performing difficult tasks, leading so increased SOB. What should the OTA do?

bath towel

Some clients utilize a ____ rather than a wash cloth to bathe the area under the panniculus due to its size and location. Utilizing this enables the client to hold both ends of the towel to control cleaning movements and reach the area more thoroughly.

· Heart Disease · Diabetes · Respiratory · DVT · Pulmonary embolism · lymphedema/lipedema · Skin breakdown

Some complications associated with obesity:

1) place the transfer board in a pillowcase to prevent skin-to-board contact 2) use a draw sheet or pad as a barrier between the skin and the board 3) have the client wear lower body clothing 4) clients with increased UB strength can perform modified push up scoots across the board

Some methods to assist with reduction of shearing include:

moving in the water or walking

Some obese clients may start with ____ to begin to increase their endurance in a gentle way.

symptoms cause the client to become w/c bound or bedridden, unless assisted

Stage five of the 5 stage Hoehn and Yahr scale for the staging of Parkinson's Disease is where symptoms cause what?

symptoms cause severe disability, but clients can still walk or stand without assistance.

Stage four of the 5 stage Hoehn and Yahr scale for the staging of Parkinson's Disease is where symptoms are what?

only one side of the body

Stage one of the 5 stage Hoehn and Yahr scale for the staging of Parkinson's Disease is where symptoms affect what?

symptoms are mild to moderate and balance in impaired, but the person can still function independently

Stage three of the 5 stage Hoehn and Yahr scale for the staging of Parkinson's Disease is where symptoms affect what?

symptoms begin affecting both sides of the body, but balance is still intact

Stage two of the 5 stage Hoehn and Yahr scale for the staging of Parkinson's Disease is where symptoms affect what?

Self Government Healthcare Employment Community Restrictions on travel, entry, or stay

Stigmatization of HIV:

exercise

Studies of people living with MS have shown that ___ can help combat fatigue and depression, improve strength, and result in increased participation in social activities.

morbidly obese who have tried other methods of weight loss, have failed, and present with comorbid conditions

Surgery is usually reserved for:

False, numerous drugs are available to slow the progression, prevent or reduce the severity of relapses, and decrease the severity of its symptoms, but there is no drug that cures MS.

T/F A drug does exist that cures MS.

False; it is considered a fatal disease. (It is also a rapidly progressing disease.)

T/F ALS is not seen as a fatal disease, as proactive treatment can prevent it from worsening.

False; many times a client will not have a need for long-term therapy, but simply a short round of education and training, adaptation, safety, ROM exercises, and functional management for occupational performance.

T/F ALS patients will need long-term ongoing therapy to help control the effects of the disease on the patient's body.

False; persons with ALS have diaphragm weakness, not an oxygen exchange issue, and so typically do not require supplemental oxygen unless they have an underlying COPD or other respiratory issue.

T/F Clients with ALS typically require supplemental oxygen due to the fact their diaphragm muscles are weak.

False, it is also a language disorder. (this is important bc verbal instruction is often ineffective. Showing a person what you want them to do is better.)

T/F Dementia is only a memory change disorder.

False

T/F Early in the ALS disease process, using the heaviest weights a client can lift for therex is the best strategy, but not for MS because it causes fatigue.

True (The gene is the HTT gene that causes an abnormally long version of the protein huntingtin, which gradually damages the brain.)

T/F For HD, genetic testing can be performed if there is a family history of the disease before symptoms appear and can confirm whether a person or embryo has the genes that cause the disease.

True, MS can affect every system including muscle dysfunction, sensory changes, visual changes, cognitive and behavioral symptoms, gastrointestinal and sexual effects, and many more.

T/F MS can affect every system in the body.

False; in general, it is not considered a fatal disease, and most people with MS have a normal or near-normal life expectancy. (In fairly rare cases, complications of MS such as pneumonia can shorten life, though many complications are preventable or manageable.)

T/F MS is considered a fatal disease.

True

T/F Most hoist lifters for bariatric clients are limited in most facilities or unavailable.

