NBCOT 3
berry and brod
after training on the task it improved but not ability to answer questions about how the system worked
GBS: Age of onset
ages 20-24 and 70-74 years
pneumatic or semipneumatic tires
air filled
low criterion
alert for every blob saying "yes" a lot of flase alarms but never miss
can imitate one step motor actions
allen 2
The purpose of sensory integration intervention is to ____so that the child may respond more efficiently and effectively in his or her environment.
alter the child's CNS
Incoordination of movement
alteration of rhythmical, repetitive movements in HD
Proximal humeral fractures are the most common fracture of the upper arm and may involve the ___
articular surface, greater or lesser tuberosity, or surgical neck.
In the Prosthetic phase how are skin ulcers obtained?
as a result of ill-fitting prosthesis socket or wrinkles in prosthetic sock
traditional cartesian theater
assumes perception is alwasy conscious
sdt definition
assumes there is no singe absolute threshold and htat ddetenction depends on perceptual judgement as a combination of sensation and decesion making prcoess
A built-up foam grip would require the client to grasp and release the utensils, but ___ of the hand muscles would not allow the client to grip the foam, even if it is built up.
atrophy
Spontaneous behaviors
attitudes will predict behavior
Over time, diminished ___ to a peripheral nerve can result in serial impingements, called double crush syndrome.
blood flow
Vestibular input is processed mostly in the ______
brain stem.
The chair is more easily moved when the client's center of mass is
close to or slightly behind the drive wheels' axle.
Do people with PD experience tingling sensation (paresthesia)?
No
Is putting a deadbolt on the door a good idea for someone with Dementia?
No. Because the person can lock a caregiver out and forget about it.
Are cognitive impairments typical with Guillain-Barré syndrome?
No. Cognitive impairments are not typical with Guillain-Barré syndrome.
Can you use slow stretching in acute phase of CTD?
No. Slow stretching is used in subacute phase.
The OT should recommend and train the clients in the use of ________ devices to improve independence and safety and functioning.
Nonoptical devices ( largeprint books)
__ positioning is the key to stability
Pelvic
Diagnosis of PD
People with initial symptoms such as resting tremor are often referred to a neurologist. At lease one primary symptom must be present
Intervention related to vision for MS
Perform home safety assessment and make recommendations to reduce risk of falls
Compression to the anterior interosseous nerve results in motor loss involving FDL, ____ & pronator quadratus.
Flexor profundus to index finger
Focus of middle stage intervention in HD
Focus on engagement in purposeful activities (leisure activities)
___occurs when the flexor pollicis longus compensates for a weak or paralyzed adductor pollicis and flexor pollicis brevis. When a client attempts to pinch, the interphalangeal joint of the thumb flexes more than usual.
Froment's sign
Rapid progression of symptoms, typically in a symmetrical ascending pattern of flaccid paralysis that begins in the feet. paralysis may occur in respiratory muscles
GBS
20%-30% of people with __ need mechanical ventilation.
GBS: Onset and acute inflammatory phase
children with this type of dysfunction may be extremely scared of movement and may move carefully
Gravitational insecurity
Difficulties with smaller movements and eye-hand coordination
HD
compensate for weak grasp in moving the wheelchair
Hand rim projections
progressive loss of nerve cells in the brain, affecting movement, cognition, emotions, and behavior
Huntington's Disease (HD)
These cushions incorporate a combination of materials, typically foam and gel.
Hybrid
Sleep = ADL or IADL?
IADL
Measuring Seat-back height
Measure from the seat surface (including the cushion) to the top of the client's shoulder; a higher back height may be needed if trunk control is poor.
Causes ape hand deformity.
Median nerve injury
Dementia: The person can no longer live alone.
Middle stage
Which standardized tool can you use to test for spasticity in MS clients?
Modified Ashworth Scale for spasticity
Which standardized evaluation tool can you use related to fatigue in MS?
Modified Fatigue Impact Scale
fracture to the metacarpal bones is called a
proximal fracture
Pronator syndrome is the entrapment of the ___ between the heads of the pronator muscles.
proximal median nerve
Extensor Thumb Zone II falls over the
proximal phalanx
Resting the arms on the thighs ____, making breathing easier and lessening fear.
releases the diaphragm
Treatment for Type III Radial head fracture
removal of the fragmented bone and cast for 3-4 weeks
A socket attaches the prosthesis to the
residual limb
In the Prosthetic phase how are Sebaceous cysts obtained?
resulting from torque of prosthetic socket
External cues, including simple verbal instructions, and rehearsal of movements are beneficial in improving a client's ability to______
resume task completion, including initiating task performance.
Children seeking proprioceptive input may try to get their needs met by engaging in what ?
rough housing and other activities that provide them with deep-pressure input or muscle resistance.
Beneficence addresses ___ for recipients of services.
safety
What is the most common fracture seen and missed in injuries to the wrist
scaphoid fracture (carpal fracture)
If minimal trunk support is required, measure from the seat surface (including the cushion) to the midback, just under the __. Lower back height (e.g., in sports chairs) increases functional mobility but decreases stability.
scapulae
A __ job that requires minimal verbal communication is a better fit for a person with PD
sedentary
ALS Physical demands at work should be minimal and __
sedentary
bundle theory
self is an illusion, no such thing as the real me
Expected outcomes of intervention for sensory integration: Increase in self-confidence and ____.
self-esteem
perceptual experience is the joint
sensitivity and response bias willingness
Wilbarger (1995) developed a concept called the________ .
sensory diet
Anterior interosseous nerve syndrome is motor loss of function without__.
sensory disturbance
Casters
smaller wheels, usually rubber, located on the front of the chair. i. They rotate freely, making steering feasible. ii. Larger casters give a more comfortable ride; they are less likely to get stuck in a hole.
For sensory input to be effective, it has to be matched to the child's ______
specific CNS requirements.
Why are orthotics used in the intervention for wrist fractures ?
to protect the extremity from motion or allow for protected motion.
Athetosis is characterized by ___
tone that fluctuates from low to normal with little spasticity.
response bias
willingness to say you detect
As tasks become more complicated and children continue to demonstrate adaptive response, their SI becomes more _______ and _____
effective and efficient.
benefit of group sessions for PD?
effective in decreasing the impact of postural instability
split brain
ego self 2 bundle self 0
function of anconeus
extends elbow
Active wrist, finger, and thumb extension splints are fabricated for ___ tendon injuries.
extensor
opthalmologist
eye doctor
Being able to ______ and use them efficiently is an important part of child development. When children have difficulty interpreting what they are feeling, they may experience delays.
feel objects and use them efficiently
A tendon repair is typically at its weakest 10-12 days postsurgery during the __ phase, in which collagen is just beginning to be laid down to strengthen the repair.
fibroplasia
Tendon Glide sequence for Flexor tendon repair?
fingers straight, MCP flexion, hook fist, then flat fist
balanced
flase alarm and miss rates are queal
The dorsal blocking splint protects the surgery and guards against __ tendon rupture.
flexor
What is stress loading
for example, scrubbing the floor, carrying a weighted handbag
Children with tactile discrimination and perception problems have difficulty grading __ or ___
force or pressure.
What is the usual cause of radial head fractures?
forceful load through and out-stretched arm.
What is a carpal fracture?
fractures to individual carpal bones
In Stage III of Alzheimer's disease, an individual requires ____ throughout ADLs as memory and physical status continue to decline.
frequent physical and verbal assistance
Early interventions for MS.
functional mobility, ADLs, fatigue management, role and routine modifications are critical for preventing and delaying onset of disability
What are the sensory impairments associated with carpal tunnel syndrome?
generally involves numbness and tingling in the thumb and index and middle fingers, especially at night.
alopecia
hair loss
A ramp run that has a rise of more than 6 inches or a horizontal projection of more than 72 inches should have
handrails on both sides
compromised pronunciation because of dysarthria
later stages of HD
OT evaluation for PD: Occupational therapists review interests, roles, and routines and set goals to help the client main- tain participation in ___
life activities
Positioning components can include wrist, elbow, shoulder, knee, and ankle devices. These devices may have a _______ activated by the user.
locking system
The primary goal in working with clients with dementia is to __
maintain functional capacity
A common symptom of Parkinson's Disease is a ___-; the flat affect and lack of nonverbal communication makes it necessary to assess pain by other means such as by asking clear questions that require a one- or two-word response.
masklike facial expression
The guiding principles of Ayres Sensory Integration treatment indicate that Registration of ________ is necessary before an adaptive response can be made.
meaningful sensory input
What is a proximal fracture?
metacarpal fracture, such as a boxer's (4th and 5th finger) fracture.
has problem walking on uneven surfaces
middle stage of HD
At the __, written words may create confusion. Picture labels are more effective.
middle stage of dementia
disturbances in memory and decision making
middle stages of HD
continual verbal cues for dementia
might be overwhelming, therefore not a good idea for people with dementia
Clients with lower limb amputations tend to have restrictions in ______ and ______.
mobility and ADLs related to lower- extremity care.
ALS Stage 2
moderate weakness.
two threshold-cheeseman merikle
objective threshold- where discrimination is at choice subjective thres where responding is above change but sibjects report being unaware of the stimuli
Evaluation begins with an
occupational profile
In the recovery phase of GBS, interventions aim to help the client resume
occupations and roles, rituals, and routines.
hypopompic
occur when a person is waking up
The sternum is broken during open-heart surgery, so the client must avoid_____, pulling up (body weight), and other movements that would strain the sternum for 6 to 12 weeks.
one-sided lifting over 10 lb
Which medication can be given to MS patient for selected urinary problems?
oxybutynin
Grade I of Cumulative Trauma Disorder
pain after activity, resolves quickly
What can you suggest about managing the Proximal humeral fracture at home?
- A home exercise program is crucial for the return of motion,function and ADL performance. - The home program can include a sling for comfort and sleeping for the first 6 weeks as needed.
What can you do if an MS patient has pain from spasticity?
- Advise on a standing home program, such as using a standing frame (weight bearing) - Use resting splints. - Maintain hips at 90° or more of flexion to reduce extensor tone in the lower extremities. - apply FOCAL HEAT MODALITIES on muscle TRIGGER POINTS. !!!
ALS Stage 4
- Can't walk (severe weakness in legs); need wheelchair; - need some assistance with ADLs
Hand: Types of Fractures
- Carpal fractures - Proximal fractures - Avulsion injuries
Radial Tunnel Syndrome: Pain management?
- Massage - TENS
How do we test vascularity?
- observation of color and trophic changes - pulse -skin temperature - Allen's test
What is the OT intervention in the acute phase of Cumulative trauma disorder (CTD)?
-Reduction of inflammation and pain through static splinting, -ice, -contrast baths, - ultra-sound phonophoresis, -iontophoresis, -high-voltage electric - interferential stimulation
What are the symptoms of Cumulative trauma disorder (CTD)?
-muscle fatigue, -pain, -chronic inflammation, -sensory impairment, -decreased ability to work
Clear space of __ between the handrail and the wall
1-11⁄2 inches
Treatments typically last between 45 and 60 minutes ___ times per week and continue for about _____.
1-2, 2 yr
What are 4 areas that the OT should look at in the eval of a person with low vision?
1. ADL & IADLs 2. Visual acuity 3. Visual fields 4. Contrast sensitivity
Educate the client on home modifications that may be needed to reduce fall risk such as?
1. Increasing lighting 2. Reducing clutter 3. Scanning the environment for obstacles 4. Using contrast as needed to increase ability to see stair edges.
What are the the types of nerve problems associated with the median nerve ?
1. Median nerve injury 2. Anterior interosseous syndrome 3. Pronator syndrome 4. Carpal tunnel syndrome
What are the 3 phases in the OT providing therapy for a client with a recent amputation?
1. Preprosthetic interventions 2. Prosthetic prescription 3. Postprosthetic interventions
How can the OT help make objects stand out from the background ?
1. Recommend using colors that contrast or are opposite to each other ex: coffee in light cup, bold-lines paper, decrease use of patterned backgrounds
What are the typical manifestations of Cataracts?
1. Reduced visual acuity 2. Blurry vision 3. Decreased ability to distinguish colors 4. Reduction in ability to drive at night 5. Distortion of visual images 6. Increased glare sensitivity 7. Difficulty distinguishing similar colors from background
What are the 2 Sensory integrative problems?
1. Sensory modulation problems 2. Sensory discrimination and proprioceptive problems
How should the OT gather general information during the evaluation process?
1. Through reading medical records 2. Completing an Occupational profile 3. Use of interviews, questionnaires and standardized or structured assessments
What are the evaluations specific to carpal tunnel syndrome?
1. Tinel's sign 2. Phalen's test 3. Moberg Pickup Test 4. Semmes-Weinstein monofilament testing
Cold application is usually used to control acute inflammation. Acute edema occurs within the first ____ hours after injury.
24 to 72
Door hardware for accessible door passages should be mounted no higher than __ above the finished floor.
48 inches
Allen Level 3 = Rancho Level
5
Difficulty with judgement
5
How many grades are associated with Cumulative trauma disorder (CTD)?
5
How many stages of PD?
5
difficulties with episodic and semantic recall
5
difficulty multitasking
5
episodic memory problem
5
What is Colles fracture?
A complete fracture of the distal radius with dorsal displacement. This is the most common type of wrist fracture.
is a realistic, nonfunctional hand worn for cosmetic purposes
A passive TD
What 2 things should the OT evaluate for a client with a contracture?
A. PROM B. AROM
a client would attend to visible sensory cues and ignore what is not in plain sight
ACL 4
Riluzole may help people remain in the mild stages longer.
ALS
Children with typical CNSs will seek out the sensory input that they need to organize themselves and to help them achieve their goals.
Adaptive response
What is prerequisite to sensory integration?
Adaptive responses
The client has lost precision pinch, thenar opposition, and the ability to bend the index and long fingers at the proximal and distal interphalangeal joints. What deformity is the client MOST likely to have?
Ape hand deformity
What hand posture is associated with a median nerve injury?
Ape hand deformity
What symptoms are associated with a median nerve injury?
Ape hand deformity: 1. sensory loss in index, middle, and radial side of ringer finger; 2. loss of pinch, thumb opposition, index finger MCP and PIP flexion; and decreased pronation
At what age can a child MASTER shoe tying?
At 6 years old
Client with Dementia: Allen's Cognitive Level 3.4
At Level 3.4, the client will typically wash only areas easily seen and reached. The client may wash one area repetitively and may forget to rinse or dry off.
Who are at highest risk for developing de Quervain syndrome?
At highest risk are women ages 35-55, women in late pregnancy, mothers of young children, and people who engage extensively in keyboarding, piano playing, knitting, needlepoint, and racket sports.
How soon should you begin ROM for Proximal humeral fracture?
At least 2 weeks after a nonoperative fracture as medically prescribed.
What is the typical onset age for Type I diabetes in children?
At the age of 10
An additional incentive for a research participant is more likely to violate the principle of
Autonomy
Why use pictures/labels or simple written words in Middle Stage Dementia?
Because written words may cause more confusion
The best corrected visual acuity of 6/60 or worse (=20/200) in the better seeing eye
Blindness
Blood supply to tendons is limited. how do nutrients reach there?
By synovial diffusion
Continuous passive motion is a technique to control pain for what diagnosis?
CRPS
The primary and most severe complication of distal radius fracture is ___.
CRPS
Spinal cord stimulator is used to treat ____.
CRPS to control pain
Interferential stimulation can be used to treat?
CTD
Myofascial pain is associated with
CTD
Nerve compression syndrome is associated with
CTD
Dementia: Middle Stage: simple home management tasks
Can be completed with assistance
What is good assessment to establish client centered goals?
Canadian Occupational Performance Measure
Which assessment empowers clients and minimizes their stress.
Canadian Occupational Performance Measure
near-reflexive directions (i.e., "sip").
Cognitive Level 1—automatic actions
remitting
Complete recovery periods
Trauma to soft tissue caused by repeated force, it indicates the mechanism of injury but is not a diagnosis.
Cumulative trauma disorder (CTD) ,also called overuse syndrome and repetitive strain injury
They provide the most support, dis- tribute pressure across their surface, and are more expensive than standard contoured surfaces.
Custom-contoured surfaces
shaped to a client's body
Custom-contoured surfaces
ego theorist
DID occurs because there indeed are different selves who have distinct consciounsess with seperate wills
The __ joint can be passively extended if the other joints of the digit are flexed to initiate tendon glide and prevent scarring of the tendon.
DIP & PIP
Instruct adults in using prescribed optical devices and magnification during _____
Daily activities
Emotional symptoms of MS
Depression, Inappropriate euphoria, Lability (sudden mood swings)
What condition is associated with Fluctuating vision loss?
Diabetic retinopathy
What is Discontinuous exercise?
Discontinuous exercise involves using various exercise activities for the same time interval while gradually increasing the intensity of the tasks.
In which way would the OTR® assess legibility during the screening?
Document the total number of readable words divided by the total number of words written.
This occurs when a peripheral nerve is entrapped in more than one location
Double crush syndrome
What is the most common type of AMD ?
Dry
decreased coordination of movement
Dysmetria
Introduce a home exercise program to address flexibility and endurance of the entire body.
Early stage intervention for HD
Write down all steps in a logical order
Early stage intervention for HD
Write down all steps in a logical order. Review steps so the client clearly understands them. Encourage completion of each step before moving on to the next step.
Early stage intervention for HD
Promote universal access to transportation for people with disabilities
Easter Seals Project ACTION
What does an Occupational Therapist generally work on with an older adult with low vision?
Enhancing their independence and function during the performance of meaningful occupations.
Ensure clients are using prescribed optical devices correctly such as ?
Ensuring appropriate light and distance from objects
What is Pronator syndrome?
Entrapment of the proximal median nerve between the heads of the pronator muscles
___are used at Stage III of Alzheimer's disease to compensate for deficits in perception related to safety with mobility.
Environmental aids
Educate clients on appropriate ____ prevention strategies
Fall
Educating the client and caregiver to allow for increased time for feeding and ADLs; stress from rushing increases symptoms.
Feeding and ADL adaptation for PD
Use distal wrist weights if effective in decreasing tremors.
Feeding and ADL adaptation for PD
Encourage the client to modify meals for smaller portions, remove distractions, eat more slowly, and use adaptive equipment such as built-up or weighted utensils, cups with lids, plate guards, and nonslip surfaces.
Feeding and ADL adaptations for PD
__ presents with pain, fatigue, and tender trigger points.
Fibromyalgia
Why task simplification for Dementia?
First step to maintain independence in daily/familiar tasks
Why would an OT use a Tumbling E chart as opposed to a Snellen E chart to asses far visual acuity?
For individuals who are illiterate or may have aphasia.
____ should be avoided in Radial Tunnel Syndrome.
Forceful wrist extension and supination
Causes deficits in task and activities that requires outter eye vision (Safe ambulation, reading, writing)
Glaucoma
What condition is associated with Peripheral vision loss?
Glaucoma
Allen Cognitive Level 4
Goal-Directed Actions - At Level 4, the client would be able to complete quick tasks and model single-step completion. Routine tasks would be independent for a client.
Good (4/5)
Good (4/5) muscle grade indicates the upper extremity moves through full ROM against gravity with moderate resistance and the client would not have difficulty washing the opposite side of the body.
Age-related changes in vision occur ______.
Gradually over time
is an overresponsivity to vestibular input
Gravitational insecurity
Dystonia are seen in
HD
In the initial stages, difficulty maintaining work performance
HD
In the later stages, compromised pronunciation because of dysarthria
HD
In the middle stages, disturbances in memory and decision making
HD
Loss of small motor control and eye-hand coordination affects ability to use tools and utensils, write, and use a keyboard.
HD
Motor difficulties and Deterioration of cognitive and behavioral abilities
HD
Symptoms usually appear in the third or fourth decade of life.
HD
__ (medication) is used to decrease chorea during performance of functional activities in HD.
Haloperidol
Trigger finger is a condition in which edema in the tendon and synovium of the digit results in lack of smooth flexion or extension of the finger. To rest the tendon and prevent snapping as the tendon pulls through the finger pulleys, the MCP joint is blocked by splinting, then gentle pull through with bending and straightening of the distal and proximal interphalangeal joints is recommended 20 times every 2 hours while the client is awake.
Heating between 71.6°F and 105.8°F increases lymph flow and helps soften tissues to promote increased range of motion. Heating does not exacerbate minimal edema.
designed to be bigger and stronger for clients who are obese or have severe spasticity.
Heavy duty chairs
The cushions provide uneven pressure relief and are lightweight.
Honeycomb-shaped plastic
Expected outcomes of intervention for sensory integration: ___ in gross and fine motor skills
Improvement
Role of OT in initial stages of PD
In initial stages we play a role when functional limitations or psycho-social issues exist
When should you provide psychoeducation to clients with dementia?
In the early stages
What does Levodopa do for PD clients?
Increases Dopamine levels
An OTR® is working with a client who fractured the distal radius 6 weeks ago. Within what time frame can controlled AROM be initiated if the fracture is healing secondarily?
Initiation of controlled AROM can begin between 3 and 6 weeks postinjury if the fixation of the fracture is adequate.
