NBCOT COTA Exam

Life-Style Performance Model (frame of reference)

- Gail Fidler - Proposes method to look at match b/t environ. and individual's needs - Four hypothesis (p. 269) - Performance and QOL can be enhanced by envir. that provides for 10 fundamental human needs: autonomy, individuality, affiliation, volition, consensual validation, predictability, self-efficacy, adventure, accommodation, reflection - Performance measured in quality of functioning in 4 domains: self-care/maintenance, intrinsic gratification, service to others, reciprocal relationships

Managing lack of initiation/participation

- Identify w/indiv. the reasons for lack of participation - Motivational hints

Latissimus dorsi

- Innervated by the thoracodorsal nerve - Origin: T6-T12, L1-L5, sacral vertebrae, ribs 9-12, iliac crest, and inferior angle of scapula - Insertion: Intertubercular groove of the humerus -Function: Shoulder EXTENSION muscles.

Muscles Innervated by Ulnar Nerve

- Intrinsic: Abductor digiti minimi, opponens digiti minimi, flexor digiti minimi, adductor, lumbricals (ulnar side), palmar interossei, dorsal interossei - Extrinsic: Flexor digitorum profundus

Muscles Innervated by Median Nerve

- Intrinsic: Abductor pollicis brevis, opponens pollicis, flexor pollicis brevis: superficial head, lumbricals (radial side) - Extrinsic: Flexor digitorum superficialis, flexor pollicis longus

Occupational Adaptation (frame of reference)

- Janette Schkade and Sally Schultz - Concerned w/processes that indiv. goes through to adapt to his/her environment - 3 elements: person, envir., interaction b/t the 2 - Two assumptions: (1) occupation provides the means by which humans adapt to changing needs and conditions (2) occupational adaptation is a normative process that is most pronounced in periods of transition

Impact of kidney disease on instrumental activities

- Lighter work load and housekeeping assistance; altered role in the family) -adapted vehicles; access to handicapped transit passes or parking spaces; special planning for long distance travel -training to change usual habits to cook appropriately for dietary limitations; planning to budget and purchase appropriate supplies; safety in cooking -ability to do banking; ability to budget funds; ability to prioritize goals; ability to achieve goals or problem solve solutions.

Complications for psychopharmacology

- Neuroleptic Malignant Syndrome: autonomic emergency leading to increased BP, tachycardia, sweating, convulsions, and coma - Tardive Dyskinesia: abnormal, involuntary, irregular movements of the head, limbs, and trunk; results from long-term or high-dose use of medications - Pseudo-parkinsons

Explain the Age Discrimination in Employment Act.

- Prohibits employment practice that discriminates/unfairly targets workers 40 years and older. - Prohibits mandatory retirement of older workers. Employers CANNOT fix a retirement age.

Volar forearm muscles innervated by the median nerve

- Pronator teres - Pronator quadratus

Managing delusions

- Redirect to reality-based thinking and actions - Avoid discussions and other exper. that focus on and validate or reinforce delusional material

Role of OT in domestic abuse

- Refer to domestic shelters/safe houses - Develop trusting relationship - Provide info. about tx and support programs - Tx for phys/emotional injuries and to develop indep. living skills - Discuss: stress and safety, fear and abuse, family/friends/support network, emergency plan

Medicare - Coverage of Durable Medical Equipment, Prostheses, and Orthoses

- Rental or purchase expenses for durable medical equipment are covered if used in a beneficiary's home and if necessary and reasonable to treat an illness/injury or to improve function - Physician's prescription is needed and must include diagnosis, prognosis, and reason for DME

Durable Medical Equipment (DME) Criteria

- Repeated use can be withstood - Primarily and customarily used for medical purpose (wheelchair/walker) - Generally not useful to a person in the absence of injury/illness *self-help items, bathtub grab bars, and raised toilet seats ARE NOT reimbursable DME because other people can use them and they are not considered medically necessary

Phase 1: inpatient rehabilitation/hospitalization stage (acute)

*Begins when the patient is determined to be medically stable following cardiac or pulmonary event *Typically after 24 hours or until patient is stable for 24 hours

COPD

*Characterized by chronic airflow limitation; results from narrowing or blockage of airways *Progressive lung condition *includes chronic bronchitis and emphysema

Initiating factors that can trigger lymphedema

*Inactivity and changes in cabin pressure during air flight *Fluctuation in weight gain and fluid volumes *Hyperemia *Hypoproteinemia

Managing manic or monopolizing behavior

- Select/design highly structured activ. that hold attn. and require shift of focus from pt to pt - Thank indiv. for participation and redirect attn. to another group member

Managing offensive behavior (physical or verbal)

- Set limits and immediately address the bx - Reasons that bx is not acceptable should be clearly presented in non-confrontational manner - Consequences of continued offensive bx - Req. that staff protects all pts from threat/harm

Dorsal forearm muscles innervated by the radial nerve

- Supinator

Task/Activity Analysis (and methods)

- The breaking down and identification of the component parts of a task/activity. - Determination of the abilities needed to effectively perform and successfully complete the task/activity - Determination if the task/activity has therapeutic value - Methods specify exact task/activity (ex. instead of "dressing" say "donning a shirt" Identify and know the procedures, materials, and tools needed analyze task/activity as it is typically perfomed analyze to be certain that all factors, skills, and demands are considered select a frame of reference

Does a patient have a right to access all of his or her records?

- Yes. It may take 30-60 days for a provider to respond, and you may need to pay a copy fee. - A patient has the right to request something in their record be amended.

main clinical syndromes of CAD

*angina pectoris *myocardial infarction (MI) *heart failure

OT eval for cystic fibrosis

*assess for developmental delays related to decreased strength and endurance and decreased attention due to pain *assess environment for adaptations for energy conservation, equipment needs *assess psychosocial status

pediatric HR

*newborn is 120 bpm (range 70-170 bpm)

Phase I of rehab for lymphatic disease

*short-stretch compression bandages, worn 24 hours/day *manual lymph drainage with complete decongestive therapy *functional activities

Model of Human Occupation (MOHO) (frame of reference)

- Gary Keilhofner - 3 elements inherent to humans: volition, habituation, performance capacity

Agoraphobia

- anxiety about being in places or situations from which escape may be difficult or embarrassing, or in which help may not be available if needed

Right heart failure:

- blood is not adequately returned from the systemic circulation to the heart; d/t failure of right ventricle, increased pulmonary artery pressures with: 1. peripheral edema: weight gain, dependent edema, venous stasis 2. Nausea, anorexia 3. change in heart sounds

Narcissistic Personality Disorder

- characterized by a grandiose sense of self-importance, a preoccupation with fantasies of success or power, and a need for constant attention or admiration

Conduct Disorder

- disregard for the rights of others leading to aggression toward people and animals, destruction of property, deceitfulness, theft, or serious violation of rules

Paranoid Personality Disorder

- persons w/ this disorder are characterized by long-standing suspiciousness and mistrust of people in general - refuse responsibility for their own feelings and assign responsibility for them to others - often appear hostile, irritable, and angry

Major Depressive Episode

- a 2-week period of depressed mood or loss of interest/pleasure - five or more of following symptoms: 1. depressed mood most of day 2. markedly diminished interest or pleasure 3. weight loss/gain, increase/decrease in appetite 4. insomnia/hypersomnia 5. psychomotor retardation/agitation 6. fatigue, loss of energy 7. feelings of worthlessness or guilt 8. diminished ability to concentrate/make decisions 9. recurrent thoughts of death/suicide

Task/Activity Synthesis

- the process of designing an activity for OT evaluation or intervention teaching activity can individual perform activity? adapt/modify grade activity

Specific Phobia

- a clinically significant anxiety from a specific object or situation leading to avoidant behavior

Social Phobia

- a clinically significant anxiety from certain types of social or performance situations leading to avoidance

Manic Episode

- a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week - three or more of the following symtoms persist during this period: inflated self-esteem or grandiosity; decreased need for sleep; more talkative than usual or pressured speech; flight of ideas; distractibility; increase in goal-directed activity or psychomotor agitation; excessive involvement in pleasurable activities that have high potential for painful consequences

Delirium

- a disturbance of consciousness w/ decreased ability to attend - covers a short period of time (hours to days) and tends to fluctuate - many causes: brain dysfunction; medication; endocrine disorders; cardiac disorders; fever; liver fxn disorders

Schizotypal Personality Disorder

- appear odd of strange in their thinking and behavior to those who come in contact with them - magical thinking, peculiar ideas, ideas of reference, illusions, and derealization are part of this individual's everyday world

Brown-Sequard syndrome

- causes disruption of the descending lateral corticospinal tracts, the ascending dorsal columns, and the ascending lateral spinothalamic tracts, which cross within one or two levels of the dorsal root entrance -results in ipsilateral paralysis, ipsilateral loss of position sense, ipsilateral loss of discriminative touch, contralateral loss of pain, and contralateral loss of thermal sense

Histrionic Personality Disorder

- colorful, dramatic, extroverted behavior in excitable, emotional persons - inability to maintain deep, long-lasting attachments

Residual Type Schizo

- continued evidence of schizo type behavior w/o complete set of diagnostic criteria

Substance Abuse

- continued use despite serious consequences

Antisocial Personality Disorder

- continuous antisocial or criminal acts - inability to conform to social norms - no regard for safety or feelings of others and they lack remorse

Amnesic Disorder

- difficulty w/ memory only, but sufficient to cause fxl disability - causes and types = 1. CVA 2. multiple sclerosis 3. Korsakoff's syndrome 4. alcoholic blackouts 5. ECT 6. TBI 7. transient global amnesia

Schizoid Personality Disorder

- discomfort w/ human interaction, their introversion, and their bland, constricted affect are noteworthy - often seen by others as eccentric, isolated, or lonely

Dementia

- disturbances of memory and multiple cog deficits (aphasia; apraxia; agnosia) - often includes personality changes - must lead to functional problems - represents a decline in the person's previous level of fxn - mental confusion due to reversible causes must be ruled out

Undifferentiated Type Schizo

- does not clearly fit into other categories

Obssessive-Compulsive Personality Disorder

- emotional constriction, orderliness, perseverance, stubbornness, and indecisiveness - essential feature is a pervasive pattern of perfectionism and inflexibility

Interview Guidelines

- est. purpose of interview - est. rapport - ask questions in an organized format - observe nonverbal communication - listen before talking - question/requestion as needed - comment in limited manner - answer personal questions in a direct an honest manner - lead and direct interview to achieve previously stated purpose - maintain confidentiality - OTA shares interview results with supervising OTR - supervising OTR develops a plan in collab with OTA

Borderline Personality Disorder

- experience extraordinarily unstable affect, mood, behavior, relationships, and self-image - fear of real or imagined abandonment leads to frantic efforts to avoid it - recurrent self-destructive or self-mutilating behavior may be threatened or carried out - majority of pts have history of trauma

Avoidant Personality Disorder

- extreme sensitivity to rejection, which may lead to socially withdrawn life - not ascocial; inferiority complex

Reactive Attachment Disorder (RAD), Disinhibited Type

- indiscriminate sociability w/ inability to exhibit appropriate selective attachments - demonstrated by excessive familiarity w/ relative strangers or lack of selectivity

Levator scapulae

- innervated by C3-C4 nerves - Origin: C1-C4 transverse processes - Insertion: vertebral border of scapula - Function: Downward rotation muscles. Scapula elevation muscle.

Pectoralis major

- innervated by lateral pectoral nerve - Origin: medial clavicle, sternum, and ribs 1-7 - Insertion: Greater tuberosity - Function: Horizontal shoulder ADDUCTION muscle.

Teres major

- innervated by the sub-scapular nerve. - Origin: Inferior angle of scapula - Insertion: Intertubercular groove of humerus - Function: Shoulder EXTENSION muscle.

Types of Teams (list)

- intradisciplinary - multidisciplinary - interprofessional* - transdisciplinary* * = most common

Disorganized Type Schizo

- marked regression demonstrating primitive, disinhibited, and disorganized behavior

Dependent Personality Disorder

- need others to assume responsibility for major areas in their lives - lack self-confidence

Oppositional Defiant Disorder

- negativistic, hostile, and defiant behaviors that result in fxl impairment

Obsessive-Compulsive Disorder

- obsessions are recurrent and persistent thoughts, images, or impulses that are disturbing, intrusive, and inappropriate - compulsions are repetitive behaviors - time consuming and distressing despite person's awareness

Major Depressive Disorder (Dx Criteria)

- one or more depressive episodes - may be a single episode or recurrent episodes

Bipolar II Disorder (Dx Criteria)

- one or more major depressive episodes - there must be at least one hypomanic episode - there is no history of manic episode

Bipolar I Disorder (Dx Criteria)

- one or more manic episodes - may be combines w/ depressive episodes

Limb-girdle muscular dystrophy

- onset begins between the first and third decades of life -proximal muscles of the pelvis and shoulder are initially affected -typically progresses slowly

PTSD

- persistant re-experiencing (for more than one month) of an extremely traumatic event that produces symptoms of increased arousal

Reactive Attachment Disorder (RAD), Inhibited Type

- persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions - interactions are excessively inhibited, hypervigilant, or highly ambivalent and contradictory in nature

Schizoaffective Disorder

- person has an uninterrupted period of illness during which, at some time, there is a major depressive episode, a manic episode, or a mixed episode concurrent w/ symptoms that meet criterion A for schizo

Delusional Disorder

- predominant symptoms are non-bizarre delusions w/ the absence of other criterion A symptoms of schizo

Paranoid Type Schizophrenia

- preoccupation w/ one or more delusions of persecution of grandeur - auditory hallucinations frequently present - tend to exhibit fewer of the negative symptoms

List the different types of interventions

- prevention - meeting health needs - the change process - management - maintenance

Types of Clinical Reasoning (list)

- procedural/scientific: implement treatment strategies via systematic gathering and interpreting of client data (technical DOING of practice) - interactive: how disability/disease affects person; focuses on the client as a person - narrative: individual's occupational story and focuses on the process of change needed to reach an imagined future - pragmatic: context where the OT's thinking occurs and treatment environment, mental activities are shaped by situation - conditional: ongoing revision of treatment, current and possible future social contexts, integrating interactive, procedural, and pragmatic reasoning in the context of the client's narrative

Panic Disorder

- recurrent panic attacks followed at least once by concern for recurrence

Negative Symptoms (Schizo)

- restricted emotion (affective flattening) - diff in experiencing pleasure (anhedonia) - decreased thought and speech (alogia) - lack of energy (anergia), and initiative - inability to relate to others

Signs and symptoms of elder abuse - neglect

-An elder's report of being mistreated -Dehydration, malnutrition, untreated bedsores, and poor personal hygiene -Unattended or untreated health problems -Hazardous or unsafe living conditions

resting tremor

-An involuntary tremor noted in resting postures

Shoulder dislocation

-Anterior dislocation most common -Etiology: 1) trauma 2) repetitive overuse -Occupational therapy intervention: 1) regain ROM - avoid combined abduction and external rotation with anterior dislocation 2) pain free ADL and role activities 3) strengthen rotator cuff

Motor Development - bilateral integration

-Begins at 9-12 months -as the child experiments with movement, the nervous system is stimulated, and the resulting sensations help the child to coordinate the two sides of the body

Catatonic Type Schizo

- severe disturbances in motor behavior involving stupor, negativism, rigidity, excitement, or posturing

Acute Stress Disorder

- similar to PTSD, however, follows directly after the event

Rotator cuff muscles

- supraspinatus - infraspinatus - teres minor - subscapularis

Secondary Prevention

- the early detection of problems in a population at risk to reduce the duration of a disorder/disease and/or minimize its effects through early detection/diagnosis, early appropriate referral, and early/effective intervention (the screening of infants born prematurely for developmental delays and the immediate implementation of intervention for identified delays)

Schizopreniform Disorder

- the individual meets the criteria for schizo, however, the episode lasts more than one month but less than the 6 months required for dx

Classification of Burns - Deep partial thickness burn

-Deep second degree burn involving the epidermis and deep portion of dermis; hair follicles and sweat glands -Appearance: red, white, and elastic -Sensation may be impaired -Potential to convert to full thickness burn due to infection -Healing time is 21 to 35 days

Risk factors for Kidney Disease

-Diabetes: can contribute to development of nephrotic syndrome -Hypertension (HTN) -Systematic lupus erythematosus: can contribute to development of nephrotic syndrome

Medical treatment of end stage renal disease (ESRD)

-Dialysis required to stay alive: hemodialysis; peritoneal dialysis (inpatient treatment, continuous ambulatory peritoneal dialysis [CAPD]) -Transplantation: cadaver; living related; living unrelated

Etiologies and risk factors for other types of diabetes

-1-2% of all cases of diabetes -Genetic syndromes -Surgery -Drugs (eg. steroids) -Malnutrition -Infections

Amputations

-Etiology: congenital, peripheral vascular disease, trauma, cancer, and infection

Stage 3 cancer

-Extensive evidence of a primary tumor that has spread to other organs in the body -Tumor can be surgically debulked, but some cells may remain behind -Deeper spread of the tumor cells in the lymphatics -Widespread cancer- multiple organs of the body -Mean 5 year survival rate is 20% plus or minus 5%

Wrist flexors innervated by the median nerve

-Flexor carpi radialis (FCR) -Palmaris longus (PL)

Major milestones in cognitive development - Symbolic play

-12-16 months: basic "make believe" play, primarily involving self, eg. eating, sleeping -12-18 months: 1) child can project "make believe" play on objects and others 2) child uses a variety of schemes in imitating familiar activities -18-24 months: 1) child increases the use of non-realistic objects in pretending, eg. substituting a block for a train 2) child has inanimate objects perform familiar activities, eg. a doll washing itself

Gestational diabetes

-2-5% of all pregnancies (40% may go on later to develop Type 2 diabetes in later life) -Usually resolves after pregnancy -Occurs at greater frequency in people in race/ethnicity risk groups -Obesity is another risk factor

Penetration of the bronchioles/bronchi by the bolus when aspiration occurs causes...

-Food enters the lung; true aspiration occurs -Bacteria can cause pneumonia (aspiration pneumonia) -If the person's immune system is functioning well, he/she may not experience pneumonia

Risk factors for scleroderma

-Genetic -Environment

Intervention for asthma:

1. prevention 2. smoking cessation and minimizing exposure to second hand smoke for pregnant women 3. annual flu shot 4. avoidance of stimulants that precipitate asthmatic episode 5. use of short or long acting dilators 6. establishment of a routine exercise program

Frequent complaints of people with GERD

-Heartburn/indigestion -Swallowing problems -Sensation of feeling that something is getting stuck in their "throat" -Chest pressure or pain -Regurgitation after swallowing

Management of autonomic dysreflexia

-Identify the offending stimulus and relieve the underlying issue immediately -Medications, if no impact can be made: immediate emergent (ie. Procardia, Nitroglycerin, Clonidine, Hydralazine); chronic (ie. Prazolin [Minipress], Clonidine [Catapres])

Diagnostic-Specific Considerations for OT (psychotic disorders)

1. requires OT practitioner to communicate simply, clearly, concretely 2. external structure and consistency to organize individual's thinking, environment, and daily activities 3. provision of supports and tools to enable recovery is essential

Facial paralysis causes...

-Incomplete closure of the mouth -Loss of the bolus out of the front of the oral cavity

Weakness of the elevation of the pharynx during swallow causes...

-Incomplete triggering (diminished neural stimulation) of the pharyngeal phase of swallowing

Middle deltoid

-Innervated by the axillary nerve -Origin: acromion -Insertion: deltoid tuberosity -Function: shoulder abduction

Community Mobility Overview**

1.Community mobility ability move around one's community engage desired occupations and pursue meaningful activities. mobility includes ability access public and/or private transportation systems; ie, buses, subways, other nity-based transportation systems. a. Transportation systems specifically developed to the mobility needs of persons meet disabilities are typically called 'paratransit. 3. Community mobility includes walk, and/or bicycle.

operating a Assessment Considerations

1.it distinguish between flexible deformity (Le, where OT practitioner can manually correct position) and fixed abnormal postures and deformities wbere changes occur). 2'The pelvis should first, and then LES, UEs, head and stability equited prior and control allows better distal

Tactile perception becomes more precise allowing for discrimination and localization to further refine fine motor skills.

13-24 months

bartending

2-3

bowling

2-3

Temperature sensation

'Hot' or 'cold' use test tubes or a thermal kit +intact -impaired 0 absent

resting hand splint

(1)Utilized for persons who need to have their wrist, digits, thumb supported in a fx position for prolonged periods -i.e. when developing contractures of long flexors

Functional Aids

(3) (NBQCI WBQC, prongs situated for client may much Walkers. Standard: requires balance with to advance. Hemi-walker: not ability two (3) nopaffae side a person. Rolling cannot it upper impaired Three-wheeled pneumatic brakes, fold-down thosest need and porting ated Functional Mobility Aids (1) Standard: situated regn ambulation. forearms neutral and proximal dosure instead axillary region provide support to have fractured, and poor 1. flaccid 2. and wheelchair Scooters provide to previously provided tions to distances.

architecture barrier

(5) leads there be a foot that extends at least inches (18 inches platform before the door preferred) the side the door to allow for door swing without backing porch lifts and lifts ramps. alternatives Copyright Code Reproduced permission. All (c) is sharp turn in direction of ramp, landing(s) are required for turning 90-degree requires minimum foot landing; 180-degree requires minimum foot landing.

cognitive-perceptual deficits

-Occur as a result of multiple pathologies including CVA, TBI, neoplasms, acquired diseases psychiatric disorders, &/or developmental disabilities

Specific Assessments for Wheelchair

(a) mechanism (e.g., of antitippers). Features (e.g., use lap cushion, pack to personal items and/or medical racing for more athletic individuals). Propulsion (c) of rim projections, motorized, use lower extremities propel). method considerations assessment. e. Devan tar liry (o, from, and school. (1) Allowance changes experienced. (3) Allowance for of adaptive (i.e., computer, augmentative communication device). (4) Facilitation of social acceptance by and participation developmentally ate activities.

MET levels; promotes endurance?

*1.5-2: too low to promote endurance *2-3: too low to promote endurance unless capacity is very low *3-4: can promote endurance if continuous and target HR is reached *4-5: recreational activities must be continuous, lasting longer than 2 minutes *5-10: yes

Types of Child Abuse

-Physical -Emotional or mental -Sexual -Neglect

Phase I of rehab for lymphatic disease-functional activities

*ADL *adaptation of IADL, work, and leisure *energy conservation techniques to minimize swelling *patient and family education for skin care, donning and doffing compression garments, environmental changes to improve mobility and function

Lymphedema

*Chronic disorder with excessive accumulation of fluid due to obstruction of lymphatics *Causes swelling in the tissues in arms and legs

Thromboangiitis obliterans

*Chronic inflammatory vascular occlusive disease *Results in diminished temperature sense, paresthesias, pain, and cold extremities *Poor or absent temperature sense can place a person at serious risk for scalding burns *If water temperature in a person's home is higher than 102 degrees F, an anti-scalding faucet and/or valve must be installed (so it's important for assess water temperature when performing a home evaluation of someone with this condition) *Begins distally and progresses proximally in both LEs and UEs

Phase 1: inpatient rehabilitation/hospitalization stage (acute)-evaluation and intervention

*Initiated at bedside with a monitored, functional assessment of self-care and mobility *Activity program is initiated is person is pain free, exhibits no arrhythmia, and has regular pulse of 100 or less *Beginning activities at MET level 1-2 -Bed mobility, static standing -Transfer from bed to chair/bedside commode -Bed bath, feeding, grooming at sink in sitting -AROM/warm-up exercises -Wheelchair mobility/ambulation in room *energy conservation and work simplification techniques *breathing exercises-abdominal diaphragmatic breathing, pursed lip breathing *monitor vital signs-before, during, after, and 4-5 minutes post activity *monitor exertion scales *as patient's activity tolerance improves, more strenuous, higher MET level activities are added in progression from basic ADL to IADL *observe and adhere to any contraindications/precautions *Educate about heart disease and recovery process, provide emotional support

side effects of TB drugs

*No appetite *Nausea, vomiting, jaundice *Fever *Easy bruising *Blurred vision *Abdominal pain *Tingling in fingers or toes *sun sensitivity (Rifampin)

assessing activity tolerance for cardiopulmonary assessment

*Observation of activities with monitoring of vital signs *Periodic monitoring of exertion -Borg rate of perceived exertion *Metabolic equivalent levels (METs)

Presenting symptoms to look for in OT cardiopulmonary assessment

*Pain/angina (note location, severity, type) *Dyspnea (note severity, position, or times at which discomfort is experienced) *Fatigue/perceived exertion *Palpitations *Dizziness: note time of occurrence and association with postural changes during activity *Edema (note location, measurements, time of day when edema is most prominent, resolution with activity)

Phase 1: inpatient rehabilitation/hospitalization stage (acute)-program focus

*Patient and family education regarding disease process and recovery -Increase knowledge of energy conservation and work simplification principles and techniques -Increase knowledge of metabolic cost of activities *Improve ability to carry out self-care and low level functional activities *Decrease anxiety *Promote risk factor modification *Discharge to home

risk factors for TB

*Person with TB of throat or chest can pass the infection by sneezing or coughing *People who have weakened immune systems *Had TB infection within 2 years at high risk for re-infection *Babies, young children, elderly *Intravenous drug users

Phases of rehab guidelines for lymphatic disease

*Phase I: management: edema secondary to lymphatic dysfunction *Phase II: management (self-management) *Education

primary vs. secondary lymphedema

*Primary lymphedema: congenital condition with abnormal lymph node or lymph vessel formation (hypoplasia or hyperplasia) *Secondary lymphedema: acquired, due to injury of one or more parts of the lymphatic system

Stages of lymphedema

*Stage 1: reversible, limb is soft and pitting, swelling may increase overnight *Stage 2: spontaneously irreversible, swelling with increase in fibrotic issue, risk for infection *Stage 3: lymphostatic elephantiasis, extreme increase in swelling skin changes

possible causes of secondary lymphedema

*Surgery *Tumors, trauma, or infection affecting the lymph nodes *Radiation therapy with fibrosis of tissues *Chronic venous insufficiency *In tropical and subtropical areas, filariasis (nematode warm larvae in the lymphatic system)

CHF

*When the myocardium is weakened and/or damaged to the extent that it cannot pump an adequate amount of blood to meet the demands of the body *Characterized by pulmonary congestion, edema, and low cardiac output

absolute contraindications for inpatient and outpatient cardiac rehab

*acute MI (within 2 days) *unstable angina not previously stabilized by medical therapy *uncontrolled cardiac arrhythmias causing symptoms of hemodynamic compromise *acute PE or pulmonary infarction *acute myocarditis or pericarditis *acute aortic dissection

bronchopulmonary dysplasia-OT eval

*assess for developmental delays/deficits *assess environment

pediatric BP

*at 1 month: 80/45 *at 6 yo: 105-125/60-80

sternal precautions

*avoid reaching backward *Keep your arms close to your sides when doing things like getting out of bed or chair *Stop what you're doing if you feel your sternum pull or ache, and avoid that activity until you check with doctor *no pushing, pulling,or lifting more than 5 pounds *do not put hands behind head when sleeping *avoid one-sided lifting over 10 lb, pulling up (body weight), and other movements that would strain the sternum for 6 to 12 weeks

Phase 2: outpatient rehabilitation/convalescence stage (subacute)

*begins as early as 24 hours after discharge from the hospital *frequency of visits depends on clinical needs of patient

severe bleeding-characteristics

*blood spurting from wound *blood fails to clot even after measures to control bleeding have been taken

angina pectoris

*chest pain caused by the insufficient supply of oxygen to the heart muscle *most commonly felt as pressure or dull ache in chest and left arm, but may be felt anywhere in upper body including neck, jaw, back, arm, and epigastric area

phase 3 of cardiac rehab/OT intervention

*community *physician referral *stress test *continuation of phase 2, less supervision and in community settings

current CPR guidelines

*compressions come first, then focus on airway and breathing (exception is newborn babies) *call 911 immediately *push at least 2 inches deep on chest for adults *push about 100 compressions/minutes *hands-only CPR for untrained lay rescuers *no interruptions

pursed-lip breathing techniques

*controls respiratory rate, decreases rate of breathing, helps remove trapped air from lungs *patient focuses on breathing patterns and maximizing use of the diaphragm when inhaling, rather than accessory muscles around the shoulder girdle. This maximizes oxygen saturation and reduces stress on the CV system during stressful activities.

vital sign considerations/precautions-phase 1 of cardiopulmonary rehab

*decrease in systolic BP greater than 20 *monitor BP for resting diastolic BP at 120, systolic at 200 *O2 sat-below 86% for pulmonary patients, below 90% for cardiac patients

Phase 2: outpatient rehabilitation/convalescence stage (subacute)-program focus

*educate patient on the importance of continued exercise *build up activity tolerance *improve ability to carry out IADL and community tasks *improve ability to perform work activities *support person's efforts in smoking cessation and lifestyle changes as needed

OT intervention for cystic fibrosis

*energy conservation *environmental adaptations *positioning to promote postural drainage *neurodevelopmental treatment to improve endurance and postural stability *facilitation of fine, gross, visual motor, cognitive, and psychosocial development *parent education *teacher education *observe medical precautions

teacher education for cystic fibrosis

*energy conservation techniques *encourage physical activity within reason *use precautions for playground play and participation in other healthful physical activities

Raynaud's phenomenon

*episodic spasm of small arteries and arterioles abnormal vasoconstriction reflex exacerbated by exposure to cold or emotional stress *tips of fingers develop cyanosis, numbness, and tingling

cystic fibrosis-effect on function

*exercise intolerance *poor nutrition due to malabsorption may contribute to developmental delays

bronchopulmonary dysplasia-OT intervention

*facilitate sensori-motor and cognitive development *address psychosocial issues that arise *adapt environment *provide parent education *parent advocacy *observe all medical precautions

shock

*failure of circulatory system to perfuse vital organs *at first, blood is shunted from periphery to compensate -victim may lose consciousness as brain is affected -HR increases, resulting in increased oxygen demand -organs ultimately fail when deprived of oxygen -heart rhythm is affected, ultimately leading to cardiac arrest and death

RDS effect on function

*future intellectual development of premature infant who had RDS and received latest treatments is good *if infant has RDS and incurs severe intracranial hemorrhage, may lead to motor, sensory, cognitive and/or language impairments *premature infants with RDS-effects may include visual defects and hypotonia

bronchopulmonary dysplasia-complications

*greater risk for hypotonia and gross motor delays *feeding problems can lead to poor nutrition *impairments in motor, sensory, speech, and cognitive function *recurrent otitis media canlead to conductive hearing loss

Lifespan and Occupational Therapy Developmental Theorists - Anne Mosey: Six major adaptive skills along with subskills

-Sensory integration of vestibular, proprioceptive, and tactile information for functional use: 1) integration of the tactile subsystems (0-3 months) 2) integration of primitive postural reflexes (3-9 months) 3) maturation of righting and equilibrium reactions (9-12 months) 4) integration of two sides of the body, awareness of body parts and their relationship, and motor plan gross movements (1-2 years) 5) motor plan fine movements (2-3 years) -Cognitive skill: the ability to perceive, represent and organize sensory information to think and problem solve; 1) utilization of inborn behavioral patterns for environmental interactions (0-1 months) 2) interrelation of visual, manual, auditory, and oral responses (1-4 months) 3) early exploration of the environment and interest in outcomes of actions: remembers action responses, believes that own actions cause responses, and has an awareness of the relation of these actions and events (4-9 months) 4) utilization of deliberate actions to achieve a goal: object permanence begins, anticipation of familiar events, imitation, interest in sizes/shapes, and perception of other objects as partially causal (9-12 months) 5) utilization of a trial and error approach to problem solving: tool use, begins to realize that alternate routes can be used, remembers the order of a simple sequence, and realizes that others can cause events to happen (12-18 months) 6) formulation of mental pictures: pretends, early cause and effect, manipulates objects in space, has a clearer understanding that others can manipulate the environment (18 months - 2 years) 7) representation of objects in terms of felt experiences: understands that there are consequences to actions that others cannot read his/her mind, and recognizes that events have causes (2-5 years) 8) representation of objects by name: begins to understand that other people may have differing opinions (6-7 years) 9) comprehension that different labels can be used for the same object, use of formal logic and speculation (11-13 years) -Dyadic interaction skill: the ability to participate in a variety of dyadic relationships; 1) family relationships (8-10 months) 2) playmate relationships (3-5 years) 3) superior/authority relationship interactions (5-7 years) 4) friend relationships (10-14 years) 5) peer-superior relationships (15-17 years) 6) intimate/sharing/committed relationships (18-25 years) 7) caring/unselfish relationships (20-30 years) -Group interaction skill: the ability to engage in a variety of primary groups: 1) parallel group - minimal awareness of or interaction with others (18 months -2 years) 2) project group - limited in duration, cooperation, and sharing (2-4 years) 3) egocentric group - cooperation, competition, longer in duration, build self-esteem (9-12 years) 4) cooperative group - compatible group, members concerned with meeting the needs of fellow members (9-12 years) 5) mature group - differing roles, concerned with completion of task as well as meeting the needs of fellow members (15-18 years) -Self-identity skills: the ability to perceive the self as a relatively autonomous, holistic, and acceptable person who has permanence and continuity over time; 1) self as a valued person (9-12 months) 2) assets and limitations of the self (11-15 years) 3) self as self-directed (20-25 years) 4) self as a productive, contributing member of a society (30-35 years) 5) self identity as an independent individual (35-50 years) 6) understanding the aging process of one's self and eventual death as part of the life cycle (45-60 years) -Sexual identity skill: the ability to feel comfortable about one's sexual nature and to engage in continued sexual relationship that takes into account mutual satisfaction of sexual needs; 1) act on the basis of one's pregenital sexual nature (4-5 years) 2) sexually mature as a positive growth experience (12-16 years) 3) give and receive sexual gratification (18-25 years) 4) sustain sexual relationship with mutual satisfaction of sexual needs (20-30 years) 5) accept sex-related physiological changes that occur as a natural part of the aging process (40-60 years)

types and causes of shock

*hemorrhagic-severe internal or external bleeding *psychogenic-emotional stress causes blood to pool away from the brain *metabolic-loss of body fluids from heat, severe vomiting or diarrhea *anaphylactic-allergic reaction to drugs, food, or insect stings *cardiogenic-MI or cardiac arrest results in pump failure *respiratory-insufficient oxygenation of blood *septic *neurogenic-TBI, SCI, etc.

Elder Abuse - Overview: Facts and figures

-Statistic for elder abuse are difficult to accurately assess due to limited reporting -Nationally, Adult Protective Services (APS) investigated 461,135 reports of elder and vulnerable adult abuse -Nationally, APS substantiated 191,908 reports of elder and vulnerable adult abuse -Definitions vary; however, there are three basic categories: 1) domestic elder abuse 2) institutional elder abuse 3) self-neglect or self-abuse

Phase 2: outpatient rehabilitation/convalescence stage (subacute)-evaluation and intervention

*home evaluation *consumer and family education *graded exercise program with slow and gradual increase of weight *begin with activities at MET level 4-5, gradually increasing as pt's tolerance improves *resumption of sexual activity usually at 5-6 MET level as per physician recommendation *practice of functional activities in d/c environment *use of energy conservation techniques and compensatory techniques in daily tasks *community activities *work site eval if applicable

management of internal bleeding

*if minor, follow RICE procedure: rest, ice, compression, elevation *major internal bleeding -summon advanced medical personnel -monitor A,B,and Cs and vital signs -keep pt comfortable and quiet, reassure them -administer supplemental oxygen if available and nearby

asthma and interventions

*increased reactivity of the trachea and bronchi to various stimuli (allergens, exercise, cold) *manifests by widespread narrowing of airways due to inflammation *interventions: smoking cessation and minimizing exposure to second hand smoke for pregnant women

deep vein thrombosis

*inflammation of a vein in association with the formation of a thrombus; usually occurs in LEs -Associated with venous stasis (bed rest, lack of leg exercise), hyperactivity of blood coagulation, and vascular trauma -Early mobility (out of bed activities) after surgery helps to eliminate venous stasis -May be a contributing factor or a complication of CVA or the result of prolonged bed rest during serious illness *requires immediate medical attention

phase 1 of cardiac rehab

*inpatient *monitoring vitals *progress ADLs and activity according to MET levels *monitoring symptoms of activity intolerance *developing home program-activity guidelines, pacing and simplification, temp precautions, etc.

contraindications/things to avoid-phase 1 of cardiopulmonary rehab

*isometric muscle work *breath holding (Valsalva) *overhead exercises or holding UEs over head for extensive time periods *lateral arm movements and exercises that stretch chest and pull incision

relevant contraindications for inpatient and outpatient cardiac rehab

*left main coronary stenosis *moderate stenotic valvular heart disease *electrolyte abnormalities *severe arterial hypertension *tachyarrhythmias or bradyarrhythmias *hypertrophic cardiomyopathy and other forms of outflow tract obstruction *mental or physical impairment leading to inability to exercise adequately *high-degree atrioventricular block

visual foundation skills

-These skills must be evaluated to differentiate perceptual dysfunction and visual system deficits -Visual acuity: the clarity of vision both near and far -Visual fields: the available vision to the right, left, superior, and inferior (an example of field loss is homonymous hemianospia [the left temporal field and right nasal field are affected]) -Occulomotor function: control of eye movements -Scanning: the ability to systematically observe and locate items in the environment

Classification of Burns - Full thickness burn

-Third degree burn involving the epidermis and dermis; hair follicles, sweat glands, and nerve endings -Appearance: white, waxy, leathery, and non-elastic -Pain free, requires skin graft -Hypertrophic scar -Healing time can take months

Peripheral nerve injuries

-Three major nerves: median, ulnar, and radial -Two types of nerve injuries: 1) compression 2) laceration

Phase I of rehab for lymphatic disease-manual lymph drainage with complete decongestive therapy

*massage and PROM to assist lymphatic flow *emphasis on decongesting proximal segments first (trunk quadrant), then extremities, directing flow distal to proximal *compression using multi-layered padding and short-stretch bandages *certified specialists

risk factors for CAD

*modifiable-cigarette smoking, high BP, elevated cholesterol levels and low-density lipoprotein (LDL) levels, elevated blood homocystine, emotional stress *non-modifiable-age, sex, race, family history of CAD *contributory-diabetes, obesity, sedentary lifestyle, elevated blood homocystine and fibrinogen levels

RDS-OT intervention

*monitor development *facilitate sensori-motor and cognitive development *address psychosocial issues *parent education regarding handling, positioning, energy conservation, and methods to facilitate normal development *adapt environment as needed *observe medical precautions *refer as necessary to ophthalmologist and other relevant services

Sensory system changes and adaptations in the older adult - Clinical implications/compensatory strategies

-Vision: 1) assess for visual deficits - acuity, peripheral vision, light and dark adaptation, depth perception; diplopia, eye fatigue, eye pain 2) maximize visual function - assess for use of glasses, need for environmental adaptations 3) sensory thresholds are increased - allow extra time for visual discrimination and response 4) work in adequate light, increase intensity, reduce glare; avoid abrupt changes in light, eg. light to dark 5) use large, high contrast print for written materials 6) provide magnifying glasses (either portable or attached to a stand/work table) to view objects and complete tasks 7) provide an eye patch for diplopia 8) decreased peripheral vision may limit social interactions; therefore, stand directly in front of the person at eye level when communicating with him/her 9) assist in color discrimination - use warm colors (yellow, orange, red) for identification and color coding 10) provide other sensory cues when vision is limited, eg. verbal descriptions to new environments, touching to communicate you are listening, "talking" clocks and watches 11) provide safety education; reduce fall risk -Hearing: 1) assess for hearing - acuity, speech discrimination/comprehension; tinnitus, dizziness, vertigo, pain 2) assess for use of hearing aids; check for proper functioning 3) minimize auditory distractions, work in quiet environment 4) speak slowly and clearly, directly in front of person at eye level 5) use nonverbal communication to reinforce your message, eg. gesture, demonstration 6) provide written and demonstrated directions/guidelines for activities 7) orient person to topics of conversation he/she cannot hear to reduce paranoia, isolation 8) provide assistive devices to compensate for functional effects of hearing loss and to ensure person's safety, eg. vibrating and flashing smoke alarms, telephones, doorbells, and clocks -Vestibular/balance control: 1) increased incidence of falls in older adults 2) fall prevention -Somatosensory: 1) assess carefully - check for increased thresholds to stimulation, sensory loss by modality, area of body 2) allow extra time for responses with increased thresholds 3) use touch to communicate - maximize physical contact, eg. rubbing, stroking, and tapping 4) provide augmented feedback through appropriate sensory channels, eg. using kitchen utensils with wide textured grips may be easier than narrow smooth handles 5) teach compensatory strategies to prevent injury to anesthetic limbs 6) provide assistive devices and environmental modifications as needed for fall prevention 7) provide feedback devices as appropriate (eg. limb load monitor) -Taste and smell: 1) assess for identification of odors, tastes (sweet, sour, bitter, salty); somatic sensations (temperature, touch) 2) decreased taste, enjoyment of food leads to poor diet and nutrition 3) older adults frequently increase use of taste enhancers, eg. salt or sugar 4) decreased home safety, eg. gas leaks, smoke

spina bifida occulta

-a bony malformation with separation of vertebral arches of one or more vertebrae with no external manifestations; may not be discovered til late childhood

coronary artery disease

*narrowing of coronary arteries causes blood supply to myocardium to be diminished, resulting in ischemia and inadequate oxygenation of heart muscle *caused by atherosclerosis, thrombus, or lodging of an embolus

What is the function of the cardiovascular system?

-delivers oxygen to organs and tissues - Removes carbon dioxide and other by-products from body -Assists in the regulation of core body temperature

care for shock

*obtain history if possible *examine victim for airway, breathing, circulation, and bleeding *assess level of consciousness *determine skin characteristics and perform capillary refill test of fingertips (in healthy individuals, nail will turn pink when pressure is released) *treat any specific condition if possible *keep victim from getting chilled or overheated *elevate legs 12 inches unless there is suspected spinal injury or painful deformities of LEs *administer supplemental oxygen if nearby *do not give any food or drink

phase 2 of cardiac rehab

*outpatient *OT 3 days/per week for 4-8 weeks *exercise and activity, progression of MET levels *weight training at 2-4 weeks if symptoms are controlled *work hardening if indicated

energy conservation and work simplification techniques

*pace oneself *monitor body position during activities *organize daily activities and work areas *delegate responsibilities

signs and symptoms of shock

*pale, gray, or blue, cool skin *increased, weak pulse *increased respiratory rate *decreased BP *nausea or vomiting *irritability or restlessness *diminishing level of consciousness

cauda equina syndrome

-injury at the L1 level and below -results in lower motor neuron lesion -flaccid paralysis with no spinal reflex activity -an areflexic bowel and bladder

simple febrile seizures

-most common type of seizure -precipitated by a fever -lasts less than 10 minutes and it includes a loss of consciousness and involuntary, generalized jerking of a grand mal seizure -usually do not cause damage and thy do not lead to epilepsy

right hemisphere specialization

-movement of left side of body -processing of sensory information from left side of body -visual reception from left field -visual spatial processing -left motor praxis -nonverbal memory -attention to incoming stimuli -emotion -processing of nonverbal auditory information -interpretation of abstract information -interpretation of tonal inflections

phantom limb pain

-pain in a limb following amputation of that limb -differentiated from far more common phantom limb sensation

sensory processing active behavioral response

-the individual avoids or seeks to avoid sensory stimuli

Stage 1 of Parkinson's disease

-unilateral tremor, rigidity, akinesia -minimal or no functional impairment

Phase 3: Maintenance/training stage (community exercise programs)

*patients generally attend maintenance/training sessions once a week following the completion of Phase 2 *groups may be integrated into individual exercise programs *OT intervention provided as necessary for IADL, leisure pursuits, and work *maintenance gym program-weight training to maintain upper and lower body strength, CV training to maintain cardiopulmonary health

bronchopulmonary dysplasia-effect on function

*poor autonomic and sensory state regulation *poor exercise/activity tolerance *reduced ability to socialize *isolation and stress *greater risk for attachment disorder

internal bleeding

*possible result of fall, blunt force trauma, or a fracture rupturing a blood vessel or organ *characteristics -ecchymosis-black and blue in injured area -body part may be swollen, tender, and firm -respiratory rate increase -pulse rate increased and weak -decreased BP -skin may appear blue, gray, or pale and may be cool or moist -patient may be nauseated or vomit -level of consciousness may decline

positioning suggestions for COPD

*pts should be encouraged to assume position that does not lessen their ability to expand the chest wall during breathing. A prone position, especially with a pillow under the chest would create discomfort by limiting expansion of chest wall, making breathing more difficult *supported supine position is better option for individuals who experience orthopnea. Side-lying is also an acceptable option. *common instructional approach for SOB associated with COPD is to assume tripod posture/position when sitting or standing. Pt instructed to lean forward, placing elbows or forearms on flat surface to reduce effort in breathing. In this position, the muscles that assist in breathing, including muscles of chest and neck can be prioritized to assist with breathing and less in holding the body in an upright posture.

OT interventions for COPD

*pursed-lip breathing techniques *stress mgmt-beneficial for the majority of patients with COPD as stress can negatively impact one's cardiovascular status *strengthening activities *use of wedge cushion provides elevation of head at night-cost-effective solution that will help patient sleep better and lessen anxiety.

possible complications of cystic fibrosis

*reduced life expectancy *cardiac symptoms *diabetes, cirrhosis, rectal prolapse

clinical manifestations of right ventricular failure

*signs of pulmonary congestion-dependent edema, weight gain, ascites, hepatomegaly *signs of low cardiac output-anorexia, nausea, bloating, cyanosis, right upper quadrant pain, jaundice

clinical manifestations of left ventricular failure

*signs of pulmonary congestion-dyspnea, dry cough, orthopnea, wheezing *signs of low cardiac output-tachycardia, lightheadedness, dizziness, fatigue weakness, poor exercise tolerance

Education phase of rehab for lymphatic disease

*skin and nail care *self-bandaging, garment care *infection mgmt *maintain exercise while preventing lymph overload *incorporation of home mgmt program into daily routine

Phase II of rehab for lymphatic disease

*skin care *compression bandages *exercise *lymphadema bandaging at night *MLD as needed *compression pumps; use with caution, limited benefits

interventions for COPD

*smoking cessation *oxygen therapy to reduce level of dyspnea

tachycardia vs. bradycardia

*tachy-greater than 100 bpm *brady-less than 60 bpm

parent education for cystic fibrosis

*treatment protocols for OT interventions *advocacy skills to obtain necessary services and equipment *advocacy skills to obtain respite services

clinical signs/symptoms or diagnoses for which therapy should be stopped or is contraindicated

*uncontrolled atrial/ventricular arrhythmias *recent embolism/thrombophlebitis *dissecting aneurysm *severe aortic stenosis *acute systemic illness *acute MI *digoxin toxicity *acute hypoglycemia or metabolic disorder *third degree heart block *unstable angina

first aid for controlling external bleeding

*use standard precautions such as wearing gloves *apply gauze pads using firm pressure. if no gauze available, use clean cloth, towel, gloved hand, or patient's hand *elevate the part if possible unless it is deformed or causes significant pain *apply a pressure bandage, such as roller gauze, over the gauze pads *if necessary, apply pressure with the heel of your hand over pressure points *monitor status of pt

Whirlpool application

*used to clean and debride wounds* 1. Fill tank with water at 100-108 degrees if treating burns temp should be body temp 2. Maintain sterile technique 3. Adjust turbine and turn it on- check the temp again 4. Slowly lower the extremity into the whirlpool treat for 20 minutes

Narcissistic mechanisms

1. Denial: failure to ack. the existence of some aspect of reality that is apparent to others 2. Projection: seeing your own unacceptable desires in other people 3. Splitting: rigid separating of positive and negative thoughts and/or feelings (all black and white, no in between (all people good or bad))

Patient Protection and Affordable Care Act

- 10 separate legislative titles that sought to improve the accessibility, fairness, quality, efficiency, accountability, and affordability of health insurance coverage in the U.S. Title I Quality, affordable health care for all Americans Title II The role of public programs Title III Improving the quality and efficiency of healthcare Title IV Preventing chronic disease and improving public health Title V Health care workforce Title VI Transparency and program integrity Title VII Improving access to innovative medical therapies Title VIII Community living assistance services and supports Title IX Revenue Provisions Title X Reauthorization of the Indian Health Care Improvement Act

Etiologies and risk factors for Type 1 diabetes (insulin dependent)

- 5-10% of all diagnosed cases of diabetes -Autoimmune -Genetic -Environmental factors

Congestive heart failure (CHF)

- A condition in which the heart is unable to maintain adequate circulation of the blood to meet the metabolic needs of the body - May be caused by coronary artery disease valvular disease, congenital heart disease, hypertension, infections

What is the Family and Educational Rights and Privacy Act (FERPA)?

- A federal law that applies to all educational agencies and institutions (e.g., schools) that receive funding under any program administered by the Department. - Once a student reaches 18 years of age or attends a postsecondary institution, he or she becomes an "eligible student," has rights under FERPA. 1. Right to have access to education records 2. Right to seek to have the records amended 3. Right to have control over the disclosure of personally identifiable information from the records 4. Right to file a complaint

What is the Health Insurance and Portability Accountability Act (HIPAA)?

- A federal law that sets standards and safeguards to assure the individual's rights to continuity in health care coverage and to ensure privacy and security of health care records. - All persons must be informed of the setting's privacy policies - All providers must protect patient confidentiality in all forms (oral, written, electronic) and implement appropriate safeguards to ensure privacy. - HIPAA does not exclude treatment from happening in group settings or open clinics. - HIPAA does not require 100% guarantee of confidentiality, but rather reasonable and vigilant safeguards.

What is the No Child Left Behind Act (NCLB)?

- A general education law that emphasizes stands-based education. - Considers OTs to be pupils services personnel and sets no requirements for OT services. - Requires schools to provide accommodations if needed for mandated tests (OT can recommend testing alternatives/classroom accommodations).

Rett's Syndrome

- A genetic disorder that affects girls, is also characterized by autistic behaviors, intellectual disability and regression of communicative abilities in early childhood

Areas of Occupation (list)

- ADL - IADL - Work - Education - Play/Leisure - Social participation - Rest/Sleep

Cognitive Disabilities Model intervention

- Activities used to elicit indiv.'s highest cog. level - Therapy focus to maintain highest level of func. - Compensation through environ. changes and activ. adaptation - OT meets w/family or caregivers to develop understanding of indiv.'s abil./deficits/care needs - OT and team develop approp. d/c plan

Managing akathisia

- Allow person to move around PRN - When possible, select GM activ. over FM or sedentary ones

Discuss the Freedom to Work Act.

- Amended the Social Security Act to enable Americans receiving retirement SS benefits (currently 65 yo) to be able to work without affecting their SS income. - NO income restrictions.

Role Acquisition (frame of reference)

- Ann Mosey - Interv. focused on acquis. of specific skills an indiv. needs to function in his/her environ. - Perf. addressed through func/dysfunc in 7 categories: task skills, interpersonal skills, family interaction, ADL, school, work, play/leisure/rec. - Principles of learning used to promote skill devel.

What is the Omnibus Budget Reconciliation Act (OBRA) of 1990?

