AOTA questions wrong
Stages of ALS
1. some weakness 2. moderate weakness 3. severe weakness 4. w/c for mobility, some assist 5. w/c for mobility, dependent 6. bed bound
the vest weigh no more than ____% of the child's body weight.
10
GBS acute phase - time line - symptoms
2-4 weeks edema, muscle weakness or paralysis, sensory loss, bladder incontinence, and pain—increase a client's risk for skin breakdown, especially a client who is totally dependent for most tasks - dysphagia/ difficulty speaking/ facial palsy - ascending pattern of symptoms from distal to proximal - bladder incontinence - stocking and glove distribution (decrease sensation) - increased pain - impotence - 20-30% require mechanical ventilation
Pressure relief typically should be performed every ______ to prevent skin breakdown
30 mins
Maintaining at least _____º of hip ______ will help reduce spasticity and can be achieved by adjusting the ______ of the chair or using a small ______ for the feet.
90º of hip flexion height stool
visual aids is best with what population
ASD
If safety and effective delivery of OT services is a concern then
Additional supervision is necessary
During the OTR®'s initial interview, a client with Stage 2 Parkinson's disease (PD) explains the importance of the client's role as head of household and expresses a fear of being dependent on his or her children. The client's chief complaints are tremors and fatigue, which are starting to affect the client's performance of higher level ADL and IADL tasks. Which intervention should be the OTR®'s focus? A. Energy conservation education, such as delegating tasks to family members to reduce fatigue B. Stress management skills, because stress tends to exacerbate symptoms such as tremors C. Activity and environmental modifications for home management skills to successfully maintain the client's role D. Therapeutic exercise to improve balance, which will enhance the client's participation in higher level tasks
C. Activity and environmental modifications for home management skills to successfully maintain the client's role
An OTR® is performing family training with a client with Stage VI amyotrophic lateral sclerosis (ALS) who is preparing for discharge home. Which points are MOST IMPORTANT for the OTR® to address? A. Adaptive equipment for ADLs and how to set up the client with ALS to perform as independently as possible B. Energy conservation for the client with ALS, as well as caregiver support resources to prevent burnout C. Positioning to prevent skin breakdown, a ROM home program, and safe bed mobility and transfers D. Therapeutic exercises for the client with ALS and how caregivers can use proper body mechanics
Correct answer is C A client with end-stage ALS would likely be totally dependent for all ADL and mobility, thus requiring major caregiver assistance for bed mobility and transfers. An OTR® instructing family members in these techniques would educate them on body mechanics. Positioning and ROM at this stage are important to prevent discomfort, contractures, and skin breakdown. A: A client with end-stage ALS would likely require total care for ADLs. B: Energy conservation is not appropriate because at this stage, the client would likely not be exerting extraneous amounts of energy. D: Therapeutic exercises are just one component of a home program.
Engagement in _______-______ interventions, along with daily ______, has been documented to assist in fall prevention
Engagement in activity-based interventions, along with daily structure, has been documented to assist in fall prevention
__________ ________ and ______ ________ evaluation are appropriate in situations when a work injury has occurred; these services are not used in _______ _______ planning.
FUNCTIONAL CAPACITIES WORK READINESS TRANSITION SERVICES
_______________ praxis enables a person to compare previous motor plans and sensory information to detect potential errors and correct the plan before attempting it again
Feedforward praxis
____________ indicates a lack of muscle tone with no resistance during passive movement
Flaccidity
Biomechanical approach
Focuses on client's physical capacity such as their movement, strength, and endurance Remediation!
demand for mastery
Forces produced by the environment which enable or restrict successful participation in occupations OA model
_________ is typically elicited during slow joint movements
Hypertonicity
Goals that aim to _______ skills in clients with dementia should be ______
IMPROVE AVOIDED
The primary goals for clients with dementia are related to ________ _________capacity
MAINTAINING FUNCTIONAL
sternal precautions
No pushing, pulling, lifting more than 10 pounds for 6 weeks avoid bilateral overhead or posterior movements to protect the incision site
GBS recovery phase intervention
OT intervention for this phase of GBS includes: 1. Design activities and dynamic splints to help maintain ROM, especially for the wrist, fingers, and ankle (hinged drop-foot orthosis 2. Instruct the client in safe mobility with appropriate assistive devices (if necessary), and help improve independence and safety with functional transfers 3. Suggest modified techniques for self-care and other adaptations for the client's daily routine 4. Continue to adapt modes of communication on the basis of the client's priorities 5. Educate the client on adaptive equipment and behavior modification techniques for home, leisure, community, and work activities 6. Provide strategies for energy conservation and fatigue management 7. Develop a client-centered fine motor program to maximize strength, coordination, and sensation in the hands and fingers 8. Complete a home assessment and recommend modifications as appropriate to help ensure the client's safe return home
GBS- Plateau phase intervention
OT intervention for this phase of GBS includes: 1. Develop and train the client in the use of communication tools, such as signs or picture boards 2. Provide environmental modifications to ensure access to the call button, remote controls, and phone 3. Adapt the phone for hands-free use 4. Adjust (and train caregivers on) supine and sitting positions that optimize function and comfort and reduce risk of skin breakdown 5. Position the client for trunk, head, and UE stability 6. Educate the client and family about the health condition and anxiety reduction techniques
Opening or closing the hips promote extensor tone?
