MODULE 4

Tim is a 29-year-old man who is recovering from a traumatic brain injury. His doctor has classified him as a level VIII on the Rancho Los Amigos Scale. What abilities and behaviors would you expect to observe as Tim completes daily activities? Select the best 3 choices. 1. Able to complete familiar tasks with stand-by assistance 2. Uses a to-do list to remember schedules or steps of a task 3. Able to multi-task 4. May wander away from tasks 5. Requires maximum assistance to learn new tasks 6. Aware of impairments, but may over or underestimate abilities

A. Able to complete familiar tasks with stand-by assistance. B. Uses a to-do list to remember schedules or steps of a task. F. Aware of impairments, but may over or underestimate abilities. Level VIII on the Rancho Los Amigos scale is Purposeful, Appropriate. A patient at this level requires stand-by assistance for tasks and is able to complete tasks with no help once the task is learned. This patient's short and long-term memory centers are intact, but he or she may need to use memory aids to sequence tasks or remember schedules. This person will be aware of impairments and abilities, but may under or overestimate skills and may refuse help or be overly dependent on outside prompting.

Pete, a 37-year-old professional mechanical engineer sustained an injury to his spinal cord at the level of T1. Pete is currently an inpatient in a rehab facility and is working with the COTA® on adaptive techniques for dressing. He has some limitations in hand dexterity but functions well with orthoses. Pete has informed the COTA® that instead of purchasing adaptive items, he would prefer to be involved in making those adaptations. Which adaptation would be the MOST BENEFICIAL for Pete to be involved in making? 1. Adjusting the seams of his work shirts to loosen his clothing and adding dressing loops 2. Making a clip attached to his neck tie for work 3. Adapting the shoes to reduce the need for lacing 4. Developing a device to be used as a button hook and zipper pull

A. Adjusting the seams of his work shirts to loosen his clothing and adding dressing loops. Patients at this level (T1) are independent in upper body dressing with adaptive equipment and require moderate to maximal assistance with shoes and socks unless adapted. Fine motor functions are enhanced with orthoses. Simply making clothing loose will make dressing easier overall. C. Changing the shoes to elastic shoelaces is a less challenging fix than adjusting his shirts. B and D. These are unnecessary as the patient has sufficient hand function to manage fasteners.

A COTA® is working with a 36-year-old patient who 8 days ago had skin graft surgery for the treatment of a 3rd degree burn to his right forearm. The COTA® issued the patient with custom-made compression garments and educated him on skin conditioning and self-massage to continue upon discharge from the rehabilitation unit. The patient asks the therapist, "Why do I need to continue this regimen for the next 2 years?" How should the COTA® respond to the patient's question? 1. As the wound matures, the scar will continue to develop and change 2. To reduce the risk of shearing forces 3. To strengthen the body's ability to insulate against cold temperatures 4. It provides sensory stimuli to prevent environmental deprivation

A. As the wound matures, the scar will continue to develop and change. Wound healing is a dynamic process. Wound healing is made up of 3 overlapping phases: inflammation, proliferation, and remodeling. The inflammation phase starts immediately after injury and serves as a means to prevent infection during healing and to deal with dead tissue. Proliferation closes the wound (epithelialization) and restores the vascular network and lasts days to weeks. Remodeling involves wound scar maturation and can take up to 1-2 years. Any disruption in these phases may result in abnormal or delayed wound healing.

An athlete who was recently involved in a sports related injury, sustained a TBI and spinal injury. MRI findings revealed a high-grade spondylolisthesis at L4-5. The patient required surgical intervention to stabilize his spine which involved an anterior-posterior fusion at the affected level. Which 3 post-surgical precautions is the patient advised to adhere to, for the first 6 weeks after surgery? Choose the 3 best answers 1. Avoid twisting 2. Avoid bending 3. Avoid lifting, pushing or pulling objects greater than 5 lbs 4. Avoid sleeping on your side 5. Avoid sitting on a hard chair, a soft chair will be more comfortable 6. Avoid walking, rather use a wheelchair

A. Avoid twisting. B. Avoid bending. C. Avoid lifting, pushing or pulling objects greater than 5 lbs. In spondylolisthesis, the fractured pars interarticularis separates, allowing the injured vertebra to shift or slip forward on the vertebra directly below it. The severity of a spondylolisthesis is graded using five descriptive categories. Doctors commonly describe spondylolisthesis as either low grade or high grade, depending upon the amount of slippage. A high-grade slip occurs when more than 50 percent of the width of the fractured vertebra slips forward on the vertebra below it. Patients with high-grade slips are more likely to experience significant pain and nerve injury and to need surgery to relieve their symptoms. Spinal fusion is the surgical procedure most often used to treat patients with spondylolisthesis.The goals of spinal fusion are to:• Prevent further progression of the slip• Stabilize the spine• Alleviate significant back pain

An OTA is working with a patient who dislocated his hip three days ago. The primary focus of the treatment session is to ensure this patient adheres to precautions during functional mobility tasks and self-care activities to prevent him from re-dislocating his hip. What are the top 3 MOST important types of adaptive equipment to recommend to this patient? Select the best 3 choices. 1. Bedside commode 2. Raised toilet seat 3. Mobile arm support 4. Universal cuff 5. Magnifier 6. Shower chair with grab bars

A. Bedside commode. B. Raised toilet seat. F. Shower chair with grab bars. Our role as OT practitioners is to ensure our patients are able to adhere to these precautions during functional mobility tasks and self-care activities to prevent hip dislocation or injury. Types of adaptive equipment we would recommend would be a bedside commode or raised toilet seat, shower chair with grab bars, non-slip tub mat, handheld shower, and also long-handled equipment for lower body dressing and bathing including a long-handled bath sponge, reacher, sock aide, or long-handled shoe-horn.

Jason is a 20-year-old specialist in the army who underwent an above-the-elbow amputation to his left upper extremity following an injury resulting from an IED explosion. What treatment techniques should the OTA use to help Jason prepare for an upper extremity prosthesis? Select the best 3 choices. 1. Education in skin inspection and skin care techniques 2. Education in how to strap on an upper arm socket 3. Therapeutic activities to train in the use of a prosthetic hook 4. Scar and pain management techniques, including deep heat, tissue massage and tapping to the residual limb's scar 5. Training in how to use the prosthesis as an assist to the intact arm to don pants, socks and shoes 6. Mirror box therapy to reduce phantom limb pain

A. Education in skin inspection and skin care techniques. D. Scar and pain management techniques, including deep heat, tissue massage and tapping to the residual limb's scar. F. Mirror box therapy to reduce phantom limb pain. -Pain management techniques including treatment for phantom limb pain are all a part of the pre-prosthetic phase of treatment for patients with new amputations. -Training in donning and using a prosthesis is part of the prosthetic phase of treatment.

For which diagnosis would the Rancho Los Amigos Levels most likely be used as part of the patient's evaluation? 1. Head injury from MVA 2. SCI Injury from falling 3. Schizophrenia 4. MI secondary to Hypertension

A. Head injury from MVA Rancho 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 from painful stimuli, turns towards sound, blinks at light, eyes follow objects, responds to family members - moving to music 4. Confused/agitated = maximal assistance - alert, tries to remove restraints, can sit, stand, walk; aggressive, mood swings, uncooperative, incoherent 5. Confused, inappropriate, non-agitated - maximal assistance - wanders 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 tasks for 30 min 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

A. Identify cues that will trigger a medication habit.B. Identify the most realistic and simple routine in which the medication could be taken.E. Practice the entire medication habit until it becomes automatic.Joanne, a 70-year-old widow who lives alone, is being seen by a COTA® at her home. She enjoys watching her favorite game shows during the day while having her coffee and regularly goes walking with her rolling walker in the afternoon, with her neighborhood friends. Joanne favors aging in place and is seeking recommendations to ensure that she complies with her medication regimen. She reports that every now and then she takes her medication late, but states that she never misses a dose. She has however been prescribed one medication that is time-sensitive. Which steps would be BEST for Joanne to follow in order to integrate good medication habits into her life routines? Choose the best 3 answer choices 1. Ident

A. Identify cues that will trigger a medication habit. B. Identify the most realistic and simple routine in which the medication could be taken. E. Practice the entire medication habit until it becomes automatic. After determining the patient's typical routines, it is important to collaborate with the patient to determine the most realistic routine in which she can establish a habit with taking her medications. Then, identify the location where the medication bottles or pill box are placed. Lastly, identify cues that will trigger the medication habit. For example, if the patient places her medications by the microwave and coffee maker which are next to each other, she ensures she sees them daily, takes them while she makes coffee or makes microwaveable meals, and reduces the likelihood of missing her medications. C. Patient wants to manage her medications herself. D. Although accessibility and readability are important, it would have been addressed at the pharmacy. F. The patient may not take her walker everywhere with her.

For a patient with reduced visual acuity, the OT practitioner's role is to modify activities and the environment so that the patient can compensate for their loss of vision and successfully complete daily activities. Which environmental modifications would be the MOST effective to increase visibility for this patient? Select the 3 best answers. 1. Increase background contrast 2. Decrease background contrast 3. Increase illumination using incandescent lighting 4. Increase illumination using halogen lighting 5. Reduce background patterns 6. Increase background patterns

A. Increase background contrast. D. Increase illumination using halogen lighting. E. Reduce background patterns.

An OT and OTA are working with an 87-year-old patient who recently had to undergo a below knee amputation as a result of uncontrolled diabetes. What type of screening/assessment should the clinicians implement FIRST with this patient? 1. Inspection of the patient's skin 2. Need for vocational training 3. Prosthetic training 4. Lower body dressing

A. Inspection of the patient's skin.The first action, with a patient who recently had an amputation, is a skin inspection.

When working with patients who sustained a TBI, OT practitioners commonly use both the Rancho Los Amigos Scale and Allen Cognitive Levels (ACL) to guide their intervention. If a patient is functioning at RLA 7, which ACL level does this correspond to? 1. Level 5 2. Level 4 3. Level 3 4. Level 6

A. Level 5. RLA 7 corresponds to ACL 5. New learning is a hallmark feature in both scales and minimal supervision for ADLs and safety concerns are common in both. RLA VII - Automatic, Appropriate. Patient requires minimal assistance for ADLs and requires minimal supervision for new learning and is able to carry over new learning. Unaware of the needs of others; unable to recognize inappropriate social interactions. Demonstrates impaired safety awareness and judgment. ACL Level 5 - Exploratory Actions. Global cognition is mildly impaired. Patient requires standby assistance. New learning can occur- learns through trial and error and can learn independently through exploratory actions. Poor organization, planning and socialization. Safety needs to be monitored- behavior impulsive.

Adeline, a 50-year-old mother of 3 teenagers, is being seen in an oncology rehab unit post having a left mastectomy. Both the surgery and chemotherapy have resulted in Adeline experiencing difficulty performing her ADLs and IADLS due to fatigue and limited AROM of her left shoulder. She reports her overall exertion level with ADLs as being "somewhat hard" which is equivalent to a rate of perceived exertion level 13/20. At this stage, Adeline's main goal is to resume helping her children with making their breakfasts and packing their school lunches. What recommendations will help Adeline achieve her goals? Select the best 3 answers. 1. Maintain a journal to track how she is feeling before, during, and after activities 2. Train in adaptive equipment to compensate for poor upper extremity ROM 3. Create a calendar of assigned duties for each of her children to do, if they are willing 4. Enlist the assistance of a h

A. Maintain a journal to track how she is feeling before, during, and after activities .C. Create a calendar of assigned duties for each of her children to do, if they are willing. F. Work on seated-level IADLs that facilitates stretching the left upper extremity such as making her favorite pizza dough with a rolling pin. By tracking activities affecting her endurance levels throughout the day, the patient can prioritize the type of activities she is able to do at the best times of the day, for that activity. Some of those activities can be assigned to her children, who are willing to help, maximizing her energy levels yet allowing the patient to fulfill her role as parent, by teaching them responsibilities. After a mastectomy, it is important to maintain and gain ROM with gentle stretches to prevent scar tissue formation.

