Pass The OT Module 4

A patient who underwent an above elbow amputation less than a week ago, is presenting with significant phantom limb pain. To address his pain, mirror box therapy has been incorporated into his OT intervention plan. What is the BEST way to explain this type of therapy to the patient?

"It lets the brain think that the amputated arm is moving normally, helping the brain to reorganize the sensation of movement in the remaining arm." **Phantom limb pain is a painful sensation that is perceived in a body part that no longer exists. The principle of mirror therapy is the use of a mirror to create a reflective illusion of an affected limb in order to trick the brain into thinking movement has occurred without pain, or to create positive visual feedback of a limb movement. It involves placing the affected limb behind a mirror, which is sited so the reflection of the opposing limb appears in place of the hidden limb. Mirror box therapy works by reorganizing the disparity between proprioception and visual feedback of the amputated arm. The mirror uses visual feedback to trick the brain into thinking the arm is still present, helping the brain to interpret the new proprioceptive sensation as normal and reducing pain. This is the best explanation to help the patient understand this type of therapy.

A patient was recently admitted to acute care after acquiring a full-thickness burn to both upper extremities. How long after having a skin graft, can this patient's AROM be assessed?

7-10 days post-op. **The skin graft typically takes one week to heal, only then can the patient's range of motion be assessed. For full-thickness skin grafts, the donor site wound heals by primary intention (sutured together). However, for split-thickness skin grafts, the wound heals by re-epithelialization. Epithelial cells migrate from the remnants of the underlying dermis across the wound bed. Initial healing of grafted area typically occurs 7 to10 days. Skin grafts contract during the healing phase, and immobility enhances loss of function. The preferred position and length of immobilization will vary by physician and burn center protocol. Excision and grafting procedures usually require a period of postoperative immobilization to allow adherence and vascularization of the grafted skin. Although the time varies among burn centers, the average period of immobilization is 3 to 5 days for most split-thickness skin grafts (STSG), and 7 to 10 days for epithelial grafts. Exercises can be resumed as soon as graft adherence is confirmed. Gentle AROM is the treatment of choice to avoid shearing of the new grafts.

An OTA is working with a patient in acute care who presents with a burn that has damaged the epidermis and deep layers of the dermis, including the hair follicles and blood vessels located in the dermis. The patient received this injury when taking a cake out from the oven. In the first treatment session, the patient asks the OTA when the wound will heal. How should the OTA best respond?

A deep partial-thickness burn typically resolves in 3-5 weeks. **When burns extend through the epidermis and into the dermis, they are considered to be partial-thickness burns. The dermis itself is divided into two regions, the uppermost being the papillary region. This area is composed mostly of connective tissue and serves only to strengthen the connection between the epidermis and the dermis. Partial-thickness burns that only extend down to this layer of the skin are considered superficial. The reticular region of the dermis contains not only connective tissue, but hair follicles, sebaceous and sweat glands, cutaneous sensory receptors, and blood vessels. Damage to this layer of the skin is classified as a deep partial-thickness burn. - First degree burn: A superficial burn that only affects the top layer of skin (epidermis). There is no blistering, it is painful, the skin is red, and it heals in 3-4 days - Second degree burn: The burn extends below the top layer of skin (epidermis) into the layers below (dermis). There is blistering, the top of blisters consist of dead skin, and it heals in 10-14 days - Third degree burn: The burn extends all the way through all layers of skin. It appears white, brown, black or cherry red in appearance. It may or may not have blisters. It requires specialized treatment and possible surgery.

Sherry is a 42-year-old woman with a C5 spinal cord injury. What adaptive feeding equipment should the OTA train Sherry to use in order to enable her to be independent in self-feeding?

A mobile arm support. **A mobile arm support will support Sherry's forearm. The support is hinged so that she will be able to use her shoulder girdle movement to lift and lower her hand to scoop food and bring it to her mouth. A universal cuff will help Sherry keep the utensil in her hand as she feeds herself.

What type of durable medical equipment is recommended for a patient with a complete C4 spinal cord injury?

A reclining shower chair. **The patient has paralysis of the trunk, upper and lower extremities and, therefore, requires total assist for bathing. Patient will not have trunk control due to lack of muscle innervation at this site. The patient would benefit with the use of a reclining shower chair due to inability to maintain unsupported sitting or supported sitting. The use of a reclining shower chair for bathing also reduces caregiver burden on patient handling.

An OTA is working with a patient with mild vision loss. One of the goals for this patient is to read while sitting in a recliner in their living room. What three interventions would be BEST to introduce with this patient? Select the best 3 choices.

A. Enlarged font B. Magnification C. Auditory recordings **General Interventions for Vision Loss - Enlarged font, magnification, auditory recordings or talking devices, severe vision loss would need screen reading software on computer (not to be confused with voice recognition software), home modifications including reduce clutter/safe clear pathways

Violet is a 93-year-old female with multiple medical diagnoses who lives in a long-term care facility. She has developed a stage 3 pressure ulcer on her right buttock which is being treated by physical therapy. What treatment techniques should the COTA® provide to assist in the healing of this ulcer? Select the 3 best answers.

A. Incorporate weight-shifting techniques into morning ADLs. B. Issue a gel cushion to the woman for use in her wheelchair. D. Work with the activities department to include the woman in Wii© Sports games during the day. **Patients who have pressure ulcers require adaptations to reduce the pressure over the ulcer area. A gel cushion in Violet's wheelchair would help to distribute the pressure equally over both of her buttocks. The COTA® could also incorporate weight shifting into Violet's morning ADL routine to relieve pressure on the area, and encourage Violet to participate in activities that require weight shifting or standing, such as Wii© Sports games. The COTA® should not have to complete wound care as nursing and physical therapy will work together to treat the ulcer. Patients who have pressure ulcers need to be encouraged to move and to drink fluids, so the COTA® would not initiate any mobility precautions or fluid restrictions.

When addressing sexuality with a teenager who has an intellectual disability, on what should the main focus of OT intervention be?

Assertiveness training, training in safe sex, family/caregiver education. **Cognitive Impairments- OT Intervention: Assertiveness training, training in safe sex, sex education, family/caregiver education. Cognitive approach to sexuality includes: • Providing education on contraceptive use for teenagers with intellectual disability • Sexual abuse prevention training for children who have trouble communicating • Working on relationship/social skills for adults with mental illness. All people, including those with cognitive disabilities (including intellectual disability, autism spectrum disorder and acquired brain injury), have the right to explore and express their sexuality in appropriate ways. Everyone needs ongoing and age-appropriate sexuality education to develop positive attitudes about their sexuality. Comprehensive sexuality education can help people with cognitive disabilities to stay safe, reduce their risk of sexually transmissible infections (STIs) and help prevent an unplanned pregnancy. Many parents don't provide sexuality education because they mistakenly think their child will not need it. Other parents try, but struggle to present the information in a way their child can understand. As occupational therapists, we are uniquely qualified to address this topic - our experience in activity analysis, making adaptations and modifications, and providing education tailored to each individual are all great assets. Acknowledging sexuality fits with the holistic values of occupational therapy as we specialize in treating the whole person, even the parts that may not initially be comfortable to discuss.

Frank is a 78-year-old man who has undergone a total hip replacement. The surgeon used a posterior approach when completing the surgery. What precautions should the COTA® make sure that Frank follows during ADL retraining? (Select the best 3 choices)

B. Avoid internal rotation of the hip. C. Avoid bending the hip past 90 degrees of flexion. E. Avoid hip adduction. **The post-surgical precautions following a posterior approach total hip replacement include no hip flexion past 90 degrees, no hip adduction, and no internal rotation of the hip. These are the precautions that Frank should follow. No external rotation of the hip, no hip extension backward, and no hip abduction are precautions that should be followed after an anterior approach total hip replacement.

An OT practitioner is running a Topical Group about the importance of managing one's Diabetes. The focus of the session is on ways to prevent and react to diabetic hypoglycemia. Which of the following statements should be included in the group discussion? Select the best 3 answers.

B. Eat additional snacks if there is an increase in physical activity. E. Don't skip or delay meals or snacks. F. Blood sugar levels can be quickly raised by eating or drinking a simple sugar source. **Diabetic hypoglycemia occurs when someone with diabetes doesn't have enough glucose in their blood. Low blood sugar is most common among people who take insulin, but it can also occur if the patient's taking certain oral diabetes medications. Common causes of diabetic hypoglycemia include: • Taking too much insulin or diabetes medication • Not eating enough • Postponing or skipping a meal or snack • Increasing exercise or physical activity without eating more or adjusting their medications • Drinking alcohol It is important to pay attention to the early warning signs of hypoglycemia and treat low blood sugar promptly. The patient can raise their blood sugar quickly by eating or drinking a simple sugar source, such as glucose tablets or fruit juice. To help prevent diabetic hypoglycemia: • Monitor blood sugar. Careful monitoring is the only way to make sure that the patient's blood sugar level remains within their target range. • Don't skip or delay meals or snacks. If the patient takes insulin or oral diabetes medication, they need to be consistent about the amount they eat and the timing of their meals and snacks. • Measure medication carefully, and take it on time. • Adjust medication or eat additional snacks if the patient increases their physical activity. The adjustment depends on the blood sugar test results, the type and length of the activity, and what medications the patient takes. • Eat a meal or snack with alcohol, if the patient chooses to drink. Drinking alcohol on an empty stomach can cause hypoglycemia. Alcohol may also cause delayed hypoglycemia hours later, making blood sugar monitoring even more important. • Record low glucose reactions. This can help the patient and the patient's health care team identify patterns contributing to hypoglycemia and find ways to prevent them. • Carry some form of diabetes identification so that in an emergency others will know that the patient has diabetes. Use a medical identification necklace or bracelet and wallet card. A. For hyperglycemia (high blood glucose) the quickest way to reduce the levels it is to take fast-acting insulin. C. If diabetic hypoglycemia isn't treated, signs and symptoms of severe hypoglycemia can occur. These include: • Clumsiness or jerky movements • Inability to eat or drink • Muscle weakness • Difficulty speaking or slurred speech • Blurry or double vision • Drowsiness • Confusion • Convulsions or seizures • Unconsciousness • Death, rarely

A COTA® is working with a 73-year-old patient who lives alone in an apartment, on the management of his medication. He has been diagnosed with Diabetes Mellitus II and is therefore at risk for developing a peripheral neuropathy. While observing the patient retrieving his medication from the upper cabinet, the COTA® observes certain actions that may be consistent with early symptoms of a peripheral neuropathy. What observations has the COTA® noted, that would MOST LIKELY require her to report a change in the patient's status? Choose the best 3 answers.