Cold spray is used to treat trigger points and increase passive stretch of a muscle tendon unit.
Initiation of controlled AROM can begin between 3 and 6 weeks postinjury if the fixation of the fracture is adequate.
What are Avulsion injuries?
Injuries where the tendon separates from the bone and its insertion and removes bone material with the tendon.
When is it safe to begin movement at the fracture site?
It depends on the fracture type, stage of healing, and physician orders.
The pelvis rotates posteriorly, resulting in sacral sitting and exion of the lumbar spine; clients tend to slide forward on the seat.
Kyphosis
Fact: Because a donor heart is denervated, the autonomic nervous system does not control the client's heart rate. The heart relies on circulating hormones, which take longer to increase and decrease the heart rate.
Learn that shit
How to do exercises with MS?
Less weight more reps
Allen's Cognitive Level. Client with dementia: At Level ___, the client will be able to wash most distal portions of the body and those that are easily seen but will not always follow the sequence thoroughly. The client may quit before completion and may have difficulty with measuring soaps, lotions, and deodorant.
Level 3.6
have features similar to those of a standard wheel- chair but are lighter in weight (often made of aluminum; <35 lb). Adjustability is limited.
Lightweight chairs
_____movement is usually tolerated the best and is introduced first.
Linear
Radial Tunnel Syndrome: Splint?
Long arm splint; elbow flexed, forearm supinated, wrist neutral
Benign MS
Loose all functional abilities after 15 years
What fractures are associated with Keinbock's disease?
Lunate fractures
Which psychiatric condition is MOST frequently seen as interfering with the occupational engagement of a client with cardiac disease?
Major depression
What are the symptoms of Median nerve injury?
Median nerve injury produces carpal tunnel-like symptoms, such as palmar numbness and numb- ness of first digit to half of the fourth digit, with generalized weakness and pain.
Riluzole
Medication For PD to help client stay in the mild stages longer
This tool assesses the impact of a person's visual impairment on ADLs and IADLs
Melbourne Low Vision ADL Index
What is the name of pressure receptors of the hand?
Merkel cells
prescribed to MS clients for functional skills
Methylprednisolone
Dementia Stage: dependent in community mobility
Middle Stage
Dementia Stage: difficulty picking out appropriate cloths
Middle Stage
It is used with children and cognitively impaired adults to test median nerve function.
Moberg Pickup Test
Do standard chairs have a good adjustability?
NO
reduced facial expression or flat affect (e.g., infrequent eye blinking) affecting nonverbal communication
Nonverbal communication problems in PD
Normal (5/5)
Normal (5/5) muscle grade indicates the upper extremity moves through full ROM against gravity with maximal resistance and the client would not have difficulty washing the opposite side of the body.
Obtain specific levels of function and the client's goals and priorities
OT evaluation for ALS
primary method for assessing/evaluating a person with dementia
Observation
___are the primary methods of assessment recommended for clients with AD. After observation, it would be important to interview family and caregivers to complete the assessment.
Observation and interview
What should we observe for during Evaluation of the Hand and Upper Extremity?
Observe posture, spontaneous use of upper extremity and hand, guarding, scar, wounds, and skin.
OT evaluation for ALS
Obtain specific levels of function and the client's goals and priorities
Dimensions of doing
Occupational participation, performance, and skill.
Cognitive deficits in PD?
Occur in later stages: memory loss/dementia; visuospatial and executive function impairments
When does prosthetic training occur?
Occurs after the client receives permanent prosthesis
for clients with hemiplegia or one arm amputated. Axles are linked to allow both wheels to operate from one side.
One-arm drive chairs
Flexor tendon OT intervention. When can you used modalities?
Only if cleared by the prescribing physician.
Dorsal wrist blocking splint can be used for
Operative tx for Median nerve injury
Is this a Operative tx or Non-operative tx for Radial Nerve Injury: Put a static wrist extension splint at 30 deg?
Operative tx.
* Sedentary Job is a better fit for someone with __
PD
Use moist heat, stretching, and gentle ROM to address rigidity in
PD
Fabricate busy boxes with safe items for handling
Pillaging and rummaging Behavior management
A client with emphysema is most likely to have what color skin?
Pinkish skin color
___is an inappropriate position for early elbow extension and flexion.
Prone
____ input may have a mediating effect on vestibular input, and the occupational therapy practitioner will often offer both types of input at the same time (e.g., encouraging the child to swing on a platform swing while "climbing" a rope with the hands).
Proprioceptive
best suggestion for Alzheimer's disease
Provide structure to unoccupied time
GBS: Design activities and dynamic splints to help maintain __, especially for the wrist, fingers, and ankle (hinged drop-foot orthosis).
ROM
Wrist drop and possible lack of finger & thumb extension is a symptom of _____.
Radial Nerve Injury
This tx. is for what injury? Static wrist extension splint at 30 deg. After 4 weeks adjust splint to 10 - 20 deg. extension.
Radial Nerve Injury (under operative treatment)
Wrist cock-up splint is a treatment intervention for ___.
Radial Nerve Injury under Non-operative tx and Radial Tunnel Syndrome (for 2 wks) under operative tx.
Burning pain in lateral forearm is a symptom of what condition?
Radial tunnel syndrome
This is treatment for CRPS is surgery to remove a thickened nerve
Removal of neuroma
Parkinson's Disease: Late stage symptoms
Resting tremor, rigidity, oral motor deficits
___ often onsets in the early stage of Parkinson's disease and progresses in severity in later stages.
Rigidity
What medication for ALS may help people remain in the mild stages longer?
Riluzole
Name the receptors of the hand that sense tension?
Rufini End Organs
for clients whose walking ability is limited. They have a large turning radius, and the seat swivels, which may make trans- fers easier and have limited adjustability.
Scooters
An OTR® in an outpatient center is working with a client who has rheumatoid arthritis. The client, who is the parent of two children, has worked with a driver rehabilitation specialist on vehicle modifications that allow safer and more comfortable operation of the client's car. Which other aspect of community mobility might a generalist OTR® address?
Securing the client's children safely in their car seats, including handling the car seats and positioning the children
Dystonia
Seen in HD. Abnormal muscle tone that causes the impairment of voluntary muscle movement. sustained posturing of a body part. typically the arms, head, or trunk
How should the OT evaluate for self-care activities?
Self-care activities should be evaluated both with and without the prosthesis.
occupation-focused assessment that determines whether volition, habituation, skills, and environment facilitate or restrict occupational participation.
Short Child Occupational Profile (MOHO-based assessment)
When is strengthening contraindicated for flexor tendon repair?
Six weeks after surgery/repair
Choreoathetosis
Slow, writhing and sudden/rapid jerky movements
AMD may cause difficulty with ____________ because individuals with AMD may have difficulty seeing facial expressions and gestures
Social participation
Increased efficiency in these lower levels of the CNS is thought to enhance higher levels of functioning.
Somatosensory and Vestibular input
Raynaud's syndrome
Spasm of blood vessels of fingers and toe
How to treat Boutonniere deformity?
Splint PIP in extension, and perform isolated DIP flexion exercises
Wearing a splint at night is appropriate for carpal tunnel syndrome. T/F
TRUE
is an extreme reaction or overreaction to tactile input;
Tactile defensiveness
Teaching ____ is useful in helping clients initiate movement to minimize the effects of bradykinesia.
Teaching self cueing is useful in helping clients initiate movement to minimize the effects of bradykinesia.
Lighting should be positioned opposite the writing hand or nearest to the best seeing eye to promote the client's vision.
The Amsler grid is used to assess central visual fields.
Research has shown a less than optimal relationship between client self-report of quality of life and health care provider ratings from quantitative measures. Third-party payers are increasingly relying on self-reporting from patients in determining coverage.
The DASH is a region-specific (not disease-specific) measure. Its focus is too narrow to characterize dysfunction; additional assessments are needed.
Kawa Model
The Kawa model, developed in Japan, was designed to create a feeling of safety within the Japanese culture. It emphasizes harmony between the person and her or his surroundings.
Analyzes a visual target in terms of its details; color, shape, and texture
The central or focal vision system
Provides background information about one's position in relation to the environment and is quick to detect motion
The peripheral or ambient visual system
Fact: Arguing with a client with dementia is never a good idea. Because people with dementia lack insight into their condition, argument is likely to increase agitation.
The primary goals for clients with dementia are related to maintaining functional capacity.
In what position should the thumb be splinted to facilitate functional pinch?
The thumb should be splinted in opposition and palmar abduction to facilitate thumb-to-tip prehension.
__ are placed lateral or medial to the thighs to control abduction or adduction
Thigh supports
Personal Responsibility and Work Opportunity Reconciliation Act
This law includes providing transportation benefits to optimize access to the workplace and assumes that lack of transportation is a major barrier and challenge in sustainable employment.
__are placed lateral to the trunk and below the armpit to facilitate trunk stability and prevent or slow scoliosis; anterior trunk supports are situated below the top and above the bot- tom of the breastbone.
Thoracic supports
How is a serial cast fabricated?
Through the use of fiberglass or plaster of paris materials to position clients
In the preprosthetic phase how can the OT facilitate wound healing?
Through the use whirlpools and massage
This is a tap on the median nerve at the wrist to elicit symptoms.
Tinel's sign
___ teams function without discipline-centered boundaries.
Transdisciplinary
The resting hand splint is made for clients who need positioning to prevent deformities, such as in rheumatoid arthritis. T/F
True
True or False: Use of a walker and lower-extremity strengthening do not address the effects of bradykinesia on mobility.
True
Use moist heat, stretching, and "gentle" ROM because The masklike facial expression of people with PD makes it imperative to diligently monitor pain during all exercise and stretching. T/F
True
Using proximal muscles can help stabilize distal joints and muscles, which may reduce tremors. T/F
True
T/F: Clients with MS may have incontinence or urinary retention
True.
Encourage proximal stabilization for improved distal movements for MS patients. T/F
True. To manage ataxia
What is is typically used for nerve laceration and recovery?
Two point discrimination
If a 10 year old child is experiencing excessive weight loss, and thrist with polyuria what condition might you suspect?
Type 1 diabetes and the child should be referred to an endocrinologist.
Long arm sling can be used to treat _____ radial head fracture.
Type I
Is vision affected in ALS?
Typically No
Multidimensional Fatigue Inventory
Used for ALS
Beck Depression Inventory -18
Used for MS
Cognitive decline similar to AD but often less severe memory involvement
Vascular dementia
What type of input does a child who appears reckless or risk takers (need a lot to get going) need?
Vestibular input
front higher than back to aid in preventing forward sliding
Wedge cushion (antithrust seats)
Characterized by a proliferation of abnormal blood vessels that leaks blood and fluid into the macula causing central vision loss
Wet AMD
This type of AMD progresses the quickest of the 2
Wet AMD
What are the 2 types of AMD?
Wet and Dry AMD
The pelvis rotates laterally, with the thighs moving to the other side.
Windswept deformity
What hand posture is associated with a Radial nerve injury?
Wrist drop posture
How can orthoses help with ataxia?
Wrist splints to minimize travel and number of joints in motion in the presence of a tremor
Can wrist fracture cause carpal tunnel syndrome?
Yes
Is AROM recommended for a child with polyarticular juvenile rheumatoid arthritis (JRA)?
Yes
Should you refer the client with HD for a driving evaluation in the early stage of the disease?
Yes
In the treatment of contractures, will the OT be able to make gains with a soft tissue contracture?
Yes because soft tissue responds to therapy
Can you use Beck Depression Inventory-18 for MS?
Yes because they may have depression.
Do PD have eating problems?
Yes they can - Dysphagia which can lead to drooling and episodes of coughing and choking
Should you assess driving in RA?
Yes you should
Does a ventricular assist device require power source from outside the body to function?
Yes, A ventricular assist device requires a power source to function properly.
Should you do resistive exercises in operative tx. for someone with Radial tunnel syndrome? If yes then when should you begin?
Yes, at 6 weeks.
Mallet finger is generally not operated on unless __.
a bone fracture also is present
optometrist
a person skilled in testing for defects of vision in order to prescribe corrective glasses
What is Tinel's sign and what is it used to test ?
a tap on the median nerve at the wrist to elicit carpal tunnel symptoms.
What are the three primary locations of primary humeral fractures?
a. Anatomical head b. Anatomical neck c. Anatomical shaft
When assessing return to work following a Cumulative trauma disorder (CTD)?
a. Assessment of job site, tools used, and body positioning b. Therapy using a work simulator, weight well, elastic bands, putty, functional activities, and strengthening activities
What are the operative treatment for de Quervain syndrome?
a. Medical treatment includes surgical release of the first dorsal compartment. b. Occupational therapy treatment postsurgery consists of a forearm-based thumb spica splint with wrist at 20° extension and thumb radially abducted for 3 weeks. c. Gentle ROM and tendon gliding exercises are performed. d. Grip and pinch strengthening begins at 2 weeks. e. Scar management and desensitization techniques are used.
Ayres Sensory Integration, which distal senses are not thought to have as large an impact until later in childhood.
a. Vision b. Hearing
Taking a sip from a glass of water places the thumb in
abduction
sensitivity
ability to detect
Dementia: Middle stage: Impairment in
all areas of function
is a body-powered, externally powered (through electrical connection or electromyographic [EMG] signals), or hybrid-powered hook or realistic-looking hand that assists with functional activities.
an active TD
Compression to the ____ results in motor loss involving FDL, Flexor profundus to index finger & pronator quadratus.
anterior interosseous nerve
People with a history of endocarditis generally take ___ before any dental procedures to prevent an infection from migrating to the heart.
antibiotics
An ___ orthosis is not appropriate for radial nerve palsy. This orthosis would be used in ulnar nerve palsy to prevent MCP hyperextension.
anticlaw
Medications for MS
antispasmodics, muscle relaxants, and anticonvulsants
When the left side of the heart fails, blood flows back into the lungs, causing difficulty breathing, ___.
anxiety, and cerebral hypoxia.
hallucinations
are along a continuium
hyponagogic
are short usually auditory hallicunations that occur when a person is falling asleep
Why are modalities used during interventions for wrist fractures?
are used to prepare tissues for work and assist with pain relief and tissue healing.
What is need for power w/c in order to attach upper trunk and head supports?
back height should be up to mid scapula or top of shoulder
Functional mobility and ______ may be impaired in lower-extremity amputations.
balance
A person with Stage 3 PD likely has ___, and forcing weight shifting may increase the client's risk of fall.
balance deficits
the whole is the sum of its parts
bundle theorist (chariot view- it is nothing without its parts)
The guiding principles of Ayres Sensory Integration treatment indicate that Better organization of adaptive responses enhances the ____.
child's general behavioral organization
Therapy is child directed and guided by the ____; the child's active participation means that therapy will be more meaningful and effective.
child's inner drive
Intervention typically occurs on an individual basis because the occupational therapy practitioner is continually monitoring the ___.
child's response to sensory input.
Dysmetria is decreased ___ of movement
coordination
anterior cingulate
does push and pull?
children with tactile defensiveness may be extrasensitive on their ___, ___, and ___
face, abdomen, and palmar surfaces of their hands.
A universal cuff compensates for loss of finger extension and ___ to allow the client to hold utensils.
facilitates grip
What is urinary retention?
failure to empty the bladder (can be seen in MS)
JB rhine
father of modern parapsychology
GBS: Most people experience signifi- cant if not complete return of function, with__as the most commonly reported residual symptom
fatigue
Ice can be used as a modality to treat ___
fatigue
Sensory input is akin(related to) to sensory nourishment because it is thought to________.
feed the body's central nervous system (CNS).
Extensor Thumb Zone IV falls over the
first metacarpal
Interferon beta 1a
help with cognitive skills for MS
good sensitivitiy
high hit rate, low false alarm
sundowing
increased agitation in the late afternoon and early evening, usually in patients with cognitive impairment
Ultrasould phonophores and ____ can be used to treat cumulative trauma disorder.
iontophoresis
What is Moberg Pickup Test and what is it used to test?
is a timed test involving picking up, holding, manipulating, and identifying small objects. Used in eval of CTS
How is ROM used in the intervention for wrist fractures ?
is allowed in the early phases of healing and repair.
emotions
it felt right brain areas of emotion and decisions
rheumatoid arthritis: Studies have shown a decrease in reported pain and disability after participation in a group program in which ____ strategies have been taught.
joint protection
willaim james
material self social self spirital self
side affects of Levodopa?
nausea and dykinesia
subliminal message
no evidence placebo affect- top down processing expectations
four steps to creative process
preperation incubation inspiration verification
effective strategies for decreased awareness
self-evaluation or self-reflection (checklist)
Define allodynia
sensation misinterpreted as pain. Feeling pain where there is no pain.
Culture-emergent model
stresses development of skills for cross-cultural interactions
awaremess supraliminal
subjective- i dont see it but can guess what it is objective- i dont see it and cant guess what it is
greenwald spangenberg pratkins paticipants took a test to asses their memory and self estemm. label was labeled either one and wasnt related to subliminal message
subliminal message had no affect. but label produced a placebo affect
MS: Therapeutic exercise can improve overall health and well-being, but the occupational therapist should emphasize the importance of resting and avoiding fatigue; Exercises are best completed "at ___ with frequent repetition in order to avoid overuse"
submaximal resistance
Lability
sudden mood shifts (symptom of MS)
chorea
sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face
liberal
the obersver says yes whenever there are may be a signal
poor sensitivity
the same hit and false alarm rate
byndle theorist
ther is no self self is not an entity but a bundle of sensations
vokey and reed given passages- identify the passages and identify any meanignful passages
they were only identified if told in advanced- experimenter heard
The National Center for Senior Transportation provides training and resources pertaining to ____.
transportation for older adults
MS: Recommend adaptive equipment such as built-up handles, reachers, and sock donners to compensate for
weak muscles and maintain joint integrity.
most typical initial symptom of ALS?
weakness in small muscles of the hand (progress from distal to proximal)
The most typical initial symptom of ALS is
weakness of the small muscles of the hand or an asymmetrical foot drop with or without night cramps, usually in the calves.
What should the OT teach the client in the care of the Myoelectrically controlled prosthesis?
wearers must be taught to replace batteries.
When using wheelchairs, clients with lower limb amputations require residual limb support; the large rear wheels should be placed __________ to counterbalance missing limbs, and the wheelchair should have _____.
further back should have antitippers.
Which medication can be given to MS patient for pain relief?
gabapentin
Gravitational insecurity is characterized by ___.
hypersensitivity to vestibular input
Underreactivity, is also known as
hyporesponsivity
decartes
i think therefore i am
Cognitive Level 6—planned actions
i. Client is independent. ii. Disability is absent.
In what areas can a terminal device be used?
i. Lower limb amputation: foot ii. Upper limb amputation: hand
If the armrest is too low, it elicits __
leaning.
A universal cuff compensates for ___ and facilitates grip to allow the client to hold utensils.
loss of finger extension
drug induced hull
lsd dmt mushrooms mdma
Kienbock's disease is associated with ___ fractures.
lunate
Primary goal for dementia patients?
maintain functional capacity
Primary goals for clients with dementia are related to ___ functional capacity.
maintaing
goals for clients with dementia focus on
maintaining not improving
rubber tires have little
maintenance
Clients with upper limb amputations tend to have more limitations in tasks related to ______?
manipulation of objects.
Performance skills related to motor skills of the uninvolved hand should be assessed in preparation for training in _______ and ______.
one-hand techniques and in use of the prosthesis when it is worn.
Wrist neutral for 2 weeks, then wrist cock up for 2 more weeks is ____ treatment for ____.
operative treatment for Radial tunnel syndrome.
behavioral changes
frontotemporal dementia
Contextual Memory Test
memory assessment
The chair is __when the client's center of mass is ahead of the drive wheels' axle.
more stable
Compression to the anterior interosseous nerve results in motor loss involving FDL, Flexor profundus to index finger & ___. This is known as anterior interosseous syndrome.
pronator quadratus
Children with this type of dysfunction may not be getting the information that they need from their muscles and joints
proprioception
Children who seek this type of input may be trying to regulate their experiences of touch or movement.
proprioceptive input
The physical therapist is primarily responsible for lower limb amputation training and ________.
prosthetic development to maximize ambulatory skills.
What is the function of a prosthetic sock or gel liner
protects the residual limb and improves the fit of the socket.
Trying to convince the client to receive services might ____and would be a violation of the client's right to refuse treatment.
provoke more anger
Aggressive stretching is a ROM protocol for ___ humeral fracture.
proximal
Chorea in HD
rapid, involuntary, irregular movements, increase during stressful situations and decrease or absent during voluntary motor activities and sleep
how do we perceive stimuli without being consciously aware of it
recall blindness
In the _____ phase of Guillain-Barré syndrome, taking rest periods without pushing to the point of fatigue is recommended while gradually increasing tolerance for activity.
recovery
The guiding principles of Ayres Sensory Integration treatment indicate that an adaptive response contributes to the development of
sensory integration.