Opening
Occupational Adaptation Model
Practice model that includes three basic tenets of person, environment, and the interaction of the person and environment Adaptation is achieved once there is experience with activity modifications followed by mastery of the occupation
GBS Recovery Phase - what happens - direction of recover - main force during this pahse
Remyelination and axonal regeneration occur during 2 year period. recovery starts at head and neck and travels distally. most people experience significant-complete return of function, fatigue as most common reported residual symptom focus on ADL/SELFCARE communication leisure reintergration
______ SKILLS have been found to be significant predictors of employment for individuals with ASD
SOCIAL
_________ is indicated when a sudden catch or resistance occurs within a quick movement throughout the range of motion for the extremity
SPASITICITY
A client is referred to a return-to-work program 3 months postlaceration with subsequent flexor tendon repair to the index finger. The client sustained the injury while working as a sous chef. Which option would provide the OTR® with the MOST comprehensive summary of the physical demands of the client's job? Dictionary of Occupational Titles (DOT) and O*Net Occupational Safety and Health Administration (OSHA) and National Institute of Occupational Safety and Health (NIOSH) Employer-provided job description and Occupational Safety and Health Administration (OSHA) U.S. Department of Labor and job demand analysis
Solution: The correct answer is A. The DOT is a standardized classification system used to define physical demands of work and occupations within the United States. It is the primary source for generic occupational descriptions worldwide and was last revised in 1991.O*Net is an online searchable database for information about occupations. Both DOT and O*Net are consulted when obtaining occupational information. B: OSHA is an agency of the U.S. Department of Labor. Its mission is to ensure safe and healthful working conditions. NIOSH, a division of the Centers for Disease Control and Prevention, is responsible for conducting research and making recommendations for the prevention of work-related illnesses and injuries. C: An employer-provided job description may not be the most inclusive or comprehensive source. D: The U.S. Department of Labor is the department of the U.S. government responsible for occupational safety, wage and hour standards, unemployment insurance benefits, reemployment services, and some economic statistics.
Continuous supervision
Supervisor is in sight of the supervisee who is working
An OTR® is planning intervention approaches for a client in the recovery stage of Guillain-Barré syndrome (GBS). According to the biomechanical frame of reference, which preparatory method is the BEST for addressing upper-body dressing? A. Instruct the client in hand-strengthening exercises using therapy putty to increase strength for manipulating fasteners on shirts. B. Measure the client for resting hand splints to wear at night to prevent contractures while ROM returns to bilateral hands. C. Teach the client how to use a dressing stick and button hook to don a formal shirt independently. D. Develop a home exercise program for the client for upper-body ROM and light strengthening and provide education on energy conservation and the importance of rest breaks.
The correct answer is A. A correctly addresses hand weakness and its effects on fine motor tasks of dressing. The biomechanical frame of reference is a common theory used in practice and focuses on restoring or remediating skills to enhance occupational performance. A hand-strengthening program would restore needed ROM and muscle power to adequately perform fine motor tasks. B, C, D: These are interventions aimed more at compensatory strategies and therefore fall under the rehabilitative frame of reference. These types of interventions may be appropriate in the plateau stage when a client may be at risk for contractures (B) and impaired ADLs requiring use of adaptive equipment (C). Education on energy conservation (D) is compensatory, not remedial.
In a predischarge consultation with a hip fracture client, the client's spouse reports planning to take the client home in a small four-door car and being unsure as to whether the client can get into the front passenger seat of the car while adhering to hip precautions. Which solution is the BEST solution for the OTR® to recommend? a. Recommend that the client sit in the rear seat of the car for transportation home. b. Recommend that the client take a cab for transportation home. c. Recommend that the client stay at the facility until proper arrangements are made. d. Recommend that the client's spouse rent a car that can accommodate precautions.
The correct answer is A. If transferring to the front seat is a problem, transferring to the back is the most economical alternative (the client backs up to the seat, sits, and slides back so that the leg that was operated on is extended and is supported by the seat). In some cases, the front seat can be removed completely or pulled forward to create more space. B, C, D: These recommendations are unnecessary and may be costly. However, some online ride-booking and taxi services enable the customer to request certain types of vehicles, so B may be the next best possibility for clients whose personal vehicle simply isn't an option.
A client with Down syndrome is preparing for transition from high school to work and is seeking a work placement. The client needs to identify vocational interests and abilities for general job tasks. To which service should the OTR® refer the client? Job coaching Functional capacity evaluation Job site evaluation Prework screening
The correct answer is A. Job coaching provides vocational evaluation to identify a client's vocational interests and abilities along with physical and mental tolerances for general job activities. B: Functional capacity evaluation provides information about a client's physical abilities to complete a specific job activity. C: Job site evaluations assess the physical demands and layout of a specific job setting. D: Prework screening is done when a client has been offered a job.
A client with developmental coordination disorder is referred for evaluation by the transition services team at a high school. Which assessment is the MOST appropriate for the OTR® to complete first with the client? Self-Directed Search Cognitive Status Examination Box and Block Test Functional capacity evaluation
The correct answer is A. The Self-Directed Search measures a client's vocational interests. B: The Cognitive Status Exam measures neurological behaviors (e.g., attention, speech, memory for work activity), which should be assessed after determining the client's vocational interests. C: The Box and Block Test addresses performance skills, which should be assessed after determining the client's vocational interests. D: A functional capacity evaluation is used to determine a client's physical capacity to perform the essential functions of a specific job.