B. Problems with coordination and proprioception while walking. C. Dropping bottles in attempts to transport them to the table. D. Shaking his hands when trying to open a child-resistant medication bottle. **Problems with coordination and proprioception while walking, dropping bottles in attempts to transport them to the table, and shaking his hands after trying to open a child-resistant medication bottle Peripheral Neuropathy is a condition affecting the nerve fibers responsible for allowing signals to flow from the brain and spinal cord to other parts of the body. Sensory, motor, or autonomic functions or a combination are affected: Vibration and position sense; sensitivity to temperature; numbness and tingling; abnormal sensorimotor functions; and pain to light touch which would normally be painless. A. Peripheral neuropathy is not expected to cause visual problems. E. Loss of forearm supination is not expected. F. Swallowing is not affected by peripheral neuropathy.

Judyth is a 58-year-old female with a diagnosis of early stage diabetic retinopathy. What home modifications should the COTA® recommend to Judyth during the initial stages of treatment? Select the best 3 choices.

B. Reposition Judyth's television to reduce glare on the screen. C. Place strips of black tape on the edges of Judyth's back entry steps which are covered with light tan tile. E. Help Judyth clear the clutter from her main hallway. **Since Judyth is in the early stages of visual impairment, she still has some functional vision and may be able to get by for a while with some easy, low cost modifications. The COTA® could help by repositioning items, such as Judyth's television set, to reduce glare and helping to clear clutter from high traffic areas, such as Judyth's hallway. She could also increase contrast in areas that might pose a safety hazard, such as placing black tape on Judyth's light colored entry steps to help Judyth see the edges of the steps. Judyth's vision is not impaired to the point of needing low vision lighting or an audio clock, both of which would cost her some money. Judyth is not yet blind and has most likely not been educated in Braille, so Braille labels would not be helpful to her.

An OT practitioner is working with a patient who is recovering from Covid-19 and is currently using supplemental oxygen at home. The focus of the session is on conducting a home safety evaluation. From the options below, which of the following recommendations is NOT an appropriate precaution?

Change the oxygen flow rate if the patient feels they are not getting enough oxygen. **Oxygen must be used as ordered by the doctor. Too much or too little can be harmful. The patient should never change the oxygen flow rate on their own as this can lead to serious side effects. If they feel they are not getting enough oxygen, they should contact their physician and notify their home care supplier. A, B and D. Oxygen does not burn, but it does support combustion. So, anything that can burn will burn much faster in an oxygen-rich environment. • Oxygen should never be used near an open flame or anything that can produce intense heat, flames, or sparks, such as a burning cigarette, a lighted match, heaters, heating pads, hair dryers, a stove or a pilot light. Anything that can produce hot flames or sparks during operation should be kept at least 6 feet away from your oxygen equipment. - Do not smoke or allow others to smoke in the same room as your oxygen system. Cigarette smoking is very dangerous: sparks from a cigarette could cause facial burns. - If you must cook while using oxygen, make sure your tubing will not touch the gas flame or electric burner. (Tuck the tubing in your shirt or position it behind you.) - Electronic or battery-operated toys or appliances, such as a game controller are capable of producing a spark when used near oxygen; therefore avoid using the items around oxygen. • Petroleum based products should not be used on the face when oxygen is being used. Do not use oil, grease, Vaseline or any other flammable substance on your oxygen equipment or on your skin near the equipment. Use water-based products only. • If frost forms on your liquid oxygen equipment, don't allow the frosted parts to come into contact with your skin. It can cause a frostbite skin injury. • Store cylinders in an upright position and secured in an approved cart or other storage device. • If you are using a humidifier, use only the recommended type and amount of water. Due to increase in back pressure and resistance to flow, disposable humidifier bottles should not be used for oxygen flows greater than 6 liters per minute. There are humidifier bottles available for higher oxygen flows

Joel, a 37-year-old male who is a construction worker, recently incurred deep partial-thickness burns to both his upper extremities while lighting a barbecue grill with lighter fluid. Joel has stated that he needs to return to work as soon as possible, as his family depends on his income. What is the MOST efficient way to help Joel achieve his goal of returning to work?

Design treatment activities that simulate both functional activities and various work skills. **Partial thickness burns (Second Degree) extend through the epidermis and into the dermis. The depth into the dermis can vary (superficial or deep dermis). These burns are typically very painful, red, blistered, moist, soft and blanch when touched. Examples include burns from hot surfaces, hot liquids or flame. Preparing a burn patient for return to work does not have to be a long-term process. Burn rehabilitation and work skills training have many similarities; therefore, it is possible to design treatment activities that simulate not only functional activities but also various work skills. Strength, activity tolerance, and flexibility, often identified as work tolerances, are obvious goals of burn rehabilitation. Physical demands of jobs, as described in the Dictionary of Occupational Titles, are also components of functional skills; lifting, stooping, pushing, pulling, handling, and manipulating are a few examples. A job analysis interview, performed as part of the activity needs analysis, will provide the type of information needed to integrate activities into the intervention plan, which should not only improve functional ability but also provide reconditioning for returning to work.

Destruction of nerves is caused by what degree of burn?

Destruction is caused by fourth-degree burns. **The word destruction means to completely destroy, which implies that both the sensory and motor parts of the nerves have been affected. This occurs in a 4th-degree-burn as the muscle is usually involved. Burns can be classified as first-degree, second-degree, third-degree, or fourth-degree depending on how deeply and severely they penetrate the skin's surface. Burns classified according to the depth of tissue injury largely determines the healing potential and the need for surgical grafting. 1. Epidermal (superficial; was first degree) burns involve only the epidermal layer of skin. 2. Partial-thickness burns (was second degree) involve the epidermis and portions of the dermis. They are characterized as either superficial or deep. 3. Full-thickness burns (was third degree) extend through and destroy all layers of the dermis and often injure the underlying subcutaneous tissue. These burns affect all three skin layers: epidermis, dermis and fat. The burn also destroys hair follicles and sweat glands. Because third-degree burns damage nerve endings (sensory nerve), the patient probably won't feel pain in the area of the burn itself, rather adjacent to it. 4. Deep burn injury (was fourth degree) extends into underlying soft tissue and can involve muscle and/or bone. In more detail: 1. First-degree (superficial) burns. First-degree burns affect only the outer layer of skin, the epidermis. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and often consists of an increase or decrease in the skin color. 2. Second-degree (partial thickness) burns. Second-degree burns involve the epidermis and part of the lower layer of skin, the dermis. The burn site looks red, blistered, and may be swollen and painful. 3. Third-degree (full thickness) burns. Third-degree burns destroy the epidermis and dermis. They may go into the innermost layer of skin, the subcutaneous tissue. The burn site may look white or blackened and charred. 4. Fourth-degree burns. Fourth-degree burns go through both layers of the skin and underlying tissue as well as deeper tissue, possibly involving muscle and bone. There is no feeling in the area since the nerve endings are destroyed.

When reviewing a patient's medical chart, the OTA reads that the patient has been diagnosed with atrophy of the optic nerve. What is the most likely cause of this?

Glaucoma. **There are many causes of optic atrophy. The most common is poor blood flow. This is called ischemic optic neuropathy. This problem most often affects older adults. The optic nerve can also be damaged by shock, toxins, radiation, and trauma. Glaucoma is a group of diseases with the common feature among all types of glaucoma being optic nerve degeneration. Much like Alzheimer's disease is a neurodegenerative disease of the brain, glaucoma is considered a neurodegenerative disorder of the optic nerve.

When should you recommend that a patient move to a long-term care facility?

If the person requires 24-hour personal care and does not require skilled nursing care. **Long term care facilities are designed for people who require 24-hour personal care but do not require skilled nursing care. Medications, meals, and personal care aides are provided. Rehabilitation services are usually available through an on-site outpatient clinic. Long term care facilities are the types of facilities often referred to as "nursing homes". Some long-term care facilities specialize in care for people with Alzheimer's disease, intellectual disabilities, or mental health conditions. A. A skilled nursing home is normally the highest level of care for older adults outside of a hospital. Skilled nursing facilities provide 24-hour nursing care, medications, rehabilitation services including physical, occupational, speech, and respiratory therapies, meals, and personal care aides. A licensed physician supervises each patient's care. People who have acute health conditions often stay in skilled nursing facilities on a short-term basis to receive continued nursing care or rehabilitation prior to returning to home. Medicare will pay for up to 100 days in a skilled nursing facility if a person has an acute health condition that had required a 3-day hospital stay. B. Assisted living is a residential option for seniors who want or need help with some of their ADLs - for example, help with cooking meals, getting to the bathroom in the middle of the night, keeping house, and traveling to appointments. Assisted living facilities offer the safety and security of 24-hour support and access to care. Day or night, help is only a phone call away. If a person is having more and more difficulty with everyday activities such as showering, dressing, getting around the house, and running errands, an assisted living facility may be the answer. They can get daily support, while remaining as independent as possible. C. Senior apartments or retirement centers are apartment complexes that specialize in renting to senior citizens. The apartments are usually smaller in size and adapted for mobility problems. People who rent senior apartments must be able to live independently. Retirement centers may also include a senior center that provides meals and activities, on-site medical facilities, and an on-site pharmacy.

If a patient is able to follow a set schedule and perform a self-care routine independently, at what Rancho level are they functioning?

Level 7: Automatic and Appropriate. **In addition, this patient at level 7 can do routine self-care w/o help if physically able. Has problems planning, starting, and following through with Ax. Has trouble paying attention in distracting or stressful situations. Unaware of severity of injury, believes will go home and pick up where left off. Tx: Can complete Ax. for 30min with min. assist.

An OTA working with a 52-year-old male patient at an assisted living facility documents that the patient regularly watches and concentrate on the evening news for about 30-minutes, as long there are no distractions. If the patient has visitors in the morning, he can recall that he had the visitors but he cannot remember what they spoke about. At what Rancho Los Amigos level is this patient most likely functioning?

Level VI. **This patient is functioning at Level 6 on the Rancho Los Amigos scale. Level VI - Confused, Appropriate Response. At this level, a person is able to attend to highly familiar tasks in non-distracting environment for 30 minutes and remote memory has more depth and detail than recent memory. Patients give context appropriate, goal-directed responses, dependent upon external input for direction. There is carry-over for relearned, but not for new tasks, and recent memory problems persist.

A patient who recently sustained a C8 SCI has just received his first wheelchair from a durable medical equipment company. OT intervention is focusing on training this patient how to use his new wheelchair. What is the FIRST step this patient should be taught?