Dementia: Cultural and __ context remain intact, but participation declines.
spiritual
The level of limb amputation is identified by ___ or _____ has been amputated through
which joint or long bone
A client with cystic fibrosis may have ___ of the skin.
yellowing
What are some communication deficits in MS?
- slurred speech - scanning speech or slow enunciation
Client has difficulties with judgment, reasoning, planning, semantic memory, and episodic memory.
Cognitive Level 5—exploratory actions
Client learns through visible, concrete, and meaningful stimuli.
Cognitive Level 5—exploratory actions
Client uses overt trial-and-error problem solving.
Cognitive Level 5—exploratory actions
External cueing can be used.
Cognitive Level 5—exploratory actions
What type of strategies can be taught to help a child with proprioception problem concentrate ?
Cognitive strategies
_____ is hypersensitivity to pain caused by misfiring synapses of the autonomic nervous system.
Complex regional pain
What is Anterior interosseous syndrome?
Compression to the anterior interosseous nerve
Attention involves internal cues.
Cognitive Level 2—postural actions
Client can only eat finger foods.
Cognitive Level 2—postural actions
Client paces and wanders.
Cognitive Level 2—postural actions
Client requires around-the-clock supervision.
Cognitive Level 2—postural actions
Client should be taken to the restroom every 2 hours.
Cognitive Level 2—postural actions
Motor actions are one step, imitated, near reflexive, and familiar and involve gross motor patterns.
Cognitive Level 2—postural actions
Spontaneous behaviors are common
Cognitive Level 2—postural actions
lient requires maximum cognitive assistance.
Cognitive Level 2—postural actions
thinking is highly disorganized.
Cognitive Level 2—postural actions
*Client cannot learn new behaviors.
Cognitive Level 3—manual actions
This assessment provides a gross measurement of visual fields. The client fixes on a central target and acknowledges the appearance of stimuli in the visual fields
Confrontation testing
What assessment could be used to test for peripheral visual field deficits ?
Confrontation testing
__ is commonly associated with the middle stage of dementia.
Confusion
Ranging each joint separately decreases the chance of rupturing finger extensor tendons with ___.
dorsal hand burns
A neurodevelopmental approach to handwriting would ideally be used for children with what problems?
- tone issues - poor postural control - poor limb function - poor automatic reactions - poor proximal stability.
How is Type III radial head fracture treated?
- treated operatively and immobilization - early motion within 1st week as medically prescribed
Tremor in PD
- typically affects one side "pill- rolling" - stops when calm/sleeping and during voluntary movment - increases with stress or cognitive tasks
What are the methods for evaluating a fracture?
- visual examination and observation - client interview, complete medical history, including a history of the event.
What pain control techniques can OTs provide for interventions for CRPS?
-TENS - splinting (static, then dynamic as tolerated), - continuous passive motion
PD: Feeding Tx
- eat smaller portions throughout the day - take more time to eat (eat slowly)
What are some examples of clinical observations?
-crossing the body at midline, -equilibrium reactions, - muscle tone, -prone extension, -supine flexion.
Person-environment-occupation model
promote change in the child, occupation, and environment to optimize occupational performance.
Goals that aim to improve skills in clients with dementia should be avoided. Such goals are:
- Client will improve money management skills to independent as evidenced by paying five of five bills on time in 30 days. - Client will improve bathing to independent while using adaptive equipment for safety.
Name the three different types of wrist fractures?
- Colles fracture - Smith's fracture - Bennert's fracture
Anterior Interosseous Syndrome
- Compression of anterior interosseous nerve (motor branch of median nerve) - Motor loss, pain, and difficult to pinch or hold object with thumb and index finger.
Which visual skills are affected by CNS damage?
- Stereopsis - Binocular depth
What can you include in a home exercise program for someone with a proximal humeral fracture?
- You can wear a sling for comfort and sleeping for the first 6 weeks
OT tx for MS with Urinary incontinence
- bladder training and instruction in self-catheterization or use of sanitary pads or absor- bent underwear - onitor times of days when fluids are consumed to ensure availability of bathrooms to minimize risk of incontinence.
What are the modalities used for pain relief and tissue healing?
- heat - ultrasound - cryotherapy - paraffin (wax dip hand) - transcutaneous electrical nerve stimulation (TENS).
Mallet Finger OT Tx
- immobilize DIP joint in extension - keep PIP joint free
What are the three common phases of healing a fracture?
- inflammation - repair - remodeling
Malignant MS
- progresses rapidly - significant disability or death in short period
Frontotemporal dementia
- progressive aphasia - symptoms similar to AD or Parkinson's disease
Being able to sort by type and size would support the child's ability to categorize objects on the basis of similarities and to note differences among objects. This skill is an important precursor to successful participation in ADLs and educational occupations.
.
The prosthesis should then be removed and the stump examined for reddened areas. If no reddened areas are apparent after __ minutes, the wearing time is increased in 15- to 30-minute increments until the client wears the prosthesis for a full day.
20
What is the nonoperative treatment for Radial nerve injury?
1.Wrist cock-up splint with or without dynamic finger and thumb extension assist, 2.passive and active ROM, 3. isotonic strengthening exercises upon muscle reinnervation
What are the three steps in the treatment of contractures?
1.superficial and deep heat to increase tissue extensibility. 2.slow stretch 3. static splinting
Splinting is used to prevent rupture because the repaired tendon is at its weakest ____ days postsurgery.
10 to 12
A tendon repair is typically at its weakest __ days postsurgery during the fibroplasia phase, in which collagen is just beginning to be laid down to strengthen the repair.
10-12
A tendon repair is typically at its weakest ___postsurgery during the fibroplasia phase, in which collagen is just beginning to be laid down to strengthen the repair.
10-12 days
Children younger than age ____are usually placed on an immobilization protocol because of their low maturity level and low ability to comply with the exercises and precautions of other protocols.
12
What point font should the OT increase the font of written material to ?
14- 16 font or larger
A child typically has regular bowel movements by what age?
18 months of age
Raised thresholds and floor-level changes at accessible doorways should be beveled with a slope no greater than
1:2
When a client is transferred off the cardiac care unit to a hospital floor, activities can exceed___ METs in progresssion of the cardiac rehabilitation program.
2
Healing of the heart muscle takes 4 to 8 weeks. During this time, activities are limited to the___ MET range.
2 to 4
Handrail: A maximum height of __inches is recommended for children.
28
Can't live alone at all
3
Operative tx for Radial tunnel syndrome: You can begin hand strengthening exercise at ___ weeks.
3
When can you perform strengthening exercises with a flexor tendon repair?
8-12 weeks after surgery
At what age do infants begin to crawl according to NBCOT?
9 months
What are the typical manifestations of Diabetic retinopathy ?
A fluctuation of: 1. Blurry vision 2. Reduction in contrast sensitivity 3. Decreased ability to drive at night 4. Reduction in color discrimination 5. Patchy spots of visual field loss 6. Total blindness
exercise stress test
A means of assessing cardiac function, by subjecting the patient to carefully controlled amounts of physical stress. A test that evaluates cardiac function during physical stress by riding a bike or walking on a treadmill.
As a client's skills emerge or improve, the occupational therapist slowly lessens or eliminates his or her support. The result is improved independence in the task or activity
Fading
T/F Overresponsivity may not be present in any of the other senses.
False
True or False: P/AROM is used in Operative treatment for Radial Nerve Injury.
False. P/AROM is used in Non-operative treatment
T/F: Burning pain in medial forearm is the symptom of radial tunnel syndrome.
False: Burning pain in "lateral" forearm is the symptom of radial tunnel syndrome.
At 6 weeks after operative flexor tendon repair, the client may be ready for light, nonresistive functional activities that promote ___.
active flexion
occupational therapy practitioners may need to ___ of some movement to ensure that it is therapeutic.
actively reduce the intensity
Adapted activities should be used that reinforce the connection between predictable tactile effects on the environment and client actions (e.g., walking, washing cars, drying and wash- ing dishes, wiping countertops, vacuuming).
Cognitive Level 3—manual actions
Attention should be directed to tactile cues
Cognitive Level 3—manual actions
Client requires moderate cognitive assistance.
Cognitive Level 3—manual actions
Goals are not related to outcomes.
Cognitive Level 3—manual actions
After diagnosis, life expectancy ranges from 1 to 5 years, with a mean survival of 3 years
ALS
Occupational performance is assessed using an ______ which also is a useful goal-setting tool.
ADL and/or IADL checklist
Which liquid is contraindicated for MS clients?
Alcohol
needs a routine.
Cognitive Level 3—manual actions
should avoid sensory overload.
Cognitive Level 3—manual actions
still able to wash hands and face and brush teeth.
Cognitive Level 3—manual actions
Attention is directed to visual and tactile cues.
Cognitive Level 4—goal-directed activity
Client can eat independently, but supervision is needed on amount of food eaten.
Cognitive Level 4—goal-directed activity
Client can no longer problem solve.
Cognitive Level 4—goal-directed activity
T/F: PD = good nonverbal communication
False: Common symptom of PD is mask like facial expression which so you won't be able to tell what the person is saying nonverbally. Best is to ask closed ended questions.
T/F: Symptom of Pronator syndrome is Deep pain in distal forearm with activity.
False: Deep pain in "proximal" forearm with activity
T/F: Symptom of Pronator syndrome is Deep pain in distal forearm without activity.
False: Deep pain in distal forearm with activity.
T/F: Forceful wrist flexion and supination should be avoided in Radial Tunnel Syndrome.
False: Forceful wrist "extension" and supination should be avoided.
In the treatment of contractures, will the OT be able to make gains with a Boney blocks?
Boney blocks require surgery to release
Rupture of the extensor tendon slip results in ___.
Boutonniere Deformity
one of the most common risk factors for GBS
Bacterial infection: Campylobacter jejuni
When should you begin Controlled AROM after a fracture?
Begin 3-6 weeks after fracture if fixation is stable.
Allow physical movement.
Behavior management for Anger
Anticipate problems and stressors.
Behavior management for Anger
Distract the client by using food or asking for assistance.
Behavior management for Anger
Rephrase negatives as positives.
Behavior management for Anger
What does comminuted mean?
Bone shattered
What kind of pain is experienced in Radial tunnel syndrome?
Burning pain
What are the symptoms of Radial tunnel syndrome?
Burning pain in lateral forearm
Hyposensitivity, is typical in the plateau phase of Guillain-Barré syndrome. T/F
False: Hypersensitivity is typical in the plateau phase of Guillain-Barré syndrome
is a fixed posture because of shortening of skin, ligaments, joint capsule, tendons, and muscles resulting from conditions such as burns, wound healing, muscle imbalance because of peripheral nerve injury, spinal cord injury, increased muscle tone from a stroke, head injury, and cerebral palsy
Contracture
The OT should instruct clients in the use of _____ to improve the visibility of certain objects in the environment.
Contrast
The measure of the ability of the visual system to distinguish various shades of gray or shades of color
Contrast sensitivity
involuntary muscle contraction and relaxation
Fasciculation
most common complaint and debilitating symptom of MS
Fatigue
The principles of motivational interviewing are to roll with resistance, express empathy, develop discrepancy, and support self-efficacy.
Controlling edema, initiating tendon glides, and making recommendations for modifying daily activities are all strategies that are indicated in the early nonoperative management of carpal tunnel syndrome.
How is de Quervain syndrome caused?
Causes include: - forceful, repetitive thumb abduction with wrist ulnar deviation, -carpometacarpal (CMC) osteoarthritis, -scaphoid fracture, - intersection syndrome, or radial nerve neuritis.
Causes include tenosynovitis, cumulative trauma disorder, fluid retention (e.g., from pregnancy, en- docrine malfunctions), ganglions, tumors, diabetes, rheumatoid arthritis, and trauma such as wrist fracture or lunate dislocation.
Carpal tunnel syndrome
What is the most common nerve compression of the upper extremity.
Carpal tunnel syndrome
____ is median nerve compression with pain and numbness into the hand and fist through half of the fourth digit.
Carpal tunnel syndrome
How is Cubital tunnel syndrome caused ?
Causes include: - fracture or dislocation of the elbow, -osteoarthritis, -rheumatoid arthritis, - diabetes, - alcohol abuse, - tourniquets, -assembly line work.
Client needs 24-hour supervision.
Cognitive Level 4—goal-directed activity
Client needs protection against safety hazards and wandering.
Cognitive Level 4—goal-directed activity
Client requires minimum cognitive assist.
Cognitive Level 4—goal-directed activity
Task setup for bathing and grooming is required.
Cognitive Level 4—goal-directed activity
should not live in colder areas because it increases muscle stiffness
PD
shuffling steps with limited or no arm swing
PD
typical early sign is a resting tremor, which affects one side
PD
walking a prescribed distance or doing simple calisthenic exercises at home is an intervention for
PD
Radial tunnel syndrome is compression of the radial nerve in the proximal forearm resulting in a ___ sensation along the lateral forearm.
dull ache and burning
When should you typically use cold application to reduce edema?
during acute inflammation 24-72 post injury
Heat and joint mobilization can increase ROM temporarily, but long-term improvement of the PIP flexion contracture requires __
dynamic splinting.
Poor mechanical articulation of speech due to abnormal lip, tongue, or cheek motor function
dysarthria
ADLs are likely intact, but IADLs, in particular those that require higher level executive function, would be affected at this stage of Dementia.
early-stage dementia
DEMENTIA: The client may be aware of memory loss at this stage and compensate by becoming rigid in routines so that the client still appears intact to others.
early-stage dementia
social skills
easy to use hard to formalize
Which STORCH infection would require the OTR® to use universal precautions to prevent the OTR® from contracting an infection when working with the infant and mother?
Cytomegalovirus
When a client is on the cardiac care unit, activities should not exceed 1 to 2 METs. Any higher MET level requires too much exertion, which results in increased oxygen consumption and a higher heart rate than may be tolerated.
Cramping and pain when walking—also known as intermittent claudication—are caused by decreased blood flow when exercising and are common symptoms of peripheral artery disease.
This is the second most common nerve compression of the upper extremity after carpal tunnel syndrome.
Cubital tunnel syndrome
caused by proximal ulnar nerve compression at the elbow between the medial epicondyle and the olecranon process. This is the second most common nerve compression of the upper extremity after carpal tunnel syndrome.
Cubital tunnel syndrome
In the ___ stage of recovery, passive range of motion, positioning of the affected extremity, and bed mobility are critical components in restoring function for ADL performance.
acute
The National Mobility Equipment Dealers Association is an industry group that provides ___.
adapted driving and mobility equipment for travelers with disabilities.
The guiding principles of Ayres Sensory Integration treatment indicate that Sensory input can be used systematically to elicit an
adaptive response.
What is depth perception?
Depth perception is a person's ability to judge the relative distance between self and another object in space. Ex: Being able to judge the relative distance between self and the stove to safely complete a cooking task
Expected outcomes of intervention for sensory integration: Development of increasingly more complex ____.
adaptive responses
____ is the most widely used medication by therapists using iontophoresis because of its anti-inflammatory properties.
Dexamethasone
Caused by changes in the blood vessels of the retina, some experience swelling of blood vessels which leak fluid in others abnormal new blood vessels grow on the surface of the retina.
Diabetic retinopathy
In which stage of Parkinson's disease does the client have difficulty with self-feeding?
Difficulty with self-feeding, including swallowing, does not typically occur until the intermediate stage of the disorder.
occurs with sheath inflammation or nodules near the A1 pulley.
Digital stenosing tenosynovitis (trigger finger)
Disadvantages of Custom-contoured surfaces
Disadvantages are that clients are limited to one position, transfers are more difficult to per- form, and the system is not adaptable (e.g., cannot accommodate a child's growth). They are appropriate for clients who need support to maintain balance, have pelvic or spinal deformities, have muscle tone abnormalities, or need additional lumbar support.
Which medication helps with cognitive skills for MS
Interferon beta 1a
What are the symptoms of Double crush syndrome?
Intermittent diffuse arm pain and paresthesias with specific postures
Slowness of movement is or is not typically seen in people with MS.
Is not. They may, however, have unsteady or incoordinated movements
What are pacemaker precautions?
Pacemaker precautions include no shoulder flexion or abduction greater than 90° on the side on which the pacemaker was implanted for the first 4 weeks.
Educate clients and refer as needed to appropriate community resources such as ?
Orientation and mobility specialist
___ pain is pain on either side of the carpal tunnel release surgery site. The source of the pain is unknown and may be ligamentous or muscular in origin.
Pillar
Symptoms are at their most disabling, with little or no change over a few days or weeks.
Plateau phase of GBS
Expected outcomes of intervention for sensory integration: Increase in the frequency or duration of ____.
adaptive responses
What is an ankle disarticulation amputation called?
Symes amputation
Which brace is recommended for children with kyphosis or a posterior convexity.
The Milwaukee brace
Which tool is designed to measure the integrated process of handwriting?
The Print Tool
The comprehensive assessment might not be possible with a client who has dementia; it might lead to fatigue and frustration and limit the OTR®'s ability to establish rapport.
The antideformity position for the elbow is elbow extension and forearm in neutral position.
Cognitive retraining is not the best choice for dealing with anxiety. T/F
True
Engagement in activity-based interventions, along with daily structure, has been documented to assist in fall prevention. T/F
True
FDP excursion occurs with IP joint flexion. T/F
True
Flexion blocking exercises increase flexion, not extension. T/F
True
Hand-based orthoses would not protect the tendon repair unless the wrist were immobile as well. T/F
True
Radial abduction does not position the thumb for thumb-to-tip pinch. T/F
True
Swallowing difficulties become apparent in the late stage of Parkinson's Disease. T/F
True
T/F: A benefit of group sessions for clients with Parkinson's disease is an improvement in their perception of their quality of life.
True
T/F: An individual with Stage III Alzheimer's disease would require the physical and verbal assistance of another person to complete ADLs.
True
T/F: Any reddened areas that do not disappear after approximately 20 minutes should be reported to the prosthetist so the prosthesis can be adjusted.
True
T/F: For MS use wrist weights during self care activities to decrease tremors
True
T/F: Leaving items out and visible might create too much visual clutter, which can increase confusion in people with dementia.
True
T/F: Walkability refers only to the built environment.
True
T/F: tretch before beginning any exercise to decrease spasticity, improve flexibility and circulation, and prevent injury
True
The Sleep Questionnaire is not a standardized assessment. T/F
True
Is bowl and bladder affected in ALS?
Typically No
Is hearing affected in ALS?
Typically No
Is sensation affected in ALS?
Typically No
Bowl & bladder: ALS
Typically not affected
Cogwheel motion is common in __ extremities
UE
They are available with rigid or folding frames, both of which fold for transport. They have an adjustable axle and quick-release wheels and are customizable.
Ultra lightweight chairs (< 30lbs)
With a Radial Nerve Injury, when can you begin isotonic strengthening exercises?
Under non-operative tx. you can begin isotonic strengthening exercises upon muscle reinnervation.
Children demonstrate a pattern that looks as though they fail to orient to the stimuli.
Underreactivity, also known as hyporesponsivity
How can you keep a wandering person from wandering out.
Use a side bolt outside of the person's reach.
Grade IV of Cumulative Trauma Disorder
Use of extremity results in pain up to 75% of time, work is limited
What can the OT teach the client to do in order to compensate for vision impairments?
Use other senses
How can the OT modify handouts and home exercise programs
Write with a dark matter or use dark text on a white surface
Do HD clients have Difficulty with mental calculations, sequencing of tasks, and memory
Yes. Also difficulty concentrating and forgetfullness
If someone comes to you with a cumulative trauma disorder, would you use ice and contrast baths in treatment?
Yes. In acute phase of CTD you can use ice, contrast baths, and static splinting.
Does tremor stop during voluntary movement in PD?
Yes. It also stops during sleep and when the person is calm.
Is visualization a stress reduction technique?
Yes. Use it with PD because stress exacerbates the symptoms
Do you need a Home exercise program for Flexor tendon OT intervention?
Yes: A clearly identified and planned home exercise program is important to ensure the client's safety and progress toward goals.
praxis
ability to plan and perofrm purposeful movement
precognition psychic
ability to predict the future
Semantic memory
ability to remember the names of objects; shows deficits
Dystonia
abnormal, sustained posturing of a body part (HD)
negative
absence of health beahvior - flat affect no social interaction
Adaptive devices generally compensate for decreased ROM or muscle strength, not ___.
improve tolerance for activity.
Expected outcomes of intervention for sensory integration: Improvement in cognitive, language, and ____ performance
academic
meant for short-term, temporary use
Standard chairs
have contours based on typical body sizes. They provide more support than flat surfaces, distribute pressure across their surface, and are less expensive than custom-made surfaces.
Standard contoured cushion surfaces
Blessed Dementia Scale
Standardized "Cognitive" assessment
Cognitive Competency Test
Standardized "Cognitive" assessment
Lowenstein Occupational Therapy Cognitive Assessment
Standardized "Cognitive" assessment
Allen Cognitive Level Screen
Standardized "Function-based" cognitive assessment
Assessment of Motor and Process Skills
Standardized "Function-based" cognitive assessment
Cognitive Performance Test
Standardized "Function-based" cognitive assessment
Executive Function Performance Test
Standardized "Function-based" cognitive assessment
Independent Living Scales
Standardized "Function-based" cognitive assessment
Kitchen Task Assessment
Standardized "Function-based" cognitive assessment
Árnadóttir OT-ADL Neurobehavioral Evaluation
Standardized "Function-based" cognitive assessment
How would you treat Swan Neck Deformity?