An OTR® is explaining to a client who was recently evaluated the value and benefit of a transitional work program. Which of the following components would be included in a transitional work program? a. Client's performance of work conditioning activities in the clinic followed by performance of worksite light-duty tasks. b. Client's exploration of options for full-time employment while participating in work conditioning program. c. Client's return to full-time employment while performing at modified work capacity. d. Client's return to part-time employment, performing all required physical job demands.
The correct answer is A. Transitional programs include monitoring the client's progress and reassessing performance to determine when job tasks can be upgraded to full time or full duty. B, D: Transitional programs are offered during the transition period when the client is able to complete some but not all job tasks; the goal is to return the client to full duty or to maximize the client's work capacity. Early implementation of a rehabilitation program will increase the likelihood of a client's successful return to work. C: Modified duty does not include the clinical portion of a return-to-work program.
An OTR® is working with a 3-year-old child with autism and oral defensiveness to improve feeding skills. Which activity is BEST to begin desensitization of this child's oral defensiveness? a. Ask the child to hold a vibrating toy and touch it gently to the face b. Provide deep pressure on distal parts of the body and slow linear rocking c. Ask the child to touch the lips with a piece of cracker d. Provide only preferred foods during feeding sessions
The correct answer is A. Tools can be used to provide oral stimulation to desensitize oral hypersensitivity. B: Deep pressure on distal parts of the body and slow linear rocking are preparatory activities that can be used for general tactile desensitization. C, D: Touching the lips with a piece of cracker and providing preferred foods will not help with desensitization.
An OTR® is assessing bed mobility with a client with Guillain-Barré syndrome (GBS) 2 weeks into the plateau phase. The patient reports dizziness on performing supine to sit at the edge of the bed and begins to lie back down. What step is MOST appropriate for the OTR® to take? A. Encourage the patient to remain upright and allow for the dizziness to subside by performing simple ROM exercises to promote circulation. B. Assist the patient back to bed safely, lower the head of the bed, and monitor vitals, comparing the current blood pressure with the resting blood pressure. C. Assist the patient back to bed slowly, elevate the lower extremities, and immediately search for the nurse to assess the patient. D. Educate the patient on the importance of sitting upright and out of bed to help regulate the nervous system and prevent secondary complications.
The correct answer is B. People with GBS are at risk for autonomic nervous system dysfunction such as postural hypotension or experiencing a significant drop in systolic blood pressure on moving from a horizontal to an upright position. Common among people who endure a prolonged time in bed, the change in position causes blood to rush to the lower extremities, resulting in feelings of lightheadedness or dizziness. The best option is to slowly and carefully assist the patient back to supine, monitor blood pressure, position the patient in Trendelenberg (lower the head of the bed and raise the lower extremities), recheck blood pressure, and then alert nursing, leaving the call bell in reach. A: The patient is already attempting to lie down to reduce the dizziness. Trying to prevent this will only increase the patient's anxiety and may result in an unsafe situation. C: It would be inappropriate to leave the room while the patient is experiencing postural hypotension, especially without having first monitored the patient's blood pressure to have information to report to nursing. D: Educating the patient on the importance of sitting upright and out of bed to help regulate the nervous system and prevent secondary complications is a valid intervention component, but it is not the most appropriate choice at this time.
An OTR® is working with a client with hemiplegia on laundry tasks. Folding the laundry proves too difficult because of the weaker extremity, and the client becomes increasingly frustrated. How should the OTR BEST modify the activity? A. Stop the task and move on to the next planned activity. B. Instruct the client to sort the laundry by type of garment using both hands. C. Use appropriate therapeutic use of self to address the client's frustration. D. Allow the client to practice hanging up clothes in the closet.
The correct answer is B. The activity analysis skill here is grading; the OTR recognizes the difficulty of performing this bilateral upper-extremity activity and appropriately downgrades the task to reduce the demands. A: Changing activities is not necessary when laundry tasks can easily be modified to better meet the client's ability; moreover, it may affect the timing of the therapeutic session. C: Therapeutic use of self is a useful skill, but the client's frustration can be connected to the difficulty of performing the task; therefore, simply altering the task demands would likely reduce the frustration. D: Hanging up clothes requires bilateral upper-extremity use and would likely increase the client's irritation because of continued difficulty.
A client who has cardiac disease is participating in outpatient occupational therapy and is able to complete activities in the 1-4 metabolic equivalent (MET) range. Dyspnea and angina limit physical activity above 6 METs. Which activity is safe to include as part of the initial intervention for this client? a. Completing self-care tasks including dressing, bathing, grooming, and hygiene for 5-minute intervals each with 12 minutes rest between activities b. Participating in very light stationary biking for 5 minutes with a short rest of 1 minute and then standing to fold towels for 5 minutes c. Pedaling a stationary bicycle for several 5-minute intervals followed by a 1- to 2-minute rest between interval and continuing with 5-minute intervals until fatigued d. Walking on a treadmill at 10 miles per hour (16 km per hour) for 5 minutes followed by a 1- to 2-minute rest, then walking on treadmill at 5 miles per hour (8 km per hour)
The correct answer is B. This routine targets different muscle groups for the same time interval while offering opportunities to gradually increase the intensity of the tasks. A: Self-care tasks are within the MET range of 1.0-2.5, which the client is currently able to complete; therefore, this intervention would not provide sufficient challenge for the client. C, D: Working on one piece of exercise equipment, such as pedaling on a stationary bike or walking on a treadmill, provides only one form of aerobic exercise and limits the targeted muscle groups. In addition, these exercises could push the client over the 6-MET limit.