An OTA must teach hip precautions to a 53-year-old female bus driver who had a hip replacement. Her surgeon used the posterolateral approach. What are the 3 precautions the OTA should teach this patient? Select the best 3 choices. 1. No hip adduction 2. No hip internal rotation 3. No hip external rotation 4. Avoid hip extension greater than 90 degrees 5. Avoid hip flexion greater than 90 degrees 6. No hip abduction

A. No hip adduction. B. No hip internal rotation. E. Avoid hip flexion greater than 90 degrees. There are two different types of total hip replacements (also referred to as total hip arthroplasty). The most common is the posterolateral approach. Precautions for this approach include the following: Avoid hip flexion greater than 90 degrees, no hip adduction, and no hip internal rotation. In simpler terms, no bending past 90 degrees, crossing legs, or pointing toes inward.

A patient who has low vision is preparing to cook a minestrone soup. Which adaptation is the MOST important to implement in order to ensure that this activity is safe for this patient to perform? 1. Place tactile labels on knobs of appliances 2. Use a large crockpot and precut ingredients 3. Plastic cutting board with prongs to attach food for cutting 4. Arrange labeled herbs and spices on an open shelf in alphabetical order

A. Place tactile labels on knobs of appliances. This option has the most impact on safety as it will allow the patient to feel when appliances, especially the stove top, are on. The specialty cutting board is for one-handed adaptation for meal prep, not necessarily for low vision. Large crockpot with precut ingredients would eliminate the need for the patient to cut up ingredients, but the patient would still need to be able to identify when the crockpot is on or off. Arrangement of spices would be beneficial but does not have the most impact on safety.

What is the most appropriate treatment intervention for a patient who is functioning at Rancho Los Amigos Level 1 (No Response)? 1. Provide PROM and sensory input 2. Provide gross motor movements for the patient to imitate 3. Show the patient photos to ignite memory 4. Begin driver's training

A. Provide PROM and sensory input. A person at this level will: begin to respond to sounds, sights, touch, or movement; respond slowly, inconsistently, or after a delay; respond in the same way to what he hears, sees or feels. Responses may include chewing, sweating, breathing faster, moaning, moving, and/or increasing blood pressure.

A young adult who recently sustained a C5 SCI is being discharged from an inpatient rehabilitation facility. What is your INITIAL recommendation for this patient once they have been discharged? 1. Refer the patient to an outpatient rehabilitation facility 2. Give the patient a list of support groups 3. Provide the patient with vocational counseling 4. Organize driver's re-education for the patient

A. Refer the patient to an outpatient rehabilitation facility.Patients are often referred to outpatient rehabilitation once they have met their inpatient rehabilitation goals. Patients with spinal cord injury continue to gain strength and increase independence during the first year of injury, so continuing intervention in another setting is most appropriate. B, C and D. The outpatient rehabilitation therapist will address community integration needs of the patient, including referrals to vocational counseling and driver's rehabilitation.

A patient who sustained a spinal cord injury demonstrates 3+ (Fair plus) muscle strength in both his upper limbs. During a home evaluation, it is identified that the patient is unable to open/close the faucets in his shower and he would like to be independent in this ADL task. The shower has separate hot and cold round-shaped handles which the patient is unable to open/close. What type of adaptation would be appropriate to recommend so that this patient's goal can be accomplished? 1. Replace the existing round handles with a lever-type handle 2. Loosen the existing handles so they are easier to turn 3. Replace the existing round handles with cross handles 4. Use slip-resistant tape on the existing handles

A. Replace the existing round handles with a lever-type handle. Lever handles will be easier to manage in comparison to handles that require turning. Round handles require more muscle strength and increased hand function to operate.

What level of assistance would you expect to provide to a person with a C5 spinal cord injury? Select the 3 best choices. 1. Set-up help and use of universal cuff for grooming tasks 2. Total assist with upper body dressing 3. Minimal assist to stand 4. Minimal to moderate assistance with upper body bathing with use of a sponge mitt 5. Total assist with home management 6. Standby assistance with bed mobility

A. Set-up help and use of universal cuff for grooming tasks. D. Minimal to moderate assistance with upper body bathing with use of a sponge mitt. E. Total assist with home management. People with C5 spinal cord injuries have partial use of the upper arms, but no functional use of the hands and no muscular control in the upper torso. A person with this level injury should be able to complete grooming tasks with set-up help and the use of a universal cuff. He or she should be able to complete upper body dressing with minimal assistance using adaptive techniques and adaptations for fasteners, and should require minimal to moderate assistance with upper body bathing, using a sponge mitt to wash reachable areas. This person would be dependent with bed mobility, standing, and home management.

A patient with bilateral lower extremity amputations demonstrates Fair+ upper body and core strength. The COTA® is teaching the patient how to use a sliding board to transfer from a wheelchair which has removable arm rests to a 3:1 bedside commode. Which instructions should the COTA® use when teaching this type of transfer? 1. Shift upper body using arms to scoot along the sliding board towards the commode 2. Tilt the torso back towards the w/c and laterally lean towards the commode 3. Have the patient perform a depression transfer and lift body over sliding board in 1 step 4. It is not possible, it would be beneficial to rather train a caregiver as the patient does not have enough strength

A. Shift upper body using arms to scoot along the sliding board towards the commode. A transfer board bridges two surfaces, such as a wheelchair and a commode. The board allows the patient to scoot on their buttocks between 2 surfaces without needing the assistance of their lower limbs. This type of transfer can therefore be done independently. Method: If transferring from a wheelchair, place the wheelchair as close as you can next to the other surface e.g. bed. commode, toilet. Be sure to lock the wheels of the wheelchair. Slide one end of the board beneath your buttocks. The other end is placed flat on the surface you are moving onto. Use your upper body to scoot yourself along the board toward the second surface. Once you are settled fully on the second surface, the slide board can be removed. Keep the board within easy reach.

What is the best method for an OTA to prevent heterotopic ossification when working with a patient in the active phase of C8 spinal cord injury? 1. The best method would be maintenance of joint ROM 2. The best method would be high-low limited stretch 3. The best method would be low-load prolonged stretch 4. The best method would be application of leg wraps

A. The best method would be maintenance of joint ROM.Heterotopic ossification refers to the growth of bone in abnormal anatomic locations and is best prevented with a joint ROM and medication routine.

To prevent falling at home, what should an OTA recommend to a senior female who has just had a hip replacement and is about to be discharged from rehabilitation? 1. The best recommendation would be removing rugs 2. The best recommendation would be taping down the edges of area rugs 3. The best recommendation would be adding more light 4. The best recommendation would be to add hand rails

A. The best recommendation would be removing rugs. Removing rugs in a patient's home is the best way to prevent future falls.

Part of the role of the OT practitioner when working with patients who are recovering from burn injuries, is to educate the patient on the aftercare of their burns. Which statements are the MOST accurate in terms of aftercare of burn injuries? Select the 3 best answers. 1. The graft and donor sites will be sensitive to hot and cold temperatures 2. Soaking in a bathtub is recommended to promote relaxation 3. After skin grafts and donor sites heal it is very important to put on a non-perfumed (unscented) lotion or mineral oil many times a day 4. Wear sunscreen with an SPF of 30 or higher and avoid prolonged sun exposure 5. Good nutrition is important for burn management. A diet high in carbohydrates and low in protein is recommended 6. Skin discoloration in areas which have healed is a sign that there may be a problem with the healing process.

A. The graft and donor sites will be sensitive to hot and cold temperatures. C. After skin grafts and donor sites heal it is very important to put on a non-perfumed (unscented) lotion or mineral oil many times a day. D. Wear sunscreen with an SPF of 30 or higher and avoid prolonged sun exposure. A. Because nerve endings were damaged, the new skin will be sensitive to hot and cold temperatures. C. After skin grafts and donor sites heal it is very important to put on a non-perfumed (unscented) lotion or mineral oil many times a day. This will help control itching and keep the skin soft, moist, and able to stretch. It is important to prevent the skin from becoming dry and starting to peel. D. Because of damaged or lost skin pigment, burn survivors are at a greater risk for sunburn. Precautions, including the use of sunblock and avoidance of prolonged sun exposure, should be taught before a patient is discharged.

While fabricating a splint for a patient who has developed carpal tunnel syndrome after giving birth to her daughter 3 weeks ago, the patient starts to complain that her right leg is cramping and becoming sore, and her leg feels warm. Looking at her leg, it appears to be swollen in comparison to her other leg. What is this patient most likely experiencing and what action should the OTA take FIRST? 1. The patient is experiencing a DVT and the activity should be stopped immediately 2. The patient is experiencing orthostatic hypotension and the OT needs to check the patients blood pressure 3. The patient is experiencing heterotrophic ossification and the OT needs to perform ROM exercises 4. The patient is experiencing autonomic dysreflexia and the OT needs to empty the catheter

A. The patient is experiencing a DVT and the activity should be stopped immediately. Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in the patient's body, usually in the patient's legs. Deep vein thrombosis signs and symptoms can include: • Swelling in the affected leg. Rarely, there's swelling in both legs. • Pain in the patient's leg. The pain often starts in the patient's calf and can feel like cramping or soreness. • Red or discolored skin on the leg. • A feeling of warmth in the affected leg. Deep vein thrombosis can occur without noticeable symptoms. Risk factors include: • Pregnancy. Pregnancy increases the pressure in the veins in the patient's pelvis and legs. Women with an inherited clotting disorder are especially at risk. The risk of blood clots from pregnancy can continue for up to six weeks after the patient has delivered the baby. • Prolonged bed rest, such as during a long hospital stay, or paralysis. When the patient's legs remain still for long periods, their calf muscles don't contract to help blood circulate, which can increase the risk of blood clots. • Inheriting a blood-clotting disorder. Some people inherit a disorder that makes their blood clot more easily. This condition on its own might not cause blood clots unless combined with one or more other risk factors .• Injury or surgery. Injury to the patient's veins or surgery can increase the risk of blood clots.

Gillian, a 27-year-old social worker, recently sustained an injury to her left upper-limb while using a pottery kiln. As a result, she has a third degree burn on her left palm and forearm, and a second degree burn on the dorsal surface of her hand and wrist. During the initial inflammatory phase of healing, the COTA® applied an intrinsic plus splint. As the edema has subsided, the COTA® decides to fit Gillian with a palmar extension splint. What is the PRIMARY biomechanical purpose of applying a palmar extension splint in this scenario? 1. To increase surface area for maximal tissue lengthening and wound healing 2. To generate maximal forces for muscle extensibility 3. To alleviate pressure points to major joints of the wrist and fingers 4. To prepare the limb for functional activities involving fine motor skills

A. To increase surface area for maximal tissue lengthening and wound healing. As it is expected that the patient will most likely flex/clench her hand for comfort due to the pain caused by the burn, the likelihood of a contracture is high. Having her hand immobilized in an extended/open position should prevent the anticipated deformity from developing. When edema was present, the intrinsic plus splint prevented shortening of the collateral ligaments as swelling of the soft tissue increases the probability of a flexed pattern developing. When the edema subsides and wound healing begins, it is best to maintain normal muscle length with a slow stretch, using extension and abduction patterns.