Splint PIP in slight flexion
Perform driving assessments for adults who have __________ vision impairment
Stable
involves holding the elbow in flexion for 5 minutes with the wrist neutral to elicit symptoms.
The elbow extension test
What assessments could be used to test for near visual acuity?
The lighthouse Near Visual Acuity Test
What are the goals of preprosthetic training?
a. Assist the client in coping with psychological aspects of limb loss b.Optimize wound healing. c. Maximize residual limb shrinkage and shaping to achieve tapered distal end, the optimal shape for a prosthetic socket. d. Desensitize residual limb. e. Maintain or increase ROM and strength. f. Facilitate independence in basic ADLs. g. Explore prosthetic options.
Bowel and Bladder Tx for PD
a. Assist the client in creating a voiding schedule. b. Instruct the client to wear absorbent underwear as needed
Compliance with HIPAA and using discretion during public communication are related to ____ and confidentiality.
autonomy
How can the OT explain how to modify an activity for nonoperative pronator syndrome?
avoid repetitive forearm rotation with resistance and prolonged elbow flexion
What is Mallet finger
avulsion of the terminal tendon and is splinted in full extension for 6 weeks
A benefit of group sessions for clients with Parkinson's disease
improvement in "their perception" of their quality of life.
Dysmetria
decreased coordination of movement
What is the function of a harness and suspension system ?
holds the prosthesis on the residual limb.
Dementia caregiver burden
home modification
OTR®s can provide information about community resources and safe transfers at various stages of the process, but ___ is a skill unique to OTR®s, will have the most benefit to caregivers of clients with dementia.
home modifications
cartesian materialism
most common view among consciousness studies rejects humunculous but accepts that things are either in or ou tof consciousness
schizophrenia
most studied area of hallucinations mind is split from reality
Children with dyspraxia have difficulty with _____ planning.
motor
The most common cause of lower limb amputation is ____________ .
peripheral vascular disease
How does cogwheel motion affect a person?
person fatigues quickly when they have cogwheel motions
As the disease advances, interventions expand from the person with ALS and his or her performance to the
physical and social environment.
Simplify approaches and environment during
sundowning,
Radial tunnel syndrome is entrapment of the radial nerve in an area extending from the radial head to the ___.
supinator muscle.
Guillain-Barré syndrome, evaluation consistently addresses pain, fatigue, and ____ problems.
swallowing
Dysphagia
swallowing difficulty
Adaptations, as opposed to ___, are the most effective strategy for decreased memory in clients with dementia. A client presents with decreased memory resulting from dementia. What is the MOST EFFECTIVE strategy for an OTR® to implement to intervene with this cognitive impairment?
targeted interventions. Cue cards or signs in key places
Somatosensory input is processed mostly in the ______
thalamus.
Clients with Parkinson's disease have balance difficulties during occupational performance that are related to postural instability, but ____ are not the cause of these postural difficulties.
vestibular sensation deficits
the pearl view dennet views the pearl as the self
views the string as the language
80% of people with MS loose
visual acuity
the client will typically recognize the need for a bath and will bathe thoroughly. ACL?
4
Independently completes wheelchair transfers using proper body mechanics. WHAT FIM LEVEL IS THIS?
7
The SETT allows for collaboration and communication among educational team members to support good decision making to determine the AT needs of a student.
.
Measure from the seating surface to the bottom of the client's flexed elbow; the armrest should be about __ inch higher.
1
How some psychological effects of limb loss?
1 changed body scheme, 2. reduced self-esteem and self-efficacy, 3. shock & disbelief, 4. anger, grief, guilt, denial, 5. hopelessness, and depression.
When a client is on the cardiac care unit, activities should not exceed ____METs.
1 to 2
How can the OT modify the environment to allow the client to use other senses?
1. Use tactile markers to mark most frequently used setting on appliances 2. Educate on writing guides that use tactile skills to help write on lines 3. Use auditory or talking items
Self-care tasks are within the MET range of ____.
1.0-2.5
What assessments could be used to test for low vision impact on ADLs & IADLs?
1.Melbourne Low Vision ADL Index 2. Canadian Occupational Performance Measure (COPM)
What are the nonoperative treatments for Pronator syndrome?
1.Splint elbow 90 to 100 degrees of flexion, forearm neutral. 2. TENS for pain, Gentle prolonged stretching supination and elbow, wrist, and finger extension, 3. activity modification avoid repetitive forearm rotation with resistance and prolonged elbow flexion
When is the repair tendon at its weakest?
10-12 days after surgery
All steps should have uniform riser heights and uniform tread widths of no less than
11 inches
Severe decline in memory. Forgets spouse and gets confused in own home
3
The person is perserative (ex. can't stop washing their hands, don't know when to stop). At this stage the person also does not know how to use tools (apraxic)
3
Unaware of hazards, and should not be left alone at all
3
can't learn how to use ambulation aid safely
3
client will typically wash only areas easily seen and reached and keeps washing the same things over and over again. ACL?
3
At what age do infants gain complete head control?
3 months
Lower limb amputations occur_____ more often than upper limb amputations
3 times
MS: optic neuritis may go away after
3-6 weeks
Radial head fractures account for ___of elbow fractures.
33%
Thresholds at doorways should not exceed __ in height for exterior sliding doors or 1⁄2 inch for other types of doors.
3⁄4 inch
Decline in basic ADLs
4
The minimum clear width of a ramp is
36 inches
A client will initiate dressing at the appropriate time of the day but will not attend to the day, temperature, or season. The client is able to don clothing slowly but has difficulty with fasteners or fails to see errors in the back (i.e., not tucking in the shirt). At what stage of the Allen Cognitive Level Screen is this client?
4.0
Positioning belt: stabilizes the pelvis; should be positioned so that it pulls on the pelvis at a __ angle to the base of the seat back
45°
The pencil rests against the distal phalanx of the radial side of the ring finger, and the pads of the fingers control the movement; the thumb is opposed to the index finger.
describes the dynamic quadruped
planning difficulty
5
reasoning difficulty
5
semantic memory problem
5
slowed performance of complex IADLS
5
Once the skin has been grafted, the wrist and hand should be protected for ___ days until the staples are removed. No AROM, PROM, or functional use of the hand should occur during this time.
5 to 7
What is the average onset age for Parkinson's?
55-60 years
How many stages in ALS?
6
If the client cannot cognitively follow a protocol for a flexor tendon injury, the extremity is casted in a protected position for__ weeks.
6
At what age do infants begin to Roll?
6 months
Carrying groceries upstairs requires___ METs.
6 to 10
Wheelchairs: minimum of __ for a pivoting 180° turn to avoid the need for repeated tries and bumping into surrounding objects
60-inch diameter or a 60-inch by 60-inch T-shaped space
When performing an informal observation how might the OT note a difference between a child without SI dysfunction and one with it ?
Children without sensory integrative dysfunction will demonstrate adaptive responses; children with sensory integrative dysfunction will not consistently demonstrate adaptive responses, if at all.
In the preprosthetic phase why does the OT facilitate maintenance of or increasing flexibility and strength of the remaining limbs?
Clients with lower limb amputations need to strengthen the upper body to maneuver a wheelchair and use mobility aids and the lower extremities to increase weight bearing.
Dementia: Simple home management tasks can be completed with assistance, but dependent in community mobility.
Middle stage
A client who is confused by simple directions and recall of recent events.
Middle stage dementia
Which assessment is used to compare child's handwriting performance with that of same-age peers?
Minnesota Handwriting Test because it is a standardized, norm-referenced assessment specific to handwriting.
List the complications related to the healing process?
Misaligned fracture, pain, decreased nutrition to the area, and decreased healing potential. Age and bone disease also affect healing.
The pencil rests against the radial side of the ring finger, and the pads of the fingers control the movement; the thumb is not opposed to the index finger and rests on the distal interphalangeal joint.
describes the lateral quadruped
Is it ok to provide PROM to someone with CRPS?
NO, do not to PROM - do gentle and pain free AROM for short periods
The pencil rests against the radial side of the middle finger, and the pads of the fingers control the movement; the thumb is not opposed to the index finger and rests on the distal interphalangeal joint.
describes the lateral tripod
an estimated two-thirds of people who develop GBS symptoms do so days or weeks after __
diarrhea or a respiratory illness.
Initial stage of HD
difficulty maintaining work performance
Aphasia
difficulty with expressive language, receptive language, or both
Windswept deformity: pelvis rotates ___, things move to the other side
laterally
FACT: Normal pain-free range of motion in internal and external shoulder rotation indicates no involvement of the rotator cuff.
FACT: Forward head posture indicates limited scapular mobility. When scapular mobility is limited, motion at the glenohumeral joint is adversely affected because of an imbalance in scapulohumeral rhythm.
____ often interferes with the ability to perform occupations such as writing, eating, shaving, and manipulating clothing fasteners in clients with Parkinson's disease.
Fine motor incoordination
Occurs when the fluid passes too slowly through a spongy meshwork. Since the fluid builds up, the pressure inside the eye rises to a level that may damage the optic nerve.
Primary open-angle Glaucoma
This type of Glaucoma has a slow onset with a major risk factor being increased intraocular pressure.
Primary open-angle Glaucoma
inflammatory disease that causes demyelination of axons in peripheral nerves
Guillain-Barré syndrome
Pacemaker precautions include no shoulder flexion or abduction greater than 90° on the side on which the pacemaker was implanted for the first 4 weeks.
Healing of the heart muscle takes 4 to 8 weeks. During this time, activities are limited to the 2 to 4 MET range. Carrying groceries upstairs requires 6 to 10 METs.
___ can benefit clients with dementia and their caregivers by providing a safe environment that prevents unsafe wandering and provides optimal occupational engagement for reduced caregiver burden.
Home modifications
to be aware of policies set by regulatory agencies, such as Medicare
Procedural justice
What is the first course of action the AOTA Ethics Commission takes when it receives an ethics complaint?
It starts a preliminary assessment. A preliminary assessment would be conducted before a full investigation, educative letter, or imposition of a sanction or discipline.
___ sign is hyperextension of the proximal phalanx of the thumb when pinching.
Jeanne's
___principles are ideally taught early in the disease process of arthritis to decrease joint stress and damage.
Joint protection
Failure to report a gift is primarily a violation of which principle?
Justice
As needed refer clients with low vision to a ______________ to determine appropriate optical devices that may be beneficial
Low vision specialist
MCPs are splinted to block hyperextension
Lumbrical bar splints to reduce MCP hyperextension and IP flexion contractures
An anticlaw orthosis is not appropriate for radial nerve palsy. This orthosis would be used in ulnar nerve palsy to prevent ___.
MCP hyperextension
What can you do to reduce extensor tone in the lower extremities?
Maintain hips at 90° or more flexion
Measuring seat height
Measure from the popliteal space to the bottom of the client's heel. Footrests should have a 2-inch clearance from the floor.
What are the nerve injuries associated with wrist fractures?
Median & Ulnar nerve injuries.
can propel a manual wheelchair with both upper extremities, both lower extremities, or one upper and one lower extremity or is pushed by an attendant or caregiver
Manual wheelchair user
can walk short distances; may need a wheelchair on occasion, especial- ly outdoors; can benefit from intermittent use of a power mobility device such as a scooter
Marginal ambulatory user
can propel a manual wheelchair for short distances; tolerates only limited use because of upper-extremity overuse injury, upper body weakness, lack of endur- ance, or respiratory problems; may at times use a manual or power wheelchair
Marginal manual wheelchair user
Measuring seat depth
Measure from the base of the back to the popliteal space of each knee; subtract 1-2 inches so that the seat edge does not reach the back of the knee and restrict motion (To allow wheelchair propulsion with the feet) or circulation. Measure both lower extremities to account for discrepancies in length.
At what stage of Alzheimer's disease (AD) will procedural memory impairments FIRST be noticed?
Middle stage
Dementia Stage: difficulty communicating needs
Middle stage
Dementia Stage: pictures/labels are better then simple written words
Middle stage
Dementia: IADLs are neglected or performed out of sequence.
Middle stage
is a timed test involving picking up, holding, manipulating, and identifying small objects. It is used with children and cognitively impaired adults to test median nerve function.
Moberg Pickup Test
Both standardized and nonstandardized assessments are included as part of an evaluation for a client with multiple sclerosis. Which standardized assessment would be MOST effective in assessing a client's endurance?
Modified Fatigue Scale
___ is regarded as an initial step in developing a group protocol. It requires identification of a problem and interaction with potential group members to determine what will promote change.
Motivation to change
Are clients with pulmonary hypertension at risk for pulmonary embolisms?
No
Do people with PD experience spasticity?
No
Can OTs administer an exercise stress test?
No OTs do not generally administer exercise stress tests.
Should you do exercice programs with PD
No because they get posture and balance problems
Pneumatic pumps are rarely used in hand therapy.
No evidence indicates that contrast baths reduce edema.
IF someone is new to exercise, should you give them a home exercise program?
No, because it may be intimidating.
Entrapment of the proximal median nerve between the heads of the pronator muscles
Pronator syndrome
Chair good for hip restriction
Recline w/c
____ is a symptom that manifests in the early stage of Parkinson's disease and continues throughout the disease course.
Resting tremor
What is the MOST severe form of discipline the AOTA Ethics Commission can impose if it determines an ethical violation has occurred?
Revoking AOTA membership
The Safe Routes to School program was funded from 2005 to 2012 as part of the__
SAFETEA-LU legislation
_____ is a national nonprofit organization that provides resources and advocates for policy related to community mobility for children.
SafeKids USA
______ is a national nonprofit organization that provides resources and advocates for policy related to community mobility for children.
SafeKids USA
A client with chronic bronchitis has poor oxygenation, resulting in a bluish tinge to skin and lips, along with edema.
Self-care tasks are within the MET range of 1.0-2.5, which the client is currently able to complete; therefore, this intervention would not provide sufficient challenge for the client.
What is used to test nerve compression?
Semmes-Weinstein Monofilament
What are the sensory impairments associated with cubital tunnel syndrome?
Sensation is decreased in the little finger and ulnar half of the ring finger.
This standardized test has subtests measure tactile, vestibular, and proprioceptive processing, visual-motor coordination and forms and space perception, bilateral integration, and praxis.
Sensory Integration and Praxis Test
What standardized test requires 90-120 minutes to administer
Sensory Integration and Praxis Test
cognitive processes
brain processes that guide behavior
The least invasive and most effective treatment for a slight malalignment is ___and this is the intervention the child would be most likely to tolerate.
buddy taping
Goals should address both the exacerbation and remission stages and should be ___ because of the progressive nature of MS.
compensatory
Treatment approaches for ALS should be
compensatory, "focusing on adapting to disability and preventing secondary complications.
Problems with modulation are characterized by children being unable to grade responses in relation to _______
external stimuli.
An OTR® is describing a client with a hand injury to an occupational therapy student. The OTR® states that the client presents with burning and stabbing pain in the hand, shiny skin, very stiff joints, and abnormal sweating and hair growth. What medical condition does this client MOST likely have?
complex regional pain syndrome
What is the most severe complication of hand fractures?
complex regional pain syndrome
Most pulmonary embolisms are caused by a ____ in a lower extremity.
deep vein thrombosis
Ayres Sensory Integration, which proximal senses are thought to dominate a child's early life experiences?
a. Vestibular b. Tactile c. Proprioceptive
What are some Postoperative and preprosthetic phase skin complications?
delayed healing, necrosis, and skin graft adherence to bone
sdt
extremely powerful can be used with any yes and no question
clairvoyance
ability to perceive objects or events -friends house on fire
When children have difficulty interpreting what they are feeling, they may experience _____
delays.
What is disarticulation amputation ?
across a joint such as hip, wrist, elbow, or shoulder.
Injury to the extensor tendon or central slip usually prevents the finger from __.
active extension
Ideal w/c for ALS client
The ideal wheelchair is high backed and reclining, lightweight, turns in a small space, and offers support for the head, trunk, and extremities. As ALS advances, the client may consider a power wheelchair with adaptable controls that is easily maneuvered with tilt or recline and head, trunk, and extremity support.
degree of challenge and skill level
dependent for FLOW
What are the Nonoperative treatment for de Quervain syndrome?
a. Medical treatment includes corticosteriod injections. b. Occupational therapy treatment consists of a forearm-based thumb spica splint with wrist in neutral and thumb radially abducted for 3 weeks. c. Activity modification and avoidance of pinch are recommended. d. After 3 weeks, the client progresses to a soft splint and isometric exercise. e. Computer ergonomics education is provided. f. Strengthening activities are provided.
What is involved in the Upper limb prosthesis training
a. Prosthesis control training b. Prosthesis use training c. Prepositioning training d.Prehension training e. Functional training
What are the postoperative treatments for CTS?
a. Surgical treatment includes traditional open carpal tunnel release surgery or endoscopic release. b. After surgery, some clients may not need therapy. c. For more complicated cases, wound care and scar mobilization are provided. d. Pain management may include use of gel pads on the scar. e. Splinting is provided only to clients who sleep with the wrist flexed or who will engage in too much activity too soon (e.g., immediate return to work). f. AROM of wrist, thumb, and fingers begins 1-2 days postsurgery. g. Nerve and tendon gliding exercises are provided. h. Strengthening activities begin in 3 to 6 weeks.
What are the goals of prosthetic training?
a. Teach the client to independently don and doff prosthesis. b. Train the client in care of the prosthesis. c. Increase the client's wearing time to full day. d. Encourage the client in independent use of prosthesis.
Joint protection and pacing techniques best address symptoms of __.
arthritis
source amnesia
attributing to the wrong source an event we have eperienced, heart about, read about or imagined
People with Parkinson's disease perform well with external __ cues
auditory
What are the Postoperative treatment for cubital tunnel syndrome during the active phase( beginning at 3 weeks) ?
discontinue the elbow splint and anticlaw splint if used before surgery, -then add elbow AROM (in pronation first, then supination; add wrist motion with elbow flexed, then extended), -ulnar nerve gliding, and desensitization techniques.
Inappropriate euphoria
intense happiness or excitment (symptom of MS)
Habituation
internalized readiness to demonstrate consistent patterns of behavior.
Paratonia
involuntary resistance to passive movement of the extremities. inability to completely relax in absence of Spastic rigidity
aphasia
language disorder
During Evaluation of the Hand and Upper Extremity, use a gentle approach to palpation when checking for ____
pain, adhesions, and edema.
GBS Evaluation consistently addresses
pain, fatigue, swallowing
Sensory Processing Measure
parent, teacher, or self-report assessment of sensory process- ing skills.
Consistent use of a short self-cue, such as "rise," each time the client needs to stand is a useful technique in helping clients with ___ to initiate movement.
parkinson's disease
A flexion glove is worn when ___ in flexion is limited in the digits
passive range of motion
Joints may only be moved ___ in controlled-movement flexor tendon protocol.
passively
A __ (belt, SubASIS bar) is positioned at the front of the pelvis to limit pelvic tilt, rota- tion, or obliquity.
pelvic stabilizer
implications of fixed- and flexible-route trips.
people who can access fixed-route public transportation may travel more successfully compared with those who do not have such access.
implication of the 1998 Transportation Equity Act for the 21st Century
people who can access public transportation in a sustainable fashion, are more likely to be successful in welfare-to-work initiatives.
Stable angina usually resolves with____.
rest, nitroglycerin, or both.
What are the primary symptoms of PD?
resting tremor, muscle rigidity, bradykinesia, and postural instability
Bio-mechanical frame of reference focuses on ___or remediating skills to enhance occupational performance.
restoring
In the Prosthetic phase how is edema obtained?
resulting from ill-fitting socket or too-tight prosthetic sock
Teaching __ is useful in helping clients initiate movement to minimize the effects of bradykinesia in parkinson's disease.
self-cueing
What are the Postoperative treatment for cubital tunnel syndrome during the protection phase( 1-3 days) ?
splint the elbow at 70°-90° flexion; provide wound care, edema control, pain management, and AROM of uninvolved joints; and teach one- handed ADL techniques.
Positioning belt
stabilizes the pelvis; should be positioned so that it pulls on the pelvis at a 45° angle to the base of the seat back
For power wheelchair users, back heights to midscapula or __ may be needed to attach upper trunk and head supports.
top of shoulder
Continue to adapt modes of communication on the basis of the client's priorities (e.g., voice- operated text messaging).
Recovery phase intervention
Is sensory function affected in Parkinson's disease?
Sensory function, including numbness, paresthesia, and texture awareness, is not affected by Parkinson's disease.
______ is regulation by the CNS of its own activity.
Sensory modulation
In what stage of PD does a person need a good amount of assistance with ADLs
Stage 4
PD: impaired mobility, need for assistance with ADLs, poor fine motor and dexterity. Stage?
Stage 4
At what stage in ALS will a person require a w/c?