- Applied to all nursing homes that receive federal money for Medicare/Medicaid patients. - Emphasized attending to resident rights, autonomy, and self determination; providing quality of care; enhancing quality of life. - Mandated the Minimal Data Set (MDS) administered upon admission and annually. RNs complete, OTs can contribute. - Must consider psychosocial wellbeing and activity pursuit patterns along with physical and cognitive abilities. - Enhancing QoL through restraint reduction and restraint-free environments - Aims to guarantee that residents have the right to choose how they want to receive care/live their lives.

Managing escalating behavior

- Avoid what can be perceived as challenging bx (eye contact, standing directly in front of person) - Maintain comfortable distance, actively listen, calm tone, speak simply and clearly, do not judge indiv. thoughts/feelings/bx, clearly present what you would like person to do, avoid pt/you feeling trapped

rood cone

- Based on Rood's *inhibitory principles* of sustained deep pressure -splint is utilized to *reduce flexor spasticity in hand*

Elbow - Muscles Innervated by Musculocutaneous Nerve

- Biceps (flexion) - Brachialis (flexion)

Elbow - Muscles innervated by the radial nerve

- Brachioradialis (flexion) - Triceps (extension) - Anconeus (extension)

Psychoeducational group

- Classroom format and principles of learning to provide info. to members and to teach skills - Teacher/student relationship exists - Homework encouraged

Cognitive Disabilities Model principles

- Claudia Allen - Cog. abil. is determined by biological factors and the potential to improve dictated by those factors - *Once max. level achieved, compensations must be made* (bio/psychologically and environmentally)

balanced forearm orthoses

- Consists of arm trough, proximal and distal arms and support bracket - Allows pt w/weak proximal muscles to utilize avail. ctrl of trunk/shoulder to engage in func. tasks

What is the Child Abuse Prevention and Treatment Act?

- Defines child abuse and neglect as mental or physical injury, negligent treatment, maltreatment, or sexual abuse of a child less than 18 years of age by a person responsible for their welfare. - Mandates professionals to report abuse and neglect to law enforcement (OT INCLUDED).

What is the Reauthorization and Amendment of Individuals with Disabilities Education Act?

- Emphasizes that the purpose of the IEP is to address the child's unique needs as related to his/her disability and decide how these needs can be served so the child has full access to the general ed curriculum. - Clarified that the IEP can include consideration of AT and behavioral interventions, strategies, and supports. - IEP planning team is open to related personnel at the request of the parent or school, in addition to the regular ed teacher. - States that the education the student receives should prepare him/her for independent living and employment. *Transition planning begins at age 14, Transition services begin at age 16 - Mandates an Individual Family Service Plan (IFSP) for children 0-2 years of age. OT identified as primary early intervention service.

Managing hallucinations

- Environ. free of distractions that trigger hallucinatory thoughts/interfere with reality-based activ. - Highly structured, simple activ. that hold attn. - Attempt to redirect to reality-based thinking

Muscles Innervated by the Radial Nerve

- Extrinsic: Extensor digitorum communis, extensor digiti minimi, extensor indicis proprius, extensor pollicis longus, extensor pollicis brevis, adductor pollicis longus

Managing effects of Alzheimer's disease

- Eye contact to show interest - Positive and friendly facial expressions and tone of voice during all communications - Do not speak about indiv. as if he/she not there - Routine that uses familiar/enjoyable activ. - Note effects of time of day on bx and activ. perf. - Attend to safety issues at all times

Objective Assessment Class C

Objective evidence of moderately severe cardiovascular disease. Marked limitation in activity due to symptoms, even during less-than-ordinary activity. Comfortable only at rest

Pronator teres

VOLAR forearm muscles innervated by the MEDIAN nerve. Origin: Medial epicondyle and coronoid process of ulna Insertion: Lateral surface of radius Function: forearm pronation

OT evaluation for bronchopulmonary Dysplasia:

a. Assess for developmental delays/deficits b. Assess the environment to determine adaptations related to energy conservation, positioning, and enhanced occupational performance

Phase 2: Outpatient Rehabilitation/Convalescence stage Program focus-

a. Educate patient on the importance of continued exercise b. Build up activity tolerance c. Improve ability to carry out IADL and community tasks d. Improve ability to perform work activities e. Support person's efforts in smoking cessation and lifestyle changes as needed

Occupational Therapy intervention for Cystic fibrosis:

a. Energy conservation b. environmental adaptations to enhance performance c. Positioning to promote postural drainage d. Neurodevelopmental treatment to improve endurance and postural stability e. Facilitation of fine, gross, visual motor, cognitive, and psychosocial development f. Parent education (1) Treatment protocols for the above interventions (2) Advocacy skills to obtain necessary services and equipment for the child (3) Advocacy skills to obtain respite services g. Observation of medical precautions during OT sessions (i.e., respiratory/cardiac contraindications)

OT intervention for bronchopulmonary dysplasia:

a. Facilitate sensori-motor and cognitive development b. Address psychosocial issues that arise c. Adapt environment d. Provide parent education regarding handling, positioning, feeding, energy conservation and appropriate environmental adaptations e. Parent advocacy related to acquiring necessary services and equipment

Classification of heart disease: Class I-

a. Heart disease; no limits to activity; no complaints b. Max MET

Classification of heart disease: Class IV-

a. Inability to carry out physical activity without discomfort; see symptoms of cardiac insufficiency present at rest; increased discomfort with any activity b. Max MET 1.5

One Stop Centers

allow for universal access for persons with disabilities a core principle of WIA

RDS-OT eval

assess for developmental delays, environment

aphasia

intervention strategies for _____ - decrease external auditory stimuli - give the individual increased response time - use visual cues and gestures - use concise sentences - investigate the use of augmentative communication devices

venous bleed

low pressure, steady flow, dark red or maroon

The Role of the Team

payer their respective case man- to approve and/or provide funding for the lividual's needed environmental modifica. dors: provide items requested therapists and required the individual to function Environmental

Major milestones in cognitive development - Problem-solving skills

-6-9 months: 1) child finds object after watching it disappear, eg. toy covered by cloth 2) child uses movement as a means to an end, eg. rolling to secure joy 3) child anticipates movement of objects in space, eg. looking toward trajectory of object circling his/her head 4) child attends to consequences of actions, eg. banging toy and realizing it makes noise 5) child repeats actions to repeat consequences, eg. banging toy to hear noise -9-12 months: 1) child is able to use a tool after demonstration, eg. using a stick to secure a toy that is out of reach 2) child's behavior becomes more goal directed 3) child performs an action to produce a response -12-15 months: 1) child recruits the help of an adult to achieve a goal 2) child attempts to activate a simple mechanism 3) child turns and inspects objects 4) child uses a trial and error approach to new challenges -18-21 months: 1) child attends to shapes of things and uses them appropriately 2) child begins to think before acting 3) child uses tool to obtain a favored object 4) child begins to replace trial and error with a thought process in order to attain a goal 5) child can operate a mechanical toy, eg. an on-off switch 6) child can predict effects or presume causes -21-24 months: 1) child recognizes operations of several mechanisms 2) child matches circles, squares, triangles, and manipulates objects into small openings, eg. shape sorters -24-27 months: child discriminates sizes -24-30 months: child can build with blocks horizontally and vertically -27-30 months: 1) child begins to relate experiences to one another, based on logic and knowledge of previous experiences 2) child can make a mental plan of actions without acting it out 3) child can see relationships between experiences, eg. if the balloon is popped, it will make a loud noise -36-38 months: 1) child can build a tower of nine cubes, demonstrating balance and coordination 2) child can organize objects by size, and builds a structure from a mental image -48-60 months: 1) child can build involved structures combining various planes, along with symmetrical designs 2) child is able to utilize spatial awareness, cause-and-effect, and mental images in problem solving

Etiologies and risk factors for Type 2 diabetes (non-insulin dependent)

-90-95% of all diabetes -Older age -Obesity -Family history - Prior history of gestational diabetes -Impaired glucose tolerance -Physical inactivity -Race/ethnicity: African-Americans, Hispanic/Latino Americans, American Indians, Asian-Americans (non-Japanese), Pacific Islanders

Child Abuse - Facts and Figures

-906,000 children were maltreated nationwide, 11.8 per 1000 in 2003 -The highest rate of abuse is among the population age 0-3, 16.1 per 1000 -Neglect was involved in 61% of the cases -Physical abuse was involved in 19% of the cases -Sexual abuse was involved in 10% of the cases -The remaining cases involved other forms of abuse, (ie. psychological maltreatment, medical mistreatment) -1,490 children died as a result of maltreatment, 2.03 per 100,000 in 2004; an average of 4 children per day -Approximately 1/3 of those deaths were from neglect -45% of those deaths were children under the age of 1 -Females make up 57.8% of abusers and more likely to be involved in neglect or physical abuse -Males make up 42.2% of abusers and are more likely to be involved in sexual abuse -In 2004, 78.9% of the cases involved abuse by one or both of the parents

athetosis

-A dyskinetic condition that includes inadequate timing, force, and accuracy of movements in the trunk/limbs; movements are writhing and worm-like

Peripheral nerve injuries - Carpal Tunnel Syndrome (CTS)

-A median nerve compression -Etiology: repetition, awkward postures, vibration, anatomical anomalies, and pregnancy -Symptoms: 1) numbness and tingling of the thumb, index, middle, and radial half of the ring fingers 2) paresthesias usually occur at night 3) person will complain of dropping things 4) positive Tinel's sign at wrist. Positive Phalen's sign 5) advanced stage of CTS can result in muscle atrophy of the thenar eminence -Conservative treatment: 1) wrist splint in neutral; should be worn at night and during the day if performing repetitive activity 2) median nerve glides 3) activity modification; avoid activities with extreme positions of wrist flexion, wrist flexion with repetitive finger flexion, and wrist flexion with a static grip 4) ergonomics - appropriate workstation design, CTS is the most common work related injury of the upper extremity -Post-operative treatment of CTR: 1) edema control - elevation, retrograde massage, compression glove and/or contrast bath 2) AROM 3) nerve and tendon gliding exercises 4) sensory reeducation 5) strengthening of thenar muscles 6) work/activity modification

Peripheral nerve injuries - Pronator teres syndrome (proximal volar forearm)

-A median nerve compression between two heads of pronator teres -Etiology: repetitive pronation and supination and excessive pressure on volar forearm -Symptoms: same as CTS and also aching pain in proximal forearm - 1) positive Tinel's sign at the forearm 2) not night symptoms -Conservative treatment: 1) elbow splint at 90 degrees with forearm in neutral 2) avoid activities that include repetitive forearm pronation and supination -Post-operative treatment: 1) AROM 2) nerve gliding 3) strengthening ( 2 weeks post-operative) 4) sensory reeducation 5) work/activity modification

Peripheral nerve injuries - Radial nerve palsy

-A radial nerve compression -Etiology: Saturday night palsy, a term used to describe sleeping in a position that places stress on the radial nerve. Also, compression as a result of humeral shaft fracture -Symptoms: weakness or paralysis of extensors to the wrist, MCPs, and thumb; wrist drop -Conservative treatment: 1) dynamic extension splint 2) work/activity modification 3) strengthening wrist and finger extensors when motor functions returns -Post-operative treatment: 1) ROM 2) nerve gliding 3) strengthening (6-8 weeks post-operative) 4) ADL and meaningful role activities

ASIA impairment scale

-A= complete, no sensory or motor function is preserved in the sacral segments S4-S5 -B = incomplete, sensory but no motor function is preserved below the neurolgical level and extends through the sacral segments -C = incomplete, motor function is preserved below the neurological level, and the majority of key muscle groups below the neurological level have a muscle grade less than 3/5 -D = incomplete, motor function is preserved below the neurological level, and the majority of key muscle groups below the level have a muscle grade greater than or equal to 3/5 -E = normal, sensory and motor function are normal

Impact of kidney disease on leisure/sports activities

-Ability to participate -Ability to pace self/self regulate -Choice of activities that allow participation with minimum risk -Awareness of precautions for participation -Access to sports facilities that have adaptive possibilities or sources for adaptations

Early mobilization programs for flexor tendons - Kleinert

-Active extension of digit with passive flexion using rubber traction -Protocol: 1) 0-4 weeks - dorsal block splint. Passive flexion and active extension within limits of splint 2) 4-6 weeks - wristlet. Place/hold exercises. Scar management 3) 6-8 weeks - AROM. Tendon gliding and differential tendon gliding. Light ADL and role activities. D/C splint 4) 8-12 weeks - strengthening and work and leisure activities

Rehabilitation to treat meningitis from Lyme disease

-Acute care: positioning, splinting, supportive care while hospitalized -Rehabilitation if there is recovery related sequelae Address present dysfunctional performance skills Neuro, motor, sensory, cognitive, functional (ADL/IADL)

Four stages of HIV infection

-Acute infection: flu-like response to initial contact with the virus -Asymptomatic disease: HIV replicates and affects the immune system, but no visible signs other than blood abnormalities are detectable -Symptomatic HIV: signs and symptoms appear -Advanced disease or AIDS: severely compromised immunity (CD4+ level drops to below 1000/mm3

Types of pain

-Acute pain has a recent onset and usually lasts for a short duration -Chronic pain is of a long duration and can lead to depression -Myofascial pain is specific to muscles, tendons, or fascia: 1) myofascial pain syndrome (MPS) - persistent, deep aching pains in muscle, nonarticular in origin; characterized by well-defined, highly sensitive tender spots (trigger points) -Fibromyalgia syndrome (FMS) is a musculoskeletal pain and fatigue disorder that can vary in intensity: 1) widespread pain accompanied by tenderness of muscles and adjacent soft tissues 2) nonarticular rheumatic disease of unknown origin -Low back pain: 1) most common work related injury 2) location - lumbar lordosis 3) etiology - a) poor posture = seated and standing b) repetitive bending using poor body mechanics c) heavy lifting d) sleeping with poor posture 4) symptoms - a) pain b) difficulty with self care activities and other role activities (especially lower extremity activities) c) difficulty sleeping

Sensory system changes and adaptations in the older adult - Somatosensory

-Additional loss of sensation with pathology: 1) diabetes, peripheral neuropathy 2) CVA, central sensory losses 3) peripheral vascular disease, peripheral ischemia

Development of self-dressing skills

-Age 1 year: cooperates with dressing (holds out arms and feet); pulls off shoes, removes socks; pushes arms through sleeves and legs through pants -Age 2 years: removes unfastened coat; removes shoes if laces are untied; helps pull down pants; finds armholes in pullover shirt -Age 2 1/2 years: removes pull-down pants with elastic waist; assists in pulling on socks; puts on front-button coat or shirt; unbuttons large buttons -Age 3 years: puts on pullover shirt with minimal assistance; puts on shoes without fasteners (may be on wrong foot); puts on socks (may be with heel on top); independently pulls down pants; zips and unzips jacket once on track; needs assistance to remove pullover shirt; buttons large front buttons -Age 3 1/2 years: finds front of clothing; snaps or hooks front fastener; unzips front zipper on jacket, separating zipper; puts on mittens; buttons series of three or four buttons; unbuckles shoe or belt; dresses with supervision (needs help with front and back) -Age 4 years: removes pullover garment independently; buckles shoes or belt; zips jacket zipper; puts on socks correctly; puts on shoes with assistance in tying laces; laces shoes; consistently identifies the front and back of garment -Age 4 1/2 years: puts belts in loops -Age 5 years: ties and unties knots; dresses unsupervised -Age 6 years: closes back zipper; ties bows; buttons back buttons; snaps back snaps

Typical developmental sequence of toileting

-Age 1 year: indicates discomfort when we or soiled; has regular bowel movements -Age 1 1/2 years: sits on toilet when placed there and supervised (short time) -Age 2 years: urinates regularly -Age 2 1/2 years: achieves regulated toileting with occasional day time accidents; rarely has bowel accidents; tells someone that he or she needs to go to the bathroom; may need reminders to go to the bathroom; may need to help with getting on the toilet -Age 3 year: goes to bathroom independently; seats him/herself on the toilet; may need help with wiping; may need help with fasteners or difficult clothing -Age 4-5 years: is independent in toileting (eg. tearing toilet paper, flushing, washing hands, managing clothing)

Developmental sequence for household management tasks

-Age 13 months: imitates housework -Age 2 years: picks up and puts toys away with parental reminders; copies parents' domestic activities -Age 3 years: carries things without dropping them; dusts with help; dries dishes with help; gardens with help; puts toys away with reminders; wipes up spills -Age 4 years: fixes dry cereal and snacks; helps with sorting laundry -Age 5 years: puts toys away neatly; makes a sandwich; takes out trash; makes bed; puts dirty clothes in hamper; answers telephone correctly -Age 6 years: does simple errands; does household chores without redoing; cleans sink; washes dishes with help; crosses street safely -Age 7-9 years: begins to cook simple meals; puts clean clothes away; hangs up clothes; manages small amounts of money; uses telephone correctly -Ages 10-12 years: cooks simple meals with supervision; does simple repairs with appropriate tools; begins doing laundry; sets table; washes dishes; cares for pets with reminders -Age 13-14 years: does laundry; cooks meals

Normal sensorimotor development mobility and stability - Prone position

-Age: 0-2 months - Gross motor skill: 1) turns head side to side 2) lifts head momentarily 3) bends hips with bottom in air 4) lifts head and sustains in midline 5) rotates head freely when up 6) able to bear weight on forearms 7) able to tuck chin and gaze at hands in forearm prop 8) attempts to shift weight on forearms, resulting in shoulder collapse -Age: 5-6 months - Gross motor skill: 1) shifts weight on forearms and reaches forward 2) bears weight and shifts weight on extended arms 3) legs are closer together and thighs roll inward toward natural alignment 4) hips are flat on surface 5) equilibrium reactions are present -Age: 5-8 months - Gross motor skills: airplane posturing in prone position; chest and thighs lift off surface -Age: 7-8 months - Gross motor skills: 1) pivots in prone position 2) moves to prone position to sit -Age: 9 months - Gross motor skill: begins to dislike prone position

Normal sensorimotor development mobility and stability - Supine position

-Age: 0-3 months - Gross motor skill: 1) head held to one side 2) able to turn head side to side -Age: 3-4 months - Gross motor skill: 1) holds head in midline 2) chin is tucked and neck lengthens in back 3) legs come together 4) lower back flattens against the floor -Age: 4-5 months - Gross motor skill: 1) head lag is gone when pulled to a sitting position 2) hands are together in space -Age: 5-6 months - Gross motor skill: 1) lifts head independently 2) brings feet to mouth 3) brings hands to feet 4) able to reach for toy with one or both hands 5) hands are predominantly open -Age: 7-8 months - Gross motor skill: equilibrium reactions are present

Normal sensorimotor development mobility and stability - Standing

-Age: 0-3 months - Gross motor skill: when held in standing position, takes some weight on legs -Age: 2-3 months - Gross motor skill: when held in standing position, legs may give way -Age: 3-4 months - Gross motor skill: 1) bears some weight on legs, but must be held proximally 2) head is up in midline, no chin tuck 3) pelvis and hips are behind shoulders 4) legs are apart and turned outward -Age: 5-10 months - Gross motor skill: stands while holding onto furniture -Age: 5-6 months - Gross motor skill: 1) increased capability to bear weight 2) decreased support needed; may be held by arms or hands 3) legs are still spread apart and turned outward 4) bounces in standing position -Age: 6-12 months - Gross motor skill: pull to standing position at furniture -Age: 8-9 months - Gross motor skill: 1) rotates the trunk over the lower extremities 2) lower extremities are more active in pulling to standing position 3) pulls to a standing position by kneeling, then half-kneeling -Age: 9-13 months - Gross motor skill: 1) pulls to standing position with legs only, no longer needs arms 2) stand alone momentarily -Age: 12 months - Gross motor skill: equilibrium reactions are present in standing

Normal sensorimotor development mobility and stability - Sitting

-Age: 0-3 months(held in sitting) - Gross motor skill: 1) head bobs in sitting 2) back is rounded 3) hips are apart, turned out, and bent 4) head is steady 5) chin tucks; able to gaze at floor 6) sits with less support 7) hips are bent and shoulders are in front of hips -Age: 5-6 months (supports self in sitting) - Gross motor skill: 1) sits alone momentarily 2) increased extension in back 3) sits by propping forward on arms 4) wide base, legs are bent 5) periodic use of "high guard" position 6) protective responses present when falling to the front -Age: 5-10 months (sits alone) - Gross motor skill: 1) sits alone steadily, initially with wide base of support 2) able to play with toys in sitting position -Age: 6-11 months - Gross motor skill: gets to sitting position from prone position -Age: 7-8 months - Gross motor skill: 1) equilibrium reactions are present 2) able to rotate upper body while lower body remains stationary 3) protective responses are present when falling to the side -Age: 8-10 months - Gross motor skill: 1) sits will without support 2) legs are closer; full upright position, knees straight 3) increased variety of sitting positions, including "w" sit and side sit 4) difficult fine motor tasks may prompt return to wide base of support -Age: 9-18 months - Gross motor skill: rises from supine position by first rolling over to stomach then pushing up into four-point position -Age: 10-12 months - Gross motor skill: 1) protective extension backwards, first with bent elbows then straight elbows 2) able to move in and out of sitting position into other position -Age: 11-12 months - Gross motor skill: 1) trunk control and equilibrium responses are fully developed in sitting position 2) further increase in variety of positions possible -Age: 11-24 months + - Gross motor skill: rises from supine by first rolling to side then pushing up into sitting position

Normal sensorimotor development mobility and stability - Release

-Age: 0-4 months - Gross motor skill: no release; grasp reflex is strong -Age: 1-4 months - Gross motor skill: involuntary release -Age: 4 months - Gross motor skill: mutual fingering in midline -Age: 4-8 months - Gross motor skill: transfer objects from hand to hand -Age: 5-6 months - Gross motor skill: two-stage transfer; taking hand grasps before releasing hand lets go -Age: 6-7 months - Gross motor skill: one-stage transfer; taking hand and releasing hand perform actions simultaneously -Age: 7-9 months - Gross motor skill: volitional release -Age: 7-10 months - Gross motor skill: presses down on surface to release -Age: 8 months - Gross motor skill: releases above a surface with wrist flexion -Age: 9-10 months - Gross motor skill: releases into a container with wrist straight -Age: 10-14 months - Gross motor skill: clumsy release into small container; hand rests on edge of container -Age: 12-15 months - Gross motor skill: precise, controlled release into small container with wrist extended

Development of stair climbing skills

-Age: 15 months - Skill: creeps up stairs -Age: 18-24 months - Skill: 1) walks up stairs while holding on 2) walks down stairs while holding on -Age: 18-23 months - Skill: creeps backwards down stairs -Age: 2-2 1/2 + years - Skill: 1) walks up stairs without support, marking time 2) walks down stairs without support, marking time -Age: 2-2 1/2 - 3 years - Skill: walks up stairs, alternating feet -Age: 3-3 1/2 years - Skill: walk down stairs, alternating feet

Development of jumping/hopping skills

-Age: 2 years - Skill: jumps down from step -Age: 2 1/2 + years - Skill: hops on one foot, few steps -Age: 3 years - Skill: jumps off floor with both feet -Age: 3-5 years - Skill: jumps over objects -Age: 3 1/2 - 5 years - Skill: hops on one foot -Age: 3-4 years - Skill: gallops, leading with one foot and transferring weight smoothly and evenly -Age: 5 years - Skill: hops in straight line -Age: 5-6 years - Skill: skips on alternating feet, maintaining balance

Normal sensorimotor development mobility and stability - Rolling

-Age: 3-4 months - Gross motor skill: 1) rolls from prone position to side accidentally because of poor control of weight shift 2) rolls from supine position to side -Age: 5-6 months - Gross motor skill: 1) rolls from prone to supine position 2) rolls from supine position to side with right and left leg performing independent movements 3) rolls from supine to prone position with right and left leg performing independent movements -Age: 6-14 months - Gross motor skill: rolls segmentally with roll initiated by the head, shoulder, or hips

Normal sensorimotor development mobility and stability - Creeping

-Age: 7 months - Gross motor skill: crawls forward on belly -Age: 7-10 months - Gross motor skill: reciprocal creep -Age: 10-11 months - Gross motor skill: creeps on hands and feet -Age: 11-12 months - Gross motor skill: creeps well

Normal sensorimotor development mobility and stability - Walking

-Age: 8 months - Gross motor skill: cruises sideways -Age: 8-18 months - Gross motor skill: walks with tow hands held -Age: 9-10 months - Gross motor skill: cruises around furniture, turning slightly in intended direction -Age: 9-17 months - Gross motor skill: takes independent steps, falls easily -Age: 10-14 months - Gross motor skill: walking: stoops and recovers in play -Age: 11 months - Gross motor skill: 1) walks with one hand held 2) reaches for furniture out of reach when cruising 3) cruises in either direction, no hesitation -Age: 15 months - Gross motor skill: able to start and stop in walking -Age: 18 months - Gross motor skill: 1) seldom falls 2) runs stiffly with eyes on ground

Sensory system changes and adaptations in the older adult - Vision

-Aging changes include: 1) presbyopia - visual loss in middle and older ages characterized by inability to focus properly and blurred images, due to loss of accommodation, elasticity of lens 2) decreased ability to adapt to dark and light 3) increased sensitivity to light and glare 4) loss of color discrimination, especially for blues and greens 5) decreased pupillary responses, size of resting pupil increases 6) decreased sensitivity of corneal reflex - less sensitivity to eye injury or infection 7) oculomotor responses diminished - restricted upward gaze, reduced pursuit eye movements; ptosis may develop -Additional vision loss with pathology: 1) cataracts - opacity, clouding of lens due to changes in lens proteins - results in gradual loss of vision, central first then peripheral; increased problems with glare; general darkening of vision; loss of acuity, distortion (surgery is an effective treatment) 2) glaucoma - increased intraocular pressure, with degeneration of optic disc, atrophy of optic nerve; results in early loss of peripheral vision (tunnel vision) (if untreated, it can progress to total blindness; if diagnosis is made early, surgery and/or medication are effective treatments) 3) macular degeneration - loss of central vision associated with age-related degeneration of the macula compromised by decreased blood supply or abnormal growth of blood vessels under the retina; typically individuals retain some peripheral vision; increased sensitivity to glare, and difficulty adjusting to light change; may progress to total blindness 4) diabetic retinopathy - damage to retinal capillaries, growth of abnormal blood vessels and hemorrhage leads to retinal scarring and finally retinal detachment; central vision is impaired, vision is blurred; complete blindness is rare (a complication of diabetes mellitus) 5) CVA, homonymous hemianopsia - loss of 1/2 visual field in each eye (nasal half of one eye and temporal half of other eye); produces the inability to receive information from right or left side; corresponds to side of sensorimotor deficit 6) medications - impaired or fuzzy vision may result with antihistamines, anti-psychotics, anti-depressants, steroids

Sensory system changes and adaptations in the older adult - Vestibular/balance control

-Aging changes: 1) diminished acuity, delayed reaction times, longer response times 2) reduced function of vestibular ocular reflex (VOR); affects retinal image stability with head movements, produces blurred vision 3) altered sensory organization - older adults more dependent upon somatosensory inputs for balance 4) less able to resolve sensory conflicts when presented with inappropriate visual or proprioceptive inputs due to vestibular losses 5) postural response patterns for balance are disorganized - characterized by diminished ankle torque, increased hip torque, increased postural sway -Additional loss of vestibular sensitivity with pathology: 1) Meniere's disease - episodic attacks characterized by tinnitus, dizziness, and a sensation of fullness or pressure in the ears; may also experience sensorimotor hearing loss 2) Benign paroxysmal positional vertigo (BPPV) - brief episodes of vertigo (less than 1 minute) associated with position change; the result of degeneration of the utricular otoconia that settle on the cupula of the posterior semicircular canal; common in older adults 3) medications - antihypertensives (postural hypotension); anticonvulsants; tranquilizers, sleeping pills, aspirin, NSAIDS 4) cerebrovascular disease - verterbrobasilar artery insufficiency (TIAs, strokes); cerebellar artery stroke, lateral medullary stroke 5) ceregellar dysfunction - hemorrhage, tumors (acoustic neuroma, meningioma); degenerative disease of brain stem and cerebellum; progressive supranuclear palsy 6) migraine 7) cardiac disease

Sensory system changes and adaptations in the older adult - Hearing

-Aging changes: 1) outer ear - buildup of cerumen (ear wax) may result in conductive hearing loss; common in older men 2) middle ear - minimal degenerative changes of bony joints 3) inner ear - significant changes in sound sensitivity, understanding of speech, and maintenance of equilibrium may result with degeneration and atrophy of cochlea and vestibular structures, loss of neurons -Types of hearing loss: 1) conductive - mechanical hearing loss from damage to external auditory canal, tympanic membrane or middle ear ossicles; results in hearing loss (all frequencies); tinnitus (ringing of the ears) may be present 2) sensorineural - central or neural hearing loss from multiple factors, eg. noise damage, trauma, disease, drugs, arteriosclerosis, etc 3) presbycusis - sensorineural hearing loss associated with middle and older ages; characterized by bilateral hearing loss, especially at high frequencies at first, then all frequencies; poor auditory discrimination and comprehension, especially with background noise; tinnitus -Additional hearing loss with pathology: 1) otosclerosis - immobility of stapes results in profound conductive hearing loss 2) Paget's disease 3) hypothyroidism

Environmental theories (stochastic or non-genetic theories) of aging

-Aging is caused by an accumulation of insults from the environment -Environmental toxins include: ultraviolet, cross-linking agents (unsaturated fats), toxic chemicals (metal ions, Mg, Zn), radiation, and viruses -Can result in errors in protein synthesis and in DNA synthesis/genetic sequences (error theory), cross-linkage of molecules, mutations

Cumulative Trauma disorder

-Also known as repetitive strain injuries (RSI), overuse syndromes, and/or musculoskeletal disorders -Risk factors: repetition, static position, awkward postures, forceful exertions, and vibration -Non-work risk factors: acute trauma, pregnancy, diabetes, arthritis, and wrist size and shape -Most common types: 1) DeQuervain's - a) stenosing tenosynovitis of the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) b) pain and swelling over the radial styloid c) positive Finkelstein's Test d) conservative treatment - thumb spica splint (IP joint free); activity/work modification; ice massage over radial wrist; gentle AROM of wrist and thumb to prevent stiffness e) post operative treatment - thumb spica splint and gentle AROM (0-2 weeks); strengthening, ADL, and role activities (2-6 weeks); unrestricted activity (6 weeks) 2) Lateral and medial epicondylitis: a) degeneration of the tendon origin as a result of repetitive microtrauma b) lateral epicondylitis - overuse of wrist extensors, especially the extensor carpi radialis brevis. Also called tennis elbow c) medial epicondylitis - overuse of wrist flexors. Also called golfer's elbow conservative treatment - 1) elbow strap, wrist splint 2) ice and deep friction massage 3) stretching 4) activity/work modification 5) as pain decreases, begin strengthening Trigger finger: a) tenosynovitis of the finger flexors - most commonly is the A1 pulley b) caused by repetition and the use of tools that are placed too far apart c) conservative treatment - 1) hand based trigger finger splint (MCP extended, IP joint free) 2) scar massage 3) edema control 4) tendon gliding 5) activity/work modification - avoid repetitive gripping activities and using tools with handles too far apart

Impact of kidney disease on self-care

-Alteration in urination -Need for sanitary techniques with self dialysis -Strict restrictive diet -Alteration in sexuality (impotence; less desirable) -Need for use of adapted equipment (tub/toilet bench; build ups; reaching assist devices; fine motor assist devices [button hooks, etc]) -Energy conservation/work simplification-fatigue -Altered mobility (wheeled mobility, use of assistive devices to walk such as an ankle-foot orthosis, walker, cane)

Signs and symptoms of elder abuse - physical abuse

-An elder's report of being physically mistreated -Bruises, black eyes, welts and/or lacerations -Rope marks and/or other signs of restraint -Bone and skull fractures, sprains and/or dislocations -Open wounds, cuts, and untreated injuries in various stages of healing -Internal injuries/bleeding -Broken eyeglasses -Under- or overdosing of prescribed drugs -A sudden change in behavior -The caregiver's refusal to allow visitors to see an elder alone

Signs and symptoms of elder abuse - emotional/psychological abuse

-An elder's report of being verbally or emotionally mistreated -Emotionally upset or agitated behavior -Extremely withdrawn and non-communicative or non-responsive behavior -Unusual behavior such as sucking, biting or rocking

Signs and symptoms of elder abuse - financial or material exploitation

-An elder's report of financial exploitation -Sudden changes in bank account or banking practice -The inclusion of additional names on an elder's bank signature card -Unauthorized withdrawal using an ATM card -Abrupt changes in a will or other financial documents -Substandard care or unpaid bills despite the availability of funds -Discovery of a forged signature -Sudden appearance of relatives claiming rights to decisions, money, or possessions -Unexplained transfer of funds -The provision of unnecessary services

Signs and symptoms of elder abuse - sexual abuse

-An elder's report of sexual assault or rape -Bruises around the breasts or genital area -Unexplained venereal disease or genital infection -Unexplained vaginal or anal bleeding -Torn, stained, or bloody underclothing

Autonomic dysreflexia

-An extreme rise in blood pressure -This is a medical emergency if not reversed

dystonia

-An involuntary sustained distorted movement or posture involving contraction of groups of muscles

Peripheral nerve injuries - Cubital tunnel syndrome

-An ulnar nerve compression at the elbow -Etiology: second most common compression; pressure at elbow (leaning on elbow) and extreme elbow flexion -Symptoms: 1) numbness and tingling along ulnar aspect of forearm and hand 2) pain at elbow with extreme position of elbow flexion 3) weakness of power grip 4) positive Tinel's sign at elbow 5) advanced stages can lead to atrophy of FCU, FDP to digits IV and V and ulnar nerve-innervated intrinsic muscles of the hand -Conservative treatment: 1) elbow splint to prevent positions of extreme flexion (especially at night) 2) elbow pad to decrease compression of nerve when leaning on elbows 3) activity/work modification -Post-operative treatment: 1) edema control 2) scar management 3) AROM and nerve gliding (2 weeks post-operative) 4) strengthening (4 weeks post-operative) 5) MCP flexion splint if clawing noted

Peripheral nerve injuries - Guyon's canal

-An ulnar nerve compression at the wrist -Etiology: repetition, ganglion, pressure, and fascia thickening -Symptoms: 1) numbness and tingling in the ulnar nerve distribution of the hand 2) motor weakness of ulnar nerve-innervated musculature 3) positive Tinel's sign at Guyon's canal 4) advanced stages can lead to atrophy of ulnar nerve-innervated musculature in the hand -Conservative treatment: 1) wrist splint in neutral 2) work/activity modification -Post-operative intervention: 1) edema control 2) AROM 3) nerve gliding 4) strengthening (2-4 weeks); focus on power grip 5) sensory reeducation

anosognosia

-An unawareness of motor deficit -May be related to a lack of insight regarding disabilities

Definition of Child Abuse

-Any behavior directed toward a child by a parent, guardian, caregiver, other family member, or other adult that endangers or impairs a child's physical or emotional health and development

Self-care development - Feeding: Intervention for oral motor control

-Appropriate positioning to allow for neutral pelvic alignment and trunk stability either in caregiver's lap or chair (infant seat or wheelchair); avoid head extension to prevent asphyxiation as a result of closing of the airway -Hand positioning of the caregiver; place the index finger longitudinally under the child's lip, middle finger under the jaw, and place the thumb on the lateral end of the mandible -Facilitate lip closure by applying slight upward pressure of the index finger under the child's lip -Hand positioning of the index and middle fingers to assist in inhibiting tongue thrust (press bowl of spoon downward and hold on tongue) -Facilitate swallow by lip closure, and by placement and slight downward pressure of the spoon on the middle aspect of the tongue -Facilitate chewing by placement of foods such as long soft cooked vegetables, between the gum and teeth -Integrate preventive measures to work out of abnormal patterns: 1) provide firm downward pressure, using a spoon, on the middle aspect of the tongue in presence of a tonic bite reflex 2) prevent tongue retraction to avoid choking 3) facilitate lip closure for a tongue thrust that can result in loss of liquids and food, drooling, and failure to thrive 4) decrease tactile sensitivity prior to feeding as well as at other times, by providing firm pressure; encourage sucking/chewing on a cloth; rub gums, palate, tongue; promote oral exploration of toys; use a NUK toothbrush; and vary texture of foods, gradually introducing mashed potatoes mixed with other vegetables and soft meats -Consider and utilize the appropriate texture of foods as related to the child's feeding problems. Thick foods are easier to swallow and manage, especially if a tongue thrust is present -A major role of the therapist is to assist the caregiver in considering and promoting a pleasant social atmosphere for feeding by utilizing positioning and handling techniques to promote eye contact and bonding in a relaxed environment -Consider the developmental sequence of feeding skills

Goals and intervention for nutrition and the elderly

-Assist in monitoring adequate nutritional intake -Assist in maintaining nutritional support: 1) refer to dietitian, nutritional consultants and/or nutritional education programs as needed 2) make recommendations for home health aide to assist with grocery shopping and meal preparation 3) refer to elderly food programs: home delivered, ie. "meals on wheels"; congregate meals/senior center daily meal programs; federal food stamp programs -Maintain physical function and promote adequate activity levels -Maintain independence in food preparation and self feeding: 1) teach work simplification and energy conservation techniques to maximize function 2) modify environment and adapt activities to enhance mastery and ensure safety

Integrated model of aging

-Assumes aging is a complex, multifactorial phenomenon in which some or all of the above processes may contribute to the overall aging of an individual; aging is not adequately explained by any single theory

Important components in the development of hand skills - Bilateral hand use

-Asymmetric movements prevail until 3 months, and then symmetric movements emerge until 10 months -By 12 to 18 months, the baby uses both hands for different functions -At 18-24 months, manipulation skills emerge -The ability to use two different hands for two very different functions emerges at age 2 1/2

Neurological system changes and adaptations in the older adult - Age-related changes

-Atrophy of nerve cells in cerebral cortex: overall loss of cerebral mass/brain weight of 6-11% between ages of 20 and 90; accelerating loss after age 70 -Changes in brain morphology: 1) gyral atrophy - narrowing and flattening of gyri with widening of sulci 2) ventricular dilation 3) generalized cell loss in cerebral cortex; especially frontal and temporal lobes, association areas (prefrontal cortex, visual) 4) presence of lipofuscins, senile or neuritic plaques, and neurofibrillary tangles (NFT); significant accumulations associated with pathology, eg. Alzheimer's disease 5) more selective cell loss in basal ganglia (substantia nigra and putamen), cerebellum, hippocampus, locus coeruleus; brain stem minimally affected -Decreased cerebral blood flow and energy metabolism -Changes in synaptic transmission: 1) decreased synthesis and metabolism of major neurotransmitters, eg. acetylcholine, dopamine 2) slowing of many neural processes, especially in polysynaptic pathways -Changes in spinal cord/peripheral nerves: 1) neuronal loss and atrophy - 30-50% loss of anterior horn cells, 30% loss of posterior roots (sensory fibers) by age 90 2) loss of motoneurons results in increase in size of remaining motor units (development of macro motor units) 3) slowed nerve conduction velocity - sensory greater than motor 4) loss of sympathetic fibers - may account for diminished, autonomic stability, increased incidence of postural hypotension in older adults -Age-related tremors (essential tremor, ET): 1) occur as an isolated symptom, particularly in hands, head, and voice 2) characterized as postural or kinetic, rarely resting 3) benign, slowly progressive; in late stages may limit function 4) exaggerated by movement and emotion

Rancho Level 7

-Automatic, Appropriate: Minimal Assistance for Daily Living Skills -consistently oriented to person and place within highly familiar environments. moderate assistance for orientation to time -able to attend to highly familiar tasks in a non-distraction environment for at least 30 min with minimal assist to complete task -minimal supervision of new learning -demonstrates carryover of new learning -initiates and carries out steps to complete familiar personal and household routine but has shallow recall of what they have been doing -able to monitor accuracy and completeness of each step in routine personal and household ADL and modify plan with min assistance -superficial awareness of their condition but unaware of specific impairments and disabilities and the limits they place on their ability to safely, accurately, and completely carry our their household, community, work, and leisure ADL -minimal supervision for safety in routine home and community activities -unrealistic planning for the future -unable to think about consequences of a decision or action -overestimates abilities -unaware of others' needs and feelings -oppositional/uncooperative -unable to recognize inappropriate social interaction behavior

Test for GERD

-Barium swallow (observing below the pharynx). Visualize external to airway in profile via x-ray -Flexible endoscopy (observing at the pharynx and descending to the esophagus directly)

beginning activities at MET level 1-2 for phase 1 evaluation/intervention of cardiopulmonary rehab

-Bed mobility, static standing -Transfer from bed to chair/bedside commode -Bed bath, feeding, grooming at sink in sitting -AROM/warm-up exercises -Wheelchair mobility/ambulation in room

Motor Development - Crossing midline

-Begins at 9-12 months -as the child becomes more mobile, movement against gravity and weight shift increase, leading to eventual crossing of the midline, often in an attempt to reach for a toy, while weight bearing on the opposing UE for balance

Controls training for body powered prosthetics - Terminal device

-Body motion to activate TD: 1) shoulder glenohumeral flexion on side of TD to be activated 2) scapular abduction (forward roll of shoulder) on side to be activated; bilateral scapular abduction for midline use or with limited strength -Instruction or intervention: therapist manually guides the patient through the motion pattern (note: for AE amputation, keep elbow locked in 90 degrees of flexion and teach TD control only) -Wrist unit rotation: 1) manual prepositioning of TD for supination, pronation or mid-position 2) for unilateral amputation, the TD is rotated in the wrist unit by using the sound hand 3) for bilateral amputation, the TD is rotated by pushing or pulling using the contralateral TD, between the knees, or against a stationary object -Instruction or intervention: the patient must analyze the task and predetermine how to grasp the object to avoid excessive or awkward body movement such as twisting and bending, eg. when carrying a tray, the fingers of the hook must be turned with the hook tips toward the person's midline (body) so the hook is in the mid-position similar to the holding pattern of the sound hand; a jar is held with the finger-tips down (pronated) toward the floor, while the sound arm opens the top

Controls training for body powered prosthetics - Elbow unit mechanism

-Body motion to activate elbow lock and unlock -Instruction or intervention: therapist manually guides the patient through these motion patterns; the patient views himself in mirror for visual feedback -Practice motions: 1) scapular depression (push residual limb into socket end) 2) humeral extension/hyperextension 3) humeral abduction -Instruction or intervention: begin with the elbow unit in an unlocked position and the elbow in flexion (arm adducted); the forearm is passively pushed back into extension to lock; listen for "click" sounds; this motion may have to be exaggerated during the initial stages -Practice TD activation with elbow locked -Instruction or intervention: lock elbow; use humeral flexion with scapular abduction to activate TD -Practice elbow flexion and lock at different levels, from full flexion to full extension -Instruction or intervention: unlock elbow and gravity will pull forearm into extension; use humeral flexion to flex elbow at desired height; when locking the elbow unit, flex the elbow slightly higher than desired, which allows for gravity to pull downward as patient locks elbow

Diminished esophageal motility causes...

-Bolus sits in the esophagus and can slowly either move toward the stomach or upward toward the pharynx -Person may feel that food is stuck in the esophagus -Person aspirates when food propels upward and he/she cannot swallow it

Hand splints for burns

-Burns to dorsum of hand: 1) wrist in 30 to 45 degrees extension 2) MCP joints in 70 to 90 degrees flexion 3) IP joints in full extension 4) thumb abducted and extended -Burns to volar surface of hand: 1) wrist in 0 to 30 degrees extension 2) MCP joints in neutral and abducted 3) IP joints in full extension 4) thumb abducted and extended

General contraindications for PAMs

-Cancer -Pacemaker -Pregnancy -Cognitive impairment -Sensory impairment -Vascular impairment -Prior to using PAMs with an individual, diagnostic and age consideration must be carefully reviewed.