An OTR® working with families of children with autism wants to ensure a family-centered intervention program. Which strategy BEST reflects use of this approach? a. Ensuring that all of the children's skill deficits are addressed b. Helping each family develop a weekend plan of activities c. Educating families about their child's deficits and needs d. Modifying families' lifestyle to ensure carryover of intervention at home
The correct answer is B. Family-centered intervention required consideration of the family's needs and priorities. Helping families select weekend activities reflects a family-centered approach to intervention. Ideally, the activities involve behaviors and skills that the children can generalize to a variety of settings. A, C, D: These strategies do not consider families' specific needs.
A client with history of Type 1 diabetes is employed as a computer programmer. The programmers sit with their desks next to and facing each other in an open floor plan. To minimize disruption and distraction, employees eat lunch and snacks in a break room that includes a full kitchen and several tables. In establishing reasonable accommodations for this employee, which suggestion is most likely to present an undue hardship for the employer? A. Alteration of the client's work schedule allowing for blood glucose monitoring and insulin injection B. Purchase of a small refrigerator to provide the client with ready access to insulin and snacks at the client's desk C. Alteration of lunch break to permit the client two 30-minute breaks instead of one 60-minute break D. Provision of improved lighting at the client's desk area and use of an antiglare magnifying computer screen
The correct answer is B. Provision of a separate refrigerator for the client's desk area may be considered an undue hardship because a refrigerator is already available in the break room, space near the client's desk is tight, and the office culture is to eat snacks in the break room. Undue hardship refers to any accommodation that would be unduly costly, extensive, substantial, or disruptive to or alter the nature of the operation of the business. Undue hardship is an exception to the ADA requirement that employers provide reasonable accommodations. The employee should store insulin and snacks in the refrigerator in the break room. A, C, D: These accommodations would be considered reasonable on the basis of the client's condition and physical demands of the job. Reasonable accommodations may include an altered work schedule and duties, facility modifications, purchasing of adaptive equipment or assistive technology, or modifying or designing a new product.
An OTR® receives evaluation orders for a client who has recently experienced a traumatic brain injury. The client is swearing and anxiously looking for something. What Rancho Los Amigos level BEST corresponds with the client's behavior? VI IV V II
The correct answer is B. IV Because the client is confused and agitated, the behavior most closely resembles Level IV: confusedagitated. A: At Level VI, the client would, although confused, generally not be agitated. C: Although confusion and memory issues are profound at Level V, the client would generally not be behaving erratically. D: Level II implies low levels of activity and limited responses.
On the way to evaluate a student in the lunchroom, an OTR® working under a fee-for-service contract observes another client with mild autism reacting negatively to a student who accidently brushed against the client in line. Which response would be BEST? a. Do nothing, because the OTR is on the way to a session with another student b. Deliver negative consequences to the client for misbehaving c. Suggest that the client move to the end of the line to avoid being crowded d. Suggest that the client eat alone in a room to avoid being crowded
The correct answer is C. Being the last person in line will create the space the client needs to successfully wait in line for lunch. Additionally, the client will feel safer knowing that no unwanted sensory stimulation can come from behind. This is a short-term solution to address the specific incident, and the OTR should work with the client to develop long-term strategies for waiting in line. A: The employment contract should not influence a practitioner's decision to act in the best interest of a student on his or her caseload. Not intervening in some way could be unethical. Even if the practitioner does not act at that moment, he or she should use the information garnered from the observation later during a treatment or consultation session. B: The OTR understands that the observed behavior is related to a sensory processing disorder that can be managed by changing the environment so the student is able to function in a safe space. The OTR has the background knowledge to differentiate a defensive reaction to sensory stimulation from "bad" behavior requiring negative consequences to alter it. D: All intervention should be directed to keeping the student in the least restrictive environment. Moving the student to a room to eat lunch alone would not necessarily remove the discomfort caused by the original stimulation of unexpected sensory stimulation while waiting in line. Isolating the student in a room for the meal after the fact would not have a therapeutic benefit.
An OTR® evaluates a client who has just entered the plateau phase of Guillain-Barré syndrome (GBS). When assessing ADLs, what would the OTR most likely expect to see? A. Bowel and bladder incontinence, which affects skin integrity and toileting routine B. Unilateral sensory impairments, which affect fine motor tasks such as oral care C. Edema and weakness in the lower extremities, which makes bathing and dressing difficult D. Shoulder weakness, which results in decreased independence in upper-body bathing and dressing
The correct answer is C. In the plateau phase, symptoms are at their most severe: Edema and weakness are common symptoms with GBS. Because symptoms are typically symmetrical and ascend from distal to proximal, bilateral symptoms would likely affect self-care of the lower body. A: Bladder incontinence can be a symptom of GBS, but the bowel is not affected. Intervention with bladder incontinence may include creating a toileting schedule and frequent skin checks to avoid breakdown. B: Symptoms are typically bilateral and begin distally; clients with GBS often exhibit mild sensory loss in the feet and hands. D: Shoulder weakness may be an observed symptom; however, the most disabling symptoms are likely to be distal rather than proximal.