Colin, an inpatient who has a T6 SCI, has been invited by the Activities Director of the rehab facility to join other patients on an outing to the Summer Farmer's Market. The market is in close proximity to the rehab facility and the outing should last an hour. Colin has full use of his upper extremities and he is modified independent in his wheelchair. As this is Colin's first time attending an event outside of the facility since his injury, the COTA® educates both the director and Colin on certain precautions. What would the MOST important points of discussion be, in this scenario? Choose the best 3 answer choices 1. To watch for any flushing, chills, or abnormal perspiration exhibited by the patient 2. The ability of the director to navigate the patient's power wheelchair over curbs safely 3. To be aware of the patient's loss of kinesthesia and proprioception. The patient's lower limbs can therefore kno

A. To watch for any flushing, chills, or abnormal perspiration exhibited by the patient. C. To be aware of the patient's loss of kinesthesia and proprioception. The patient's lower limbs can therefore knock into or get caught in environmental barriers. F. Maintain fluids to regulate body temperature and observe skin for overheating below the level of injury. Watch for flushing, chills, abnormal perspiration; check limbs when navigating small spaces with wheelchair due to loss of sensation; and maintain body fluids to regulate body temperature. Autonomic dysreflexia which is caused by obstruction of the catheter tubing, drain bladder, or constriction of the abdominal or groin area. It can be exhibited by signs of pounding headache, flushing and chills. Regular water intake will help maintain body temperature. Skin checks ensure the patient is not overheating in the summer heat and that the skin is clear of nicks, cuts, and bruises - this is important because of absence of sensation below the level of injury.

A teenager is recovering from a recent C6 SCI which he sustained while playing rugby. He is an avid gamer and his main goal is to be able to use a computer to resume his preferred leisure activity. What assistive device will enable this teenager to use his PC with ease? 1. Typing Stick 2. Universal cuff 3. Key guard 4. Mouth stick

A. Typing Stick. A C6 SCI will be able to use a tenodesis grasp to hold and use a typing stick.

Analisa, a 22-year-old college student, recently sustained a TBI when she was involved in a MVA. She is currently receiving OT services in an inpatient rehab unit. Analisa's main goal is to return to college, but she is becoming increasingly frustrated with her progress as she is unable to read a book without losing her place, and after a while the print starts to appear blurry. What adaptations should the COTA® introduce to Analisa to help her progress towards her goal of returning to college? Select the 3 best answers. 1. Use a guide or window to aid in maintaining place and to limit the amount of work presented at one time 2. Position reading material at 10-point print 24 inches away 3. Focus on auditory skills while building visual skills 4. Break prolonged near work into shorter tasks 5. Increase complexity and decrease complexity as tolerated 6. Place adjustable tabletop lighting above and angled toward the

A. Use a guide or window to aid in maintaining place and to limit the amount of work presented at one timeC. Focus on auditory skills while building visual skillsD. Break prolonged near work into shorter tasks These adaptations will compensate for decreased visual attention and scanning and allow Analisa to tolerate and complete her reading tasks as she continues to improve her visual skills. B, E, and F. are adaptations that are counterintuitive. It would be most difficult to read smaller print material farther away. Increasing complexity gradually and having lighting flooding reading material above and behind the reader would be most ideal.

Frank, a 74-year-old man who has bilateral cataracts and a mild memory deficit, lives alone in a single-story house. Frank is independent in all his ADLs, but he is finding it increasingly difficult to remember to take his medication on time. What compensatory strategy should the COTA® recommend to promote success with Frank's medication management? 1. Use a programmable talking medication pill bottle with auto alarm feature 2. Place a large, visible calendar on an upper cabinet door in the kitchen in which his pill bottles are stored 3. Have his son do a weekly setup for 1-week of medications in a pill box every Sunday 4. Request for the pharmacist to have pills delivered in perforated packets, each pre-filled for daily consumption with time instructions

A. Use a programmable talking medication pill bottle with auto alarm feature.The talking device is attached to a prescription bottle with the prescription information recorded into the device by a pharmacist. This method compensates for vision and memory deficits.

A patient who has been diagnosed with AMD (Age-related Macular Degeneration) is having difficulty applying her make-up in the mornings. She completes her morning ADL routine in her bathroom which is lit by a large central fluorescent light, and when applying her make-up, she uses a standard mirror which hangs on the wall. In terms of lighting, which adaptations are the MOST appropriate to recommend to this patient, to improve her efficiency when applying her make-up? Select the best 3 answers. 1. Use non-glare bulbs 2. Use light bulbs that are at most 50 watts 3. Avoid using fluorescent lighting 4. Use lighting on a flexible arm 5. Stand facing the window to increase lighting 6. Encourage the patient to ask a family member to apply her make-up for her

A. Use non-glare bulbs. C. Avoid using fluorescent lighting. D. Use lighting on a flexible arm. A. Glare can be very difficult for people with low vision, so it is important to control glare as much as possible. C. Exposure to harsh fluorescent lighting can cause eye strain and blurred vision as fluorescent lights are much brighter than other incandescent bulbs. D. Lighting on a flexible arm can provide extra lighting for close work such as applying make-up, and it can be positioned to suit the task. Macular degeneration is one of the most common causes of vision loss, especially in those over the age of 50. It is a progressive eye condition that causes damage to the macula. One of the symptoms of macular degeneration, including AMD, that some people might notice is difficulty seeing in low light situations, or when there's a sudden change in lighting, like when you come inside from being out in the sun.Other strategies to improve vision in low light situations: - Add more light from desk or floor lamps or clip-on lamps (like on books or headboards) - Put light behind and on the side of the stronger eye- Increase contrast where needed - Try different kinds of light (halogen, incandescent, flood)

Proper positioning of the patient's upper limb is crucial in burn management because the position of greatest comfort for the patient is usually the position which results in contracture and deformity. In which position does a patient typically hold their injured upper limb, placing them at risk for developing contractures? 1. Abduction and flexion 2. Adduction and flexion 3. Abduction and extension 4. Adduction and extension

B. Adduction and flexion. Anti-contracture positioning and splinting must start from day one and may continue for many months post-injury. It applies to all patients whether they have been skin grafted or not. Positioning is important to influence tissue length by limiting or inhibiting loss of ROM secondary to the development of scar tissue. Patients rest in a position of comfort; this is generally a position of flexion and also the position of contracture. Proper positioning is critical because the position of greatest comfort for the patient is usually the position of contracture. The typical position of comfort consists of adduction and flexion of the UEs, flexion of the hips and knees, and plantar flexion of the ankles. The toes are generally pulled dorsally. Acutely burned hands are held by edema in a dysfunctional position consisting of wrist flexion, MP extension, IP flexion, and thumb adduction.

An OT practitioner is educating a patient who has recently undergone a total hip arthroplasty how to transfer to and from a chair while adhering to their post-op hip precautions. What is the BEST method to teach the patient to use when sitting down from a standing position? 1. Back up to the chair, extend the non-operated leg forward, reach back for the armrests and slowly lower to the sitting position 2. Back up to the chair, extend the operated leg forward, reach back for the armrests and slowly lower to the sitting position 3. Back up to the chair, keep both legs together, reach back for the armrests and slowly lower to the sitting position 4. There are no specific precautions for transitioning from standing to sitting

B. Back up to the chair, extend the operated leg forward, reach back for the armrests and slowly lower to the sitting position. A firmly based chair with armrests is recommended. To move from standing to sitting, the patient is instructed to back up to the chair, extend the operated leg forward, reach back for the armrests, and slowly lower to the sitting position. For the person with a posterolateral approach, care should be taken not to lean forward when sitting down. To stand, the patient extends the operated leg and pushes up from the armrests. Once standing, the patient can reach for an ambulatory aid, such as a walker if it is being used. Because of the hip flexion precaution for the posterolateral approach, the patient should sit on the front part of the chair and lean back. Firm cushions or blankets may be used to increase the height of chair seats and may be especially helpful if the patient is tall. Low chairs, soft chairs, reclining chairs, and rocking chairs should be avoided.

4 months ago, a 35-year-old patient was involved in a MVA which resulted in his spinal cord being completely severed. The focus of his OT intervention has been on strengthening his wrist so that he can have the opportunity to actively participate in his dressing tasks, at home. The patient however has very weak wrist extensors and requires the assistance of a tenodesis splint. What level of spinal cord injury does this patient most likely have? 1. C5 SCI 2. C6 SCI 3. L1 SCI 4. T11 SCI

B. C6 SCI. A patient with a C6 injury typically has head, neck, shoulder, arm and wrist movement. He can shrug his shoulders, bend is elbows, pronate/supinate his forearms, and extend his wrists. A Tenodesis Splint is an ideal splint for a C6 quadriplegic patient or anyone with wrist extension strength but no finger strength. As the patient is able to achieve wrist extension, he can utilize the tenodesis grasp pattern. The tenodesis grasp is the natural flexion of the fingers when the wrist is extended, and extension of the fingers with wrist flexion. This natural movement pattern allows the patient to grasp an object. Although this movement is present, it is often weak and may need to be supported with a tenodesis splint. This splint stabilizes the thumb and holds the fingers in slight flexion. When the wrist is extended, the static line attached to the wrist cuff pulls the finger MP joints into flexion, creating a fingertip pinch ability and gross grasp ability. Some tenodesis splints are simple and provide just enough support to enhance the natural movement of the hand while others may be more elaborate with moving parts to provide increased grip strength. A. At this level, the patient would have no voluntary wrist and hand movement. C. At this level the patient would have intact hand function. Only his lower limbs would be affected/paralysed. D. From T1, hand function is fully intact.

Edema in an acutely burned hand typically results in the hand being held in a dysfunctional position of wrist flexion, MCP hyperextension, IP flexion, and thumb adduction. If this position of deformity is not prevented during the stage of healing, it can lead to severe dysfunction. What is this dysfunctional hand position hand commonly known as? 1. Polydactyly hand deformity 2. Claw hand deformity 3. Ape hand deformity 4. Cleft hand deformity

B. Claw hand deformity. Acutely burned hands are held by edema in a dysfunctional position consisting of wrist flexion, MP extension, IP flexion, and thumb adduction. This position, often called the "claw hand" or "intrinsic minus" position, can lead to severe dysfunction if not prevented during the healing process and active scar formation. Claw hand deformity is characterized by: • MCP hyperextension • PIP & DIP flexion Claw hand deformity can also be caused by: • Congenital defect, a defect present at birth • Ulnar nerve pals • Paralysis of the ulna and median nerves • Leprosy, which still remains a common cause of the claw hand. A. A baby born with polydactyly has more than five fingers on one hand. An extra finger is often a small piece of soft tissue that can be simply removed. Sometimes, the extra finger contains bones but not joints. Very rarely, the extra finger is a fully functioning digit. A baby may be born with several extra fingers. C. In ape hand deformity (simian hand), the thenar muscles become paralyzed due to impingement of the median nerve and are subsequently flattened. This hand deformity is not by itself an individual diagnosis; it is seen only after the thenar muscles have atrophied. D. Cleft hands are congenital disorders, and significant deformities are present at birth. Cleft hand is characterized by the absence of 1 or more central digits of the hand, also known as lobster-claw deformity.