Cardiopulmonary system changes and adaptations in the older adult - Age-related changes

-Cardiovascular age-related changes: 1) changes due more to inactivity and disease than aging 2) degeneration of heart muscle with accumulation of lipofuscins (characteristic brown heart); mild cardiac hypertrophy left ventricular wall 3) decreased coronary blood flow 4) cardiac valves thicken and stiffen 5) changes in conduction system - loss of pace maker cells in SA node 6) changes in blood vessels - arteries thicken, less distensible; slowed exchange capillary walls; increased peripheral resistance 7) resting blood pressures rise - systolic greater than diastolic 8) decline in neurohumoral control - decreased responsiveness of end-organs to beta-adrenergic stimulation of baroreceptors 9) decreased blood volume, hemopoietic activity of bone 10) increased blood coagulability -Pulmonary system age-related changes: 1) chest wall stiffness, declining strength of respiratory muscles results in increased work of breathing 2) loss of lung elastic recoil in increased work of breathing 3) changes in lung parenchyma: alveoli enlarge, become thinner; fewer capillaries for delivery of blood 4) changes in pulmonary blood vessels: thicken, less distensible 5) decline in total lung capacity - residual volume increases, vital capacity decreases 6) forced expiratory volume (air flow) decreases 7) altered pulmonary gas exchange - oxygen tension falls with age (at a rate of 4mmHg/decade; PaO2 at age 70 is 75, versus 90 at age 20) 8) blunted ventilatory responses of chemoreceptors in response to respiratory acidosis - decreased homeostatic responses 9) blunted defense/immune responses - decreased ciliary action to clear secretions, decreased secretory immunoglobulins, alveolar phagocytic function

Skeletal system changes and adaptations in the older adult - Age-related changes

-Cartilage changes: decreased water content, becomes stiffer, fragments, and erodes; by age 60 or more than 60% of adults have degenerative joint changes, cartilage abnormalities -Loss of bone mass and density: peak bone mass at age 40; between 45 and 70 bone mass decreased (women by about 25%; men 15%); decreases another 5% by age 90: 1) loss of calcium, bone strength; especially trabecular bone 2) decreased bone marrow red blood cell production -Intervertebral discs: flatten, less resilient due to loss of water content (30% loss by age 65) and loss of collagen elasticity; trunk length, overall height decreases -Senile postural changes: 1) forward head 2) kyphosis of thoracic spine 3) flattening of lumbar spine 4) with prolonged sitting, tendency to develop hip and knee flexion contractures

Aging changes

-Cellular changes: 1) increase in size; fragmentation of Golgi apparatus and mitochondria 2) decrease in cell capacity to divide and reproduce 3) arrest of DNA synthesis and cell division -Tissue changes: 1) accumulation of pigmented materials, lipofuscins 2) accumulation of lipids and fats 3) connective tissue changes: decreased elastic content, degradation of collagen; presence of pseudoelastins -Organ changes: 1) decreased functional capacity 2) decrease in homeostatic efficiency -Gerontology: the scientific study of the factors impacting the normal aging process and the effects of aging -Geriatrics: the branch of medicine concerned with the illnesses of old age and their care -Ageism: discrimination and prejudice leveled against individuals on the basis of their age - 1) isolates elders socially 2) permits attitudes and policies that discourage elders from full participation in work, leisure and other meaningful occupations 3) perpetuates fears of aging 4) diminishes quality of life

Preprosthetic treatment

-Change of dominance activities, if needed -ROM of uninvolved joints -Prepare limb for a prosthesis -Desensitization -Wrapping to shape and shrink the residual limb: 1) wrap distal to proximal 2) tension should decrease with proximal wrapping -ADL training, including education in skin care -Supportive counseling to facilitate adjustment -Individualize treatment to enhance physical and psychological adjustment

Other system changes and adaptations in the older adult - Integumentary changes

-Changes in skin composition: 1) dermis thins with loss of elastin 2) decreased vascularity; vascular fragility results in easy bruising (senile purpa) 3) decreased sebaceous activity and decline in hydration 4) appearance - skin appears dry, wrinkled, yellowed, and inelastic; aging spots appear (clusters of melanocyte pigmentation); increased with sun exposure to sun 5) general thinning and graying of hair due to vascular insufficiency and decreased melanin production 6) nails grow more slowly, become brittle and thick -Loss of effectiveness as protective barrier: 1) skin grows and heals more slowly, less able to resist injury and infection 2) inflammatory response is attenuated 3) decreased sensitivity to touch, perception of pain and temperature; increased risk for injury from concentrated pressures or excess temperatures 4) decreased sweat production with loss of sweat glands results in decreased temperature regulation and homeostasis

Muscular system changes and adaptation in the older adult - Age related changes

-Changes ma be due more to decreased activity levels (hypokinesis) and disuse than from the aging process -Loss of muscle strength: peaks at age 30, remains fairly constant until age 50; after which there is an accelerating loss, 20-40% loss by age 65 in the non-exercising adult -Loss of power (force/unit time): significant declines, due to losses in speed of contraction, changes in nerve conduction and synaptic transmission -Loss of skeletal muscle mass (atrophy): both size and number of muscle fibers decrease, by age 70 lose 33% of skeletal muscle mass -Changes in muscle fiber composition: selective loss of Type II, fast twitch fibers, with increase in proportion of Type I fibers -Changes in muscular endurance: muscles fatigue more readily: 1) decreased muscle tissue oxidative capacity 2) decreased peripheral blood flow, oxygen delivery to muscles 3) altered chemical composition of muscle - decreased myosin ATPase activity, glycoproteins and contractile protein 4) collagen changes - denser, irregular due to cross-linkages, loss of water content and elasticity; affects tendons, bone, cartilage

Major milestones in cognitive development - Early object use

-Child focuses on action performed with objects, eg. banging, shaking (3-6 months) -Child explores characteristics of objects and expands the range of schemes, eg. pulling, turning, poking, tearing (6-9 months) -Child combines objects in relational play, such as objects in containers (8-9 months) -Child notices the relation between complex actions and consequences such as opening doors, placing lids on containers, and differential use of schemes based on the toy being played with, eg. pushing a train or rolling a ball (9-12 months) -Child acts on objects with a variety of schemes (12 months +) -Child links schemes in simple combinations, eg. placing a baby in carriage and then pushing the carriage (12-15 months) -Child links multi-scheme combinations into a meaningful sequence, eg. putting food in a bowl, scooping the food using a spoon, and feeding a doll (24-36 months) -Child links schemes into a complex script (36-42 months)

Fractures - Medical treatment

-Closed reduction: types of stabilization include short arm cast (SAC), long arm cast (LAC), splint, sling, or fracture brace -Open reduction internal fixation (ORIF): types include nails, screws, plates, or wire -External fixation -Arthrodesis: fusion -Arthroplasty: joint replacement

Cardiopulmonary system changes and adaptations in the older adult - Strategies to slow or reverse changes in cardiopulmonary systems

-Complete a cardiopulmonary assessment prior to commencing an exercise program: 1) this is essential in older adults due to the high incidence of cardiopulmonary pathologies 2) select an appropriate graded exercise testing protocol 3) standardized test batteries and norms for elderly are not available 4) many elderly cannot tolerate maximal testing; submaximal testing commonly used 5) testing and training modes should be similar -Individualized exercise prescription is essential: 1) choice of training program based on - fitness level, presence or absence of cardiovascular disease, musculoskeletal limitations, individual's goals, roles, and activity interest 2) prescriptive elements (frequency, intensity, duration, and mode) are the same as for younger adults 3) walking, chair and floor exercises, Yoga, Tai-Chi, and modified strength/flexibility calisthenics are well-tolerated by most elderly 4) consider pool programs (exercises, Tai-Chi, walking, swimming) for persons with musculoskeletal and neurological impairments 5) consider multiple modes of exercise on alternate days to maintain interest and reduce likelihood of muscle injury, joint overuse, pain, fatigue, and boredom -Aerobic training programs can significantly improve cardiopulmonary function in the elderly: 1) decreases heart rate at a given submaximal power output 2) improves maximal oxygen uptake (VO2max) 3) greater improvements in peripheral adaptation, muscle oxidative capacity then central changes 4) improves recovery heart rates 5) decreases systolic blood pressure, may produce a small decrease in diastolic blood pressure 6) increases maximum ventilatory capacity - vital capacity 7) reduces breathlessness, lowers perceived exertion 8) psychological gains, improves sense of well-being, self-image 9) improves functional capacity -Improve overall daily activity levels for independent living: 1) lack of exercise/activity is an important risk factor in the development of cardiopulmonary disease 2) lack of exercise/activity contributes to problems of immobility and disability in the elderly

Sensory system changes and adaptations in the older adult - Taste and smell

-Conditions resulting in additional loss of sensation: 1) smoking 2) chronic allergies, respiratory infection 3) dentures 4) CVA, involvement of hypoglossal nerve

Rancho Level 6

-Confused, Appropriate: Moderate Assistance -inconsistently oriented to person, time, place -able to attend to highly familiar tasks in non-distracting environment for 30 min with moderate redirection -remote memory has more depth and detail than recent memory -vague recognition of some staff -able to use assistive memory aide with max assist -emerging awareness of appropriate response to self, family and basic needs -moderate assist to problem solve barriers to task completion -supervised for old learning (self care) -shows carry over for relearned familiar tasks (self care) -max assist for new learning with little or no carry over -unaware of impairments, disabilities and safety risks -consistently follows simple directions -verbal expressions are appropriate in highly familiar and structured situations

Rancho Level 5

-Confused, Inappropriate Non-Agitated: Maximal Assistance -alert, not agitated but may wander randomly or with a vague intention of going home -may become agitated in response to external stimulation, and/or lack of environmental structure -not oriented to person, place or time -frequent brief periods, not purposeful sustained attention -severely impaired recent memory, with confusion of past and present in reaction to ongoing activity -absent goal directed, problem solving, self monitoring behavior -often demonstrates inappropriate use of objects without external direction -may be able to perform previously learned tasks when structured and cues provided -unable to learn new information -able to respond appropriately to simple commands fairly consistently with external structures and cues -responses to simple commands without external structure are random and non-purposeful in relation to command -able to converse on a social, automatic level for brief periods of time when provided external structure and cues -verbalization about present events become inappropriate and confabulatory when external structure and cues are not provided

Ranch Level 4

-Confused/Agitated: Maximal Assistance -alert and in heightened state of activity -purposeful attempts to remove restraints or tubes or crawl out of bed -may perform motor activities such as sitting, reaching and walking but without any apparent purpose or upon another's request -very brief and usually non-purposeful movements of sustained alternatives and divided attention -absent short term memory -may cry out or scream out of proportion to stimulus even after its removal -may exhibit aggressive or flight behavior -mood may swing from euphoric to hostile with no apparent relationship to environmental events -unable to cooperate with treatment efforts -verbalization are frequently incoherent and/or inappropriate to activity or environment

chorea

-Consists of involuntary movements of the face and extremities which are spasmodic and of short duration

Prevention of scleroderma

-Control symptoms of Raynaud's phenomenon -Have screening echocardiograms to rule out pulmonary hypertension -Smoking cessation

Medical treatment of lupus

-Control symptoms to prevent complications -Treat with diuretics and drugs that prevent spillage of protein in the urine (angiotensin converting enzyme-ACE)

Neurological system changes and adaptations in the older adult - Strategies to slow or reverse changes

-Correct medical problems: improve cerebral blood flow -Improve health: diet, smoking cessation -Increase levels of physical activity: may encourage neuronal branching, slow rate of neural decline, and improve cerebral circulation -Provide effective strategies to improve motor learning and control: 1) allow for increased reaction and movement times - will improve motivation, accuracy of movement 2) allow for limitations of memory - avoid long sequences of movement 3) allow for increased cautionary behaviors - provide adequate explanation, demonstration when teaching new movement skills 4) stress familiar, well-learned skills; repetitive movements

Terminal devices (TDs) - Hooks Voluntary opening (body powered)

-Cosmesis: considered poor; does not replicate a hand -Pinch force: contingent on number of rubber bands, but more bands also increase the effort required to open -Prehension patter: precise, fine pinch possible -Weight: lighter in weight than hands; aluminum models are even lighter; range from 3-0-8.7 oz -Durability: very durable; stainless steel models are even more rugged -Reliability: little servicing needed -Feedback: some proprioceptive feedback experienced from tension on shoulder harness and limb pressure in socket when operating TD or elbow -Effort to activate: more effort to open -Use in various planes: difficult at high planes for AE -Visibility of items being grasped: very good visibility -Cost: low cost

Terminal devices (TDs) - Hands voluntary opening (body powered)

-Cosmesis: cosmetically appealing -Pinch force: pinch force stronger than VO hook but less than myoelectric hands -Prehension pattern: cylindrical grasp identical to myoelectric hand -Weight: heavy range: 10.0-13.8 oz -Durability: less durable; glove is delicate; spring mechanism may need repairs -Reliability: needs more servicing than VO and VC TD but less than myoelectric -Feedback: feedback similar to VO hook -Effort to activate: effort to activate -Use in various planes: similar to VO hook -Visibility of items being grasped: less visibility; similar to myoelectric hand -Cost: higher cost than BP hook but lower than myoelectric

Terminal devices (TDs) - Hands (myoelectrically controlled)

-Cosmesis: cosmetically appealing -Pinch force: strong pinch; proportional control allows for variable pinch force up to about 25 lb -Prehension pattern: cylindrical grasp rather than fine pinch; hand configuration is identical for myoelectric and BP hands -Weight: heaviest 16.8 oz -Durability: less durable; glove is delicate; control systems may need servicing -Reliability: most servicing needed -Feedback: some feedback through intensity of muscle contraction, particularly for proportional control -Effort to activate: low effort to activate -Use in various planes: very good for BE -Visibility of items being grasped: less visibility than hooks -Cost: higher cost for TD and systems

Terminal devices (TDs) - Voluntary closing TRS Grip (body powered)

-Cosmesis: poor cosmesis -Pinch force: considered excellent for strong grasp; can achieve >50 lb, contingent on amount of force the individual can exert on the cable -Prehension pattern: fine pinch possible -Weight: heavier than VO hooks, but some models are lighter than hands. Range: 10-16 oz -Durability: very durable stainless steel TD -Reliability: little servicing needed -Feedback: better proprioceptive feedback -Effort to activate: more effort to sustain grasp; can have manual lock -Use in various planes: similar to VO hook -Visibility of items being grasped: better visibility than hands but less than VO hook -Cost: higher cost than VO but lower than myoelectric

Interventions for impairment level problems for the rehabilitation for immunological system disorders

-Counsel people to be compliant with screening and treatment regimens -Set personal goals to invest behaviorally in one's health -Provide support to those dealing with immunological system disorders that are chronic illnesses (ie, AIDS) -Provide supportive counseling and social support for psychological disorders that can develop (eg. anxiety disorder, depression, and/or adjustment disorders) -Refer to physician for drug therapy and complementary medicine as indicated for accompanying physical and/or psychiatric disorders (eg. kidney disease, depression)

Mechanical principles of splinting

-Decrease pressure: wide, long splint base is the most desirable. Round edges are needed -Using sling applied with a 90 angle of pull -Use low load to increase duration -Maintain three-point pressure versus circumference -Avoid the position of deformity (wrist flexion; MCP hyperextension; IP joints flexed; thumb adducted) -Select the appropriate splinting position -Functional position: wrist 20-30 extension; MCPs 45 flexion; IPs 20-30 flexion; thumb abducted -Safe position (intrinsic + OR antideformity): wrist 0-20 extension; MCPs 70-90 flexion; IPs in extension; thumb abducted and extended

Other system changes and adaptations in the older adult - Gastrointestinal changes

-Decreased salivation, taste, and smell along with inadequate chewing (tooth loss, poorly fitted dentures); poor swallowing reflex may lead to poor dietary intake, nutritional deficiencies -Esophagus: reduced motility and control of lower esophageal sphincter; acid reflux and heartburn, hiatal hernia common -Stomach: reduced motility, delayed gastric emptying; decreased digestive enzymes and hydrochloric acid; decreased digestion and absorption; indigestion common -Decreased intestinal motility; constipation common

Types of arthritis - Osteoarthritis

-Degenerative joint disease: 1) not systemic but wear and tear 2) commonly affects large weight bearing joints 3) attacks hyaline cartilage -Etiology: 1) genetic 2) trauma 3) inflammation 4) cumulative trauma 5) endocrine and metabolic disease -Symptoms: 1) pain 2) stiffness 3) limited range of motion 4) bone spurs -Types of bone spurs: 1) Heberden's nodes at the DIP joints 2) Bouchard's nodes at the PIP joints

Outcomes of poor nutrition in the elderly

-Dehydration is common in the elderly, resulting in fluid and electrolyte disturbances: 1) thirst sensation is diminished 2) may be physically unable to acquire/maintain fluids 3) Environmental heat stresses may be life threatening and should be treated as medical emergencies -Diets are often deficient in nutrients, especially vitamins A and C, B12, thiamine, protein, iron, calcium, vitamin D, folic acid, and zinc -Increased use of alcohol or taste enhancers (eg. salt and sugar) influences nutritional intake -Drug/dietary interactions influence nutritional intake (eg. reserpine digoxin, anti-tumor agents, and excessive use of antacids)

Cognitive Development - Jean Piaget

-Described the process of cognitive development from birth to adolescence -Major constructs: 1) adaptation - responding to environmental challenges as they occur 2) mental schemes - organizing experiences into concepts 3) operations - the cognitive methods used by the child to organize schemes and experiences to direct subsequent actions 4) adapted intelligence or cognitive competence 5) equilibrium - the balance between what the child knows and can act on and what the environment provides 6) assimilation - the ability to take a new situation and change it to match an existing scheme or generalization 7) accommodation - the development of a new scheme in response to the reality of a situation, or discrimination -hierarchical development of cognition: 1) sensorimotor period 2) preoperational period 3) concrete operations 4) formal operations -Piaget stated that maturation of cognition is dependent on the following items: 1) organic growth, especially the maturation of the nervous system and endocrine glands 2) experience in the actions performed on objects 3) social interaction and transmission 4) a balance of opportunities for both assimilation and accommodation

Assessment of pain

-Determine location of pain: localized or diffuse -Evaluate intensity of pain: 1) pain intensity scale of 0-10 is most commonly used 2) identify the time of day the pain is most intense -Determine the onset and duration of pain: 1) gradual or sudden onset 2) the length of time pain has been experienced -Description of pain: common descriptors include sharp, throbbing, tender, burning, and shooting -Functional assessment of pain: 1) pain scales that commonly address function (McGill Pain Questionnaire, Pain Disability Index, Functional Intereference Estimate)

Diagnosis and medical treatment of Lyme disease

-Diagnosis: presence of symptoms and signs; history of exposure to ticks, especially in geographic areas where Lyme disease is known to occur; blood titer to determine whether antibodies for Lyme disease are present -Medical treatment: antibiotics (oral or intravenous); management of joint-related symptoms from the accompanying arthritis

Assessment of nutrition in elderly

-Dietary history: patterns of eating, types of foods -Psychosocial: mental status, desire to eat, depression, grief, social isolation, social supports -Body composition: 1) weight/height measures 2) skin fold measurements (triceps/subscapular skin fold thickness) 3) upper arm circumference -Olfactory and gustatory sensory function -Dental and periodontal disease, fit of dentures -Ability to feed self: mastication, swallowing, hand/mouth control, posture, physical weakness and fatigue -Integumentary: skin condition, edema -Compliance to special diets -Functional assessment: basic activities of daily living, feeding; overall exercise/activity levels, amount and type of social participation

Dupytren's disease

-Disease of the fascia of the palm and digits: 1) fascia becomes thick and contracted 2) results in flexion deformities of the involved digits -Conservative treatment had not been successful -Occupational therapy intervention: 1) wound care - dressing changes, whirlpool if infection is suspected 2) edema control - elevation above the heart 3) extension splint - initially at all times except to remove for ROM and bathing 4) A/PROM, and progress to strengthening when wounds are healed 5) scar management (massage, scar pad, and compression garment) 6) functional tasks that emphasize flexion (gripping) and extension (release)

Relationship of swallowing dysfunction to occupation

-Disruption of role relative to family unit, ability to comfortably eat at the dinner table: modified diet could be infantalizing; tube feeding may preempt person's ability to partake in the family meal in cultural/social context -Disruption of ability/comfort level for eating out in public: person may chose not to dine in a public social context; if business lunches or dinners are part of a vocational role, the person may not be able to resume his/her vocation without modification of expectations regarding how participation in social meals relates to vocational performance -Alteration of self-concept concerning life roles and appearances: if person is tube fed, how does that alter how he/she perceives self? -- sex appeal can be questions; self image as it impacts on life roles (eg. jet-setter or fashion plate) can be altered;; if tube fed, how does that alter how others perceive him/her? --accepted, feared, or pitied by children, grandchildren, family and friends

Body mechanics principles and methods

-Do not move items that are too heavy; ask for assistance -Slide or push an object along the surface rather than lift it, if possible -Directly face the object about to be lifted. Do not face the direction in which the item is going to move -Keep object close to the body during lifting and carrying -Hold object centered at waist level -Feet should be kept flat on the floor; balancing on toes should be avoided -Maintain a firm and broad base of support. Maintain the body balanced over a wide stance -Bend at the knees and hips, not at the waist -Keep the back straight as possible -Breathe while lifting -Lift by straightening legs; do not pull upward with arms and back -Do not rotate the trunk. Pick up the object completely and then pivot the entire body -Lower the body to the level of the work

Medical treatment of acute renal failure

-Drug control of underlying medical contributory conditions -Emergent, acute dialysis

Developmental Continuum in self-feeding and associated component areas - Age 6-8 months

-Eating and feeding performance: attempts to hold bottle but may not retrieve it if it falls; needs to be monitored for safety reasons -Concurrent changes in performance components: 1) sensorimotor - N/A 2) cognition - object permanence is emerging and infant anticipates spoon or bottle 3) psychosocial - is easily distracted by stimuli (especially siblings) in the environment

Developmental Continuum in self-feeding and associated component areas - Age 24-30 months

-Eating and feeding performance: demonstrates interest in using fork; may stab at food such as pieces of canned fruit; proficient at spoon use and eats cereal with milk or rice with gravy utensil -Concurrent changes in performance components: 1) sensorimotor - tolerates various food textures in mouth; adjusts movements to be efficient (eg. forearm supinated to scoop and lift spoon) 2) cognition - expresses wants verbally; demonstrates imitation of short sequences of occupation (eg. putting food on plate and eating it) 3) psychosocial - has increasing desire to copy peers; looks to adults to see if they appreciate success in an occupation; interested in household routines

Developmental Continuum in self-feeding and associated component areas - Age 12-14 months

-Eating and feeding performance: dips spoon in food, brings spoonful of food to mouth, but spills food by inverting spoon before it goes into mouth -Concurrent changes in performance components: 1) sensorimotor - begins to place and release objects; likely to use pronated grasp on objects like crayon or spoon 2) cognition - recognizes that objects have function and uses tools appropriately; relates objects together, shifting attention among them 3) psychosocial - has interest in watching family routines

Developmental Continuum in self-feeding and associated component areas - Age 9-13 months

-Eating and feeding performance: finger-feeds self a portion of meals consisting of soft table foods (eg. macaroni, peas, dry cereal) and objects if fed by an adult -Concurrent changes in performance components: 1) sensorimotor - uses various grasps on objects of different sizes; able to isolate radial fingers on smaller objects 2) cognition - has increased organization and sequencing of schemes to do desired activity; may have difficulty attending to events outside visual space (eg. position of spoon close to mouth) 3) psychosocial - prefers to act on objects than be passive observer

Developmental Continuum in self-feeding and associated component areas - Age 6-9 months

-Eating and feeding performance: holds and tries to eat cracker but sucks on it more than bites it; consumes soft foods that dissolve in the mouth; grabs at spoon but bangs it or sucks on either end of it -Concurrent changes in performance components: 1) sensorimotor - good sitting stability emerges; able to use hands to manipulate smaller parts of rattle; guided reach and palmar grasp applied to hand-to-mouth actions with objects 2) cognition - uses familiar actions initially with haphazard variations; seeks novelty and is anxious to explore objects (may grab at food on adult's plate) 3) psychosocial - recognizes strangers; emerging sense of self

Developmental Continuum in self-feeding and associated component areas - Age 15-18 months

-Eating and feeding performance: scoops food with spoon and brings it to mouth -Concurrent changes in performance components: 1) sensorimotor - shoulder and wrist stability demonstrate precise movements 2) cognition - experiments to learn rules of how objects work; actively solves problems by creating new action solutions 3) psychosocial - internalized standards imposed by others for how to play with objects

Developmental Continuum in self-feeding and associated component areas - Age 5-7 months

-Eating and feeding performance: takes cereal or poured baby food from spoon -Concurrent changes in performance components: 1) sensorimotor - has good head stability and emerging sitting abilities; reaches and grasp toys; explores and tolerates various textures (eg. fingers, rattles); puts objects in mouth 2) cognition - attends to effect produced by actions, such as hitting or shaking 3) psychosocial - plays with caregiver during meals and engages in interactive routines

Neurological system changes and adaptations in the older adult - Clinical implications

-Effects on movement: 1) overall speed and coordination are decreased; increased difficulties with fine motor control 2) slowed recruitment of motoneurons contribute to loss of strength 3) both reaction time and movement time are increased 4) older adults are affected by the speed/accuracy trade off (the simpler the movement, the less the change; more complicated movements require more preparation, longer reaction and movement times; faster movements decrease accuracy, increase errors) 5) older adults typically shift in motor control processing from open to closed loop, eg. demonstrate increased reliance on visual feedback for movement 6) demonstrate increased cautionary behaviors, an indirect effect of decreased capacity -General slowing of neural processing; learning and memory may be affected -Problems in homeostatic regulation: stressors (heat, cold, excess exercise) can be harmful, even life-threatening

Psychosocial development and major theorists - Erik Erikson

-Ego adaptation is the adaptive response of the ego in the development of the personality -Eight stages of man are identified and include a critical personal-social crisis that when resolved by the individual gives the individual a sense of mastery and results in the acquisition of a personality quality -Basic trust vs mistrust: the infant/baby realizes that survival and comfort needs will be met; hope is integrated into the personality (birth to 18 months) -Autonomy vs doubt and shame: the child realizes that he/she can control bodily functions; self-controlled will is integrated into the personality (2 to 4 years) -Initiative vs. guilt: the child gains social skills and gender role identity; a sense of purpose is integrated into the personality (preschool age) -Industry vs inferiority: the child gains a sense of security through peers and gains mastery over activities of his/her age group; a feeling of competency is integrated into the personality (elementary school age) -Self-identity vs. role diffusion: the teenager begins to make choices about adult roles, and with the resolution of this identity crisis a sense of fidelity or membership with society is integrated into the personality (teenage years) -Intimacy and solidarity vs isolation: the young adult establishes an intimate relationship with a partner and family; the capacity to love is achieved (young adulthood) -Generativity vs self-absorption: the adult finds security in the contribution of his/her chosen personal/professional roles; the capacity to care is achieved (middle adulthood) -Integrity vs despair: the mature adult reflects on his/her own value, and shares with the younger generation the knowledge gained; wisdom is acquired (maturity)

Lyme disease (tick bite disease)

-Etiology and risk factors: disease from tick bites (tick attach to people as they brush by the object to which the tick is attached; tick attaches to hidden and hairy areas such as groin, armpits, and scalp

Hip fractures

-Etiology: 1) trauma 2) osteoporosis 3) pathological fractures (ie. cancer) -Types: 1) femoral neck fracture 2) intertrochanteric fracture 3) subtrochanteric fracture -Medical management: 1) closed reduction for minimally displaced fractures 2) open reduction internal fixation (ORIF) 3) joint replacement -Occupational therapy evaluation: 1) review precautions and weight bearing status before initiating evaluation 2) occupational role requirements and expectations 3) ADL focus on dressing, bathing and transfers 4) ROM and strength of upper extremities 5) conduct other assessments as needed, (eg. cognitive) -Occupational therapy intervention: 1) bed mobility and bedside ADL 2) upper extremity strengthening 3) functional ambulation and transfers with appropriate weight bearing status and appropriate ambulation device (ie. walker, crutches) (the type of ambulation device is determined by the person's weight bearing status) 4) instruct in and practice use of assistive devices for use in the home (eg. shower chair, elevated commode seat) 5) practice role activities (eg. small meal preparation) using proper weight bearing status and ambulatory device -Precautions: 1) weight bearing status and the amount of ROM allowed at the hip will be determined by the surgeon 2) time frames for beginning OT intervention are also determined by the surgeon -Complications: 1) avascular necrosis 2) non-union 3) degenerative joint disease 4) the result of complications can be the need for a total hip replacement

Total hip replacement/total hip arthroplasty

-Etiology: 1) trauma, from hip fracture 2) disease, most often arthritis; surgery is then elective -Types: 1) total hip joint implant - replaces acetabulum and femoral head 2) Austin Moore - partial hip replacement. Replaces femoral head 3) hybrid cemented total hip arthroplasty -Surgical procedures: 1) cemented or uncemented 2) anterolateral or posterolateral (more common) -Occupational therapy evaluation: 1) review precautions and weight bearing status before initiating evaluation 2) occupational role requirements and expectations 3) ADL - focus on dressing, bathing, and transfers 4) ROM and strength of upper extremities 5) conduct other assessments as needed (eg. cognitive) -Occupational therapy intervention: 1) educate the individual in hip precautions (a) do not flex beyond 90 degrees b) do not adduct or cross legs [do not internally rotate (for anterolateral approach avoid external rotation)] c) do not pivot at hip d) sit only on raised chair and raised toilet seat e) transfer sit to stand by keeping operated hip in slight abduction and extended out in front) 2) instruct in and practice use of long handled equipment 3) provide transfer training (practice with tub bench, raised toilet seat; practice car transfers; practice bed to chair transfers) 4) practice role activities [eg. small meal preparation] using proper weight bearing status and ambulatory device

Hepatitis

-Etiology: a viral infection -Risk factors for Type A - contaminated seafood; protective immunization possible -Risk factors for Type B, C and other identified forms - body and blood borne exposure; protective immunization possible for type B -Healthcare workers are most susceptible to hepatitis B -Prevention: practice standard precautions with all persons to prevent contact with blood or body fluids -Sequelae: fever; fatigue; the above contribute to decreased tolerance for activity participation and lack of energy

Osteogenesis Imperfecta

-Etiology: an autosomal dominant inherited disorder -Signs and symptoms: 1) fractures in utero, and during the birthing process in the most severe cases 2) brittle bones that fracture easily 3) multiple fractures as the child grows 4) deformities of the arms and legs 5) developmental growth problems 6) eye abnormalities (ie blue sclera, cataracts) 7) risk of hearing impairments -Medical management: 1) cast and braces 2) pain management 3) audiological consultation 4) activity restrictions due to high risk of fractures and actual fracture occurrence -Occupational therapy evaluation: 1) activity interests that can be safely pursued 2) environmental risk factors -Occupational therapy intervention: 1) activity adaptation and assistive device prescription to facilitate safe participation in daily occupations 2) environmental modifications to maintain safety 3) preventive positioning and protective splinting/padding 4) activities to increase muscle strength 5) weight bearing activities to facilitate bone growth 6) family, caregiver and teacher education regarding proper handling, positioning, safety, and activity/environmental modification

Acquired Immunodeficiency Syndrome (AIDS)

-Etiology: infection by the human immunodeficiency virus (HIV) -Risk factors for infection: unprotected sex; contact with blood or body fluids -Prevention: Avoid unprotected sex via abstinence or use of condoms; avoid contact with body fluids (blood procedures; breast feeding; secreations of vagina/rectum during birth [protection of baby], during sex, during hygiene); urine or feces; tears (low % of infection) -Practice standard precautions with all persons

Stress incontinence

-Etiology: local damage to bladder sphincter associated with aftereffects of bearing children, morbid obesity, weakening of accessory musculature associate with normal aging

Small Bowel Obstruction

-Etiology: secondary to scar tissue; secondary to radiation of the abdomen (long term effect); result of tumor obstruction -Surgical treatment: resection with open stoma (colostomy); closed abdominal surgery

Neurogenic Bowel

-Etiology: sympathetic nerve impairment, generally occurring in persons who have spinal cord injury above the (thoracic) T-6 level -- loss of control of anal sphincter; sensory loss resulting in a lack of awareness of feces in the bowel; motor loss, decreased or lost ability to self-initiate or control a bowel movement -Flaccidity of muscles results in incontinence

Interventions for inpatient rehabilitation for immunological system disorders

-Evaluation and restoration of functional abilities: self-care; instrumental ADLs; energy conservation and work simplification; use of the Pizzi Assessment of Productive Living for Adults with HIV (PAPL) for persons with HIV -Restoration of activity/exercise tolerance -Achievement and maintenance of quality of life -Role readjustment intervention -Planning to return to community: access to environment; participation issues

Purdue pegboard

-Evaluation for coordination/dexterity -Test of fingertip dexterity and assembly job simulation -subtests include: a. Thirty second test: right hand, left hand, both hands, R+, L+, and both. b. One minute test: assembly -Scoring: thirty second test is the number of pins placed in the board in 30 seconds. Assembly is the number of parts assembled during 1 minute

Occupational therapy evaluation and intervention - Full thickness burn (requiring grafting)

-Evaluation: 1) ROM (5 to 7 days post-operative) 2) same as for superficial and deep partial-thickness burns -Post-operative intervention: 1) 72 hours: dressing changes, splint at all times 2) five to seven days: begin AROM, light ADL and meaningful activities, sterile whirlpool 3) over seven days: PROM as tolerated, ADL and meaningful activities 4) when wounds are healed, use massage 5) order compression garments 6) provide otoform/elastomer inserts 7) strengthening

Occupational therapy evaluation and intervention - Superficial partial-thickness burns

-Evaluation: 1) occupational therapy history and roles 2) ROM, 72 hours post-operative 3) sensation, when wounds are healed 4) strength, when wounds are healed 5) ADL and meaningful role activities, as soon as possible -Intervention: 1) wound care and debridement, sterile whirlpool, and dressing changes 2) gentle AROM and PROM to individual's tolerance 3) edema control 4) splinting, if necessary 5) ADL and role activities

Occupational therapy evaluation and intervention - Deep partial-thickness burns

-Evaluation: same as for superficial partial-thickness burns -Intervention: 1) wound care and debridement, sterile whirlpool, and dressing changes 2) gentle AROM and PROM to individual's tolerance 3) edema control 4) splinting 5) occupational role activities and ADL 6) strengthening (when wounds are healed)

Categories of play

-Exploratory play (0-2 years): 1) child engages in play experiences through which he/she develops a body scheme 2) sensory integrative and motor skills are also developed as the child explores the properties and effects of actions on objects and people 3) child plays mostly with parents/caregiver(s) -Symbolic play (2-4 years): 1) child engages in play experiences through which he/she formulates, test, classifies, and refines ideas, feelings, and combined actions 2) this form of play is associated with language development 3) objects that are manageable for the child in terms of symbolization, control, and mastery are preferred by the child 4) child is mostly involved in parallel play with peers, and begins to become more cooperative over time -Creative play, (4-7 years): 1) child engages in sensory, motor, cognitive, and social play experiences in which he/she refines relevant skills 2) child explores combinations of actions on multiple objects 3) child begins to master skills that promote performance of school and work related activities 4) child participates in cooperative peer groups -Games, (7-12 years): 1) child participates in play with rules, competition, social interaction, and opportunities for development of skills 2) child begins to participate in cooperative peer groups with a growing interest in competition 3) friends become important for validation of play items and performance, while parents assist and validate in the absence of peers

Wrist extensors innervated by the radial nerve

-Extensor carpi radialis brevis (ECRB) -Extensor carpi radialis longus (ECRL) -Extensor carpi ulnaris (ECU)

Sequelae/complications of diabetes

-Fatigue/decreased activity tolerance -Urinary disturbance -Visual loss, low vision, blindness -Peripheral neuropathy (amputations) -Propensity to develop wounds -Poor general health/increased rate of infections disrupting life roles and activity participation -Hypoglycemia: symptoms include vagueness, dizziness, tachycardia (abnormal increased heart rate), pallor (redness of face), weakness, diaphoresis (increased sweating), seizures, and/or coma; if person is conscious, immediately provide carbohydrates in the form of hard candy, fruit juice or honey; if person is unconscious immediately call for emergency medical care -Hyperglycemic crises: ketoacidosis - signs include dehydration, rapid and weak pulse and acetone breath (sweet smell); hyperosmolar coma - signs include stupor (decreased cognition), thirst, polyuria (large production of urine), and neurologic abnormalities; call for emergency medical services as IV fluids and insulin are required

Important components in the development of hand skills - Manipulating skills according to Exner's Classification System

-Finger-to-palm translation: a linear movement of an object from the fingers to the palm of the hand eg. picking up coins (12-15 months) -Palm-to-finger translation: with stabilization, a linear movement of an object from the palm of the hand to the fingers, eg. placing coins in a slot (2- 2 1/2 years) -Shift: a linear movement of an object on the finger surfaces to allow for repositioning of the object relative to the finger pads, eg. separating 2 pieces of paper (3 - 3 1/2 years) -Simple rotation: the turning or rolling of an object held at the finger pads approximately 90 degrees or less eg. unscrewing a small bottle cap ( 2 - 2 1/2 years) -Complex rotation: the rotation of an object 360 degrees, eg. turning a pencil over to erase (6-7 years) -In-hand manipulation with stabilization: several objects are held in the hand and manipulation of one object occurs, while simultaneously stabilizing the others, eg. picking up pennies with thumb and forefinger while storing them in the ulnar side of the same hand (6-7 years)

Visual-motor and visual-perceptual assessments - Erhardt Developmental Vision Assessment (EDVA) and Short Screening Form (EDVA-S)

-Focus: a behavior rating scale to determine visuomotor development that assesses involuntary visual patterns including eyelid reflexes, pupillary reactions, doll's eye responses and voluntary patterns including fixation, localization, ocular pursuit, and gaze shift -Method: 1) there are 271 test items organized developmentally into seven clusters 2) the clusters are presented and items are sequenced developmentally 3) upon administration of each item, a response is scored for each eye 4) models for assessment and management, and items required for testing are provided -Scoring and interpretation: 1) responses are scored as normal, well-integrated, emerging, or not present 2) a developmental level is provided for each cluster and a final developmental level is estimated 3) EDVA-S comprises 67 components of permanent vision patterns, and is scored in the same manner as EDVA (if a test item is scored emerging or not present, a full evaluation using EDVA is indicated) 4) baseline levels allow for identification of delays, and also determine the sequenced developmental items that have not been attained (a baseline also allows progress to be tracked and interventions to be established) 5) findings will determine indications for an ophthalmic evaluation -Population: birth to 6 months. Since the 6 month level is considered the norm, the EDVA-S can be used for assessing older children

Overall Development Assessments - First STEP Screening Test for Evaluating Preschoolers

-Focus: a checklist and rating scale which identifies preschool students at risk and in need of a more comprehensive evaluation -Method: 1) it assesses five areas/domains as identified by IDEA which include cognition, communication, physical, social and emotional, and adaptive functioning (table-top tasks are administered while sitting across from the child; additional space is needed for gross motor tasks) 2) an optional Social-Emotional Rating Scale is rated by the examiner based on the child's behavior during testing 3) an optional Adaptive Behavior Checklist is rated by the examiner according to the information obtained from a parent or caregiver interview regarding daily functioning 4) an optional Parent/Teacher Scale provides additional information not obtained during the testing -Scoring and interpretation: 1) each item has criteria for grading and scores for each domain are totaled 2) total domain scores are converted to composite scores to determine whether the child's performance is within acceptable level or at risk 3) determination of a child's strengths and areas needing improvement for treatment planning -Population: 2 years 9 months through 6 years 2 months

Social Participation Assessments - Participation scale (P-Scale) (Version 4.8)

-Focus: a measure of restrictions in social participation related to community mobility, access to work, recreation and social interaction with family, peers, neighbors, etc -Method: 1) eighteen item questionnaire addressing the nine domains of participation identified in the International Classification of Function, Disability, and Health 2) Self-care, mobility and social function and their functional sub-units are assessed (the score forms include the areas of functional skills, caregiver assistance and modifications -Scoring and interpretation: scores above 12 on the scale (ranging from 0 to 90) indicate the need for intervention -Population: 15 years and older with physical disabilities

Development assessments of neonates - Neurological Assessment of Pre-term and Full-term newborn infant (NAPFI)

-Focus: a rating scale consisting of a brief neurological examination incorporated into routine assessment; 1) can be used with newborns in an incubator and/or on a ventilator if handling can be tolerated 2) habituation, movement and tone, reflexes, and neurobehavioral responses including state transition, level of arousal and alertness, auditory and visual orientation, irritability, consolability, and cry are assessed -Method: items are administered in a sequence; first in a quiet or sleep state, followed by items not influenced by state, then during the awake state -Scoring and interpretation: 1) the infant's state is recorded, based on six gradings of state, for each item 2) interpretation of scores allows the therapist to document a pattern of responses to reflect neurological functions and identify deviations for diagnosis 3) a comparison of pre-term with full-term infant behavior is provided -Population: pre-term and full-term newborn infants

Visual-motor and visual-perceptual assessments - Preschool Visual Motor Integration Assessment (PVMIA)

-Focus: a standardized norm referenced assessment which evaluates visual motor integration and visual perceptual skills of preschoolers, including perception in space, awareness of spatial relationships, color and space discrimination, matching two attributes simultaneously and the ability to reproduce what is seen and interpreted -Method: two performance subtests and two behavioral observation checklists: 1) the Drawing subtest requires the child to recognize and reproduce lines and shapes that increase in level of complexity 2) the Block Patterns subtest requires the child to recognize color and shape and reproduce block patterns and match block pictures using 3 dimensional blocks 3) it has a section that first predetermines that the child has the requisite skills to continue with the test items 4) the behavioral observation checklists are completed during testing by the administrator to document observed behaviors in an orderly manner to be used in test interpretation -Scoring and interpretation: 1) the child's fine motor skills and visual perceptual abilities are examined separately, to the extent possible 2) each task has specific criteria listed on the score sheet 3) to attain the precision needed to accurately score the child's final products, templates and a ruler are provided to be used when scoring each subtest 4) raw scores are converted to standard scores and percentile ranges for both subtests and for the total test (impairments indicated by standards scores below 80 and percentile scores below 25) 5) administrator's recorded behavioral observations of the child during the testing are not included in the score. These observations are used in test interpretation and subsequent intervention planning 6) interpretation of the child's performance and current emerging abilities are made based upon the combination of numerical scores, behavioral observations, and error analysis -Population: preschoolers aged 3 1/2 to 5 1/2 years old

Visual-motor and visual-perceptual assessments - Motor-Free Visual Perception Test (MVPT-3)

-Focus: a standardized, quick evaluation to assess visual perception (excludes motor components) in five areas including spatial relationships, visual discrimination, figure-ground, visual closure, and visual memory -Method: 1) the number of items administered depends on the child's age (for children aged 4 to 10 years, items 1-40 are administered; for persons aged 10 years or older, items 14-65 are administered) -Scoring and interpretation: 1) raw scores are translated into perceptual ages and perceptual quotients 2) average performance is determined as a standard score of 80-120 and percentile ranks of 25-75 -Population: children and adults aged 4 to 95 years

Sensory Processing Assessments - Sensory Pofile (SP): Adolescent/Adult SP

-Focus: allows client to identify their personal behavioral responses and develop strategies for enhanced participation -Method: a questionnaire measures individual's reactions to daily sensory experiences -Scoring and interpretation: cutoff scores indicate typical performance and probable, definite, and significant differences (differences, indicate which sensory system is hindering performance; can be used for intervention planning) -Population: 11-65 years

Visual-motor and visual-perceptual assessments - Developmental Test of Visual Perception (2nd, Edition) (DTVP-2) and Developmental Test of Visual Perception - Adolescent and Adults (DTVP-A)

-Focus: assess visual perceptual skills and visual motor integration for levels of performance and for designing interventions and monitoring progress -Methods: 1) DTVP-2 is comprised of eight subtests including eye-hand coordination, copying, spatial relations, visual-motor speed, position in space, figure-ground, visual-closure, form-constancy 2) DTVP-A is comprised of four subtests of visual motor integration, composite index, and motor-reduced visual perception composite index -Scoring and interpretation: 1) raw scores, age equivalents, percentiles, subtest standard scores, and composite quotients are provided 2) three indexes provided - general visual perceptual; motor-reduced visual perception; visual motor integration -Population: children aged 4 to 10 years for the DTVP-2; adolescents and adults aged 11 to 74 years for the DTVP-A

Visual-motor and visual-perceptual assessments - Test of Visual-Perceptual Skills (3rd ed) (TVPS3)

-Focus: assess visual-perceptual skills and differentiates these from motor dysfunction as a motor response is not required -Method: 1) seven visual-perceptual skills including visual discrimination, visual memory, visual-spatial relationships, visual form constancy, visual sequential memory, visual figure-ground and visual closure are assessed 2) tests items are presented in a multiple choice format and are sequenced in complexity (if subjects have 3 consecutive errors, the test is discontinued) 3) behavior observed during testing is also recorded -Scoring and interpretation: 1) indications of visual perceptual problems are determined by standard scores below 80 and percentile ranks below 25 2) information is used to establish an intervention program which may impact on learning -Population: four through 19 years

Play assessments - Test of Playfulness (TOP)

-Focus: assesses a child's playfulness based on observations according to four aspects of play -Method: 1) observed behaviors are rated according to intrinsic motivation, internal control, disengagement from constraints of reality, and framing 2) the extent, intensity and skillfulness of play are also observed and rated -Scoring and interpretation: scores in the 25 percentile or below indicate the need for intervention -Population: 15 months to 10 years

Social Participation Assessments - School Function Assessment (SFA)

-Focus: assesses and monitors functional performance in order to promote participation in a school environment (it does not measure academic performance) -Method: a criterion referenced questionnaire assesses the student's level of participation, type of support currently required, and performance on school related tasks -Scoring and interpretation: two different scoring mechanisms 1) basic level of criterion cutoff scores - scores falling below the cutoff point indicate a performance that does not meet expectations 2) advanced level scores range from 0 to 100, indicating appropriate grade level functioning

Psychological and Cognitive Assessments - Coping Inventory and Early Coping Inventory

-Focus: assesses coping habits, skills and behaviors, including effectiveness, style, strengths and vulnerabilities to develop intervention plans for coping skills -Method: 1) Coping Inventory: questionnaire assesses coping with self and coping with environment according to three categories of coping styles - productive, active and flexible 2) Early Coping Inventory: questionnaire assesses the effectiveness of behaviors according to sensorimotor organization, reactive behavior, and self-initiated behavior -Scoring and interpretation: 1) determines the level of adaptive behavior and whether or not intervention is needed 2) a coping profile can be grafted for each dimension -Population: 1) coping inventory: 15 years and above 2) Early Coping Inventory: 4 to 36 months

Visual-motor and visual-perceptual assessments - Test of Visual-Motor Skills (TVMS) and Test of Visual-Motor Skills: Upper Level (TVMS-UL)

-Focus: assesses eye hand coordination skills for copying geometric designs -Method: 1) the individual copies and draws geometric designs which become sequentially more complex (there are 23 geometric forms in the TVMS which are scored for 8 possible errors and 16 in the TVMS-UL which are scored for 9-22 possible errors in motor accuracy, motor control, motor coordination, and psychomotor speed) 2) test behavior is also documented -Scoring and interpretation: 1) the resulting score can be translated into a motor age, standard score, and percentile rank 2) characteristics and errors of the drawings are examined and provided clinical information 3) information is used to establish a treatment plan -Population: TVMS - two through 13 years; TVMS-UL - twelve through 40 years

Development assessments of neonates - Assessment of Premature Infants' Behavior (APIB)

-Focus: assesses infant's pattern of developing behavioral organization in response to increasing sensory and environmental stimuli (an extension and refinement of the Neonatal Behavioral Assessment Scale [NBAS]) -Method: a behavior checklist and scale -Scoring and interpretation: 1) scores are obtained prior to administration for a baseline, during administration and following administration 2) scores reflect the degree of facilitation provided by the examiner 3) eye movements and asymmetry of performance are measured 4) function and integration of the physiological, motor, state, attentional/interactive, and regulatory systems are determined 5) interpretation of scores allows the therapist to plan interventions, measure outcomes, and plan follow-up -Population: premature infants

Play Assessments - Play History

-Focus: assesses play behavior and play opportunities -Method: 1) the primary caregiver provides information about a child in three categories including general information, previous play experience, and actual play that occurs over three days of play (previous play experiences and actual play, consisting of nine aspects that address the form and content of behavior, are analyzed according to materials, action, people, and setting) -Scoring and interpretation: 1) a description of play is obtained and play dysfunction is determined 2) a treatment plan can be developed based on strengths and deficits -Population: children and adolescents

Motor Assessments - Toddler and Infant Motor Evaluation (TIME)

-Focus: assesses the quality of movement -Method: 1) five primary subtest asses mobility, stability, motor organization, social/emotional abilities and functional performance 2) quality rating, component analysis, and atypical positions can be assessed by a clinicians with advanced training -Scoring and interpretation: 1) cutoff scores are indicative of moderate or significant motor delays 2) subtests give more specific information -Populations: birth to 3 years and 6 months

Visual-motor and visual-perceptual assessments - Beery-Buktenica Developmental Test of Visual Motor Integration (5th ed. (Beery VMI-5)

-Focus: assesses visual motor integration (can be used as a classroom screening tool) -Method: 1) the child copies 24 geometric forms which are sequenced according to level of difficulty 2) once the child fails to meet grading criteria for three consecutive forms, the test is discontinued -Scoring and interpretation: 1) raw score can be translated to percentile ranks, standard score, and age equivalency 2) average scores fall between 80 and 120 and average percentiles fall between 25 and 75 -Population: short form for children ages 2 to 7 years. Full form for children ages 2 to 18 years

Psychological and Cognitive Assessments - Childhood Autism Rating Scale (CARS)

-Focus: determines the severity of autism (ie. mild, moderate, or severe) and distinguishes children with autism from children with developmental delays who do not have autism -Method: an observational tool is used to rate behavior (fifteen descriptive statements include characteristics, abilities, and behaviors that deviate from the norm -Scoring and interpretation: 1) scores below 30 = no autism 2) scores of 30 to 36.5 = mild to moderate autism 3) scores of 37 to 60 = severe autism -Population: children over 2 years of age who have mild, moderate, or severe autism

Visual-motor and visual-perceptual assessments - Motor-Free Visual Perception Test-Vertical (MVPT-V)

-Focus: evaluation of individuals with spatial deficits, due to hemi-field visual neglect or abnormal visual saccades -Method: thirty-six items vertically placed are used to asses spatial relationships, visual discrimination, figure ground, visual closure, and visual memory (excluding motor components) -Scoring and interpretation: 1) provided perceptual ages and perceptual quotients 2) inadequate performance is determined as a score of 85 or less -Population: children and adults with visual field cuts or without visual impairments (appropriate for individuals with brain injury since it reduces confounding variables)

Play assessments - Transdisciplinary Play-Based Assessment (TPBA)

-Focus: measures child's development, learning style, interaction patterns, and behaviors to determine need for services -Method: 1) non-standardized play assessment employing team observations based on six phases 2) observations are categorized into the developmental domains of cognitive, social-emotional, communication and language, and sensorimotor -Scoring and interpretation: 1) a program plan is developed and can include developmental levels, family assessment, intervention services and strategies to promote an appropriate activity environment 2) a curriculum is available to address particular needs -Population: infancy to 6 years

Sensory Processing Assessments - Sensory Profile (SP) and Infant/Toddler SP

-Focus: measures reactions to daily sensory experiences -Method: 1) obtains caregiver's judgement and observation of a child's sensory processing, modulation, and behavioral and emotional responses in each sensory system via a caregiver questionnaire -Scoring and interpretation: 1) cutoff scores indicate typical performance and probable, definite, and significant differences (differences, indicate which sensory system is hindering performance; can be used for intervention planning) -Population: SP - 3-10 years; Infant/Toddler SP - birth -36 months

Overall Development Assessments - Hawaii Early Learning Profile, Revised (HELP)

-Focus: non-standardized scale of developmental levels. An educational curriculum-referenced test that assesses six areas of function including cognitive, language, gross motor, fine motor, social-emotional, and self-help -Methods: 1) administered in the child's natural environment, in the context of the family, and during typical routines 2) developmentally appropriate items are administered according to established protocols 3) a protocol using a warm-up period, structured play and snack time is recommended -Scoring and interpretation: 1) developmental age range levels of skills in each of the six areas can be approximated 2) specification of skills noted on a chart can be transferred to a checklist for analysis of expected skills that are absent 3) a description of behavior and possible causes of difficulty, all within the context of the family and environment, can be obtained 4) developmental structuring of skills is provided in the form of a sequence of conceptual strands, so skills needed as a foundation for more advanced skills are provided -Population: children, ages birth through 3 years, with developmental delay, disabilities, or at risk, HELP for Preschoolers is available for children ages 3 to 6, with and without delays

Motor Assessments - Erhardt Developmental Prehension Assessment (EDPA) Revised and Short Screening Form (EDPA-S)

-Focus: observation checklist based on performance which assesses three clustered areas including involuntary arm-hand patterns; voluntary movements of approach; and prewriting skills: 1) EDPA allows for charting and monitoring of prehensile development 2) EDPA-S identifies developmental gaps in prehensile development and the need for further assessment -Method: 1) test is administered in sections according to the appropriate age level 2) there are 341 test components in the EDPA categorized according to involuntary arm hand patterns, voluntary movements, and prewriting skills 3) the EDPA-S contains 128 components -Scoring and interpretation: 1) Part one: right and left hand scores are scored as normal or well-integrated, not present or emerging, or abnormal 2) Part Two: scores are placed into a developmental level for each cluster 3) Part three: function is determined for involuntary arm-hand patterns, voluntary movements and prewriting skills 4) gaps in hand skills and developmental levels can be determined (intervention can be planned and provided depending on individual needs) -Population: children of all ages and cognitive levels with neurodevelopmental disorders

Play Assessments - Revised Knox Preschool Play Scale (RKPPS)

-Focus: observations of play skills to differentiate developmental play abilities, strengths and weakness, and interest areas -Method: 1) administered in a natural indoor and outdoor environment with peers (two 30 minute periods of observations are completed indoors and outdoors) 2) observations are organized according to 6 month increments up to age 3 3) four dimensions of play including space management, material management, pretense/symbolic (including imitation), and participation are assessed -Scoring and interpretation: 1) the four dimensions of play are described (each dimension contains behavioral description/factors) 2) the mean scores of all four dimension scores provide a play age score indicative of the child's play maturity 3) the effectiveness of treatment can also be determined -Population: 0 through 6 years (it is useful with children for whom standardized testing may not be appropriate)

Overall Development Assessments - Pediatric Evaluation of Disability Inventory (PEDI)

-Focus: standardized behavior checklist and rating scale that assesses capabilities and detects functional deficits, to determine developmental level, monitor the child's progress and/or to complete a program evaluation (Modifications and Caregiver Assistance Scales determine the level of assistance and adaptations needed to enhance partipication -Method: 1) observation, interview, and scoring of the three domains (self-care, mobility and social skills and their functional sub-units are assessed) -Scoring and interpretation: 1) the score forms include the areas of functional skills, caregiver assistance and modifications (the three sections are scored separately) 2) identifies children with patterns of delay 3) progress and outcomes can be monitored -Population: 6 months to 7 years

Motor Assessments - Peabody Developmental Motor Scales (2nd ed.) (PDMS-2)

-Focus: standardized rating scales of gross and fine motor development -Method: 1) gross and fine motor subtests measure reflexes, sustained control, locomotion, object manipulation, grasping and visual motor integration 2) test items are administered one level below the child's expected motor age in order to obtain a basal age level 3) test is discontinued with three consecutive scores of zero -Scoring and interpretation: 1) a developmental profile of gross and fine motor skills is provided 2) standard scores are provided 3) strengths and weaknesses are indicated once the percentile ranks are grafted 4) a motor activity program useful for planning and implementing training is provided -Population: children, ages birth to 6 years, with motor, speech-language, and/or hearing disorders

Overall Development Assessments - Bayley Scales of Infant Development, 3rd Edition (BSID-III)

-Focus: standardized rating scales that assess multiple areas of development to attain a baseline for intervention and to monitor progress (evaluates 5 domains: cognitive, language, and motor which are performance based tasks, and social-emotional and adaptive behavioral skills) -Method: 1) age appropriate items are selected from items on the different domain scales 2) involves parents completing two questionnaires -Scoring and interpretation: 1) composite scores yield qualitative descriptors and performance levels for each domain 2) results are used to plan interventions for any delays -Population: 1 to 42 months

Overall Development Assessments - Denver Developmental Screening Test II

-Focus: standardized task performance and observation screening tool for early identification of children at risk for developmental delays in four areas including personal-social, fine motor-adaptive, language, and gross motor skills -Method: 1) test includes 125 test items 2) test items below the child's chronological age level are administered with sequential progression towards higher level chronological items until the child fails three items 3) behaviors observed during the screening are marked on a checklist 4) questionnaires for home screening of environments and prescreening of development are available to administer to parents/caregivers -Scoring and interpretation: 1) each item scored indicates the chronological age at which it is expected to be performed. The child's performance on that item is compared to determine whether it is age appropriate or delayed, and is marked as pass or fail 2) the test is discontinued when three items are failed 3) the screening allows for interpretation of a child's performance in terms of being normal, abnormal, questionable, or unstable in personal-social, fine motor-adaptive, language, and gross motor abilities 4) interpretation of findings must be considered in the context of other pertinent information and with ongoing observation -Population: 1 month to 6 years

Overall Development Assessments - Miller Assessment for Preschoolers (MAP)

-Focus: standardized task performance screening tool that assesses sensory and motor abilities consisting of foundation and coordination indexes, cognitive abilities including verbal and nonverbal indexes, and combined abilities which include complex tasks index -Method: 1) items are administered that relate to the age of the subject 2) supplemental nonstandardized observations may be administered -Scoring and interpretation: 1) measures are obtained in sensory and motor abilities, cognitive abilities, and combined activities 2) the child's performance is compared with norms 3) percentile equivalents can be obtained for each index and for performance overall 4) results used for treatment planning -Populations: 2 years 9 months to 5 years 8 months

Motor Assessments - Bruininks-Oseretsky Test of Motor Proficiency (2nd ed.) (BOT-2)