Stage 4. Due to extreme weakness in legs. Person also needs some assistance with ADLs.
f the regular chair is in for repair or the client lacks judgment to self-propel then __ chair is good
Standard chair
They are heavy (typically made of steel; 335 lb) and have limited adjustability.
Standard chairs
Middlesex Elderly Assessment of Mental State
Standardized "Cognitive" assessment
Cognition remains intact with Guillain-Barré syndrome and therefore does not typically require evaluation.
Supporting the arms and trunk against the table provides three points of stability against a stable surface, offering optimum support for task performance.
Deep heat is indicated for contractures, scarring, pain, and muscle spasms, not for generalized stiffness.
Sustained wrist extension while making a fist will provoke lateral epicondylitis (tennis elbow) symptoms.
Gentle correction is characterized by altering the environment as needed, reminding the child of the rules, and redirecting the child. T/F
T
Why would you Advise on a standing home program, such as using a standing frame?
To decrease spasticity such as with MS clients
Stage 5 of PD
Total dependence in ADLs and Mobility
is unable to self-propel a manual wheelchair; is depen- dent on a power chair or attendant
Totally or severely mobility-impaired user
pinkish skin
emphysema
meditation is disassociation of self and body as to hypnosis is
displacement of self
ALS Signs and symptoms are progressive and move
distal to proximal.
Clients with emphysema have ___ lungs, which partially expand the ribcage.
hyperinflated
What is Swan neck deformity?
injury to the metacarpophalangeal (MCP), PIP, or DIP joints character- ized by PIP hyperextension and DIP flexion; the PIP is splinted in slight flexion.
hypophonia
reduced volume of speech in PD
phycosis
refes to amental split fromr eality and reationality
write goals that focus on minimizing symptoms' effect on ___
occupational performance.
In the realm of nerve healing and testing, list the order in which recovery occurs:
one-point moving, one-point discrimination, two-point moving, and two-point discrimination.
Windswept deformity: pelvis rotates laterally and
things move to the other side
limen
threshold
To descend curbs, move the chair around to descend backward; guide the large wheels down the curb to the street. Clear the casters by __; and then turn the chair to face forward.
tilting the chair
MS: Overcome weakness in dorsiflexion?
use ankle foot orthosis
pacing
walking back and forth in the same area.
Can high voltage electric be used to treat cumulative trauma disoerder?
yes
difficulty maintaining work performance
Initial stage of HD
Prosthesis wearing schedule: Initial wearing time
Initial wearing time should be 15-30 minutes.
___ tremors occur during voluntary movement, in MS, and providing proximal stabilization may be effective in decreasing the intensity of the tremor with eating.
Intention
Do you need to evaluate cognition in GBS?
NO. Because cognition is not affected in GBS
One of the non-oper tx ideas for Radial Tunnel Syndrome is pain free ROM and ____.
Nerve glides
Is strengthening a good ideas to reduce fatigue caused by neurological factors in MS?
No, it can only reduce the weakness from being "deconditioned.
postural instability is a primary symtom of
PD
This is a Symptom of which condition?: Deep pain in proximal forearm with activity
Pronator syndrome
This is training in the operation of each component of the upper limb prosthesis.
Prosthesis control training
This is training in the integration of prosthesis components for efficient assist during functional use
Prosthesis use training
Most common fracture of UE
Proximal humeral fracture
What ADL adaptation can you do to reduce tremors in MS?
Proximal stabilization
___frame of reference focuses on restoring or remediating skills to enhance occupational performance.
Bio-mechanical
hand-strengthening program - which frame of reference?
Bio-mechanical because it is restoring hand strength
Treatment approaches should be compensatory, "focusing on adapting to disability and preventing secondary complications.
ALS
degenerative disease in which the motor neu- rons in the brain, spinal cord, and peripheral system are destroyed and replaced by scar tissue.
ALS
A person that report tripping or stumbling when walking or running or difficulty fastening clothes what diagnosis you think he has?
ALS because it starts out distally. weakness of the small muscles of the hand or an asymmetrical foot drop with or without night cramps, usually in the calves are the initial symptoms.
Holding the MCP joints in flexion helps prevent contracture of the ___.
collateral ligaments
With which client would a soft neoprene splints to position thumb and forearm be used ?
commonly used with clients with rheumatoid arthritis or cerebral palsy to increase functional use of the hand
Difficulty with spatial orientation has an impact on their
community mobility.
Symptoms of ___ often include pain, swelling, stiffness, and sudomotor and trophic changes.
complex regional pain syndrome
Age, diabetes, and a __(indicated by shingles) are all factors that delay the wound healing process.
compromised immune system
A ___ splint is used for clients with cerebrovascular accident, traumatic brain injury, or cerebral palsy.
cone antispasticity
Amputation can be ______or caused by _______ or__________ of whole or part of a limb such as leg, foot, arm, or hand.
congenital traumatic surgical removal
executive function
conscious control of thoughts, emotions, and actions to accomplish goals and solve problems
What is Boutonniere deformity?
disruption of the central slip of the extensor tendon characterized by proximal interphalangeal (PIP) flexion and distal interphalangeal (DIP) hyperextension; the PIP is splinted in extension, and isolated DIP flexion exercises are performed.
In the middle stages of HD
disturbances in memory and decision making
What is Duran protocol?
early passive ROM program
Full-length armrests provide more support for arms and better support for a lap tray than shorter ones; they promote__
ease of arm use for transfers.
according to sperry the split brain was essentially two conscious people
ego theorist
Standard contoured cushion surfaces
have contours based on typical body sizes. They provide more support than flat surfaces, distribute pressure across their surface, and are less expensive than custom-made surfaces.
The __ is considered more functional than the hand because of its greater precision, greater vis- ibility of object being grasped, lesser weight, lower cost, greater reliability, and ability to to into close quarters
hook
Overreactivity, also known as
hyperresponsivity
When are Steroids given to MS patients?
in acute stages, and only for temporary use
What is important to know for wrist fracture intervention?
it is important to provide a home program
MS clients experience Partial or complete paralysis of a part of the body; muscle spasticity, especially in __
lower extremities
An estimated 150,000 people in the United States have ________.
lower limb amputations.
Trendelenberg position
lower the head of the bed and raise the lower extremities when person experiences postural hypotension (sitting up from supine)
How should the hook or cosmetic hand prosthesis be cleaned?
with soap and water. Additional cleaning may be needed if the prosthesis is heavily soiled.
Clients using a myoelectric device must have two super cial muscle sites that can fit __ the prosthesis socket with suf cient EMG signals to power the hand
within
When does early active motion protocol begin?
within days of surgery to prevent adhesions and pro- mote tendon gliding and excursion.
Anterior interosseous nerve syndrome is motor loss of function ___ sensory disturbance.
without
Which muscles should be involved in a warm activity with MS clients?
warm up with proximal musculature before distal musculature
Desensitization of the residual limb through
weight bearing on various surfaces, massage, tapping and rubbing
ego theory
what unites my experiences is that i am the one experiencing them all self is a united entity that holds all of our experiences together
The sensory diet intervention strategy is specific to children with __________ because children with typical CNS functions are thought to be able to seek out the sensory input that they need on their own.
sensory integrative dysfunction
At the later stage of HD, the client is usually unable to talk, walk, or perform basic ADLs without ___ assistance
significant
Poor ability to conceptualize, plan, and execute motor actions are associated with
signs of poor perception of touch and body position (somatodyspraxia)
What is a below the wrist amputation called?
transmetacarpal
What is a below the ankle amputation called?
transmetatarsal
psychodynamic frame of reference
unresolved childhood events are the reason for dysfunction. A psychodynamic intervention is usually discussion based.
How should the OT fabricate a wrist extension splint to prevent wrist drop?
use a functional splint with 45º of wrist extension worn during day
Initial complaints of MS?
visual disturbances, dizziness, and weakness
The first_______ of life are a critical time for development of SI.
7 yrs
is the ability of a structure and concomitant function to be changed gradually by its own ongoing activity
Plasticity
____ are an important part of Ayres Sensory Integration treatment.
Play and imagination
is considered the act of organizing this information.
SI -sensory integration
is thought to be due to hyporesponsivity to a stimulus; children may look for intense input or large quantities of input.
Sensory-seeking behavior
T/F: Too much sensory input is not necessarily a good thing.
True
What are the standardized tests used to detect SI dysfunction ?
a. Sensory Integration and Praxis Test b. Miller Function and Participation Scales c. Bruininks-Oseretsky Test of Motor Proficiency d. School Function Assessment
Ayres Sensory Integration concepts have been adapted to meet the needs of children who are included in populations with known CNS differences (e.g., _____)
autism spectrum disorders, fragile X, cerebral palsy)
Ayres hypothesized that SI takes place in the lower levels of the CNS, specifically at the _____and the _______
brain stem and the thalamus.
Suspended equipment provides the opportunity for children to ____.
gain vestibular input
Ayres hypothesized that "refinement of primitive functions" especially those related to ______, ____, and ______ _____ would lead to increased functional skills, including learning, behavior, and motor skills.
posture, balance, and tactile perception,
The guiding principles of Ayres Sensory Integration treatment indicate that More mature and complex patterns of behaviors involve consolidations of more ___.
primitive behaviors
Other types of equipment are also used to provide different types of input. Some of the inputs that are targeted include vibration, tactile input (e.g., playing in a bin of rice or beans), and proprioceptive (e.g., ___).
pulling oneself up a rope
Children seeking vestibular input may appear to be______
reckless or risk takers; they may need a lot to get going.
When providing vestibular input, the occupational therapy practitioner looks for red flags to ensure that ____. These red flags include the child's report of nausea or dizziness, blanching, hyperactivity, and lethargy.
too much input was not provided.
Projected action sequences involving children having to be able to move their bodies in relationship to changing environmental conditions (e.g., a child responding to a ball being kicked to him or her) are difficult for children with
vestibular-proprioceptive problems
Children with tactile discrimination and perception problems should be taught to compensate for motor skills by using ______.
visual guidance
Fractures to individual carpal bones are called
carpal fractures
What must be present to diagnose MS?
"episodes of exacerbation and remission and slow or step-by-step progression over six months; there must also be evidence of lesions in more than one site in the white matter and no other neurological ex- planation for the clinical picture"
What are the nonoperative tx for Radial tunnel syndrome?
1. Long arm splint, elbow flexed, forearm supinated, & wrist neutral. 2. Massage or TENS for pain management, 3. Pain free ROM, 4. Nerve glides, 5. Activity modification avoid forceful wrist extension and supination
What are the 8 functional impairments related to aging changes that occur?
1. Ability to see close objects & coordinate eyes decreases 2. Images become blury 3. Ability to see at night decreases 4. Eyes adapt slower to light/dark conditions 5. Contrast sensitivity decreases 6. Decrease in ability to view objects in low light 7. Ability to distinguish certain colors diminishes(blue/green) 8. Visual fields become narrower
Human Activity Assistive Technology model includes interactions and balance among four major elements:
1. Activity 2. Context 3. Human skills 4. Assistive technologies
What are the phases of OT intervention for Cumulative trauma disorder (CTD)?
1. Acute 2. Subacute 3. Return to work 4. Functional capacity evaluation 5. Work hardening
What are the symptoms of CPRS ?
1. Allodynia 2. Hyperalgia (increased response to painful stimuli) 3. Hyperpathia (pain that continues after stimuli removed) 4. Edema 5. Contractures 6. Bluish or red shiny skin 7. Abnormal sweating and hair growth 8. Muscle spasms 9. Decreased strength 10. Low tolerance for activity
What are the operative tx for Radial tunnel syndrome?
1. Long arm splint, elbow flexed, forearm supinated, wrist neutral for 2 weeks, 2. then wrist cock up for 2 more weeks, passive and active pronation and supination, 3. hand strengthening exercise at 3 weeks, 4. resistive exercise as 6 weeks
What diagnosis are associated with central vision loss?
1. Cataracts 2. Age-related macular degeneration (AMD)
What are some OT interventions strategies for treating a client in the postprosthetic phase?
1. Client education about the prosthesis 2. Training to don and doff the prosthesis 3. Prosthesis wearing schedule 4. Limb hygiene 5. Care of the prosthesis 6. Upper limb prosthesis training 7. Provision of adaptive equipment as needed 8. Work with the client to develop the repertoire of skills needed to perform ADLs and IADLs
What are the the types of nerve problems associated with the ulnar nerve ?
1. Cubital tunnel syndrome 2. Claw hand
Name the flexor tendon protocols
1. Duran 2. Kleinert 3. Early active motion 4. Immobilization protocol 5. Splinting
How can the OT make computer adaptations for a person with Low vision?
1. Electronic magnifications programs/ equipment 2. Screen-reading software 3. Software programs that convert sound to text
What should the OT focus on when assessing the clients work, home, or both to make recommendations to improve safety and functioning?
1. Examine lighting in home or yard, contrast of items in the environment and glare 2. Identify optical and adaptive aids the client currently has, how and whether they are used, and their effectiveness
Extensor tendon intervention after surgical repair
1. Exercises promote tendon excursion and prevent adhesions. 2. Modalities include heat, to gradually prepare the tissue for motion, and NMES, to promote tendon excursion and activation. Use of modalities begins once cleared by the prescribing physician. 3. A clearly identified and planned home exercise program is important to ensure the client's safety and progress toward goals. 4. Tendon glides are used to promote excursion and prevent adhesions. 5. ROM 6. Strengthening usually is not initiated until the late phase of the repair, around 8-12 weeks after surgery.
What are some examples of functional tasks affected by Low-vision ?
1. Functional & comm. mobility skills (driving, ambulating. Increased fall risk 2. Reading & Writing 3. Shopping & Meal prep 4. Financial & Home management 5. Clothing selecting & management 6. Leisure activities 7. Recognizing faces & facial expressions 8. Medical management 9. Decreased social participation & communication & possible psychological issues
What are some Postoperative and preprosthetic phase signs and symptoms ?
1. Pain 2. Skin complications 3. Edema of residual limb 4. Bone spurs 5. Neuroma on distal end of residual limb 6. Phantom limb 7. Phantom sensation
Three things that lead to volition
1. Personal causation: a person's sense of competence and effectiveness while engaged in occupations 2. Values: that which is important and meaningful to the person 3. Interests: activities that provide enjoyment and satisfaction to the person
What are the 2 most common types of Glaucoma ?
1. Primary open-angle Glaucoma 2.Angle closure Glaucoma
What are some Prosthetic phase signs and symptoms?
1. Skin ulcers 2. Sebaceous cysts 3. Edema 4. Sensory changes
What are some OT interventions strategies for treating a client in the preprosthetic phase?
1. Training in limb hygiene 2. Wound healing 3. Limb shrinkage and shaping 4. Desensitization of the residual limb 5.Maintenance of or increasing flexibility and strength of residual limb 6. Maintenance of or increasing strength and flexibility of remaining limbs. 7. Wheelchairs:
What are the Types of CRPS and when do they develop?
1. Type I: develops after a noxious event 2. Type II: develops after a nerve injury
In the Prosthetic phase how is what are some sensory changes that can occur?
1. loss of sensory information as a result of missing limb, 2. residual limb hyperesthesia (oversensitivity), 3. areas of absent or impaired sensation, 4. phantom limb or phantom sensa- tions
At what is do kids begin walking?
12 months
Footrests should have a __ clearance from the floor.
2-inch
Trigger finger is a condition in which edema in the tendon and synovium of the digit results in lack of smooth flexion or extension of the finger. To rest the tendon and prevent snapping as the tendon pulls through the finger pulleys, the MCP joint is blocked by splinting, then gentle pull through with bending and straightening of the distal and proximal interphalangeal joints is recommended ___ while the client is awake.
20 times every 2 hours
Hand Rail: A height of_, or waist height depending on the person's height, measured to the top of the gripping surface from the ramp surface or stair nosing, is recommended for adults.
34-38 inches
The minimum clear width of an accessible route is __, except at doors.
36 inches
The focus at this point is on caregiver education to structure the environment and tasks. Person is extremely distractible. Explain how and what stage is the person is?
3: have nothing else in the bathroom besides a toothbrush with toothpaste on it, so nothing can distract him. Direct their hand toward the toothbrush and see if procedural memory kicks in
Can live alone but has serious safety risks. Thats why he needs supervision
4
Can't drive because they are highly distractible, and impairment in executive functions such as judgment and planning problem solving.
4
provide simple written directions to complete tasks
4
How soon as you begin the ROM protocol for proximal humeral fracture?
4-6 after the fracture as prescribed by the physician
Electrical stimulation and ultrasound are not used on tendon injuries until ___ postinjury.
6-8 weeks
How long do you have to wait before you can use electrical stimulation or ultrasound on tendon injuries?
6-8 weeks after the injury
Define Complex regional pain syndrome CRPS ?
A chronic pain condition most often affecting one of the limbs (arms, legs, hands, or feet), usually after an injury or trauma to that limb. CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems.
A dorsal flexor tendon repair splint is used for clients with flexor tendon repair.
A client with emphysema is most likely to have pinkish skin.
What is Smith's fracture?
A complete fracture of the distal radius with palmar displacement.
These are interventions aimed more at compensatory strategies and therefore fall under the rehabilitative frame of reference. These types of interventions may be appropriate in the plateau stage when a client may be at risk for contractures (B) and impaired ADLs requiring use of adaptive equipment (C). Education on energy conservation (D) is compensatory, not remedial.
A cone antispasticity splint is used for clients with cerebrovascular accident, traumatic brain injury, or cerebral palsy.
Should the OT perform a driving eval on a client with a recent amputation?
A driving evaluation should be performed.
A fair minus (3/5)
A fair minus (3/5) muscle grade indicates the client is able to move the upper extremity through less than full range of motion against gravity and would be unable to reach the opposite side of the body.
In lower limb prostheses, a pylon is used to connect the TD to the socket.
A prosthetic sock or gel liner protects the residual limb and improves the fit of the socket.
Conversion disorder
A rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found.
Pediatric Interest Profiles
A self-report survey of play and leisure interests. (MOHO-based assessment)
is an individualized plan that provides a specific child with the optimal sensory experiences that the child needs to be functional in his or her environment.
A sensory diet
hypochondriasis
A somatoform disorder in which a person interprets normal physical sensations as symptoms of a disease
Cognition, sensation, vision, hearing, bowel and bladder control typically are not affected in
ALS
Goals center on keeping the person as active and independent as possible for as long as possible
ALS
Signs and symptoms are progressive and move distal to proximal.
ALS
Why should you include the adjacent digits in a splint?
Adjacent digits need to be included in the splint because flexion of adjacent digits can apply too much force to the tendon repair, resulting in a possible rupture.
replaces the sling backrest; tension is adjusted by loosening and tight- ening the strapping system; accommodates kyphosis
Adjustable-tension backrest
Radial Nerve Injury: Operative Tx. After how many weeks should you adjust the splint to 10-20 deg. in extension moving down from 30 deg?
After 4 weeks
a condition in which the macula deteriorates, causing vision loss
Age-related macular degeneration (AMD)
These cushions are lightweight; they provide even pressure relief but have to be prop- erly inflated to perform well. They also reduce postural stability.
Air lled
Late stage Dementia
All areas of occupations are lost. Dependent in all ADLs Can't ambulate safely Communication lost No understanding of the cultural, social, or spiritual contexts
walks back and forth in the same area (pacing)
Allen level 2
Claudia Allen's Cognitive Disability Theory
Allen's cognitive Levels
These cushions provide scheduled pressure relief through alternating levels of inflation and deflation; they also reduce postural stability.
Alternating pressure
The __ Act of 1990 established the mandate to provide complementary paratransit services under Title II, Part B.
Americans With Disabilities
established accessibility guidelines for buildings and facilities (ex. ramp size, slope, width etc.)
Americans With Disabilities Act of 1990
is the result of optimal organization and leads to efficient goal-directed action.
An adaptive response
In the preprosthetic phase how can the OT facilitate limb shrinkage and shaping with elastic shrinker or removable rigid dressing?
An elastic shrinker or removable rigid dressing can be used if the client is unable to perform proper wrapping techniques.
How can aquatic therapy be beneficial to MS clients?
Aquatic therapy can help reduce the effects of weakness and provide gentle exercise
MS: How can you reduce the effects of weakness?
Aquatic therapy: buoyancy of water helps reduce the effects of weakness
Provide opportunities for activities and movement. ex rocking chair etc.
Behavior management for Wandering
Use distraction techniques to interrupt pacing (i.e., familiar pictures on the wall
Behavior management for Wandering
This assessment tool rates the importance of different activities to the person and how a person's perception of performance changes over time
Canadian Occupational Performance Measure (COPM)
This semistructured interview identifies a person's perception on his or her performance in the areas of self-care, productivity, and leisure
Canadian Occupational Performance Measure (COPM)
Activities should be simple, concrete, and supportive of desired social roles.
Cognitive Level 4—goal-directed activity
client-directed assessment that covers everyday activi- ties including self-care, school tasks, social activities, family-related activities.
Child Occupational Self-Assessment (MOHO-based assessment)
What happens in later stage of HD?