False; it does not generally cause pain as a primary symptom, but rather secondarily by cramping, decreased ROM or stiffness, frozen shoulder, and pain from immobility.

T/F Pain is a primary symptom of ALS.

True; can not let the pt have prolonged immobility.

T/F Research shows IMPORTANCE of early activity and therapy.

True

T/F Respiratory functioning, diaphragm functioning, and speech and swallowing are eventually affected in most people with ALS.

True

T/F The OTA can treat lymphedema under the guidance of an OT, however, extra training and, in some cases, certification must first be obtained.

True (may have to sleep in upright posture (recliner or 1,2,3+pillows))

T/F Though ALS patients have intact sensation, they are at high risk for skin breakdown and pressure injuries from the combination of issues such as decreased nutrition (feeding/swallowing difficulty), trouble with lying in positions that provide pressure relief (weak diaphragms will make them not want to lay back or lie flat bc of SOB), and weakness resulting in their being unable to roll themselves in bed.

True

T/F Unlike lymphedema, clients with lipedema are not usually at risk for infections.

False, some clients may have developed compensatory techniques to allow them to remain at a functional level. Because of this, it is always best to allow clients to demonstrate or attempt to demonstrate their method of functional mobility if possible.

T/F When first meeting a client who is morbidly obese, you should assume they can not transfer correctly so you can educate them on the correct way to transfer.

False; most women with MS have fewer relapses even though most MS medications are not safe to take during pregnancy.

T/F While pregnant, most women with MS have an increased number of relapses.

False, it should not be mistaken for obesity because dieting does NOT make any difference to the condition.

T/F You can decrease lipedema by a correct diet and exercising regularly.

socks (Most socks have elastic openings, and they may not be large enough for the client, which can cause pressure areas and constrict lymph flow.) (You should use bariatric sock or stocking aid.)

Take caution with the use of ____ with clients who are obese, especially if the LEs are edematous or if the client has lymphedema.

making a snack such as peanut butter on crackers or a smoothie, an exercise group in standing, or a craft activity

Tasks for a higher level group might include:

catch or hit a balloon, fold towels, or color pictures

Tasks for a lower level group might include:

might perform seated exercise movements to music and sing along, or play bingo

Tasks for a midlevel group might include:

1) home safety (power w/c safety) 2) tub/shower and toilet transfers and equipment 3) positioning and bed mobility 4) ADL and IADL adaptation and performance 5) ROM 6) energy conservation

The HH OTA working with the client with ALS may focus on:

1) break down tasks into simple steps 2) ask questions with yes/no or a list of choices 3) label items around the house with their names and functions

The OT may teach the caregiver of an HD client to:

1) problem solving 2) relaxation techniques 3) physical activities or hobbies 4) seeking support groups 5) referring them to behavioral or psychological counseling

The OTA can assist the client with coping mechanisms such as:

· Providing positioning and pressure relief devices such as: foam, gel, and low-air loss or alternating pressure specialty cushions and mattresses · Encourage low impact exercise · engaging in discussion with the interdisciplinary team in reference to pain meds

The OTA must address pain by:

TAPS (turn and position system) (The TAPS sizes XL/XXL and have weight limits of 800 lbs.)

The ____ is a system that assists with turning and repositioning the client who is immobile and obese. The system is made with low-friction material to reduce the amount of stress and strain on caregivers and reduce the sheer and friction with turns and boosting of the client's body. This system comes with a low-friction glide sheet to cover the bed and has Velcro anchors to assist with positioning, dense foam wedges to help stay in the side-lying position, a top glide sheet that has boost straps, and micro climate disposable body pads.

panniculus

The ____ is the excessive adipose tissue in the lower abdominal region that hangs down, creating an increased pull against the client's lower back. This can create pain by adding increased pressure on the LEs, hinder daily activities, interfere with ambulation, and cause lymphedema.

combined restrictive/malabsorptive operations (RGB)

The ____ operation is the most common type of bariatric surgery; it combines restrictive and malabsorptive procedures.