An OTA is working with an 84-year-old patient who recently had a cerebellar stroke. Upon completing a dressing evaluation, the patient is initially unable to recognize one of her shirts that the OTA selected from the patient's closet. Only when the OTA brings the shirt to the patient, is she able to identify that it is indeed her shirt. What visual deficit does this most likely indicate? 1. Cataracts 2. Diminished visual acuity 3. Glaucoma 4. Macular degeneration

B. Diminished visual acuity. Visual acuity is a measure of how well an individual can see. It is a measure of the ability of the eye to distinguish shapes and details of objects at a given distance. The patient could not see the shirt when it was presented to her from the closet, but could see it when it was brought close to her in bed. The only factor that changed in this situation was the distance at which she was able to see the object.

A 67-year-old man who has recently been diagnosed with glaucoma is receiving OT services. The patient lives independently and he has stated that he wants to continue living an independent life in his own home. In his spare time, he directs a choir at his local church, usually twice a week. His ability to read the music book while on the podium has, however, become very difficult for him due to the reflective glare from the glossy pages of the music book. Which adaptation would be MOST BENEFICIAL for helping him cope with his visual difficulties, while supporting his participation in his preferred leisure activity? 1. Suggest that he wears headphones to follow the music and lyrics as he conducts the choir 2. Direct a lamp from behind the patient's shoulders while he is reading the music from matte sheet music paper 3. Suggest that the patient purchase an iPad with his notes in yellow against a black background 4. Ma

B. Direct a lamp from behind the patient's shoulders while he is reading the music from matte sheet music paper. Glare is light directed to the eyes, either coming from the top or the sides. Flooding the light from the back of the person will reduce glare and make reading easier.Glare is caused by the reflection of light off of surfaces. You can reduce glare by controlling the light source, adapting the surface reflecting it, or by filtering it before it reaches your eyes. 1. Adjust the Light SourceDirect light causes the most glare. Use a desk lamp for directed, diffused task lighting when needed instead of bright overhead light. 2. Adjust the SurfaceShininess is measured by reflection and glare. That means the duller the surface, the less glare there will be. Use work surfaces that have matte finishes. 3. Shield Your EyesIf you cannot eliminate the glare, then stop it before it gets to your eyes. Polarized lenses on sunglasses eliminate a lot of glare. Prescription lenses can be polarized as well.

A man who sustained a second degree deep partial thickness burn to his right thumb, index and middle fingers 2 months prior, receives outpatient hand therapy. As a part of treatment, the OTA provides massage to the affected area. What activity should this man be able to complete if the massage has been effective? 1. Pick up a 10 pound bowling ball bag. 2. Identify and retrieve loose change from a number of objects located in his coat pocket. 3. Shake hands with others without being self conscious of his burn scars. 4. Use lateral pinch to turn a key in a door lock.

B. Identify and retrieve loose change from a number of objects located in his coat pocket. When a burn has healed, massage is combined with stimulation activities such as immersion in textures or brushing and stereognosis activities to improve tactile sensation. If treatment is effective, the man's tactile sensation will improve and his stereognosis will become functional once again.

An OTA is working with an elderly patient who has recently relocated to an assisted living facility. While assisting the patient in transferring from a commode to a chair, the patient begins to slip. What IMMEDIATE action should the OTA take in this scenario? 1. It would be best to have the patient return to the commode 2. It would be best to ease the patient to the floor, then get assistance 3. It would be best to continue with the transfer and try to get the patient to onto the chair as quickly as possible 4. It would be best to call for help and get the attention of a caregiver

B. It would be best to ease the patient to the floor, then get assistance. Easing the patient to the floor protects both the patient and the therapist from injury. A, B: Trying to move the patient too quickly or reversing the transfer can result in injuries to both the patient and OT.D: Help may not arrive in time to assist, resulting in the OTA dropping or injuring the patient.

Max, a 52-year-old male patient who is recovering from a recent TBI is consistently making progress in his recovery. At this stage of his recovery, he has now developed an interest in watching the morning news, but he has to watch the TV in his room where there is the least amount of distractions. After about 30 minutes however, Max becomes disinterested in watching TV and he starts walking around the facility. Max is aware that he has been injured and that is why he is in this facility, but he has little insight into the extent of his impairments. Max is starting to recognize some of the nursing staff but he is unable to recall their names. In terms of his ADLs, Max has made significant progress as he has re-learnt to brush his teeth independently. Although he is able to follow simple instructions, Max is not yet able to learn new tasks. At what Rancho Los Amigos level is Max functioning? 1. Level 7 2. Level 6 3. Le

B. Level 6. Level VI - Confused, Appropriate: Moderate Assistance.At this level, patients typically demonstrate the following: • Goal directed behavior • Unaware of impairments, disabilities, and safety risks • Consistently follows simple directions • Able to retain learning for familiar tasks they performed pre-injury (e.g. brushing teeth) however unable to retain learning for new tasks • Able to attend to highly familiar tasks in non-distracting environment for 30 minutes with moderate redirection • Remote memory has more depth and detail than recent memory • Vague recognition of some staff

When working with a patient who has a progressive disease, what will the focus of OT intervention typically be? 1. Providing compensatory strategies 2. Maintaining function 3. Performing isometric motions 4. Performing aggressive ROM

B. Maintaining 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.

A patient who was recently involved in a MVA in which he sustained a TBI, is functioning at a Level II according to the Rancho Los Amigos scale. What is the MOST USEFUL pre-feeding technique that could be used for graded stimulation of the patient's cranial nerves? 1. Place small pieces of the patient's favorite foods on the front of the patient's tongue 2. Place items with strong smells (i.e. cinnamon, lavender, orange) under the patient's nose for 2-3 seconds 3. Gently rub different flavorings of salt and sweet foods on the back of the patient's tongue 4. Provide tactile massage on the patient's jaw, nose, and ears to prepare for mastication

B. Place items with strong smells (i.e. cinnamon, lavender, orange) under the patients nose for 2-3 second. RLA level II - Generalized Response. At this level, the patient begins to respond to sensory stimuli, including visual, auditory, tactile or movement. This RLA level corresponds to ACL level 1- Automatic Actions. ACL Level 1 describes the patient's arousal to external cues. This cognitive level is largely instinctual behavior, and patients require total assistance with activities. A patient who is below cognitive level 1 would be in a coma. Patients react to immediate stimuli, but are not able to process and interpret stimuli. The patient is probably not able to respond appropriately to stimuli placed in the mouth, as this requires a higher level of response, but will be able to respond to a strong smell.

Martin is a 43 year old man who sustained a C3 spinal cord injury 10 weeks ago. The OTA is assisting with a wheelchair assessment with Martin to improve his independence with mobility. What kind of propulsion should the OTA recommend for Martin? 1. Manual wheelchair with knobbed hand rims and spoke guards 2. Power w/c equipped with chin or head controls 3. Power w/c equipped with a sip n puff switch 4. Power w/c equipped with eye gaze controls

B. Power w/c equipped with chin or head controls. A spinal cord injury at level C3 compromises innervation to the diaphragm, making it difficult or impossible for a person to breathe without mechanical intervention. Since Martin sustained a C3 injury, he most likely uses a ventilator to breathe and would not have enough breath control or power to use a sip n puff switch. He would have enough neck movement to use a chin or head control switch. These switches are easier to use and less expensive than eye gaze control systems, which would be more technology than what Martin requires to propel his wheelchair. He would not be able to use a manual wheelchair due to the level of his injury.

A 28-year-old patient sustained a complete, C4 spinal cord injury from a skiing accident. The patient has been recovering in an inpatient wing at the local hospital, receiving rehabilitative services. The patient is being discharged to return home within the next few weeks and requires a customized wheelchair for home use. Considering that his home has no accessibility issues, what type of wheelchair would be the MOST suitable for this patient? 1. Lightweight wheelchair with recline feature 2. Power wheelchair with chin or pneumatic (sip and puff) controls 3. Manual wheelchair 4. Manual wheelchair with joystick option

B. Power wheelchair with chin or pneumatic (sip and puff) controls. Patients with injuries at the C4 level will likely depend on others for help with almost all of their mobility and self-care needs. If injuries are at the C4 level, patients have active movement of the neck muscles, plus innervation to the diaphragm. This would allow them to use power wheelchairs operated by either chin or pneumatic (sip and puff) controls.

Marcy is a 75-year-old woman who is recovering from a total hip replacement in the skilled nursing facility. She requires a wheelchair for mobility. What features should her wheelchair include? Select the best 3 choices. 1. Hemi-drive 2. Reclining back 3. Pommel cushion 4. Wedge cushion 5. Elevating footrests 6. Chest harness

B. Reclining back. C. Pommel cushion. E. Elevating footrests. When recovering from a total hip replacement, the patient's hip should be positioned in less than 90 degrees of hip flexion and adduction. The affected leg should be elevated to reduce edema. A wheelchair with a reclining back, pommel cushion to abduct the hips, and elevating footrests will allow for proper positioning. A hemi-drive wheelchair is designed for people with the use of one arm. A wedge cushion puts the patient at risk of flexing the hip past 90 degrees. A chest harness is not necessary and might be considered a restraint in this setting.

Adam, a 52-year-old male who is morbidly obese is having difficulty accessing his bathtub-shower combo as the glass shower door easily becomes dislodged when he is climbing into the shower. He manages to climb into and out of the bathtub with ease, holding onto a grab bar for support but due to his size, his body tends to dislodge the glass door from its frame. What is the BEST modification that can be made in this scenario, so that Adam can safely and independently enter his shower? 1. Encourage the patient to rather sponge bath while sitting on a commode 2. Remove the shower door and replace it with a shower curtain or a folding plastic door 3. Remove the bathtub and install a walk-in shower 4. Encourage the patient to hire a caregiver to assist him with getting into the shower

B. Remove the shower door and replace it with a shower curtain or a folding plastic door. Removing the shower door is essential as it can result in the patient potentially injuring himself if it becomes completely dislodged and either falls on him or traps him between the grab bar and glass door. Purchasing a shower curtain or a folding plastic door is practical and affordable. A. This is not a modification to the shower and the patient needs to remain mobile and independent. C. This is a costly and unnecessary modification to undertake. At this stage, the patient is safely managing to step into and out of the shower. The only change that needs to be made at this point, is to remove the barrier (glass shower door). D. This is not a modification, and the patient does need assistance getting into and out of the shower.

A 76-year-old patient has recently been admitted to a rehabilitation facility following a fall at a local grocery store. The patient was diagnosed with Diabetes Mellitus Type II, 15 years ago and her diabetes is being controlled by medication. The patient reports that although her "sugars are good", she sometimes has "problems with her eyes", and this is the reason for her fall. Observing the patient, she demonstrates some difficulty navigating around the facility and she describes seeing floaters, having blurry vison at times and poor night vision. Based on these symptoms, what secondary complication has this patient MOST likely developed from her Diabetes? 1. Nephropathy 2. Retinopathy 3. Neuropathy 4. Preeclampsia

B. Retinopathy. Diabetic retinopathy symptoms usually affect both eyes. The patient can have diabetic retinopathy and not know it. This is because it often has no symptoms in its early stages. As diabetic retinopathy gets worse, the patient will notice symptoms such as: • seeing an increasing number of floaters • having blurry vision • having vision that changes sometimes from blurry to clear • seeing blank or dark areas in the field of vision • having poor night vision • noticing colors appear faded or washed out • losing vision

When a patient is totally dependent in self-care but can instruct others in preferences for care, what spinal cord injury level did the patient very likely sustain? 1. SCI C5 2. SCI C1-C3 3. SCI C8-T1 4. SCI C7

B. SCI C1-C3. C1-C2 Neck FL, EXTC3 Lateral neck FLDependent in self-care, can instruct others, can chew and swallow.

Maryanne recently had to undergo a posterolateral total hip arthroplasty. She is planning on attending an event on Saturday evening with her sister, who will be picking her up in a standard motor vehicle. As this will be the first-time, post-surgery, for Maryanne to leave the rehab facility, the COTA® begins the process of training her in car transfers. After sliding the passenger seat back, Maryanne ambulates with her front-wheeled walker towards the car. What should the COTA® instruct Maryanne to do NEXT during this transfer? 1. Wedge the walker between the door and passenger seat and laterally slide onto the seat 2. Slowly turn the walker and back up to the front passenger seat 3. Lean against the edge of the seat, extend the unaffected leg, and scoot up towards the driver's seat 4. Bend forward to avoid hitting the top of the car and scoot onto the passenger seat

B. Slowly turn the walker and back up to the front passenger seat.After adjusting the passenger seat back and reclined, the patient should back up to the passenger seat, hold onto a stable part of the car, place the operated leg farther forward than the un-operated leg, and slowly scoot and sit on the passenger seat.