-Focus: standardized test assesses and provides an index of overall motor proficiency; fine and gross motor composites, including consideration of speed, duration, and accuracy of performance, and hand and/or foot preferences -Method: 1) there is a long and short form with 8 subtests: fine motor precision, fine motor integration, manual dexterity, bilateral coordination, balance, running speed and agility, upper limb coordination and strength (hand and foot preference is initially determined) -Scoring and interpretation: 1) a total motor composite score consists of four motor areas: fine manual control, manual coordination, body coordination, and strength and agility 2) age equivalency and descriptive categories, and performance scores indicate motor strengths and weaknesses 3) scores may be used as a basis for suggesting treatment goals and to evaluate change -Population: 4 years to 21 years

Clinical aspiration

-Food enters the airway -Person can clear airway by coughing (reflex intact) -Person silently aspirates -Bolus enters lung and person does not react -Bolus enters the lung and person experiences respiratory distress without a cough -Person coughs too weakly to raise the bolus in order to expel it

Cardiopulmonary system changes and adaptations in the older adult - Clinical implications

-For cardiovascular changes: 1) changes at rest are minor - resting heart rate and cardiac output relatively unchanged; resting blood pressures increase 2) cardiovascular responses to exercise - blunted, decreased heart rate acceleration, decreased maximal oxygen uptake and heart rate; reduced exercise capacity, increased recovery time 3) decreased stroke volume due to decreased myocardial contractility 4) maximum heart rate declines with age 5) cardiac output decreases, 1% per year after age 20 - due to decreased heart rate and stroke volume 6) orthostatic hypotension - common problem in elderly due to reduced baroreceptor sensitivity and vascular elasticity 7) increased fatigue; anemia common in elderly 8) systolic ejection murmur common in elderly 9) possible ECG changes - loss of normal sinus rhythm; longer PR and QT intervals; wider QRS; increased arrhythmias -For pulmonary changes: 1) respiratory responses to exercise - similar to younger adult at low and moderate intensities; at higher intensities, responses include increased ventilatory cost of work, greater blood acidosis, increased likelihood of breathlessness, and increased perceived exertion 2) clinical signs of hypoxia are blunted; changes in mentation and affect may provide important cues 3) cough mechanism is impaired 4) gag reflex is decreased, increased risk of aspiration 5) recovery from respiratory illness - prolonged in the elderly 6) significant changes in function with chronic smoking, exposure to environmental toxic inhalants

Sign and symptoms of diabetes

-Frequent urination -Excessive thirst -Unexplained weight loss -Extreme hunger -Visual changes -Sensory changes (tingling/numbness) in the hands or feet -Fatigue -Very dry skin -Slow healing wounds -Increased rate of infections

Terminal devices (TDs)

-Function to grasp and maintain hold on an object -The two main types of TDs are the hook and the hand: 1) voluntary opening (VO) = hook remains closed until tension is placed on cable and then it opens 2) voluntary closing (VC) = hook remains opened until tension is placed on cable and then it closes -Determination of the most appropriate TD is based upon the person's interests, roles, and preferences (TDs can be interchangeably used with prosthesis if the shaft size is the same

Prosthetic treatment

-Functional training with prosthesis: practice engagement in activities of interest and occupational role activities -Donning and doffing the prosthesis -Increased prosthetic wearing tolerance -Individualize treatment to enhance physical and psychological adjustment

Rancho Level 2

-Generalized Response: Total Assistance -demonstrates generalized reflex response to painful stimuli -responds to repeated auditory stimuli with increased or decreased activity -responds to external stimuli with physiological changes generalized, gross body movement and/or not purposeful vocalization -responses noted above may be same regardless of type and location of stimulation -responses may be significantly delayed

Sequelae of HIV infection

-Generalized lymphadenopathy/enlarged lymph nodes: fatigue; weight loss (malabsorption of nutrients [wasting syndrome]); general malaise -Fever -Diarrhea -All of the above results in decreased tolerance for activity participation and lack of energy -Neurological impairments: cognitive impairment (eg. safety issues, communication and expression impairments, alteration of personality, decreased ability to engage as before in interpersonal relationships); affective changes; sensory changes (associated with dementia); basic ADL impairments such as inability to hold and manipulate objects for use (money, combs, tooth brushes, writing implements, feeding utensils, telephone, remote control, etc.); myelopathy (spinal cord pathology); peripheral neuropathy; visual impairment (ie. peripheral: cytomegaloviral (CMV) infection, retinopathy, central: neurobehavioral loss/impairment)

Biologic theories of aging

-Genetic: aging is intrinsic to the organism; genes are programmed to modulate aging changes, overall rate of progression -Individuals vary in the expression of aging changes, eg. graying of hair, wrinkles, etc -Polygenic controls exist (multiple genes are involved): no one gene can modulate rate of development in all aspects of aging -Premature aging syndromes (progeria) provide evidence of defective genetic programming; individuals exhibit premature aging changes, ie. atrophy and thinning of tissues, graying of hair, arteriosclerosis, etc. 1) Hutchinson-Gilford syndrome - progeria of childhood 2) Werner's syndrome - progeria of young adults -Doubling/biologic clock (Hayflick limit theory): functional deterioration within cells is due to limited number of genetically programmed cell doublings (cell replication) -Free radical theory: free radicals are highly reactive and toxic forms of oxygen produced by cell mitochondria. The release radicals: 1) cause cell damage to cell membranes and DNA cell replication 2) interfere with cell diffusion and transport, resulting in decreased O2 delivery and tissue death 3) decrease cellular integrity, enzyme activities 4) result in cross-linkages - chemical bonding of elements not generally joined together; interferes with normal cell function 5) results in accumulation of aging pigments, lipofuscins 6) can trigger pathologic changes - atherosclerosis in blood vessel wall; cell mutation and cancer -Cell mutation (intrinsic mutagenesis): errors in the synthesis of proteins (DNA, RNA) lead to exponential cascade of abnormal proteins and aging changes -Hormonal theory: functional decrements in neurons and their associated hormones lead to aging changes; 1) hypothalamus, pituitary gland, adrenal gland are the primary regulators, timekeepers of aging (thyroxine is the master hormone of the body; controls rate of protein synthesis and metabolism; secretion of regulatory pituitary hormones influence thyroid) 2) decreases in protective hormones (estrogen, growth hormone, adrenal DHEA [dehydroepiandrosterone]) 3) increases in stress hormones (cortisol) - can damage brain's memory center, the hippocampus, and destroy immune cells -Immunity theory: thymus size decreases, shrivels by puberty, becomes less functional; bone marrow cell efficiency decreases; results in steady decrease in immune responses during adulthood (immune cells, T-cells, become less able to fight foreign organisms; B-cell become less able to make antibodies; autoimmune diseases increase with age)

Important components in the development of hand skills - Grasping skills according to Erhardt Prehension Developmental Levels

-Grasp of the pellet (prone or sitting): 1) no voluntary grasp or visual attention to the object (natal) 2) no attempt to grasp, but visually attends to the object (3 months) 3) raking and contacting object (6 months) 4) inferior-scissors grasp: raking object into palm with adducted totally flexed thumb and all flexed fingers, or two partially extended fingers (7 months) 5) scissor grasp: between thumb and side of curled index finger, distal thumb joint slightly flexed, proximal thumb joint extended (8 months) 6) inferior pincer grasp: between ventral surfaces of thumb and index finger, distal thumb joint extended, beginning of thumb opposition (9 months) 7) pincer grasp: between distal pads of thumb and index finger, distal thumb joint slightly flexed, thumb opposed (10 months) 8) fine pincer grasp: between fingertips or fingernails, distal thumb joint flexed (12 months) -Grasp of the cube: 1) neonate visually attends to object, grasp is reflexive 2) visually attends to object and may swipe. Sustained voluntary grasp possible only upon contact, ulnar side used, no thumb involvement, wrist flexed (3 months) 3) primitive squeeze grasp: visually attends to object, approaches if within 1 inch, contact results in hand pulling object back to squeeze precariously against the other hand or body, no thumb involvement (4 months) 4) palmar grasp: fingers on top surface of object press it into center of palm with thumb adducted (5 months) 5) radial-palmar grasp: fingers on far side of object press it against opposed thumb and radial side of palm (6 months), with wrist straight (7 months) 6) radial-digital grasp: object held with the opposed thumb and fingertips, space visible between (8 months) with wrist extended (9 months)

Important aspects in the development of upper extremity function

-Head and trunk control -Eye/hand interaction/sensory-perceptual interaction -Shoulder (scapular) stability/mobility -Humeral control -Elbow control -Forearm control -Wrist control -Thumb opposition and stability -Palmar arches of hand -Isolated finger control

Types, signs and symptoms of heat syndromes/hyperthermia

-Heat cramps are characterized by a normal body temperature, nausea, diaphoresis (increased sweating), muscle twitching or spasms, weakness, and/or severe muscle cramps -Heat exhaustion is characterized by a rapid pulse, decreased blood pressure, headache, nausea, vomiting, cool pallid skin, mental confusion -Heat stroke is characterized by hot, dry red skin; a body temperature higher than 104 degrees; slow, deep respiration;; tachycardia (increased heart rate); dilated pupils (increased ANS); confusion; progressing to seizures and possibly loss of consciousness

Etiology and risk factors of heat syndromes/hyperthermia

-Heat production increases with infection, exercise, and/or drugs -Heat loss decreases with high humidity and/or temperature, excess clothing, obesity, cardiovascular disease, dehydration, sweat gland dysfunction, lack of acclimatization, and/or drugs -When an individual's heat loss is not sufficient to offset his/her heat production, his/her body will retain heat and a heat syndrome can develop -Individuals who are elderly, obese or taking drugs are at increased risk

Intervention for heat syndromes/hyperthermia

-Heat stroke is a medical emergency and hospitalization is required immediately: immediately call emergency medical services; lower person's body temperature by getting the person to a cooler area, placing ice packs on arterial pressure points and/or spraying the body with a cool mist; IV infusions and medications are necessary -Heat cramps and heat exhaustion usually do not require hospitalization: loosen clothing and have the person lie in a cool place; replace fluid and electrolytes with fruit juice or a balanced electrolyte drink (if these are not available, give fluids and seek additional medical attention); massage muscle if cramps are severe; IV infusions and oxygen may be indicated if symptoms are severe

Risk factors for cancer

-Heredity: some tumors seem to have a high hereditary risk (breast cancer, prostate cancer, skin cancer, colon cancer) -Environmental: chemical polution -Habit or lifestyle related: tobacco can contribute to lung cancer and head and neck cancer; drinking alcohol contributes to some head and neck cancers; obesity/high fat diets may be linked to an increased risk of some cancers

Occupational therapy evaluation for fractures

-History of injury -Results from X-ray tech -Edema -Pain -AROM: 1) do not assess PROM or strength until ordered by physician 2) exceptions are humerus fractures which often begin with PROM or AAROM -Sensation -Roles, occupations, ADL and activities related to roles

Occupational therapy intervention for fractures

-Immobilization phase: stabilization and healing are the goals: 1) AROM of joints above and below the stabilized part 2) edema control - elevation, retrograde massage, and compression garments 3) light ADL and role activities with no resistance, progress as tolerated -Mobilization phase: consolidation is the goal 1) edema control - elevation, retrograde massage, contrast baths, and compression garments 2) AROM (progress to PROM when approved by physician [4 to 8 weeks]; exceptions are humerus fractures which often begin with PROM or AAROM) 3) light functional/purposeful activity 4) pain management - positioning and physical agent modalities 5) strengthening - being with isometrics when approved by physician

Sequelae and symptoms of Lyme disease

-Impairs the immune response and affects the neurological and orthopedic systems -Early symptoms: fatigue, severe headache, chills and fever, muscle and joint pain, swollen lymph nodes, rash (erythema migrans - a circular red patch occurring 3 days - 1 month after the bite from an infected tick; commonly in the groin, thigh, trunk and armpits; the center of the rash may clear as it enlarges, resembling a bull's-eye) -Late symptoms: arthritis in large joints, nervous system abnormalities (numbness, pain, Bell's palsy, meningitis); heart rate irregularities

Cognitive changes and adaptations in the older adult - Strategies to slow or reverse changes

-Improve health: 1) correct medical problems - imbalances between oxygen supply and demand to CNS, eg. cardiovascular disease, hypertension, diabetes, hypothyroidism 2) assess needed pharmacological changes; drug reevaluation; decrease use of multiple drugs; monitor closely for drug toxicity 3) reduce chronic use of tobacco and alcohol 4) correct nutritional deficiencies -Increased physical activity -Increase mental activity: 1) keep mentally engaged, "Use it or Lose it"; eg. chess, crossword puzzles, book discussion groups, reading to children 2) maintain an engaged lifestyle - socially active, eg. clubs, travel, work, volunteerism; allow for personal choice in activity 3) use cognitive training activities -Provide multiple sensory cues to compensate for decreased sensory processing and sensory losses and to maximize learning, eg. provided visual demonstrations, written instructions, and verbal cues -Provide stimulating, "enriching" environment; avoid environmental dislocation, eg. hospitalization or institutionalization may produce disorientation and agitation in some elderly -Reduce stress; provide counseling and family support

Muscular system changes and adaptation in the older adult - Strategies to slow or reverse changes

-Improve health: 1) correct medical problems that may cause weakness; hyperthyroidism, excess adrenocortical steroids (eg. Cushing's disease, steroid); hyponatremia (low sodium in blood) 2) improve nutrition 3) address alcoholism/substance abuse -Increase levels of physical activity, stress functional activities, and activity programs: 1) gradually increase intensity of activity to avoid injury 2) plan and include adequate warm-ups and cool downs; appropriate pacing and rest periods -Provide strength training to increase/ maintain muscle strength required for functional activity: 1) significant increases in strength are noted in older adults with isometric and progressive resistive exercise regimes 2) high-intensity training programs (70-80% of one-repetition maximum) produce quicker and more predictable results than moderate intensity programs; both have been successfully used with the elderly 3) age not a limiting factor; significant improvements noted in 80-90 year old elders who were frail and institutionalized 4) improvements in strength can improve functional abilities and occupational performance 5) maintain newly gained and existing strength and incorporate into functional activities -Provide flexibility and range of motion exercises to increase range of motion needed for functional activity: 1) utilize slow, prolonged stretching, maintained for 20-30 seconds 2) tissues heated prior to stretching are more distensible, eg, warm pool 3) maintain newly gained range; incorporate into functional activities 4) mobility gains are slower with older adults

Modified barium swallow (MBS)

-In diagnostic radiology suite -Done with swallowing team and radiologist: person seated at uprighted edge of radiology table; person must have adequate sitting balance; person must be supervised at all times -Person administered trial boluses laced with barium: person should be given boluses mixed with food consistencies, purees, thick liquids, solids, and thin liquids; if the person aspirates the test ceases -Video records moving x-ray of swallow. A copy of the video is kept as part of the record -Still x-ray shots are taken if aspiration is observed

Prevention of heat syndromes/hyperthermia

-In hot weather, wear light-weight, loose fitting clothing -Avoid hot places; seek shade, use fans, and air conditioners -Rest frequently -Increase fluid intake

Praxis/motor planning deficits causes...

-Inability to effectively chew and coordinate tongue movements to propel the bolus toward the base of the tongue -Residual food centrally located in the oral cavity -Difficulty forming bolus with smoother consistencies

Lifespan and Occupational Therapy Developmental Theorists - Lela Llorens

-Individual is viewed from two perspectives: 1) specific period of time, referred to as horizontal development 2) over the course of time, referred to as longitudinal/chronological development -Both of these perspectives occur simultaneously -The integration of these two aspects is critical to normal development -The role of the occupational therapist is to facilitate development and assist in the mastery of life tasks and the ability to cope with life expectations -Lloren's frame of reference integrated many of the concepts of Gesell, Amatruda, Erikson, Havighurst, and Freud

Vocal cord paralysis causes...

-Inefficient closure of the vocal folds during the pharyngeal phase of swallow -Vocal cords are in paramedian position; swallow may be safe -vocal cords fail to meet/close to protect airway; aspiration may occur

Weakness of the tongue/base of tongue structures causes...

-Inefficient propulsion of bolus at an efficient rate of speed past the base of the tongue into the pharyngeal cavity -Lack of closure at the cricopharyngeal junction - sub-optimal propulsion of the bolus; interference with the normal timing of the swallow sequence; failure to trigger closure of the vocal folds during swallowing; aspiration

Deep Vein Thrombosis (DVT): Venous disease

-Inflammation of a vein in association with the formation of a thrombus; usually occurs in the lower extremities -May be a contributing factor to or a complication of a CVA or the result of prolonged bed rest during serious illness.

OT developmental evaluation - Developmental History

-Information regarding the mother's pregnancy and specifics of birth history: 1) Apgar score of the infant's heart rate, respiration, reflex irritability, muscle tone, and color at one, five, and ten minutes after birth, measures on a scale of 0,1, 2 2) number of weeks premature, adjusted age 3) number of days/weeks in incubator, intubated and/or on ventilator, or nasogastric tube -Medical history: admissions and lengths of hospitalizations for illness, disease, surgery, and medications -Developmental history considering important developmental milestones, times of achievement, and any difficulties/problems surrounding attainment -Parent interview to address the above, and the parent's perspective on developmental progress and/or concerns, home situation, family history, school history, support systems, and insurance coverage

Important components in the development of hand skills - Releasing skills

-Initially, involuntary dropping, then object is pulled out of one hand by the other hand -Development progresses from no release (0-1 months) to involuntary release (1-4 months) to two-stage transfer (5-6 months) to one-stage transfers (6-7 months) to voluntary release (7-9 months) -By 9 months, release by full arm extension -Refinement continues up to age four with the attainment of graded release

Rhomboids (major and minor)

-Innervated by the dorsal scapular nerve -Origin: C7-T5 spinous process -Insertion: spinous process -Function: downward rotation of scapula (both), scapula adduction (major)

Stage 4 cancer

-Inoperable primary lesion -Survival dependent on depth and extent of the tumor spread as well as the ability to have the tumor respond to therapy (mean 5 year survival rate is <5%) -Multiple metastases

Mandated Medicaid Services

-Inpatient and hospital services -Outpatient (eg. laboratory work, x-rays, skill nursing) and physician's services -Home health (level and amount of care can vary) -Early periodic screening diagnosis, and treatment services (EPSDT) for persons 21 years-old and younger -Services identified as needed to treat a condition during EPSDT (including OT) must be provided -SNFs receiving Medicaid must provide skilled rehabilitation services (including OT) to residents who require them

Controls training for body powered prosthetics - Teach manual control of turntable for internal or external rotation

-Instruction or intervention: unilateral - patient reaches over to rotate upper arm unit -Bilateral - patient pulls or pushes against a stationary object in that environment or with opposite prosthesis

Post-operative rehabilitation for cancer

-Intervention planning based on a client's medical status and blood value guidelines that can affect safety during activity (platelets, hemoglobin, etc) -Post-operative precautions related to structural changes from surgery: dependent on the location of the tumor and the procedure done (eg. if joint is replaced with an en bloc resection and shoulder indwelling prosthetic; abdominal precautions when the tumor is in the abdominal cavity; regional precautions when there is an incision near a joint, etc)

Important components in the development of hand skills - Carrying skills

-Involves a combination of movements of the shoulder, body and distal joints of the wrist and hand to hold the item, making appropriate adjustments as necessary to maintain this hold

Classification of Burns -Superficial (first degree burn)

-Involves the epidermis only -Minimal pain and edema, but not blisters -Healing time is 3 to 7 days

Irritants in autonomic dysreflexia

-Irritants that would normally cause pain to the areas below the spinal injury specific to the bowel: bowel irritation or over-distention; constipation/impaction; distention during bowel program (digital stimulation); hemorrhoids; infection or irritation (appendicitis) -Bladder infection or over distention: urinary tract infection (UTI); urinary retention; blocked catheter; overfilled urine collection bag; non-compliance with intermittent catheterization program -Skin-related disorders: any skin irritation below area of injury; decubitus ulcers; ingrown toenails; burns; tight or restrictive clothing or pressure to skin from clothing restrictions or wrinkles -Sexual activity: over-stimulation during sex (stimuli to the pelvic region that would be felt as pain if sensation were intact); menstrual cramps; labor and delivery -Other: heterotopic ossification/myositis ossificans; skeletal fracture

Medicare - OT in hospice care

-Is provided to persons who are certified as terminally ill (medical prognosis of fewer than 6 months to live) OT services are provided to enable a patient to maintain functional skills and ADL performance and/or to control symptoms

Intervention for stress incontinence

-Kegel exercises to strengthen pelvic floor -Timed routines for emptying bladder before it is full enough to cause spillage -Lifestyle adjustments to use incontinence supporting garments, for a socially acceptable solution and to decrease public attention to the incontinence -Medications may be used when the physician feels the client can tolerate the side effects of drug therapy support -Electric stimulation may be used if the client fits the parameters of recovery for the condition

Other system changes and adaptations in the older adult - Renal, urogenital changes

-Kidneys: loss of mass and total weight with nephron atrophy, decreased renal blood flow, decreased filtration - 1) blood urea rises 2) decreased excretory and re-absorptive capacities -Bladder: muscle weakness; decreased capacity causing urinary frequency; difficulty with emptying causing increased retention - 1) urinary incontinence common (affects over 10 million adults; over half of nursing home residents and one third of community dwelling elders); affects older women with pelvic floor weakness and older men with bladder or prostate disease 2) increased likelihood of urinary tract infections

Sensory impairment of the oral cavity causes...

-Lack of awareness of residual food on the side of the mouth that has decreased sensation -Pocketing of food -Spillage of residual food into the airway at a time when the vocal cords are open; timing of the swallow sequence is off

short-term memory loss

-Lack of registration and temporary storing of information received by various sensory modalities -Includes the loss of working memory

long-term memory loss

-Lack of storage, consolidation, and retention of information that has passed through working memory -Includes the inability to retrieve this information

Psychosocial development and major theorists - Lawrence Kohlberg: Stages of moral development

-Level 1, preconventional morality: occurs up until the age of 8: 1) stage 1, punishment and obedience - the child is obedient in order to avoid punishment 2) stage 2, instrumental relativism - the child makes moral choices based on the benefit to self and sometimes to others -Level 2, conventional morality: occurs at about 9 or 10 years of age: 1) stage 1, social conformity - the child desires to gain the approval of others 2) stage 2, law and order - rules and social norms are internalized -Level 3, postconventional morality: age range can vary, and not all will achieve this level (social contracts - the young adult has social awareness and an awareness of the legal implications of decisions/actions)

Sociological theories of aging

-Life experience/lifestyles influence aging process -Activity theory: older persons who are socially active exhibit improved adjustment to the aging process; allows continued role enactment essential for positive self-image and improved life satisfaction -Disengagement theory: distancing of an individual or withdrawal from society; reduction in social roles leads to further isolation and life dissatisfaction -Dependency: increasing reliance on others for meeting physical and emotional needs; focus is increasingly on self

Demographics, mortality and morbidity

-Life span: maximum survival potential, the inherent natural life of the species; in humans 110-120 years -Senscence: the weakening of the body at a gradual but steady pace during the last stages of adulthood through death -Life expectancy: the number of years of life expectation from year of birth - 1) 77.8 years in US women live 5.2 years longer than men 2) current trends are contributing to increased life expectancy (advances in health care, improved infectious disease control; advances in infant/child care, decreased mortality rates; improvements in nutrition and sanitation) -Categories of elderly: 1) young elderly - ages 65-74 2) old elderly - ages 75-84 3) old, old elderly or old and frail elderly - ages > 85 -Persons over 65: represent a rapidly growing segment with lengthening of life expectancy; currently 12.5% of US population; by year 2030, expected over 65 population will be 22% of US population -Socioeconomic factors: 1) half of all older women are widows; older men twice as likely to be married as older women 2) most live on fixed incomes: social security is the major source of income; poverty rate for persons over 65 is 11.4%; another 8% live near the poverty rate 3) about half of older persons have completed high school 4) non-institutionalized elderly: most live in family setting 5) institutionalized elderly: about 5% of persons over 65 reside in nursing homes; percentage increases dramatically with age (22% of persons over 85) -Leading causes of death (mortality) in persons over 65, in order of frequency: 1) coronary heart disease (CHD), accounts for 31% of deaths 2) cancer, accounts for 20% of deaths 3) cerebrovascular disease (stroke) 4) chronic obstructive pulmonary disease (COPD) 5) peumonia/flu -Leading causes of disability/chronic conditions (morbidity) in persons over 65, in order of frequency: 1) arthritis, 49% 2) hypertension, 37% 3) hearing impairments, 32% 4) heart impairments, 30% 5) cataracts and chronic sinusitis, 17% each 6) orthopedic impairments, 16% 7) diabetes and visual impairments, 9% each 8) most older persons (60-80%) report having one or more chronic conditions -Health care costs: 1) older persons account for 12% of population and 36% of total health care expenditures 2) older persons account for 33% of all hospital stays, 44% of all hospital days of care

Types of scleroderma

-Limited: skin involvement (with good prognosis); linear scleroderma (bands of thicker skin, with good prognosis) -Systemic: Systemic sclerosis of internal organs, which is life threatening; CREST syndrome with a good prognosis (calcinosis or calcium in the skin; Raynaud's phenomenon; esophageal dysfunction; sclerodactyl of fingers and toes; telagiectasis or red spots covering the hands, feet, forearms, face and hips); general morphea

Rancho Level 3

-Localized Response: Total Assistance -demonstrates withdrawal or vocalization to painful stimuli -turns toward or away from auditory stimuli -blinks when strong light crosses visual field -follows moving object passed within visual field -responds to discomfort by pulling tubes or restraints -responds inconsistently to simple commands -responses directly related to type of stimulus -may respond to some persons (family/friends) but not to others

Stage 2 cancer

-Localized spread of the tumor -Lesion is operable and can be removed with margins -Spread is limited and usually responds well to treatment (chemo/radiation/immunotherapy) -Mean 5 year survival rate is 50% plus or minus 5%

Stage 1 cancer

-Localized-Tumor present, no perceived spread of disease -Lesion operable -Prognosis good (70-90% mean survival at 5 years) -No spread of disease to the lymph nodes -No metastatic lesions

body scheme disorders

-Loss of awareness of body parts as well as the relationship of the body parts to each other & objects. -Includes body neglect and asomatognosia

Structures involved in Gastric Esophageal Reflux Disease (GERD)

-Lower esophageal sphincter and gastric sphincter: food enters stomach and mixes with stomach acid/digestive juices; lower esophageal sphincter inefficiently closes => stomach contraction propels acid/acidic bolus back into the esophagus -Person reports heartburn sensation, indigestion or dull chest pain -Positional elevation of the head above the stomach, when the person is reclined, may discourage upward retropulsion of the bolus from the stomach

Hand splinting design standards

-Maintain arches of the hand (proximal transverse arch; distal transverse arch; longitudinal arch) -Do not impinge upon creases of the hand (distal and proximal palmar creases; distal and proximal wrist creases; thenar crease

Skeletal system changes and adaptations in the older adult - Clinical implications

-Maintenance of weight bearing is important for cartilaginous/joint health and mobility -Increased risk of falls and fractures

Rehabilitation to treat Bell's palsy from Lyme disease

-Make a facial splint to prevent long term asymmetry of facial muscles (clip or pincer mold of the inside and outer lip of the mouth on the involved side, elastic attaching mouth mold to ear piece [similar to eyeglass ear rim]) -Use electric stimulation to stimulate denervated muscles -Teach person to use their fingers to assist buccal closure and prevent spillage of the bolus through the lips -Provide counseling concerning alteration in body image, since the individual is coping with a facial deformity

Prevention, early intervention and control for cancer

-Mammograms are recommended for women beginning at age 40, yearly after age 50 -Prostate and testicular exams are indicated for all adult males -Skin checks should be done regularly for people who have a family history of skin cancer or those who have a high exposure potential to the sun (construction workers, fishermen, etc) -Those with a family history of colon cancer should have screening and follow-up colonoscopies throughout adulthood and interventional colonoscopy if they are symptomatic -Women should have regular pap smears to detect vaginal/cervical/uterine cancer -Women who have a risk for ovarian cancer should be screened by blood test and abdominal ultrasound -Protecting/monitoring the environment -Avoiding contributory habits (health care professionals should coach people who want to quit or change habits)

Management Principles, Functions, and Strategies

-Management that has a positive attitude about change and innovation fosters best practice -Successful management supports open communication, team building, decentralization of resources, and the sharing of power -Management that utilizes strategic thinking in a systems model can respond proactively to market demands and changes -The use of different management styles (ie. the manager's characteristic way of performing management tasks) has a significant impact on productivity, change and growth -Management's understanding and application of theories of motivation and behavior facilitates appropriate and effective responses to situations, fosters program efficacy, and promotes employee satisfaction -Administrative functions of management include program development, fiscal and personnel management, and program evaluation -Management by Objective (MBO): a complete system of management based upon a core set of goals to be accomplished by a program - 1) mission and goals are established 2) measurable objectives are quantified 3) specific time frames for accomplishment of objectives are established 4) staff training needs and deterrents to progress are identified 5) program evaluation is instituted

Role of Occupational Therapy in elder abuse

-Mandatory reporting: 1) elder abuse per se may or may not be designated as a specific crime in a state; however, most physical, sexual, and financial/material abuse are crimes in all states 2) healthcare workers are required to report suspected or observed cases of elder abuse 3) failure to report may be considered a crime 4) in most states Adult Protective Services, the area Agency on Aging, or the county Department of Social Services is designated to provide investigation and services -Occupational therapy intervention: 1) treat for physical and emotional injuries 2) develop a trusting relationship 3) assist in developing a support system 4) refer to appropriate disciplines and/or agencies

Role of Occupational therapy in child abuse

-Mandatory reporting: 1) the Child Abuse Prevention and Treatment Act (CAPTA) was originally passed in 1974 and most recently amended in October of 1996 2) all states must have child abuse and neglect reporting laws to qualify for federal funding under CAPTA 3) all states require reporting of known or suspected cases of child abuse or neglect by healthcare providers. Standard or reporting may vary 4) failure to report suspected child abuse may be considered a crime 5) in most states, good faith reporting is immune from liability 6) all states require reporting to be made to a law enforcement agency or child protective services -Occupational therapy intervention: 1) treat physical injuries, emotional injuries, and developmental delays 2) develop a trusting relationship with child and non-abusive caregivers 3) provide support to non-abusive caregivers 4) refer to appropriate disciplines and agencies

Overview and contributing factors to poor nutrition in the elderly

-Many older adults have primary nutrition problems. -Nutritional problems in the elderly are often linked to health status and poverty rather than to age itself: 1) chronic diseases alter the overall need for nutrients, the abilities to take in and utilize nutrients, energy demands, and overall activity levels (eg. Alzheimer's disease, CVA, and diabetes) 2) limited, fixed incomes severely limit food choices and availability -There is an age-related slowing in basal metabolic rate and a decline in total caloric intake; most of the decline is associated with a concurrent reduction in physical activity (both undernourishment and obesity exist in the elderly and contribute to decreased levels of vitality and fitness) -Contributing factors to poor dietary intake: 1) decreased sense of taste and smell 2) poor teeth or poorly fitting dentures 3) reduced gastrointestinal function (decreased saliva; gastromucosal atrophy; reduced intestinal mobility; reflux) 4) loss of interest in foods 5) isolation, lack of social support, no socialization during meals, loss of spouse, loss of friends 6) lack of functional mobility (inability to get to a grocery store to shop; inability to prepare foods)

Psychosocial development and major theorists - Abraham Maslow

-Maslow developed a hierarchy of basic human needs, proposing that if the lower-level needs are not met, the individual is unable to work on higher-level pursuits -Philosophic: basic survival needs (ie. good, water, rest warmth) -Safety: the need for physical and physiologic security -Love and belonging: the need for affection, emotional support and group affiliation -Self-esteem: the need to believe in one's self as a competent and valuable member of society -Self-actualization: the need to achieve one's personal goals,after attaining all of the psychosocial developmental milestones

Flexible endoscopic esophageal swallow (FEES)

-May be done at bedside or in an office setting -Food consistencies are laced with green food coloring -A flexible endoscopic catheter containing a miniature video camera is passed through the nasal cavity into the pharyngeal cavity -The person is given a variety of consistencies to swallow and observation is made to determine whether the swallow is intact or impaired -Sensation for light touch in the pharyngeal cavity can be tested by forcing air through the endoscopic tube generating a light touch stimulus

Hypertrophic scars from burns

-Most common with deep second and third degree burns -Appears six to eight weeks after wound closure -One to two years to mature -Compression garments should be worn 24 hours daily: 1) applied when wounds are healed 2) recommendation is to wear 24 hours a day for 1-2 years until scare is matured -Additional intervention include ROM, skin care, ADL, role activities, and patient/family education

Impact of kidney disease on performance components/skills/client factors

-Motor dysfunction: fatigue; muscle pain; edema limiting mobility; weakness -Sensory system function: neuropathy/vision loss (diabetes/drug related) -Cognitive dysfunction: alteration of body image due to dialysis (tied to equipment/schedule) or post transplant (foreign tissue); delusions due to sepsis or toxicity; dementia, multi-infarct or metabolic -Perceptual/neurobehavioral dysfunction: dementia/infarct related;stroke related -Psychological/emotional dysfunction: mood/adjustment disorder; poor management of pyschosocial disorders can increase the risk of cardiac arrest; supportive counseling and social support are indicated; drug therapy and complementary medicine

Muscular system changes and adaptation in the older adult - Clinical implications

-Movements become slower -Increased complaints of fatigue -Connective tissue becomes denser and stiffer: 1) increased risk of muscle sprains, strains, and tendon tears 2) loss of range of motion: highly variable by joint and individual's activity level 3) increased tendency for fibrinous adhesions, contractures -Decreased functional mobility, limitations to movement -Gait may become unsteady due to changes in balance, strength; increased need for assistive devices -Increased risk of falls

Antideformit positions following burn injury

-Neck: neutral to slight extension -Chest/abdomen: trunk extension and scapula retraction -Axilla: shoulder abduction 90 degrees and external rotation (airplane splint) -Elbow: extension -Forearm: neutral to supination -Wrist: 30-45 degrees extension -Hand: MCPs 70 degree flexion, IP extension, and thumb abducted -Knee: knee extension, anterior burn, mild flexion -Ankle: 5 degree dorsiflexion

Interventions for participation problems for the rehabilitation for immunological system disorders

-Needs assessment to determine individual issues the person has with mobility, social, or political access to their personal, home or community environments -Identification and facilitation of procurement of system changes to allow person access and ability to participate as a contributing member of society

OT developmental evaluation - Assessment of Newborn, infant, and child

-Neurological status: 1) state of consciousness 2) testing of reflex integration 3) muscle tone -Musculoskeletal status: 1) skeletal status including extremity and spine deformities 2) range of motion status 3) posture at rest and posture during active movement 4) evaluation and intervention for musculoskeletal dysfunction -Developmental assessments: there are many published tools that measure neonate, infant and child development

Complications with amputations

-Neuromas: nerve endings adhered to scar tissue (these can be very painful and hypersensitive) -Skin breakdown -Phantom limb syndrome: sensation of the presence of the amputated limb -Phantom limb pain: sensation of the presence of the amputated limb but is also painful -Infection -Knee flexion contractures in transtibial amputation -Psychological impairments due to shock/grief

Racho Level 1

-No Response : Total Assistance complete absence of observable change in behavior when presented visual, auditory, tactile, proprioception, vestibular, or painful

Cognitive changes and adaptations in the older adult - Age-related changes

-No uniform decline in intellectual abilities throughout adulthood: 1) changes do not typically show up until mid 60s; significant declines affecting everyday life do not show up until early 80s 2) most significant decline in measures of intelligence occurs in the years immediately preceding death (termed terminal drop) -Tasks involving perceptual speed show early declines (by age 39); require longer times to complete tasks -Numeric ability (tests of adding, subtracting, and multiplying): abilities peak in mid-40s, well maintained until 60s -Verbal ability: abilities peak at age 30, well maintained until 60s -Memory: 1) impairments are typically noted in short-term memory; long-term memory retained 2) impairments are task dependent, eg. deficits primarily with novel conditions, new learning -Learning: all age groups can learn. Factors affecting learning in older adults: 1) increased cautiousness 2) anxiety 3) sensory deficits 4) pace of learning - fast pace is problematic 5) interference from prior learning

Assessment tools

-Observation -Interviews -Self-report -Checklists -Rating scales -Goal-attainment scaling -Performance tests -Norm-referenced assessments (compare to the scores to a set population's performance) -Criterion-referenced assessments (compare performance to preestablished criterion)

Occupational therapy evaluation for arthritis

-Occupational role requirements and expectations -ROM (focus on AROM): 1) PROM should be avoided, especially in the inflammatory stage 2) note deformities and nodules -Muscle strength: 1) avoid muscle testing unless requested by physician 2) document strength in relation to function -Grip strength: use sphygmomanometer -ADL and role activities: note if ADL and role activity deficits are related to pain, limitation in motion, deformity, weakness, or fatigue -Pain: use pain scales -Edema: volumeter or tape measure

Optional Medicaid Services

-Occupational therapy, physical therapy, speech language therapy -Durable medical equipment -Services provided by independently practicing licensed professionals including psychologists, psychiatric social workers, and other mental health professionals -Targeted case management -Prescription medication -Dental care, eyeglasses -Crisis response services -Transportation -Psychiatric inpatient services for persons aged under 21 or over 65 -Related services (including OT) provided by school systems to children with disabilities (note: this provision overlaps IDEA legislation and has led to questioning as to whether services to individual children should be funded as an educational or a health care service)

General Principles of Motor Development

-Occurs in a cephalocaudal/proximal to distal direction-Progresses from gross to fine movement -Progresses from stability to controlled mobility -Occurs in a spiraling manner, with periods of equilibrium and disequilibrium -Sensitive periods occur when the infant/child is affected by environmental input

Sensory system changes and adaptations in the older adult - Age-related changes

-Older adults experience a loss of function of the senses: 1) may lead to sensory deprivation, isolation, disorientation, confusion, appearance of senility and depression 2) may strain social interactions and decrease ability to interact socially and with the environment 3) may lead to decreased functional mobility and increased risk of injury 4) alters quality of life -Vision: there is a general decline in visual acuity; gradual prior to sixth decade, rapid decline between ages 60 and 90; visual loss may be as much as 80% by age 90 -Hearing: occur as early as fourth decade; affects a significant number of elderly (23% of individuals aged 65-74 have hearing impairments and 40% over age 75 have hearing loss; rate of loss in men is twice the rate of women, also starts earlier -Vestibular/balance control: degenerative changes in otoconia of utricle and saccule; loss of vestibular hair-cell receptors; decreased number of vestibular neurons; VOR gain decreases; begins at age 30, accelerating decline at ages 55-60 resulting in diminished vestibular sensation -Somatosensory: 1) decreased sensitivity of touch associated with decline of peripheral receptors, atrophy of afferent fibers- lower extremities more affected than upper 2) proprioceptive losses, increased thresholds in vibratory sensibility, beginning around age 50 - greater in lower extremities than upper extremities, greater in distal extremities than proximal 3) loss of joint receptor sensitivity; losses in lower extremities, cervical joints may contribute to loss of balance 4) cutaneous pain thresholds increased; greater changes in upper body areas (upper extremities, face) than for lower extremities -Taste and smell: 1) gradual decrease in taste sensitivity 2) decreased smell sensitivity

Cognitive changes and adaptations in the older adult - Clinical implications

-Older adults utilize different strategies for memory: context-based strategies vs. memorization (young adults)

Structures involved in dysphagia and swallowing disorders

-Oral facial musculature -Pharyngeal and laryngeal structures -Piriform sinuses -Vocal folds -Bronchioles/bronchi -Lungs -Esophagus

Important components in the development of hand skills - Pre-writing skills

-Palmar-supinate grasp: held with fisted hand, wrist slightly flexed and slightly supinated away from mid-position; arm moves as a unit (1-1 1/2 years) -Digital-pronate grasp: held with fingers, wrist neutral with slight ulnar deviation, and forearm pronated; arm moves as a unit (2-3 years) -Static tripod posture: held with crude approximation of thumb, index, and middle fingers, ring and little fingers only slightly flexed, grasped proximally with continual adjustments by other hand, no fine localized movements of digit components; hand moves as a unit (3 1/2-4 years) -Dynamic tripod posture: held with precise opposition of distal phalanges of thumb, index, and middle fingers, ring and little fingers flexed to form a stable arch, wrist slightly extended, grasped distally, MCP joints stabilized during fine, localized movements of PIP joints (4 1/2-6 years)

Self-care development - Feeding: Evaluation of feeding

-Parent interview including parent's concerns, feeding history, behavior during feeding, weight gain or loss -Medical and developmental history -Observation of feeding including postural control, oral sensitivity, motor control of the jaw, lip, tongue, cheek, and coordination and endurance of all -Recommendation for videofluoroscopy swallow study especially if the child has a high risk of aspiration

Early mobilization programs for flexor tendons - Duran

-Passive flexion and extension of digit -Protocol: 1) 0-4 1/2 weeks - dorsal blocking splint. Exercises in splint include passive flexion of PIP joint, DIP joint and to DPC. 10 reps every hour 2) 4 1/2-6 weeks - active flexion and extension within limits of splint 3) 6-8 weeks - tendon gliding and differential tendon gliding, scar management, light ADL and role activities 4) 8-12 weeks - strengthening and work activities

Pain - Definition

-Personal sensation of hurt that can significantly affect an individual's quality of life

Sequelae of scleroderma and recommendations

-Poor circulation, as in Raynaud's phenomenon: 1) use of dressing in layers of clothing and clothing style modifications for neutral warmth; 2) biofeedback (guided imagery to concentrate on improving distal circulation); 3) education to encourage skin inspection; 4) activity modifications to prevent trauma to fingers and toes -Contractures: 1) splinting at optimal resting length for hands/wrists to attempt to slow progressive development of contractures; 2) use of silicone gel in the palms of the hands; 3) use of electrical/mechanical vibration to decrease burning sensation in hands -Facial disfigurement and alteration in body image and self-identity: "look good/feel better" programs; support groups in person and online -Thoracic spinal lesions can result in paraparesis, neurogenic bowel/bladder, altered mobility, altered activity of daily living activities: 1) neuro rehabilitation and 2) biomechanical approaches is indicated -Space occupying lesions in the brain produce stroke-like symptoms: 1) rehabilitation for functional deficits

Signs and symptoms of neglect

-Poorly nourished appearance or inadequately clothed -Consistently tired or listless behavior -Inconsistent attendance in school -Poor hygiene or obsession with cleanliness -Left alone in dangerous situations, for long periods of time and/or at an inappropriate young age -Unable to relate well to adults or form friendships

Skeletal system changes and adaptations in the older adult - Strategies to slow or reverse changes

-Postural exercises: stress components of good posture -Weight bearing (gravity-loading) exercise can decrease bone loss in older adults, eg. walking, stair climbing, all activities that are performed in standing -Nutritional, hormonal and medical therapies

Pre-operative rehabilitation for cancer

-Pre-operative functional assessments and preparation of the client for post-operative phase and care -Client and caregiver education concerning recover and follow up care/functional expectations and client engagement

Reflex development and integration

-Predictable motor response elicited by tactile, proprioceptive, or vestibular stimulation -Primitive reflexes are present at or just after birth & typically integrate throughout the first year -Persistence/ re-emergence of primitive reflexes are indicative of CNS dysfunction- may interfere w/ motor milestone attainment, patterns of mvmt, musculoskeletal align, & fx

Respiratory Distress Syndrome (RDS):

-Premature birth - Insufficient production of surfactant to keep alveoli (air pockets of the lungs) open -Lunge collapse after each breath

Important components in the development of hand skills - Scissor use skills

-Prerequisite skills for scissors use include the ability to: 1) open and close a hand 2) isolate or combine the movements of the thumb, index and middle fingers 3) Use hand bilaterally; one hand to use the scissors, one to stabilize the item being cut 4) coordinate arm, hand, and eye movements 5) stabilize the wrist, elbow, and shoulder joints so that movement can occur at the distal joints 6) interact with the environment in the constructive developmental play stages -Stages of development in scissor use, the child sequentially; 1) shows an interest in scissors, 2-3 years 2) holds and snips with scissors, 2-3 years 3) opens and closes scissors in a controlled fashion, 2-3 years 4) manipulates scissors in a forward motion, 3-4 years 5) coordinates the lateral direction of the scissors, 3-4 years 6) cuts a straight forward line, 3-4 years 7) cuts simple geometric shapes, 3-4 years 8) cuts circles, 3 1/2-4 1/2 years 9) cuts simple figure shapes, 4-6 years 10) cuts complex figure shapes, 6-7 years

Etiology and risk factors of decubitus ulcers

-Pressure that interrupts normal circulation causing localized areas of cellular necrosis: greatest risk is over bony prominences (eg. ischial tuberosity); intensity and duration of the pressure determines the severity of the decubiti -Conditions that predispose an individual to the formation of decubitus ulcers include immobility or altered mobility, weight loss, edema, incontinence, obesity, pathological conditions, and/or changes in skin condition due to aging -The presence of substance abuse, cognitive deficits, and/or psychological impairments can jeopardize the individual's ability to understand and complete the required daily decubitus prevention regimen

Intervention for decubitus ulcers

-Prevention is the most effective intervention -Use wheelchair cushions, floatation pads, and pressure-relief bed aids to distribute pressure over a larger skin surface -Train the individual and/or caregivers in positioning and weight-shifting techniques and schedules and in proper skin care: full push-ups, lateral leans, forward leans, or wheelchair tilt/recline options are common techniques used depending upon the abilities of the individual; weight shifts should occur every 30 minutes for 30 seconds or every 60 minutes for 60 seconds; integrate weight-shifting into daily activities (eg. lean forward to pick up the phone, lean sideways when reading the mail) -Train in proper skin care: keep skin free of excessive moisture, dryness and heat; check skin at least two times per day for any evidence of breakdown (most individuals perform this in bed in the morning before arising and in the evening before sleep; target for inspection the scapula, elbows, ischia, sacrum/coccyx, trochanters, heels, ankles, and knees) -Encourage adequate intake of fluids and food to maintain nutrition, promote healing, and achieve a recommended body weight -Medical management including occlusive dressings, debridement, surgery and/or grafting may be needed depending upon the severity of the decubitus ulcer -Encourage participation in meaningful and productive activities: individuals who pursue active lifestyles have fewer decubiti

Treatment for renal disease

-Prevention, early intervention, and control of hypertension through diet, medication, exercise, stress reduction and smoking cessation -Prevention, early intervention and control of diabetes

Rehabilitation for diabetes

-Preventive exercise -Education concerning compliance and need for medical management of condition -Psychological and emotional support to improve self care habits -Lifestyle readjustment to complications when and if they occur: low vision; safety assessment and intervention; physical adaptations -Protective issues regarding peripheral neuropathy: safety assessment; education concerning risk associated with sensory loss; skin care; pain management; adapted equipment/techniques to facilitate participation in lifestyle; instrumental activities supporting compliance of self management -Early attention to wound management: teach skin care and inspection techniques; teach person to self advocate quickly when changes are observed -Assistance in problem solving and modifying self care as changes occur in the medical status of the condition: problem solve resources for specialized treatment; teach person to recognize changes in their functional status that warrant further attention and intervention

Self-care development - Feeding: Oral-motor development

-Prior to 33 weeks of gestation an infant is fed by non-oral means -35 weeks of gestation or after: jaw and tongue movements are strong enough to allow for feeding -40 weeks of gestation: rooting reflexes, gag and cough reflex are present for up to four months, protecting the airway and decreasing the chances of aspiration -4-5 months: munching occurs consisting of a phasic bite and release of a soft cookie -6 months: strong up and down movement of the tongue -7-8 months: beginning of mastication of soft and mash foods with diagonal jaw movement -9 months: lateral tongue movements make mastication of soft and mashed foods effective, able to drink from a cup; however, jaw is not firm -12 months: jaw is firm; there is rotary chewing allowing for a good bit on a hard cookie -24 months: able to chew most meats and raw vegetables

Lifespan and Occupational Therapy Developmental Theorists - Havighurst

-Proposed that people need to develop certain skills at different ages to meet social standards -Believed that these developmental tasks rely on biological, psychological, and sociological conditions: 1) proposed that there are certain sensitive periods, when biological, psychological, and sociological conditions are optimal for the accomplishment of a developmental task 2) described "teachable moments", referring to the sensitive periods when conditions are optimal for integration of previous knowledge and the accomplishment of new developmental task with assistance -Six stages of development are described along with specific developmental tasks for each stage (infancy and childhood; middle childhood; adolescence; early adulthood; middle adulthood; and later adulthood) -In current society, the tasks of some stages may occur later than described by Havinghurst

Drug therapy for HIV

-Protease inhibitors work to suppress the viral load in the bloodstream: must be take consistently on time or effectiveness is lost; has shown a dramatic change in the management, treatment and survival of person with a diagnosis of HIV/AIDS -Chemotherapy: less effective than protease inhibitors; loaded with side effects (specific to drugs used); drugs used related to neoplastic process observed (examples include Kaposi's sarcoma, lymphoma); drugs used to treat Hodgkin's (highly differentiated type, non-differentiated type); drugs used to treat opportunistic infections (examples include Foscarnet)

Rehabilitation to treat joint pain and swelling from Lyme disease

-Provide education regarding acute arthritic flares: rest; anti-inflammatory medicine compliance; splinting or wrapping to protect inflamed joints and prevent overstretching of large joints; teach energy conservation and work simplification -Following flare in sub-acute phase, provide gradual re-introduction of normal performance of daily tasks and activities

Intervention for dysphagia and swallowing disorders

-Provide family-centered intervention to determine an acceptable dinner table alternative to interaction -Work with person toward developing new roles and occupations to transition from old role (ie. head of table) -Provide ongoing education and information to family regarding person's feeding/nutrition

Rancho Level 10

-Purposeful, Appropriate: Modified Independent -able to handle multiple tasks simultaneously in all environments but may require periodic breaks -able to independently procure, create, and maintain own assistive memory devices -independently initiates and carries out steps to complete familiar and unfamiliar personal, household, community, work and leisure tasks but may require more than usual amount of time and/or compensatory strategies to complete -anticipates impact of impairments and disabilities on ability to complete daily living tasks and takes action to avoid problems before they occur but may require more than usual amount of time and/or compensatory strategies -able to independently think about consequences of decisions or actions but may require more than usual amount of time and/or compensatory strategies to select the appropriate decision or action -accurately estimates abilities and independently adjusts to task demands -able to recognize the needs and feelings of others and automatically respond in appropriate manner -periodic periods of depression may occur -irritability and low frustration tolerance when sick, fatigued and/or under emotional stress -social interaction behavior is consistently appropriate

Rancho Level 9

-Purposeful, Appropriate: Stand by Assist on Request -independently shifts back and forth between tasks and completes them accurately for at least two consecutive hours -uses assistive memory devices to recall daily schedule, to do list, and record critical information for later use with assistance when requested -initiates and carries out steps to complete familiar personal, household, work and leisure tasks independently and unfamiliar personal, household, work and leisure tasks with assistance when requested -aware of and acknowledges impairments and disabilities when they interfere with task completion and task appropriate corrective action but requires stand by assist to anticipate problem before it occurs and take action to avoid it -able to think about consequences of decisions or actions with assistance when requested -accurately estimates abilities but requires stand by assist to adjust to task demands -acknowledges others' needs and feelings and responds appropriately with stand by assist -depression may continue -may be easily irritable -may have low frustration tolerance -able to self monitor appropriateness of social interaction with stand by assist