Lock the brakes. **The wheelchair must be stable before the man can transfer into or out of it. The brakes will stabilize the wheels and prevent the chair from rolling as the man transfers. It is very important that the man develops the habit of locking the wheelchair brakes when transferring, so he should be taught to always do this step first.

Beverly recently sustained a TBI and she is currently functioning at Rancho Los Amigos 8 (Purposeful Appropriate). OT intervention is focusing on improving her sequencing and problem-solving skills so that she can be discharged to a transitional living program. Beverly is currently participating in a cooking group which is structured to help her work towards achieving her goals . Last week, Beverly was able to successfully mix, dissolve in liquid, and mold Jell-O from a box. Which meal preparation activity should the COTA® work on NEXT?

Make a grilled cheese sandwich following a written recipe. T **To work on improving problem-solving and sequencing, the patient must advance to perform more complex steps and away from few, structured steps. Since the patient has successfully performed a hot-cold meal prep with 2 ingredients - a liquid and a powder - she is able to progress to a simple hot meal prep which involves 2 slices of bread, butter and cheese. She is also working on safely handling a heated pan and must problem-solve to monitor temperature, and correct errors. B. A three-course hot meal is too advanced at this time as the process involves too many steps. C. Watching a video does not challenge problem-solving and anticipation for errors as the patient is basically following a demonstration. This is downgrading from her current level. D. This is also downgrading as it requires less steps than her current ability of meal prep.

When fitting a pressure garment glove on a patient's right dominant hand, 6 weeks post burn injury, how can you ensure the best fit?

Make sure the compression garment exerts equal pressure, and if necessary, use a silicone gel pad under the garment to distribute the pressure more evenly It is difficult to predict who will develop scarring. **Research shows that less severe burns (also called superficial partial thickness burns) that heal in less than 10 days generally have no scarring. More severe burns such as deep partial thickness burns which take more than 21 days (3-weeks) to heal, usually develop scarring. Full thickness burns and other burns that require skin grafting are at high risk for scarring. To be effective, compression garments must exert equal pressure over the entire burned surface area. Because of body contours, bony prominences, and postural adjustments, flexible inserts or pressure-adapting conformers are often needed under the garments to distribute the pressure more evenly. As with the garments, the fit of a conformer should be monitored at regular intervals for effectiveness and signs of deterioration and be replaced as needed to maintain exact contouring. Silicone gel pads, Silastic elastomer, Otoform-K, Plastazote, and Velfoam are useful for hand scars. Topical silicone gel treatments seem to remain the first point of clinical recommendation in scar management. SGS has been used in scar therapy for over 30 years, during which its efficacy has been the subject of numerous clinical evaluations. The exact mechanism of action of silicone in the prevention and management of hypertrophic scars is unclear, although it is likely to influence the collagen remodeling phase of wound healing. It appears to soften, flatten and blanch the scar, making it comfortable and improving its appearance.

What type of wheelchair should be recommended FIRST to a patient who has a C6 spinal cord injury?

Manual wheelchair. **A patient who has a C6 SCI can use a manual wheelchair because they have the ability and muscles available to propel a manual wheelchair. even though Individuals with a C6 spinal cord injury can vary in their ability to propel a manual wheelchair depending on their own muscle capacity, the environment in which they need to propel the chair in, and the distances they expect to propel the chair, a manual chair would be suggested first before any of the other options.

In burn management, massage is a recognized modality used to help soften and desensitize healed grafted areas and burn scars. What is the BEST massage technique for treating a burn scar that is hypersensitive?

Massage should be performed in a circular motion, using gentle pressure initially and increasing the pressure gradually as tolerated. **Massage is beneficial for desensitizing well-healed but hypersensitive grafted areas or burn scars and for softening tight scar bands during sustained stretching exercises. When massaging a scar band, the clinician should be sure that the scar is fully stretched and pre-moisturized to reduce shearing forces and prevent splitting of immature or unstable, problematic scar tissue. Massage should be performed in a circular motion, with more pressure applied gradually as tolerated over time. Scar massage is widely advocated as an integral part of burn scar management; while the exact mechanisms of its effects are not known, it appears to help in several ways, for example: i. Application of a moisturiser - burn scars are often lacking in moisture depending on the depth of the injury and the extent of the damage to the skin structures. They can become very dry and uncomfortable and this can lead to cracking and breakdown of the scar. By massaging with an unperfumed moisturiser or oil, the upper layer of the scar becomes softer and more pliable and therefore more comfortable; this also helps to reduce itching which can also be a common problem. ii. When scars become thick and raised, they hold additional fluid which reduces their plasticity. Through deep firm massage of the scar using the thumb or fingertips, the effect of this excess fluid can be reduced. Massaging while performing stretches helps to increase ROM of a limb affected by a burn scar. iv. Burn scars contain four times more collagen than other scars which is rapidly laid down in whorls and bundles. Deep massage of the scar in small circular movements is thought to help improve with alignment of the scar tissue as it is formed. v. Sensory impairment and changes in cutaneous sensation is common in burn scars. Regular massage and touching of the scars helps with desensitisation of hypersensitive scars. vi. Psychological factors of individuals having difficulty in coming to terms with having, what they feel is, an unsightly scar can also be reduced by touching the scar and learning to accept how it looks and feels.

Agnes is an 89-year-old woman who lives alone in her single story home. For mobility, Agnes walks with a wheeled walker and she can take care of her basic ADL tasks independently. She, however, has difficulty with her IADLs and is homebound. Agnes has difficulty preparing meals for herself and her family members are unable to cook for her every day. What service should the OTA recommend so that Agnes can get adequate nutrition?

Meals on Wheels. **Many communities offer delivery of hot meals to homebound residents. Meals on Wheels is a federally funded program that helps these communities pay for food and facilities that allows for the preparation and delivery of these hot meals. Most programs offer 5 hot meals per week. Recipients must be mostly or completely homebound.

A woman who has a progressive disease has recently been admitted to a long term care facility. When the OTA enters the woman's room to introduce herself, the woman asks the OTA how OT can help her, especially as she has a progressive disease. How should the OTA respond to the woman's question?

Occupational Therapy intervention can help the woman maintain her existing level of function. **When a patient has a progressive disease, it means the patient will not improve in function. Therefore, it is important to maintain function as much as possible. The woman may be more agreeable toward OT treatment if she knows that the expected outcome of therapy is realistic.

A patient has been referred to OT post bariatric surgery. What should the OT practitioner focus on when working with this patient?

Occupational goals. **Occupational therapy intervention for managing obesity must focus on occupational goals; in fact, some patients may not be interested in tracking weight. Many patients are more motivated by occupational goals, such as being able to do a specific task or occupation; increasing their endurance to make mobility and ADLs/IADLs easier; participating in enjoyable past occupations or a desired new occupation; fitting into previously worn clothing; and improving other health/bio-measures, such as HbA1c, blood pressure, and cholesterol. Concrete bio-measures can be especially motivating when they have meaning for a patient. Bariatric surgery typically produces greater weight loss and maintenance than all other methods and is recommended for patients with a BMI over 40 or a BMI over 35 with obesity-related comorbidities. Bariatric procedures can also significantly affect occupations after surgery and require behavior modification for long-term success. A. Obesity affects both the physical and mental wellbeing of the patient. Mental health and self-esteem are commonly affected by obesity, thus using assessments such as the Beck Depression Inventory II, the Beck Anxiety Inventory, the Rosenberg Self-Esteem Scale, and the Eating Disorder Evaluation Questionnaire are useful and important in this population. D. Because obesity can affect participation in occupation, occupational therapy practitioners can treat obesity as the primary condition or reason for referral, as well as in conjunction with various conditions and disabilities. The most successful lifestyle interventions include exercise and diet and behavior modification and are delivered by a multidisciplinary team. Occupational therapists can be the team member that delivers the lifestyle intervention.

A 65-year-old male patient is currently in an acute care hospital and recovering from a thoracic spinal surgery. To maintain spinal precautions, while lying supine in bed, what is the BEST location for a patient to place frequently accessed items such as a remote or phone?

On the same side of the arm he is reaching. **If the item is on the same side of the arm he is reaching, it will prevent twisting of the back. Placing frequently accessed items under the pillow causes external rotation and humeral abduction more than 90 degrees.

A patient has diabetes and recently had a lower extremity amputation. After the surgery, the patient reports feeling the presence of the limb and itching of the amputated limb. What is this patient experiencing?

Phantom sensations. **Phantom limb sensation - sensation or perception of movement coming from the missing limb or body part. A phantom limb sensation is a non-painful perception of the continued presence of an amputated limb. Patients may report phenomenon from the missing limb such as tingling or itching. These non-painful phenomena are termed phantom sensations. The phantom limb may also be felt to be in a different position, shape or size to the missing limb.

A patient who has been diagnosed with low vision, lives alone in a 2-bedroom single story house, is being seen at her home with the purpose of providing her with recommendations to help her compensate for her visual difficulties. What would an appropriate INITIAL recommendation for this patient be?

Provide a dark colored bath mat on a white tiled bath floor. **Initial interventions for patients with low vision should focus on increasing contrast and lighting. Placing a dark colored bath mat on a while tiled floor increases the contrast of objects on the floor of the bathroom, which should improve the patient's safety.

A male patient who recently had a right knee replacement is due to be discharged from OT. Despite teaching him how to use assistive devices for dressing, he continues to have significant difficulty performing his dressing tasks independently. The patient is planning on returning to his home to live with his wife of 50 years. His wife has agreed to assist her husband in his ADLs. What measures should be taken to ensure that this patient's needs can be met by his wife?

Provide caregiver training and evaluate the wife's ability to perform dressing tasks on the patient. ** The OT has educated the patient in the use of devices and the patient has made a conscious decision to receive assistance from his spouse rather than use the equipment. The OT must respect the patient's decision, but does have a responsibility to make sure that the spouse is capable of providing the type of assistance that the patient requires in an appropriate and safe manner.

A patient with a C5 spinal cord injury needs to learn pressure relief techniques. What pressure relief method should the OTA teach the patient to relieve pressure in bed?

Relieve pressure using an overhead trapeze and attached rope ladder. **To relieve pressure in bed, the patient can hook his elbow around the overhead trapeze to lift his body off the bed and around the rope ladder to turn his body from side to side.

Samuel, a high school soccer coach, recently had a below elbow transradial amputation of his right dominant arm due to a gunshot wound. The loss of his arm has caused him great anxiety about dating, fearing rejection "because of my deformity". Samuel is hesitant and fearful to put on his new arm prosthesis. What should the COTA® focus on NEXT during the intervention process, to help Samuel overcome his aversion to wearing his prosthesis?