Chorea movements are replaced by hypertonicity
____ pain is pain that lasts longer than 6 months.
Chronic
Client is able to understand cause and effect.
Cognitive Level 4—goal-directed activity
Hands-free sitter
Client can maintain a seated position without using the hands. The seat- ing system design emphasizes mobility, stability (stable base of support), and comfort.
Dyspraxia is also known as ______ and _____
developmental dyspraxia and somatodyspraxia.
What additional information is MOST important to gather before developing an intervention plan?
Contextual and environmental factors that support the client's ability to adapt to the diagnosis. WHAT DOES THIS MEAN?
Ultrasound phonophores can be used to treat ___.
Cumulative Trauma Disorder
bundle theorists
did occurs because the mind is consittied by discourses they are involved with
Causes deposits of yellow- colored extracellular material within the macula of the eye.
Dry AMD
When should you use provocative nerve test and why?
During Evaluation of the Hand and Upper Extremity to elicit symptoms and clarify the injury.
*Affect on ADLs in early stage of dementia
During the early stage, ADLs remain intact.
may involve metal and loop components; angle of pull needs to be 90º for most effective outcome
Dynamic splinting
An OTR® is working with a community organization whose mission includes promoting universal access to transportation for people with disabilities. Which organization might the OTR® contact for training and technical assistance?
Easter Seals Project ACTION
______ is a cooperative project with the U.S. Department of Transportation's Federal Transit Administration that promotes universal access to transportation for people with disabilities under federal law and beyond. Project ACTION partners with transportation providers, the disability community, and others to provide training, technical assistance, applied research, and outreach and communication.
Easter Seals Project ACTION
What is the technique called when a person uses their peripheral vision to compensate for central vision loss?
Eccentric viewing
esp little evidence
difficult to replicate
The Beverly Foundation categorizes cleanliness of vehicles, friendliness of vehicle operators, and safety of transit waiting areas as components of Acceptability.
Executive function deficits are a common symptom of ASD and may result in impaired judgment.
How do coping strategies work for an MS client?
Explaining coping strategies to people with MS can help in handling exacerbations. It minimizes cognitive and emotional diturbances.
Allen Cognitive Level 5
Exploratory Actions - clients are able to improve actions through trial and error and are able to complete several steps at a time
Compression to the anterior interosseous nerve results in motor loss involving ___, Flexor profundus to index finger & pronator quadratus.
FDL
Somatodyspraxia is characterized by ___.
difficulties with motor planning.
True/False: Burning pain in medial forearm is a symptom of Radial tunnel syndrome.
False. Burning pain in "Lateral" forearm not medial
T/F: Decorticate posture and impaired respiratory mm. are symptoms of Parkinson's disease?
False: Spasticity, tingling sensation (paresthesia), Decorticate posture and impaired respiratory mm are not the symptoms of PD.
What is another name for muscle twitch
Fasciculation
The Occupational Therapy Code of Ethics (2015) states, "Occupational therapy personnel shall treat clients, colleagues, and other professionals with respect, fairness, discretion, and integrity." What principle does this statement directly relate to?
Fidelity
How many grades are associated with Cumulative trauma disorder (CTD)?
Five grades (I-V) according to severity
____ involves the therapist encouraging the child to complete the first step of the task, and then the therapist completes the rest of the task.
Forward channing
What is Bennet's fracture?
Fracture of the first metacarpal base.
Expected outcomes of intervention for sensory integration: Enhancement of family life.
Free bee :)
When does preprosthetic training begin?
From postsurgery until client receives permanent prosthesis
is flexion of the IP of the thumb when a lateral pinch is attempted.
Froment's sign
This is training in the control and use of the prosthesis during functional activities such as incorporation of the TD as a functional assist with a focus on a problem-solving approach
Functional training
Mild sensory loss in the hands and legs ("glove-and-stocking distribution")
GBS
Pain, mostly in the lower extremities
GBS
These cushions conform to the shape of the buttocks; they are adequate for postural control, heavy, and sensitive to temperature.
Gel filled
Pediatric Volitional Questionnaire
observational assessment to understand volition. (MOHO-based assessment)
Children with ____ ____ may prefer to have their feet stay on the ground.
Gravitational insecurity
Clients with ____ should not be pushed to the point of fatigue, which will occur with strengthening at the highest level of tolerance.
Guillain-Barré syndrome
___is symmetrical (bilateral) in its presentation; therefore, evaluation of only one side of the body is not appropriate.
Guillain-Barré syndrome
In ___ Shoulder weakness may be an observed symptom; however, the most disabling symptoms are likely to be distal rather than proximal.
Guillain-Barré syndrome (GBS)
Because of paralysis of muscles in the head and neck, spoken communication is often impaired in the plateau phase of __.
Guillain-Barré syndrome.
Acute weakness occurs in at least two extremities that ad- vances and reaches its maximum in 2-4 weeks
Guillain-Barré syndrome: Onset and acute inflammatory phase
Avoid open-ended questions during therapy sessions with
HD
During later stages, large bursts of movement when small movements are intended
HD
Use word association to aid with retrieval of information in early stage of
HD
chorea and fine motor incoordination
HD
__ temperatures are contraindicated for people with MS.
Hot
Dementia: The first signs of memory loss manifest in __
IADLs
interferential stimulation
IFS; interfering electrical currents to increase circulation and flexibility' decrease pain, edema, and muscle spasms
Thumb Zone I falls over the ___
IP joint
One-step commands are not needed until Stage __ of Alzheimer's disease.
IV
One-step commands are not needed until Stage _of Alzheimer's disease.
IV
Total assistance is not needed generally until the end of Stage __ of Alzheimer's disease.
IV
Total assistance is not needed generally until the end of Stage ___ of Alzheimer's disease.
IV
An OTR® is evaluating a client in the plateau phase of Guillain-Barré syndrome in a hospital setting. Which symptom is the OTR MOST likely to observe?
Inability to communicate vocally
Unstable angina does or does not resolve with rest or nitroglycerin?
It does not resolve, It requires emergency treatment.
Why would a therapist advise immobilization protocol?
It is advisable only for patients who are unable to care for themselves or who do not have the cognitive capacity to ensure safety postoperatively. This protocol is sometimes used with children to prevent rupture of the repair.
What is a ROM protocol for Proximal humeral fracture and when should we start it?
It is aggressive stretching. You can begin 4-6 weeks after the fracture as prescribed by the physician.
The pelvis rotates anteriorly, increasing the curvature of the lumbar spine; clients tend to use upper extremities for support.
Lordosis
The best-corrected visual acuity less than 6/12 (<20/40) in the better-seeing eye ( excluding those who are categorized as being blind.
Low vision impairment
First thing you can do to help clients with dementias in maintaining independence with daily tasks?
Make the tasks simpler
Rupture or avulsion of terminal extensor tendon results in
Mallet Finger
Allen Cognitive Level 3
Manual Actions: clients are able to engage in simple tasks that have repetitive actions with limited choices, and a client at Level 3 would require assistance for personal budget planning.
Extensor Thumb Zone III falls over the
MCP joint
How to measure seat width?
Measure the widest part of the thighs or hips, and add 1-2 inches.
Sensory loss from thumb to radial side of ring finger may be a result of
Median nerve injury
Dementia: Safety is a major concern; risks include wandering, letting a stranger in the house, or causing a fire
Middle stage
Improve the safety and ability of older adults with low vision to function by _________.
Modifying the environment
Massage or TENS unit can be used for pain management with a person who has Radial tunnel syndrome. Is the operative tx or nonoperative?
Nonoperative
___ treatment of a brachial plexus stretch injury includes education on how to minimize further irritation to the brachial plexus, including postural education and education regarding avoidance of provocative positions (e.g., overhead activities).
Nonoperative
Energy conservation and pacing, including prioritizing and planning important activities around medication times to ensure participation when medications are most effective
PD
a point-by-point agreement of 70% is generally too low for good interrater reliability and suggests that there are differences in the way practitioners are administering the assessment.
Once the skin has been grafted, the wrist and hand should be protected for 5 to 7 days until the staples are removed. No AROM, PROM, or functional use of the hand should occur during this time.
Children demonstrate a pattern that looks as though they overorient to the stimuli.
Overreactivity, also known as hyperresponsivity
*Evaluating a person with ___ at only one time of day may not provide an accurate picture of strengths and deficits.
PD
Active music therapy can enhance motor skills (specifically bradykinesia), emo- tional health, ADL performance, and quality of life
PD
Which disorder? External cueing and feedback from caregivers is an important strategy to improve safety and in this case reduce freezing episodes. The rhythmic nature of counting out loud or using a beat helps promote smoother movements that are more coordinated.
Parkinson's disease
What assessments could be used to test for contrast sensitivity?
Pelli-Robson Contrast Sensitivity Chart
One side of the pelvis is lower than the other side, which can lead to scoliotic posture and pressure ulcers on the ischial tuberosity.
Pelvic obliquity
This evaluation is holding the wrist in full flexion for 1 minute to elicit changes in sensation
Phalen's test
____ pain is usually associated with amputation.
Phantom
the sensation that the missing limb is still there; usually not painful, but may remain for the rest of the person's life
Phantom limb
a sensation that appears to occur in the missing limb; can be of any type, such as cramping, relaxed, numb, cold, and burning
Phantom sensation
Allen Cognitive Level 6
Planned Actions - client would handle unlimited steps in an activity including diagrams and written directions and would be independent with personal budget planning.
What can Dry AMD possibly cause?
Possible atrophy of the retina and a gradual loss of central vision
If a person has wrist drop, what are some possible muscle functions that may be affected?
Possible lack of finger and thumb extension
What is Postprandial orthostatic hypotension?
Postprandial orthostatic hypotension occurs when a person goes from supine to standing shortly after eating a meal. It generally affects older adults, people with hypertension, and people with Parkinson's disease.
This is training in TD control during grasp activities
Prehension training
This is the identification of the optimal position of each positioning unit (e.g., wrist, elbow) to perform an activity or grasp an object
Prepositioning training
Difficulty focusing on near objects
Presbyopia
Research on qualitative and quantitative measures suggests that practitioners should assess clinical outcomes from both a qualitative and a quantitative perspective and that subjective information plays a crucial role in maximizing therapeutic outcomes.
Quantitative measures such as goniometry have demonstrated poor reliability and decreased responsiveness compared with client self-report measures of function.
____ fractures account for 33% of elbow fractures.
Radial head
____ syndrome is entrapment of the radial nerve in an area extending from the radial head to the supinator muscle.
Radial tunnel
This is defined as an entrapment of the radial nerve in an area extending from the radial head to the supinator muscle
Radial tunnel syndrome
____ is compression of the radial nerve in the proximal forearm resulting in a dull ache and burning sensation along the lateral forearm.
Radial tunnel syndrome
The maximum slope of a ramp is 1:12.
Ramp slopes between 1:16 and 1:20 are preferred. Most ambulatory people and most people who use a wheelchair cannot manage a slope of 1:12 for 30 feet.
How should you provide ROM to dorsally burned hands?
Range one joint at a time to prevent rupturing of extensor tendons.
occupational therapist assists the client with parts of the task that are too difficult, but the client finishes the task himself or herself.
Scaffolding
Elastic bandaging provides light compression and can initially be used when the wounds are not closed.
Scar massage and ROM activities are an important part of burn rehabilitation but are not interventions for preventing hypertrophic scars.
Self-efficacy facilitates independent follow-through in the home context. The resulting confidence may ultimately lead to the desired behavior.
Splinting, home exercise compliance, and ADL strategies all are important components of an intervention plan for clients with arthritis. Fostering self-efficacy, however, promotes the client's compliance with all aspects of the plan.
What can you do to improve cognitive abilities of clients with MS?
Spreading demanding tasks throughout the day allows for rest periods to promote cognitive ability.
Non operative tx for Median nerve injury?
Static thenar web spacer splint
What is the operative treatment for Radial nerve injury?
Static wrist extension splint 30 degrees, after 4 weeks, adjust splint to 10 to 20 degrees of extension.
Iontophoresis treatment should be discontinued if the client has not reported at least 50% relief of symptoms.
Strength and endurance activities are a focus of the biomechanical frame of reference
Would vertical strips on the floor be appropriate to help family members deal with a freezing episode with Parkinson's disease?
Strips on the floor or carpet where freezing occurs is one intervention approach, but the strips should be horizontal, not vertical.
AROM or PROM of more than one joint at a time increases the chance of a tendon rupture after a burn to the dorsal hand. T/F
TRUE
light touch may be particularly noxious to a child with ?
Tactile defensiveness;
What can the OT teach a client with central vision to maximize their vision ?
Teach clients to rotate or turn their trunk to use peripheral vision.
What can the OT teach a client with peripheral vision to maximize their vision ?
Teach clients to rotate the head and trunk more to ensure they are seeing the entire visual field.
What can the OT teach a client to help identify any hazards in the environment and to locate desired objects?
Teach clients to scan in an organized manner
Which Tool is a standardized way of measuring a child's ability to produce handwriting?
The Print Tool
state and local transportation decision makers play a role in bringing attention to safety concerns related to individual users of different transportation modes
The Safe, Accountable, Flexible, Efficient Transportation Equity Act
What assessments could be used to test for far visual acuity?
The Snellen E chart or Tumbling E chart
Why add 1-2 inches when measuring seat width?
The added width provides clearance between the thighs and chair to ease repositioning and transfers, avoid rub- bing or pressure, and accommodate bulky clothing.
behavioral frame of reference
The behavioral frame of reference relies on the idea that behavior is learned and that it can be unlearned. Using breathing and relaxation techniques during a stressful event can facilitate a change in response.
In the preprosthetic phase how can the OT facilitate limb shrinkage and shaping with elastic bandage?
The client is trained to wrap the residual limb in an elastic bandage to reduce edema and develop a tapered shape.
cognitive-behavioral frame of reference
The cognitive-behavioral frame of reference works on the thoughts and reactions related to environmental triggers. Through journaling and reflection, the client can identify triggers that cause the anxiety to escalate.
Why activity modification for Radial Tunnel Syndrome?
To avoid "forceful" wrist extension and supination
A client with Alzheimer's disease (AD) perseverates on having to pick up children from daycare. At which stage of the disease process is this client likely at?
The middle stage of AD is characterized by clients' thinking that they are back in an earlier stage of life.
Minimum door width
The minimum clear opening is 32 inches. (Note: The minimum clearance width for a standard adult-size wheelchair is 26 inches; the minimum clearance width for a walker is 18 inches.)
Seated position
The reference seated position is as follows: The trunk is upright and in midline position; the hips, knees, and ankles are flexed to 90°; the pelvis is in neutral; the head is in midpo- sition; and the arms are at the side of the trunk with the elbows flexed to 90°
Teach clients how to maximize the use of ________ during performance of daily activities
Their remaining vision
What kind of orthotics are commonly used to provide support for healing structures?
Thermoplastic and casting orthoses
What happens to mm. when a person has CTD?
They get fatigued
splint forms a "C" bar between the thumb and index web space
Thumb abduction splint to prevent thumb adduction contracture
is a tap over the cubital tunnel to elicit symptoms.
Tinel's sign for cubital tunnel
Why would you use a sling for Proximal humeral fracture?
To Immobilize the fracture in nonoperative treatments.
These chairs have smaller rear wheels, making them lighter and easily movable. They are used for short distances or temporary use.
Transporter chairs
designed to be pushed by an attendant or caregiver.
Transporter chairs
What are the treatments for Digital stenosing tenosynovitis (trigger finger)
Treatment includes splinting the MCP at 0° for 3 to 6 weeks or surgically releasing the A1 pulley.
_ is a measure of localized soft-tissue pain.
Trigger point evaluation
Ability to initiate movement is not typically impaired in people with MS. True or False
True
Any patient provided with a splint should be given thorough written instructions, which include the contact name and number of the practitioner who fabricated the splint. T/F
True
Which injury can be treated with a long arm sling?
Type I radial head fracture
A __ fracture of the radial head requires removal of the fragmented bone and a cast for 3-4 weeks to ensure proper healing and support.
Type III
What is the typical duration of Ayres Sensory Integration treatment?
Typically 1 to 2 times per week for 2 year
What are the symptoms of Ulnar nerve injury?
Ulnar nerve injury results in ulnar claw deformity and numbness of the ulnar side of the hand and the fifth and half of the fourth digits, with generalized weakness of the ulnar side of the hand and pain.
Grade V of Cumulative Trauma Disorder
Unrelenting pain, unable to work
problems are characterized by poor bilateral coordination and difficulty sequencing actions.
Vestibular-proprioceptive
The OT should instruct the client in reducing ____ and ____ and improving organization to increased safety and ease in locating items
Visual and Physical clutter
___ are an effective strategy for deficits in orientation.
Visual reminders
effective strategy for deficits in orientation.
Visual reminders
In what 2 interests should be evaluated in a client with a recent amputation.
Vocational and recreational
origin of sdt
WW2 radar operator are the blobs enemy air craft? must make decision on subjective criteria, each decision has consequence
___ sign is the little finger held in abduction.
Wartenberg's
is the fifth finger held abducted from the fourth finger.
Wartenberg's sign
Should you teach stretching to MS clients?
Yes, Stretch before beginning any exercise to decrease spasticity, improve flexibility/circulation, and prevent injury.
Is fluidotherapy contraindicated for MS clients?
Yes, because it is heat based
Secondary parkinsonism
a condition in which people experience symptoms similar to those of PD, but the cause is related to the ingestion of drugs or other toxic chemicals. Certain medications used to treat mental illness may produce parkinsonian symptoms
Volition
a person's desire to participate in certain occupations (MOHO)
What is important for the OT to explain about care of the prosthesis?
a. Clean the interior with mild soap and water.
What should the OT educated the client about in Limb hygiene?
a. Daily cleansing b. Inspection of stump for reddened areas, particularly insensate areas
How can the OT work with the client to develop the repertoire of skills needed to perform ADLs and IADLs
a.For clients with lower limb amputations, functional mobility, including transfers, bed mobility, and wheelchair mobility b.Methods to perform vocational and leisure activities; job site analysis and intervention c. Home evaluation and intervention, if necessary d.Emotional and psychosocial support
Why is the hook considered more functional than the hand ?
because of its -greater precision, -greater visibility of object being grasped, -lesser weight, - lower cost, -greater reliability, -ability to fit into close quarters
A client with ___ has poor oxygenation, resulting in a bluish tinge to skin and lips, along with edema.
chronic bronchitis
The Multiple Sclerosis Functional Composite measures short-distance walking, hand function, and __
cognition, but does not directly assess fatigue.
Clients with multiple sclerosis typically have greater ____ abilities in the morning and after rest breaks.
cognitive
Allow increased time to complete tasks
cognitive compensatory strategy
The client has become increasingly impulsive and difficult to redirect. What type of dementia does this client MOST LIKELY have?
frontotemporal dementia
Primary goals for clients with dementia are related to maintaing __ capacity.
functional
Identifying activities with meaning for the individual client allows the OTR to measure___ needed for those activities.
functional ROM
When performing an informal observation of a child with SI problems, how should the OT go about this?
i. Observations occur in the child's natural settings, such as at home, at school, and in the community. ii. The occupational therapy practitioner looks for the ways in which the child responds to typical events as well as to novel ones.
Sundowning behaviors
i. Use adequate lighting. ii. Provide a safe area for physical activity. iii. Provide reassurance in a calm and caring manner. iv. Provide the client with fluids during the day. v. Reduce noise and clutter. vi. Avoid using restraints
If the armrest is too high
it positions the shoulder in elevation.
If deformities exist, apply __ pressure to determine whether the deformity is flexible or inflexible
manual
NMES is best used to facilitate ___.
muscle contraction
Poor Plus (2+/5)
muscle grade indicates the upper extremity moves through full ROM in a gravity-eliminated plane and tolerates minimal resistance before breaking. Because seated on a tub bench requires upper-extremity motion against gravity and the client is able to wash the same side of the body with the upper extremity, a greater than poor plus muscle grade is indicated.
Fasciculation
muscle twitch
Rigidity often is associated with __
musculoskeletal pain"
the cartesian view
my ego is my soul, basis of religions that soul is continuing entity
ALS: A __ or universal cuff is used for upper-extremity stability during self-care or fine motor tasks.
neck collar
A _____ approach to handwriting would ideally be used for children who have tone issues, poor postural control, poor limb function, poor automatic reactions, and poor proximal stability.
neurodevelopmental
function of thenar eminence
opposition of thumb (required for grasp-and-pinch patterns)
OT Evaluation for PD includes an interview to obtain a brief history and observation of how symptoms such as rigidity, bradykinesia, tremors, and postural instability impair areas of occupational performance. We also assess ___ that have been altered or eliminated.
preferred activities
According to Ayres Sensory Integration, optimal brain function is based on ______?
sensory input
ALS Stage 3
severe weakness
Athetosis
slow, writhing movements
Overresponsiveness to stimuli may be the result of ______ or ________
tactile defensiveness or gravitation insecurity.