An OT practitioner is working with a patient who has a visual impairment. The focus of the session is on helping this patient manage his medication independently. As the patient has difficulty reading standard labels on medicine bottles, the OT practitioner identifies that reprinting the labels in a larger print is necessary. Using a reading acuity test card, how can the OT practitioner determine the minimum size print that should be used for re-labelling this patient's medication? 1. The second last line of print that is easily read on the reading acuity test card indicates the minimum size of the print 2. The last line of print that is easily read on the reading acuity test card indicates the minimum size of the print 3. Labels on medication bottles should never be enlarged 4. The first line of print that is easily read on the reading acuity test card indicates the minimum size of the print

B. The last line of print that is easily read on the reading acuity test card indicates the minimum size of the print. For visual impairments, objects should be enlarged to make them more visible. Instructions can be reprinted in larger print, medications and other items relabeled, and calendars enlarged. The last line of print that is easily read on the reading acuity test card indicates the minimum size that print should be enlarged for the patient. Contrast should also be increased because it does little good to enlarge print if the print is faint. Black on white or white on black print is usually more visible than any other color combination. Many items are now manufactured with larger print, including calculators, clocks, watches, telephones, check registers, glucose monitors, scales, playing cards, games, and puzzles.

What are the symptoms of orthostatic hypotension? 1. The symptoms would include warm, swollen extremities, fever, and/or ROM limitations 2. The symptoms would include lightheadedness, pallor, and visual changes 3. The symptoms would include an immediate pounding headache, sweating, extreme rise in BP, anxiety, perspiration, flushing, chills, nasal congestion, and bradycardia 4. The symptoms would include palpitations of the heart and swollen fingers

B. The 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 a wheelchair, elevate legs to bring BP within normal limits; if symptoms persist, then recline w/c back to lower head

What should the focus of preoperative OT intervention be for a patient who is scheduled to have a total hip replacement using the posterior surgical approach? 1. Gait training 2. The use of equipment and modified techniques to perform transfers and BADLs 3. Precautions before a posterior total hip replacement 4. The OT practitioner does not have a role in this scenario

B. The use of equipment and modified techniques to perform transfers and BADLs. Provocative positions: hip flexion, adduction, internal rotation. Restrictions associated with posterior lateral hip replacements involve no bending past a 90° angle, no internal rotation of the operated leg, and no crossing one's legs. The restrictions result in a patient having to modify the way in which they perform ADLs. Improving functional independence is a key component to the practice of occupational therapy. In order to achieve this in patients having a THR, an occupational therapist must educate the patient on the use of equipment, which includes a: raised toilet seat, reacher, sock aide and shoe horn.The fact that the hospital stay for the patient is typically short, means that individuals are returning home sooner and as a result, need to feel prepared to perform their ADLs earlier. Therefore, educating patients on ways to perform ADLs with precautions is imperative.

A woman on the inpatient unit has a diagnosis of traumatic brain injury to the temporal lobe with auditory agnosia. The woman's daughter has complained to nursing staff that the certified nursing assistants (CNAs) are yelling at her mother when they provide her care. The CNAs report that the woman does not hear the instructions when they provide care. What advice should the OTA give to the CNAs? Select the 3 best choices. 1. Make sure that the patient has her hearing aides in prior to providing care 2. Try giving the patient instructions in writing 3. Pair gestures and visual cues with auditory instructions 4. Look directly at the patient when speaking to her 5. Request training in use of the communication device provided by speech therapy 6. Present tasks one at a time with simplified verbal instructions

B. Try giving the patient instructions in writing. C. Pair gestures and visual cues with auditory instructions. E. Request training in use of the communication device provided by speech therapy. Auditory agnosia is the inability to recognize and process sound in spite of intact hearing mechanisms. Presenting the woman with written instructions might help compensate for this deficit. If the woman cannot follow written instructions, pairing gestures and visual cues with the auditory instructions may also be effective. If speech therapy has introduced a communication device to compensate for the auditory agnosia, the CNAs responsible for the woman's care should be trained in the use of the device. The other answers provide options that compensate for hearing impairment or cognitive limitations, not auditory agnosia.

When working with a patient who is recovering from a TBI, the OTA observes that the patient seems to be experiencing difficulty seeing objects out of the corners of his eyes and he becomes startled when the OTA moves toward him. What diagnosis does this patient most likely have? 1. Poor perceptual skills 2. Visual field cut 3. Glaucoma 4. Nearsightedness

B. Visual field cut. Visual field loss, also known as "visual field cut," can be partial or complete. For example, it can range from a nearly complete loss of peripheral vision to a small area of partial loss. People with visual field loss may have trouble seeing objects out of the corners of their eyes, lose their place while reading, startle when people or objects move toward them, or bump into people and objects. Loss of peripheral vision is referred to as a visual field cut, meaning that you can't see one side of vision from one of your eyes or you can't see one side of vision from both of your eyes. A visual field cut is formally called hemianopsia or hemianopia. When both eyes have a symmetrical problem with peripheral vision, it is called homonymous hemianopsia.

Sharon is a 35-year-old patient who recently sustained a coup-contrecoup brain injury. She has been assessed to be functioning at Rancho Los Amigos V (confused, inappropriate) and at this stage, she requires maximal assistance for her BADLs. She is generally cooperative when completing her ADLs but becomes agitated when confronted with the more complex ADL tasks such as brushing her teeth. As Sharon's level of alertness is erratic, OT sessions are held when she is most alert and responsive. Using the task of brushing her teeth, what strategy is the BEST to help Sharon successfully complete this task? 1. Post-It® Notes placed on the mirror indicating the steps in the sequence of brushing her teeth 2. While she holds the toothbrush, guide the toothbrush to her mouth, followed by a one-step command such as "to your mouth" 3. Use of visual imagery and rhythmic cues to reduce hesitation to ensure the patient follow

B. While she holds the toothbrush, guide the toothbrush to her mouth, followed by a one-step command such as "to your mouth." This strategy minimizes cognitive demand and reduces stress experienced by the patient by breaking down the task into specific components followed by simple cues to reduce the complexity. A coup injury occurs on the brain directly under the point of impact. A contrecoup injury occurs on the opposite side of the brain from where the impact occurred. Coup and contrecoup injuries are a type of traumatic brain injury that results in the bruising of the brain. A. Demands increased attention and processing to sequence the task as opposed to using simple 2-word auditory cues. C. This would be a more appropriate intervention for a person with Parkinson's who has difficulty initiating and continuing a movement pattern. D. This would be a memory retraining approach, not an attention or focus approach.

An OTA is treating a patient with visual perceptual difficulties, secondary to a traumatic brain injury (TBI). During an intervention, the patient is instructed to place pieces of a game onto a picture board in order to construct a design/picture. By using this activity, what three visual perceptual skills does this patient have to use to successfully complete the activity? Select the best 3 choices. 1. Form constancy 2. Visual closure 3. Visual spatial awareness 4. Figure ground 5. Visual motor integration 6. Visual memory

C, D, E. This activity targets visual spatial awareness, figure ground and visual integration. C. Visual Spatial Awareness: The ability to understand where objects are in relation to each other D. Figure ground: The ability to see an object on top of a background color or scene E. Visual motor integration: The ability to use both motor and visual skills in coordinating a task A. Form constancy - the ability to notice that two objects are the same even if they are different in size, color, etc. B. Visual closure - the ability to identify two objects that are the same even if part of one is missing F. Visual memory - the ability to remember visual information It is important to keep in mind that visual perception is not the same as visual acuity.

What adaptation is contraindicated for a patient with paraplegia who wants to prevent pressure ulcers? 1. A skin inspection mirror 2. A gel cushion for the patient's wheelchair 3. A donut style cushion 4. A pressure relief bed

C. A donut style cushion. Donut cushions do not provide even pressure over the sitting surface, but instead create pressure areas that could lead to ulcers.

An OTR® and COTA® are conducting a home evaluation for a patient who recently had a total hip replacement. The patient's surgery was performed via a posterior approach and as per protocol, the patient has been advised to take specific precautions. The OT practitioners have identified that as the patient enjoys entertaining guests during poker matches and football games, which involves extended periods of sitting, they need to reinforce sitting precautions with him. What type of chair is the most appropriate to recommend for this patient, to help him adhere to the post-op precautions? 1. A loveseat with pillows placed onto the lumbar area 2. Reclining chair with cushions removed to elevate the affected limb 3. A firm, elevated chair with armrests 4. A barstool with a swivel seat

C. A firm, elevated chair with armrests. This supports the optimal and safe position to maintain adherence to hip precautions with arm rests to allow safe transitions from sit-to-stand and stand-to-sit A. Building up the rear part of the loveseat may cause more trunk flexion B. Hip flexion past 90 degrees D. Spinning to turn on a bar stool may cause hip internal rotation After undergoing a total hip replacement surgery, there are certain precautions that need to be taken, especially if the surgery was performed via a posterior approach. The primary concern is the avoidance of a hip replacement dislocation. After a total hip replacement with a posterior incision, three movements should be avoided to prevent dislocation of the hip prosthesis. 1. Hip flexion past 90 degrees. Sitting in a low chair or flexing the knee and hip to don a sock may break this 90-degree rule and put the patient at risk for hip dislocation. 2. Crossing the operated leg over your non-operative leg (adduction). When lying down, the patient should not cross one leg over the other to maintain this hip precaution. When sleeping, many patients are required to use a special wedge called an abduction pillow to help keep their legs separated. 3. Internal rotation of the hip.

Ella, a 25-year-old college graduate, who has been diagnosed with a borderline personality disorder, recently sustained self-inflicted deep partial thickness burns to both her hands when she submerged them into a pot of boiling water. As both of Ella's hands have been splinted in an anti-deformity position, she is unable to use her hands for function. One of her main goals at this stage of her recovery is to feed herself. What is the MOST practical adaptation you can recommend to enable Ella to be more self-sufficient during meal times? 1. From a psychological point of view, self-inflicted burns are indicative of attention seeking behavior and providing any adaptations, will only reinforce this negative behavior 2. From a physical point of view, no adaptations are possible at this stage of the patient's healing process as her hands are in splints and covered with dressings and bandages 3. A spoon can be attached

C. A spoon can be attached to a universal cuff which is strapped over the splint.

Mary, a 55-year-old self-employed web designer, is receiving occupational therapy in an outpatient stroke rehabilitation program. The focus of intervention is on training Mary in strategies to compensate for her difficulty with saccades, which are the eye movements one uses to rapidly refixate from one object to another. One of Mary's goals is to return to meeting her friends at the local coffee cafe for their weekly board game night. Post CVA, Mary's husband drives her to the café to avoid having her cross any roads. He has however noticed that when she is walking towards the café, she does not notice people crossing in front of her, from her side view. Which activities should the COTA® use to address Mary's deficit so that her participation in her preferred leisure activity can be maximized? 1. Card-shuffling task in which the patient plays a familiar game of Bridge with the clinician. 2. Adapted bowling a

C. An object-matching activity in which familiar objects are placed in plain sight on multiple shelves. In normal saccades, the person would demonstrate the ability to gaze rapidly from one fixation point to another even when the targets are changing position on a vertical or horizontal axis without undershooting or overshooting targets and without difficulty finding the target. The goal for Mary is to improve saccades by looking between two visual fixation points with a wide visual field to generalize to community mobility. She may compensate by moving her head and trunk.