Rancho Level 8

-Purposeful, Appropriate: Stand by Assistance -consistently oriented to person, place, and time -independently attends to and completes familiar tasks for 1 hour in distracting environments -able to recall and integrate past and recent events -uses assistive memory devices to recall daily schedule, to do list and record critical information for later use with stand by assist -initiates and carries out steps to complete familiar personal, household, community, work and leisure routines with stand by assist and can modify the plan when needed with min assist -requires no assistance once new tasks are learned -aware of and acknowledges impairments and disabilities when they interefere with task completion but requires stand by assist to take appropriate corrective action -thinks about consequences of a decision or action with min assist -overestimates or underestimates abilities -acknowledges other's needs and feelings and responds appropriately with min assist -depressed -irritable -low frustration tolerance/ easily angered -argumentative -self centered -uncharacteristically dependent/independent -able to recognize and acknowledge inapprorpaite social interaction behavior while it is occuring and takes corrective action with min assist

Tendon repairs

-Rationale for early mobilization: 1) prevents adhesion formation 2) facilitates wound/tendon healing -Occupational therapy goals: 1) increase tendon excursion 2) improve strength at repair site 3) increase joint ROM 4) prevent adhesions 5) facilitate resumption of meaningful roles, occupations, and activities

Intervention for scleroderma

-Raynaud's phenomenon: : keep fingers and toes warm; dress in layers; drug therapy, biofeedback -Pulmonary artery problems: drug therapy; oxygen (nasal) -Gastrointestinal problems: soft diet, avoidance of alcoholic beverages and spicy foods); treatment of infection with drug therapy -Fibrosis of the skin: protective gloves (cotton, insulated, mildly compressive) and drug therapy -Myositis (inflammatory muscle disease): cessation of exercise and drug therapy -Fibrosis of the lungs: drug therapy

Important components in the development of hand skills

-Reaching skills -Grasping skills according to Erhardt Prehension Developmental Levels -Releasing skills -Carrying skills -Bilateral hand use -Manipulating skills according to Exner's Classification System -Pre-writing skills -Scissor use skills

Lifespan and Occupational Therapy Developmental Theorists - Anne Mosey

-Recapitulations of ontogenesis frame of reference -The development of adaptive skills, essential learned behaviors, is considered critical for successful participation in occupational performance -Six major adaptive skills along with subskills are delineated (sensory integration of vestibular, proprioceptive, and tactile information for functional use; cognitive skill; dyadic interaction skill; group interaction skill; self-identity skill; sexual identity skill)

Prevention of diabetes

-Regular physical activity may reduce the risk of type 2 diabetes -Maintaining normal body weight may be preventitive

Convalescence rehabilitation for cancer

-Rehabilitation of motor impairments -Rehabilitation of sensory impairments -Rehabilitation of cognitive impairments -Rehabilitation of neurobehavioral impairments -Psychological support to enhance coping ability during recovery from cancer treatment phase: liminality (self recognition of vulnerability and self sense of mortality); occupational role and body image adjustment; obtainment of social support -Development of health supporting behaviors (screening, follow-up, diet, exercise, stress management, vocational skill support or assistance to change job skills)

Purpose of splinting

-Rest -Prevent deformities and contractures -Increase joint ROM -Protect bone, joint, and soft tissue -Increase functional use -decrease pain -restrict ROM

Human immunodeficiency virus (HIV) infection

-Retrovirus: the RNA of the virus combines with recombinant RNA of human cells; the new DNA has 1 strand of normal RNA/1 strand of virus; the virus can eclipse into the cell, remaining dormant until stimulated by the body -HIV attacks the lymphatic system (the system that protects the body's immunity to opportunistic infections); the T-cells (also known as CD4+ cells) attack the cells of the body including central nervous system cells, gastrointestinal tract cells, uterine/cervical cells

Scleroderma

-Rheumatic, connective tissue disease associated with impaired immune system -Etiology: unknown -Main components: 1) vascular (Raynaud's phenomenon; constant recurrent constriction of small blood vessels leading to pulmonary hypertension; 2) decreased esophageal motility); 3) fibrotic (scar tissue resulting from excess collagen (protein) causing thickness of skin and a burning sensation in the skin; 4) fibrosis of the lungs causing restrictive lung disease); autoimmunity (B cell-produced antibodies [anti-centromere, anti-topisomerase I antibodies])

Skier's Thumb (Gamekeeper's Thumb)

-Rupture of the ulnar collateral ligament of the MCP joint of the thumb -Etiology: fall on extended thumb -Occupational therapy intervention: conservative treatment including 1) a thumb splint (for 4 to 6 weeks) 2) AROM and pinch strengthening (at 6 weeks) 3) focus on ADL that require opposition and pinch strength 4) post-operative treatment includes 1) thumb splint for 6 weeks, 2) AROM, PROM can begin at 8 weeks and strengthening at 10 weeks

Rehabilitation to treat numbness from Lyme disease

-Safety assessment and interventions to preserve safety and prevent injury -Management of aesthesias that are perceived as painful -Occupation-based interventions to encourage and preserve function and to cope with chronic pain condition

Interventions for community-based care rehabilitation for immunological system disorders

-School related: transition from home schooling back to school for child returning; transition of having student return to class for the classmates -Work related: participatory as per Americans with Disabilities Act (ADA) -Population-related intervention: coalition-related and grant initiatives for prevention and outreach programs

Classification of Burns - Superficial partial thickness burn

-Second degree burns involve the epidermis and upper portion of dermis (eg. sunburn) -Appearance: red, blistering, and wet -Painful, no grafting necessary, heals on its own -Healing time is 7 to 21 days

Interventions for activity level problems for the rehabilitation for immunological system disorders

-Self care: adaptations and training to do self care tasks with greatest ease while conserving energy (for example for an individual with scleroderma alter grasp and pinch patterns and level of demand and upper extremity demand; alter size of feeding utensils and tooth brushes to accommodate decreased ability to open mouth; prevent shearing forces on skin during specific personal activities of daily living tasks) -Work: work capacity evaluations; modification to work site to allow participation in component task and activities; counseling and intervention for transition to disability status when work is no longer possible -Leisure/sport: modify specific tasks and activities (eg. to protect body parts involved by sclerodermic changes); evaluate interests and skills to introduce new leisure or sports activities of interest to the person to transition to less physically demanding tasks as a disease progresses -Rest: monitor and intervene to maximize the ability to be well positioned during sleep; monitor sleep habits and patterns and intervene when strategies are needed to relax and unwind or to schedule time and opportunity for relaxation

Rehabilitations issues of small bowel obstruction

-Self-care aspects of stoma care must be addressed for persons with decreased fine motor skills (eg. individuals with peripheral neuropathy secondary to chemotherapy treatment) -Decrease mobility of gross movements that cause traction on the healing scar: bending, stooping, foot/lower leg related self-care (dressing, bathing, nail and foot care) -Altered appetite in post-operative phase

Cognitive Development - Jean Piaget: Hierarchical development of cognition

-Sensorimotor period (ages birth to 2 years): 1) reflexive stage - schemes begin in response to reflexes (1 month) 2) primary circular reacting - child learns about cause and effect as a result of reflexive sensorimotor patterns that are repeated for enjoyment (2 to 4 months) 3) secondary circular reaction - voluntary movement patterns emerge due to coordination of vision and hand function, and an early awareness of cause and effect develops (5 to 8 months) 4) coordination of secondary schemata - voluntary movement in response to stimuli that cannot be seen as in object permanence, and early development of decentered thought (9 to 12 months) 5) tertiary circular reactions - the child seeks out new schemes, with improved gross and fine motor abilities; tool use begins (12 to 18 months) 6) inventions of new means through mental combinations - the child demonstrates insight and purposeful tool use, and explores problem solving options. The ability to represent concepts without direct manipulation emerges (18 months to 2 years 7) child progresses from reflexive activity to mental representation to cognitive functions of combining and manipulating objects in play -Preoperational period (ages 2 to 7 years): 1) classification - categorizing objects according to similarities and differences 2) seriation - the relationship of one object or classification of objects to another 3) conservation - the end product of the preoperational period. The child is able to recognize the continuities of an object or class of objects in spite of apparent changes 4) the preoperational period is divided into two phases - preconceptual the child expands vocabulary and symbolic representations ( 2 to 4 years) and intuitive thought phase, the child imitates, copies or repeats what is seen or heard and bases conclusions on what he/she believes to be true rather than on logic. Inductive reasoning denotes a transition to the next stage (4 to 7 years) 5) Child progresses from dependence on perception, as opposed to logic, and egocentric orientation to logical thought, for solving problems. Child enjoys verbal play -Concrete operations (ages 7 to 11 years): 1) reversibility - an expansion of conservation, leads to increased spatial awareness 2) rules - as rules are better understood, they are also applied 3) Empirico-inductive thinking - the child solves problems with the information that is obvious and present 4) child uses logical thinking on observed or mentally represented objects, enjoying games with rules which help the child adjust to social demands -Formal operations, (ages 11 through the teen years): 1) hypothetico-deductive thinking, the ability to analyze and plan 2) child uses logic to hypothesize many ways to solve problems, and can draw from past and present experiences to imagine what can have an effect on future situations

Peripheral nerve injuries - Radial nerve laceration

-Sensory loss high lesions at the level of the humerus: medical aspect of dorsal forearm. Radial aspect of dorsal palm, thumb, and index, middle and radial 1/2 of ring phalanges -Motor loss low lesion at the level of the forearm: 1) loss of wrist extension due to absent or impaired innervation to ECU 2) EDC, EI, EDM (MCP extension) 3) EPB, EPL, APL (thumb extension) -Motor loss high lesion at the level of the humerus: 1) all the above, including ECRB, ECRL, and brachioradialis 2) if level of the axilla, loss of triceps (elbow extension) -Functional loss: 1) inability to extend digits to release objects 2) difficulty manipulating objects -Deformity: wrist drop -Occupational therapy intervention: 1) dynamic extension splint 2) ROM 3) sensory reeducation if needed 4) instruct in home program 5) activity modification

Peripheral nerve injuries - Median nerve laceration

-Sensory loss: 1) central palm (thumb to radial 1/2 of ring finger) 2) palmar surface of thumb, index, middle, and radial 1/2 of ring fingers 3) dorsal surface of index, middle, and radial 1/2 of ring fingers (middle and distal phalanges) -Motor loss for a low lesion at the wrist: 1) lumbricals I and II (MCP flexion of digits II and III) 2) opponens pollicis (opposition) 3) abductor pollicis brevis (abduction) 4) flexor pollicis brevis (flexion of thumb MCP) -Motor loss for high lesion at or proximal to the elbow: 1) same as for low lesion at wrist 2) FDP to index and middle fingers, and FPL (flexion of tip of index, middle fingers, and thumb) 3) FCR (inability to flex to radial aspect of wrist) -Deformity: 1) flattening of thenar eminence, "ape hand" 2) clawing of index and middle fingers for a low lesion 3) benediction sign for a high-lesion -Functional loss: 1) loss of thumb opposition 2) weakness of pinch -Occupational therapy intervention: 1) dorsal protection splint with wrist positioned in 30 degree flexion if a low lesion. Include elbow (90 degree flexion) if a high lesion 2) begin A/PROM of digits with wrist in flexed position at two weeks post-operative 3) scar management 4) AROM of wrist 4 weeks; include elbow if a high lesion 5) begin strengthening at 9 weeks -Splinting consideration: C-bar to prevent thumb adduction contracture -Sensory reeducation: begin when individual demonstrates a level of diminished protective sensation (4.31) on Semmes-Weinstein

Peripheral nerve injuries - Ulnar nerve laceration

-Sensory loss: 1) ulnar aspects of palmar and dorsal surfaces 2) ulnar 1/2 of ring and little fingers on palmar and dorsal surfaces -Motor loss for low lesion at the wrist: 1) palmar and dorsal interossei (adduction and abduction of MCP joints) 2) Lumbricals III and IV (MCP flexion of digits 4 and 5) 3) FPB and adductor pollicis (flexion and adduction of tumb) 4) ADM, ODM, FDM (abduction, opposition, and flexion of 5th digit) -Motor loss for high lesion wrist or above: 1) same as with low lesion, including FCU (flexion towards ulnar wrist) 2) FDP IV and V (flexion of DIPs of ring and little fingers) -Deformity: 1) claw hand 2) flattened metacarpal arch 3) + Froment's sign (assessment of thumb adductor while laterally pinching paper) -Functional loss: 1) loss of power grip 2) decreased pinch strength -Occupational therapy intervention: 1) similar to median nerve repair 2) splinting consideration - MCP flexion block splint 3) sensory reeducation - same as median nerve

Intervention for GERD

-Sleeping with more than one pillow (elevating the head to discourage regurgitation associated with body posture) -Drug therapy -Diet modification: less spice; small meals on more frequent basis -Stress management

Occupational therapy intervention for arthritis

-Splinting: 1) resting hand splints in the acute stage 2) wrist splint only if arthritis specific to wrist 3) ulnar drift splint to prevent deformity 4) silver ring splints to prevent boutonniere and swan neck deformities 5) dynamic MCP extension splint with radial pull for post-operative MCP arthroplasties 6) hand base thumb splint for CMC arthritis -Joint protection techniques -Energy conservation techniques -ROM (focus on AROM): 1) gentle PROM if person unable to perform AROM 2) all exercises should be pain free -Heat modalities: 1) hot packs can be used before exercise 2) paraffin is recommended for the hands -Strengthening: 1) avoid during inflammatory stage 2) gentle strengthening while avoiding positions of deformity -ADL and role activities: 1) joint protection and energy conservation techniques should be incorporated 2) adaptive equipment should be provided to prevent deformity, decrease stress on small joints, and extend reach

Clinical exams and functional findings for dysphagia and swallowing disorders

-Staff report questioning swallowing dysfunction: person coughs during or after drinking water or other thin liquid -The person's face changes color during or after eating: flushed/reddened color, ashen appearance for persons with darker skin; blanches -Person gasps for breath, but has a partial or complete airway obstruction: to clear the obstruction and raise the bolus that has been aspirated, the Heimlich maneuver is used as long as the person is awake and responsive; if the person loses consciousness, basic life support procedures are used to continue to try to reestablish airway -- this includes abdominal thrusts and back blows, plus periodically looking in the oral cavity to try to visualize the object, if visualized, it may be possible to remove the object and restore respiratory function -Bedside swallowing assessment: assessment of level of alertness, ability to follow directions, level of awareness of impairment, orientation to activity; assessment of sensory and motor components of swallowing; assessment of ability to manage own secretions -- auscultation of neck to hear elongation of the oropharyngeal structures and to listen for wetness/gurgling which could be a sign of insufficient swallowing; clinical observation of person; assessment of swallowing function using trial boluses: suggestion of diet modification, as indicated; recommendations for further testing

Types, signs and symptoms of decubitus ulcers

-Stage I: redness, edema, superficial epidermis and dermis involved. -Stage II: redness, edema, blistering and hardening (induration) of tissue, skin is open and inflammation extends to the fat layer with superficial necrosis in advanced Stage II lesions -Stages I and II are considered partial thickness ulcers -Stage III: a full thickness skin lesion extending down to the muscle, the ulcer margin is thickened -Stage IV: ulcer extends down to the bone and includes bone destruction -Decubiti are often called pressure sores or bed-sores by lay persons

Psychological theories of aging

-Stress theory: homeostatic imbalances result in changes in structural and chemical composition: 1) General Adaptation Syndrome (Selye) - initial alarm reaction, progressing to stage of resistance, progressing to stage of exhaustion 2) closely linked to hormonal theory -Erikson's bipolar theory of lifespan development: stages of later adulthood -1) integrity - individual exhibits full unification of personality; life is viewed with satisfaction (productive life, sense of satisfaction), remain optimistic, continues to grow 2) despair - individual lacks ego integration; life is viewed with despair (fear of death, feelings of regret and disappointment, missed opportunities)

End of life care (hospice) for cancer

-Support quality of life as disease advances and functional status declines -Provide client with as much control as they can and desire to have to their day to day life and lifestyle-support -Be present, be accountable, listen and counsel as possible concerning progression of disease and sense of liminality -Encourage planning for death, control over goodbyes, funeral arrangements, advanced directives, etc. -Empower life celebration and life reflection (journaling, scrapbooks, phone call contact and recontact, letter writing) -Refer for legal support, if needed and requested.

Medical treatment of cancer

-Surgery: lumpectomy; en bloc resection; reconstruction; amputation -Chemotherapy: intravenous; shunt (ommaya reservoir to brain); oral -Radiation: external beam (wide beam; cone down); brachytherapy (seed implantation, flexible rods) -Immunotherapy: interferon; monoclonal antibodies -Hormonal therapy -Transplantation: bone marrow

Types of arthritis - Rheumatoid arthritis

-Systemic, symmetrical and affects many joints -Most commonly attacks the small joints of the hands -Characterized by remissions and exacerbations -Begins in the acute phase as an inflammatory process of the synovial lining -Symptoms: 1) pain 2) stiffness 3) limited range of motion 4) fatigue 5) weight loss 6) limited activities of daily living status, diminished ability to perform role activities 7) swelling 8) deformities -Types of deformities common with rheumatoid arthritis: 1) ulnar deviation and subluxation of the wrists and MCP joints 2) boutonniere deformity - flexion of PIP joint and hyperextension of DIP joint 3) swan neck deformity - hyperextension of PIP joint and flexion of DIP joint

Lifespan and Occupational Therapy Developmental Theorists - Havighurst: Six stages of development

-Tasks of infancy and childhood: 1) walk 2) take solid food 3) talk 4) control elimination of body wastes 5) develop sex differences and sexual modesty 6) develop physiologic stability 7) understand concepts of social and physical reality 8) develop emotional ties with parents, siblings, and others 9) understand right from wrong, conscience evolves -Tasks of middle childhood: 1) develop physical skills needed for games 2) establish health self-concept 3) make friends with children of the same age 4) read, write, and calculate 5) acquire a fund of information necessary for everyday life 6) develop morality and values 7) formulate opinions about social groups and institutions -Tasks of adolescence: 1) establish relationships with male and female friends of same age, increasing in quantity and quality 2) develop masculine/feminine social role 3) become comfortable with and respect one's changing body 4) decrease emotional reliance on parents/other adults 5) prepare for marriage and family life 6) prepare for economic career 7) develop a value system to shape behavior or develop one's own philosophy 8) behave in a socially responsible manner -Tasks of early adulthood: 1) choose a partner 2) adjust to a partner 3) start a family 4) raise children 5) manage a home 6) pursue an occupation 7) develop civic responsibility 8) join/form a compatible social group -Tasks of middle adulthood: 1) guide adolescents toward becoming responsible and well adjusted adults 2) engage in adult civic and social responsibility 3) progress in an occupational career 4) pursue leisure-time activities 5) relate to partner as a person 6) deal with and accept physiologic changes of middle age 7) accept aging parents -Tasks of later adulthood: 1) cope with decreasing physical strength and health 2) adjust to retirement and reduced income 3) adjust to death of spouse/partner 4) affiliate with one's age-group 5) change social roles 6) arrange for the most appropriate and appealing living environment

Prevention of autonomic dysreflexia

-Teach person/caregiver frequent pressure relief principles -Ensure compliance with intermittent catheterization -Practice well-balance diet habits -Ensure medication compliance -Educate person with condition and caregivers or family members: recognition of the cause, signs, symptoms (ie. sweating, headache); first aid procedures to deal effectively with the occurrence; prevention methods for this condition

Rehabilitation to treat heart irregularities from Lyme disease

-Telemetry during daily performance of tasks and activities that support role performance -Pulse oximetry measurements, if oxygenation is poor during performance of daily tasks and activities -Work simplification, adaptation, and modification to prevent further complications associated with arrythmia

Signs and symptoms of sexual abuse

-The child reports being inappropriately approached, touched, and/or assaulted -Abuse may be physical (eg. touching), non-physical (eg. indecent exposure), or violent (eg. rape), so signs may include emotional and physical indicators -Precocious sexual behavior or knowledge -Copying adult sexual behavior -Inappropriate sexual behavior (eg. putting tongue in other's mouth when kissing) -Soreness or injury around the genitals -Reluctance or refusal to let caregivers wash parts of the body -Sexual play

Signs and symptoms of physical abuse

-The child reports being physically mistreated -Unexplained injuries -Repeated injuries -Abrasions and lacerations -Small circular burns such as cigarette or cigar burns -Burns with a "doughnut" shape on the buttocks that may indicate scalding, or any burn that shows the pattern of an object used to inflict injury, such as an iron -Friction burns such as those from a rope -Unexplained fractures -Denial, unlikely explanations, or delays in treatment on the part of the caregiver

Signs and symptoms of emotional or mental abuse

-The child reports being verbally and/or emotionally mistreated -Aggressive or acting out behavior such as lying or stealing -Shy, dependent, or defensive appearance -Verbally abuses others with language that appears to have been directed toward them

Intervention Planning

-The formulation of the plan for intervention based upon an analysis of evaluation results according to selected frame(s) of reference -Collaboration with the individual, family, significant others, and/or caregivers is essential to establish a relevant, meaningful plan that will be followed -Prioritization of problem areas to be addressed in interventions: 1) values, interests, and needs of the individual, family, significant others, and caregivers 2) individual's current and expected roles and environmental contexts 3) the treatment setting's characteristics, resources, and limitations (eg. length of stay) 4) the likelihood that the problem will respond to intervention within the given setting (concrete and specific problems are more likely to be effectively resolved than abstract global ones; services must be available within the setting to effectively address the problem; otherwise a referral is indicated) -Formats of written intervention plans can vary from setting to setting -Intervention plan content (STG, LTG, intervention methods, duration/frequency/number and type of intervention - recommendations for add'l OT services/referrals

General concepts and definitions of aging

-The process of growing old -Describes a wide array of physiological changes in the body systems -A complex and variable process -Common to all members of a given species -Aging is developmental, occurs across the life span -Progressive with time -Evidence of aging: 1) decline in homeostatic efficiency 2) decline in reaction time (increased probability that reactions to injury will not be successful) -Varies among and within individuals

Rotator cuff tendonitis

-The rotator cuff functions together to control the head of the humerus in the glenoid fossa -Site of impingement: coracoacromial arch (acromion, coracoacromial ligament, and coracoid process) -Etiology: 1) repetitive overuse 2) curved or hooked acromion 3) weakness of rotator cuff 4) weakness of scapula musculature 5) ligament and capsule tightness 6) trauma -Occupational therapy conservative intervention: 1) activity modification - avoid above shoulder level activities until pain subsides 2) educate in sleeping posture - avoid sleeping with arm overhead or combined adduction and internal rotation 3) decrease pain - positioning, modalities, and rest 4) restore pain free ROM 5) strengthening - below shoulder level 6) occupational and role specific training -Occupational therapy post-operative intervention: 1) PROM (0-6 weeks); progress to AA/AROM 2) decrease pain - being with ice, progress to heat 3) strengthening (6 weeks post-operative) - begin with isometrics, progress to isotonic (below shoulder level) 4) activity modification - light ADL and meaningful role activities; progress as tolerated 5) leisure and work activities (8-12 weeks post-operative)

overhead suspension sling

-This orthotic device incorporates an arm support that is supported by a sling and suspended by an overhead rod -Persons presenting with proximal weakness (amyotrophic lateral sclerosis, Guillian-Barre syndrome, muscular dystrophy) with muscle grades in the 1/5 to 3/5 range are appropriate candidates

Prevention of Lyme disease

-Ticks are usually found on animals, on the tips of grasses and shrubs, in woody areas, and on the fringes of gardens, especially those surrounding new homes that were built in formerly wooded areas -Avoid tick-infested areas especially in May, June and July -Wear light colored clothing so ticks can be easily seen -Tuck pants legs into socks or boots and shirt into pants -Tape the area where pants and socks meet -Spray insect repellent containing DEET on clothes and exposed skin, excluding the face -Use permethrin (kills ticks on contact) on clothes -Wear a hat and long -shirt -Walk in the center of trails and avoid contact with grass and brush -After being outdoors change clothes and inspect skin for the presence of ticks -Remove any ticks with tweezers, grasping the tick as close as possible and pull straight back -Save the live tick (if retrieved) in a plastic container and take it to a local health department for identification

Medical treatment of nephrotic syndrome

-Treat with diuretics and drugs that prevent spillage of protein in the urine -Drug control of fluid overload and/or spillage of protein into the urine (proteinuria) -Encourage compliance with drug therapy, dietary and exercise recommendations

Complex Regional Pain Syndrome (CRPS)

-Type I formerly known as reflex sympathetic dystrophy (RSD) -Type II formerly known as causalgia -Vasomotor dysfunction as a result of an abnormal reflex -It can be localized to one specific area or spread to other parts of the extremity -Etiology: may follow trauma from surgery or fall (Colle's fracture) -Symptoms include severe pain, edema, discoloration, osteoporosis, sudomotor changes, temperature changes, trophic changes, and vasomotor instability -Occupational therapy intervention: 1) modalities to decrease pain 2) AROM to involved joints 3) ADL to encourage pain-free active use 4) stress loading (weight bearing and joint distraction activities, including scrubbing and carrying activities) 5) splinting to prevent contractures and enable ability to engage in leisure/productive activities 6) interventions to avoid include passive range of motion, passive stretching, joint mobilization, dynamic splinting, and casting 7) encourage self management

Classification of amputations

-Upper extremity level of amputation: 1) forequarter = loss of clavicle, scapula and entire upper extremity 2) shoulder disarticulation = loss of entire upper extremity 3) above-elbow (AE)(long or short) = amputation above the elbow at any level on the upper arm 4) elbow disarticulation = amputation of the upper extremity distal to the elbow joint 5) below-elbow (BE)(long or short) = amputation below the elbow at any level of the forearm 6) wrist disarticulation = amputation distal to the wrist joint. Loss of entire hand 7) finger amputation = amputation of digit(s) at any level -Lower extremity level of amputation: 1) hemipelvectomy = amputation of half of pelvis and entire lower extremity 2) hip disarticulation = amputation at the hip joint. Loss of the entire lower extremity 3) above-knee amputation (transfemoral) = amputation above knee at any level on the thigh 4) knee disarcticulation = amputation at the knee joint 5) below-knee amputation (transtibial) = amputation below knee at any level on the calf. Most common 6) complete tarsal = amputation at the ankle 7) partial tarsal = amputation of metatarsals and phalanges 8) complete phalanges = amputation of toe(s)

Interventions for home care rehabilitation for immunological system disorders

-Use of a collaborative assessment (eg. Canadian Occupational Performance Measure [COPM] to set client goals) -Evaluation and restoration of functional ability -Restoration of activity/exercise tolerance -Community mobility: to inner and outer boundaries of home environment; into the street./block; further ability to venture out into the community (ie. marketing, use of transportation, medical/business appointments, leisure access)

Rehabilitation to treat pain from Lyme disease

-Use of physical agent modalities to reduce pain -Use of stress management (complementary care) techniques to control the intensity of the pain and to increase coping ability -Use neutral warmth to decrease intensity of pain -Use of adapted techniques to avoid triggering of movements that exacerbate pain during activity (eg. sit on higher seat to decrease stress load in sit or stand)

Occupational therapy intervention for pain

-Utilize physical agent modalities and massage in preparation for functional activities -Teach proper positioning techniques -Splint in the resting position -Gentle ROM -Teach relaxation exercises -Utilize proper body mechanics during self-care, leisure, and work activities -Correct environmental factors -Correct standing and seated postures -Modify activities and provide ADL training and adaptive equipment, as needed -Provide alternative exercise programs (eg. aquatic therapy, Tai-Chi, Aichi)

shoulder slings

-Utilized to support a flaccid arm after neurologic insult for short and controlled periods of time -Long term use may be detrimental in terms of soft-tissue contracture, edema, and the development of pain syndromes

Important components in the development of hand skills - Reaching skills

-Visual regard accompanied by swiping/batting, with closed hand and abducted shoulder (newborn) -Hands come together at midline for bilateral reaching with shoulders abducted with partial internal rotation, forearm pronation, and full finger extension (4 months) -Increased dissociation of body sides, allows for unilateral reaching with less abduction and internal rotation of the shoulder, and the hand is more open (6 months) -As trunk stability improves, shoulder flexion with slight external rotation, elbow extension, forearm supination, and slight wrist extension begin to emerge (9 months)

General signs of abuse

-Withdrawal -Nightmares -Running away -Anxiety or depression -Guilt -Mistrust of adults -Fear -Aggressiveness

Increase endurance

-Work at 50% of maximal resistance or less -Increased repetitions, and duration, not resistance -use energy conservation methods

Treatment for LE amputations

-Wrapping to shape residual limb and decrease swelling -Desensitization -Strengthening (UE) with the focus on triceps -Transfer training, stand pivot -ADL training; LE dressing is the most difficult -Standing tolerance -W/C mobility

Early mobilization programs for extensor tendons

-Zone I and II: 1) mallet finger deformity 2) 0-6 weeks - DIP extension splint -Zone III and IV: 1) boutonneire deformity 2) 0-4 weeks - PIP extension splint (DIP free); AROM of DIP while in splint 3) 4-6 weeks - begin AROM of DIP and flexion of digits to the DPC -Zone V, VI, and VII: 1) 0-2 weeks - volar wrist splint with wrist in 30 degrees of extension, MCPs in 0-10 degrees of flexion, and IP joints in full extension 2) 2-3 weeks - shorten splint to allow flexion and extension of IP joints 3) 4 weeks - remove splint to begin MCP active flexion and extension 4) 5 weeks - begin active wrist ROM. Wear splint in between exercise sessions 5) 6 weeks - discharge splint

myoclonus

-a brief and rapid contraction of a muscle or group of muscles

dyskinetic cerebral palsy

-a lesion in the basal ganglia results in fluctuations in muscle tone -dystonia: excessive or inadequate muscle tone -athetosis: writhing involuntary movements which are more distal than proximal -chorea: spasmodic involuntary movements which are more proximal than distal and a lack of contractions

ataxic cerebral palsy

-a lesion in the cerebellum results in hypotonia and ataxic movements -characterized by a lack of stability so coactivation is difficult, resulting in more primitive total patterns of movement

spastic cerebral palsy

-a lesion of the motor cortex will result in spasticity with flexor and extensor imbalance -hypertonia: increased muscle tone -hyperreflexia: increased intensity of reflex responses

Klumpke's plasy

-a paralysis of the lower brachial plexus including the 7th and 8th cervical and 1st thoracic nerves -relatively rare -results in paralysis of the hand and wrist, often with ipsilateral Horner's syndrome -characteristic signs are that the hand is limp and the fingers do not move

Erb's palsy

-a paralysis of the upper brachial plexus including the 5th and 6th cervical nerves; C7 may also be involved in some cases -muscles most often paralyzed include the supraspinatus and infraspinatus as well as the deltoid, biceps, brachialis, and subscapularis -he arm cannot be raised, elbow flexion is weakened and weakness in retraction and protraction of scapula may be noted -the arm grossly presents with the arm straight and wrist fully bent -after the age of 6 months, contractures may begin to develop -positioning and ROM exercises are necessary to retain external rotation, abduction, and flexion at the shoulder as well as distal flexibility

Becker muscular atrophy

-a variant of Duchenne muscular muscular dystrophy that is slower to progress, less severe, and less predictable -loss of motor function of the hips, thighs, pelvic area, and shoulders -enlarged calves -cardiac system can be involved -survival can be into late adulthood (normal lifespan if no cardiac involvement)

simple partial seizures

-abnormal electrical impulses occur in a localized area of the brain, often in the motor strip of the frontal lobe -involuntary, repetitive jerkin of the left hand and arm occurs, but the individual can maintain interaction with their environment -may become generalized, and result in a loss of consciousness

cerebral arteriovenous malformation (AVM)

-abnormal, tangled collections of dilated blood vessels that result from congenitally malformed vascular structures

symptoms of Guillain Barre Syndrome

-acute, rapidly progressive form of polyneuropathy characterized by symmetric msuclar weakness and mild distal sensory loss/paresthesias -weakness is always more apparent than sensory findings and is at first more prominent distally -may complain of painful extremities -subjective and objective sensory disturbances -deep tendon reflexes are lost and sphincters are spared -respiratory failure and dysphagia

Herpes Zoster (shingles)

-an acute, painful mononeuropathy caused by the varicella-zoster virus -characterized by vesicular eruption and marked inflammation of the posterior root ganglion of the affected spinal nerve or sensory ganglion of the cranial nerve ; ventral root involvement (motor weakness) -infection can last from 10dys to 5 wks -pain may persist for months

spina bifida cystica

-an exposed pouch compised of the spinal cord meninges

impaired attention

-an inability to attend to or focus on specific stimuli -may result in distraction by irrelevant stimuli -includes difficulty w/ sustained attention & selective attention in addition to dividing & altering attention between two tasks

interventions for seizure disorders

-assess and intervene for developmental delays as necessary -observe all medical and safety precautions -document and report and seizure activity, medication side effects, or behavioral changes

Improving coordination

-begin with gross motor, grade up to fine motor -ROM within reach yet challenging -focus on accuracy and speed

infantile spasms or west syndrome, infantile myoclonic seizures or jackknife epilepsy

-begins at 3 to 9 mths of age -dropping of the head and flexion of the arms occur -seizures may occur hundreds of times per day -prognosis is generally poor -spasms sometimes decrease after several years, but are often replaced by other seizure disorders -these seizures often indicate an underlying disorder such as tuberous sclerosis

symptoms of Parkinson's disease

-begins insidiously with a resting "pill rolling" tremor of one hand -tremor -rigidity -resistance to passive motion that is not velocity dependent (cog wheel or lead pipe_) -akinesia -postural instabiltiy -festinating gait -falling backwards (retropulsion) or forwards -mask face -micrographia

Stage 2 of Parkinson's disease

-bilateral tremor, rigidity or akinesia, with or without axial signs -independent with ADL -no balance impairment

cerebral hemorrhage

-bleed secondary to hypertension or aneurysm

Left heart failure:

-blood is not adequately pumped into systemic circulation; d/t an inability of left ventricle to pump blood out of lungs, increases in ventricular end-diastolic pressure and left pressures with pulmonary signs and symptoms including: 1. dyspnea: exertional, orthopnea (in supine), paroxysmal nocturnal (sudden shortness of breath at night) 2. cough, rales, wheezing 3. weakness, fatigue 4. tachycardia, change in heart sounds 5. chest pain

ideational apraxia

-breakdown in the knowledge of what is to be done or how to perform -lack of knowledge regarding object use - the neuronal model about the concept of how to perform is lost, although the sensorimotor system may be intact.

myoclonic-akinetic seizure

-brief, involuntary jerking of the extremities, with or without loss of consciousness -akinetic seizures include a loss of tone -difficult to control

chorea

-brief, purposeless, involuntary movements of the distal extremities and face -usually considered to be a manifestation of dopaminergic over activity in the basal ganglia

spinal muscular atrophy

-caused by a decrease of a motor neuron protein called Survival of Motor Neuron, Chromosome 5 -weakness of the voluntary muscles of the shoulders, hips, thighs, and upper back which can result in spinal curvatures -muscles for breathing and swallowing can be affected -the earlier the age of diagnosis, the greater the severity of functional deficits and the shorter the life expectancy

anterior cord syndrome

-caused by flexion injuries -motor function, pain, pinprick, and temperature sensation are lost bilaterally below the lesion while proprioception and light touch are preserved

Hot pack application

-check temperature of hydrocollator 165 is standard -place hot pack in cover and add four layers of a folded towel between patients skin and hot pack cover -check skin after 5 minutes to assess for issues -remove after a total of 20 minutes

Lennax-Gastaut syndrome

-children with severe seizures, mental difficulties, and a specific EEG pattern -seizures of different types begin during the first three years of life and are difficult to control -associated with various brain disorders from structural abnormalities to birth asphyxia -a regression of developmental status can occur in some cases

symptoms of TBI

-concussion characterized by post-traumatic loss of consciousness -cerebral contusion/laceration/edema accompanied by surface wounds and skull fractures -hemiplegia or monoplegia and abnormal reflexes -decorticate or deceberate rigidity -fixed pupils -coma -changes in vital signs

Stage 5 of Parkinson's disease

-confined to a wheelchair or bed -maximally assisted

thalamic pain

-continuous, intense pain occurring on the contralateral hemiplegic side; the result of a stroke involving the ventral posterolateral thalamus; poor rehabilitation potential

ataxia

-describes a lack of coordination while performing voluntary movements it may appear as clumsiness, inaccuracy, or instability -movements are not smooth and may appear disjointed or jerky

Arthrogryposis multiplex congenita

-detected at birth and associated with loss of anterior horn cells -presence of weakness, deformities, and associated joint contractures -position of rest for the upper extremities tends to be internal rotation of the shoulder, extension of the elbows, and flexion of the wrists -for the lower extremities, there is flexion and internal rotation of the hips and clubfeet -may be stable, mildly progressive,e or may improve -related problems include congential heart defects, spinal defects, torticollis, and involvement of the diaphragm

spatial relations impairment

-difficulty relating objs to each other or to the self secondary to a loss of spatial concepts (up/down, front/back, under/over, etc.)

cerebral infarction

-due to either embolism or thrombosis of the intra or extracranial arteris

OT intervention for chronic pain

-educate the individual about contributing factors -assist the individual in identifying and responding adaptively to pain behaviors (remove behavioral reinforcers, establish a behavior contract, provide positive reinforcers and educational support, demonstrate change and allow person to experience success, practice well behaviors) -assist the individual in developing strategies and using techniques to manage pain -teach coping skills/stress management/assertive communicaiton -provide relaxation training -refer to other professionals for direct pain/symptom control intervnetiosn -establish a realistic daily activity program -prescribe assistive devices as appropriate -teach energy conservation techniques -provide meaningful diversional activities -provide family education

Edema reduction

-elevate extremity above heart -manual edema mobilization -retrograde massage -compression garments -cold packs -contrast bath -elastic bandage, wraps and intermittent compression pumps

sensory processing high neurological threshold

-failure to register or respond to routine environmental sensation or sensation must be experienced over a prolonged time period to elicit a behavioral response

signs and symptoms of snesory processing disorders

-fluctuating or extreme responsiveness while engaging in everyday activities -difficulties in interacting with the environment in play, learning, and social situations, and while engaging in other developmental and health promoting activities -difficulty with conceiving, planning,and sequencing, or executing novel actions (tendency to avoid or reject simple motor challenges) -poor initiation of activities as demonstrated in some children due to difficulty generating ideas (ideation) -difficulty with goal directed action on the environment (adaptive response) -response may present along a continuum of under responsivity to over responsivity -tactile processing dysfucntion manifestations (tactile defensiveness) -deficits in tactile discrimination -poor awarenss of position of body, body parts, and body scheme -clusiness, awkwardness -distractibiltiy -motor planning and movement difficulties -reliance on visual cues to motor plan -use of too much or too little force -poor awareness of personal space -seeks heavy resistance and pressure -hypo or hypersensitivity to movement -gravitational insecurity -low muscle tone -postural ocular deficits -decreased balance and equilibrium reactions -deficits in bilateral coordination -low endurance -deficeint motor planning and sequencing -dyspraxia -postural disorders

complex regional pain syndrome type 2

-formerly known as neuralgia -pain occurring along the branches of a nerve -frequently paroxysmal

Adhesive capsulitis

-frozen shoulder -Restricted passive shoulder range of motion: greatest limitation is external rotation, then abduction, internal rotation, and flexion -Etiology: 1) inflammation and immobility 2) linked to diabetes mellitus and Parkinson's disease -Occupational therapy conservative intervention: 1) encourage active use through ADL and role activities 2) PROM 3) modalities -Occupational therapy post-operative intervention: 1) PROM immediately following surgery 2) pain relief - modalities 3) encourage use of extremity for all ADL and role activities

Motor Development - laterality

-hemispheric specialization for specific tasks varies with different individuals (handedness is considered to be stable by age 5; however, strong preferences can be seen much earlier)

sensory processing poor registration

-high neurological thresholds and active behavioral responses

unilateral spatial neglect

-inattention to or neglect of stimuli presented in the extra-personal space CONTRAlateral to the lesion -may occur independently of visual deficits

Dynamic splint

-includes a resilient component (elastic rubber band, or spring) which the individual moves - designed to increase PROM or to augment AROM

conus medullaris syndrome

-injury of the sacral cord and lumbar nerve roots -resulting in lower extremity motor and sensory loss and an areflexic bowel and bladder -if the lesion is in the sacral segments, reflexes may be occasionally preserved

dyskinesias

-involuntary, non repetitive, but occasionally stereotyped movements affecting distal, proximal, and axial musculature in varying combinations -most are representative of basal ganglia disorders

Transient Ischemic attack (TIA)

-is a transitory stroke that for the most part lasts only a few minutes -occur when the blood supply to part of the brain is briefly interrupted -symptoms, which usually occur suddenly, are similar to those of stroke but do no last as long (most disappear within an hour) -symptoms include: numbness or weakness in the face/arm/leg; confusion or difficulty in talking or understanding speech; trouble seeing in one or both eyes; difficulty with walking, dizziness, and/or loss of balance and coordination -are often warning signs that a person is at risk for a more serious and debilitating stroke

posterior cord syndrome

-least frequent syndrome -injury to the posterior columns -results in proprioceptive loss -pain, temperature, touch are preserved -motor function preserved to varying degrees

sensory processing sensory avoiding

-low neurological thresholds and active behavioral responses

sensory processing sensory seeking

-low neurological thresholds and active behavioral responses

sensory processing sensory sensitivity

-low neurological thresholds and passive behavioral responses

symptoms of occult spinal dysraphism

-may result in spinal cord being split(diplomyelia) or being tied down and tethered (diastematomyelia) which may lead to neurological damage and developmental abnormality as the child grows

Duchenne's muscular dystrophy

-most common type of muscular dystrophy -detected between 2-6 yrs old -inherited, sex linked and recessive occurring in males -pseudohypertrophy: enlargement of calf muscles and at times enlargement of forearm and thigh muscles giving an appearance the child is muscular and healthy -weakness of the proximal joints progresses to the point that the child has significant functional mobility impairments -ambulating with a trendelenburg (waddling) gait with frequent falls -difficulty getting up from the floor to a standing position; uses hands to crawl up the thighs to get to the standing position (Gower's sign) -weakness occurs in all voluntary muscles, including heart and diaphragm -behavioral and learning dififculties and delayed speech may occur -individuals rarely survive beyond early 20s due to respiratory problems, infections, and/or cardiovascular complications

tonic-clonic/grand mal seizures

-most common type of seizure disorder in children -a brief warning/aura such as numbness ,taste, smell -tonic phase includes a loss of consciousness, stiffenign of the body, heavy and irregular breathing, drooling, skin pallor, and occasional bladder and bowel incontinence for a few seconds before clonic phase begins -clonic phase includes alternating rigidity and relaxation of muscles -postictal state follows the clonic phase, and includes a period of drowsiness, disorientation, or fatigue

left hemisphere specialization

-movement of the right side of body -processing of sensory information from right side of body -visual reception from right field -visual verbal processing -bilateral motor praxis -verbal memory -speech -bilateral auditory reception -processing of verbal auditory information

symptoms of multiple sclerosis (MS)

-multiple and varied neurologic symptoms and signs, usually with remissions and exacerbations -paresthesias in one or more extremities, on the trunk, or in the face -weakness or clumsiness in the leg or hand -visual disturbance (diplopia, parital blindness, nystagmus, eye pain) -emotional disturbances (labiltiy, euphoria, and reactive depression) -balance loss and/or vertigo -bladder dysfunction -cognitive features may include apathy, memory loss, lack of judgement, and inattention -sensorimotor findings may include: spasticity, increased reflexes, ataxia, weakness ,gain instability, easy fatigue, hemiplegia or quadriplegia

symptoms of amyotrohpic lateral sclerosis (ALS)

-muscle weakness and atrophy -cramps and fasciculations precede weakness -signs usually begin in the hands -lower motor neuron signs are soon accompanied by spasticity, hyperactive deep tendon reflexes, and evidence of corticospinal tract involvement -dysarthria and dysphagia are evident -sensory systems, eye movements, and urinary sphincters are often spared

radiculalgia

-neuralgia of nerve roots

symptoms of post-polio syndrome

-new onset of weakness -easily fatigued -muscle pain -joint pain -cold intolerance -atrophy -loss of functional skills

Fascioscapulohumeral Muscular dystrophy

-occurs in early adolescence -involves the face, upper arms, and scapular region, causing masking, weakness, decreased mobility of the face, and the inability to lift the arms above shoulder level -as it progresses, the weakness can extend to the abdominal muscles and sometimes the hip muscles -progresses slowly and rarely affects the cardiac or respiratory systems; thus, life expectancy can be relatively normal

tethered cord syndrome

-occurs in the tail end of the spinal cord when the cord is stretched as a result of compression, being trapped with a fatty mass or scar tissue, developmental abnormality, or an injury -visible signs include a hairy patch of skin, a hemangioma, and/or dimple of the lower sign -difficulties with bowel and bladder control, gait disturbances, and/or deformities of the feet, low back pain, scoliosis

referred pain

-pain arising from deep visceral tissues that is felt in a body region remote from the site of pathology, resulting in tenderness and cutaneous hyperalgesia

complex regional pain syndrome type 1

-pain maintained by efferent activity of sympathetic nervous system -characterized by abnormal burning pain, hypersensitivity to light touch, and sympathetic hyperfunction (coldness, sweating) -usually associated with traumatic injury

general intervention/treatment for neurological system disorders

-positioning (seating and wheeled mobility prescriptoin, bed positioning, pressure reduction and relief techniques) -postural control training -motor learning approaches -motor control retraining/relearning for functional integration of affected limbs -specific ADL training/retraining/adaptation -presciption of assistive devices and technology -splinting for contracture prevention and/or enhancement of function (tenodisis splint) -family/caregiver education -cognitive perceptual retraining/compensation in the context of functional activities -visual skills retraining and/or adaptation -interventions for sexual dysfunction -bowel and bladder training -skin care education -durable medical equipment presciption -sensory re-education, compensation, and safety training -assistance with the development of coping strategies -community re-integration -return to work or work hardening programs

Landau-Kleffer syndrom or acquired epileptic aphasia

-progressive encephalopathy -loss of language skills -auditory agnosia (inability to distinguish different sounds) -behavioral disturbances such as inattention

status epilepticus

-prolonged seizures or seizures in rapid succession -can be life threatening -sometimes triggered when medication is stopped abruptly -rarely does sudden death occur

spina bifida with meningocele

-protrusion of a sac through the spine, containing cerebral spinal fluid and meninges as well as the spinal cord or nerve roots

spina bifida with myelomeningocele

-protrusion of a sac through the spine, containing cerebral spinal fluid and meninges as well as the spinal cord or nerve roots -most commonly located in the lumbar region

symptoms of myasthenia gravis

-ptosis -diplopia -muscle fatigue after exercise -dysarthria -dysphagia -proximal limb weakness -sensation and deep tendon reflexes intact -symptoms fluctuate over the course of the day -in relapsing periods, quadriparesis may develop -life threatening respiratory muscle involvement may occur

Stage 4 of Parkinson's disease

-requires help with some or all ADL -unable to live alone without some assistance -unable to walk and stand unaided

middle cerebral artery (MCA) stroke

-results in contralateral hemiplegia, hemianesthesia, homonymous hemianopsia, aphasia, and/or apraxia, unilateral neglect, spatial dysfunction

posterior cerebral artery (PCA) stroke

-results in homonymous hemianopsia, thalamic pain, hemisensory loss, and/or alexia

dystonia

-results in sustained abnormal postures and disruptions of ongoing movement resulting from alterations of muscle tone -may be generalized or focal

internal carotid artery (ICA) stroke

-results in symptoms similar to those associated with MCA CVA

tremor

-rhythmic, alternating, oscillatory movements produced by repetitive patterns of muscle contraction and relaxation

complications of cerebral palsy

-seizures in 50% -language and cognitive deficits in 50-75% : speech and language deficits; difficulty coordinating breathing with swallowing; dysarthria; aphasia -visual impairments occur in 40-50% : stabismus; nystagmu; myopia; hypertopia; presbyopia -feeding: difficulty swallowing; chewing -diminished sensation

symptoms of spina bifida with a myelomeningocele

-sensory and motor deficits occurring below the level of the lesion -lower extremity paralysis and/or deformities -bowel and bladder incontinence -decubitis ulcer and deep vein thrombosis

complex partial or psychomotor seizures

-symptoms vary -alterations in consciousness and unresponsiveness -may appear confused or dazed, unable to respond to questions or directions -automatic motions such as lip smacking, chewing and swallowing, and nervous movement of the hands/fingers, and repetitive movements occur -visual and auditory occur just before the seizure

prevention of autonomic dysreflexia

-teach person/caregiver frequent pressure relief principles -ensure compliance with intermittent catheterization -practice well balanced diet habits -ensure medication compliance -educate the person with the condition and caregivers on how to use prevention methods; recognize the cause, signs, and symptoms; and initiate first aid procedures to deal effectively with the occurrence of this condition

sensory processing passive behavioral response

-the individual makes no attempt to change the intensity or duration of sensory input

sensory processing low neurological threshold

-the minial stimulous facilitates a behavioral over response

petit mal seizure

-typically occur between ages 4-12 -a loss of consciousness without loss of muscle tone occurs -rapid blinking or staring into space -child does not fall down, but does not recall the episode or any lapse in time

hemiballismus

-usually characterized by involuntary flinging motions of the extremities -the movements are often violent and have wide amplitudes of motion -they are continuous and random and can involve proximal and/or distal muscles on one side of the body

symptoms of spina bifida meningocele

-usually does not present with symptoms impacting on function as the spinal cord itself is not entrapped -occasionally slight instability and neuromuscular impairments, such as mild gait involvement and bowel or bladder problems may occur

symptoms of spina bifida occulta

-usually does not result in symptoms -occasionally slight instability and neuromuscular impairments, such as mild gait involvement and bowel or bladder problems may occur

occult spinal dysraphism (OSD)

-when external manifestations such as a red birthmark, patch of hair, a demal sinus, a fatty benign tumor, or dimple covering the site are present

paresthesias, allodynia

-with nerve injury or transection

Stage 3 of Parkinson's disease

-worsening of symptoms -fist signs of impaired righting reflexes -onset of disability in ADL performance -can lead independent life

5-grade angina scale:

0- No angina 1- Light, barely noticeable 2- Moderate, bothersome 3- Severe, very uncomfortable 4- Most pain ever experienced

Intermittent Claudication rating scale:

0- No claudication pain 1- initial, minimal pain 2- Moderate, bothersome pain 3- Intense pain 4- Maximal pain, cannot continue

5-grade dyspnea scale:

0- No dyspnea 1- Mild, noticeable 2- Mild, some difficulty 3- Moderate difficulty, but can continue 4- Severe difficulty, cannot continue

10-grade angina/dyspnea scale:

0- nothing 0.5- very, very slight 1- very slight 2- slight 3- Moderate 4- somewhat severe 5- severe 6 7- very severe 8 9 10- very, very severe, maximal

Infant movement patterns progress from reflexive to voluntary and goal-directed.

0-6 months

Vestibular, proprioceptive, and visual systems become more integrated and lay the foundation for postural control, which facilitates a steady visual field.

0-6 months

Visual and tactile systems become more integrated as the child reaches out and grasps objects, laying the foundation for eye-hand coordination.