Liftware Steady spoon/fork

The _____ has a gyroscope built into the handle that decreases spillage from tremors.

INJURY SEVERITY SCORE (ISS)

The _____ is an internationally validated and accepted trauma scoring system. It is a reliable predictor of survival and mortality. Each of 6 body regions is given a score.

keep the individual engaged and active

The best way to prevent wandering is to:

late stage

The client in the ____ can no longer manage basic ADL tasks, and requires assistance for most tasks. Motor symptoms are severe. By this point, choreatic movements have usually stopped, although some clients continue to experience severe chorea.

sit at the edge of bed and tolerate weight through the legs

The client must be able to _____ to utilize a bariatric stand assist lift.

powders (They can use a hair dryer on cool setting to dry between skin folds, they can use moisture-wicking material, they can put a dry sock or towel between skin folds, or use a drying machine for the shower on cool setting.)

The client should limit the use of ____ to dry moisture in the skin folds because this can cause "caking" that can lead to a breeding ground for bacteria.

fatigue management, energy conservation, and mobility

The client with MS may initially require mobility equipment, such as a cane, walker or wheelchair, for _________________, and later may use a manual wheelchair or scooter for longer distances. Eventually, many clients will use a power wheelchair full time for all mobility, pressure relief, and positioning.

1) psychologist 2) clergy member 3) fitness trainer

The more psychologically and emotionally damaged the client feels, the greater chance of poor eating habits, social isolation, decreased motivation, and negative self worth. It is beneficial to the client to seek professional counseling and assistance, such as from a:

Relapsing-remitting MS

The most common disease course of MS characterized by clearly defined relapses/exacerbations of worsening neurological function that are followed by partial or complete recovery periods (remissions), during which symptoms improve partially or completely.

to perform clothing management, to use a urinal, and to stretch out the back and hips for repositioning and comfort

The reclining component of the power w/c is used for _____.

pressure relief and to prevent some of the stooped posture and forward head position by providing a mechanical advantage

The tilt component of the power w/c is used for ____.

Huntington's disease

The toilevator is most often indicated for what degenerative disease?

eyes

The weakness from ALS is progressive, and eventually the client can only move his or her _____.

1) restrictive operations 2) malabsorptive operations 3) combined restrictive/malabsorptive operations

There are 3 types of operations that can be done for obesity:

Secondary Progressive MS

This type of MS follows after the relapsing-remitting course. Most people who are initially diagnosed with relapsing-remitting MS will eventually transition to this type, which means that the disease will begin to progress more steadily (although not necessarily more quickly), with or without relapses.

Primary Progressive MS (PPMS)

This type of MS is characterized by steadily worsening neurological function from the beginning. Although the rate of progression may vary over time with occasional plateaus and temporary, minor improvements, there are no distinct relapses or remissions.

Progressive-relapsing MS

This type of MS is the least common of the four disease courses. It is characterized by steadily progressing from the beginning and occasional exacerbations along the way. People with this type may or may not experience some recovery after these attacks; this disease continues to progress without remissions.

1) Acute HIV infection (you get sick) 2) Clinical latency (slowly progresses) 3) AIDs - 10-15 years (Opportunistic infections)

Three stages of HIV:

1) ROM exercises 2) skin care 3) lymph drainage 4) some clients seek liposuction for removal of fatty deposits

Treatment of lipedema includes: (OTA can treat lipedema after receiving specialized training.)

1) manual lymph drainage (massage technique) 2) application of compression wraps to the affected extremity 3) skin care 4) ROM exercises to increase lymph flow

Treatment of lymphedema can include:

1) obtain enough physical assistance to safely turn the client, while being sensitive to the client's feelings regarding the need for extra staff and to avoid embarrassment for the client 2) use the draw sheet lengthwise under the client to evenly distribute the body weight; this lessens the amount of strain for the caregiver and client 3) use dense foam wedges instead of pillows for positioning (dense foam will support more weight and maintain better alignment than pillows) 4) educate caregivers and client on the importance of turning and repositioning

Turning and Repositioning suggestions:

Mechanical, thermal, radiant

Type of energy that may be involved in an injury

"locked in"

Ultimately the eye muscles do stop working, and the ALS client is "_______" where they have no ability to communicate or move, though their thinking and awareness may be intact.