Repeated donning and doffing, and prosthetic skill training. **With repetition for prosthetic wear and skill training in functional use, the patient will gain self-efficacy and adapt to occupations with a sense of control and independence that will encourage continued use of the prosthetic. Adapting and getting comfortable with the prosthetic will help reduce fear and anxiety with its use. A. Although skin hygiene is important for the residual limb, it should be taught first. B. ROM exercises are designed to encourage the use of the stump and build strength to operate the prosthetic, but this occurs before fit and operation of the prosthetic. C. Active rather than passive learning will decrease hesitation and fear of prosthetic use.

A 22-year-old male patient who was recently involved in a motorcycle accident, enquires about his prognosis. He is told that he will most likely be able to walk again but that he may have a loss of function in his hips and legs, as well as little or no voluntary control of his bowel and bladder. At which spinal cord level did this patient MOST likely sustain his injury and which nerves have therefore been affected?

S1-S5 Sacral Nerves. **The spinal cord does not extend beyond the lumbar spine. L2 is the lowest vertebral segment that contains the actual spinal cord. After this level, nerve roots exit each of the remaining vertebral levels beyond the spinal cord. Damage to the spine at the sacrum levels affects the nerve roots as follows: S1 - the hips and groin area S2 - the back of the thighs S3 - the medial buttock area S4 & S5 - the perineal area The pelvic organs are also controlled by the nerves in the sacral region. These organs include the bladder, bowel and genitals. The sacral plexus is formed by the anterior rami of the sacral nerves S1, S2, S3 and S4. The sacral plexus is a network of nerve fibres which supplies the skin and muscles of the pelvis and lower limb. There are 5 major nerves within the sacral plexus. These major nerves can be remembered by the saying Some Irish Sailor Pesters Polly. The first letter of each of these words stands for Superior Gluteal nerve, Inferior Gluteal nerve, Sciatic nerve, Posterior cutaneous nerve, and Pudendal nerve. The superior gluteal nerve is a motor nerve that innervates the gluteus medius, gluteus minimus and tensor fascia lata. The inferior gluteal nerve is also a motor nerve, which innervates gluteus maximus. The sciatic nerve is the largest. It is both a motor and sensory nerve. The motor nerve component of the sciatic nerve innervates the muscles in the back of the leg and the sole of the foot. Sensory neurons of the sciatic nerve are found in the skin of parts of the leg and the foot. The posterior cutaneous nerve is a sensory nerve which innervates the skin of the back of the thigh and lower leg, as well as the perineum. The pudendal nerve has both sensory and motor functions. It innervates the genitals, anal and urethral sphincters.

Following an above-knee amputation, what should be addressed FIRST when working with a 57-year-old diabetic patient who has impaired sensation in their residual lower limb?

Skin inspection. **The first thing that should be addressed with a patient who recently had an amputation is a skin inspection. Being diabetic and having impaired sensation makes skin inspection even more crucial for this patient because skin breakdown could lead to another amputation. Skin inspection should be an immediate precaution that needs to be assessed before beginning intervention. If there is any skin breakdown, steps need to be taken to ensure that intervention strategies won't further compromise skin integrity

A COTA® is educating a patient who is due to undergo a total hip arthroplasty about post-op precautions. In terms of sleeping positions, what should the patient be advised to avoid during the initial stage of his recovery?

Sleeping in prone. • **Avoid putting pillows under your knees as you sleep. • Avoid sleeping on your stomach, as it is difficult to prevent your hip from twisting/rotating. The best position to sleep in after total hip replacement is on your back with a pillow between your legs. You can also sleep on your non-operative side with two pillows lined between your legs. When you're sleeping on your back, make sure you don't cross your ankles or legs. When you're sleeping on your side, avoid bending your knees.

A COTA® is working with an elderly patient who has recently undergone a posterior hip replacement. What is the safest position for this patient when performing lower body dressing?

The best position would be to use a supported chair. The safest position would not be supine for LB dressing for someone who just had hip surgery. If they have posterior precautions they would be at risk of breaking these precautions because they would be bending further than 90 degrees, rolling side to side to pull pants up, etc. It is recommend to give the patient a supportive chair with arm rests or a wheelchair when working on this task with patients.

A patient has swelling in an upper extremity due to an obstruction in her lymphatic vessels. What is this condition called?

The correct term is lymphedema ** Lymphedema is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system, which normally returns interstitial fluid to the thoracic duct and then the bloodstream. Though incurable and progressive, a number of treatments can ameliorate symptoms. Tissues with lymphedema are at risk of infection.

When completing a home visit with an 84-year-old woman who is recovering from hip replacement surgery, what is the MOST important aspect of the woman's functioning within her home that should be assessed?

The height of the woman's toilet. **Toilets, especially older models, are often at a height that requires significant hip flexion to sit down. If the woman's toilet is low and the woman must bend her hip past 90 degrees of flexion to sit, she risks dislocating her new hip. The woman may need a raised toilet seat to compensate for the height of her toilet, so this height is important to measure during the evaluation. The other items are also important to assess, but are not likely to place the integrity of the woman's new hip in jeopardy.

What is the best strategy to help an elderly man who is visually impaired, identify common toiletry items (hairbrush, deodorant, and toothpaste), taking into consideration that these items are colored differently and are not all placed in an upright position?

The most appropriate procedure would be to place items in labeled open containers in an upright position Items should be placed in the upright position in labeled containers where the patient can easily access them. **Because the patient has a visual perceptual disability, he may confuse items even if only one set is available. While a home aide may be necessary in some circumstances, the goal of adaptive interventions is to allow the patient to be as independent as possible. The sense of touch alone may not be adequate and may be influenced by visual perceptions. Additionally, some toiletry items are similar in shape. The patient should continue with remedial exercises, such as sorting and identifying, to improve perceptual skills.

Which of the following assistive devices is most effective in helping an elderly woman who is recovering from C1 SCI to breathe?

The most effective help would be to provide a mechanical ventilator **A nasogastric, like all feeding tubes, helps supply food to the patient and is used especially in individuals with high risk of aspiration. An oxygen mask, although beneficial, is not the most effective in this scenario. An individual with a C1 injury has no diaphragmatic function and requires a mechanical ventilator.

What is the most likely reason why a patient who recently had their second digit amputated, would complain of pain and tingling in that missing digit, when there are no signs of swelling or inflammation in the affected hand?

The most likely reason would be phantom pain. **Phantom pain is pain that feels like it's coming from a body part that's no longer there. Doctors once believed this post-amputation phenomenon was a psychological problem, but experts now recognize that these real sensations originate in the spinal cord and brain

A 48-year-old male patient who is a sous-chef by profession, recently had to undergo an above elbow amputation of his right dominant extremity. The focus of OT intervention is on functional training of his myoelectric prosthesis. When addressing bilateral tasks such as cutting vegetables, what role does the patient's myoelectric hand play?

The myoelectric hand acts as the assisting hand and holds the vegetables to stabilize them. **During training of the use of a myoelectric hand, in almost all cases, the unaffected hand becomes the dominant extremity. The critically important component of sensory feedback is often the determining factor in deciding which hand to use as the dominant hand and a myoelectric hand lacks this distal sensory feedback. During purposeful and occupation-based bilateral activities it is therefore important for the OT practitioner to stress throughout the training that the myoelectric TD is used as an assist and a stabilizer. It is not appropriate to train a person with a unilateral amputation to eat holding a spoon, to write, or to brush their teeth using their myoelectric hand. Their unaffected hand takes over the role of the dominant extremity and performs these tasks.

A 52-year old man is voluntarily being seen for a driving assessment after recently being diagnosed with Parkinson's disease. The patient presents with no motor control or perceptual difficulties and his ability to alternate his attention between tasks is within the normal functional limits for driving. In terms of his visual acuity, measurements are 20/60 without his corrective lenses, and 20/40 with his corrective lenses, which is the level at which an individual can pass a driver's license test in the United States. How would you interpret the above visual acuity values of 20/40 and 20/60?

The patient is able to see at 20 feet what a person with normal vision could see at 40 feet, and without corrective lenses the patient is able to see at 20 feet what a person with normal vision could see at 60 feet. **20/20 vision is normal vision acuity (the clarity or sharpness of vision) measured at a distance of 20 feet. If you have 20/20 vision, you can see clearly at 20 feet what should normally be seen at a distance. The 20/40 measurement measures what the patient who is being tested can see at 20 feet in comparison to what a person with normal vision (20/20 vision) sees at 20 feet. Therefore, 20/60 vision measures what the patient sees at 60 feet in comparison to what a person with normal vision can see at 60 feet. D. This measures the refractive error of the eye and uses + and - symbols

A veteran with a spinal cord injury is performing a grooming activity on the inpatient rehabilitation unit. The OTA notices that the patient's right leg appears to becoming swollen, is changing color and is warm to the touch. What does the OTA suspect the patient is experiencing and what action should she take?

The patient is experiencing a deep vein thrombosis (DVT), the activity should be stopped immediately, and the OTA should notify nursing staff. **Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs. Deep vein thrombosis can cause leg pain or swelling, but also can occur with no symptoms. Deep vein thrombosis can develop if you have certain medical conditions that affect how your blood clots. It can also happen if you don't move for a long time, such as after surgery or an accident, or when you're confined to bed. Deep vein thrombosis can be very serious because blood clots in your veins can break loose, travel through your bloodstream and lodge in your lungs, blocking blood flow (pulmonary embolism). Deep vein thrombosis signs and symptoms can include: - Swelling in the affected leg. Rarely, there's swelling in both legs. - Pain in your leg. The pain often starts in your calf and can feel like cramping or soreness. - Red or discolored skin on the leg. - A feeling of warmth in the affected leg. If DVT is suspected, activity should be stopped. Nursing staff and the patient's physician should be notified so steps can be taken to prevent stroke or heart attack as a result of the DVT.

What activity would a patient who is functioning at Rancho Los Amigos 8 (Purposeful and Appropriate) be able to accomplish?

The patient will be able to come up with several solutions to a problem such as being out of milk when trying to cook macaroni and cheese. **Rancho Los Amigos 8 (Purposeful and Appropriate) At this stage, the person has purpose in daily living. • They can do more complex things such as meal planning and preparation, home tasks, and taking their medication. • They can recall and integrate past and present. • Carryover for new learning is evident. • The person needs no supervision once activities are learned and can be independent at home and in the community. • The person may continue to show some decreased abilities, reasoning, judgment, stress tolerance, and emotional and intellectual capacity compared to pre-injury, yet be functional in society.