0-6 months

tactile and proprioceptive systems continue to be refined, laying the foundation for development of somatosensory skills.

0-6 months

intermittent claudication rating scale

0-No claudication pain 1-initial, minimal pain 2-moderate, bothersome pain 3-intense pain 4-maximal pain, cannot continue

5-grade angina scale

0-no angina 1-light, barely noticeable 2-moderate, bothersome 3-severe, very uncomfortable 4-most pain ever experienced

5-grade dyspnea scale

0-no dyspnea 1-mild, noticeable 2-mild, some difficulty 3-moderate difficulty, but can continue 4-severe difficulty, cannot continue

10-grade angina/dyspnea scale

0-nothing 0.5-very, very slight 1-very slight 2-slight 3-moderate 4-somewhat severe 5-severe 7-very severe 10-very, very severe (maximal)

Medicare Title 18-PL 89-97

1) Established Medicare and Supplemental Security Income (SSI) 2) SSI enables persons with disabilities to receive a monthly income enabling them to live in the community

ADA-criteria for classifying an individual as disabled

1) a person with a physical or mental impairment that substantially limits one or more major life activities, 2) a person having a record of such an impairment, 3) a person regarded as having such an impairment

Omnibus Budget Reconciliation Act (OBRA) of 1981

1) affirmed application of Section 504 of the Rehabilitation Act of 1973 which prohibits discrimination in federally funded programs to a diversity of services (head start programs, block grant programs, community development programs) 2) provided Medicaid financing for community-based services for people with developmental disabilities when services were demonstrated to be less expensive than institutional care

Title III- Public places operated by private entities must be designed, constructed, and altered to comply with accessibility standards

1) all new construction of public accommodation must be accessible, 2) physical barriers existing facilities must be removed if removal is able to be carried out without much difficulty or expense, 3) The US government, indian tribes, religious organizations, and or/private tax-exempt membership clubs are exempt from ADA accessibility standards

Title IV Telecommunications

1) all televisions must include closed captioning 2) telephone companies must provide telecommunications relay services (TRS) to persons with hearing or speech impairments 24 hours per day, 7 days per week

ADA title I employment Prohibitions

1) allows questions about one's ability to perform a job but Prohibits inquires a to whether one has a disability 2) prohibits employment tests that tend to screen out people with disabilities

Technology Related Assistance for Individuals with Disabilities Act

1) funded the development of technology and technologic aids for persons with disabilities to improve communication, mobility, self-care transportation, and education

Americans with Disabilities Act (ADA)

1) prohibits discrimination against qualified persons with disabilities in employment, transportation, accommodations, telecommunications, and public services

Rehabilitation Act of 1973

1) prohibits discrimination on the basis of disability in any program or activity that receives federal assistance 2)required all federal agencies to develop action plans for the hiring, placement, and advancement of persons with disabilities, 3) required contractors who received federal contracts over a pre-set amount to take affirmative action to employ persons with disabilities

Fair Housing Act

1) prohibits discrimination on the basis of disability, religion, sex, color, race, national origin, and familial status, 2) Required owners of housing to make reasonable exceptions to their standard tenant policies to allow individuals with disabilities equal housing opportunities (i.e. allow a seeing eye or service dog in a "no-pets" apartment) 3) Required that tenants with disabilities be allowed to make reasonable modifications to common use areas and their private living space to enable access 4)the housing owner is not required to fund these modifications but should allow them 5) required that newly constructed multifamily residences (4 or more apartments) be built to meet established accessibility standards

ADA Title I employment

1) prohibits employers from discrimination against persons with disabilities in any aspect, or phase of employment including, recruitment, hiring, working conditions, hours, promotion, training opportunities, termination, social activities, and other privileges of employment

Types of auxiliary aids and services

1) taped texts, qualified readers, or other methods that can effectively make visually delivered materials accessible to persons with visual impairments, 2) qualified interpreters or other methods that can effectively make aurally delivered material accessible to persons with hearing impairments, 3) modification or acquisition of devices or equipment, similar actions or services that increase accessibility 4) similar actions or services that increase accessibility

Types of "reasonable accommodations"

1)acquisition or modification of equipment or devices, 2)modifications or adjustments to examinations, training materials, or publications, 3) provision of ancillary aids or services, 4) modified or part-time work schedules, job restructuring, or reassignment to a vacant position, 5) improvement of existing facilities used by employee so they are usable by and accessible to persons with disabilities and/or other similar accommodations

What are the 3 key pieces of legislation related to gerontic practice?

1. Age Discrimination in Employment Act. 2. Freedom to Work Act. 3. Omnibus Budget Reconciliation Act (OBRA) of 1990.

Paraffin Application

1. Check temperature of paraffin- 125 to 130 f is standard 2. After washing and thoroughly drying the hand, dip the hand into paraffin and quickly pull out. Repeat this process 8-10 times forming a glove of paraffin ove the hand. 3. Following the dip method, the hand should be wrapped with cellophane and then covered with a towel for 20 minutes

What are the 5 key pieces of legislation specific to pediatric practice?

1. Child Abuse Prevention and Treatment Act 2. Early Intervention and Education Acts 3. Reauthorization and Amendment of Individuals with Disabilities Education Act 4. Individuals with Disabilities Education Improvement Act (IDEA 2004) 5. No Child Left Behind Act (NCLB)

Explain the Individuals with Disabilities Education Improvement Act (IDEA 2004)

1. Directly addresses the student's functional performance along with academic performance. 2. Provides for a multi-year (not to exceed 3 years) IEP to allow for long-term planning and to coincide with a child's national transitions (pre-school to elementary, middle to high school). 3. Provides for increased flexibility in IEP meetings (team members can be excused from attending, allows revisions/amendments to be made to parents/districts after the meeting, allows use of technological alternatives like video conference calls). 4. Requires that recommendations for early intervention, special ed, etc. be made based on peer-reviewed research. 5. A screening by a specialist is not equivalent to an evaluation for eligibility for IDEA services. 6. Requires all students with disabilities be assessed in compliance with NCLB. 7. Provides for early coordinated intervening services for gen ed students from kindergarten - 12th grade who need additional supports to succeed (not special ed). 8. Clarifies the purpose of IDEA is to prepare children with disabilities for further education, employment, and independent living. 9. Allows school personnel to individually consider each case of a student with a disability who violates the school's code of conduct. 10. Allows each state to define developmental delay criteria to determine if an infant/toddler eligible for early intervention. 11. Requires an IFSP include: developmental level; family priorities, concerns, resources; natural environments; measurable outcomes; projected, length, frequency, duration of research-based services; transition plans. 12. Clarifies the role of the parent and IFSP team in determining the site for service (maximize the natural environments as appropriate). 13. Requires states to establish procedures for the referral of infants/toddlers who are victims of abuse/neglect to early intervention services.

Scar management

1. Early mobilization 2.massage in circles with friction 3. compression- Conan for the digits; isotonic glove for the hand, and tube grip for the IE 4.scar pad with compression 5. Splinting to prevent contracture 6. Edema control

Mature mechanisms

1. Humor: using comedy to express feelings and thoughts w/out provoking discomfort in self/others (laughing at self for coming to function dressed inapprop.) 2. Sublimation: redirecting energy from socially unaccep. impulses to socially accep. activ. (angry indiv. channels it into aggressive sport) 3. Suppression: consciously or semiconsciously avoiding thinking about disturbing problems, thoughts or feelings

Assessment Methods for Psychosocial Assessments

1. Interviews- structured and unstructured 2. Standardized tests 3. Clinical observation and rating scales. 4. Questionnaires 5. Self report inventories

Joint protection principles and methods

1. Maintain joint ROM by using max ROM during daily activities 2. Maintain muscle strength by using max strength during daily activities 3. Use the strongest and largest joint possible for task completion (knees and hips for lifting, not back. Push items with full body rather than pulling. Lift with both hands palms facing up, carry purses/bags on forearm

Education on splinting

1. Maintenance and routine skin care and inspection 2. Ensure individual accepts and understands purpose/function/limitations 3. Teach proper donning/doffing 4. Provide FX use training 5. Re evaluate

Medical Model

1. Model that views the individual c a disability as a person who has incurred a physiological insult that has resulted in reduced functional capacity 2. Focus is placed on identifying the disease or dysfunction 3. OT frames of reference address the pathological process of the disease or dysfunction ( biomechanical, NDT)

Community Model

1. Model views the individual w/ a disability as lacking skills, resources, and support for community participation. 2. focus is placed on identifying and developing the skills needed for one's expected environment 3. OT frames of reference promote development of performance skills and/or areas of occupation within the individual's performance contexts ( lifestyle performance, occupation adaptation)

4 basic steps of program development

1. Needs assessment 2. Program planning 3. Program implementation 4. Program evaluation

OT/OTA role for splinting

1. OT/OTA team must carefully assess for most appropriate splint 2. OT must set splinting goals 3. Experienced OTAs can fabricate STATIC SPLINTS and can assist with dynamic splints

Energy conservation techniques:

1. Pace yourself 2. Monitor body position during activities 3. Organize daily activities and work areas 4. delegate responsibilities

Immature mechanisms

1. Passive-aggressive: aggression towards others which is indirectly or unassertively expressed 2. Regression: returning to earlier stage of devel. to avoid tension/conflict of the present one 3. Somatization: conversion of psychological symptoms into physical illness

Phase 3: Maintenance/training stage

1. Patients generally attend maintenance/training session once a week following the completion of Phase 2 2. Groups may be integrated into individual exercise programs 3. OT intervention is provided as necessary for IADL, leisure pursuits and work 4. Maintenance gym program a. weight training to maintain upper and lower body strength b. Cardiovascular training to maintain cardiopulmonary health

Areas Addressed in Psychosocial Assessment

1. Performance skills (i.e. cognitive, perceptual, psychological, and social) and their impact on performance in areas of occupation 2. Client factors and physical conditions or limitations that impact functional behaviors and performance in areas of occupation 3. The impact of the individual's social, cultural, spiritual, and physical contexts 4. Identification of roles and behaviors that are required of the individual either by society or for the achievement of his/her desired self-determined goals. 5. Precautions and safety issues such as suicidal and/or aggressive behavior 6. History of behavior patterns 7. Individual's goals, values, interests, and attitudes

Energy conservation and work simplification principles and methods

1. Plan rest periods 2. Schedule tasks with balance between light/heavy 3. Organize tasks 4. Avoid multi trips 5. Eliminate non essential tasks 6. Delegate 7. Combine 8. Sit to work 9. Organize cabinets so frequently used items are near 10. Use AE as needed 11. Use appliances 12. Slide rather than lift 13. Use lightweight items 14. Rest before fatigue sets in

Fluidotherapy application

1. Preheat machine between 102-118 degrees f 2. Adjust blowers according to persons sensitivity 3. Place persons hand in the sleeve for 20 minutes; during this time person can exercise hand 4. Treatment is for 20 minutes and the persons hand is slowly removed from the machine making sure there are no particles coming out

Program Development

1. Purpose: - directly meet the needs of a specific population(s) or group(s) - clearly focus evaluation and intervention efforts and activities - increase visibility and use of available services - convert an idea into a practice reality 2. Role of OTA/COTA - collab with OTR and perform tasks given by OTR

Neurotic mechanisms

1. Rationalization: creating self-justifying explanations to hide the real reason for one's own or another's bx 2. Repression: blocking from consciousness painful memories and anxiety-provoking thoughts 3. Displacement: redirecting emotion or reaction from one object so similar but less threatening one (child angry w/parents and hits younger sis) 4. Reaction formation: switching of unacceptable impulses into its opposite (hugging someone you want to hit)

Expiratory muscles:

1. Resting expiration: done by passive relaxation of inspiratory muscles and elastic recoil tendency of lungs 2. Expiratory muscles used when quicker, fuller expiration is desired or in disease; include quadratus lumborum, intercostals, rectus abdominis, triangularis sterni

Outpatient

1. Setting in which the individual who does not require hospitalization but has functional deficits requiring evaluation and intervention may receive these services on an outpatient basis in private clinics, medical offices, and/or hospital satellite center 2. Focus: of outpatient care is diagnostic evaluations, interventions to increase functional performance, consumer education, and prevention

Signs and symptoms of a MI:

1. Severe substernal pain of more than 20 minutes during which may radiate to neck, jaw, arm, epigastric area 2. Dyspnea, rapid respiration, shortness of breath 3. indigestion, nausea, and vomiting 4. pain may be misinterpreted as indigestion 5. Pain unrelieved by rest and/or sublingual nitroglycerin

Common types of PAMs used by entry level OT practitioners

1. Superficial thermal (paraffin, hot packs, fluido therapy) 2. Superficial cooling agents (cold packs, ice massage) 3. Mechanotherapy (ultrasound, whirlpool) 4. E stim units such as NMES, TENS, HVGS, and Iontophoresis

What are the signs/symptoms or diagnoses for which therapy should either be stopped or is contraindicated?

1. Uncontrolled atrial/ventricular arrhythmias 2. Recent embolism/thrombophlebitis 3. Dissecting aneurysm 4. Severe aortic stenosis 5. Acute systemic illness 6. Acute MI 7. Digoxin toxicity 8. Acute hypoglycemia or metabolic disorder 9. Third degree heart block 10. Unstable angina

Breathing exercises:

1. abdominal diaphragmatic breathing: strengthens diaphragm, decreases energy required for activity. 2. Pursed lip breathing: controls respiratory rate; decreases rate of breathing, helps remove trapped air from lungs 3. Techniques are done during al exercises and activities

Early Intervention Programs

1. acceptance criteria are based on "at risk" status of the infant or toddler who is under the age of 3: birth complications, suspected delays in development, failure to thrive, maternal substance abuse during pregnancy, birth to an teen mom, established disability/diagnosis 2. Acceptance consists of: 33% developmental delay, established diagnosis 3. OT focus: 1. development of cognitive process, psychosocial/communication/interaction, and sensorimotor skills 2. development of play and activities of daily living skills 3. provision of family education 4. provision of advocacy and advocacy training

Schools

1. acceptance criteria for OT services include: child required special education services, and occupational therapy will enable the child to benefit from special education. 2. OT focus: based on an educational model vs. medical model, addresses the students functional performance along with academic performance, activities are utilized to address the goals and objectives documented in the IEP using both corrective and compensatory methods, Assistive technology, performance skill deficits and client factors, ADL, school, and play,

Home Health

1. acceptance criteria: presence of a medical or psychiatric condition that is not serious enough to warrant hospitalization 2. Treatment is usually 60 minutes once a day for up to 5 days a week 3. OT focus: active engagement of the client, family and caregivers in the treatment planning, implementation, and re-evaluation, functional improvement in areas of occupation and role functioning in the home, environmental modifications and activity adaptations that maintain optimal functioning and improve quality of life

Wellness and Prevention Programs

1. acceptance is most often by individuals self referral to meet a personal need or by an institution's provision of a program to its members or employees 2. OT focus:disease prevention and health promotion, can range from traditional domain to contemporary areas of concern

Forensic settings

1. admission is due to engagement in criminal activity by a person. The person can be remanded to a variety of settings depending on the nature of the crime and if he/she has psychiatric diagnosis (jail, prison, psychiatric unit) 2. LOS is determined by the court 3. OT focus: determination of individuals competency to stand trial, facilitation of skills and provision of structures programs to enable the person to function at his.her highest level within their current environment since discharge may be delayed or not possible

Residential Programs

1. admission is for a developmental, medical or psychiatric condition that has resulted in functional deficits that impede independent living, but are not severe enough to require hospitalization 2. are on a continuum from 24 hour supervised quarter way houses, halfway houses, or group homes to supportive apartments with weekly or "bi weekly" check ins. 3. OT focus: consultation to and/ or supervision of residential program staff, remediation of underlying performance skill deficits and compensation for client factors that affect independent living skills,ADL training, activity adaptation, and environmental modification, referral to appropriate residential services along the continuum of care, education about ADA, fair housing act, and section 8 housing

Partial hospitalization/ day hospital programs

1. admission is for a medical or psychiatric condition that has been sufficiently stabilized to enable an individual to be dc'd home or to community residence; however the individual still has symptoms remaining which require active treatment 2. Treatment is 5 days/week 3. LOS is determined by diagnosis 4. OT focus: on the individuals functional skills and deficits in his/her performance areas and the occupational roles there are required in his/her current and expected environments, functional improvement in areas of occupational and occupational role functioning remediate of underlying performance skill deficits and compensation for client factors that affect functional performance, development of skills for community living and identification of community supports for community participation

OT Setting - Outpatient

1. admission is for a medical or psychiatric condition that is not serious enough to warrant hospitalization or for a condition that has sufficiently stabilized to enable the individual to be dc'd from a hospital but remaining symptoms require active treatment 2. OT focus: active engagement of the client in the treatment planning, implementation, re-evaluation,and dc process, remediation of underlying performance skill deficits that affect functional occupational performance, functional improvements in performance areas and occupational roles, compensatory strategies for remaining performance skill deficits and client factors, consumer, family, and caregiver education

Sub-acute care/intermediate care facilities

1. admission is for a medical or psychiatric diagnosis that has progressed from an acute state but has not stabilized sufficiently to be treated on an outpatient basis 2. LOS is determined by diagnosis and presenting symptoms (5-30 days) 3. OT focus: is functional improvements in performance skills and areas of occupation, active engagement of the client in the treatment planning, implementation, and re-evaluation process

SNF

1. admission is for a medical or psychiatric diagnosis that is chronic and requires skilled care, but the individuals illness is stable with no acute symptoms 2. LOS from 1 month to the individuals lifetime 3. OT focus: if individuals with rehabilitation have potential, the focus of eval and intervention is the same under rehab hospitals. Individuals without rehab potential, eval and intervention - more concerned with palliative care and the maintenance of quality of life,

Long-Term hospitals

1. admission is for a medical or psychiatric diagnosis that is chronic with the presence of symptoms that cannot be treated on an outpatient basis 2. LOS is determined by diagnosis and presenting symptoms (1 month to years) 3. OT focus: functional improvements in performance skills and patterns and areas of occupation, development of compensatory strategies for residual deficits and client factors, maintenance of quality of life, development of skills for discharge to the least restrictive environment

Adult Day Care

1. admission is for adults and elders with chronic physical, and or psychosocial impairments, and or for individuals who are frail but semi-independent. services are provided in a congregate or group setting 2. OT focus: on the individuals functional skills and deficits in the areas of occupation, his/her environment, and the adult day centers environment. Maintenance of the healthy, functional aspects of the individual and facilitation of adaptation to impairments, engagement in purposeful activities that provide appropriate stimulation , relate life-long interests, develop new interests, and foster a sense of community with other participants.

Long Term Acute Care

1. admission is for chronic or catastrophic illnesses or disabilities that require extensive medical care and/or dependency on life support or ventilators 2. the average LOS is greater than 25 days to maintain Medicare certification 3. OT focus: for all clients evaluation and intervention is concerned with palliative care and the prevention and treatment of complications. For individuals who are cognitively intact, the focus of eval and intervention is mastery of the environment and the attainment of client-centered goals

Acute Care Hospitals

1. admission is for medical or psychiatric diagnosis that cannot be treated on an outpatient basis 2. initial onset of a new illness or major health problem 3. LOS is determined by diagnosis and presenting symptoms (1-7 days) 4. OT role can be a generalist or a specialist (NICU, BURNS)

OT Considerations for Personality Disorders

1. assistance to the individual in identification of the above issues may increase commitment to treatment and the pursuit of behavioral change 2. cognitive behavioral approaches can increase fxl and coping skills and may decrease symptomatic behaviors

OT Considerations for ADHD/Hyperactive Disorders

1. behavior's impact on home, school, play/leisure, and social participation considered 2. environmental mods and activity adaptations to structure the client's home environment can enhance fxn 3. environmental mods and activity adaptations to structure school 4. training in social skills and self-management 5. interventions to improve sensory modulation are emphasized 6. consultation provided to parents, family members, teachers, and employees 7. in school-based practice, ongoing collab w/ IEP team and parents in vital

OT Considerations for RAD

1. close and ongoing collab w/ the child's family facilitates successful outcomes 2. actively involve parents in treatment 3. assist children to form a more secure sense of self 4. limit the child's exposure to multiple caregivers 5. provide high levels of structure and consistency 6. goals need to be specific, realistic, and attainable

Intellectual Disorders Impact on Development

1. cognitive development - slower learning ability - shorter attention span - diff w/ problem solving and critical thinking - diff generalizing info and mastering abstract thinking - increased distractibility 2. motor development - slower development w/ milestones occurring later - uncoordinated appearance of movements - low muscle tone 3. sensory development - diminished sensory modulation abilities - hyper- or hypo-sensitivity to all sensory stim 4. language development - decreased ability in recalling and retrieving words - diff grasping and expressing concepts - diff w/ the motor aspects of creating language 5. psychosocial development - impaired ability to respond to social cues - excessive shyness or aggressiveness

OT Considerations for Disorders Usually Diagnosed in Infancy, Childhood, or Adolescence

1. contributing disorders (ADHD, mood, learning disorders) 2. child's goals, stressors, and family and social relationships should be considered 3. skill development may improve emotional adjustment 4. behavioral approaches must be consistent throughout all programming 5. therapist should assist the parents, other family members, teachers, and school personnel to understand the nature of the child's condition and develop strategies for behavior management

Psychotic Disorders Impact on Fxn

1. deficits in cognitive-perceptual and social interaction skills 2. deficits in the processing of sensory information 3. diff w/ own ego boundaries often socially inappropriate, sometimes intrusive 4. lost or failed to develop social and communication skills necessary for effective and satisfying interpersonal interactions and relationships 5. deficits in cognitive function

Rett's Syndrome Dx Characteristics and Sequelae

1. deterioration of language, receptive and expressive communication skills and social skills may plateau at a 6 month to one year development level 2. motor deterioration characterized by a loss of purposeful hand movements w/ the development of stereotypical movements, such as hand wringing and licking, biting, and slapping of fingers 3. muscle tone becomes hypotonic and then progresses to spasticity and then rigidity (ataxic, uncoordinated gait) 4. muscle wasting can make these children prone to scoliosis and eventually need wheelchair 5. breathing patterns become irregular, marked by hyperventilation, apnea, and holding of breath 6. regression occurs in cognition and praxis 7. EEGs are abnormal and seizures common

OT Mental Health Eval Focus

1. determination of values, interests, desired occupational roles, and self-determined goals 2. identification of cognitive, perceptual, and psychosocial strengths and skills and their ability to facilitate recovery 3. ID of cognitive, perceptual, and psychosocial deficits and limitations and their impact on fxn and lifestyle 4. determination of fxl problems associated with psychiatric symptoms (safety awareness, judgement) 5. treatment history and ability and interest to engage in recovery 6. ID of coping skills, stressors, and environmental and social supports

OT Mental Health Intervention (Long-Term Hospitalization)

1. development and implementation of a plan for self-determined goal achievements 2. provision of a normalizing environment 3. engagement of the person in the treatment process 4. provision of graded activities to develop the skills needed for competence in ADL, IADL, social participation, leisure/play, school, and/or work 5. development of relaxation and stress management skills 6. continuation of assessment to determine realistic and meaningful discharge goals 7. skills and external supports for discharge

Asperger's Dx Characteristics

1. diff w/ social interaction 2. restricted interest and behaviors 3. characterized by clumsiness 4. delayed developmental and motor milestones 5. differentiated from autism by adequate language and the level of social interaction and engagement in activities w/ others

OT Considerations for Pervasive Developmental Disorders/Autism Spectrum Disorders

1. evaluate developmental and fxl levels 2. develop sensorimotor, social interaction, vocational readiness, and community participation skills relevant to child's level 3. provide sensory integration if indicated 4. prescribe and train in tech based augmentive communication if indicated 5. provide adaptive and positioning equipment to facilitate function (i.e. splints for Retts' syndrome that limit full elbow flexion) 6. collab w/ interdisciplinary and family team

What are the effects on function from cystic fibrosis (CF)?

1. exercise intolerance 2. Poor nutrition due to malabsorption may contribute to developmental delays

RAD Impact on Function

1. high need to be in control 2. frequent lying 3. affectionate and overly related w/ strangers 4. frequent episodes of hoarding or gorging on food w/o physical need 5. denial of responsibility 6. projecting blame of actions on others

OT Considerations for Substance Abuse

1. individuals abilities and potential may be over-estimated due to "learned survival skills" 2. important to assess the individual's identification of the reasons for substance abuse use during eval 3. development of the skills necessary to cope w/ life stressors (communication and social skills; skills to engage productively in work, education, and other productive activities; skills to use leisure time w/o substances) 4. life-long patterns of denial, resistance, and other defensive behaviors can make treatment difficult 5. referrals

Major Depressive Episode Impact on Function

1. individuals are often tearful, brooding, and isolative 2. anxiety 3. hopelessness, lack of energy, and slow though processing lead to limited interest in activity and difficulty in performing tasks in all areas of occupation

ADHD/Hyperactivity Impact on Fxn

1. infants are over-active, diff to soothe when crying, and demonstrate poor sleeping habits 2. defensiveness to environmental stim, frequent irritability, aggressive, emotional lability, and fluctuating performance 3. diff w/ delayed gratification in school and home 4. deficits in perceptual motor tasks 5. disorders in memory, speech, thinking, and hearing 6. depression secondary to functioning and learning difficulty

Manic Episodes Impact on Function

1. lack of inhibition 2. may become labile, threatening, or assaultive in later stages 3. may require little sleep w/ high undirected energy levels 4. poor judgement 5. substance abuse increases

OT Considerations for Manic Episodes

1. limit-setting to set and improve boundaries, reduce individual's fears of losing control, increase participation in intervention 2. engagement in activities that provide structure and opportunity to release excess energy 3. period b/w episodes used to educate individual and others

OT Mental Health Intervention Focus (During Periods of Acute Hospitalization)

1. management of all behaviors that threaten the safety and well-being of the individual and others on unit 2. stabilization of behavior to enable engagement in interention 3. engagement in activities that are "do-able" to enable success and promote reality-based thinking 4. engagement of the person in the treatment process 5. development of relaxation and stress management skills 6. development of skills needed to pursue desired occ roles and attain self-determined goals 7. engagement in activities to improve communication skill and self-expression 8. the gathering and sharing of ongoing assessment info w/ treatment team 9. A w/ discharge planning

Clubhouse programs

1. membership is open to adults and elders with a current mental illness or a history of mental illness, members have equal access to all housing and functioning opportunities regardless of functional level or diagnosis 2. OT focus: the role of the OT is integrated into the clubhouse model which has staff acting as generalists who contribute to the development and enrichment of members' abilities and the promotion of their recovery.

Rehabilitation hospitals

1. overall admission is for a disability that is medically stable but which has residual functional deficits requiring skilled rehabilitation services 2. LOS is determined by presenting deficits and rehabilitation potential ( 1 week to months) 3. OT focus: functional improvement in performance skills and patterns, areas of occupation, and occupational roles. Development of compensatory strategies for residual deficits and client factors.

Supported Education Program

1. participant criteria include adolescents or adults who require intervention to develop skills that are needed to succeed in secondary and/or post secondary education 2. OT focus: improvement in performance skills and patterns that are needed for the occupational role of the student, education and training in compensatory strategies to support academic performance, exploration of participants educational interests and aptitudes to ensure self-determined engagement in a school, college, technical training, program, or community-based adult education classes

Prevocational Programs

1. participant criteria include adolescents or adults who require intervention to develop skills that are prerequisite to work 2. OT focus: improvement in task skills and social skills that is prerequisite to vocational training or work, development of work habits and abilities, exploration of work interests and aptitudes to ensure D/C to a relevant vocational training program, school, or work setting

The Role of the Team

1. practitioners part of an interdiscipli- nary team that determines the needs abilities of an individual with disability specific environ- ment. Basis team construction. a. The facility which the individual disability presently resides and/or participates. The individual's needs and her abilities/func tional Geographical location. Funding ity (ie., third-party payers and/or offices individuals with disabilities). Support caregivers. The should always include the consumer and caregivers. 4. Professional team members may belong to Rehabilitation Engineers Society of North America (RESNA) and/or Registry Rehabilitation Technology Suppliers (NRRTS). Both professional organizations help develop standards measuring tools to ensure proper design, prescription, and delivery of rehabilitation technology. available the individual with a disabil-

Dx Criteria for ADHD/Hyperactivity Disorders

1. presence of six or more symptoms in the inattention domain, the hyperactivity-impulsivity domain, or both 2. symptoms present for at least 6 months or more 3. symptoms in inattention domain may include: lack of attention to detail, poor listening, limited follow through of tasks, diff w/ organization, and avoidance of tasks that require sustained attention, tendency to lose things, distractibility, and forgetfulness 4. symptoms in hyperactivity domain include: fidgeting, inability to remain seated, inappropriate activity level for given situation, frequent movement, excessive talking 5. symptom in impulsivity domain include: answering questions before fully stated, diff w/ turn taking, interrupting 6 visual perceptual, auditory perceptual, language, and/or cognitive problems may be present

OT Mental Health Intervention (In Community Setting)

1. provision of services that facilitate recovery and A in the maintenance of existing skills 2. A w/ continued development of skills needed for community living, social participation, and pursuit of valued occ roles 3. dev of skills and supports to enable ongoing recovery 4. dev of skills and the provision of A, if needed, to obtain concrete practical resources to support community living

Stages of lymphedema (3)

1. reversible lymphedema: limb is soft and pitting; swelling may increase overnight 2. Spontaneous irreversible lymphedema: swelling will increase with fibrotic tissue; risk for infection 3. Lymphostatic elephantiasis: extreme increase in swelling skin changes (fibrosis, sclerosis, papillomas)

OT Considerations for Intellectual Disorders

1. self-determination and person-centered planning within the person's capabilities a focus 2. support and assistance may be required to address performance skills and patterns in areas of occupation 3. development of community and social participation skills a major focus 4. interdisciplinary team and family collab 5. collab w/ educational team needed if school age

OT Considerations for Anxiety Disorders

1. skills training and using CBT approaches may reduce avoidant behavior 2. developing relaxation and stress management skills may decrease the incidence and severity of symptoms 3. providing graded activities designed to promote efficacy to increase self-confidence, motivation, and participation in intervention

Hospice

1. terminal illness that has a life expectancy of 6 months or less 2. OT focus: Maintenance of the individuals control over his/her life. Facilitation of engagement in meaningful occupations and purposeful activities that are consistent with the individuals roles and values, reduction or removal of distressing symptoms and pain, environmental modifications and activity adaptations that maintain optimal functioning and improve quality of life, caregiver and family support

OT Considerations for Eating Disorders

1. the building of trust is essential for effective intervention due to the secrecy, guilt, anger, resitance, and ego fragility often associated w/ eating disorders 2. OT must be honest, supportive, and gently confrontational when indicated 3. evaluation and intervention must include identification of the socio-emotional needs the eating disorder had fulfilled for the person so that health promoting occupational-based alternatives can be explored and developed (non-food related areas of interest should be explored) 4. education about nutritional food management and the development of healthy leisure time

OT Considerations for Major Depressive Episodes

1. the provision of a safe environment and the management of behaviors (individuals closely monitored) - most dangerous time is when depression begins to lift and the person becomes mobilized

Education Model

1. views the individual c a disability as lacking knowledge or skills 2. focus is placed on learning and making the behavioral changes needed to interact successfully in the environment 3. OT frames of reference are based on learning theories to facilitate adaptation in the environment ( role acquisition, cognitive remediation)

playing cards

1.5-2

putting on make-up while sitting

1.5-2

standing

1.5-2

MET 1.5-2 METs 2-3 METs 3-4 METs 4-5 METs 5-6 METs 6-7 METs 7-8 METs 8-9 METs >10 METs

1.5-2 METs: Standing, walking slowly 2-3 METs: Level walking (2mph), level bicycling (5mph) 3-4 METs: Level walking (3mph), bicycling (6mph) 4-5 METs: Walking (3.5 mph), bicycling (8mph) 5-6 METs: Walking at a brisk pace (4mph), bicycling (10mph) 6-7 METs: Walking at a very brisk pace (5mph), bicycling (11mph), swimming leisurely (20yd/min) 7-8 METs: Jogging (5mph), bike (12mph) 8-9 METs: Running 6mph, bike 13mph, swim 30yd/min >10 METs: Running, swimming moderate/hard

Vocational Programs

1.acceptance is for the development of specific vocational skills. Person has the prerequisite abilities to work, but requires training for a specific job and/or ongoing structure, support and/or supervision to maintain employment 2. OT focus: remediation of underlying performance skill deficits and compensation for client factors that affect the work performance area, development of general work abilities and specific job skills, consultation to and/or supervision of vocational direct care staff, identification and implementation of readable accommodations in accordance with ADA, referral to state offices of vocational and education services, for persons with disabilities for further evaluation, education, and training.

Case Management Programs

1.there are two different focuses: one is clinical, one is administrative. Clinical: provides individualized support and intervention to a client with a serious illness which significantly limits his/her ability to access and/or engage in existing community services and/or therapeutic programs . Administrative: connects a person with a serious illness to the appropriate and need community services and/or therapeutic programs, overseeing this service provision to ensure that quality of care in a cost-effective manner is achieved. 2. OT focus: on the individuals client facts and functional skills and deficits in his/her performance skills and patterns,areas of occupation, and the occupational roles that are required in his/her current expected environment

What is an adult's normal respiratory rate?

12-18 br/min

What is a normal infant heart rate?

120 bpm; range 70-170 bpm

normal adult BP

120/80 (range 110-140/60-80)

Further integration of all systems promotes complexity of motor planning as the child expands his/her repertoire of movement patterns

13-24 months

Motor planning abilities contribute to self concept as the child begins to master the environment.

13-24 months

Symbolic gesturing and vocalization promotes ideation, indicating the ability to conceptualize.

13-24 months

Kubler- Ross states of death and dying (and OT intervention for each)

1: Denial: allow indiv. to ask questions and discuss situation at his/her own pace 2: Anger: allow indiv. to vent anger while identifying its source and devel. more effective coping strategies 3: Bargaining: involves responding honestly to ?'s 4: Depression: providing phys. and psycho. comfort for indiv. and his/her loved ones 5: Acceptance: provide ongoing support to indiv. and family

playing piano

2-3

Further development of tactile discrimination and localization lead to improved fine motor skills.

2-3 years

Motor planning and praxis ideation also progress during this period.

2-3 years

Period of refinement as the vestibular, proprioceptive, and visual systems further develop, leading to improved balance and postural control

2-3 years

Basic Styles Seating

2. Contoured custom-contoured. Ergonomically supports the individual. Provides excellent support. Enhances postural alignment. Decreases abnormal posturing. e. Provides pressure relief. difficult for independent decre- UE muscle strength. g. for individuals moderate severe central nervous dysfunction neurological Basic Styles 2. Flat, noncontoured. b. or factory-ordered. rigid seating individuals, those who perform pendert transfers, andfor those minimal musculoskeletal involvement.

me Role of Occupational Therapy (OT) Practitioners

2. OT practitioners advocate for and design environ- ments that use principles of universal design meet physical, sensory, sociocultural, psychological needs individual. Table 15-1. OT practitioners can help identify settings and approaches implement the OBRA, and IDEA. porson's environment-living, vocational, a-whether takes place hospital, nursing school, practitioners familiar with

Evaluation of Driver Ability

2. establishment competency participate in clinical screening perfor- mance skills, prerequisite abilities, and factors. a. Visual-perceptual: acuity, vision, sensitivity, peripheral scanning, spatial relations, depth perception needed input environment. Color recognition not requirement as blindness be readily compensated driving b. Cognitive-perceptual: orientation, alertness, ability attention, problem response time, orientation, recognition, and knowledge rules the are drive safely appropriately for driving conditions, and anticipate actions drivers road conse- quences one's own actions. Motor: adequate range motion, strength, endur- response vehicle control including accurate steering to remain make and braking. Psychosocial: presence of impulsive agitated behaviors, psychiatric symptoms such suicidal delusions, halluci- nations, can to drive safely. e. medications perfor- alertness, driving (which range none, poor, to drive OTAS occupational therapist supervision can perform clinical for of factors without additional specialized training. screening areas requiring evaluation, therapist refer individual rehabilitation specialist. mandated diversity On-the-road evaluation: are levels driving that considered when evaluating person's abilities he/she is behind wheel and driving. Operation: brake, b. Evaluation Driver Ability can contribute the evaluation occupational therapist supervision. tical: ability respond changes road conditions traffic/driving Chapter

biking 6 mph

3-4

cleaning windows

3-4

walking 3 mph

3-4

shower seated

3-4 METs

Driven to challenge his/her sensorimotor competencies through roughhouse play, playground activities, games, sports, music, dancing, arts and crafts, household chores, and school tasks. (provide opportunities to promote social development and self-esteem.

3-7 years

Gestational period

38-42 weeks, divided into three trimesters

painting

4-5

raking leaves

4-5

tennis (doubles)

4-5

Class I heart disease-MET level tolerated

4.5 and over

What is an infant's normal respiratory rate?

40 br/min

phase 1 of cardiopulmonary rehab: LOS

5-14 days in hospital

digging garden

5-6

ice skating

5-6

The Role of the Team

5. professional team members. Assistive technology professional (ATP): analzE consumer needs, help select appropriate assistive technology identified and proid. training in use the b. Computer design provision of efficient technology. c. trainer: for driving adaptations. subsequent section driver rehabilitation. Nurse: ensure medical care medication regimes prescribed the doctor. e. Occupational and occupational assistant: refer section. Physical therapist: mobility difficulties individual encounter the environment. Physician: and assess services and purchases. Psychologist: assist adjustment indicated. i. Rehabilitation counselor: assess and advise vocational issues. j. Speech language pathologist: to assess mend augmentative communication aids. Rehabilitation design equipment assist with modifications adaptive equipme 1. Seating mobility specialist (SMS): seating, positioning, mobility needs and appropriate recommendations. Social worker: to obtaining funding. evaluae n. Teacher: children the school system, help any modifications within classroom setting

IQ Ranges

55-69 = a mild intellectual disability - focus placed on individual acquiring social and voc skills to function independently - min support required 40-54 = a mod intellectual disability - focus usually placed on the individual acquiring independence in routine daily skills and skills necessary to perform in desired occupational roles w/ supports and structure - limited support and A may be required 25-39 = severe intellectual disability - focus usually placed on individual acquiring communication skills and some basic health habits - A required for performance of most tasks - supervised living required - sig impairments in motor functioning and physical development typical 25 or below = profound intellectual disability - A and ongoing supervision - supervised living required - significant impairments in motor and physical development

Borg scale for rating perceived exertion: Scale 6-20

6- No exertion at all (how you feel when lying in bed or sitting in a chair relaxed 7- Extremely light 8 9- Very light (little to no effort) 10 11- Light 12- (target range: how you should feel with exercise or activity) 13- Somewhat hard 14 15- Hard (heavy) 16 17- Very hard (How you feel with the hardest work you have ever done) 18 19- Extremely hard 20- Maximal exertion (Don't work this hard)

Carrying groceries upstairs

6-10 METs

Tactile and proprioceptive responses also lead to midline skills and eventually crossing of midline

6-12 months

Tactile, proprioceptive, gustatory, and olfactory perceptions are integrated, allowing for primitive self-feeding

6-12 months

Vestibular, visual, and somatosensory responses increase in quantity and quality as the infant becomes more mobile.

6-12 months

tactile and proprioceptive perceptions become more refined, allowing for development of fine motor and motor planning skills.

6-12 months

manual lawn mowing

6-7

shoveling snow

6-7

swimming leisurely

6-7

tennis (singles)

6-7

walking 5 mph

6-7

What is a normal adult heart rate?

70 bpm; range is 60-100 bpm

What is a normal infant blood pressure? 1 month? 6 years?

75/50 mmHg 1 month- 80/45 6 years- 105-125/60-80

fencing

8-9

running

8-9

vigorous basketball

8-9

What is a normal adult blood pressure?

<120/<80 mmHg; range 110-140/60-80

somatoagnosia

A body scheme disorder that results in diminished awareness of body structure, and a failure to recognize body parts as one's own

Medicaid

A federal and state assistance program that pays for health care services for people who cannot afford them and/or have a disability

An OTR® is providing occupational therapy services to a client in acute care who was diagnosed with a pulmonary embolism. What is the most typical cause of a pulmonary embolism? A. Deep vein thrombosis B. Pulmonary hypertension C. Pulmonary edema D. Lung cancer

A. Deep vein thrombosis

An OTR® is working with a client who is being treated medically with a wound vacuum-assisted closure (wound VAC). What precaution does the OTR need to take during a therapy session with the client with a wound VAC? A. Do not turn off the wound VAC during treatment. B. Keep the client in a supine position. C. Do not have the client ambulate. D. Avoid moving the extremity with the wound VAC.

A. Do not turn off the wound VAC during treatment. The wound VAC should not be turned off without the nurse's knowledge because it can only be turned off for 2 hours within a 24-hour period.

An OTR® is working with a client who suddenly complains of pressure and tightness in the chest. The client's symptoms resolve with rest and a nitroglycerin tablet administered under the tongue. What condition is the client MOST likely to have experienced during the treatment session? A. Stable angina B. Unstable angina C. Myocardial infarction D. Atrial flutter

A. Stable angina

abduction splint

AKA- bobath finger spreader soft splint positions the digits and thumb is abduction in an effort to reduce tone

Dorsal Interossei

Abduction & assists in MCP flexion & extension of IP joints of digits II-V

Adductor Pollicis Longus

Abduction & extension of the CMC joint Origin: middle 1/3 of the ulna & radius Insertion: first metacarpal on the radial side

Abductor Digiti Minimi

Abduction of the pinky - Origin: pisiform and tendon of flexor carpi ulnaris - Insertion: proximal phalanx of the pinky

Level 4: Goal Directed Actions

Ability to carry out simple tasks through to completion; indiv. relies heavily on visual cues; he/she may be able to perform estab. routines but cannot cope w/unexpected events

Level 6: Planned Actions

Absence of disability; person can think of hypothetical situations and do mental trial- and - error problem solving

deformity, Major Styles and Accessories of Seating Systems

Accessories insert prevents hammock effect, provides solid base support. seat prevents hammock effect, provides base of support; easy lower seat to height. 3. Lumbar support 4. Foam (of various densities) enhance sitting comfort. Contoured foam cushion enhances pelvic and cushions. a. (1) Facilitates alignment. (2) without changing Good individuals increased stability. b. (1) Minimal postural Provides pressure relief. Good trunk control 7. cushions antithrust that higher than the back prevent the individual from sliding his/her seat. 8. Pelvic guides interior sides of wheelchair hip hips extend up side chair just below person's provide support.

Basic task skills group

Activ. designed to develop the basic cog. skills necessary for the completion of simple tasks

Palmar Interossei

Adduction & assistance with MCP flexion and extension of IP joints of digits II-V - Origin: ulnar surface of 2nd metacarpal, radial surface of 4th & 5th metacarpal - Insertion: ulnar surface of 2nd proximal phalanx, radial surface of 4th & 5th proximal phalanx

Adductor (hand)

Adducts CMC joint of the thumb - Origin: base of 2nd & 3rd metacarpal, trapezoid & captitate; palmar border & shaft of 3rd metacarpal - Insertion: sesamoid, base of proximal phalanx & tendon of extensor pollicis longus

Bariatric Considerations Wheelchair Prescription'

Adjustable backrest accommodate excessive posterior bulk. c. Reclining wheelchair accommodate excessive anterior cardiorespiratory compromise (e hypotension). Power application attached heavy duty wheet. chair accommodate excessive fatigue 10. Prescription' Wheelchair must be prescribed wheelchairs are rated for their obesity category. a. Selection based on characteristics, safety, function. bariatric has body mass that positioned several inches forward comparison with the nonobese wheelchair forward comparison the stand- wheelchair. forward more cient push (full extension). 3. wheelchair can be ordered special adap- tations. increased durability. and bariatric considerations for wheelchair measurement contributed Susan O'Sullivan.

can an OT change a patient's oxygen levels?

An OT is not allowed to make changes in a patient's level of oxygen intake without standing orders by the physician in charge of the patient's care

Tuberculosis (TB):

An airborne infection caused by a bacterium (mycobacterium tuberculosis). Can be pass the infection by sneezing or coughing.

Asthma:

An increase reactivity of the trachea and bronchi to various stimuli (allergens, exercise, cold)

Architectural Barriers

Architectural Barriers 1. Architectural the home the nity make negotiation space difficult or impos- 15

Coronary artery disease (CAD):

Artherosclerotic disease process that narrows the lumen of coronary arteries resulting in ischemia to the myocardium

intervention to prevent falls

Ask assistance tränsIe not stand do walk the room or kitchen alone (2) Uolize prescribed assistive devicels) late, especially unfamiliar ound Keep assistive device times. Use presoribed adaptive equipment (4) Stand before beginning walk id from change in position segin balance Do bend (6) Wear supponti bber-soled low-heeled shoes (7) Aoid smooth-soled only socks paychological and sperific sentions to Sear alling Adkoosdedge vday the individual's concems discussions k factons encourage problem solving (3) Modify activities to sale achievable build confidence (4) Provide activities condition- decrease becoming (5) Develop contingency use the event a to Complete appropriate referrals. (1) physician for of polymedication. to optometrist/vision specialist vision assessment

Wheelchair Measurement and Considerations

Assessment Footrests have 2-inch clearance floor, selected this measure- measurement seat surface (including cushion) upward of following depend- ing on trunk control, activity level, strength, and of person disability. (1) Midback under inches Midscapula axilla. the shoulder, c. height functional mobility sports chairs. (1) height can back d.Higher height may be needed if stability. (1) If back height is extended, potential problems recognized. (a) Added back height ual locking handle and/or shifting. (b) back height may difficulty fitting chair into car ment. Standard height: Hemi-height: inches. Super-low: 14.5 inches. height. a. Shoulders should hanging sides; elbow degrees. b. Measure each elbow seating surface Armrests that are encourage leaning forward. d. that high shoulder elevation. Types 5. Seat height. a. ankles should be positioned at degrees: thigh heel. chaptul

partici- General Assessment and Prescription Considerations

Assessment Prescription Considerations 1. OTA contributes evaluation the occupational supervision Assess the ability of the wheelchaif interface with other b. Determine the individual's medical sts ing prognosis (is condition progressive?) functional level/needs Collaborate with consumer cangnier interdisciplinary idencite section chapter.

Retrograde massage

Assists with return of blood and lymphatic fluid to the venous system 1. Gentle stroking is applied to centripetal direction 2. Massage should be performed with the extremity elevated

CAUTION!

Avoid extreme positions of elevation for individuals with right-sided heart weakness; this can cause the fluid to empty into the heart too fast

DSM-IV-TR used a multiaxial format for diagnosing mental disorders

Axis I = identified the clinical disorders and other conditions that may be a focus of clinical attention Axis II = included personality disorders and mental retardation Axis III = identified general medical conditions Axis IV = listed psychosocial and environmental problems Axis V = provided a global assessment of funtioning (GAF)P coded 0-100; code of 1-10 designated a person who has completed a serious suicide act or presents a persistent danger to self or others; code 100-91 designated a person who functions at a superior level

An OTR® is evaluating a new client and notes that the client has a bluish tinge to the skin and lips. The client also presents with significant edema. Which medical condition is this client MOST likely to have? A. Emphysema B. Chronic bronchitis C. Cystic fibrosis D. Cirrhosis of the liver

B-chronic bronchitis

An OTR® is working with a client who has been placed on bedrest because of a deep vein thrombosis. After anticoagulation therapy has been initiated, what is the accepted waiting period to resume occupational therapy interventions involving ambulation? A. 12 hours B. 2-3 days C. 5-7 days D. 8-10 days

B. 2-3 days

An OTR® is conducting a treatment session with a client with chronic obstructive pulmonary disease. The client is engaged in a light work task while sitting, suddenly experiences extreme shortness of breath, and panics. Which response by the OTR® would be MOST appropriate? A. Ask the client to lean backward and rest the arms on the chair arms, then practice pursed lip breathing B. Ask the client to lean forward and place the forearms on the thighs, then practice pursed lip breathing C. Ask the client to sit upright and allow the arms to dangle and guide the client to use visual imagery D. Ask the client to sit upright, use one arm for the work task, and use the other arm to bear weight and support the trunk

B. Ask the client to lean forward and place the forearms on the thighs, then practice pursed lip breathing

In reading a client's medical chart, the OTR® notes that the client has a history of postprandial orthostatic hypotension. What activity precautions should the OTR give the client? A. Limit standing to 30 minutes while completing an occupation, such as cooking. B. Avoid a positional change from lying down to standing within 30 minutes of eating a meal. C. Take several minutes in the morning to move from lying down to sitting and then standing after being in bed all night. D. Avoid leaning the head too far forward, for example, bending over to tie shoes while sitting.

B. Avoid a positional change from lying down to standing within 30 minutes of eating a meal. 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.

Which psychiatric condition is MOST frequently seen as interfering with the occupational engagement of a client with cardiac disease? A. Panic attack B. Major depression C. Personality disorder D. Hypochondriasis

B. Major depression

A client who has cardiac disease is participating in outpatient occupational therapy and is able to complete activities in the 1-3 metabolic equivalent (MET) range. Dyspnea and angina limit physical activity above 5 METs. Which activity is safe to include as part of the initial intervention for this client? A. Completing self-care tasks including dressing, bathing, grooming, and hygiene for 5-minute intervals each with 1-2 minutes rest between activities B. Participating in very light stationary biking for 5 minutes with a short rest of 1 minute and then standing to pack moderate weight items into boxes for 5 minutes C. Pedaling a stationary bicycle for several 5-minute intervals followed by a 1- to 2-minute rest between interval and continuing with 5-minute intervals until fatigued D. Walking on a treadmill at 10 miles per hour (16 km per hour) for 5 minutes followed by a 1- to 2-minute rest, then walking on treadmill at 5 miles per hour (8 km per hour)

B. Participating in very light stationary biking for 5 minutes with a short rest of 1 minute and then standing to pack moderate weight items into boxes for 5 minutes Discontinuous exercise involves using various exercise activities for the same time interval while gradually increasing the intensity of the tasks.