A patient is functioning at level III (Localized response) according to the Rancho Los Amigos scale, due to a recent TBI. What is the MOST USEFUL pre-feeding technique that can be used for graded stimulation of the patient's cranial nerves? 1. Place small pieces of the patient's favorite foods on the front of the patient's tongue 2. Place items with strong smells (i.e. cinnamon, lavender, orange) under the patient's nose for 2-3 seconds 3. Gently rub different flavorings of salty and sweet foods on the patient's tongue 4. Provide tactile massage on the patient's jaw, nose, and ears to prepare for mastication

C. Gently rub different flavorings of salty and sweet foods on the patient's tongue. Patients who are responding at Level III on the Rancho Los Amigos scale react to immediate stimuli, but are not able to process and interpret stimuli. Olfactory Stimulation • The Olfactory nerve is the most commonly injured cranial nerve after TBI and there may not be a response to smell stimulation • Many TBI patients have trachs, which eliminate the exchange of air through the nostrils and therefore inhibits the sense of smell • Nasogastric tubes, can also block the sense of smell.

An OTA is working with a 78-year-old male patient, for home health therapy services. The patient states that since he had his recent hip replacement, he is experiencing pain during sexual intercourse. The OTA confirms that the patient is following the prescribed precautions to prevent injury to his hip, during sexual activity. What NEXT should the OTA further explore in order to help the patient with this issue? 1. His medical condition, health, age, and cognitive status 2. The time, location, and environment 3. His current feelings about sex, sexual preferences, and the role he plays 4. The status of his relationship with his girlfriend

C. His current feelings about sex, sexual preferences, and the role he plays. The patient's hip replacement may have affected his ability to participate in sex by changing his role with his girlfriend due to the pain and difficulty he is experiencing during intercourse. The OTA should be aware of how the man normally participates in sex and how he feels about any changes in sex roles that have occurred as a result of the hip replacement before discussing the man's concerns regarding sex.

While consulting with an elderly woman at her home, she complains that dressing herself has become very challenging, especially early in the morning. She wears spectacles for low vision but reports that her glasses are not helping her. When working on a home modification for her, what would be the best modification to her bedroom, so that she can independently dress herself ? 1. Increase the distance between the patient and the object 2. Increase glare from sunlight 3. Increase lighting 4. Decrease organization

C. Increase lighting.

What adaptation would be MOST BENEFICIAL in enabling an inpatient who has C7 tetraplegia to participate in a game of ping pong? 1. It would be most beneficial to introduce holding the paddle with a natural tenodesis grasp pattern 2. It would be most beneficial to introduce wearing a short opponens splint to stabilize the thumb for grasping 3. It would be most beneficial to introduce fasten hook and loop straps to secure the paddle to the hand 4. It would be most beneficial to introduce foam padding to build up the handle of the paddle

C. It would be most beneficial to introduce fasten hook and loop straps to secure the paddle to the hand.This adaptive method will compensate for the patient's limited grasp and dexterity, allowing the patient to engage in the table tennis game. Some ability to extend shoulder, arms, and fingers but dexterity may be compromised in the hands and/or fingers. Lack control of bowel movement and bladder

A 22-year-old male who sustained an injury to his right knee when he fell off his snowboard, has had to have a total knee replacement. Post-op, what are the 3 most important precautions, this patient should adhere to? Select the best 3 answers. 1. No standing on tiptoes 2. No standing on one foot 3. No pivoting or twisting on knee 4. No kneeling on unaffected knee 5. No kneeling on affected knee 6. No squatting

C. No pivoting or twisting on knee. E. No kneeling on affected knee. F. No squatting.Precautions include no squatting, kneeling on affected knee, and pivoting or twisting on knee. Other precautions include:Don't cross your legs. Do sit in chairs which have seats as high as your treated knee. Don't keep standing for extended periods of time. Don't keep sitting for more than one hour at a time. Don't sleep on the side which had the surgery. Do climb one stair at a time.

An OTA is working with a patient who is currently functioning at Level V (Confused-inappropriate) on the Rancho Los Amigos scale. The focus of therapy is on improving this patient's efficiency in self-feeding. The patient has been served a plate of food with a variety of different foods. He however, appears disorganised and takes much longer to finish his meal than is expected. How can the OTA help the patient achieve efficiency in self-feeding? 1. Ensure the food is cut up in small pieces to prevent choking 2. Have the patient take a drink of water after every bite 3. Only give the patient one food type at a time 4. Provide the patient with pureed foods

C. Only give the patient one food type at a time. By working with the patient on self-feeding and giving the patient one food type at a time, will help the patient with their goal. Feeding is not the same as eating or swallowing. If the OTA was working on the swallow reflex then putting the patient on a pureed diet would be the answer.

Elizabeth, a 16-year-old girl, was recently involved in a MVA which resulted in her sustaining an extensive crush injury to her right upper limb. Subsequently, she had to have her right dominant arm amputated, below her elbow. Elizabeth is the lead violin chair in her high school string orchestra, and she wishes to continue playing the violin with dreams of studying at the music conservatory. She has been fitted with a myoelectric body-powered prosthesis which has an accessory grip to hold her bow, a spring for wrist actions, and a mechanism which allows for pronation and supination. Elizabeth has completed practicing grasping and controlling the bow. Which of the following activities should the COTA® work on NEXT during the Functional Training step of the Post-Prosthetic Phase? 1. Fine-tuning the instrument while plucking the strings with the prosthetic 2. Body mechanics to find the optimal position in the chair in

C. Playing simple scales to integrate bilateral use. Bilateral activities that require one dominant extremity (the TD) and one functional assist (the non-dominant hand) are the best tasks for practice during the functional training phase. A. Although this task requires bilateral use and is an important part of playing the violin, it allows a simple motion of the prosthetic rather than integrating its use during the actual musical performance. B. Positioning is important, but it doesn't include bilateral use. D. Accessing and storing the violin and bow would be important during holding and carrying, in the controlling and use training steps of the phase.

An OT practitioner is working with a patient with a C5 SCI who is in the acute stage of their recovery. In what position should the OT practitioner position this patient's forearms to prevent contractures from developing? 1. Supination 2. Flexion 3. Pronation 4. Extension

C. Pronation. Functionally, a C5 CSI has shoulder control and the ability to actively flex their elbows and supinate their forearms. Their inability to actively pronate, makes them prone to contractures in their supinators. Range of motion and stretching exercises are therefore essential in the acute stage, to prevent elbow flexion and supination contractures.

A professional dancer had to have an emergency amputation of his right dominant upper extremity after sustaining a crush injury to that limb. The patient is keen to resume dancing as soon as possible and has chosen a functional prosthesis to meet his needs. What professional would typically make this prosthesis? 1. Orthotist 2. Sonographer 3. Prosthetist 4. Orthodontist

C. Prosthetist . A prosthetist, as defined by The American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc.,[1] 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 or congenital deformities or absences.

Oliver is a 13-year-old boy who has been diagnosed with Stargardt disease which causes progressive damage to the macula, resulting in macular degeneration. Oliver is starting to show signs that he is struggling to use a standard computer at school and often reports that he is unable to read the text that is displayed on the computer screen. What type of assistive technology is the MOST appropriate to recommend for Oliver to help him access his school work on the computer? 1. Computer screen magnifier 2. Speech recognition software 3. Screen reading program 4. Screen magnification software

C. Screen reading program.The screen reading program will be the best adaptation for a child with a progressive condition resulting in loss of vision.A screen reader is a software application that enables people with severe visual impairments to use a computer. Screen readers work closely with the computer's Operating System (OS) to provide information about icons, menus, dialogue boxes, files and folders. A screen reader uses a Text-To-Speech (TTS) engine to translate on-screen information into speech, which can be heard through earphones or speakers. A TTS may be a software application that comes bundled with the screen reader, or it may be a hardware device that plugs into the computer. Since the majority of users don't use a mouse, all screen readers use a wide variety of keyboard commands to carry out different tasks. Tasks include reading part or whole of a document, navigating web pages, opening and closing files, editing and listening to music. A visually impaired computer user will use a combination of screen reader commands and operating system commands to accomplish the many tasks a computer is capable of performing.

A patient with fibromyalgia is scheduled to eat lunch as part of an occupational therapy feeding group. As the OTA assists the patient with a wheelchair to chair transfer, the patient's muscles give out and he begins to fall. What is the best action for the OTA to now take? 1. Call 911 2. Grasp the patient firmly and assist him back to the table 3. Slowly lower the patient to the ground and then get help 4. Lift the patient up by his legs and try to put him back in the wheelchair

C. Slowly lower the patient to the ground and then get help. Slowly lowering the patient to the ground is the safest way to protect both the patient and the OT from injury.

A patient who sustained a head injury as a result of a sports injury, is currently functioning at Level VI (Confused-Appropriate) on the Rancho Los Amigos Scale. The patient is due to be discharged and the plan is for him to go live with his 44-year-old sister. As she works from home, she has agreed to be available 24/7, to help with her brother's care. Before the patient is discharged, what is the most important information the patient's sister should be given to BEST equip her to take care of her brother? 1. Effective methods of cueing to help the patient initiate and end BADLs 2. List of mental health resources to ensure the patient maintains regular visits to prevent depression 3. Strategies to use to reduce or prevent caregiver burnout 4. The importance of using visual cues as reminders

C. Strategies to use to reduce or prevent caregiver burnout. Since the patient's sister will be the primary caregiver and available 24 hours a day, the subject of burnout should be addressed early especially if the patient requires extensive assistance. The OT practitioner should consider the effects caregiving can have on a person. The patient will be dependent on his sister for all aspects of his life ie: safety, psycho-social support, and IADLs. Depressive mood, stress and anxiety, physical exhaustion and decreased social and leisure participation are some of the factors experienced by the caregiver. By teaching her strategies to cope, her new role as caregiver could be made easier.

You are reviewing your patient's chart and you come across the abbreviation "AODM", what does this indicate? 1. The patient had a recent heart attack 2. The patient has optical nerve damage 3. The patient has Type II diabetes 4. The patient recently had a stroke

C. The patient has Type II diabetes. AODM indicates that the patient has Type II diabetes. AODM stands for-Adult Onset Diabetes Mellitus

A patient who recently had an above knee amputation has confided in you that he is concerned about his relationship with his girlfriend as he is afraid to express himself sexually. What would be the best course of action for you to take? 1. To provide treatment that would desensitize the residual limb 2. To reassure the patient that everything will be fine 3. To ask open-ended questions in order to further explore his concerns 4. To reassure the patient that his concerns are normal

C. To ask open-ended questions in order to further explore his concerns The best course of action would be to ask open-ended questions in order to further explore his concerns,especially if the patient is concerned with body image and sexual expression. Don't provide reassurance because it doesn't deal with concerns. Losing a limb is not just about the patient adjusting to functioning without that limb. There is also a significant psychological component that impacts on the person's life. Most people, under normal circumstances have difficulty getting used to a change in their body image. Understandably, accepting the loss of a limb is a major adjustment for anyone. Prior to an amputation, the physical image a person has, is one of being "whole", and after the amputation their physical image becomes one of being "part whole." Fear of rejection often makes it difficult for the amputee to pursue a relationship and to be intimate. The presence of a disease or disability has been shown to have a large impact not only on the patient's but also on their partner's sexual activities. It is therefore important that professionals address sexuality during the rehabilitation process with the patients and their partners.