An OTR® in an outpatient clinic is working on energy conservation strategies with a client with multiple sclerosis (MS). The client states that fatigue is negatively affecting work performance. What is the BEST action for the OTR to take next? A. Perform a worksite evaluation to make personalized recommendations for energy conservation and environmental modification. B. Conduct a job demands analysis and collaborate with the client to problem-solve to reduce fatigue related to specific job demands. C. Ask the client to complete a daily diary to identify common work tasks and rate each task for how much energy it requires. D. Advise the client to improve sleeping patterns and further assess cognition for difficulty with executive functioning.
The correct answer is C. More information is needed to determine appropriate interventions; this client-centered approach involves the OTR® working with the client to identify the specific work tasks that cause fatigue. Strategies to address fatigue can then be determined. A: A worksite evaluation is an unlikely option in this treatment setting. Only in certain settings would a workplace evaluation be appropriate (e.g., work hardening). B: A job demands analysis focuses on the job rather than the client and is therefore is less client centered than the approach in option C. As in option A, a job demands analysis is possible only in certain treatment settings and is not likely to be covered by insurance in this outpatient setting. D: Sleep patterns do not necessarily contribute to on-the-job fatigue; therefore, focusing on sleep without first assessing whether sleep patterns are an issue does not address the client's immediate concerns. The client has given no indication that executive functioning is a problem, so cognitive assessment is not appropriate at this time.
A COTA® is working toward service competency for adaptive feeding equipment instruction. How would the OTR® BEST establish the COTA's service competency? A. The OTR reviews the COTA's documentation of multiple patients whose feeding impairments warranted adaptive equipment, then discusses the progress notes and related documentation with the COTA. B. The OTR observes the COTA educating clients on how to use adaptive feeding equipment to ensure that the COTA instructs clients following the plan of care. C. The COTA and OTR observe the same client using adaptive feeding equipment and, using established procedures and protocols, rate the client at the same level of performance. D. The OTR collects information from various sources, including other therapists, the COTA's documentation, and feedback from clients, to determine competency.
The correct answer is C. Service competency is defined as "the process of teaching, training, and evaluating in which the OTR determines that the COTA performs tasks in the same way that the OTR would and achieves the same outcomes" (AOTA, 2009, in Youngstrom & Gentile, 2019). In this example, both the COTA and the OTR observe the same client performing a task and rate that performance at the same level using the same outcome measure. A, D: These are indirect approaches to determining the COTA's skill; indirect approaches are insufficient to establish service competency. B: Although it is important for the COTA to be able to instruct the client according to the plan of care, the outcomes are a key component of service competency. There can be minor variations in how two different practitioners perform tasks such as instruction in adaptive feeding equipment, but the client outcomes must be similar.
An OTR® is preparing to assess a student who is 17 years old and has moderate symptoms associated with autism spectrum disorder (ASD). The purpose of the assessment is to determine the student's strengths and needs for a work-study experience as part of a transition services program. What type of assessment would be MOST BENEFICIAL to administer when gathering information to achieve this goal? A. Self-administered occupational performance checklists B. Self-perception questionnaire related to occupational performance C. Social interactions and social adjustment inventory D. Functional capacities and work readiness evaluation
The correct answer is C. Social skills such as getting along with others and functioning socially in a group situation have been found to be significant predictors of employment for individuals with ASD. This would be the most beneficial information to gather in this assessment. A, B: Assessment of vocational potential to prepare for transition services should focus on social and vocational functioning for individuals with ASD; occupational performance areas that relate to work, leisure, and social skills should be the focus, not personal ADLs. Assessments addressing prevocational skills should be brief and focused on work-related skills to avoid discouraging the student. D: Functional capacities and work readiness evaluation are appropriate in situations when a work injury has occurred; these services are not used in transition services planning.
While assessing muscle tone in an inpatient who has multiple sclerosis, the OTR® moves the patient's upper extremity rapidly through its full range while the patient relaxes the limb. The OTR® notes a slight catch of the upper extremity in the midrange of motion. Which of the following occurred during the assessment of this movement? A. Hypertonicity B. Flaccidity C. Spasticity D. Weakness
The correct answer is C. Spasticity is indicated when a sudden catch or resistance occurs within a quick movement throughout the range of motion for the extremity A: Hypertonicity is typically elicited during slow joint movements. B: Flaccidity indicates a lack of muscle tone with no resistance during passive movement. D: Weakness is assessed through active movement such as moving the extremity against gravity.
An OTR® reviews recommended guidelines on the use of weighted vests to help provide sustained touch pressure and promote organization in a child with autism. Which statement describes a correct use of a weighted vest? a. The child must be between 4 and 7 years old. b. The vest is worn for 45 minutes to 1 hour at a time. c. The vest's weight should be no more than 10% of the child's body weight. d. Weight should be distributed over the trunk and upper extremities.
The correct answer is C. The evidence-based recommendation is that the vest weigh no more than 10% of the child's body weight. A, B, D: These choices have no basis in the available evidence.
Which of the following goals would be appropriate for a client with mild dementia? A. Client will improve money management skills to independent as evidenced by paying five of five bills on time in 30 days. B. Client will verbalize with 100% accuracy the names of at least four family members once cued when looking at family photos. C. Client will maintain good safety during independent light meal preparation while using visual cues for sequencing as needed. D. Client will improve bathing to independent while using adaptive equipment for safety.
The correct answer is C. The primary goals for clients with dementia are related to maintaining functional capacity. A, D: Goals that aim to improve skills in clients with dementia should be avoided. B: Verbalizing names of family members, although useful, is probably not appropriate; because the client is only mildly involved, recognition of family members is likely intact.