An OTR® is working with a client in acute care who is complaining of leg cramps and pain when walking. These problems are a common symptom of what condition or surgical procedure? A. Cardiac arrhythmia B. Peripheral artery disease C. Lung transplantation D. Coronary artery bypass graft

B. Peripheral artery disease

hypertension

BP above 120/80

Psychodynamic/Psychoanalytic (frame of reference)

Based on work of S. Freud, A. Freud, Jung, Sullivan - Principle developers: Gail Fidler and Ann Mosey - Rarely used today - Indiv. may protect themselves from anxiety through use of "defense mechanisms" (some healthy, some not) - Projective and func. tasks used to promote self-awareness and identification of intrapsychic content

Level 3: Manual Actions

Begins w/use of hands to manipulate objects; indiv. may be able to perform limited number of tasks w/long-term repetitive training

E stim application

Benefits: pain control, decreases swelling, stimulates and strengthens muscles, muscle re education, stimulates deserved muscle 1. Transcutaneous electrical stim (TENS) decreases pain (based on gate control theory) 2. Neuromuscular stimulation (NMES) increases muscle contraction and strength ***RED FLAG*** CONTRAINIDCATIONS: DO NOT USE WITH PEOPLE WHO HAVE A CARDIACT PACEMAKER, PHRENIC OR URINARY BLADDER STIMULATORS, OR PRESENCE OF THROMBOSIS OR THROMBOPHLEBITIS OR OVER THE CAROTID SINUS

Cryotherapy application

Benefits: relieves pain controls edema decreases abnormal tone facilitates muscle tone commonly used to treat acute injuries and post surgical repairs 1. Apply ice pack with a dry or wet towel between the clients skin and the cold pack. Check skin after 3-5 minutes 2. Ice massage; applied in circular motion directly to the skin for 3-5 minutes ***RED FLAG*** CONTRAINDICATIONS: DO NOT USE WITH PEOPLE WITH SENSORY DEFICITS, IMPAIRED CIRCULATION, OR RAYNAUDS DISEASE

Transfer Considerations

Board placed under individual's gluteal during weight shift, other is transferred Individual then extremities and slide tenodesis grasp or splint functional the person weight extended Dependent: caregiver required fully perform transfer 5. Mechanical Hoyer trans-aid mobility Bed transfer Bedrail. transfer (1) Active-aid commode with sed allow transfer bathroom otherwise possible Bedside commode. devices (i.e, walken) Wheelchairs arms, variability a. Adjust according individual's strengths and limitations regarding component/skills different floor/ground surfaces. of the personal when bariatric (1) Use good bsody mechanics obtain adequate assistance transfers, use mechanical lifts Train to variety different (i.e. bed, wheelchait, toilet, and/ car) Transfer Types Stand-pivot: individual stands to transfer surface. seated a position not is decreased ance and/or precautions. board those are not stand to transfer (i.e, individuals with spinal cord injuries amputations). lifts: chairs allow le surface individuals may othery able transfer independently

Edema

Bodies initial response to injury Pitting- acute brawny- chronic Measuring circumference* -tape measure, recorded in CM -compare extremities and document landmarks -figure 8 method eval of hand/arm mass via volunteer* significant change is more than 10 ML***

Precautions and contraindications to performing joint measurements (ROM)

Bone metastasis unhealed fracture/recent dislocation infection post surgery myositis osssificans subluxed or unstable joints skin grafts

An OTR® is working with transplant recipients who have recently been discharged from a major hospital. Which type of client would be MOST likely to develop an infection posttranplantation and require greater infection control measures? A. A client with a kidney transplant B. A client with a heart transplant C. A client with a lung transplant D. A client with a liver transplant

C. A client with a lung transplant A client with a lung transplant is the most susceptible to infection because the transplanted organ is exposed to bacteria and germs on inhalation.

An OTR® is working on the intensive care unit of a hospital. The client has hypertension and has an arterial line catheter inserted in the radial artery. What change in the client is the OTR MOST likely to record during treatment? A. A decrease in blood pressure when the head of the bed is elevated B. A decrease in heart rate when client is positioned from supine to short sitting at the edge of the bed C. An inaccurate blood pressure reading when the wrist is moved D. An increase in respiration rate when the client is positioned side lying

C. An inaccurate blood pressure reading when the wrist is moved An arterial line catheter is inserted in the radial artery at the wrist to continuously monitor arterial pressure. When the wrist is moved, it can disrupt the catheter and affect the blood pressure reading.

An OTR® is working with a client who had a pacemaker implanted 10 days ago. Which activity would be contraindicated because of pacemaker precautions? A. Heating tea in a microwave at waist level B. Lifting a light jacket from one surface to another C. Placing hair in a ponytail using both upper extremities simultaneously D. Brushing hair using the upper extremity opposite the pacemaker placement

C. Placing hair in a ponytail using both upper extremities simultaneously 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. Shoulder abduction or flexion greater than 90° on the side opposite pacemaker placement is acceptable movement. Clients' shoulder movement is restricted only on the operated side.

An OTR® is working in a cardiac rehabilitation program. Of the four clients on the OTR's caseload, which client would require a longer warm-up and cool-down period during exercise and activity sessions? A. The client with congenital heart disease B. The client with a coronary artery bypass graft C. The client with a heart transplant D. The client with an automatic defibrillator

C. The client with a heart transplant 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.

!!! URGENT !!!

CONTRAINDICATIONS FOR MEM AND OTHER EDEMA REDUCTION TECHNIQUES: 1. DO NOT USE WITH PEOPLE WITH INFECTION, GRAFTS, OR WOUNDS; VASCULAR/CIRCULATION DAMAGE; BLOOD CLOTS; UNSTABLE FRACTURES; CONGESTIVE HEART FAILURE; OR CARDIAC EDEMA

Bathroom Considerations bathrooms

Considerations Number bathrooms home. location of bathroom(s) relative to bedroom. room, kitchen, and living spaces impor- individual. Width of bathroom doorway. of bathing the individual with disability peforms (ie. sponge bath) previ- ously and currently. of shower/tub: separate stall, glass door with curtain-enclosed tub shower, fashioned claw-legged tub.

An OTR® is working with an acute-care client who has a ventricular assist device. Which precaution is essential when engaging this client in occupational activities? A. Do not administer an exercise stress test to this client. B. Instruct the client in sterile dressing changes to prevent infection. C. Educate the client to avoid yearly influenza and pneumonia vaccines. D. Avoid disconnecting the drive line to the power source during movement.

D. Avoid disconnecting the drive line to the power source during movement. A ventricular assist device requires a power source to function properly. The drive line connects to the power source. If the OTR is not careful, the drive line can become disconnected during activity.

An OTR® is working with a client 3 days post open-heart surgery. The OTR® emphasizes to the client to follow all sternal precautions during exercise and activities for 3 months. Which precaution is part of sternal precautions? A. Scar massage to the sternal scar B. Wearing of a sternal splint guard when out of bed C. Breathing out on exertion D. Avoidance of one-sided lifting or pulling up

D. Avoidance of one-sided lifting or pulling up

An OTR® is working with a client with myocardial infarction during the early rehabilitation phase in an outpatient facility. In reviewing the home program with the client, the OTR® discusses activity and exercise limitations according to metabolic equivalent (MET) levels. Which activity would be contraindicated within the first 4 weeks after a myocardial infarction because of the activity's MET level? A. Light housekeeping B. Knitting and crocheting C. Dressing and undressing D. Carrying groceries upstairs

D. Carrying groceries upstairs 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. A, B, C: Light housekeeping, knitting and crocheting, and dressing and undressing require 1.0 to 2.5 METs, well within the 2.0 to 4.0 MET range.

An OTR® is interviewing a new client who physically presents with a "barrel chest." This appearance is most often associated with what condition? A. Cystic fibrosis B. Asthma C. Collapsed lung D. Emphysema

D. Emphysema

While an OTR® is working with a client on the grooming task of brushing teeth, the client mentions having to take antibiotics before going to the dentist for any dental work. What condition is MOST likely a part of the client's medical history? A. Chronic obstructive pulmonary disease B. Lung cancer C. Hip replacement D. Endocarditis

D. Endocarditis People with a history of endocarditis generally take antibiotics before any dental procedures to prevent an infection from migrating to the heart.

An OTR® is working with a client who is experiencing dyspnea while performing a daily occupation in sitting. What sitting position would BEST minimize the client's dyspnea while performing the occupational task? A. Sitting with trunk erect and rigidly in midline B. Sitting with trunk extended and slightly to one side in a more relaxed posture C. Slouching to one side and leaning on one arm for improved trunk support D. Slouching forward while avoiding maximum forward trunk bending

D. Slouching forward while avoiding maximum forward trunk bending To ease breathing, lean partially forward, propping the forearms on the upper thighs.

Supinator

DORSAL forearm muscles innervated by the RADIAL nerve. Origin: Lateral epicondyle and ulna Insertion: Radius Function: Forearm supination

Wheelchair Prescription and Assessment Purposes of Wheelchair Seating Positioning***

Decrease deformity through ized seating needed. 10. Decrease through provision limbs. Wheelchair Seating and Positioning Enable functional with the with available. Facilitate mastery the environment. occupational engagement and partici- pation. functional posture by provision appropri- ate back, trunk, and leg supports. limb function, occurs proper support. Promote comfort during upright activities of daily 7. Provide physiological tissue through prevention of shearing. sensory readiness social interaction through provision position.

An OTR is working with a client who has ventricular tachycardia. The client's vital signs include a heart rate greater than 100 beats per minute. What is the appropriate therapeutic response to this client's situation?

Defer the client's participation in occupational therapy until later, because the client is medically unstable.

home tions. Overall Characteristics of the Home of

Door sills: identify where they present, entrance to dwelling bedroom doors, bathroom doors, kitchen doorway. 10. Elevators: doorway, type operation. IL. Hallways: width hallway entrance. 12. Doorways: width entrance measure door frame; frame frame Doorways: of opening for entrance d and throughout dwelling that opened. a. Space accommodate door swing must be minimum inches needed for using walkers. minimum inches needed using wheelchairs. 14. Type(s) door handles: handles functional knobs. 15. Identification objects obstrucin doorways pathways. of pets: can obstacles safety concerns vision, problems, who require assistive devias 17. Carpeting: wall wall th height of 18. Electrical cords: placed flow traic good condition or frayed, overloaded underng carpeting. Presence of firm chair the dwelling height. 20. Light accessibility from varios (standing chair). inches Telephones: number phones, location Lype (e.g., cordless, cell, push button rotaryl gency numbers telephone. Presence working smoke detectors. 23. Presence heaters wood-buming 24. Presence emergency call system gency exit

Driver Rehabilitation

Driver Driving of living. 2. Purposes. Provide mobility within one's community. for autonomy for self-directed activity pursuit. c. engagement including tional, avocational, social, and Physical, cognitive, psychiatric, developmental disabilities affect safely effectively. Driver requires extensive on-the-road training and behind-the-wheel driving diversity environments. Knowledge of general state driving regulations and statutes specifically individuals with acquired prior driver rehabilitation practitioner performs on-the-road driver evaluation and/or become state licensed driving instructor. State regulations determine eligibility. D. practitioners who practice driver rehabilita- tlon should become certified driving rehabilitation specialists, DVE

Grip strength

Dynamometer -position UE shoulder abducted to side, elbow flexed to 90, and forearm in neutral Types of grip strength tests: -dynamometer: handle placed on position #2. Mean of 3 trials is compared to norms -one trial in all five positions for each hand. A bell curve is observed if individual is applying max effort -sphygmomanometer cuff or vigorimeter/bulb dynamometer: used to evaluate the grip strength of a person with arthritis

Additional Considerations ATDS and EADLS

EADLS 1. The appliances and cords to used ATDS and EADLS be determined. Charging instructions must followed, as strict schedules. The individual's telephone answering evaluated to attached. Surge protectors used avoid blown Backup systems electrical devicen dl be established. Instruction provided to indind OT practitione present. 7. Warranty information obtainl the consumer educated about these conditions.

equipment). Electronic Aids to Daily Living (EADLS)

ECUS), communica- 1. Definition: EADLS formerly known mental control units (ECUS) and are 'mem purposefully manipulate interact with ronment by alternately accessing trical devices switch, voice activation control, computer interface... (Bain 1998 2. Purposes. Enable control of devices within the envan D. Compensate for functional limitations mize functional abilities. c. Increase independence home school wd other environments. d. Conserve energy during home manageme work

Two types of isotonic exercise

Eccentric- lengthening concentric- shortening

Interventions

Educate Train caregivers persons with memory sensory impairments on effective communica techniques. b. Facilitate carryover of intervention technique Bain, Increase potential individual and his/her awareness rights Monitor changes adjustment assess carryover information. home modifications ensure safety a. Remove potential hazards deaning medications, sharp objects, matches stne and firearms a person confused forge b. Follow modifications identified earlier chapter Chapter for additional nodifatis sensory resources. Provide personal emergency system

Legislation Related to the Environment

Environment 1. Americans with Disabilities Act (ADA): civil law aimed at allowing full participation in society people with disabilities. Several sections mandate accessible environie for persons with disabilities. b. Included are policies dealing with public sevic employment, public accommodations. 2. Omnibus Budget Reconciliation Act dates that restraints cannot be used without justification, agreement, and documentation 3. Individuals with Disabilities Education Act (IDEA mandates that children disabilities geine education in least restrictive and most environment. a. Inclusive models are be used to enable chil to be taught a regular classIOom. b. Education must prepare iving and emplovment environme child for indepgnd The role of practitioners environmental ase ment and modification has increased with mentation of the OBRA, and IDEA. (See 4 more specific information on OR IDEA.)

Contextual Evaluation

Environment: Intervention the individual with disability (3) Opportunities for socialization (4) Sociocultural norms, values, and expectations Social roles: expectations for performance Availability and of transportation. Overall accessibility. Sociocultural considerations. independent function. (5) Community resources available. individual's network relation ships between individual disability

Purposes of Environmental Evaluation and Intervention

Environmental Identify device's availability, safety, cs. Determine device's frequency 6. Determine funding financial resources for equip- ment and/or modifications. a. questionable ethics inter- of the with show him/ her device order top-of-the-line equipment that is covered his/her insurance, he/she does financial resources self-pay. Determine environmental constraints. For example, individual be living in flight walk-up apartment device locked up lobby, opening of vandalism theft. 8. individual with a disability and device allow reevaluation. Ensure device will for possible modifica tions, upon reassessment of individual change in found. and everyday Chapter 15

Funding for Environmental Modifications

Environmental State One-Stop Centers, Vocational and Educationd Services Individuals with Disabilities (VESID) Offices for Vocational Rehabilitation (OV, of Vocational Rehabilit steep. and (DVRS) pay for home work modification modifications enable person to wod school. 2. Private companies fund modifications et ADA insurance, Medicaid, Compensation will reimburse fer devices/adaptations. 4. Centers for Living disability organizations fund modifications to enabl community participation.

Fall Prevention and Management Falls Etiology, Prevalence, Prognosis***

Etiology, Prevalence, Prognosis unintentional causing one make unexpected contact ground floor. and fall injury are major health concern 1or the elderly. figures follow FTovided the need for ỢT practitioners to be active the prevention falls. These statistics will be the NBCOT examination. Between 30% of persons over age of fall each year. Note: be greater because are based only upon reported falls. Twenty-four percent of falls result soft and fractures. CFalls are the leading cause of death the eklerly, 12% all for persons aged older by falls.

Lymphatic disease (lymphedema):

Excessive accumulation of fluid d/t obstruction of lymphatics causes swelling of soft tissues in arms and legs.

Electronic Aids to Daily Living (EADLS)

Expanded keyboards that provide persons with visual-motor deficits (e.g, persons with residual deficits post-CVA). Key for persons limited motor accuracy control individuals with ataxia). (1) Contracted keyboards that provide smaller keys constrained for persons with limited motion func- tional motor control individuals with arthritis). Light-touch keyboard systems for persons with decreased strength and/or mobil- ity (eg., individuals with muscular dystrophy). (h) Delayed touch keyboard activation systems persons with poor control (eg., individuals with movernents). Chorded keyboards that of keys which standard characters by pressing various combinations keys for one-handed use (eg., individ- uals hemiplegia). (6) Tongue-touch keypad (1TK) imbedded in an orthotic device persons with severe motor good tongue (eg., individual Augmentative communication: meth- ods of communication require consider: message is conveyed. (2) Portability: easy use variety of environ- mental ability individual dently Dependability: durability, service indene Independence (6) Vocabulary flexibility. (7) Time for repairs maintenance. (8) Types simple communication limited pictures to complex portable systems with extensive capacity. Chapter

Mildred Ross' Five Stage groups (purpose and 5 stages)

Expanded on work of Lorna Jean King and extended use of sensorimotor approaches to other chronic pop. (MR, Alz, neuro impairment, etc) - 1: orienting members to session and each other - 2: GM activ. that are stimulating/alerting - 3: brief activities that utilize perceptual-motor skills designed to be calming and inc. focus - 4: activities to provide cog. stim to promote org. thinking - 5: discussions to promote satisfaction/closure

Extensor Pollicis Longus

Extension of the IP joint of the thumb Origin: ulna middle 1/3 Insertion: distal phalanx of the thumb

Extensor Pollicis Brevis

Extension of the MCP and CMC joints of the thumb Origin: radius middle 1/3 Insertion: proximal phalanx of the thumb

Extensor Digiti Minimi

Extension of the MCP joint of the pinky Origin: lateral epicondyle Insertion: EDC at MCP level of the 5th digit

Extensor digitorum communis

Extension of the MCP joints and contributes to the extension of the IP joints Origin: lateral epicondyle Insertion: medial band to middle phalanx & lateral band to distal phalanx

Extensor Indicis Proprius

Extension of the MCP of the index finger and contributes to extension of the IP joints Origin: ulna middle 1/3 Insertion: EDC at MCP level

Environmental Modifications Cognitive and Sensory Deficits General Interventions***

Facilitate General Interventions 1. environment familiar, predictable. a. Provide the to increase orientation to place, and situa- b. Remove decrease extraneous stimuli individual vision. tactile cues decrease confusion, awareness, and independence (e.g., directions, labels). Keep the for consistency 6. ease. Use contrasting background foreground or figures from background. 3. restraint reduction techniques agitated, and/or wanderer. See next section. 7.

Evaluation of Risk Factors for Falls

Falls OTA contributes evaluation process OT supervision a. Upon establishment of service competency, can collect about extrin- factors contribute to Intrinsic factors requiring evaluation. a. Age-related changes reduced sensory capacity (1) (a) Presbyopia (decreased acuity) (b) vision low-light situations is reduced. (c) perception. (2) Vestibular Vertigo. Postural with vision results compound risk b. Age-related changes neuromuscular system. (1) Decreased of neurons result decreased reaction response Decreased number fibers extremity strength and (3) combination above factors difficulties from and maintaining c Comorbidity and pathological including congestive heart arrhythmias, hypotension, cerebrovascular disease, riosclerosis and atherosclerosis, diabetes mellitus. d. Medication side effects polypharmacy. Delirium and/or f. Anxiety and/or depression. Cognitive span, distract- ibility, impaired judgment. Prior within year. i. Fear of falling lead decreased mobility progressive deconditioning, which increase falls. Extrinsic factors requiring evaluation: safety hazards within the environment predispose one and (1) Floors: uneven, presence of throw rugs. Toys or other left floors stais. (3) Pets foot. (4) High-pile carpets. Low-lying furniture. (6) Stairs, excessive steepness, lack of loose handrails. (7) footwear.

balance Etiology, Prevalence, Prognosis unintentional of

Falls factor admissions e. Women more risk for falls men, due their increased incidence of osteoporosis; aged whereas 42% of women of the same age fall. Within 6 of fall, more two-thirds of elderly who fall Results of Fractures: Most common sites the pelvis, hip, femur, vertebrae, humerus head. b. Increased and c. confidence to function independently. d. Decreased engagement in activity and restriction activities that result physical decondi- tioning and deterioration, contributing to like- lihood reoccurrence, Increased risk recurrent falls.

Fetal sensorimotor development - auditory

First Trimester: NA Second Trimester: Will turn to auditory sounds Third Trimester: debris in middle ear, loss of hearing

Fetal sensorimotor development - vision

First Trimester: eyelids fused, optic nerve and cup being formed Second Trimester: startle to light, visual processing occurs Third Trimester: fixation occurs, able to focus (fixed focal length)

Fetal sensorimotor development - vestibular system

First Trimester: functioning at the end of the first trimester BUT NOT COMPLETELY DEVELOPED

Fetal sensorimotor development - movement

First Trimester: sucking, hiccupping, fetal breathing, quick generalized limb movement, positional changes, **7.5 weeks: bend neck and trunk away from perioral (relating to/occurring in mouth) stroke Second Trimester: Quickening, sleep states, grasp reflex, reciprocal and symmetrical limb movements Third Trimester: 28 weeks, primitive motor reflexes, rooting, suck, swallow, palmar grasp, plantar grasp, MORO (startle), crossed extension

Fetal sensorimotor development - taste

First Trimester: taste buds develop Second Trimester: NA Third Trimester: Can respond to different tastes (sweet, sour, bitter, salt)

Fetal sensorimotor development - touch and tactile system

First trimester: first sensory system to develop, response to tactile stimulus Second Trimester: receptors differentiate Third trimester: touch functional, actual temperature discrimination at end of third trimester, most mature sensory system at birth

Fetal sensorimotor development - muscle spindle

First trimester: muscle starts to differentiate, tissue becomes specialized Second trimester: Motor end plate forms, Clonus response to stretch Third trimester: some muscles are mature and functional, others still maturing

What type of splint is used for positioning with a person who has a brachial plexus injury?

Flail arm splint

Flexor Digitorum Profundus

Flexion of DIP - Origin: proximal 2/3 of ulna & interosseous membrane - Insertion: Distal Phalanx

Flexor Pollicis Longus (EPL)

Flexion of IP joint of thumb - Origin: radius, middle 1/3 - Insertion: distal phalanx of thumb

Flexor Digitorum Superficialis

Flexion of PIP joints Origin: medial epicondyle Insertion: middle phalanx

Flexor Digiti Minimi

Flexion of the MCP joint and opposition of the pinky Origin: hook of hammate & flexor retinaculum Insertion: proximal phalanx of 5th digit

Wrist flexors innervated by the ulnar nerve

Flexor carpi ulnaris (FCU)

Cognitive Disabilities Model evaluation

Focus is on identifying indiv.'s current cog. abilities and their implications for perf., indep. and need for assistance; obs during func. task emphasized - Use of Allen Cognitive Levels Leather Lacing Task, Routine Task Inventory and Cognitive Performance Test

Biomechanical Frame of Reference

Focuses on ROM, strength, and endurance required to perform an occupation.

Skiers thumb

Hand based thumb splint to protect the ulnar collateral ligament of the MCP joint of the thumb until healed

An OTR is working with a client with orthostatic hypotension. The client becomes lightheaded and complains of blurred vision while sitting on the edge of the bed. What action does the OTR need to take if the client remains lightedheaded?

If the client remains lightheaded and his or her blood pressure drops more than 20 mm HG systolic and 10 mm HG diastolic, then the client's lower extremities need to be elevated to return blood flow to the head.

Assistive Technology (AT) Act of 2004

Improved access to and acquisition of AT by funding direct services to support individuals with all types of disabilities and all ages, in all environments including school, work, home, and leisure.

Social interaction group

Include interventions to develop communication skills, socially acceptable behavior, and interpersonal relationship skills Maybe conducted in a modular and/or psychoeducational format

Static progressive splint

Includes static adjustment part (turnbuckle or strap) that allows the patient or therapist to make changes to the tension or angle to increase motion

Trapezius (upper, middle and lower)

Innervated by spinal accessory nerve (CNXI) - Origin: Upper fibers: occiput and ligamentum nuchae; Middle fibers: spinous processes of T1-T5; Lower fibers: spinous processes of T6-T12 - Insertion: Upper fibers: lateral 1/3 of clavicle; Middle fibers: acromion and spine of scapula; Lower fibers: Medial end of spine of scapula - Function: Upward rotation muscle, scapula elevation, scapula depression

Anterior deltoid

Innervated by the AXILLARY nerve Origin: clavicle Insertion: deltoid tuberosity Function: shoulder flexion

Coracobrachialis

Innervated by the MUSCULOCUTANEUS nerve Origin: coracoid process Insertion: deltoid tuberosity Function: shoulder flexion

Serratus anterior

Innervated by the long thoracic nerve - Origin: Ribs 1-8, and aponeurosis of intercostals - Insertion: superior and inferior angles of scapula nd vertebral border of scapula - Function: Upper rotation muscle Innervated by the dorsal scapular nerve. - Origin: see above - Insertion: see above - Function: Downward rotation and scapular abduction muscles.

Type of Intervention: Prevention

Interventions designed to promote wellness, prevent disabilities and illness, and maintain health

Type of Intervention: Maintenance

Interventions designed to support and preserve the individual's current functional level (this is where no improvement in function is planned d/t chronicity of the disorder or the progression of the disease)

Level 2: Postural Actions

Movement that is assoc. w/comfort; some awareness of large objects in environ. and indiv. may assist the caregiver w/simple tasks

What is the Early Intervention and Education Acts?

Multiple acts that have provided the foundation for current early intervention and education services: - Mandates for free and appropriate education (FAPE) for all children regardless of disability (3-21 yo) in the least restrictive environment (LRE). *LRE meant mainstreaming - Requires public schools provide OT to special ed students if OT is needed for the student to benefit from special ed. - Designated OT as a primary early intervention service. - Funding for family support services and programs to train professionals in early intervention. - Recommendations for states to develop infant and toddler programs (birth to 3 years).

Auditory system is immature at birth and develops as the infant orients to voices and other sounds

Neonatal period

Tactile, proprioceptive, and vestibular inputs are critical from birth onward for the eventual development of BODY SCHEME

Neonatal period

Visual system develops as infant responds to human faces and items of high contrast placed approx. 10 inches from face.

Neonatal period

vestibular system, although fully developed at birth, continues to be refined and impacts on the infant's arousal level (Helps the infant to feel more organized and content)

Neonatal period

Static splint

No moving parts and immobilizes a joint or part

Objective assessment Class A

No objective evidence of cardiovascular disease. No symptoms and no limitation in ordinary physical activity

Objective Assessment Class B

Objective evidence of minimal cardiovascular disease. Mild symptoms and slight limitation during ordinary activity. Comfortable at rest

Objective Assessment Class D

Objective evidence of severe cardiovascular disease. Severe limitations. Experiences symptoms even while at rest.

Peripheral Vascular Disease

Occlusive peripheral arterial disease (PAD) Chronic, occlusive disease of the medium and large vessels Associated with HTN, hyperlipidemia Associated with CAD, diabetes, CVD, metabolic syndrome, smoking Diminished blood supply to extremities

Level 5: Exploratory Actions

Overt trial and error problem solving; new learning occurs

Architectural Barriers

PA S60 degree wheelchair turning space requires derance space ol 60 x 60 inches. See Figure 15-3. maimal height the individual reach fonvard siting is 48 inches, nydad tipping. Figure 15-4 d. Maximal height reaching sideways is 54 inches and obstruction present is 46 See Figure 15-5. The maximal height countertops should inches. Parking spaces have adjacent 4-foot aisle allow wheelchairs to maneuver. Pathways and walkways should be 48 inches Ramps should be minimum of 36 inches wide and should have nonskid surface upper and lower levels. The ratio of slope rise is 1:12 of rise, 12 is required). See 15-6 354. Railings should between inches and 36 high, depending on person's reach; 32 inches average. Curbs ramps should be least high. (4) Level platforms ramp design. (a) the ramp excessively long, foot landing(s) required to allow for rest. If the person using ramp limited upper extremity strength decreased cardiopulmonary capacity, foot foot landing(s) required.

Order of sensation return for peripheral nerve injuries

Pain, moving touch, static light touch, and touch localization

Abductor Pollicis Brevis

Palmar abduction Origin: Bones of hand Insertion: radial side of thumb

Signs and symptoms of COPD:

Patients present with a mixture of clinical features. These include the following: 1. Primary complaint of dyspnea on exertion 2. Diminished breath sounds, wheezing Chronic inflammation of distal conducting airways Chronic bronchitis: inflammation of tracheobronchial tree with cough and sputum lasting at least 3 months Emphysema: permanent abnormal enlargement and destruction of air spaces.

Medicare Part A

Pays for services provided by inpatient hospitals, SNFs, home health agencies, rehabilitation facilities, and hospices - automatically provided to all who are covered by the social security system that meet Medicare criteria - fixed dollar amount for patient care for each diagnosis regardless of length of stay/number of services provided - specific time limits and also require deductible and coinsurance payments - 20% of HHC must be paid by patient - minimum 5 days/week services

Medicare Part B

Physician services, hospital outpatient services, durable medical equipment, orthotics, prosthetics, supplies, and other professional services including OT services provided by independent practitioners. - considered "supplemental" and therefore must be purchased by beneficiary usually as a monthly premium - no specific time limit - interventions must be provided by COTA/OTA with general supervision from OTR - 3 days/week services

Pinch strength

Pinchmeter position of upper extremity: shoulder addicted to side, elbow flexed to 90, forearm in neutral types of pinch strength tests: -key or lateral pinch: thumb pulp to the lateral aspect of the index middle phalanx -three jaw chuck (palmar pinch): pulp of thumb to pumps of index and middle fingers -tip to tip: thumb pulp to pulp of index finger three trials on each hand; compare the mean to the norms

Evaluation of Risk Factors for OTA

Poor lighting glare. Poor thresholds. Extension cords. (11) furniture other unstable objects support. (12) Improper transfer techniques. (13) Problems with adaptive equipment, las needed equipment, excessive equipm Bathroom (1) grab (2) thilization unstable to for support. (3) Toilet seat low. (4) Wet floor is) of wet sink surface for supp (6) floor. c. Kitchen. (1) Low doors open. Step stool without Chairs (4) Wet surfaces rug floor. d. (1) too high (2) Movement bed. Reaching into closets. room. (1) Wires and/or clutter (2) Chairs too high too pile loose lighting.

Innate tactile, proprioceptive, and vestibular reactions.

Prenatal period

responds first to tactile stimuli

Prenatal period

Bathroom Considerations

Presence and location grab bars for toilet and bath/shower (the soap dish and towel bar are bars). home rental, landlord's agreement to grab bars to installed needed. 7. Height of sink, and toilet. Presence a mat or surface in shower/tub. 9. Presence of throw outside shower. 10. Availability handheld 11. Presence of antiscald valves and/or faucets. Location of toilet paper holder.

Bed Mobility

Rolling, bridging, side-lying, supine, and sitting. 1.Some diagnoses require special positioning Maintain alignment of vulnerable Provide variation postures. the effect pathological reflex activity. Provide variations motion. e. Provide stretch prone contracture. i increase Iaclude supine as right- left-side tioning Specific mobility'positioning techniques. Status post-tostal hip replacement. (1) May not permitted the nonoper. side. This result internal rotation

Teres Minor

Rotator cuff muscle. innervated by the axillary nerve. Origin: axillary border of scapula Insertion: greater tuberosity Function: external rotation

Subscapularis

Rotator cuff muscle. innervated by the subscapular nerve. Origin: anterior surface of scapula Insertion: lesser tuberosity Function: internal rotation

Infraspinatus

Rotator cuff muscle. innervated by the subscapular nerve. Origin: infraspinatus fossa Insertion: greater tuberosity Function: external rotation

Supraspinatus

Rotator cuff muscle. innervated by the subscapular nerve. Origin: supraspinatus fossa Insertion: greater tuberosity Function: apart of the abduction and flexion groups

Prone tilting ** reflex persistent throughout life**

STIMULUS: - After positioning infant in prone, slowly raise one side of the supporting surface RESPONSE: - Curving of the spine toward the raised side (opposite to the pull of gravity); abduction/extension of arms and legs FUNCTIONAL SIGNIFICANCE: - Facilitates postural adjustments to maintain center of gravity ONSET AGE: - 5 months

Supine Tilting and Sitting Tilting ** reflex persistent throughout life**

STIMULUS: - After positioning infant in supine or sitting, slowly raise one side of supporting surface RESPONSE: - Curving of the spine toward the raised side (opposite to the pull of gravity); abduction and extension of limbs FUNCTIONAL SIGNIFICANCE: - Facilitates postural adjustments to maintain center of gravity and preserve positioning in quadruped ONSET AGE: - 7-8 months

Quadruped Tilting ** reflex persistent throughout life**

STIMULUS: - After positioning infant on all fours, slowly raise one side of supporting surface RESPONSE: - Curving of hte spine toward the raised side (opposite to the pull of gravity); abduction/extension of arms and legs FUNCTIONAL SIGNIFICANCE: - Facilitates postural adjustments to maintain center of gravity and preserve positioning in quadruped ONSET AGE: - 9-12 months

Plantar Grasp

STIMULUS: - Apply pressure with thumb on the infant's ball of foot RESPONSE: - Toe flexion FUNCITONAL SIGNIFICANCE: - Increases input to sole of food; integration is associated with readiness of independent gait ONSET AGE: - 28 weeks gestation INTEGRATION AGE: - 9 months

Asymmetric Tonic Neck (ATNR)

STIMULUS: - Fully rotate infant's head and hold for 5 sec RESPONSE: - Extension of extremities on the face side, flexion of extremities on the skull side FUNCITONAL SIGNIFICANCE: - Promotes visual attention to upper extremity, decreases incidence of rolling ONSET AGE: - 37 weeks gestation INTEGRATION AGE: - 4-6 months

Traction

STIMULUS: - Grasp infant's forearms and pull-to-sit RESPONSE: - Complete flexion of UE FUNCITONAL SIGNIFICANCE: -Promotes momentary grasp to enable child to hold onto mother when being pulled ONSET AGE: - 28 weeks gestation INTEGRATION AGE: - 2-5 months

Landau

STIMULUS: - Hold infant in horizontal prone suspension RESPONSE: - Complete extension of head, trunk, and extremities FUNCITONAL SIGNIFICANCE: - Regulates tone; promotes prone extension to manage flexor tone ONSET AGE: - 3-4 months INTEGRATION AGE: - 12-24 months

Galant

STIMULUS: - Hold infant in prone suspension, gently scratch or tap alongside spine with finger from shoulders to buttock RESPONSE: - lateral trunk flexion and wrinkling of skin on stimulated side FUNCITONAL SIGNIFICANCE: - enhances trunk stabilization by facilitating lateral trunk movement ONSET AGE: - 32 weeks gestation INTEGRATION AGE: - 2 months

Suck-Swallow

STIMULUS: - Place index finger inside infant's mouth with head in midline RESPONSE: - Strong, rhythmical sucking FUNCITONAL SIGNIFICANCE: - Facilitates nutritive sucking for ingestion of liquid ONSET AGE: - 28 weeks gestation INTEGRATION AGE: - 2-5 months

Tonic Labrinthine - Prone

STIMULUS: - Place infant in prone RESPONSE: - Increased flexor tone FUNCITONAL SIGNIFICANCE: - Facilitates full-body flexor tone; allows posture to adapt to that of the head ONSET AGE: - >37 weeks gestation INTEGRATION AGE: - 6 months

Neck righting (on body) NOB

STIMULUS: - Place infant in supine and fully turn head to one side RESPONSE: - Log rolling of the entire body to maintain alignment with the head FUNCITONAL SIGNIFICANCE: -Facilitates rolling; maintains body orientation in response to cervical position changes ONSET AGE: -4-5 months INTEGRATION AGE: - 5 years

Body righting (on body) (BOB)

STIMULUS: - Place infant in supine, flex one hip and knee toward the chest and hold briefly RESPONSE: - Segmental rolling of the upper trunk to maintain alignment FUNCITONAL SIGNIFICANCE: - Facilitates rolling; maintains body orientation in response to cervical position changes ONSET AGE: - 4-6 months INTEGRATION AGE: - 5 years

Symmetric Tonic Neck (STNR)

STIMULUS: - Place infant in the crawling position and extend the head RESPONSE: - Flexion of hips and knees FUNCITONAL SIGNIFICANCE: - Facilitates quadruped position in preparation for crawling breaks up total-body extension ONSET AGE: - 4-6 months INTEGRATION AGE: - 8-12 months

Backward parachute (protective extension backwards) ** reflex persistent throughout life**

STIMULUS: - Quickly but firmly tip infant off-balance backward RESPONSE: - Backward arm extension or arm extension to one side spinal rotation FUNCTIONAL SIGNIFICANCE: -Protects from backwards falls ONSET AGE: -9-10 months

Sideward Parachute (protective extension sideward) ** reflex persistent throughout life**

STIMULUS: - Quickly but firmly tip infant off-balance to the side while in the sitting position RESPONSE: - Arm extension and abduction to the side FUNCTIONAL SIGNIFICANCE: - Unilaterally support body for use of opposite arm; prevents falls ONSET AGE: - 7 months

Moro

STIMULUS: - Rapidly drop infant's head backwards RESPONSE: - First Phase: arm extension/abduction, hand opening -Second Phase: arm flexion and adduction FUNCITONAL SIGNIFICANCE: - Protective response to 'stress', helps develop extensor tone during a period when flexor tone is dominant ONSET AGE: - 28 weeks gestation INTEGRATION AGE: - 4-6 months

Downward Parachute (protective extension downward) ** reflex persistent throughout life**

STIMULUS: - Rapidly lower infant toward supporting surface while suspended vertically RESPONSE: - Extension of the lower extremities FUNCTIONAL SIGNIFICANCE: - Prepares lower extremities for surface contact (.e. standing); breaks a fall ONSET AGE: - 4 months

Forward Parachute (protective extension forward) ** reflex persistent throughout life**

STIMULUS: - Suddenly tip infant forward toward supporting surface while vertically suspended RESPONSE: - Sudden extension of the upper extremities, hand opening, and neck extension FUNCTIONAL SIGNIFICANCE: - Places upper extremities in anticipation of surface contact to break a fall; supports prop sitting ONSET AGE: - 6-9 months

Palmar Grasp

STIMULUS: - place finger in infant's palm RESPONSE: - finger flexion, reflexive grasp FUNCITONAL SIGNIFICANCE: - Increases palmar tactile input; prepares muscles for voluntary grasp ONSET AGE: - 37 weeks gestation INTEGRATION AGE: - 4-6 months

Standing Tilting ** reflex persistent throughout life**

STIMULUS: -After positioning infant in standing, slowly raise one side of the supporting surface RESPONSE: - Curving of the spine toward the raised side (opposite of the pull of gravity); abduction /extension of limbs FUNCTIONAL SIGNIFICANCE: - Facilitates postural adjustments to maintain center of gravity and balance during standing and walking ONSET AGE: - 12-21 months

Labyrinthine/optical (head) righting ** reflex persistent throughout life**

STIMULUS: - Hold infant suspended vertical and tilt slowly (about 45 deg.) to the side, forward, backward, or other side RESPONSE: - Upright positioning of the head FUNCTIONAL SIGNIFICANCE: - Basis for head management and postural stability; orients head in space vertically ONSET AGE: - Birth - 2 months

Rooting

STIMULUS: - Stroke corner of mouth, upper lip, & lower lip RESPONSE: - Movement of tongue, mouth, and/or head during the stimulus FUNCTIONAL SIGNIFICANCE: - Helps baby locate feeding source ONSET AGE: - 28 weeks gestation INTEGRATION AGE: - 3 months

D2 flexion

Scapula adducted, downwardly rotated Shoulder extended, abducted, IR Elbow extended and forearm supinated Wrist extended towards radial side Fingers extended, abducted eg. pulling up seatbelt from starting position

D1 Flexion

Scapula: Abducted and upwardly rotated Shoulder: Flexed, adducted, externally rotated Elbow: :SLightly flexed Forearm:Supinated Wrist: Flexed toward radial side Fingers: Flexed, adducted Thumb:Flexed, adducted

A client with morbid obesity and obstructive sleep apnea is collaborating with an OTR® on improved sleep routines and positioning. What sleep position is optimal for this client? A. Supine position with head of the bed elevated B. Supine position with only the client's head elevated C. Side-lying position with head of the bed elevated D. Side-lying position with only the client's head elevated

Side-lying position with head of the bed elevated -Because of the obesity, the client will be able to breathe better in a side-lying position with the entire upper trunk elevated. -Elevation of the entire upper body improves breathing more than elevation of the head only.

functional mobility aids

Siding boards allow independent transfers from Merent surfaces for who are able stand pivol. dpper extremity mobility aids for performance, Baritric considerations. Selection mobility are based specific patient (patient safety, pattern, fatigue) and weight capacity. Typical gait changes greater abduction and hip difficulty from increased girth, Extra wide walkers are used with changes elevation: e.g. sit-to-stand, A duty, wide walkers are used to ambulation,

functional mobility aids

Siding boards allow independent transfers from Merent surfaces those not to stand pivol. dpper extremity mobility aids performance, considerations. Selection mobility are based on specific patient needs (patient safety, gait pattern, fatigue) and weight capacity. h Typical gait changes include greater hip abduction hip rotation, less knee flexion, difficulty ing from side increased wide walkers are assist changes elevation: e.g. sit-to-stand, Hewy duty, are ambulation,

Boutonniere

Silver rings or PIP extension splint to place the PIP joint in extension to allow for the lateral bands to move dorsal to the PIP axis *often combined with DIP flexion exercises while wearing the splint

risk factors for pneumonia in the the general population

Smoking, antibiotic use, and chest surgery

drivrr

THERAPYED. Environment: c. ergonomics should increase safety prevent discomfort. Consid- erations include: position relation to visibility endpoints. (2) seatbelt and shoulder restraint. (3) Access steering column controls. clearance inches deployment. d. The person's to manage automotive obtain should assessed.

O'Connor Tweezer Test

Test of Eye hand coordination using tweezers - the number of seconds to place all pins in board using tweezers is the score

Crawford Small Parts Dexterity Test

Test of fine motor dexterity using small tools (tweezers and screwdriver) -the score is the time it takes to complete the assembly

Minnesota Manual Dexterity Test

Test of gross hand and arm movements Subtests: a. Placing test: measures rate of hand movement (one hand only) b. Turning test: measures rate of bilateral finger manipulation Scoring: time to complete board. One practice trial and 4 scored trials

Neurologic disorders sensation testing

Tested for dermatome pattern

Jebson-Taylor Hand Function Test

Tests hand function 7 subtests: -writing -simulated page turning -picking up common objects -simulated feeding -stacking -picking up large light objects -picking up large heavy objects the time that it takes to complete each subject is the score

Who is exempt from ADA employer guidelines?

The United States Government, Indian Tribes, and/or private tax-exempt membership clubs

perseveration

The continuation or repetition of a motor act or task. INTERVENTION: a. Bring perseveration to a conscious level & train the person to inhibit the behavior. b. Redirect attention c. Engage the individual in tasks that require repetitive action.

Tertiary prevention

The elimination or reduction of the impact of dysfunction on an individual (the provision of rehabilitation services to maximize community integration)

Evaluation and Intervention

The role OTA evaluation. The OTA contributes the evaluation process. b. OTA assist with collection evaluation once service competency been established.

Kinesthesia movement sense

Therapist moves segment person responds up or down

Proprioception position sense

Therapist positions involved extremity person duplicates position with contralateral extremity

spasticity reduction splint

This splint places the spastic distal extremity on submaximal stretch to reduce spasticity

Thromboangiitis obliterans (Buerger's disease)

Thrombo = vessel angitis - inflamation. obliterans- artery occlusion or blockage Chronic inflammatory vascular occlusive disease of small arteries and also veins. More common in male smokers. Begins distally and progresses proximally. Symptoms: pain, paresthesias, cold extremities, diminished temp sensation, fatigue, risk of ulceration and gangrene Hands and feet

Flexor Pollicis Brevis

Thumb MCP flexion Origin: bones of the hand Insertion: radial side of thumb

De quervain's

Thumb splint including the wrist and leaving the IP joint free to place the first dorsal compartment at rest

appliances, Electronic Aids to Daily Living (EADLS)

Tum lights. control appliances, open and dane doons/drapes phones, computers, office machinery Semmon Omideranions in selection method: selection requires knowledge ance of throughyput/transmission Avability Salety Relahility Durahilits Assembly Operation i schedule. and future I Apes technology. Phones large pads, dialing speakerphones, amplifiers, videophones, smarphone applications. .Monitoring allow communication cPesonal response system (PTRS): summon the button the vocalization of command. Advanced systems automatically call PERS monitoring detected. Electronically controlled openers and closers. Computers individuals disabilities nore fully participate social, productive activities. O) Facilitate performance of functional Lasis (eg, turning off household items, banking, shopping). Allow for communication socialization through Internet support groups. Provide the productive work tele- commuúng (4) alternative modes that can compen- sate diversity disabilities. Adaptations include: laj for individuals mobil- ity impairments individuals with anyotrophic sclerosis). activation individuals with severe Inobility impairments functional (eg., upper extremity contractures) Programmable keyboards Customized overlays enlarged letters numbers for persons with vision; raphics and individuals tognitive impairments)- for weigha

Ulnar drift

Ulnar drift splint/deviation splint to decrease pain, provide stability, and realign the MCP joints of digits 2-5 for a person with arthritic changes

Light touch

Using a cotton ball or cotton swab, patient responds 'yes' or 'touched' when touched. + intact -impaired 0 absent

Localization

Using a cotton swab, person responds 'yes' when touched and then with vision points to area that they are touched +intact -impaired 0 absent

Static two point discrimination

Using a disk-criminal or, Boley gauge, or paper clip 1. Test begins at 5 mm 2. Applied to fingertips in a longitudinal orientation 3. Person responds one or two depending on the number they feel 4. Distance between points is increased until seven out of 10 responses are correct 5. Test is stopped at 15 mm scoring -normal = 5 mm -fair= 6-10 mm -poor= 11-15 mm -protective = one point perceived -anesthetic= no points percieved

Moving two point discrimination

Using a disk-criminator, Boley gauge, or paper clip 1. Testing begins with points 5-8 mm apart 2. Applied proximal to distal on fingertips in a longitudinal orientation following the digital nerve 3. Person responses to the number of points he/she feels (one, two) 4. Seven out of 10 responses must be correct before decreasing teh stance of the two points scoring: normal = 2 mm

Pain (protective sensation)

Using a sterile safety pin or paper clip, the person will respond to 'sharp' or 'dull'. correct response indicates intact pain sensation incorrect response indicates absent pain sensation *note* a response of 'sharp' to the 'dull' stimulus may indicate hypersensitivity

Pronator quadratus

VOLAR forearm muscles innervated by the MEDIAN nerve. Origin: Distal ulna Insertion: Distal radius Function: forearm pronation

contraindications-COPD

Valsalva maneuver

Wheelchair Training

Wheelchair Mobility Training Assess cognition determine individual's abiliny to learn and use wheelchair independently a. personal attendants and the training, needed. Determine goals community mobility 3. Check wheelchair and seating system needed adjustments. 4. Instruct Instruct pressure push-ups shifts leaning one side, then other) Instruct the purpose of devices wheelchair lap Provide schedule weight shifts 7. Instruct wheelchair propulsion joystick, control, puff). a. Use of wheelchair gloves propulsion protect hands. techniques (eg. fen assist propulsion when upper extremin affected). Instruct operating a device. set/release brakes. b. swing-away leg rests removable transferring. Caution when powered wheelchir. Safe from wheelchair and wheelchair ground, possibie 9. Instruct in wheelchair down port removal ease storige trunk). Instruct in wheelchair community. Practice in and essential. (1) Traverse different asphalt, (2) Ascend Negotiate curbs: Negotiate obstacles garher streets, chairs restaurants) wheelie."

Specific Assessments for Wheelchair Prescription

Wheelchair Prescription 1. can collect the following areas: Client factor and performance skill Sensory (e.g., sensory person development necessiiscular can require ositioning knowledge. Poor trunk application postural supports). Musculoskeletal (e.g. physical limitations, Muscu compromised respiratory status, impede mobility, powered wheelchair prescription). precautions require cushion raise seat height. Cognition (eg., deficits cognitive impede ability operate powered devices) Psychosocial supports to assist with transporting the wheelchair). Personal assessment. (1) Age developmental status. Medical history, medical status, and weight. work Leisure and special chair enable the to pursue interests). (5) Daily and and desired Socioeconomic status, financial tations. C. Contextual assessments. Physical (a) Areas travel wheelchair use. Surfaces and that traveled indoors (eg., floor surfaces) outdoors (eg., sidewalks). Building characteristics of school, work, and/or worship. (a) Entrance accessibility. Doorways. () Hallways. (d) Restrooms. Workspace Parking. Other specifics described this chapter. (eg, availability social Wheelchair characteristics considered in assessment. (1) Transportability/portability. (2) Wheelchair types

Words to Avoid in Documentation

Words that do not reflect progress/potential for improvement: -chronic -status quo -maintaining -little change -plateau -making slow progress -stable or stabilizing -same as -uncooperative -dislikes therapy -confused/disorient -inability to follow directions -patient refused -custodial care needed -treatment repeated -repeated instruction -unmotivated -extreme depression -fair to poor potential -chronic/long term condition -general weakness

Extensor carpi ulnaris (ECU)

Wrist EXTENSORS innervated by the RADIAL nerve. Origin: Lateral epicondyle Insertion: Fifth metacarpal Function: extension of the wrist and ulnar deviation.

Extensor carpi radialis longus (ECRL)

Wrist EXTENSORS innervated by the RADIAL nerve. Origin: Supracondylar ridge of the humerus Insertion: Second metacarpal, base Function: extension of the wrist and radial deviation.

Extensor carpi radialis brevis (ECRB)

Wrist EXTENSORS innervated by the RADIAL nerve. Origin: lateral epicondyle Insertion: Third metacarpal, base Function: Extension of the wrist and radial deviation.

Palmaris longus (PL)

Wrist FLEXORS innervated by the MEDIAN nerve. Origin: Medial epicondyle Insertion: palmar aponeurosis Function: Flexion of the wrist

Hand burns

Wrist at 15-30 degrees extension MCP 50-70 flexion IPs full extension to maintain soft tissue structures in a safe position

Carpal tunnel syndrome

Wrist splint positioned in neutral; decrease carpal canal pressure especially at night

remedial of training approach

_____ __ ________ _______ -focuses on resoration of components to increase skills -deficit specific - targets cause of symptoms -assumes the cerebral cortex is malleable and can reorganize -emphasizes performance components - utilises tabletop and computer activities such as memory drills, block designs, parquetry, as treatment modalities

compensatory functional approach

_____ __________ _______ -involves the repetitive practice of functional tasks - emphasizes modification - activity choice is driven by tasks the person needs, or wants, to perform - emphasizes intact skill training - treats symptoms, not the cause - environmental adaption - treatment is task specific -utilizes functional ADL/IADL tasks

orthoses

_______ are utilized in neuromuscular dysfunction to meet the following goals: - prevent/correct defmority via prolonged stretch and proper alignment - control spasticity - prevent/decrease/accomdate contractures of the joint or soft tissue - correct biomechanical malalginment by external force - position the hand in a functional posture to promote engagement in activities - compensate for weakness - provide proximal support - support a painful joint - promote a distal mobility - enhancea specfic activity - immobilize jointsand soft tissues to promote healing - prevent or reduce scarring via prolonged pressure and appropriate stretch

dyssynergia

a breakdown in movement resulting in joints being movedseperately to reach a desired target as opposed to moving in a smooth trajectory, decomposition of movement

wernicke's aphasia

a deficit inaudtiroy comprehension that affects semantic speech performance,manifested in paraphasia or nonsensical syllables

Types of teams: multidisciplinary

a number of professionals from different disciplines conduct assessments and interventions independent from one another

Child Abuse Prevention and Treatment Act (CAPTA)

a) Defines child abuse and neglect as mental or physical injury, negligent treatment, maltreatment, or sexual abuse of a child less than 18 years of age by a person responsible for the child's welfare under circumstances that indicate that a child's welfare or health is being threatened or harmed.