•When client requires increased rest for recovery of vital signs (Including O2 sat and resp rate) •HR- 50 or more bpm increase •BP - decrease of >20 mmHg •Mean arterial pressure (MAP) (Normal 80-100 mmHg) (65-80Modify tx) (<65 stop tx) (<60 mmHG may signal inadequate tissue perfusion) •O2 sat decrease of 10% from baseline - modify tx

WHEN TO MODIFY TX

1) Do a great chart review •Look for precautions, orders •Read recent notes of client's status •Take note of all lines, tubes, drains, and airway-•Note pt needs for supplemental O2 •Note baseline vitals •Continual assessment of nonverbal signs and symptoms of pain should occur •Sweating, pallor, mental status change, sig. change in vital signs

WHEN TO START TX

•When pt breathes don't align with ventilator •Client distress - notify nursing •Significant changes in vital signs •Table 36-5= -MAP <65 -HR < 40 or > 130 -Resp <5 or > 40 -O2 < 88 -When changes don't result in stable vital signs- see example (HR 140 doesn't come down w/ 5 min rest) -See other scenarios on p. 972

WHEN TO STOP TX

1) ankle-foot orthoses 2) hospital bed 3) patient lifter with sling 4) bathing and toileting equipment

What are some other necessary equipment for ALS clients?

1) is the client stable for the type of transfer being performed? 2) can the client assist in the transfer? 3) how many people are required to safely perform the transfer? 4) is there enough room to safely perform the transfer? 5) is there appropriate DME to accommodate the client's weight?

What are some questions to ask before initiating the transfer of a bariatric client?

1) encourage healthy, enjoyable (not exhausting) exercise during the day to get endorphins and blood flowing. this will promote a relaxing and low key evening to help switch the body end of day focus. 2) turn on lights in the rooms that will be occupied during the evening 3) try to keep the client engaged in a meaningful task, such as looking at pictures, playing a game, or sorting and folding laundry 4) select one or more of the rooms to become a "quiet place" where there is bright light and soothing music 5) if this time marks a particular trend in the clients life, try to mimic what they may have done at that time in the past. it may include setting the table, picking up children from school, or reading the newspaper, and these "normal" activities may be comforting 6) only allow brief naps during the day of 20 minutes or less. hours of sleeping can confuse the body's circadian rhythms and keep clients awake at night 7) if pacing is involved, make sure the path is clear to increase safety 8) if increased frustration or agitation seems to be happening, hold the client's hand, or put a hand on his or her back or knee. sometimes a soothing massage can be comforting and decrease tension that may be building. 9) promote evenings or positive interactions and memories 10) maintain a comfortable temperature in the home

What are some sundowning strategies to make life easier for both the client and caregiver for the afternoon/evening hours?

1) stress 2) heat 3) emotional or physical trauma

What can exacerbate MS and cause relapses?

multiple sclerosis

What disability is a cooling vest indicated for?

atrophy, weakness, and decreased reflexes (observable when the info from the spinal cord to the muscles is disrupted)

What does the lower motor signs for ALS include?

increased reflexes and increased muscle tone (observable when the info from the spinal cord to the muscles is disrupted)

What does the upper motor signs for ALS include?

1) sensation 2) hearing 3) sphincter muscle control 4) gastrointestinal function

What is NOT affected in a person with ALS?

They can suggest using a sturdy chair that will not tip; clients can wrap their legs around chair legs and keep their elbows on the table for proximal stability and to decrease extra movements while self-feeding.