A 4-year-old child with autism always flushes the toilet before using it and leaves the toilet unflushed after using it. What should the OTR® do to ensure correct toileting habits? a. Give a reward every time the child flushes the toilet after using it b. Suggest a sensor-activated toilet to ensure it is flushed after each use c. Use a visual schedule depicting the correct flow of actions during toileting d. Facilitate memory by prompting the child to flush the toilet after each use
The correct answer is C. A visual schedule tends to work better than auditory and operant conditioning for children with autism when teaching them the correct steps in using the toilet. A, B, D: Giving a reward, using a sensor-activated toilet, or prompting the child to flush the toilet are behavioral and environmental modifications that do not necessarily ensure transfer of learning in other contexts.
An OTR® is discussing with a parent different types of technology to improve the handwriting skills of an 8-year-old child with autism. Which approach is the BEST example of a basic technology that can improve handwriting skills? An iPad application for correct letter formation Computer software that prompts a child to copy a sentence in cursive A pencil grip to facilitate pencil grasp during writing Internet games on visualperceptual skills
The correct answer is C. Of the options, only a pencil grip is considered a basic technology. A, B, D: These options are considered educational and electronic technologies.
An OTR® is working with an 18-month-old child with bilateral transverse upper-arm deficiency who was recently fitted with myoelectric prosthetics. Which self-care tasks would be appropriate to work on in therapy? a. Donning and doffing prosthetics independently b. Using ties or hook-and-loop fastener to fasten shoes bimanually c. Raising upper extremities to assist with upper-body dressing d. Indicating to a caregiver when more juice is desired
The correct answer is C. On the basis of the child's condition and age, raising the upper extremities to assist with upper-body dressing is appropriate. A, B: These self-care tasks are appropriate for the condition, but not appropriate given the child's age. D: This self-care task is appropriate for the child's age, but not necessarily related to the child's condition.
An OTR® receives a referral to evaluate a client with dementia. What type of assessment would the OTR® likely use to evaluate this client? A. Nonstandardized assessment tool that assesses memory B. Standardized assessment tool that assesses executive function C. Observation of client and interview with caregivers D. Assessment tool that examines occupational performance and performance skills in detail
The correct answer is C. When assessing clients with dementia, observation and interview of caregivers are the primary method of assessment. A, B, D: Although having information about executive function and memory would be helpful, observation will yield more information about how these performance skills affect the client's daily life. The comprehensive assessment might not be possible with a client who has dementia; it might lead to fatigue and frustration and limit the OTR®'s ability to establish rapport.
An OTR® will begin teaching dressing skills to a 4-year-old child with autism. To ensure success during the first attempt, which activity should the OTR® choose? a. Use a shirt with large buttons for easy manipulation b. Use the child's favorite shirt that fits really well c. Use an over-the-head shirt that is slightly large for the child d. Use a cotton shirt that does not have an itchy hem and collar
The correct answer is C. When beginning to teach dressing skills, the OTR® begins with basic, simple articles of clothing, such as loose-fitting pants and over-the-head, slightly large shirts, to allow for success. A, B: These are more advanced dressing skills. D: Because the case description did not indicate any tactile issues with dressing, there is no basis for selecting this activity.
An OTR® receives a referral to complete a functional capacity evaluation (FCE) on a client who is employed full time as a machinist in the tool-and-die trade. The client completed a course of outpatient therapy after a wrist fracture to the dominant hand. Which assessment would be MOST clinically appropriate to determine a client's ability to return to full-duty employment? A hand evaluation A situational assessment A fitness-for-duty assessment A job demands analysis
The correct answer is D. A job demands analysis looks to define the actual demands of the job and involves the use of questionnaires, interviews, observations, and formal measurement completed in the actual work environment. Many FCEs include a job demands analysis. A: A hand evaluation is a comprehensive assessment of upper-extremity function that does not assess the actual material handling skills required for job performance. B: Situational assessment is used to assess a client's ability to perform the exact same tasks in an environment identical to that of the actual target vocation. C: Fitness-for-duty assessment determines whether a worker can perform the essential functions of a specific job. The evaluation screens for conditions that may place the worker at risk for injury and takes place only after an employer has offered employment.
An OTR® receives a referral to evaluate an older adult client with moderate-stage dementia who resides in a long-term care facility. While the OTR® is conducting the assessment, it becomes apparent that the client is becoming agitated. The client tells the OTR® that she or he is going to make the client late to pick up the client's children from daycare. What is the BEST approach for the OTR® to take in this situation? A. Remind the client that the children are grown adults. B. Attempt to engage the client in an alternative activity. C. Leave the client alone and plan to return later in the day. D. Assure the client that the client will be able to get to the daycare on time.
The correct answer is D. It is important to use therapeutic use of self with clients who have dementia. By acknowledging the client's issue, the OTR® is able to establish rapport and demonstrate empathy. In addition, by living in the client's reality, the OTR® will be able to observe how the client responds to stimuli and how to approach the client in the future and plan interventions. A: Arguing with a client with dementia is never a good idea. Because people with dementia lack insight into their condition, argument is likely to increase agitation. B: Asking a client with dementia who is agitated to complete any new task would not be wise; it might increase the client's agitation. C: Abandoning a client with dementia would not be wise because the OTR® might be able to calm the client with therapeutic use of self.