A 32-year-old woman was recently involved in a MVA and subsequently sustained a complete SCI at the level of C6. The patient is the mother of 2 children, one of which is 3 months old and whom she is exclusively breastfeeding. As a result of her injury, her milk ejection reflex is absent affecting her milk production, and her ability to handle her infant is impaired due to poor hand function. With the help of medication and visualization, the patient has been able to produce some milk. What should the COTA® recommend for the patient to do, in order to maximize her independence in feeding her child? 1. Create an adapted handle on the bottle filled with baby formula 2. Place the child in a frontal sling carrier which has an opening, to support the baby's head and allow for the baby to allow latch onto the mother's breast 3. Use nursing pillows and wedges to support the mother's arms during breastfeeding 4. Lay su

C. Use nursing pillows and wedges to support the mother's arms during breastfeeding. A functional let-down reflex is required to provide adequate milk to a nursing infant. Infant suckling activates tactile receptors in the breast, and this signal is carried via afferent nerves in the T4-6 dorsal roots to the spinal cord and then to neurons in the hypothalamus, which releases oxytocin into the bloodstream. Oxytocin triggers milk ejection from the breast. Suckling-induced afferent stimuli are absent in women with SCI above T4. Fatigue is a concern for patients with spinal cord injuries. Supporting her arms is essential to reduce fatigue.

In which visual perceptual skill is a patient demonstrating an impairment, if they report that they are having difficulty recognizing traffic signs when they are driving and a sign is partially hidden either by a tree or another vehicle? 1. Visual Discrimination 2. Visual Memory 3. Visual Closure 4. Visual acuity

C. Visual Closure.Visual Closure is the ability to visualize a complete whole when given incomplete information or a partial picture. A. Visual discrimination is the ability to determine differences or similarities in objects based on size, color, shape, etc. B. The ability to recall or remember the visual details of what you have seen is known as visual memory. D. Visual acuity is a measure of the ability of the eye to distinguish shapes and the details of objects at a given distance. 20/20 vision is a term used to express normal visual acuity (the clarity or sharpness of vision) measured at a distance of 20 feet.

Ken is a 56-year-old patient who had a left above-knee-amputation due to peripheral vascular disease secondary to advanced kidney failure. It has been 8-months since his surgery and fitting Ken with a prosthesis has not been possible as he has had recurring infections in his residual limb. Ken is currently receiving dialysis 3-days per week which has resulted in him developing hemodialysis-related fatigue. Ken's wife who is acting as his caregiver has been assisting him with minimal assistance, using the stand-pivot method for transfers. Ken's wife is, however, becoming concerned for his safety when assisting him during these transfers due to his fatigue. What should the COTA® do NEXT in response to Ken's wife's concern? 1. Begin the process of discussing the need for additional assistance at home with social services 2. Work on caregiver training with sliding board transfers with emphasis on transferring to

C. Work on caregiver training with sliding board transfers with emphasis on transferring to both sides of the patient's body. It is best to learn to transfer in both directions as the patient must learn how to get on and off the transfer surface in both directions when using the slide board method. It is common for patients on dialysis to experience generalized fatigue. By having the wife and patient work together on a safe back-up plan to maximize independence in using the toilet and shower for ADL needs, the patient will be able to continue performing tasks even when he is most weak. A. At this time, maximizing independence while maintaining the patient's locus of control with the use of an alternate transfer method does not necessitate the need for additional assistance. It is also expected that he will be getting a prosthesis which may reduce the need for additional assistance. B. It is best to learn both directions of transfer. D. This is contraindicated on days when the patient is expected to become fatigued with activity.

Carol, a 58-year-old housewife who recently sustained a mild TBI, has been admitted to a rehabilitation facility. She is currently working with a COTA® and the focus of the session is on identifying the components of ADL tasks using card sorting exercises. Once Carol is able to achieve this, the COTA® asks her to separate clothing into 2 piles of light colors and dark colors, before washing the clothing. What approach is the COTA® using in this scenario? 1. Using a remedial approach to improve color differentiation 2. An adaptive approach to compensate for Broca's aphasia 3. A compensatory approach to minimize inattention 4. A transfer-of-training approach working on the skill of categorization

D. A transfer-of-training approach using the skill of categorization. Categorization is chunking information or placing it in groups. It is a part of thought functions that relies on the person's past experiences by identifying something they have seen or encountered in the past. After working on a tabletop activity such as sorting pictures to identify parts of a task, the patient "transfers" this skill to real-life situations to improve or restore cognitive skills. A transfer-of-training approach promotes engagement in tasks that will enhance recovery from a brain injury. A. This task is working on a specific cognitive deficit area, specifically thought functions, not visual perceptual problems. B. Working on compensating for expressive aphasia is not a goal in this task. C. Deficit of inattention is not observed in this task

A 26-year-old inpatient who sustained a mild TBI while skateboarding, is displaying decreased attention and disorganization, as well as a low threshold for becoming frustrated. Premorbidly, he was attending community college, pursuing a career in Business Database Development. His goal is to return to school within a month. Which activity should the OTA select in order to improve this patient's attention and organization? 1. Simple craft projects such as painting a wood coaster 2. Household tasks with organizing the kitchen counter 3. A competitive, board game involving 3 other players 4. A visual, action-adventure computer game that follows a linear sequence

D. A visual, action-adventure computer game that follows a linear sequence. An adventure computer game relates to his interest of using computers and follows a linear sequence that requires a long attention span and organizing steps. A. The wood coaster activity does not demand extensive attention and organization skills. B. This would be more related to life-tasks in occupational roles other than that of the role of a student. C. Competitive games do demand extensive attention, organization, and patience which may easily cause frustration.

An OTA is working with an overweight patient who appears to be very tired and he has difficulty raising his arms to perform lower body dressing. When asked to sit at the edge of the bed, the patient appears lethargic. What term best describes this patient's behavior? 1. Anosognosia 2. Dyspnea 3. ORIF 4. Anergia

D. Anergia. Anergia is a chronic state of lethargy and low energy characterized by being unable to complete everyday tasks. The lethargy and fatigue that the patient displays is consistent with this term. -Anosognosia- a deficit of self-awareness, a condition in which a person who suffers a certain disability seems unaware of the existence of his or her disability. -Dyspnea- A shortness of breath or breathlessness is the feeling or feelings associated with impaired breathing. -Open Reduction Internal Fixation (ORIF) involves the implementation of implants to guide the healing process of a bone, as well as the open reduction, or setting, of the bone itself.

An OTA is treating a patient who recently sustained a C2 SCI injury, and he is therefore dependent on a mechanical ventilator to breathe. In order to perform passive range of motion exercises in the most effective way, the OTA decides to transfer the patient from his bed to a reclining chair. Before transferring this patient, what part of preparing for the transfer is essential for ensuring the patient's safety. 1. Make sure the ventilator is working properly 2. Check the patient's blood pressure 3. Make sure that a staff member is near in case assistance is needed 4. Assemble 3-5 staff members to assist with the transfer

D. Assemble 3-5 staff members to assist with the transfer. The OTA should never attempt to transfer a ventilated patient on her own, for the patient's safety as well as her own safety - risk of injuring self if proceeds to transfer patient by herself.

Which "aging in place" setting is the MOST appropriate for a senior who is independent in their BADLs but needs maximum assistance with their IADLs? 1. Home health aid 2. Adult day care 3. Skilled Nursing Facility 4. Assisted living

D. Assisted living. Many alternatives are available for older adults to age in place, with the idea being that aging in place relates to the preferred place of residence. The environment, when modified to address a good person-environment fit, can increase or maintain an older adult's occupational participation. It may be in a single-family dwelling, an apartment, or an assisted living senior complex or with family. Assisted living is for people who need help with daily care, but not as much help as a nursing home provides. Assisted living facilities range in size from as few as 25 residents to 120 or more. Typically, a few "levels of care" are offered, with residents paying more for higher levels of care. Assisted living residents usually live in their own apartments or rooms and share common areas. They have access to many services, including up to three meals a day; assistance with personal care; help with medications, housekeeping, and laundry; 24-hour supervision, security, and on-site staff; and social and recreational activities. Exact arrangements vary from state to state.

A COTA® is working with a 72-year-old patient who is recovering from recent hip surgery which was indicated after the patient sustained a fracture to her femur. The surgeon used an antero-lateral approach to remove the head of the femur and replace it with a prosthesis. The current focus of OT intervention is on educating the patient on how to perform ADLs while adhering to post-op precautions. For lower body dressing, what is the MOST important position the patient should avoid? 1. Assistance with lower-body dressing will be required due to the fracture 2. Avoid dressing while seated on the edge of the bed 3. Avoid extending the knee of the operated leg 4. Avoid crossing the operated extremity over the non-operated extremity at either the ankles or the knees.

D. Avoid crossing the operated leg over the non-operated leg at either the ankles or the knees. When the femoral head is surgically removed, it is replaced with an endoprosthesis. This joint replacement is referred to as a hemipolar arthroplasty or sometimes referred to as a hemiarthroplasty. Depending on the surgical procedure used (posterolateral or anterolateral approach), specific precautions for positioning the hip must be observed to prevent dislocation. These precautions are the same as for a total hip arthroplasty or hip replacement. For the anterolateral approach, positions of instability include adduction, external rotation, and excessive hyperextension. Lower-Body Dressing post hip-surgery: The patient is instructed to sit in a chair with arms or on the edge of the bed for dressing activities. The patient is instructed to avoid hip flexion, adduction and rotation, or crossing the legs to dress. The patient must refrain from crossing the operated extremity over the non-operated extremity at either the ankles or the knees. In addition, assistive devices may be necessary for observing precautions.

An OTA has been working with a patient who sustained a C6 spinal cord injury, in the inpatient rehabilitation department. To help this patient maximize his independence during self-care activities at home with caregiver assistance, what type of adaptive device would be best to recommend to this patient? 1. Power wheelchair with head control 2. Wheelchair-mounted mobile arm supports 3. Electronic aid to daily living 4. Custom-fitted tenodesis splint

D. Custom-fitted tenodesis splint. A patient with a C6 spinal cord injury will have decreased strength through scapular protraction and limited horizontal adduction, and a mobile arm support would be beneficial to better support the weight of the arm and improve position of the arm for activities. At C6 spinal cord injury level, the patient should be able to use active tenodesis motion with the need for a splint.