What is a suggestion the OTA can make to help an HD client with ataxia and chorea while self feeding?

from a cane to a rollator style walker to a power wheelchair, along with a manual or transport wheelchair as backup

What is the typical progression of equipment for ALS?

mid stage

What stage is self feeding and eating especially difficult for HD clients due to motor control challenges such as ataxia and chorea as well as swallowing?

early stage

What stage of HD is depression, irritability, and disinhibition common, as well as sometimes hypersexuality?

seating clinic; manual wheelchair with tilt and recline as well as positioning components or an "attendant" joystick in the back of the power w/c for caregiver control (this is usually bc clients with PD in the advanced stage cannot safely control a power w/c due to rigidity and decreased initiation)

Wheelchair management can be complex for positioning in the advanced stage, and should be addressed by a _____. What is often the wheelchair of choice?

progressive muscular atrophy or lower motor predominant ALS

When a client has primarily lower motor neuron signs at the time of diagnosis, it is called _____.

progressive bulbar palsy or bulbar predominant ALS

When an ALS client has speech and swallowing deficits initially, it is called _____.

physician

When initially starting an activity, the client might require initial clearance by a ____, supervision for adequate performance, injury prevention, and encouragement for follow-through with the task.

bedpan

When toileting, take caution with the use of a ____with the client, as it can cause discomfort and increased chances of pressure areas.

shearing (force or pressure against skin to cause skin compromise)

When utilizing a transfer board for transfers to a wheelchair or bedside commode, it is important to prevent _____ during the transfer.

accommodate the client's weight

When utilizing any transfer device, the OTA must make sure that the device can:

educate him or her and demonstrate compensatory techniques to assist with hygiene and maceration management (maceration means excessive moisture in contact with the skin)

When working with the client who is obese with a panniculus, it is important to: (panniculus severity is usually graded on the appearance of the panniculus but tim said we don't have to know the grades for the test. just know there are different grades of severity)

Parkinson's disease

Which diagnosis is the U-step laser indicated for?

midstage

Which of the 3 stages of HD? numerous ADL/IADL difficulties, jerky and uncoordinated movement, cognitive, and behavioral changes

early stage

Which of the 3 stages of HD? subtle changes in mood, movement, and cognition

late stage

Which of the 3 stages of HD? the client requires 24/7 total care

1) walking 2) swimming 3) dancing 4) water aerobics 5) stretching

Which types of exercises may be beneficial for PD patients to increase strength, flexibility, and balance and also improve well-being and reduce depression or anxiety?

the client could have had a change in medical status or may not be feeling as strong that day

Why can the OTA not judge the amount of assist required by reviewing a previous transfer?

No, but they may able to maintain muscle strength longer with careful exercise

Will clients with ALS benefit from traditional strengthening exercises to build muscle?

involuntary twitching in their fingers, toes, and face decreased coordination during occupational performance

With motor movement, clients with HD in the early stage will display:

1) poor nutrition 2) tension on wound edges 3) reduced perfusion (delivery of blood/fluid to the tissue) 4) emotional stress

Wound healing is noted to be slower in clients who are obese due to:

ALS (Lou Gehrig's Disease)

____ affects motor neurons in the brain and spinal cord, and affects all voluntary muscle control including breathing and swallowing.

Vision and visual muscles

____ and ____ can be affected by ALS in the very late stages of the disease as the muscles weaken.

group treatments

____ are a potential option for dementia management as well. It is important to consider the composition of the group members to try to match persons at a similar stage or level, as possible, to increase the success of the group. Selection of those clients with fewer behavioral challenges may also make the group run more smoothly.

aggregates (or clusters of specific substances within brain cells called Lewy bodies)

____ are microscopic markers of PD.

LOUD

____ focuses on speaking loudly, clearly, and more slowly and is facilitated by speech language pathologists. Clients are educated and trained in the techniques and then expected to add the exercises to their daily routines.

Lymphedema (Research has shown that obesity can be a risk factor for type II lymphedema)

____ is a complication of obesity and usually presents as swelling in the lower part of the arms or legs with the client who is obese, but can encompass the whole extremity.