During an occupational therapy evaluation, which approach would pose the biggest barrier to engaging in a client-centered process with an adult client who is unable to converse? a. Paying attention to the meaning of nonverbal cues b. Being directive c. Being too empathetic with the client d. Asking too many closed-ended questions
The correct answer is D. Questions that have a simple yes-no or single-word answer do not capture the essence of an individual client as an occupational being. Although closed-ended questions might be helpful in filling out an assessment tool with single-word answers, they prevent the client from conveying their perspective, which is the core of client-centered practice. Closed-ended questions have their place with clients who have limited verbal ability, but they must be used with skill. A: Paying attention to nonverbal cues, especially when they contrast with the client's words, is fundamental to effective client-centered interaction. B: Being directive is often essential, particularly during the initial contact with a client. Redirecting conversation to obtain necessary information is a fundamental skill to ensure the assessment is completed within the required timeline. C: Acknowledging a client's feelings helps to build rapport and establish an effective therapeutic relationship.
A COTA® working on an inpatient rehabilitation unit has had two patients fall in the past month. The supervising OTR® has concerns about the COTA®'s safety awareness during certain interventions. Which approach is the BEST for the OTR® to take to address these concerns? A. Speak with the rehabilitation manager about possible disciplinary action. B. Review the documentation of the two patients who fell and discuss their cases thoroughly with the COTA® to determine the causes of the falls. C. Ask the COTA® whether more thorough supervision is needed and then proceed to provide close supervision. D. Collaborate with the COTA® to determine potential causes of the falls and provide direct supervision with more deliberate feedback.
The correct answer is D. Supervision that is more frequent may be necessary when the OTR®, COTA®, or both determine that additional supervision is needed to ensure safe and effective delivery of occupational therapy services. In this case, safety is a major concern, and therefore additional supervision may be necessary. A: This unnecessary step would put the COTA®'s job at risk; more appropriate solutions exist before going to this type of extreme measure. B, C: These approaches offer more indirect supervision; moreover, C is not appropriate because whether the COTA® says yes or no, more supervision is warranted because of the OTR®'s safety concerns.
An OTR® is preparing to discharge a client with a complete L2 spinal cord injury to home. Which IADLs would the client likely need assistance with? Financial management Meal preparation Use of technology Home maintenance
The correct answer is D. The client may need assistance with heavy household maintenance and cleaning. A, B, C: The client should not have difficulty with these IADLs given the level of spinal cord injury.
A child receiving occupational therapy for handwriting holds a pencil with flexed fingers and a supinated forearm. According to the biomechanical model of practice, which piece of adaptive equipment would MOST LIKELY promote a more functional forearm position for handwriting? a. A triangular pencil grip b. A moldable pencil grip c. A piece of raised-line paper d. A rubber band sling
The correct answer is D. The scenario describes a transitional grasp. If applying the biomechanical approach, a rubber band sling (e.g., a Handi-Writer) would promote a more neutral wrist position and pronated forearm position. A, B, C: These options are appropriate pieces of adaptive equipment to use with children with handwriting needs. However, only the rubber band sling would address the child's forearm position.
Whom would an OTR® working in an outpatient return-to-work program NOT consider a primary referral source for a functional capacity evaluation (FCE)? Physician Case manager Attorney Career counselor
The correct answer is D. A career counselor is defined as an individual who counsels individuals or provides group educational and vocational guidance services. A career counselor would not be considered a primary referral source. A, B, C: Physicians, case managers, and attorneys are all considered primary referral sources for FCE.
An adolescent with Down syndrome is applying for a part-time job and completing an online job application. Which visual-perceptual skill would this adolescent need to use to locate the appropriate tab to click on to submit the application? Form constancy Depth perception Visualspatial orientation Figureground recognition
The correct answer is D. Figureground recognition allows a person to distinguish between the foreground and the background so as to focus on the essential information (or objects) and not be distracted by other information. A, B, C: Form constancy, depth perception, and visualspatial orientation are other important visualperceptual skills, but they do not allow a person to distinguish between the foreground and the background.
An OTR® in an inpatient facility is working with an adolescent with major depression who repeatedly expresses feelings of worthlessness and poor self-concept. What therapeutic activities will BEST address this client's self-concept issues? A. Activities that establish normal daily routines B. Activities that engage the client socially C. Activities that do not require too many choices D. Activities that allow for self-expression
The correct answer is D. For clients who have self-concept symptoms, activities that allow for self-expression and self-exploration help combat feelings of worthlessness and guilt. A, B, C: These activities are recommended for clients with cognitive, motivational, and emotional issues rather than those with poor self-concept.
An administrative assistant at a university has developed overuse injury affecting the right, dominant hand characterized by pain in the wrist after extensive keyboarding use. The client was treated with static splinting, rest, and a course of anti-inflammatory medication for 2 weeks. The client attempted to return to work; however, the pain persists, and the client is unable to sleep at night, affecting the ability to focus and complete daily tasks. In determining the client's ability to return to work, what should the occupational therapist do FIRST? a. Complete an initial intake interview and document the client's perceived ability to perform job duties. b. Consult with the client's supervisor to determine the feasibility of the client's returning to modified duty. c. Perform ROM, manual muscle testing, and sensory testing to predict the client's ability to return to work. d. Simulate a workstation to assess the job the client must perform daily.