Children with what type of problem may have difficulty with visual-motor tasks and motor planning in general
tactile discrimination and perception problems
Fine motor manipulation skills may be delayed as a result of what SI problem ?
tactile discrimination and perception problems
What is one of the most common types of sensory integrative dysfunction.
tactile discrimination and perception problems
characterized by difficulty making sense of, or interpreting, tactile input.
tactile discrimination and perception problems
Fibromyalgia presents with pain, fatigue, and ___
tender trigger points.
psychokinesis
the ability to move objects
telpathy
the ability to rad and communicate with other minds
Agnosia
the inability to recognize familiar objects.
Example of Cognitive disability frame of reference
training caregivers to provide appropriate environmental supports for the client.
Prospective Memory Screening
memory assessment
Rivermead Behavioural Memory Test-Extended Version
memory assessment
MS: Managing ataxia with orthoses
- cervical collar or wrist splints to reduce travel
ALS Stage 6
- confined to bed - dependent for ADLs and most self-care tasks.
Wrist exercises are used to facilitate movement and improve performance of the upper extremity; ex- amples include:
-AROM with wrist extended and fingers flexed; -blocking exercises; -tendon and nerve gliding exercises; - strengthening exercises, such as theraplast and use of hand exercises
What is the OT intervention in the subacute phase of Cumulative trauma disorder (CTD)?
-Slow stretching, -myofascial release, -progressive resistive exercise as tolerated, -proper body mechanics, -education on identifying triggers - returning to acute phase treatment with flareups; - static splint during activities that cause pain
What is the Nonoperative treatment for Double crush syndrome?
-Treat according to each nerve injury or syndrome, -avoid movements or postures that aggravate the symptoms, -nerve gliding exercises, and exercises for scapular stability, posture, and core trunk strengthening
What edema control techniques can OTs provide for interventions for CRPS?
-elevation, -massage, -AROM, -contrast baths, -compression
Visual-perceptual problems are common in children with other types of SI dysfunction. What might they have trouble with ?
-form and space perception, -figure-ground perception, -spatial orientation, -depth perception -visual closure.
At __days postsurgery, the tendon is still newly repaired and has the strength of the original suture.
1-9
What are the typical manifestations of Age-related macular degeneration (AMD)?
1. Impaired mobility 2. Reduced ability to perform ADL & IADLS 3. Decreased ability to recognize faces and perform detail work( reading needlepoint)
Describe the the common phases of healing?
1. Inflammation (provides cellular activity needed for healing) 2. Repair (forms the callus for stabilization) 3. Remodeling (deposits bone)
A client with cystic fibrosis may have yellowing of the skin.
A client with cirrhosis of the liver will tend to have an orange tint to the skin.
What are the the types of nerve problems associated with the radial nerve ?
A. Radial nerve injury B. Radial tunnel syndrome
The suggested interrater reliability of a standardized test is 80%
Ace wrapping a splint reduces edema, not contracture.
___ and proper body mechanics are essential for long-term control of an inflammatory cumulative trauma disorder.
Activity modification
Client with Dementia: Allen's Cognitive Level 4.0 and 3.8
At Levels 4.0 and 3.8, the client will typically recognize the need for a bath and will bathe thoroughly as long as no major problems develop during the bathing process (i.e., lack of soap).
According to ________, distal senses are not thought to have as large an impact until later in childhood.
Ayres Sensory Integration
According to ________, proximal senses are emphasized; these senses are thought to dominate a child's early life experiences.
Ayres Sensory Integration
Goals for seating and wheeled mobility systems
Bodily structures and function Function Activity and participation
Caused by entrapment of the median nerve as it courses through the carpal tunnel. This is the most common nerve compression of the upper extremity.
Carpal tunnel syndrome
Co-op
Client centered problem solving approach used with children. Outcome of this approach is Skill acquisition, generalization, transfer, and positive gains in self efficacy and independent strategy development.
Propped sitter
Client lacks the ability to sit without support. Total body support is required of the seating system for posture and repositioning.
Hands-dependent sitter
Client uses one or both hands to maintain a seated position. Pelvic and trunk support is required of the seating system to free the hands for activities.
What are clients able to do at 3 to 4 METS?
Clients can walk, shower seated, and perform upper-body exercises (3 to 4 METS) as tolerated
are a specific set of observations that allow the occupational therapy practitioner to make some inferences about how the child's CNS is functioning.
Clinical observations
How should you communicate with later stage PD?
Closed ended questions that require one- or two-word response
micrographia
Communication difficulties, including smaller and smaller handwriting in PD
Children with _______ also experience difficulty with tactile perception and discrimination.
Dyspraxia
severe physical and mental disabilities
HD
tone really increases in later stage
HD
Wrapping the legs around the chair legs to stabilize the pelvis and placing the elbows on the table to stabilize the upper trunk
HD education
Do people with Guillain-Barré syndrome experience rigidity?
NO. Rigidity does not occur with Guillain-Barré syndrome
___ is compression of the median nerve and causes diffuse pain along the medial aspect of the forearm.
Pronator syndrome
Which intervention would be MOST BENEFICIAL to use for initially facilitating grasp and release patterns for prewriting tasks in a child who has mild flexor tone in the thumb?
Provide a soft thumb abductor splint for the child to wear during prewriting tasks.
Aggressive stretching is a ROM protocol for ___.
Proximal humeral fracture.
- most common fracture of the upper arm - may involve the articular surface, greater or lesser tuberosity, or surgical neck.
Proximal humeral fractures
What is the job of the pulleys and where are they found.
Pulleys are found on the flexor side to prevent bowstringing and consist of A1, A2, A3, and A4 and C1, C2, C3, and C4.
Design activities and dynamic splints to help maintain ROM, especially for the wrist, fingers, and ankle (hinged drop-foot orthosis).
Recovery phase intervention
Recovery start at the head and neck and travel distally.
Recovery phase of GBS
Remyelination and axonal regeneration occur over a period as long as 2 years.
Recovery phase of GBS
What can Anterior interosseous syndrome result in ?
Results in a motor loss involving the -flexor digitorum longus, -flexor profundus to the index finger, - and pronator quadratus
What standardized test requires specialized training to administer ?
Sensory Integration and Praxis Test
PD: bowel/bladder ?
Sensory loss, including bowel and bladder as well as sexual dysfunction in PD
Why is an arterial line catheter inserted in the radial artery?
To monitor arterial pressure
PD: mild to moderate impairments in function. Stage?
Stage 3
impaired balance secondary to postural instability resulting in mild to moderate impairments in function
Stage 3 of PD
Mini-Mental State Examination
Standardized "Cognitive" assessment
Modified Mini-Mental State Examination
Standardized "Cognitive" assessment
Neurobehavioral Cognitive Status Screening Examination
Standardized "Cognitive" assessment
Repeatable Battery for the Assessment of Neuropsychological Status
Standardized "Cognitive" assessment
unilateral symptoms, typically a resting tremor, with no or minimal loss of function
Stage 1 of PD
bilateral symptoms; balance is not affected, although problems develop with trunk mobility and postural reflexes
Stage 2 of PD
In which stage of PD is balance impaired?
Stage 3
Burns to the dorsum of the hand require the metacarpophalangeal joints to be splinted in 70°-90° of flexion to prevent clawing of the fingers and shortening of the tendons and ligaments. This type of splint is also referred to as an antideformity splint or a safe position splint. T/F
True
Clients with MS should have as much control over their daily routines as possible, so having the caregiver plan routines for the client is not the most appropriate strategy. T/F
True
T/F: Children search for experiences in the environment that provide them with the "just-right" challenge; they have a sense of inner drive.
True
T/F: Clients may experience anxiety because of the guilt they feel over benefiting from someone else's death or while waiting for a matching donor. Organ recipients may also be affected by a type of posttraumatic stress disorder.
True
T/F: For MS use weighted utensils for feeding.
True
T/F: Holding the neck in midline improves swallowing
True
What are the Nonoperative treatment for cubital tunnel syndrome?
a. Edema control b. Pain management c. Elbow splint or positioning at 30°-60° flexion for 3 weeks d. Ulnar nerve gliding e. Proximal conditioning activities f. Posture and ergonomic training
What are some important considerations when prescribing an upper limb prosthesis?
a. Length, strength, flexibility, and skin integrity of the residual limb b. Patient preference for cosmesis (appearance) and function c. Hand dominance d.Typical activities to be performed with the prosthesis (home, work, leisure) e.Motivation and attitude f. Financial coverage g. Cognition
OT intervention for Proximal humeral fractures:
a. Orthotics (e.g., humeral fracture brace) can be worn for support of the fracture ends. b. ROM may begin as early as 2 weeks after a nonoperative fracture as medically prescribed. c. A sling is used to immobilize the fracture in nonoperative treatments. d. A ROM protocol consists of aggressive stretching and can begin 4-6 weeks after the fracture as prescribed by the physician. e. Management at home i. A home exercise program is crucial for the return of motion and function and for ADL per- formance. ii. The home program can include a sling for comfort and sleeping for the first 6 weeks as needed.
What type of interviews and caregiver questionnaire assessments are used for children with SI problems ?
a. Sensory Profile b. Sensory Processing Measure c. Touch Inventory for Elementary-School-Aged Children
What are the evaluation specific to cubital tunnel syndrome?
a. Tinel's sign is a tap over the cubital tunnel to elicit symptoms. b. Froment's sign c. Wartenberg's sign d. The elbow extension test
Name the three types of radial head fractures?
a. Type I (nondisplaced) b. Type II (displaced with a single fragment) c. Type III (comminuted)
Name the Extensor tendon zones
a. Zone I: distal interphalangeal joint b. Zone II: middle phalanx c. Zone III:proximal interphalangeal joint d. Zone IV: proximal phalanx e. Zone V: metacarpal phalangeal joint f. Zone VI: metacarpalphanageal bone g. Zone VII: carpal bones and wrist
What are some Prosthesis components?
a.Terminal device (TD) b. A socket that attaches the prosthesis to the residual limb. c. Positioning components. d.A harness and suspension system e. Function of upper limb prostheses f. Function of lower limb prostheses g. A prosthetic sock or gel liner
What is Kleinert protocol?
active extension of digits with passive flexion via traction, typically a rubber band.
It is important to consider ___ digits when applying an orthosis.
adjacent
Wiping independently after a bowel movement and managing clothing independently typically happens ___.
after age 3 and usually before age 5.
What is Radial tunnel syndrome?
an entrapment of the radial nerve in an area extending from the radial head to the supinator muscle
The Unified Huntington's Disease Rating Scale assesses changes in the areas of motor function, cognitive function, functional capacity and __
behavioral abnormalities
distinguishing feature of frontotemporal dementia
behavioral changes
How is Carpal tunnel syndrome caused?
by entrapment of the median nerve as it courses through the carpal tunnel.
How can you modify tasks to improve ataxia for MS clients?
by promoting hand-over-hand techniques for fine motor tasks (e.g., using the unaffected extremity over the hand with tremor when dialing a phone
How can you achieve maximum FDP excursion?
by splinting the MCP joint in extension, isolating PIP and DIP flexion
How can you measure outcomes when assessing hand and UE, before and after therapy?
by using Quick Disabilities of the ARm, Shoulder, and Hand Questionnaire (Quick DASH)
ALS Stage 1
can walk, independent with ADLs, and has some weakness.
Akinesia
can't initiate movement
15%-20% clients with ___ conditions, meet the criteria for major depression.
cardiac
Help the client advocate for better control over the environment; family or coworkers may prefer a cool home or work environment, but __temperatures increase muscle stiffness
colder
Splint wear schedules should be communicated clearly in both oral and written format, although with a joint arthroplasty, the patient is required to wear the splint ___.
continuously
At 6 weeks after repair of flexor tendons, strengthening is ___.
contraindicated
Passive motion of the PIP joint in boutonniere deformity is ___ during the splinting phase of conservative treatment.
contraindicated
berry and brodbent
control output of hypothetical sugar factory by changing size of workforce
In upper limb prostheses, a control system is combined with the harness to transmit body forces to _____
control the cable that operates the TD
To provide pelvic stability, a solid seat is inserted on top of the sling seat; and
cushions are placed on top of the solid seat.
sperry ego
cut corpus collosum- thought that these results revealed a doubling of conscious awareness and ebem that his patients had two free wills in one cranial vault
When the right side of the heart fails, blood flows back into the venous system. Symptoms of right-sided heart failure include ___.
cyanotic nail beds, jaundice, and lower-extremity edema.
caused by cumulative microtrauma resulting in tenosynovitis of the thumb muscle tendon unit, the abductor pollicis longus and extensor pollicis brevis, and the tendons in the first dorsal compartment of the wrist.
de Quervain syndrome
conservation
decision is a yes only when it is almost certain that there is a signal
summary of SDT
decisions are always made in the prescnce of noise decisions are made with respect to criterion performance hit rate is biased depends on criterion
Dysmetria
decreased coordination of movements
Haleperidol
decreases chorea in HD during functional activities
What are the symptoms associated with Pronator syndrome?
deep pain proximal forearm with activity
thrombocytopenia
deficiency of clotting cells
Akinesia
delayed initiation of movement. HD
Flat (planar) cushion surfaces
do not accommodate body shape. They are appropriate for clients who need no or minimal postural support and can reposition themselves independently.
A dorsal hood splint ___ offer adequate protection for the fractured metacarpal.
does not
Heating between 71.6°F and 105.8°F increases lymph flow and helps soften tissues to promote increased range of motion. Heating ___exacerbate minimal edema.
does not
esp and law enformement
dont participate in it, those that do found it unhelpful
hallucination
entirely internal- experiencer believes that what they see or hear is real
An ___________ of community, home, school, and work should be completed.
environmental analysis
Positioning the thumb in extension shortens the ___.
extensor pollicis longus
Methylprednisolone is prescribed to MS clients for __
functional skills
Define Hyperalgia
increased response to painful stimuli
Iontophoresis is used to control ___. conditions.
inflammatory
meditation
is generally induced as opposed to spontaneous disassociation of self from body
What is Phalen's test and what is it used to test?
is holding the wrist in full flexion for 1 minute to elicit changes in sensation from Carpal tunnel syndrome
issues with DID
is it a role or people faking it? highly suggestible people, easily hyponotized leading questions varying roles we play
A client with middle-stage dementia will have decreased __ along with decreased performance skills that may lead to falls.
judgment
Within the child-directed environment, the occupational therapy practitioner strives to create the___.
just-right challenge
Apraxia
loss of skilled, purposeful movements
illusion
misperception of external stimuli -ponzo illusion
high criterion n
no false alarms but many misses only make decision when highly confident-really big blobs`
Flow is effortless
not planned
too conservation
not willing enough
non fixed perceptual thresholds
nothing is in or out of consciousness but that sensory info is processed in different ways with different consequences for different behaviors
buddha first bundle theorist
notions self is just a label
Carpal tunnel syndrome presents with ___ in the thumb, index and middle fingers.
numbness and tingling
split brain
objects on right visual field can be named left cannot
Adaptive responses occur in ___ and are prerequisite to sensory integration.
optimal arousal states
A client with cirrhosis of the liver will tend to have an ___ to the skin.
orange tint
What should be remembered when providing a client with a client an elbow or knee extension splint?
positioning in as much extension as possible
positive symptoms
prescence of problematic behavior -hallucination, bizarre behavior
What are the motor impairments associated with carpal tunnel syndrome?
presents as diminished fine motor coordination; in advanced cases, the adductor pollicis muscle may be atrophied.
Surgery aims to____________ as possible while providing healthy skin, soft tissue, vascularization, sensation, and muscle and bone.
preserve as much limb length
1. Decrease in Subcutaneous fat around the eye 2. Decrease in Strength of muscles, tone, and transparency of corneas. 3. Sclera and iris show signs of degeneration 4. Pupils become smaller 5. Lens of eye becomes thicker, inflexible and more opaque. 6. Cornea becomes thicker 7. Eye disease become more common ARE ALL CONSIDERED TO BE ?
primary visual aging changes
Dementia with Lewy bodies
progressive deficits in attention and executive function, memory impairment, fluctuating cognition, visual hallucinations, parkinsonism, autonomic dysfunction, falls, and sleep disorder; aphasia, apraxia, and spatial disorientation
Difficulty with _______ is characterized by children appearing gawky and awkward and having difficulty grading force.
proprioception
Children who seek activities with deep-pressure input or muscle resistance need what kind of input ?
proprioceptive input
Guillain-Barré syndrome typically results in more extreme distal muscle weakness rather than ___, so addressing trunk control will not be an effective intervention.
proximal muscle weakness
What is the purpose of fabricating a Resting hand, ball, and cone antispasticity splints
purpose is to decrease tone in the hand and up- per extremity
In lower limb prostheses, a ____ is used to connect the TD to the socket.
pylon
Radial tunnel syndrome is entrapment of the radial nerve in an area extending from __.
radial head to the supinator muscle.
In the preprosthetic phase how can the OT facilitate desensitization of the residual limb?
through weight bearing on various surfaces, massage, tapping and rubbing.
Bennett's fracture is an intraarticular fracture of the ___ metacarpal bone.
thumb
An arterial line catheter is inserted in the radial artery at the___ to continuously monitor arterial pressure.
wrist
Extensor Thumb Zone V falls over the
wrist
Environment should be consistent, familiar, and modified to elicit orienting experiences.
Cognitive Level 1—automatic actions
Motor actions are in response to one-word, near-reflexive directions (i.e., "sip").
Cognitive Level 1—automatic actions
ix. Client requires constant 24-hour supervision.
Cognitive Level 1—automatic actions
ADLs can be accomplished by imitating the caregiver (i.e., washing the face)
Cognitive Level 2—postural actions
During grooming and bathing, items should be presented to client one at a time, in sequen- tial order of use.
Cognitive Level 3—manual actions
Motor actions are limited to one-step, familiar, and action-oriented activities.
Cognitive Level 3—manual actions
Client requires 24-hour supervision.
Cognitive Level 4 and 3 —manual actions
Client can follow two- or three-step activities.
Cognitive Level 4—goal-directed activity
Labels and pictures can be used as reminders.
Cognitive Level 4—goal-directed activity
Caregiver standby or supervision is needed for cognitive assist.
Cognitive Level 5—exploratory actions
Client can follow a four- to five-step process and learn new concrete ideas.
Cognitive Level 5—exploratory actions
Educate caregivers to speak slowly and clearly with simple, one-step instructions and to intro- duce new concepts one at a time
Cognitive tx for PD
Nondisplaced fractures of the humeral neck require a ___, not an orthosis.
sling
Hypertonicity is typically elicited during __joint movements.
slow
Pursed lip breathing can ____ and ____.
slow breathing and reduce anxiety
Expected outcomes of intervention for sensory integration: Enhancement of occupational engagement and ____.
social participation
procedural memory
something we can do but explicitly hard to explain
PD: Written Communication tx
- rest before writing (use large paper and larger felt tip pens) - If handwriting is illegible (pay bills online/phone)
OT techniques to address dysphagia
- Minimize distractions during mealtime. - Adapt food consistency (thicken liquids, downgrade diet to soft foods). - Use manual swallowing techniques. - Allow sufficient time for meals.
List the complications with flexor tendon injuries:
- Nerve involvement, usually laceration - Pain & Edema - deviation of the wrist and digits
How do we test coordination?
- O'Conner Dexterity Test - Nine-hole Peg Test - Jebsen-Taylor Hand Function Test - Minnesota Rate of Manipulation Test - Crawford Small Parts Dexterity Test - Purdue Pegboard Test
sensory receptors in the hand
- Pacinian corpuscles (vibration) - Rufini end organs (tension) - Merkel cells (pressure)
ALS Stage 5
- Severe weakness in arms also - dependent for all ADLs
What are some Common presentations of children with vestibular-proprioceptive problems ?
- decreased equilibrium reactions, -poor posture, -lower-than- average tone, -delayed gross motor skills.
What is the affect of Dopamine?
- influences speed/accuracy of motor skills - postural stability - cognition - affect and expression
During the eval process for testing hand and UE what should you interview the client on?
- pain - splints - functional use - use ADL checklist
What motor abilities are lost with Median nerve injury?
- pinch - thumb opposition - MCP & PIP flexion of index finger - decreased pronation
cogwheel motions
- primary sign in PD (jerky movements) under muscle rigidity/stiffness - common in UE - person fatigues quickly when they have cogwheel motions
What types of splints can the OT use to reduce soft-tissue contractures?
1. Antideformity (safe position) burn splint 2. Elbow or knee extension splint 3. Wrist extension splint to prevent wrist drop 4. Thumb abduction splint to prevent thumb adduction contracture 5. Lumbrical bar splints to reduce MCP hyperextension and IP flexion contractures 6. Resting hand, ball, and cone antispasticity splints 7. Soft neoprene splints to position thumb and forearm 8. Splint to prevent foot drop 9. Serial casting 10. Dynamic splinting: may involve metal and loop components; angle of pull needs to be 90º for most effective outcome
What are the client factors limiting performance that should be evaluated by the OT?
1. Any changes in sensation in the residual limb, including hypersensitivity and sensation loss 2. Presence and severity of phantom sensations 3. Pain 4. Experiences of self, including body image, self-concept, and self-esteem 5. Strength, flexibility, and endurance of the residual limb in preparation for prosthesis wearing; full body strength, flexibility, and endurance 6. Skin integrity
What are the 7 primary visual aging changes that occur?