Huntington's Disease (HD)

____ is a neurodegenerative genetic disease which causes the death of brain cells.

Stemmer's sign

____ is a test for lymphedema, however it can present with false negative. This is a thick fold of skin at the base of the second toe or finger. If the skin cannot be pinched or lifted, it could be a positive indication of lymphedema.

wandering

____ is another effect of the symptoms of dementia, and is caused by confusion and disorientation. Whereas the walking about or wandering may seem aimless, generally most clients have a purpose and an intended destination (such as hunger, pain boredom, anxiety, stress)

Lipedema

____ is characterized by a bilateral symmetrical increase in the stored fat, generally of the LE. It may appear similar to lymphedema due to the increased size of body mass, however, it is a hormone-driven condition that progresses rapidly with weight gain, especially in females, and usually around puberty. · Requires specialized training - tx does not include pressure wraps · Condition can be painful - any drainage, very gentle

caregiver education and training

____ is often required for advanced PD so he or she can manage safely care for the dependent loved one.

Osteoarthritis (OA)

____ is one potential risk to the joints of a client who is obese. As the cartilage between the joints deteriorates from excessive weight and repetitive movements, the joint space becomes smaller and ligaments become lax.

Bariatric

____ is the branch of medicine focused on obesity-from its cause to its treatment.

Mechanical ventilation

____ is utilizing a medical device to assist with breathing.

aromatherapy; citrus

____ may also be very beneficial; however, it is important to be aware of what scents clients preferred or disliked earlier in their life. It seems to be safe and effective and may have an important role in managing behavioral problems in clients with dementia. Scents with a strong ____ smell can help calm the limbic system.

adaptive equipment, including a shower seat or tub bench

____ may assist clients who have mild balance challenges during bathing; the client may need to sit while donning pants.

physical activity (should be a gradual increase)

____ should always be a part of a treatment program with the client who is obese. Clients must maintain strength and mobility to prevent further weight gain.

14%

____% of individuals in US are not aware they have an AIDS infection.

"external cause of injury"

_____ - means the mechanism and manner of the injury (MOI)

Z-Slider

_____ are comprised of plastic sheeting material folded over into a tube used to perform lateral transfers and reposition clients. This device is to be placed between the draw sheet and the bedsheet with the arrows pointing in the direction of the move. Once in place, the client can be pulled by a draw sheet laterally or pushed in the direction of the desired move as the device rolls upon itself. Upon completion of the transfer, remove the device; it can also be used to slide the client up in the bed.

glide lateral air transfer (weight limit up to 1000 lbs)

_____ can also be used for safer transfers. Once the client is in supine position, assist to rolling to the side for placement of the pad. Then, once the deflated pad is under the client, secure all straps across the client, attach air hoses, and inflate. The client can be transferred, in supine position only, from one flat surface to another with ease and with no skin shearing. The devices must be deflated once the transfer is complete and before changing of position.

urinary stress incontinence; hygiene and skin integrity

_____ can also result from pressure on the pelvic and abdominal organs from the weight of the panniculus. Depending on the size of the panniculus, ______ can also present problems.

inappropriate remarks and touching

_____ can be a difficult behavior to manage with those with dementia, which is why it is important to dress professional and conservative.

bright light

_____ from time in the sun or internal lighting is effective in the treatment of seasonal affective disorder; some benefits were reported for restlessness, but a particular beneficial effect has been found for sleep disturbances with dementia.

Attendance at a quarterly multidisciplinary clinic

_____ has been proven in research to increase life expectancy of ALS, potentially due to the proactive care and aggressive symptom management.

Multiple Sclerosis (MS)

_____ is a disorder of the central nervous system that affects the myelin coating around nerve fibers and causes plaques to form in the brain and/or spinal cord.

dementia

_____ is a term describing a variety of diseases and conditions that develop when nerve cells in the brain die or no longer function normally, and cause changes in a person's memory, behavior, and ability to think clearly.

restrictive

_____ operations limit food intake by reducing the amount of food the stomach can hold (separating the stomach into two pouches-one smaller than the other) and slowing the passage of food to the stomach.

bed positioning

_____ will also be important for contracture management as well as comfort and the avoidance of skin issues including pressure injuries for late stage HD.