A OTA® is training a caregiver on how to assist a 27-year-old patient who recently sustained a complete C6 spinal cord injury. The focus of the training is currently on bed to wheelchair transfers, using a sliding board. The OTA® is working with the caregiver and the patient at the patient's home, where the patient has an adjustable bed with bed rails. What part of the transfer sequence will the patient MOST LIKELY have the ability to perform without assistance ?

The patient will be able to lock their elbows while rocking slightly forward and side to side as the caregiver places the board underneath their hips. **The patient has possible movements of scapular protraction, some horizontal adduction, forearm supination, and radial wrist extension. Gravity-assisted movements of the trunk while locking the arms by passively extending the elbows allows the patient to slide along the board, as long as the caregiver supports the hips and holds the board. A. This requires the ability to sit upright unsupported while managing both lower extremities with the arms. B. This requires the ability to use the triceps in order to perform depression transfers. C. This requires the ability to use one's fingers to manipulate power controls.

When working with a patient who is recovering from a 3rd degree burn injury, what phase of OT intervention aims to enhance performance skills, provide adaptive equipment, and teach alternative techniques in self-care as needed?

The phase would be the rehabilitative phase. **Post-operative Intervention: - 72 hours: dressing changes, splint at all times - 5-7 days: begin AROM, light ADL, sterile whirlpool, meaningful activities (MA) - Over 7 days: PROM as tolerated, ADL, MA - Use massage - when wounds are healed - Order compression garments

Using the GCS, if a TBI patient does not respond in any way to being pinched (specific stimulus), what score would you assign him for Motor Response (M)?

The score would be 1. **The Glasgow Coma Scale (GCS) is the most common scoring system used to describe the level of consciousness in a person following a traumatic brain injury. The GCS is a reliable and objective way of recording the initial and subsequent level of consciousness in a person after a brain injury. Clinicians use this scale to rate the best eye opening response, the best verbal response, and the best motor response an individual makes. The final GCS score or grade is the sum of these numbers. The Glasgow Coma Scale—based on a 15-point scale for estimating and categorizing the outcomes of brain injury on the basis of overall social capability or dependence on others Motor Response 6—Obeys commands fully 5—Localizes to noxious stimuli 4—Withdraws from noxious stimuli 3—Abnormal flexion (i.e. decorticate posturing) 2—Extensor response (i.e. decerebrate posturing) 1—No response Verbal Response 5—Alert and oriented 4—Confused, yet coherent, speech 3—Inappropriate words and jumbled phrases consisting of words 2—Incomprehensible sounds 1—No sounds Eye Opening 4—Spontaneous eye opening 3—Eyes open to speech 2—Eyes open to pain 1—No eye opening Four possible levels for survival (3 is low/15 is perfect): Mild (13-15) Moderate Disability (9-12) Severe Disability (3-8) Vegetative State (<3)

A patient in the burn unit has been referred for OT intervention. The patient's chart reveals that the degree of burns they sustained from their injury has resulted in nerve damage. What degree of burn affects nerve endings?

Third-degree burn. **Burns can be classified as first-degree, second-degree, third-degree, or fourth-degree depending on how deeply and severely they penetrate the skin's surface. Burns classified according to the depth of tissue injury largely determines the healing potential and the need for surgical grafting. 1. Epidermal (superficial; was first degree) burns involve only the epidermal layer of skin. 2. Partial-thickness burns (was second degree) involve the epidermis and portions of the dermis. They are characterized as either superficial or deep. 3. Full-thickness burns (was third degree) extend through and destroy all layers of the dermis and often injure the underlying subcutaneous tissue. These burns affect all three skin layers: epidermis, dermis and fat. The burn also destroys hair follicles and sweat glands. Because third-degree burns damage nerve endings (sensory nerve), the patient probably won't feel pain in the area of the burn itself, rather adjacent to it. 4. Deep burn injury (was fourth degree) extends into underlying soft tissue and can involve muscle and/or bone. In more detail: 1. First-degree (superficial) burns. First-degree burns affect only the outer layer of skin, the epidermis. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and often consists of an increase or decrease in the skin color. 2. Second-degree (partial thickness) burns. Second-degree burns involve the epidermis and part of the lower layer of skin, the dermis. The burn site looks red, blistered, and may be swollen and painful. 3. Third-degree (full thickness) burns. Third-degree burns destroy the epidermis and dermis. They may go into the innermost layer of skin, the subcutaneous tissue. The burn site may look white or blackened and charred. 4. Fourth-degree burns. Fourth-degree burns go through both layers of the skin and underlying tissue as well as deeper tissue, possibly involving muscle and bone. There is no feeling in the area since the nerve endings are destroyed.

A patient who has glaucoma has significant difficulty walking within her home. She easily becomes disoriented to direction and location and cannot find her way around. She is also constantly tripping and bumping into objects. What technique should this patient be trained in, to assist her with mobility in her home?

Trailing Technique. **Trailing is a method that can be used to get to a desired location while maintaining contact with a surface. This means of travel is taught to facilitate orientation by memorizing landmarks located along a frequently travelled route. This technique involves the patient using the back of her hand to feel the wall to the same side and slightly to the front of her location as she walks. Her hand will touch obstacles and doorways as she encounters them, helping the patient to know where she is in her home.

An inpatient who had an anterolateral right total hip replacement, 10 days ago, is beginning training in IADLs. The patient's session is taking place in the kitchen and he is using a front-wheeled walker, to assist him with his mobility. The patient is preparing to make spaghetti bolognaise, using pasta and a jar of marinara sauce. During the meal preparation , the patient requires moderate verbal cues to ensure that he adheres to his hip precautions, by using proper body mechanics. Which one of the anticipated errors would the COTA® MOST LIKELY prevent by cueing the patient?

Transporting ingredients from the counter to the kitchen island by lunging and stepping forward onto his left leg. **In an anterolateral approach, the patient must prevent hip adduction, external rotation, and hyperextension of the operated leg. When the patient is about to step forward and lunge onto his left leg, he is leaving his operated leg behind him, thereby, breaching his hip precautions for hyperextension. It would be best to keep the items close to his body and ambulate to the kitchen island using a walker tray. A, B and D. These do not interfere with the hip precautions for the anterolateral approach.

Virginia, a 65-year-old woman who has a history of osteoarthritis, had to have a knee replacement 4 weeks ago due to joint degeneration. Virginia is generally an active person but post-op she has had little interest in pursuing her interests which are swimming, teaching outdoor painting to adults, and playing word games on her smartphone. During a recent home health visit by the COTA®, it was identified that her major barrier to resuming her leisure activities is fatigue. Virginia has already been taught activity pacing strategies to help her conserve her energy, but she has seen minimal improvements and it has therefore been difficult for her to persevere with these strategies. The COTA® decides to introduce a visual feedback strategy to help motivate Virginia to self-manage her symptoms of fatigue while participating in her preferred activities? Which visual feedback strategy would be the MOST EFFECTIVE in helping Virginia manage her fatigue?

Use of a pedometer app to measure movement, and a handwritten journal to log daily activities. S **Since the patient is familiar with smartphone technology, a phone app that measures her steps and movements throughout the day along with logging the activity in a notebook will help her visually track the trends in her activities and determine when symptoms of fatigue occur. In this way, she will be able to implement fatigue management strategies more effectively, continue to measure the effects of strategies on patterns of fatigue, and see results. A. This measures response of the heart's performance during an activity but does not measure overall fatigue. B. External feedback from other people is more appropriate for monitoring and correcting behavior. D. This measures lung function and volume, and logging would track the effects of activity on lung function, not patterns of fatigue.

An OT practitioner is working with a morbidly obese patient in their home. The focus of the session is on assessing whether the patient is able to wash themselves using a bariatric transfer tub bench set-up in the bathtub. Which factor is likely to have the MOST impact on the patient's safety during this task?

Water spillage from the tub. **Morbidly obese is defined as an individual with a body mass index (BMI) of 40 or greater. Individuals who are exceptionally large experience difficulty performing ADLs and IADLs. A bariatric transfer tub bench set-up in the bathtub can eliminate the need to stand to shower, thus increasing safety and conserving energy. The bench should be built to accommodate the user's weight. The larger equipment may not be easily obtainable and may need to be special ordered. Evaluating potential issues with water spillage from the tub is essential as an obese person using a transfer tub bench that fits into the standard tub may encounter problems managing water overflow because the width of their hips may cover the area on the bench originally designed for placement of the shower curtain, and water on the floor can lead to a fall. B. Grab bars should be installed to prevent falls and ease transfers. A licensed contractor must securely mount these as suction grab bars which are commercially available would not be safe for this patient as the amount of pull and weight would cause the suction to release from the wall. However, the information provided in the question only states That the patient is using a bathtub to bathe themselves. It cannot be assumed that a shower is available. C. The use of a hair dryer to thoroughly dry one's skin in hard-to reach areas such as buttocks, crotch, or on abdominal folds is highly recommended to prevent rashes and fungal infections in the folds. However, the question is asking about potential safety risks during bathing and not after when drying oneself.

A 25-year-old woman who recently sustained a T3 SCI is concerned about being able to live a fulfilling life with her injury. She fears that she will "never be able to be intimate with another person ever again." In this scenario, how should the OT practitioner INITIALLY respond to the patient's concerns?

"It is natural to continue to have physical, emotional, and sexual needs after a SCI". **The OT should validate the patient's feelings and make sure the patient understands that her concerns are legitimate. Sexuality is an ADL that plays an important part in an individual's life. Sexuality and sexual participation are common concerns for individuals with disability and chronic illnesses. Research has shown that sexuality and concerns with sexual participation after a disability can impact an individual's quality of life and self-esteem. As health care professionals, occupational therapy practitioners are well equipped to address sexual participation and sexuality with patients to maximize engagement and satisfaction. OT entails client-centered and occupation-based interventions that maximize engagement and participation in meaningful ADLs. The effects of an illness or disability on the ability to participate in sexual activity can be addressed with occupational therapy intervention. Occupational Therapy practitioners are in an excellent position to normalize sexual health as part of rehabilitation and assist in specifics for sexual activity, such as adaptive sexual devices, environmental controls, and adapted clothing.