A patient who works as a housekeeper complains of experiencing difficulty locating specific cleaning supplies on the shelves of her local supermarket. She reports that finding the items she needs to purchase is taking significantly more time which suggests that she may be having problems with her visual scanning abilities. The OTA is tasked with screening this patient for specific visual issues and presents the patient with a piece of paper on which several different shapes have been scattered. The patient is asked to circle all the triangles and she successfully completes the task. However, the OTA observes that the patient approached the task in a very haphazard manner. Based on this information, what does this patient's behavior MOST likely indicate? 1. She has a problem with visual feedback 2. She is using cognitive compensatory techniques 3. She has decreased visual scanning abilities 4. She is demonstrating d

D. Decreased visual attention. People with deficits in visual attention often approach visual scanning tasks in an unorganized way. Since the patient circled the triangles in a random/haphazard manner, the OTA can conclude that the patient displays signs of decreased visual attention.

Gabriel, a 53-year-old patient who was recently diagnosed with leukemia, has just completed a grueling month of chemotherapy which has had an impact on his muscle strength and stamina. Gabriel is struggling to perform simple motor tasks such as standing during his BADLs and walking around his home. What should the focus of OT intervention be at this stage of his treatment? 1. Encourage the patient to lift weights to improve his strength 2. Encourage the patient to walk around the block, to maintain his strength and ROM 3. Help the patient manage his medications 4. Focus on energy conservation

D. Energy Conservation. Chemotherapy can result in muscle weakness, muscle cramps, and muscle fatigue. Energy conservation is achieved by the simplification of work. By changing the way certain activities are done, muscle fatigue; joint stress and pain can be minimized. Applying energy conservation techniques to daily living activities, for example, can increase his endurance, maintain his muscle strength and muscle power; therefore preventing unnecessary strain on the patient's muscles, respiration and heart.

Diane, a 52-year-old patient, recently sustained a complete C8 SCI from a skiing accident. She has been depressed with the notion that she will not be able to return to the active lifestyle she once led. Diane currently needs minimal assist for bathing and community mobility, and stand-by assist for BADLs and light meal prep. Diane's sister who had a knee replacement a month ago, has agreed to act as her caregiver as they share an apartment. In preparation for Diane's discharge, the OTR® and COTA® will be meeting with Diane and her sister to discuss Diane's discharge plans. What is the MOST IMPORTANT information the clinicians need to obtain during this interview? 1. The accessibility of the home and vehicle to accommodate Diane's mobility devices 2. The financial ability of the family to install assistive technology to compensate for upper body weakness 3. The potential of Diane's sister to facilitate im

D. Family values and functional capacity of the caregiver and whether independence will be encouraged. The cultural values, physical and mental capacity will influence role expectations and whether independence will be encouraged. During caregiver training, the patient should be empowered to direct care effectively to support engagement and maintain self-efficacy.

t what Rancho Los Amigos level is a patient functioning if they can turn toward sound, respond to family members, and follow an object with their eyes? 1. Level 5 2. Level 2 3. Level 8 4. Level 3

D. Level 3. Rancho level 3: Localized response = total assistance - withdrawal from painful stimuli, turns towards sound, blinks at light, eyes follow object, responds to family members - moving to music

A COTA® is working with a 72 year-old woman on a self-feeding task with adaptive utensils. The patient has dual diagnoses of diabetes mellitus type II and hypertension. The COTA® notices that the patient's skin becomes pale, her breathing becomes deeper and a "fruity odor" on her breath is evident. The patient suddenly appears very weak and starts to complain of excessive thirst. What should the COTA® do IMMEDIATELY in response to these observations? 1. Return the patient to her room and offer her a glass of juice to quench her thirst 2. Check her blood pressure and recline her in her wheelchair with her feet elevated 3. Teach the patient breathing techniques as a tool to cope with stress as she is experiencing anxiety 4. Report the symptoms to the patient's charge nurse

D. Report the symptoms to the patient's charge nurse. This patient is demonstrating a diabetic crisis which needs immediate medical management. Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours: -Excessive thirst - Frequent urination - Nausea and vomiting - Abdominal pain - Weakness or fatigue - Shortness of breath - Fruity - scented breath - Confusion This is considered a medical emergency requiring prompt action by a nurse or physician as this is a sign of diabetic ketoacidosis which can lead to a coma and possibly death if not treated. A. Offering the patient food with glucose can exacerbate the symptoms. Therefore this is not an option.

What should an OTA do FIRST if a patient in a rehab clinic experiences lightheadedness and dizziness when standing up from a wheelchair? 1. Call the charge nurse 2. Check the patient's blood pressure 3. Give proprioceptive input such as weight-bearing until symptoms subside 4. Return the patient to the wheelchair and raise legs on elevating footrests

D. Return the patient to the wheelchair and raise legs on elevating footrests. The patient exhibits the symptoms of orthostatic hypotension in response to changes in body position. The OTA should help the patient sit back down in the wheelchair and should raise the patient's legs on the elevating footrests. The OTA can then check the patient's blood pressure and/or call the charge nurse to report the patient's condition.

A COTA® is working with an insulin-dependent 58-year-old patient on upper body strengthening exercises using the arm bike. The patient starts to become agitated and begins to complain of shakiness and that his hands are feeling clammy, making it difficult for him to grasp the handlebars tightly. What should the COTA® 's IMMEDIATE response be? 1. Stop the activity, loosen his clothing, and provide the patient water to drink 2. Reduce the resistance level of the bike as the patient is demonstrating reduced activity tolerance 3. Stop the activity, lay him down, and contact nursing who may have to inject insulin 4. Stop the activity, call for assistance, and provide him fruit juice

D. Stop the activity, call for assistance, and provide him fruit juice. The question is asking what the COTA®'s immediate response should be. The first step is to make sure that the patient is safe which involves stopping the activity and preventing a medical emergency by providing glucose orally while waiting for the medical staff to assess and treat the patient.

A 78-year-old woman requires maximum assistance with IADLs, but she is able to complete her BADLs independently. Her daughter asks the OTA where the woman should live. What should the OTA recommend? 1. The OTA should recommend a home health aid 2. The OTA should recommend adult day care 3. The OTA should recommend a senior nursing facility 4. The OTA should recommend assisted living

D. The OTA should recommend assisted living. Assisted living is a residential option for seniors who want or need help with IADLs, such as cooking meals, housekeeping, and traveling to appointments.

A 72-year-old man was admitted to the hospital for a C3 spinal cord injury four days ago. He asks the OTA if he will ever have movement in his legs and his arms again. How should the OTA respond? 1. The OTA should tell the man that if sensation does not return within 24 - 48 hours, it is less likely to return. 2. The OTA should tell the man that if motor function does not return within 24 - 48 hours, it is less likely to return. 3. The OTA should tell the man that if sensation or motor function does not return within 72-96 hours, it is likely to return. 4. The OTA should tell the man that if sensation or motor function does not return within 24 - 48 hours, it is less likely to return.

D. The OTA should tell the man that if sensation or motor function does not return within 24 - 48 hours, it is less likely to return. Prognosis for recovery depends on whether the lesion is complete or incomplete. The faster sensation, motor function, or both return, the better the prognosis for recovery.

What type of adaptive equipment would be best to recommend to patients at SCI C1-C4 to promote independence with drinking? 1. A movable tray 2. A cup with a wide brim 3. A wide and tall glass 4. The use of a long bottle or straw

D. The use of a long bottle or straw. Patients who are at SCI C1-C4 would benefit from using a long bottle or straw in order to drink independently.

A COTA® is working with a 32-year-old male patient who recently sustained an injury to his left non-dominant upper limb, which resulted in him having to undergo a below-elbow amputation of that limb. The focus of OT intervention is on tub-shower transfers. The patient is experiencing intense sensitivity and pain in that limb, and he does not want to wear a prosthesis to perform his ADLs. What should the COTA® focus on NEXT during the treatment session? 1. Train in protective sensory feedback using light touch with application of various textures from rough to soft 2. Ace-wrapping in a circular pattern proximal to distal end of the limb for pain 3. Training in compensatory techniques and use of adaptive equipment for self-care 4. Training in desensitizing techniques incorporating massage and wrapping of the residual limb.

D. Training in desensitizing techniques incorporating massage and wrapping of the residual limb.Addressing the patient's pain FIRST, should always be a priority.'' A. This is necessary for sensory retraining, however, gradual use of textures would be beneficial. B. Ace-wrapping should be performed diagonally, distal-to-proximal in a figure-of-eight pattern. Circular pattern can cause restriction to circulation. Tapping and gentle massage would be one of many preferred protocols for pain management. C. Training in compensatory techniques and use of adaptive equipment for self-care should be the next step in the intervention plan, once the patient's pain has been controlled. As the patient verbalized a preference for continuing to perform ADLs without the use of prosthetics, following the ethical principle of Autonomy, the patient's wishes will be respected and the focus will be on client-centered adaptive and compensatory techniques that include the residual limb. Training will include use of the residual limb as a stabilizer for bimanual activities, training in adaptive equipment, and one-handed techniques.

Preeclampsia

This condition is characterized by high blood pressure, excess protein in the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby.

Nephropathy

(Kidney damage). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from the blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.

A 93-year-old woman is about to get discharged from the rehabilitation department after a hip replacement. When discussing home discharge and safety, what are the three most important modifications to review with this patient to reduce her fall risk? (Select the best 3 choices). 1. Removing throw rugs 2. Removing trash cans 3. Reducing clutter in mobility pathways and around sitting areas 4. Removing pillows and blankets on sofas and chairs 5. Placing objects at appropriate heights 6. Using adaptive equipment such a long-handled reacher and a shoehorn

1) Removing throw rugs; 3) Reducing clutter in mobility pathways and around sitting areas; 5) Placing objects at appropriate heights Home safety concerns and modifications are important to review with patients to reduce their fall risk. Recommendations may include removing throw rugs, reducing clutter in mobility pathways and around sitting areas, and placing objects at appropriate heights.

A patient has been walking down a familiar street for 30 minutes requires some cuing for stepping off a curb, orientation, and time. At what Rancho level is this patient functioning? 1. 8 2. 7 3. 6 4. 5

6 Rancho Level VI -Sometimes oriented to person, place and time -Long-term memory more complete than short-term memory -Able to pay attention to familiar activities for up to 30 minutes with some cuing -Able to follow simple directions -Beginning to respond appropriately to family and friends -Able to complete familiar activities with supervision -Requires maximum assistance for new activities -Moderate assistance to problem -solve during tasks -Vaguely recognizes staff members -Unaware of impairments, safety risk

A patient with a high level SCI who resides in a nursing home has developed a reddened area on her sacral spine. The area is being monitored by nursing staff and they report that the area remains red for longer than one hour and it does not blanch when touched. What condition does the resident have? 1. A stage 1 pressure ulcer 2. A stage 3 pressure ulcer 3. A first degree burn 4. A contagious rash

A. A stage 1 pressure ulcer. Stage 1 ulcers are reddened areas that do not blanched when pressure is applied. Redness stays for longer than one hour when exposed. These ulcers are reversible.

An OT practitioner is observing a male patient who recently sustained a TBI, shave his face using an electric shaver. The patient is able to operate and control the shaver with skill, but he takes an excessive amount of time to shave his face and repeatedly goes over the areas which have already been shaved. What is this type of behavior MOST likely indicative of? 1. Difficulty problem-solving 2. Difficulty sequencing 3. Difficulty following directions 4. Difficulty with termination of activity

D. Difficulty with termination of activity. Taking an excessive amount of time with an activity reflects that this patient has difficulty with terminating the activity.

Increased pressure in the eye, damage to the optic nerve, and decreased peripheral vision and/or tunnel vision can be caused by what condition? 1. Macular degeneration 2. Glaucoma 3. Diabetic retinopathy central vision 4. Homonymous hemianopsia

B. Glaucoma Causes increased pressure in the eye, which damages the optic nerve and results in decreased peripheral vision or tunnel vision