1. Decrease in Subcutaneous fat around the eye 2. Decrease in Strength of muscles, tone, and transparency of corneas. 3. Sclera and iris show signs of degeneration 4. Pupils become smaller 5. Lens of eye becomes thicker, inflexible and more opaque. 6. Cornea becomes thicker 7. Eye disease become more common
What are the operative tx for median nerve injury? (OT)
1. Dorsal wrist blocking splint worn for 4-6 weeks. 2. AROM and PROM in splint for digits and thumb, tendon gliding exercises, 3. scar massage 4. Discontinue splint at 6 weeks and begin strengthening exercises
Interventionsaftersurgicalrepair
1. Exercises promote tendon excursion and prevent adhesions. 2. Modalities include heat, to gradually prepare the tissue for motion, and NMES, to promote tendon excursion and activation. Use of modalities begins once cleared by the prescribing physician. 3. A clearly identified and planned home exercise program is important to ensure the client's safety and progress toward goals. 4. Tendon glides are used to promote excursion and prevent adhesions. 5. ROM 6. Strengthening usually is not initiated until the late phase of the repair, around 8-12 weeks after surgery.
Flexor tendon OT intervention
1. Exercises promote tendon excursion and prevent adhesions. 2. Modalities include heat, to gradually prepare the tissue for motion, and neuromuscular electrical stimulation (NMES), to promote tendon excursion and activation. Use of modalities begins once cleared by the prescribing physician. 3. A clearly identified and planned home exercise program is important to ensure the client's safety and progress toward goals. 4. Tendon glides are used to promote excursion and prevent adhesions. Tendon glides are a sequence of movements used to promote full tendon excursion and full AROM and prevent adhesions (the sequence of movements is fingers straight, MCP flexion, hook fist, then flat fist). 5. ROM 6. Strengthening usually is not initiated until the late phase of the repair, around 8-12 weeks after surgery. 7. If the client cannot cognitively follow a protocol, the extremity is cast in a protected position for 6 weeks.
Flexor tendon intervention
1. Exercises promote tendon excursion and prevent adhesions. 2. Modalities include heat, to gradually prepare the tissue for motion, and neuromuscular electrical stimulation (NMES), to promote tendon excursion and activation. Use of modalities begins once cleared by the prescribing physician. 3. A clearly identified and planned home exercise program is important to ensure the client's safety and progress toward goals. 4. Tendon glides are used to promote excursion and prevent adhesions. Tendon glides are a sequence of movements used to promote full tendon excursion and full AROM and prevent adhesions (the sequence of movements is fingers straight, MCP flexion, hook fist, then flat fist). 5. ROM 6. Strengthening usually is not initiated until the late phase of the repair, around 8-12 weeks after surgery. 7. If the client cannot cognitively follow a protocol, the extremity is cast in a protected position for 6 weeks.
What are the OT interventions for CRPS?
1. Gentle, pain-free AROM for short periods; no PROM or painful treatment 2. Stress loading 3. Pain control techniques 4. Edema control techniques 5. Desensitization techniques, fluidotherapy 6. Blocked exercises, tendon gliding 7. Joint protection, energy conservation
What are the operative treatments for Pronator syndrome?
1. Half cast 2. AROM all UE joints while wearing cast, 3. muscle strengthening in 1 week, 4. full AROM gained by 8 weeks
The most common cause of upper limb amputation is _____.
trauma.
Fidelity
treat clients, colleagues, and other professionals with respect, fairness, discretion, and integrity
How is Type I radial head fracture treated?
treated with a long arm sling.
How is Type II radial head fracture treated?
treated with immobilization for 2-3 weeks and early motion with medical clearance.
Refers to the sharpest, clearest vision attainable by the client on the best circumstances, using vision out of the best eye, with standard corrective lenses (glasses/ contacts)
Best-corrected vision
Festinating gait is small rapid steps resulting from a forward-tilted head and
trunk posture
What is choreoathetoid?
twisting, writhing, worm like movements
The prosthetist collaborates with the client and occupational therapist to identify the prosthetic options appropriate to address the client's goals and to construct and ensure the proper fit of the prosthesis. This is an example of ?
An interdisciplinary Team Management
What assessment could be used to test for central visual field deficits ?
Amsler grid
Clients using a myoelectric device must have _____ that can fit within the prosthesis socket with sufficient EMG signals to power the hand.
two superficial muscle sites
This type of Glaucoma is an emergency, acute condition in which aqueous fluid becomes blocked, quickly raising intraocular pressure
Angle closure Glaucoma
Administering an assessment without determining competence is in violation of the principle of ___.
Beneficence
If the client cannot cognitively follow a protocol for a flexor tendon injury, what should you do then?
Cast the extremity in a protected position for 6 weeks
The lens of the eye becomes more opaque, and a reduction of light going to the retina occurs.
Cataracts
The steps in developing a professional development plan are to (1) reflect on current performance to date and determine learning needs on the basis of the self-assessment results; (2) review progress toward previous professional development goals; (3) ascertain what resources exist to meet identified professional development goals; (4) modify previous professional development goals and set new ones; (5) take action to meet professional development goals; and (6) document completed professional development activities. Thus, after identifying personal needs for growth by means of a self-assessment, the next step an OTR would take would be to determine what learning needs to occur.
Coban™ self-adherent wrap will be difficult to manage in a large area such as the thighs. It is more commonly used in small areas such as the fingers.
It is part of the role and responsibilities of the AOTA Ethics Commission to educate the membership on issues related to the ____.
Code of Ethics
____ remains intact with Guillain-Barré syndrome and therefore does not typically require evaluation in that domain.
Cognition
Client is dependent on caregiver for ADLs.
Cognitive Level 1—automatic actions
Client needs assistance with ambulation and transfers.
Cognitive Level 1—automatic actions
Client needs monitoring to ensure adequate nutrition.
Cognitive Level 1—automatic actions
Client needs passive, active, or assistive ROM for prevention of bed sores, osteoporosis, infections, and contractures.
Cognitive Level 1—automatic actions
Client requires total cognitive assistance.
Cognitive Level 1—automatic actions
___ is used to treat trigger points and increase passive stretch of a muscle tendon unit.
Cold spray
do not accommodate body shape. They are appropriate for clients who need no or minimal postural support and can reposition themselves independently.
Flat (planar) cushion surfaces
Name the flexor tendons:
Flexor digitorum super cialis (FDS), exor digitorum profundus (FDP)
Foam
Foam is of variable density. Foam that is soft and pliable will mold itself around the buttocks. If it is too soft, the client may totally compress it, making it useless for pressure man- agement. Foam cushions are lightweight and low cost; however, heat and moisture can build up. Custom-contoured foam is more expensive and provides better postural control; shearing is reduced, and weight-shifting capability is reduced.
for clients with hemiplegia. Chair height is lower to permit foot propelling. The foot rest for the nonhemiplegic extremity is re- moved.
Hemi-height chairs
What instructions you can give to family in middle stage HD?
Instruct the family to use simple written cues or words to promote completion of self-care and simple household activities.
Cold application is usually used to control acute inflammation. Acute edema occurs within the first 24 to 72 hours after injury.
NMES is best used to facilitate muscle contraction and a TENS unit will best aid the client in reaching the treatment goal of pain control.
Items such as large-print books or magazines, talking clocks, and so forth are examples of ?
Non-optical OT intervention recommendations based on eval
Advise clients on streamlining the workload to perform difficult tasks when medication is at optimal effect
PD
Freezing
PD
Jobs to be avoided are those that require extensive gross motor movements, such as walking, reaching, or bending (because of balance and gait deficits)
PD
Levodopa is usually given to clients with
PD
Plan activities around medication times
PD
Posture is stooped, with a lack of arm swing during mobility and loss of pos- tural reflexes. What might this person have?
PD
Tremors are often absent with voluntary movement.
PD
Use distal wrist weights if effective in decreasing tremors.
PD
bradykinesia is a primary symptom is
PD
muscle rigidity is a primary symptom of
PD
What are the nonoperative tx for median nerve injury?
Static thenar web spacer splint
Early Stage: HD - How can you modify the environment?
label items with their name and function due to memory loss
T/F: Group sessions are effective in decreasing the impact of postural instability for clients with Parkinson's disease.
True
T/F: Neuroma is hypersensitive and painful to touch.
True
T/F: No evidence indicates that contrast baths reduce edema.
True
T/F: Passive and active pronation & supination is a tx. for Radial tunnel syndrome under operative tx.
True
T/F: Socialization has not been a reported outcome of group sessions.
True
T/F: The most recognized treatment of complex regional pain syndrome is a stress loading program and use of the upper extremity in functional activities that promote occupational engagement.
True
T/F: sagittal bands center the extensor tendons over the MCP joint
True
How long do people with ALS usually live?
Up to 5 years after diagnosis
What are the nonoperative treatments for CTS?
a. A carpal tunnel syndrome splint or wrist cock-up splint at 0°-10° wrist extension is used to relieve pressure on the median nerve in the carpal tunnel and control edema; a prefabricated wrist cock-up splint can be used if wrist position is adjustable. b. Nerve and tendon gliding exercises are used. c. Activity modification includes ergonomic handles, gel pads, or padding on handles. d. Client education recommends avoidance of postures and activities that aggravate the condition (e.g., those that involve wrist flexion). Training is provided in the use of an ergonomic keyboard modification, if applicable. e. Postural retraining and proximal conditioning exercise are provided.
Explain the Prosthesis wearing schedule that the OT would initiate in the postprosthesis phase?
a. Initial wearing time should be 15-30 minutes. b.The prosthesis should then be removed and the stump examined for reddened areas. c. If no reddened areas are apparent after 20 minutes, the wearing time is increased in 15- to 30-minute increments until the client wears the prosthesis for a full day. d. Any reddened areas that do not disappear after approximately 20 minutes should be reported to the prosthetist so the prosthesis can be adjusted
OT intervention for radial head fractures:
a. Orthotics are used for immobilization as needed. b. ROM is begun early, within the 1st week if medically cleared. c. A sling is used for Type I fractures or comfort if the client has pain and is nervous in public places.
believers in paranormal activity
arre more likely to report it
Clients with Parkinson's disease typically are not affected cognitively and are ___.
aware of their deficits
kinesthesia
awareness of movement of body parts
A lack of sensory input at critical points in development may result in _______ or ________.
learning or behavioral disorders.
Someone with Stage IV ALS is likely to have severe weakness in the lower extremities, causing an inability to ambulate.
because the client has a partial-thickness skin graft at the anterior aspect of the forearm and to maintain maximum surface area of the grafted area, it is better to position the forearm in a neutral position. The forearm should be positioned in neutral to maintain maximum surface area of the grafted area.
When the axle is aligned __, access to the push rims is improved. Movement efficiency is increased because the user can go further with fewer strokes.
below the shoulder
subliminal
below the threshold
What are the components of splints to prevent foot drop
below-the-knee splint to keep ankles at 0º for possible future ambulation
Statements about AROM and exercise document progress from a ___ frame of reference.
biomechanical
When providing vestibular input, the occupational therapy practitioner looks for red flags to ensure that too much input was not provided. These red flags include the child's report of nausea or dizziness, ____, ___, and ___.
blanching, hyperactivity, and lethargy.
Ex: of a proximal fracture
boxer's fracture (fracture at 4th &5th metacarpal)
Amsler grid is used to assess
central visual fields
Breathing out on exertion is a breathing technique for clients with ___.
chronic obstructive pulmonary disease(COPD)
What type of client would a serial cast be used for ?
clients with increased tone stretch out soft tissue contractures over time
minimizing multitasking is what type of strategy?
cognitive compensatory strategy
What increases tremors in PD?
cognitive tasks and stress
Ayres hypothesized that "refinement of primitive functions" especially those related to posture, balance, and tactile perception, would lead to increased functional skills, including ______, ____, and ______ _____ .
learning, behavior, and motor skills.
A __ splint is used for clients with flexor tendon repair.
dorsal flexor tendon repair
Although all other IADLs might be impaired, spatial orientation will affect community mobility the most, making
driving unsafe.
Adaptive responses are thought to lead to changes at the _____ these changes alter the brain through a process called neural plasticity.
neuronal synaptic level
The extensor tendons cross the wrist dorsally under the ___, separating into 8 compartments to prevent bowstringing.
extensor retinaculum
The distinguishing feature of ___ dementia is behavioral changes with an increase in disinhibited behavior, decreased social tact, lack of empathy, and lack of interest.
frontotemporal
Pronator syndrome is the entrapment of the proximal median nerve between the __.
heads of the pronator muscles.
Sloping the "seat" down toward the rear of the wheelchair (seat dump) can __
help stabilize the pelvis. But too much sloping can make transfers difficult and cause pressure.
Ulnar claw is a result of an ulnar nerve injury and ___ of the metacarpophalangeal joint in the small and ring finger with proximal interphalangeal flexion.
hyperextension
Praxis problems, or dyspraxia, involve difficulty with any of the three parts of praxis:
ideation, planning, execution.
The primary goal of intervention for upper-extremity overuse with musicians is to____ when playing the instrument. Observing the student during a rehearsal and practice would allow the practitioner to gather this information.
identify and reduce muscle tensions
Why would you need a higher back seat height?
if trunk control is poor
Stage 3 of PD?
impaired balance secondary to postural instability leading to mild to moderate impairments in function.
Stage 4 of PD?
impaired mobility, need for assistance with ADLs, poor fine motor and dexterity. Stage?
If the bulbar tract is affected in ALS then initial symptoms can also include difficulty breathing, slurred speech, decreased volume in speech, or ___
impaired swallowing.
Akinesia
impairment of voluntary and spontaneous movement initiation resulting in freezing, es- pecially during gait activities
goal of medical and rehabilitation treatment for MS is "to minimize the severity, amount, and length of exacerbations in order to __"
improve function
The guiding principles of Ayres Sensory Integration treatment indicate that The more inner directed a child's activities are, the greater the potential for the activities to ___.
improve neural organization.
Use of specific cueing methods and clear verbal and visual instructions may facilitate ___.
improved motor movements for activity participation
Discontinuous exercise involves using various exercise activities for the same time interval while gradually ___.
increasing the intensity of the tasks.
hubble fix
incubation insight conceptual combination analogy visualization
Goal of ALS
keep person as active and independent as possible for as long as possible
Aortic stenosis and aortic insufficiency have symptoms similar to those of ___.
left-sided heart failure.
orthostatic hypotension
low blood pressure that occurs upon standing up
MCP joint extension splint helps isolate proximal and distal IP joint flexion and allows ____.
maximum FDP excursion
During the OT eval where might an OT find imitations in a patient with a recent amputation?
may be seen in all areas of occupation.
What are the motor impairments associated with cubital tunnel syndrome?
may include decreased grip and pinch strength because of weak interossei, adduc- tor pollicus, and flexor carpi ulnaris muscles.
Which nerves innervate flexor tendons?
medial, radial, and ulnar branches of the hand
Before applying any medication using phonophoresis, the OTR® needs to be aware of the client's current ___.
medication and any medication allergies
baclofen
medication for spasticity (can be used for MS)
natural induction of hull
meditation dreams illness rituals
Hopkins Verbal Learning Test-Revised is a
memory assessment
episodic memory
memory of specific personal events and situations (episodes) tagged with information about time
biofeedback
more control and conscious effort, action and awareness are seperate
Huntington's disease (HD) is a progressive loss of__
motor control.
recall sleep paralysus
motor cortex stops body from moving while brain is active
Compression to the anterior interosseous nerve results in ___ involving FDL, Flexor profundus to index finger & pronator quadratus.
motor loss
Mental rehearsal is most helpful with
motor planning issues.
Akathisia
motor restlessness (HD)
dysarthria
motor speech disorder
Zone II of the flexor tendon system has been called ___ because excessive scarring makes it difficult to get good results from a repair.
no man's land
With a ____ fracture of the humeral neck, support from a sling and supervised exercise lead to the most desirable outcome.
nondisplaced
Chunking, repeating information, and rhymes are effective strategies for clients whose memory loss is __
not progressive in nature.
hallucinations
occu in the absence of an appropriate external stimulus has full force or impact of corresponding actual perception not response to attempts of control by experiencer
According to the Occupational Therapy Practice Framework: Domain and Process, community mobility is an instrumental activity of daily living, not an ____.
occupational performance skill
The child has to be able to ____ and____ the sensory input to respond to the environment.
organize and use
reality monitoring
our abilitty to distinguish our own internally generated thought from external public reality
In the acute phase of Guillain-Barré syndrome, the patient may be experiencing muscle belly tenderness and ___; energy conservation techniques will allow the patient to engage more productively in daily self-care tasks.
overall fatigue
Grade II of Cumulative Trauma Disorder
pain during activity, resolves when activity stopped
Among others ___ ROM and nerve glides are non-oper. tx ideas for Radial Tunnel Syndrome.
pain free
The goal in amputations is a residual limb that is ___ and ____.
pain free and functional
Grade III of Cumulative Trauma Disorder
pain persists after activity, affects work productivity, objective weakness and sensory loss
Allydonia
pain response from stimuli which do not normally provoke pain. Temperature or physical stimuli can provoke allodynia, which may feel like a burning sensation
Define Hyperpathia
pain that continues after stimuli is removed
HD: Occupational therapy evaluation should include functional daily living skills, cognitive abilities such as problem solving, motor performance, strength, __
personal interests, and values.
Pain on either side of the surgical release is called
pillar pain.
Methylprednisolone
prescribed to MS clients for functional skills
Procedural memory
recall of information on how to perform a task, such as knowing how to write or ride a bike; remains intact
Personal episodic memory
recall of time-related information about oneself, such as where and whether one ate breakfast; shows deficits
esp
refers to the ability to perceive stimuli that are outside the 5 sense
Providing structure to unoccupied time is an important consideration for clients with Alzheimer's disease (AD) to prevent behavior problems and maintain quality of life. In addition, structure promotes an increase in goal-directed activity and may aid in __
regular sleep patterns.
Measure the client for resting hand splints to wear at night to prevent contractures while ROM returns to bilateral hand. Which frame of reference does this strategy fall under?
rehabilitative frame of reference because it is a compensatory approach
rummaging
searching
hypnosis
similar loss of contol and consciousness but different controller displacement of self
FIRST intervention used with clients with dementia to maintain independence in daily living tasks
simplify the tasks
Why are interviews and caregiver questionnaires used ?
to gain an understanding of how sensory problems influence participation in daily activities
Why is it important to provide a home program during the intervention of wrist fractures ?
to increase progression of function and outcomes.
In the preprosthetic phase why does the OT facilitate maintenance of or increasing flexibility and strength of residual limb?
to prevent flexion contractures of the knees and hips of the residual limb in clients with lower limb amputations.
Why would you use static splinting in the acute phase of cumulative trauma disorder?
to reduce the inflammation and pain b/c restricting the repetitive movements.
Why would you suggest humeral fracture brace for a patient with Proximal humeral fracture?
to support the fracture ends
Why should you use an ADL checklist during the interview/eval?
to uncover ADL dysfunction and set goals
too liberal
too willing
What should the OT consider when training a client with a myoelectrically controlled prosthesis?
training in alignment of the electrodes to obtain good electrode contact.
What is an Above the knee amputation called?
transfemoral
What is an above the elbow amputation called?
transhumeral
What is a below the elbow amputation called?
transradial
What is a below the knee amputation called?
transtibial
Cubital tunnel syndrome involves the __ nerve.
ulnar
Ulnar claw refers to hand posture with ___ nerve injury.
ulnar
The back can be reclined to ease discomfort associated with hip flexion. Too much of a backward angle makes the chair __
unstable.
Moving the axle __ relative to the seat lowers seat height, which improves stability; if the seat is too low, poor propulsion patterns may result because of abducted arms.
up
Brachial & brachiocephalic arteries supply blood to
upper arm and forearm
hinged drop-foot orthosis
use it for GBS
What is Semmes-Weinstein monofilament testing and what is it used for?
used to test for loss of sensation in eval of CTS.
Distinguishing features of dementia with Lewy bodies are __ and Parkinson-like motor symptoms.
visual hallucinations
Distinguishing features of dementia with Lewy bodies are __
visual hallucinations and Parkinson-like motor symptoms.
Pacing, difficulty choosing appropriate clothing, and __language are all common behavioral symptoms of middle-stage dementia related to loss of impulse control and difficulty communicating needs.
vulgar or rude
What to include in home exercise program for PD client?
walking a prescribed distance (with caregiver assistance and supervision or with assistive device, as needed) or doing simple calisthenics or AROM exercises
pseudo hallucination
when a person knwos the hallucination isnt real LSD
Carpal tunnel syndrome may be caused by a ____ that results in compression of the median nerve as it runs through the carpal tunnel
wrist fracture
What are the components of an antideformity (safe position) burn splint:
wrist, 20º extension; metacarpophalangeal (MCP) joints, 90º flexion; proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints, 0º extension
Do MS clients have spasticity?
yes