Rancho Los Amigos Levels of Cognitive Functioning

1.No Response = total assistance- not even response to pain 2. Generalized Response = total assistance- general response to pain, gross body movements, vocalizations, response may be delayed 3.Localized Response = total assistance- withdrawal to painful stimuli, turns towards sound, blinks to light, eyes follow object, response to family members, moving to music 4.Confused/Agitated = maximal assistance-alert, try to remove restraints, can sit, stand, walk, aggression, mood swings, uncooperative, incoherent 5. Confused/Appropriate/Non-Agitated = maximal assistance- wander around, non-oriented to person, time, place, brief periods of attention, poor memory/learning, can respond to simple commands, able to converse for brief periods, making a sandwich 6. Confused Appropriate = moderate assistance- sometimes oriented to person, time, place, able to do task for 30 mins in structured environment, slight remote memory, carryover of easy tasks, unaware of impairments, appropriate verbal responses, repetitive self-care 7. Automatic Appropriate = minimal assistance for ADLs- oriented to person, time, place, 30+ min on task in familiar environment, carryover of new learning, awareness of the condition, can't estimate consequences of their actions 8. Purposeful appropriate - standby assistance - has memory of past events, can do household and community work, leisure; depressed, irritable, argumentative, recognizes inappropriate social behavior 9. Purposeful appropriate: standby assistance on request - 2+ hours on task, can do work and leisure, aware of impairments, able to think about consequences, depression, irritable, self-monitors appropriately 10. Purposeful appropriate - modified independence - able to multitask, independently maintains memory, anticipates consequences, brief depression periods, socially appropriate, low frustration tolerance

A senior has just suffered a right upper extremity amputation and he wants to start dancing again. This patient needs to get an artificial limb. What professional would make this?

A Prosthetist **A prosthetist, as defined by The American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., is a person who measures, designs, fabricates, fits, or services a prosthesis as prescribed by a licensed physician, and who assists in the formulation of the prosthesis prescription for the replacement of external parts of the human body lost due to amputation, congenital deformities, or absences.

Jason, a 45-year-old backhoe operator, recently injured his spinal cord at the level of T2. The COTA® has been educating Jason on strategies to compensate for his sensory loss in order to prevent the development of skin breakdown and pressure ulcers. Jason is independent in all his transfers and he tends to spend most of his day in a seated position. He enjoys reading science fiction books and plays Dungeons and Dragons with his friends for 3 hours, once per week. What strategies would the patient be able to perform in order to maintain skin integrity? Choose the best 3 answers.

A. Use a long, curved mirror to inspect the bony prominences of the lower body. D. Lift his body away from the surface to avoid shearing forces. E. Rolling side-to-side to monitor and ensure dryness of the skin using touch. **The bony prominences are more prone to pressure ulcers and can be monitored using a curved mirror. The patient has intact motor and sensory upper extremity function to check and ensure that the skin is dry, especially around the perineal area, to prevent bacterial growth and infection, which is a precursor to skin breakdown. B. The patient has compromised vital capacity and endurance to perform a demanding task. C. The patient is unable to bridge; it requires leveraging from the feet. The ability to perform anterior weight shifting for pressure relief can be performed as low as C6 SCI requiring gravity assist at the trunk. F. The patient does not require a reclining shower chair.

Using everyday objects, how would you screen a patient's visual perceptual skills to identify if there are any deficits in this area?

Ask the patient to pick an apple from a fruit basket. **Visual perception is the ability to see and interpret (analyze and give meaning to) the visual-information that surrounds us. By choosing the apple from the fruit basket, the patient is required to use visual discrimination and figure ground perceptual skills. A. This would assess stereognosis which is the ability to recognize and identify common objects through tactile manipulation without the use of visual cues. B. Graphesthesia, also called graphagnosia, is the ability to recognize symbols when they're traced on the skin. D. This assesses memory (ability to recall information).

Myra is a 61-year-old patient who sustained a third degree burn to her left elbow and forearm 3 months ago. She completed her course of outpatient therapy two weeks ago, but a message from Myra's doctor has been received that she is developing heterotopic ossification at the burn site. What type of OT intervention is indicated to address this condition?

Active range of motion within Myra's pain limits. **Heterotopic ossification is the development of bone on the outside of the body, usually around a site that has sustained trauma such as a severe burn. It can totally immobilize an affected joint if it is not addressed. There are no cures or effective treatments for this condition, but research shows that a regular active range of motion program can maintain existing joint range of motion. Research is mixed on the use of passive range of motion for this condition. Splinting would only be used if the ossification is progressing in spite of range of motion and the patient's joint must be positioned to allow functional use of the limb.

What would an OTA recommend to a senior male who is chronically ill and lives with family members, but during work hours needs a place to eat meals, relax, receive both mental and social stimulation, and requires an appropriate "aging in place" setting?

Adult day care **Adult day care is a planned program of activities designed to promote well-being through social and health-related services. Adult day care centers operate during daytime hours, Monday through Friday, in a safe, supportive, cheerful environment. Nutritious meals that accommodate special diets are typically included, along with an afternoon snack.

A 58-year-old female presents with little or no voluntary control of her bowel & bladder and a bilateral loss of function in her hips and legs. Based on this information, what type of nerve injury did this patient most likely sustain?

An injury to S1-S5 Sacral Nerves. **In addition, patients can manage their bowel and bladder on their own with special equipment. Most likely will be able to walk.

What are three compensatory techniques an OTA can teach a patient who recently had a hip replacement? Select the best 3 choices.

B. Storing frequently used items at eye to waist level. C. Using adaptive equipment such as a long-handled shoehorn. E. Sitting vs. standing when completing dressing and bathing tasks. **Teaching a patient compensatory techniques such as using long handled adaptive equipment, storing frequently used items at eye to waist level, and sitting vs standing when completing dressing and bathing tasks will help the patient to maintain the hip in a neutral position with no flexion past 90 degrees and no adduction.

Pre-discharge, a COTA® is educating an obese patient who has multiple physical and mental health diagnoses about ways of how they can manage their GERD at home. What are the MOST beneficial recommendations the COTA® should provide to this patient? Select the 3 best answers.

B. Stress Management. C. Diet modifications- less spice, less alcohol, small meals more frequently. E. Sleeping with multiple pillows to elevate the head. **B. It is suggested that a contributing factor for GERD may be anxiety. When people are anxious they tend to engage in behaviors that may trigger or worsen acid reflux, like smoking, drinking alcohol, or eating fatty or fried foods. These can be soothing behaviors that can then lead to the pain and discomfort of heartburn. The reverse may also be true as GERD symptoms, such as chest pain and trouble swallowing, can be worrisome and increase anxiety or trigger a panic attack. It's important to remember that an association does not imply causation. C. Foods commonly known to be heartburn triggers cause the esophageal sphincter to relax and delay the digestive process, letting food sit in the stomach longer. Trigger foods are high in fat, salt or spice such as: • Fried food • Fast food • Pizza • Potato chips and other processed snacks • Chili powder and pepper (white, black, cayenne) • Fatty meats such as bacon and sausage • Cheese • Tomato-based sauces • Citrus fruits • Chocolate • Peppermint • Carbonated beverages Instead of eating three large meals, it may help to eat five or six smaller meals throughout the day. This will give your stomach time to empty after you eat, minimizing the pressure on the LES and reducing the risk of acid reflux. E. The reason why symptoms may be worse while lying flat is that the position puts the stomach and the esophagus on the same level. This can result in the acid from the stomach more easily flowing into the esophagus. When standing or sitting up, gravity can help keep the stomach acid where it belongs and out of the esophagus. Using a pillow that raises the upper body while lying down or sleeping helps gravity help keep the stomach acid in the stomach. Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus. Most people can manage the discomfort of GERD with lifestyle changes and over-the-counter medications. But some people with GERD may need stronger medications or surgery to ease symptoms. Factors that can aggravate acid reflux include: • Smoking • Eating large meals or eating late at night • Eating certain foods (triggers) such as fatty or fried foods • Drinking certain beverages, such as alcohol or coffee • Taking certain medications, such as aspirin

What is the medical term used to describe a patient's loss of their peripheral vision?

Bitemporal hemianopsia - **vision is missing in the outer half of both the right and left visual field. The visual field of each eye can be divided in two vertically, with the outer half being described as temporal, and the inner half being described as nasal. "Bitemporal hemianopsia" can be broken down as follows: bi-: involves both left and right visual fields temporal: involves the temporal visual field hemi-: involves half of each visual field anopsia: blindness

At what SCI level can a patient start doing depression transfers?

C6-7. **A patient at C6-7 can do depression transfers. A patient at C7 SCI has elbow extension, full strength of entire shoulder, limited grasp, release, and dexterity.

Visuospatial deficits are a common and early sign of dementia. As the OT practitioner working with a patient who presents with symptoms of dementia, which tool is the MOST effective for screening for visuospatial deficits?

Clock-Drawing Test. **Visuospatial ability is affected in multiple types of dementia, including in the very early stages of Alzheimer's disease. The Clock Drawing Test (CDT) is a nonverbal screening tool in which the patient is asked to draw a clock. Placement of the numbers around the circle requires visual-spatial, numerical sequencing, and planning abilities. A. The Assessment of Motor and Process Skills (AMPS) is an observational assessment that allows for the simultaneous evaluation of motor and process skills and their effect on the ability of an individual to perform complex or instrumental and personal activities of daily living (ADL). B. The Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) is too lengthy to use as a visual perception screening tool. E. The Modified Ashworth Scale is the most universally accepted clinical tool used to measure the increase of muscle tone.

Rancho Los Amigos Levels 1-10 is an evaluation tool used to measure what, in patients with TBI?

Cognitive Functioning

What is the best adaptation for a patient complaining of a lack of clarity when looking at her kitchen supplies?

The best adaptation would be to increase background contrast. **Visual acuity (VA) is acuteness or clearness of vision. It depends on optical and neural factors: the sharpness of the retinal focus within the eye, the intactness and functioning of the retina, and the sensitivity of the interpretative faculty of the brain.

A patient was admitted to the surgical ward for an above-knee amputation, one week ago, due to a gunshot wound. While working with the patient, who is seated in a wheelchair, practicing donning his trousers, he suddenly reports feeling light-headed with pain in his left arm. What is the BEST action for the OTA to take, in this scenario?

Use the call button to ask for immediate medical assistance. **Left arm pain might be a sign of a heart attack so nursing staff should be notified immediately.

Bobby was involved in a MVA 2-months ago which resulted in him sustaining a C3 Spinal Cord Injury. He uses a sip-and-puff power wheelchair and is in the process of adapting his home to his needs. Bobby wants to be able to access the thermostat to adjust the temperature of his single-level condominium. What is the MOST IMPORTANT feature that should be considered when selecting an appropriate control interface?

Ease of the patient's ability to access and operate the device. **It is most important to consider what the patient's functional abilities are first. It is important to consider his capabilities first, to narrow down a selection for the control interface.

What is the BEST intervention for edema control in a patient admitted to acute care, 72 hours after a burn?

Elevation of body part. **Elevation encourages drainage of fluid and allows it to be reabsorbed by the body. The swollen part should be positioned above the level of the heart so that gravity can assist with the drainage.