psuedobulbar affect (PBA)

_____, or uncontrollable emotionality out of proportion to the situation, with laughing and/or crying, can be common with ALS. Some clients will experience depression and have difficulty with coping.

deep brain stimulation (DBS)

______ is a surgical procedure in which electrodes are inserted into the specific spots in the brain that are involved in motor function. A device called an impulse generator (IPG), which is similar to a pacemaker, is implanted under the client's collarbone to provide electrical impulses to the electrodes. For many people, this procedure can dramatically relieve some symptoms and improve QOL. It is most effective in clients with tremors for whom medication is having side effects. Studies show benefits lasting 5 years.

The location of the damage in the brain and/or spinal cord

_______ determines the type and severity of the symptoms of MS.

Adjustable gastric banding (AGB) or lap band surgery

a type of restrictive operation that includes attaching an inflatable band around the top portion of the stomach and tightening it like a belt. side effects: nausea, vomiting, acid reflux, heartburn, stomach ulcer, gastritis, gas bloat, trouble swallowing, dehydration, diarrhea, constipation, and weight regain

Vertical Sleeve Gastrectomy (VSG)

a type of restrictive operation which removes large portion of the stomach (gastric sleeve) side effects: diarrhea, vomiting, dumping syndrome (sweating, flushing, lightheadedness, rapid heart rate, palpitations, upper abdominal fullness, nausea, diarrhea, cramping, and active audible bowel sounds.)

Vertical Banded Gastroplasty (VBG)

a type of restrictive operation which utilizes a combo of band and staples to separate the stomach to create the small pouch side effects: ongoing nausea and vomiting is common if too much food is consumed

planning abilities, insight, and judgement/reasoning, memory, creative thinking, and diminished orientation

cognitive difficulty that some pts with HD may show:

1) first, the focus may be only on what is lost or impaired without the understanding of what the client with dementia can still do at each stage of the disease 2) second, the intervention may be too narrowly focused on the single client, the person with dementia.

dementia-specific interventions have two common pitfalls: a more effective plan is to engage the caregiver team in using person-centered strategies that work for this client and make participating easier for both the client with dementia and the caregivers

severe stage

hallucinations and delusions may occur with mild, moderate, or severe PD?

>20% expected weight

obese is defined as:

1) Joint stability 2) Management of the panniculus

physical/motor client factors that could impede occupation performance bc of obesity:

denial about the disorder, anger and grief about changes, behavioral problems, such as attention seeking, and psychotic and abusive behavior

psychological difficulty that some pts with HD may show:

Biliopancreatic diversion (BPD or duodenal switch)

the only type of malabsorptive operation which is the most complicated operation. It involves removal of the lower portion of the stomach, then connects the small intestines and bypasses the first 2 sections of the small intestines (duodenum and jejunum) side effects: diarrhea, vomiting, flatulence, nutritional deficiencies, dumping syndrome

mild stage

tremors on one side of the body may occur with mild, moderate, or severe PD?

1) tremor of the hands, arms, legs, jaw, or face 2) bradykinesia or slowness of movement 3) rigidity or stiffness of the limbs and trunk 4) postural instability or impaired balance and coordination: may fall backwards, or sideways when turning

what are the four hallmark symptoms seen with PD?

EARLY STAGE (Cognitive symptoms start early)

• Assist with consistent daily routine (eg. lists, calendars, notes) • Teach caregiver to ask Yes/No Qs, give list of choices, label household items • Reduce clutter for safety

Mild stage of PD

• LSVT BIG • AE - shower seat/tub seat/large handled utensils/cups with lids to prevent spills

Advanced stage of PD

• More rigidity (try to keep trunk flexible, maintain mobility, transfers, initiate movements) • Power W/c - tilt used for pressure relief; recline to perform clothing management

LATE STAGE

• Prevent skin breakdown • Padded orthotics for contracture management

MID STAGE

• Stabilizing techniques (eg. Wrap feet around stable chair legs) • AE • Toilevator (toilet elevator) • Tub bench with suction feet