The correct answer is D. Simulation of actual job demands will provide the most accurate and objective assessment of capabilities. A: An initial intake interview and the client's perceived ability to perform job duties are subjective components of a functional capacity evaluation; however, subjective data are not predictive of ability to return to work. B: The client's physical abilities should be assessed before exploring options for modified duty. C: The types of assessments are not indicative of the client's actual ability to perform job tasks and cannot predict recovery.
An OTR® is using the Ayres Sensory Integration Intervention program for a 6-year-old child with attention deficit hyperactivity disorder and sensory-seeking behaviors. Which principle should the OTR® keep in mind when selecting activities for this intervention program? a. The sensory environment is completely structured to allow for optimum integration of sensory information. b. Sensory experiences are limited to one sensory factor at a time to ensure mastery. c. Passive participation on the part of the child is encouraged. d. Appropriate activities are done individually and not in a small group.
The correct answer is D. The Ayres Sensory Integration Intervention program is applied individually rather than in groups. A: In the Ayres program, complete structuring of the sensory environment is not recommended. B: The Ayres program incorporates multiple sensory experiences to ensure mastery. C: The OTR® encourages the child's active participation in the Ayres program.
A client presents with decreased awareness of cognitive deficits. What is the most effective strategy for an OTR® to implement to intervene with this cognitive impairment? A. An auditory signal that cues the client when he or she is not acting in a safe manner B. Reduction of the number of choices presented to the client at any given time C. Mental rehearsal of a task before participation to increase the likelihood that all steps will be completed D. Instruction in the use of a self-evaluation checklist (i.e., "Did I complete all the steps?")
The correct answer is D. Use of self-evaluation or self-reflection before or after a task are the most effective strategies for decreased awareness. A: Auditory signals, although helpful for certain cognitive deficits, might be frustrating for someone with decreased cognitive deficits. B: Reducing choices is an intervention strategy useful for decreased attention and decreased memory. C: Mental rehearsal is most helpful with motor planning issues.
An OTR® is conducting a classroom observation as part of an evaluation for a 6-year-old child with attention deficit hyperactivity disorder. The therapist decides to approach this case using the Occupational Adaptation Model. Which target of observation is MOST consistent with the use of this model? a. The way the child modulates various stimuli in the classroom environment b. The teacher's teaching styles and whether they match the student's learning styles c. The demand that the classroom rules place on the child's ability to follow them d. The child's ability to navigate the physical classroom
The occupational environment includes classroom rules, which create a demand for mastery. The interaction between the child's ability to follow the rules (desire for mastery) and the occupational environment creates a press for mastery.
Service Competency
Two people performing the same procedure, with the same or equivalent procedures obtaining the same or equal results. the process of teaching, training, and evaluating in which the OTR determines that the COTA performs tasks in the same way that the OTR would and achieves the same outcomes
_______ is assessed through active movement such as moving the extremity against gravity
Weakness
Undue Hardship
an action or accommodation that is excessively costly, extensive, substantial, or disruptive, or fundamentally would alter the nature or operation of the business
energy conservation is a __________ approach
compensatory
Activities for clients with major depression should be able to be completed ______ to provide a sense of _________ and competence.
easily; success
_________ ________ may exacerbate symptoms in clients with MS
emotional stress
GBS typically report ________ as the most common residual symptom
fatigue
comprehensive assessment might not be possible with a client who has dementia BECAUSE it is best to ________ and ________ caregivers
fatigue and frustration and limit the OTR®'s ability to establish rapport SHORT attention span observe and interview
______ temperatures are contraindicated for people with MS
hot
The Ayres Sensory Integration Intervention program is applied _______ rather than in ______.
individually groups
Self-directed search
measures a client's vocational interests
______ ________ is most helpful with motor planning issues
mental rehearsals
The _________ ________ is the first step in determining needs, skills, and abilities and identifying whether further assessments are needed.
occupational profile
job coaching
provides an appropriate level of support on the basis of individual needs in the work environment; it may include job training or assistance for job task completion provides vocational evaluation to identify a client's vocational interests and abilities along with physical and mental tolerances for general job activities
_______ support of the trunk, shoulder, and elbow may help increase ______ control of the hands and fingers
proximal, distal
_________ involves the OTR® working with the client on components of the activity that prove too difficult, but the client ultimately finishes the activity independently, thereby improving motivation.
scaffolding
Use of self- __________ or self-________ before or after a task are the most effective strategies for decreased awareness
self evaluation self reflection
For clients who have self-concept symptoms, activities that allow for ______-_______________ and ______-_______________ help combat feelings of worthlessness and guilt
self-expression self-exploration
Mild dementia
stage 4 clear cut deficits on clinical interview person still oriented to time place and recognize faces and people can complete ADLS, not IADLs difficulty in anything requiring sequencing or planning increased denial requires assistance at home
Moderate dementia
stage 5 cannot live alone help with both ADLS/IADLS requires cues and assistance cannot recall major relevant facts such as phone address and name of family members lack of orientation to time and place
Moderately severe dementia
stage 6 incomplete sentences cannot follow 2-step tasks personality and emotional change (increased fustration, agitation, anxious, obsessive, delusion incontinence
severe dementia
stage 7 bedbound unintelligible utterance secondary complication
GBS Plateau Phase Evaluation
this is when symptoms are at its worse! OT evaluation for this phase of GBS often occurs in intensive care because the client is receiving extensive medical care assessment covers communication control of the physical environment comfort and positioning anxiety management