A 67-year-old male patient has moderately low vision secondary to macular degeneration. One of the patient's goals is to make a Thanksgiving dinner for his entire family. What is the most important client factor to consider when working with this patient?

Peripheral vision. **This patient has macular degeneration which means a loss of central vision. Before working with this patient, it is important to consider how much peripheral vision he does have. If the patient's vision deficit becomes severe and he cannot see at all, then the OT practitioner must consider tactile discrimination.

The COTA® is planning on initiating treatment with Celia, a patient in the intensive care unit who has sustained third degree burns on 70% of her body. What treatment techniques should the COTA® plan on using during Celia's first few treatment sessions? Select the best 3 answers.

D. Positioning for edema control. E. Splinting to maintain the involved extremities in an antideformity position. F. Active range of motion activities as tolerated. **Since Celia is in the intensive care unit she would be in the acute phase of rehabilitation. Treatment techniques that should be used during this phase include positioning for edema control, splinting to prevent contractures as well as passive and active range of motion activities as the patient will tolerate. - Preventive Positioning: The purpose of preventive positioning is to reduce edema and maintain the involved extremities in an antideformity position. Elevation of the entire extremity above heart level can reduce the severity of distal edema formation, especially when paired with AROM exercises. - The focus of movement in the acute phase is to preserve ROM and functional strength and decrease edema. A, B and C. It is too early in the course of treatment for scar massage, self range of motion exercises, or activities focusing on specific fine motor skills.

Ricardo, a 74-year-old patient with a BMI of 30 who has been diagnosed with Diabetes Mellitus Type II had to undergo a transfemoral amputation, a week ago. Ricardo has now been transferred to a post-acute rehabilitation facility, where he is receiving OT. While an COTA® is working with him on lower body dressing techniques, Ricardo states, "This should be a piece of cake. I've put my pants on all my life". What is the MOST important aspect of the education process, that the COTA® should focus on at this point in Ricardo's ADL training?

Energy conservation and work simplification. **Ricardo may be unaware , following an amputation, that energy expenditure during basic ADLs is expected to be high with patients who have undergone an amputation. Energy expenditure increases with age and weight. Therefore, due to deconditioning and obesity, it would be necessary to teach activity pacing and monitor perceived exertion, simplify work, and coordinate breathing with movement during dressing. A. Bridging is a technique used for bed mobility training. B and C. Prosthetic training and balance activities would be addressed afterwards.

A 42-year-old male songwriter has recently begun to experience difficulty reading what he has typed on his computer due to a visual impairment caused by early-stage cataracts. What is the best computer adaptation to recommend to this patient at this stage of his disease?

Font enlargement. **A cataract is a clouding of the lens of a patient's eye. This can make it difficult to see what is on the computer screen. Most cataracts develop slowly. During the early stages of cataract development, the OT can recommend a magnifying glass or font enlargement so the patient can see the screen.

A patient with a C6 spinal cord injury is being educated on how to use a button hook and zipper pull to perform upper body dressing tasks in bed. To provide the patient with some pressure relief while performing the dressing task, what would be the best approach?

Forward weight-shifting or sitting using loops. **To perform pressure relief techniques in bed, the patient is capable to use loops and forward weight-shifting to relieve pressure.

If a patient has brief depression periods but can multitask, independently maintain memory, and anticipate consequences, what would his Rancho Los Amigos level be at?

He would be assessed at Rancho level X

A patient who has a T10 SCI has developed a Stage 3 decubitus ulcer on his sacrum and has therefore been admitted to an inpatient facility for wound care. The patient is independent in his self-care, only requiring stand-by assist for bathing. Pain and upper body weakness due to deconditioning have been identified as his barriers at this time. The discharge plan for this patient is for him to return home, and for continued wound care management to be implemented through home health care. The patient has stated that when he returns home, he would like to be able to continue using his riding lawn mower. Which aspect of him using his lawn mower could prevent him from achieving his goal?

If the method of transfer produces a shearing effect. **A shear force is described as a sliding or rubbing in the same direction as the movement. It is considered in therapy during movement as it can cause skin damage or breakdown. Therefore, the person should focus on upper body strengthening and weight shifting to offload the forces at the sacrum. A. The biceps will need to be activated and the lumbar spine may not be fully supported. However, this does not place a negative impact on the patient's ability to use his mower. C. Compression forces occur during compression transfers when the patient pushes with both arms to lift his body. This method will avoid shearing, therefore, does not impact on his use of the mower. D. Rotational forces are expected to occur in a squat-pivot method. However, the patient is unable to perform a squat-pivot method due to lower body paralysis.

Willard is an 87-year-old male who suffered a CVA 3 months ago. He previously lived alone in a double-story home but after his Stroke, was transferred to a SNF to receive rehab services. Willard's progress over this time has been limited and he continues to need moderate to maximum assistance with his BADL and IADL tasks. Willard has been informed by Medicare that they will not continue to pay for his to stay in the rehabilitation wing of the skilled nursing facility past 100 days. At Willard's discharge planning meeting, what should the OT practitioner recommend in terms of Willard's living situation?

Move to the long-term care wing of the skilled nursing facility. **Willard has been actively participating in his rehabilitation program for 3 months, but has not gained the level of independence that he needs to move back home, even if he employs home health aides to help him with his ADL tasks. Medicare will not continue to pay for Willard to stay in the rehabilitation wing of the skilled nursing facility past 100 days, so he will have to pay privately or move. Willard would need to be able to complete his ADL tasks with stand by to minimal assistance only, to be able to move to an assisted living apartment. Since Willard cannot meet the requirements for living in a more independent setting, moving to the long term care wing of the skilled nursing facility is the best option

Ethel has severe osteoarthritis in her neck and shoulders. She lives alone in her own home and is independent with most activities, but she has trouble reaching into the upper cupboards of her kitchen to retrieve dishes. What adaptation could the OTA recommend to help Ethel access her dishes?

Place frequently used dishes on the countertop. **If Ethel has severe osteoarthritis in her neck and shoulders, she will probably have just as much difficulty reaching down and into a lower cupboard as she has reaching into an upper cupboard. Placing the dishes on the countertop will insure that the dishes are located between chest and waist height, making the easy for Ethel to access.

An OTA working with several patients in a senior nursing facility, is making recommendations to for low vision. What are the best ways to modify the environment, to ensure the patients' safety especially at night?

Place night lights in the patient's room and along the path to the bathroom. **Modify the environment with the following: o Place night lights in the patient's room along the path to bathroom. o Place fluorescent strips of tape along the edges of the sink, toilet and near bed. o Place clock at eye level. o Mark call light with bright color. o Bring TV closer.

An OTA is working with a patient who is recovering from a recent TBI. The focus of the intervention is currently on meal preparation. The patient has successfully prepared cold cereal. In order to appropriately grade this activity, what is the next type of meal the OTA should select, to help this patient progress to the next level?

Prepare a hot beverage, soup, or prepared dish. **The progression of graded cooking tasks is as follows: 1 - access a prepared meal 2 - prepare a cold meal 3 - prepare a hot beverage, soup, or prepared dish 4 - prepare a hot one-dish meal 5 - prepare a hot multi-dish meal Based on this progression, the OTA should have the patient prepare a hot beverage, soup, or prepared dish to progress to the next level.

A COTA® is meeting a new patient for the first time. The patient recently had a left knee replacement, and her pain has been manageable. The patient immediately identifies that her most important goal at this stage of her recovery, is to be independent in her lower body dressing. However, the patient is reluctant to engage in dressing tasks in front of the clinician as she feels uncomfortable dressing in front of a stranger. How should the COTA® address the patient's apprehension with dressing during therapy so that she can still achieve her goal?

Provide oversized clothing so that the patient can dress over her own clothing. **The OTR® should respect the privacy and wishes of the patient. However, in order to analyze the patient's ability to perform a task as part of the patient's goals, it may be necessary to adapt the task for the purpose of maintaining the patient's dignity. A. This is a relaxation technique which is not indicated in this scenario. The patient's pain is manageable and her issue with being uncomfortable dressing in front of a stranger is valid, and not related to anxiety but for a desire for privacy. B. Allowing the patient to stand unattended would be unsafe. D. The patient's need for increased assistance is unlikely.

A 2-year-old child is participating in occupational therapy for prosthetic training. The child has absence of his right upper extremity at the proximal forearm level. What would be the most effective activity for the child to participate in FIRST?

Pushing a large therapy ball toward a target with his right upper extremity. **A gross motor activity that does not require opening of the prostheses should be introduced first to allow the toddler time to get used to the new prosthetics. The activity will help the toddler learn how to move his residual arms while operating the prostheses without the added requirement of holding objects with the terminal devices.

An OTA is providing passive range of motion to a patient in the intensive care unit who sustained a severe traumatic brain injury. The patient has been given a rating of 2 on the motor portion (M) of the Glasgow Coma Scale. During range to the left arm, the patient's body suddenly extends, causing the arm to straighten and fall down on the bed. What is the MOST likely cause for this reaction?

Range of motion of the patient's arm is painful for the patient. **A rating of 2 on the motor portion of the Glasgow Coma Scale may have been assigned due to the observation of decerebrate rigidity in response to pain. Decerebrate rigidity causes the arms and legs to extend and internally rotate. If this happened to the patient's left arm during passive range of motion, the patient may have been responding to pain during the motion.

A 62-year old patient with a history of diabetic retinopathy and early-stage Parkinson's has been admitted to an inpatient rehab facility due to a ground-level fall resulting in a tibial fracture of the left lower extremity. He now wears a CAM boot with current orders for weight-bearing as tolerated and is participating in a light, cold meal prep activity in the rehab kitchen. The patient suddenly reports feeling "shaky" with a headache increasing in intensity and states, "I wasn't able to eat breakfast and wanted to get here on time". What should the OTA IMMEDIATELY do next?

Report the change in medical condition to the charge nurse who will determine if the patient needs to adjust their blood glucose levels. **A rapid fall in blood glucose levels is called hypoglycemia. It causes the release of hormones, such as epinephrine. The release of these counter-regulatory hormones results in symptoms such as nervousness, irritability, nausea, palpitations, and tremor. Patients who are cooperative, lack CNS abnormalities, and are able to take liquids by mouth can be treated with oral carbohydrates such as glucose gel, juice or soda. Only give solid foods such as candy to a person with a normal level of consciousness. Since this patient's level of alertness and dietary restrictions are not clear, the OTA should report the change in medical condition to the charge nurse, who can then test the patient's blood glucose and take the appropriate action based on the test results.

An OTA has been assigned to work with a patient who is recovering from a recent TBI. The patient is alert and the plan is for them to be transferred to an outpatient rehab facility. When treating this patient, which deficit would have the MOST impact on the patient's ability to contribute to and participate in their OT intervention plan?

Self-awareness. **TBI survivors often have deficits in self-awareness and subjective well-being; they are often unaware of their acquired deficits. Impaired self-awareness reduces the motivation to participate in the rehabilitation activities, as they are deemed unnecessary, and this imposes significant challenges for recovery. Improving self-awareness is essential for improving cognition, as patients need to recognize their deficits in order to improve them.

Michael is a 53-year-old inpatient who was recently involved in a MVA which resulted in him sustaining a TBI and a minor injury to his left non-dominant upper limb. Michael has stated that his main long-term goal is to return to his job, working as a sales assistant in a men's clothing store. On a cognitive level, Michael is functioning at Rancho Los Amigos IX - Purposeful Appropriate. His static hand splint which he has been wearing for the past 6 weeks, has only just been removed and the focus of OT intervention is on facilitating bilateral hand function, and improving his sensory perceptual and attention skills. Which of the following activities would MOST EFFECTIVELY utilize an integrated functional approach involving the use of these skills in order to help Michael achieve his long-term goal?

Sorting through utensils in a drawer and making scrambled eggs on the stove. **Sorting through utensils uses sensory perceptual skills - visual and tactile feedback. Sustained attention is required to monitor and safely complete a cooking task. The patient's left hand can be involved as a stabilizer during the task. These tasks would therefore most effectively integrate sensory perceptual and attention skills, with bilateral hand use which are necessary for the patient's performance in his work tasks. A. Although this activity addresses hand function, it challenges the use of long and short-term memory and visuospatial skills for goals towards navigation rather than goals toward particular work-related tasks. C. This integrates the functions of strength, range or motion, and organization but does not address perceptual and attention skills. In addition,the patient may not be ready to work with heavy loads as he is just starting to use his left-hand again. D. This task places a high demand on the use of attention and problem-solving under time constraints, but it does not include sensory perceptual skills involving bilateral hand use

A patient who sustained a deep partial thickness burn to the radial side of the palm of his right hand is having a thermoplastic splint fabricated for him, in the hand clinic. His burn covers the thenar eminence and extends up to the PIP joints of the index and middle fingers. His wound has closed and is healing with scar tissue developing. How should this patient's hand be splinted?

Splint on the volar surface with MCP joints in full extension, IP joints in full extension, thumb in horizontal abduction. **Since the burn crosses joints and is forming scar tissue, the hand, thumb and fingers will need to be positioned in full extension to prevent the formation of contractures due to scarring. The wound is closed, so it is safe to splint over the volar surface with an appropriate wearing and cleaning schedule.

An OT practitioner is working with a female patient who has chronic lower back pain despite having had a L4-L5 lumbar fusion 4-years ago. The patient is finding using the toilet very challenging when she is having "a bad pain day". What is the BEST recommendation for this patient, when she is having an acute episode of back pain?

Straddle the seat and face the back of the toilet. **During an acute episode of back pain, a toilet can be used by straddling the seat and facing the back of the toilet. This offers a wider base of support and also provides use of the toilet tank when coming to a standing position. By using the toilet in this manner, the patient can be fully supported and have a wider base of support which enables them to keep their back aligned. Body mechanics is critical for back stabilization- maintaining a straight back, bending from the hips, avoiding twisting, maintaining good posture, and using a wide base of support. A. A raised toilet seat is traditionally used to limit hip flexion post hip-surgery which places more stress on the lower back when standing up.

What would be the BEST prosthesis for a patient who has had an above-elbow amputation? Prior to the amputation, the patient was a secretary at a law firm but will be switching jobs and will now be answering phones using a headset. The patient is independent in all one-handed skills and is mainly concerned about the appearance of their residual limb rather than the function of the prosthesis.

The best choice would be a cosmetic prosthesis. **The patient is independent with using one hand and does not need an active/functional prosthesis. The patient will therefore simply need a cosmetic prosthesis.

An OTA is establishing a patient's fall risk at home. The patient has fibromyalgia, high blood pressure, diabetes mellitus Type II, and bilateral knee osteoarthritis. The patient is able to transfer in and out of his tub-shower combo but has fallen 3 times, without any major injuries. The OTA has already ruled out unmanaged blood sugar, polypharmacy, and acute illness as contributing factors to the patient's falls. What is the MOST IMPORTANT factor to consider during information gathering?

The status of the patient's current cognitive skills, to be trained in adaptive techniques for safe transfers. **The patient has multiple diagnoses that already affect his ability to transfer safely, but his cognitive status has not yet been determined. The OTA should gather information about the patient's cognitive status to determine if he is considering his physical limitations when transferring in and out of his shower. If the patient's cognitive status is limited to the point that he is unable to remember adaptive transfer techniques, the OTA will need to pursue modifications to the patient's shower instead to prevent falls.

How can a patient with a C7 SCI achieve their goals of maximizing their independence when dressing?

Using a button hook. **SCI C7- Dressing independently but may need button hook as does not have full hand function. Motor levels representing upper and lower extremity function (and key muscles) are as follows: C5 - Elbow flexion (biceps) C6 - Wrist extension (extensor carpi radialis) C7 - Elbow extension (triceps) C8 - Finger flexion (flexor digitorum profundus) T1 - Small finger abductors (abductor digiti minimi)

A patient who recently sustained extensive injuries to both his lower limbs as a result of being shot multiple times, has had to have a bilateral above the knee amputation. After the patient has been medically cleared, what is the first aspect of OT intervention, the OTA should focus on?

Wrapping of the residual limbs for shaping and swelling. - **Steps for a lower extremity amputation - Wrapping of the residual limb for shaping and swelling - Desensitization - Upper strengthening with a focus on tricep strength - Transfer training - ADL training with a focus on lower extremity - Standing tolerance 7. Wheelchair mobility

What symptoms would you expect to observe if a patient with a SCI is experiencing orthostatic hypotension?

he symptoms would include lightheadedness, pallor, and visual changes. **Orthostatic hypotension - decrease in BP (result of lack of muscle tone in abdomen and BLE). Symptoms include lightheadedness, pallor, and visual changes. Check BP, If patient is in wheelchair elevate legs to bring BP WN, if symptoms persists, then recline w/c back to lower head.

A COTA is working with a 73-year-old patient who lives alone in an apartment, on the management of his medication. He has been diagnosed with diabetes mellitus 2 and is therefore at risk for developing peripheral neuropathy. While observing the patient retrieving his medication from the upper cabinet, the COTA observed certain actions that may be consistent with early symptoms of a peripheral neuropathy. What observations has the COTA noted, that would MOST LIKELY require her to report a change in the patient's status? Best 3 answers

•Dropping bottles in attempts to transport them to the table •Shaking his hands when trying to open a child-resistant medication bottle •Problems with coordination and proprioception while walking

An inpatient who had a posterolateral total hip replacement, 3 days ago, is beginning transfer training with a COTA®. The patient is working on transferring from a wheelchair onto a 3-in-one commode over the toilet. While adhering to the post-operative precautions and techniques, the patient verbalizes having difficulty extending the knee of their operated leg due to arthritic knee pain. As the patient has good standing balance with stand-by to supervised assist, the COTA® decides to modify the environment rather than the method of transfer. Which modification is the MOST EFFECTIVE to ensure a safe transfer while still adhering to the prescribed hip precautions?

Adjust the height and angle of the commode so that the front legs are slightly lower than the back legs. **In a posterolateral approach, the patient must maintain flexion of the hip no more than a 90 degree angle. Since the patient is having difficulty extending her leg out, to ensure THP adherence, adjusting the angle of the adjustable commode by 1 notch - front lower than the back legs, will ensure a safe transition to standing prior to returning to the wheelchair. A. This is contraindicated as raising the front legs forces a hip angle to more than 90 degrees. B. The cushion would promote increased hip flexion and is therefore contraindicated. D. Since the patient has difficulty extending her leg, modifying the angle of the commode seat would be most helpful.

Which example, as listed below, would BEST demonstrate that a patient has astereognosis?

Ask the patient to pick a quarter from a bag while their vision is occluded. **Stereognosis: the mental perception of depth or three-dimensionality by the senses, usually in reference to the ability to perceive the form of solid objects by touch.

A 56-year-old patient who lives with his 28-year-old daughter has recently started to experience difficulty identifying items in his pantry when a different brand is bought or the items are not facing with the label in front. Which of the following adaptations would assist the patient, the most?

Arrange the items in the pantry to be clearly visible and placed upright on the shelf. **Items can be placed in the upright position in labeled containers where the patient can easily access and see them. Since this patient has a visual perceptual disability, he may confuse items even if only one set is available. While a home aide may be necessary in some circumstances, the goal of adaptive interventions is to allow the client to be as independent as possible. The sense of touch alone may not be adequate and may be influenced by visual perceptions. Additionally, some pantry items are similar in shape. The patient should continue with remedial exercises, such as sorting and identifying, to improve perceptual skills.

An OT practitioner is working with a patient who recently sustained a crush injury to his right dominant hand which resulted in him undergoing a right wrist disarticulation. The patient is undecided whether he wants a prosthesis, and the focus of OT intervention is therefore on educating him about the care of his residual limb which has partial sensation. What are the MOST important strategies the OT practitioner should teach this patient to help him care for his residual limb? Select the 3 best answer choices.

B. Inspect the residual limb when removing the wrap and washing the limb. D. Visually track the residual limb when completing activities. E. Adjust the position of the residual limb when seated for extended periods. **F. It is best practice to teach the patient to learn to use their non-affected upper limb as their dominant upper limb as their sensation will be intact. A wrist disarticulation procedure is the surgical separation of the wrist and hand from the arm. A wrist disarticulation involves the removal of the carpal bones and all structures distally. A patient with an upper limb amputation requires instruction regarding the care and safety of their residual limb that lacks all or partial sensation. The patient should be taught to inspect the limb when removing the wrap and washing the limb. The patient is also taught to visually track a sensory-impaired residual limb when completing activities, adjusting the position of the limb when seated for extended periods e.g.: in a chair and reading to prevent stretch or compression injury to the tissues, and refraining from using the limb for sensory input, such as testing water temperature.

A patient has recently been admitted to acute care for second and third-degree burns on the dorsal surface of his forearm and hand. Which splint would be appropriate for this patient?

Intrinsic plus splint. **Burns to the dorsum of the hand require the metacarpophalangeal joints to be splinted in 70°-90° of flexion to prevent clawing of the fingers and shortening of the tendons and ligaments. This type of splint is also referred to as an antideformity splint or a safe position splint. A: A resting hand splint is for support or immobilization.