Categories of WIA One-Stop Services

a) core services (outreach, intake/orientation, initial assessment, eligibility determination for services, assistance with job search and placement, job market information, and career counseling b) intensive services for individual who do not attain successful employment after receipt of core services includes( comprehensive assessments of service needs and skill level, development of individualized plans for employment, case management, and counseling c) training services for individuals who do not attain successful employment after receipt of core and intensive services. These services typically provided off-site from one-stop center and include adult education and literacy training, on-the-job training, and individualized vocational training

Work Investment Act (WIA)

a) established a federally sponsored national employment and vocational training system, b) Established a "one-stop" delivery system for all adults aged 18 or older seeking access to employment and training service. This means traditionally separate "unemployment" offices and "vocational rehabilitation services" are now available at a "one-stop center"

Title III public places

a) private services that serve the public (restaurant, stores, theaters) cannot discriminate in the provision of services b) public transportation systems must be accessible, c) private transportation systems must be accessible and non-discriminatory (livery services, taxis, tour bus companies)

Ticket to Work and Work Incentives Improvement Act (TWIIA)

a) strives to make it more realistic and easier for a person with a disability to work, b) removes a major disincentive to work by allowing individuals with disabilities to maintain their Medicare or Medicaid health care benefits. 1) allows an individual with a disability to keep Medicare benefits for an additional 54 months after starting work. 2) eliminates limits on Medicaid "buy in" options. c) enables consumers to have a choice in their service provider beyond public assistance programs, d) establishes community-based vocational planning and assistance programs, e) increases consumer choices for accessing employment support services f) all states can design their own program

Occupational therapy evaluation for RDS:

a. Assess for developmental delays b. Assess the environment

Occupational Therapy evaluation for Cystic fibrosis:

a. Assess for developmental delays related to decreased strength and endurance and decreased attention d/t pain b. Assess the environment to determine adaptations for energy conservation and possible equipment needs. c. Assess psychosocial status (1) child and family stress related to frequent hospitalizations, school absences, social isolation, and ongoing home treatment (2) fatigue related to the level of care that is required (3) emotional stress related to the pain and prognosis

Complications of BPD:

a. Greater risk for hypotonia and gross motor delays b. Feeding problems can lead to poor nutrition (1) malabsorption problems (2) fragile bones with an increased risk of fractures c. Central nervous system problems, such as damage to parts of the brain, can lead to delays or impairments in motor, sensory, speech, and cognitive function d. recurrent otitis media can lead to conductive hearing loss that can affect the developmental of speech and language as well as cognition

Phase 2: Outpatient Rehabilitation/Convalescence Stage Evaluation and intervention-

a. Home evaluation b. Consumer and family education c. Graded exercise program with slow and gradual increase of weight d. Begin with activities at MET level 4-5, gradually increasing as patient's tolerance improves e. Resumption of sexual activity usually at 5-6 MET level as per physician recommendation f. Practice of functional activities in the discharge environment g. Use of energy conservation techniques and compensatory techniques in daily tasks h. Community activities i. Work site evaluation if applicable

Classification of heart disease: Class III

a. Marked limitations; comfort at rest; less than ordinary activity- fatigue, palpitations, dyspnea, and angina pain b. max MET 3.0

Occupational therapy intervention for RDS:

a. Monitor development b. Facilitate sensori-motor and cognitive development c. Address psychosocial issues that arise d. Provide parent education regarding handling, positioning, energy conservation, and methods to facilitate normal development e. Adapt environment as needed f. Observe medical precautions

Risk Factors of Coronary artery disease:

a. Non-modifiable risk factors: age, sex, race, significant family history b. Modifiable risk factors: cigarette smoking, high blood pressure, elevated cholesterol levels, inactivity c. Contributing risk factors: diabetes, obesity, stress. d. Two or more risk factors increase the risk of CAD

BPD Effects on function:

a. Poor autonomic and sensory state regulation, can impact on the alert state which is necessary for proper feeding. b. Poor exercise/activity tolerance d/t illness and compromised respiration c. Reduced ability to socialize d/t long periods of poor health and the increased susceptibility to infection d. Isolation and stress on the child and family members can lead to psychosocial problems e. Greater risk for attachment disorder, affecting the child's ability to relate to others d/t isolation and dependence on technological equipment

Classification of heart disease: Class II-

a. Slight activity limit; comfort at rest; ordinary activity results in fatigue, pain, dyspnea, palpitations b. max MET 4.5

What are the effects on function from RDS?

a. The future intellectual developmental of the premature infant who had RDS and who received the latest treatments appears to be good b. The functional effects for infants who develop bronchopulmonary dysplasia (BPD) or who incure a severe intracranial hemorrhage may include motor, sensory, cognitive, and/or language impairments c. For premature infants with RDS, functional effects may include visual defects, hypotonia, and other health issues that can impact on development.

Signs and symptoms of TB:

a. a bad cough for more than 2 weeks b. chest pain c. blood tinged sputum or phlegm d. weakness or fatigue e. Weight loss f. Loss of appetite g. Chills/fever h. Night sweats

Phase 1: Inpatient rehabilitation/hospitalization stage evaluation and intervention-

a. initiated at bedside with a monitored, functional assessment of self care and mobility b. if person is pain free, exhibits no arrhythmia, and has regular pulse of 100 or less, an activity program is initiated c. Intense monitoring during activity especially in CCU d. Beginning activities at MET level = 1-2 1. bed mobility, static standing 2. transfer from bed to chair/bedside commode 3. bed bath, feeding, grooming at sink in sitting 4. AROM/warm-up exercises 5. wheelchair mobility/ambulation in room e. energy conservation techniques f. breathing exercises

Phase 1: Inpatient rehabilitation/hospitalization stage program focus-

a. patient education regarding disease process and recovery 1. Increase knowledge of energy conservation and work simplification principles and techniques 2. Increased knowledge of the approximate metabolic cost of activities b. Improve ability to carry out self care and low level functional activities c. decrease anxiety d. support smoking cessation and dietary modification efforts if warranted e. discharge home

Interventions for COPD:

a. smoking cessation b. oxygen therapy: reduce level of dyspnea, improve/decrease maximal voluntary ventilation, polycythemia, by correcting hypoxia, decrease pulmonary HTN, improve quality and quantity of sleep, improve cognitive function and exercise tolerance.

pallor

absence of rosy color in light skinned individuals, associated with decreased peripheral blood flow, PVD

pallor:

absence of rosy color in light skinned individuals, associated with decreased peripheral blood flow, Peripheral vascular disease (PVD)

Intervention

accommodate absent grasp. extensions added not standard foot reduced effort steering can accommo date range, strength, endurance Steering wheel positioning adjustments can steering atypical allo when, person determined to be unsale unable drive, alternatives maintain community mobility and implemented a. Support must be provided the individual with this loss and ramifications for the b. Interventions safety tranit user and pedestrian Intervention 1. equipment be individuals with specific limitations. Hand controls replace accelerators and foot knobs control include Standard round a with intact extremity. (2) Ring accommodate prosthesis.

Secondary Lymphedema

acquired, due to injury of one or more parts of lymphatic system. Possible causes may include: surgery, tumors, trauma to lymph nodes, radiation therapy with fibrosis of tissues, chronic venous insufficiency

Screening

acquisition of info to determine the need for an in-depth eval and to obtain a preliminary understanding of the individual's needs, limitations, assets, and resources includes: - chart/med record review - checklists - observations - interview OTA contributes - can collect screening data, supervision depends on experience and est. of service competency

closed tasks

activities in which the environment is stable and predictable and methods of performance are consistent over time

Self-awareness group

activities such as values clarification, awareness of personal assets, limitations, and behaviors; and the individual's impact on others.

Sensory awareness group

activities to promote sensory functions and environmental awareness

tuberculosis

airborne infection caused by a bacterium

Types of teams: interprofessional

all professional disciplines relevant to the case at hand agree to collaborate for decision-making (eval and intervention are still conducted independently however there is a greater understanding of each profession's perspective)

Contrast bath

alternating immersion in hot and cold water

SARS (severe acute respiratory syndrome)

an atypical respiratory illness caused by a coronavirus. Initial outbreak in southern mainland China with worldwide spread

figure ground dysfunction

an inability to distinguish foreground from background

General Environmental Considerations Definition and Maior Concepts

and Maior Concepts 1. The environment "the aggregate of phenomena that surrounds individual and influences (her) development existence" (Mosey, 1996, p. 171). environment which lives, and exposure to various settings, influences his or her development and adaptation. The environment facilitate because for adaptation problem-solving strategies to developed. Conversely, environment can hinder develop- and adaptation impoverished hostile. 5. A person's abilities, limitations, problems, activities, occupations be fully under- stood without considerations his/her current and expected environment. 6. Physical/nonhuman environment. Everything nonhuman (i.e., buildings, objects, tools, devices, animals, trees). Sensory environment. Visual: lighting, colors, posters all over Auditory: loudness of loudspeakers, class- room noise. c. Tactile: seating textures. d. Olfactory: pleasant offensive odors. Gustatory: pleasant offensive 8. Social-cultural/human environment. a. Social roles: organized pattern behavior that characteristic enerauem defined position social system" (Mosey, 1996, p. 64); for example, student, parent, worker. Social network: "the of voluntary relationships that make individual's social environment" (Mosey, 1996, 184). aspects: "the social structures, values norms, and expectations that accepted shared of people" d. Psychological aspects: environmental character- istics that affect mood and stress level (e.g., a calming, cheerful envi chaotic, uncomfortable, depressing setting). 9. The AOTA description environment beyond the physical and social environment to include concept In the AOTA Practice Framework, context "refere law expected occupant environment Practice ramework expanded variety interrelated conditions are within and surrounding the interrelated less tangible physical and sto 15

An OTR is working on the organ transplant unit of a major hospital. What psychiatric condition is a client with a long-term transplantation MOST likely to experience?

anxiety

aspiration pneumonia

aspirated material causes an acute inflammatory reaction within the lungs; usually found in patients with impaired swallowing ability (dysphagia)

Aspiration pneumonia

aspirated material that causes acute inflammatory reaction within the lungs; usually found in pts with impaired swallowing ability (dysphagia)

Kinesthesia

awareness of positioning of body parts and body movement

decreased BP may be related to...

bed rest, drugs, arrhythmias, blood loss/shock, and MI

when to monitor exertion scales-phase 1 eval and intervention-cardiopulmonary rehab

before, at peak, 30 seconds before end, after, and 3-5 minutes post

Cyanosis:

bluish color related to decreased cardiac output or cold; especially lips, fingertips, nail beds

cyanosis

bluish color related to decreased cardiac output or cold; especially lips, fingertips, nail beds

Types of teams: transdisciplinary

characteristics of interdisciplinary teams are maintained and expanded upon ongoing communication, collab, and shared decision-making

Chronic venous insufficiency

chronic leg edema, skin pigmentation changes, scaly appearance, itchy

cystic fibrosis

chronic, progressive lung disease characterized by production of abnormal mucous

Angina pectoris:

clinical manifestation of ischemia characterized by mild to moderate substernal chest pain/discomfort most commonly felt as pressure or dull ache in the chest and left arm but may be felt anywhere in the upper body including neck, jaw, back, arm, epigastric area. a. brought on by increased demands on heart: exertion/exercise, emotional upsets, smoking, extremes of temperature (especially cold), overeating, tachyarrhythmias

superficial vein thrombophlebitis

clot formation and acute inflammation in a superficial vein, localized pain usually in saphenous vein

atelectasis

collapsed or airless alveolar unit, caused by hypoventilation secondary to pain

Primary Lymphedema

congenital condition with abnormal lymph node or lump vessel formation

Goal setting group

consists of activities designed to identify personal objectives and treatment goals and the steps to their achievement

A client with hypotension would generally have a ___ in blood pressure when the head of the bed is elevated.

decrease

vestibular

deficits include hyposensitivity/underresponsivity, hypersensitivity/overresponsivity, sensory seeking, gravitational insecurity treatment- provide compensatory skill development, reduce environmental barriers and identify facilitators of occupational performance, use group treatment to develop social interaction, consult with and/or educate teachers and parents, share intervention strategies to promote the child's occupational performance in the home, school, and community.

undue hardship

defined as action that would be significantly difficult or overly expensive given the financial resources of the employer, its size, and major functions

Motor Development - visual-motor integration

dependent on lower level skills of visual attention, visual memory, visual discrimination, kinesthesia, position in space, figure ground, form constancy, and spatial relations

Rubor:

dependent redness with PVD

Phase 2: outpatient rehabilitation/convalescence stage (subacute)-LOS

dependent upon several factors-pt's physical and mental status post event and/or surgery, progress through MET levels, activity tolerance, and prognosis

Motor Development - oral-motor control

developed in area of feeding, foundations for early oral communication and later language development

Primary muscles of inspiration:

diaphragm intercostals

varicose veins

distended, swollen superficial veins, may lead to varicose ulcers

Interventions to Prevent

distract- Interventions Intervention based upon the determinatin individual's problems the factors identified in evaluation 2. OTA implements intervention with Of sion to; a. Eliminate or minimize all fall factos disease manage medication. Improve functional mobility (1) resistive strengh weights and o exercises to strength, endurance (2) Passive range of motion (PROM) indicated joint (3) Specific coordination training Neuromuscular reeducation (5) Balance (a) Sit and stand positions. (b) Static (c) Turning, walking staits (10)

when to do weight training for cardiac rehab

during phase 2 (outpatient), at 2-4 weeks if symptoms are controlled

Cubital tunnel syndrome

elbow splint positions at 30 degrees of flexion to prevent elbow flexion at night which will decrease ulnar nerve symptoms

Raynaud's phenomenon

episodic spasm of small arteries and arterioles abnormal vasoconstriction reflex exacerbated by exposure to cold or emotional stress - Tips of fingers develop pallor, cyanosis, numbness, and tingling. Affects largely females.

Interventions to Prevent

er raining ed obility training wherlchr safery training del physical for gait/ambola y compensation strategies living for safety popriate adaptive and tain (4) aders long shochom d leg lifer deessing stick walker deut for artivities instrut tion danges eon teriniques with faily and casegivers to seduce falis and instability dherkist deue lighting colons to delineate hazardous ionment, teduce dutter h carpet edy fasten handrails sides of light switches bottom. l ondkid secure Mo grab oer and toilets. sondkid night-lights. ollet seat ll ig ligts light within ephones easy-to-teach Soe ack existing mattress one thicker bed iht as needed ange furmitone couces dhais are at yoper Reove duttr A dr cos eange cy anery and dose ne isens teau ds beween sye acked pasement or stable hand vrc sadety es he indivdual

3 main aspects of service

evaluation, intervention, outcomes (all client-centered, interactive, and dynamic)

pleural effusion

excessive fluid between visceral and parietal pleura

diaphoresis

excessive sweating associated with decreased cardiac output

unilateral body neglect

failure to respond to or report unilateral stimulus presented to the body side contralateral to the lesion

Combined median ulnar

figure of eight or dynamic MCP flexion splint to position MCPsin flexion for digits 2-5 to prevent the hand from assuming the intrinsic minus position

Discharge planning group

focuses on activities to problem solve potential obstacles and identify resources for successful community reintergration

Coping skills group

focuses on activities to problem solving and stress management techniques needed to cope with life stressors

ADL/IADL group

focuses on self care and independent living skills such as cooking, money management, transportation, etc.

Arthritis

functional splint or safe splint, depending on stage.. to place joints at rest until inflammation decreases

Gestational age vs conceptual age

gestational age: age of fetus/newborn, in weeks, from first day of mother's last normal menstrual period Conceptual age: age of a fetus/newborn in weeks since conception

Overall Characteristics of the Home

good private one-family, family, apartnment, walk-up, elevator access. 2. Protection from weather/environmental changes. Presence and of driveway. 4. Level which person lives. Entrance dwelling wheelchair raimp. level entrance, 6. Number of entrances that are accessible the vidual, Some buildings allow residents to delivery because has ramp. 7. Steps: the number present outside dwelling, inside dwelling, laundry room, the mailbox, Railings: location and number railings outside and facing entrance door; presence railings for interior a. Interior should inches ease grasp. railings should those who walk: 34-38 inches, depending on height. Railings should inches in diameter nonskid surfaces.

tachycardia:

greater than 100 bpm

Manual edema mobilization

hands-on-technique for stimulating the lymphatic system to remove the edema * requires specialized training

arterial bleed

high pressure, spurting, red

Restraint Reduction

iNighmime activities. Eliminate extraneous noise soothing background music of familiar favorite objects person's lving personalize structured environment with promote sense security. 3. The implements interventions pational therapist's agitation andjor wandering incidents. Interventions Approach b. Communicate with use simple state- ments/instructions Distract with activity or innerest to ributes to assessment agitation, sestiensness andfor wander. upational supervision for toileting adliness physical discomfon Pam dom envinment TA intervention occupational ision contributing factors/ supenvisas amd ian for medical evaluation/pain pobilems Interventions include person. Redirect location. e an activity interest or divension. f. Camouflage doors, length or no-crossing signs, vertical blinds. on planters mark end hall. Install non-dead Velcro doors. i alarms, personal monitoring devices and Pearrange furniture to wandering a comfortable and furni- induding broad-based rockers emal positioning Pin bonles, appopriate source of nourishment Indration dient-directed routine adve attention to underlying feelings nd epressed concerns trust LFamily or visits. Liimal-assisted or ocial Eartise other restless, anxious arior Chapter

Leisure group

identification of interests, development of activity specific skills, identification of resources, ad recognition of the importance of healthy use of unstructured time.

Prevocational group

identification of skills, limitations, interests, work behavior, and job hunting skills.

dysdiadochokinesia

impaired ability to perform rapid alternating movements

functional impairments

impaired alertness or arousal the person has a decreased response to environmental stimuli

right-left discrimination

inability to discriminate between the right & left sides of the body or to apply the concepts of right & left to the environment

akinesia

inability to initiate movement

impaired organization/sequencing

inability to organize thoughts with activity steps properly sequenced

acalculia

inability to perform calculations

alexia

inability to read

astereognosis

inability to recognize objects, forms, shapes, and sizes by touch alone; a failure of tactile recognition although sensory testing is intact

agraphia

inability to write

Diabetic angiopathy

inappropriate elevation of blood glucose levels and accelerated atherosclerosis; neuropathies, ulcers lead to gangrene and amputation

diabetic angiopathy

inappropriate elevation of blood glucose levels and accelerated atherosclerosis; ulcers may lead to gangrene and amputation

side lying may ____ the respiration rate.

increase or decrease, depending on the client

rigidity

increased resistance to passive movement throughout the range; may be cogwheel (alternative contraction/relaxation of muscles being stretched) or lead pipe (consistent contraction throughout range)

What disorders are not protected by ADA?

individuals who are actively abusing substances or compulsively gambling or persons who have kleptomania, pyromania, or sexual behavior disorders are not protected by ADA

bronchopulmonary dysplasia

infant must work harder than normal to obtain sufficient oxygen for survival

intrinsic feedback

information received by the learner as a result of performing the task, recieved from tactile/vestibular and visual systems during and after the task

Posterior deltoid

innervated by Axillary nerve - Origin: spine of scapula - Insertion: deltoid tuberosity - Function: Horizontal shoulder ABDUCTION muscle. Shoulder EXTENSION muscles

biceps

innervated by MUSCULOCUTANEOUS nerve Origin: Coracoid process and supraglenoid tubercle Insertion: Radial tuberosity Function: elbow flexion with forearm supination

brachialis

innervated by MUSCULOCUTANEOUS nerve Origin: distal two-thirds of humerus Insertion: ulnar tuberosity Function: elbow flexion with forearm pronation

anconeus

innervated by RADIAL nerve Origin: lateral epicondyle and capsule of elbow joint Insertion: olecranon and upper one-quarter of dorsal ulna Function: elbow extension

triceps

innervated by RADIAL nerve Origin: long head; infraglenoid tuberosity. Lateral head: posterior humerus. Medial head: distal to lateral head Insertion: olecranon of ulna Function: elbow extension

brachioradialis

innervated by RADIAL nerve Origin: supracondylar ridge Insertion: distal radius Function: elbow flexion with forearm neutral

Symptoms of early stage PVD

intermittent claudication. Pain descried as burning, searing, aching, tightness, or cramping. Occurs predictably with walking and is relieved by rest.

Viral pneumonia

interstitial or inter alveolar inflammatory process caused by viral agents (influenza, adenovirus, herpes, measles, etc.)

spatial relations

intervention strategies for ____ ___ dysfunction: - utilize activities that challenge underlying spatial skills -utilizze tasks that require discrimination of right/left

body neglect

intervention strategies for ____ ____ -provide bilateral activities - guide the affected side through the activity - increase sensory stimulation to the affected side

spatial neglect

intervention strategies for ____ ______ -provide graded scanning activities - grade activities from simple to complex - use anchoring techniques to compensate -utilize manipulative tasks in conjuction with scanning activities - use external cues

memory loss

intervention strategies for _____ ___: -use rehearsal strategies -"chunck" information into sections - utilize memory aids (alarm watches,timers, etc) - utilizes 'temporal tags' focusing on when the event to be remembered occured

sequencing

intervention strategies for _____ and organizing deficits - use external cues (written, dialy planners) - grade tasks that are increasingly complex in terms of number of steps required

perseveration

intervention strategies for ________ - bring _____ to a conscious level and train the person to inhibit the behaivor -redirect attention -engage the individual in tasks taht require repetitive actions

Type of Intervention: The change process

interventions designed to achieve behavioral changes and functional outcomes *establish/restore/remediation/restoration

Type of Intervention: Management

interventions designed to reduce or minimize disruptive or undesirable behavior that interfere with therapeutic activities or procedures needed to change areas of dysfunction that are the main focus of intervention (ex. patient becomes excessively anxious during their first use of a wheelchair in an environment outside of the hospital - supportive interventions are needed to decrease anxiety) *modify/adapt/compensate

Type of Intervention: Meeting Health Needs (and those needs)

interventions designed to satisfy inherent, universal human needs - psychophysical - temporal balance and regularity - safety - love and acceptance - group association - mastery - esteem - sexual - pleasure - self-actualization

Bacterial pneumonia

intra-alveolar bacterial infection

variable conditions

involve practice skills in various contexts to improve transfer of learning and retention skills.

mental practice

involves cognitive rehearsal of a skill without actually moving

blocked practice

involves repeated performance of the same motor skill

random practice

invovles practice of several tasks that are presented in a random order, encouraging reformulation of thesolution to the presented motor problem

MET level 7-8 activities

jogging (5 mph), bicycling (12 mph), sawing hardwood, basketball, mountain climbing, ice hockey, touch football, horseback riding (gallop)

Transfer Considerations

know where his/her center gravity is all times. c. Individual transferred should lifted with practitioner using his/her extremities not his/her 4. Perform wheelchair transfers safely. Clear any clutter, Ask help or stand-by questioning ability to transfer Use belts if needed. d. Stabilize/lock brakes. Swing rests flip footplates. f. Remove armrest individual unable assist, too heavy to bring standing position, or the individual weight-bearing precaution. Considerations Aises identify an individual's and pecially cognitive physical abilities. he OTA should aware his or her own es avoid personal consumer injury e vf proper body merbapirs should taloced. a broad base support.

disorientation

lack of knowledge of person, place or time

Medicare

largest single payer for OT services Administered by CMS Intermediaries determine if services provided are within Medicare guidelines Person(s) eligible: 65+, all ages with end-stage renal disease/permanent kidney failure that may require dialysis or kidney Tx, those with long-term disability (ALS, MS, etc.), who have received gov't-funded disability benefits for 24 months, and retired railroad workers -DOES NOT cover most chronic illnesses, long-term supportive care, or all medical expenses incurred when ill - DOES cover a therapist's design of a maintenance plan and the occasional re-evaluation of plan's effectiveness

Bradycardia:

less than 60 bpm

functional Evaluation Intervention

level of supervision required will be deter mined by OTA's experience and established service competence d. The OTA cannot independently evaluate or evaluation results. eKeep possible. if device stationary, positioned enable ease e. Provide muliple sesions 5. Documentation. Document Document recommended selected nd tationale for reimbursement ju OTA collaborates with supervisor to tdentify tasks an disability accomplish occupational roles person pursue Determine person's values Assess the individual's and deficits, ing client performance skills. (1) Stability positioning and seating assessed person's ability use (2) anatomic site person purposeful movement must determined will influence device's control device activated by shoulder, elbow, tongue, eye movements). physical interaction with an is possible, ability speech recognition should be assessed. person's technological knowledge, comfort level should be determined. d. Determine the environments which device when will used. Identify assistive technology Consider input method: how device will activated frequency (2) Consider the processing how device will process information from the input method. (3) Consider the results are needed (response input occurs). Consider the feedback method: ensures device being auditory, visual, proprioceptive). The the implements intervention The of supervision depends upon OTA's and compe- (1) individual's and goale Based abilities, tions school/work/leisure status (4) cost. Reevaluation guidelines. status the individd disability efficiency of use devices. of device durability Additional sonic, electric, or radio implementation of intervention, OTA informs the supervising occupational thera- pist change individual's status and other relevant information affect treat- Intervention principles Select and several on determine individual's needs best. Determine specific reviewing and incorporating all team members' infor- mation.

MET level 2-3 activities

level walking (2 mph), level bicycling (5 mph), radio/TV repair, janitorial work, bartending, riding lawn mower, bowling, billiards, playing piano

MET level 3-4 activities

level walking (3 mph), bicycling (6 mph), welding, cleaning windows, volleyball, badminton (social doubles), archery, washing dishes, laundry, showering while standing (3-3.5)

broca's aphasia

loss of expressive language indicated by a loss of speech production

ataxia

loss of motor contol including tremors, dysdiadochockinesia, dyssynergia, and visual nystagmus

dietary interventions for CAD

low salt, low cholesterol, weight reduction

respiratory distress syndrome

lungs collapse after each breath

Title III public accommodations and services operated by public entities

mandates that places of public accommodation (i.e. hospitals, health care providers' offices, schools, day care centers, and other places of accommodation, restaurant, theaters) may not discriminate against persons with disabilities with respect to their participation in or ability to benefit from the service, goods, facility, use or tother programming aspects

ADA Title II public services

mandates that state and local governments and their departments, agencies, and or component parts may not discriminate,exclude or deny persons with disabilities participation in or benefit from services, programs, or activities of these public entities (includes transportation, public education employment, recreation, social services, health care, courts, town meetings, and voting)

Contextual Evaluation

manipula- to The contributes evaluation process with OT supervision. targeted evaluation include: a. Physical considerations. (1) Arrangement furniture. Accessibility items needed activi- ties safe (3) Housing/workplace Neighborhood characteristics.

Signs and symptoms of DVT:

may be asymptomatic early. progressive inflammation with tenderness to palpitation: change in LE temp, color, circumference, appearance, tenderness/pain. Requires immediate medical attn.

opponens splints

may be short or long, designed to support the thumb in a position of abduction and opposition, utilized during functional activities to compensate for weakness patterns

What is a "qualified individual with a disability"?

means a person with a disability who is able to perform the "essential functions" of a job (that is, the tasks fundamental to the position) with or without reasonable accommodations

Lifting both arms to 90° of flexion would make breathing...

more difficult

"reasonable accommodations"

must be provided by businesses with 15 or more employees to persons with disabilities to enable them to perform essential job functions unless accommodations would impose an "undue" hardship on the business

classification of HF-objective assessment-class A

no objective evidence of CV disease; no symptoms

pacemaker precautions

no shoulder flexion or abduction greater than 90° on the side on which the pacemaker was implanted for the first 4 weeks.

signs and symptoms of TB

o Bad cough for more than 2 weeks o Chest pain o Weakness or fatigue o Weight loss o Loss of appetite o Chills/fever o Night sweats

classification of HF-objective assessment-class B

objective evidence of minimal CV disease. Mild symptoms and slight limitation during ordinary activity.

classification of HF-objective assessment-class C

objective evidence of moderately severe CV disease. Marked limitation in activity due to symptoms, even during less-than-ordinary activity.

classification of HF-objective assessment-class D

objective evidence of severe CV disease. Severe limitations. Experiences symptoms even while at rest.

of Wheelchairs

of 2. Specialized wheelchairs. Reclining indicated individuals who are unable independently maintain upright sitting position. b. Tilt-in space: indicated pressure relief individual with severe extensor throw him out the chair seat and back maintain nomal seat-to-back C. One arm-drive, hemi-chair, amputee frame, and powered outlined 15-3. Recreational: designed with thick tube-type large front casters including and surfaces. 4. Sports: specially designed racing, cycling. basketball, and competitive sports. Typically ultra-lightweight with low low back, that accommodates tucked position, leg straps, slanted drive wheels, small push Stander: designed enable person indepen- dently change seat height and/or elevate stand- position. Stair-climbing: designed to navigate while balancing two using sensors gyro- scopes. wheelchair: heavy extra-wide wheel- chair designed mobility individuals obese. following

Types of teams: intradisciplinary

one or more members of one discipline evaluate, plan, and implement treatment

bradykinesia

overall slowing of movement patterns

intermittent claudication

pain, cramping, fatigue occurring during exercise and relieved by rest, associated with PVD, pain is typically in calf

Intermittent claudication:

pain, cramping, fatigue occurring during exercise and relieved by rest, associated with PVD; pain is typically in calf

Occlusive peripheral arterial disease-early stages

patients exhibit intermittent claudication. Occurs regularly and predictable with walking and is relieved by rest

Occlusive peripheral arterial disease-late stages

patients exhibit rest pain, muscle, atrophy, trophic changes (i.e., hair loss, skin and nail changes)

Classification of heart failure-Class I

patients with cardiac disease but resulting in no limitation of physical activity

Classification of heart failure-Class IV

patients with cardiac disease resulting in inability to carry on any physical activity without discomfort, symptoms of HF or angina syndrome may be present even at rest

Classification of heart failure-Class III

patients with cardiac disease resulting in marked limitation of physical activity (less than ordinary activity causes fatigue, palpitation, dyspnea, or angina pain)

Classification of heart failure-Class II

patients with cardiac disease resulting in slight limitation of physical activity (ordinary physical activity results in fatigue, palpitation, dyspnea, or angina pain)

Risk factors for TB:

people with a weakened immune system are at greater risk for rapid onset of TB: 1. HIV/AIDS 2. substance abuse 3. diabetes 4. scoliosis 5. cancer of the head or neck 6. Leukemia or Hodgkin's disease 7. severe kidney disease 8. low body weight

emphysema

permanent abnormal enlargement and destruction of air spaces, causes tissue breakdown

What is volition?

personal motivation, causation, values, interests

Evaluation Performance and Client Factors

physically devices optimal capability). d. Neuromuscular (eg. coordination, assess person's mically and environmental manipula- tion). skills (eg., following directions and judg- ment, assess is of limitations and able to follow recall operation assistive technology wheelchairs) use of f. Psychosocial (e.g., support, assess if individual ask assis- tance, needed the right person). utilize rhyth-

Interventions for Occurrence of Falls

plan Occurrence of . Check injury a Hip fracture complaints pain hip, especially on palpation, extemal rotation of inability ecight on changes in or weight-bearing status. b Head injury consciousness, mental confusion. Spinal cord loss of sensation voluntary ovement & Cams, bruises painful swelling Oheck for diziness that may have preceded the fall. Provide seassurance 4 Provide first emergency services necessary. Do attemps to indiividual alone, get help Solicit witeesses of 70omment incident established procedures der he individual to prevention intervention ggam to present teoccurtences. anery

Proprioceptive

position of the body In space

Pediatric Seating Positioning Systems

position, formation acetabulum position.development, and bowel Positioning Prone standers effect thine (TLR). (2) provide more support posteri deformities n for function and school seting Facilitate parent/teacher/sibling/ c. decrease and field. d. Triwall construction infants decrease scissoring peer interactions General goals stated 2. pattern. a. Llsually molded weight-bearing knees ankles, optimal

me Role of Occupational Therapy (OT) Practitioners

practitioners can advocate for ADA, OBRA, IDEA compliance to enable individuals function independently-and with least restriction-as possible, their environment.

reflex development

prenatal period

Physical agent modalities (PAMs)

preparatory methods to be used before purposeful and/or occupation based activities

motor learning

principles: - contemporary approache to treating motor dysfunction incorporate principles of motor learning during interventions focused on remediating motor control in persons with CNS dysfunction -ultimate goal of utilizing this theory is the acquisition of functional skills that can be generalized to multiple situations and environments Stages: 1- skill acquisition stage- occurs during initial instruction and practice of the skill 2- skill retention stage- involves 'carry over' as individuals are asked to demonstrate their newly acquired skill after intital practice 3- skill transfer stage- involves the individual demonstrating the new skill in a new context

NDT

principles: - normalization of postural and limb tone is prerequisite to normal movement - avoidance of movements and activities that increase tone - inhibition of primitive refllexes - development of normal patterns of posture and movements - improvement of quality of movement and performance of the involved side - associated reactions should be avoided - postural reactions are considered basis for control of movement - focus is on improving quality of movement normalization of movement patterns integration of both sides of the body/reestablishment of symmetry establishment of the ability to WB and weight shift through the limbs establishment of normal righting and equilibrium patterns

car and shepherd's motor relearning program

principles: - person is active participant whose goal is to relearn effective strategies for performing functional movement - postural adjustments and limb movements are sinked together - successful task relearned has occured when activities are performed automatically and efficiently - the learning of skills does not follow a developmental sequence - continued practice of compensatory strategies - intervention is not focused on learning specific movements but instead on learning general strategies for solving motor problems

Rood's approach

principles: - sensorimotor control is developmentally based; treatment must begin at pt's current level and progress sequentially - muscular responses of the agonisits, antagonists, and synergists are believed to be reflexively programmed according to a purpose or plan - Sequence of motor development 'ontogenic motor patterns' supine, withdrawal, rollover, prone extension, neck cocontraction, prone on elbows, quadruped, standing, walking Four sequential phases of motor control 1- recriporcal inhibition/innervation- an early mobility pattern that is primarily reflex goverend by spinal and supraspinal centers 2- cocontraction - defined as a simultaneous contraction of the agonist and antagonist that provides stability in a static pattern 3 - heavy work - 'mobility superimposed on stability' the proximal muscles contract and move and the distal segments are fixed 4- skill - considered the highest level of control and combines stability and mobility, consist of a stabilized proximal segment while the distal segments move in space

PNF

principles: - the response of the neuromuscular mechanisms can be hastened through stimulation of the proprioceptors - techniques are superimposed on patterns of movement and posture, focusing on sensory stimulation from manual contacts, visual cues, and verbal commands - normal motor development proceeds in a cervicocaudal and proximodistal direction - early motor behavior is dominated by reflex activity - early motor behiavor is characterized by spontaneous movement, which oscillates b/w extremes of flexion and extension - developing motor behavior is expressed in an orderly sequence of total patterns of movement and posture - in development, there are shifts b/w flexor and extensor dominance - freqency of stimulation and repetitive activity are used to promote and retain motor learning and to develop strength and endurance - goal-directed activity is made up of reversing movements - diagonal patterns or mass movement patterns are utilized during functional activities

task-oriented approach

principles: -occupational performance emerges fromthe interaction of multiple systems, including personal and performance contexts -personal/environmental/CNS are hieaarchially organized - behavioral changes reflect his/her attempts to compensate and to achieve functional goals - individuals must practice with varied strategies to find optimal solutions for motor problems -functional tasks help organize motor behavior interventions focus on: -adjustingto role and task performance limitations -creating an environment that utilizes the common challenges of every day life -practicing functional tasks -remediating a client factor -minimizing inefficient movement -adapting the environment -modifying the task - using Assistive tech

substance use disorder prevention that promotes optimal recovery and treatment (SUPPORT) for patients and communities act (HR6)

promoted medicaid coverage for non pharmacological therapies for the management of pain

Pneumoncytis pneumonia (PCP)

pulmonary infection caused by a fungus in immunocompromised hosts; most often found in patients following transplantation, neonates, and those infected with HIV

Wheelchair Components

pursue Fixed: minimal but be wheelchairs and/or b. Detached: for adjustable: ease transfers and better d. allow moving closer surfaces. Full holding of and possi- transfers rentals. f. Wraparound, space reduces the width the chair l'ixed: minimal seen older wheelchairs Swing-away: allows on floor to approach wheelchair. c. Detachable: path transfers. d. Elevating: reduction. 3. Footplates, a. Fixed: minimal and/or Swing-away: allows Heel loops: prevent feet slipping off footrest posterior direction. d. Ankle straps: prevent slipping off footrest. Tires. a. Pneumatic: air-filled, requires cushioned ride, absorbent. Semipneumatic: mainte- good cushioning. G. Solid-core rubber. minimal maintenance, tires mounted on or wheels.

Primary prevention

reduction of the incidence or occurrence of a disease/disorder within a population that is currently well or considered to be potentially at risk (parenting classes for teen parents to prevent child neglect/abuse)

consistent motion tasks

require individual to deal with environmental conditions that are in motion during activity performance; motion is consistent and predictable between trials

open tasks

require people to make adaptive decisions about unpredictable events because objects within the environment are in random motion during task performance

Stable angina usually resolves with...

rest, nitroglycerin, or both

Anatomy of heart

right atrium, right ventricle, left atrium, left ventricle

Overall Environmental Evaluation Evaluation of Performance Skills Client Factors***

role the occupational contributes to the evaluation process collaboration with the supervisor. Supervision required. (2) level supervision required mined by experience established service competence. h. Service competency be established. OTA cannot independently or inter- evaluation results. Performance are essential when conducting environmental evalua- for they are allow person function in his/her environment. LUpon establishment service competency, OIA following areas: Sensory (eg, assess Getermine there impairment discrimi- nation inluence safety the manipula- devices). driving Visual perceptual processing skills of Test, standardized to assess visual motor for poten- tial difficulties computer Musculoskeletal skills range of motion, strength, endurance, assess (1) (4) (5)

MET level 8-9 activities

running (5.5 mph), bicycling (13 mph), swimming (30 yd/min), fencing, basketball (vigorous), heavier shoveling

MET level 10+ activities

running 6 mph (10 METs), handball (competitive), squash (competitive)

D1 extension

scapula: adducted, downwardly rotated shoulder: extended, abducted, internally rotated elbow: extended forearm: pronated wrist: extended toward ulnar side fingers: extended, abducted thumb: extended, abducted

Operationalizing the Occupational Therapy Process (image)

see p. 33 (table 3-1) EVAL - OCCUPATIONAL PROFILE - why is the client seeking services - what is important to/for the client - occupational history - client's priorities EVAL - ALALYSIS OF OCCUPATIONAL PERFORMANCE - observe performance - use specific assessments - refine hypothesis about occupational performance - create goals in collab with patient INTERVENTION - PLAN - objective, measurable occupation-focused goals and time frames - create/promote, establish/restore, maintain, modify, prevent - Methods for delivery - discharge needs/refer to others if needed INTERVENTION -IMPLEMENTATION - therapeutic use of occupations/activities - preparatory methods/tasks - education/training - advocacy - group interventions (if warranted) - Monitor client/results INTERVENTION - REVIEW - re-evaluate plan and implementation relative to achieving outcomes - modify PRN - evaluate need for continuation/discontinuation TARGETING OUTCOMES - early in process, select outcomes that are valid, reliable, congruent with goals, based on ability - apply outcomes to measure progress and adjust goals/interventions - compare progress toward goal achievement to outcomes throughout intervention process - assess outcome and use results to make decisions about the future direction of intervention

Telehealth Model

service delivery model which can include features of the above models by providing medical, rehabilitative and/or educational services to persons via telecommunications technologies

Are services for youth provided in WIA?

services for youth aged (14-21) with disabilities are also provided for in the WIA to assist in a successful transition from school to work

Strengthening activities for patients with COPD

should include approaches such as free weights, arm ergometer (a flywheel moved by a pedaling action of the arms), and elastic bands, which all help to build strength.

Architectural Barriers

sible (eg steps, narrow doors) require modifica allow accessibility. Modifications be made according national Council, Inc., Falls Church, Vinginia Wheelchair dimensions accessibility nerd a. wheelchair 24-26 rim. Figure 15-1. (1) Some doorways room spaces be limiting clear (2) cleatance width for 32-inch doorway width minimum, with being Figure (a) additional inches is needed allow swing (b) Doorways can be widened necessary. Removing doorstops 34 in width. • Replacing existing hinges with add 1%-2 inches in widh Doorway saddles can removed floor patched, or wedge be plate front the saddle, rubber placed saddle. (3) Hallways be inches wide Ser 15-2. Fgure mables manevering Caperight b. Average wheelchair length inches (1) Adequate turning spaces are needed

Bedroom Considerations

size of bed, height floor to mattress, ape mattress wheeled frame or not, posi- ae bed (against the wall freestanding). the from which the individual with sability enters/exits. 3Ahiliy change location, if needed. LAessibility dothes and dresser drawers. Suficient available for bedside commode, Considerations anded

Definition and Maior Concepts

social environments nonetheless exer influence performance" (AOTA 2008, Contexts include cultural, personal, tempor virtual. (1) "cultural context includes customs activity patterns, behavior standards, and tations accepted by the society of whi client is a member" (AOTA "personal context demos individual such age, socioeconomic status, educational that not health condition" 2008, p. "temporal context includes stages time year, time of day and duration activity, history" (AOTA 2008, The virtual context refers the "enviro in which communication by mea airways or computers absence of cal contact" (AOTA 2008, 645); exan e-mail, video-conferencing, web-based networking.

dynamic splint

splints have a resiliant component and are utilized to increase passive motion, assist weakmotions,or substitute for loss of motion

MET level 1.5-2 activities

standing, walking slowly, flying, motorcycling, playing cards, sewing, knitting, typing, desk work, shaving legs while sitting, putting on make-up while sitting

Accessory muscles of inspiration

sternocleidomastoid, scalenes, levator costarum, serratus, trapezius, and pectorals

increased BP may be related to...

stress, pain, hypoxia, drugs, and disease

Valsalva maneuver

technique where patient "bears down" or holds his/her breath while engaging in strenuous activity in order to gain more power. This is taxing on the lungs, creates SOB, and stresses the CV system by initially elevating blood pressure. It is contraindicated in patients with CV conditions, such as COPD and CABG.

Assistive Technology/Electronic Aids Daily Living (EADLS)***

technology (e.g., simple switches and lights, appliances, and other electni equipment). Assistive Technology Devices (ATDS) Definition: "any piece of equipment or prodICt used increase, maintain, improve functional capa- bilities individuals with disabilities. 2. expansion adaptive equipment. Assistive devices for environment may ered "high tech" or "low a. High costly that require ordering and may specific training to (eg, environmental control ECUS), augmentative alternative [AAC] communica- devices, computers). Low tech: inexpensive household and/or catalog items are readily available for (e.g., shoehorn, aid). Some high-tech devices (e.g., fabricated cost-effective using inexpensive commercially available micro- control, 2.

Spinal cord (C6-C7)

tenodesis splint- facilitates grasp and release

cognition

the ability of the brain to process, store, retrieve, and manipulate information. it involves the skills of understanding and knowing, the abiilty to judge and make decisions, and an overall environmental awareness

perception

the integration/interpretation of sensory impression received from the environment into psychologically meangingful information

intention tremor

the worsening of action tremor as the limb approaches a target in space

patients generally discharged to phase 2 of cardiopulmonary rehab when...

they are able to carry out activities at MET level 3.5

ayres sensory integration approach

this approach has the following principles: 1- neuroplasticity of the CNS allows for its modifications 2- sensory integration occurs in a developmental sequential manner 3- higher cortical-processing functions are dependent on adequate processing and organization of sensory simuli by lower brain centers 4- adequate modulation of sensory stimuli must occur for an adaptive response to occur 5-adaptive responses facilitate the integratio of sensory stimuli 6- individuals seek out sensorimotor experiences that have an organizing effect

neurofunctional approach

this approach.. -based on learning theory -specifically used for indidivuals with acquired neurological impairments -focuses on retraining real-world skills rather than cognitive-perceptual processes - utilizes an overal adaptive approach, but incorporates some remediation components -treatment is foucsed on training specific functional skills in true contexts

qadraphonic approach

this approach... - based on remediation -based on information-processing theory and teaching/learning theory -microperspective includes evaluation of management of performance component subskills such as attention, memory, motor planning, postural control, and problem solving - macroperspective eval includes the use of narratives, interview, real-life occupations

dynamic interactional approach

this approach... - emphasizes transfer of info from on siutation to the next - utilizes varying treatment environments - practice of a targeted strategy with varied tasks and situations - emphasizes metacog skills as basis of learning and generalization of learning - trnasfer of learning ust be taught from one situation to te next and does not occur automatically - the person's processing nabilities and self-monitoring techniques are used to facilitate learning for different tasks or environments - the therapist or OTA utilizes awareness questioning to help teh individual detect errors, estimate task difficulty, and predict outcomes

information-processing approach

this approach... - provides info on how the individual approaches the task -investigates how performance changes with cueing - standardized cues are given to determine their effect on performance - cues and feedbackare utilized to draw attention to relevant features of the task - investigate questions that are used to provide insight to underlyig deficits

cognitive disabilities model

this model.... Originally developed for use with individuals who have psychosocial dysfunction, currently also being utilized with persons with neurologic dysfunctional and dementia. Each level describes the extent of a person's disability and difficulty in performing occupations. After the person's level has been established, routine tasks are presented that the person can perform or that have been adapted so that he/she can perform them. Focus is placed on adaptive approaches and strengthening residual abilities. (Therapy Ed, 280)

serial splint

this splint is Utilized to achieve a slow, progressive increase in motion by progressive remolding

orthrokinetic splints

this type of splint utilizes tactile input to facilitate and/or inhibit appropriate muscle groups

tactile discrimination

treatment for this includes deep-touch pressure to the hands as well as the body, performed simultaneously when providing treatment for deficits in motor planning, provided graded actiities requiring ____ _____ activities using a mixture of textures and items

proprioception

treatment for this includes providing firm touch, pressure, joint compression or traction, provide resistance to active movement to help the child learn the appropriate amount of force to perform tasks, provide activities in various body positions combining vestibular proprioceptive information, provide slow linear movement/resistance/deep pressure, use adaptive techniques (ex- weighted vests)

discrimination deficits

treatment for this is similiar to propception; provide activities requring the child to demonstrate the ability to grade the force or efforts of movements

dysmetria

undershooting (hypometria) or overshooting (hypermetria) of a target

hemiballismus

unilateral chorea characterized by violent, forceful movements of the proximal muscles

Class IV heart disease-MET level tolerated

up to 1.5

Class III heart disease-MET level tolerated

up to 3.0

Class II heart disease-MET level tolerated

up to 4.5

Accessory muscles of inspiration:

used when a more rapid and deeper inhalation is required or in disease; include: sternocleidomastoid scalenes levator costarum serratus trapezius Pectorals

first aid for minor external bleeding

usually clots within 10 minutes (may take longer if patient is taking aspirin or nonsteroidal anti-inflammatory drugs)

static splints

utilized for external support, prevention of motion, stretching of contractures, aligning joints for healing, resting joints or reducing pain

postural interventions

utilizing ________ _____ to aid with oral motor dysfunction, includes chin tuck, head tilt, head turn

Rood's disease

vertebral collapse caused by TB resulting in compression of the spinal cord

mendelsohn's maneuver

voluntarily prolonging the rise of the larynx by prolonging tongue contraction

MET level 4-5 activities

walking (3 1/2 mph), bicycling (8 mph), painting, light carpentry, table tennis, golf (carrying clubs), tennis (doubles), raking leaves, many calisthenics

MET level 5-6 activities

walking at brisk pace (4 mph), bicycling (10 mph), digging garden, ice or roller skating

MET level 6-7 activities

walking at very brisk pace (5 mph), bicycling (11 mph), swimming leisurely (20 yd/min), tennis (singles), snow shoveling, manual lawn mowing, water skiing

Evaluation 5. Smaller facilitate maneuverability. Pneumatic and semipneumatic types available, solid-core best indoors and smooth Caster locks be increased during Frame. minimal may wheelchairs Folding: and facilitates mobility community fit or c. ultra-light, active-duty weight, standard, and duty frame (1) the weight generally, greater demands individual's expected desired considered. friction/rubbing Anti-tippers prevent wheelchair tipping backward forward. get caught curbs. b. Seatbelts activities. Attach level not waist level. Extend across at 45-degree angle. c. Harnesses position lacking sufficient trunk troughs to position support flaccid upper extremity and elevation. Lapboards purpose trough, beneficial as working 'table- surface. Head supports allow for improved improved communication, and feeding assistance, the is kept neutral position. Mobile supports allow an extremity with weakness engage feeding and activities. extensions allow person range in upper extremity independently late the i. Hand projections independent propulsion persons handgrip. These increase the the chair and mobility narrow doors and/ CHAIR or narrow spaces. Hillholder (also 'hillelimber and devices) allow wheelchair move forward automatically when backward engaging level each wheel. individuals long rest, Seating positioning systems section details).

wheelchair

Signs and symptoms of asthma:

wheezing, dyspnea, chest pain, facial distress, non-productive cough with acutes exacerbation where aitways may become obstructed with vicious, tenacious mucous (more severe in children than adults)

signs and symptoms of asthma

wheezing, dyspnea, chest pain, facial distress, non-productive cough, may include increased symptoms with exposure to cold in adults

Desensitization for hypersensitivity

work over scar 1) massage 2)texture 3) vibration 4) three phase desensitization kit 5)fluido *should be performed several times daily

Auditory, tactile, and proprioceptive perceptions are heightened allowing for development of sounds for the purpose of communication.

6-12 months

Hot water (relationship to pulmonary conditions)

adds to humidity and makes breathing more difficult.

signs and symptoms of MI

*severe substernal pain of more than 20 mins duration *dyspnea, rapid respiration, SOB *indigestion, nausea, vomiting

Classification of Burns - Fourth degree burn

-Involves fat, muscle, and bone -Electrical burn: destruction of nerve along pathway

anterior cerebral artery (ACA) stroke

-results in contralateral hemiplegia, grasp reflex, incontinence, confusion, apathy, and.or mutism

possible complications of RDS

*severe intracranial hemorrhage *bronchopulmonary dysplasia *developmental delay

normal breathing rate

12-18 breaths per minute

basketball

7-8

jogging at 5 mph

7-8

mountain climbing

7-8

sawing hardwood

7-8

normal adult HR

70 bpm (range 60-100 bpm)

chronic bronchitis

A client with chronic bronchitis has poor oxygenation, resulting in a bluish tinge to skin and lips, along with edema.

Atherosclerosis:

Characterized by thickening of the intimal layer of the blood vessel wall from the focal accumulation of lipids

Functional Mobility Aids

Ambulation Orthotic devices (sometimes referred to braces) prevent contractures provide stabil- joints involved. (1) orthosis. orthosis. (3) hip-knee-ankle-foot orthosis. Straight: one leg. (2) (WBQC): shaft connected four-pronged when to balance straight

Ulnar nerve injury

Anti law or lumbrical bar to position MCPs in flexion of digits 4 & 5; used to prevent clawing of 4th and 5th digit

Six levels of cognitive performance Level 1: Automatic Actions

Automatic motor responses and changes in the ANS; conscious response to the external environment is minimal

Muscle weakness (ALS, SCI, GBS)

Balanced forearm orthosis (BFO), deltoid sling/suspension sling to support the proximal UE to allow for use of distal extremity during activity IEP such as eating. It mounts to a WC and prevents loss of shoulder motions

Types of MMT: break test, resistance test

Break test: -position in gravity eliminated or against gravity -stabilize proximal to joint the muscles cross -resistance applied in opposite direction of movement -muscle grades Resistance test: -resistance applied throughout the range -individual can compensate easily -requires experienced therapist

An OTR® is working with a client population with severe intellectual disabilities. What risk factor MOST predisposes this client population to pneumonia? A. History of smoking B. Antibiotic overuse C. Aspiration of food D. Chest surgery

C. Aspiration of food

Personality Disorder Cluster Groups

Cluster A - paranoid, schizoid, and schizotypal - individuals w/ these disorders are often perceived as odd and eccentric Cluster B - antisocial, borderline, histrionic, and narcissistic - individuals w/ these disorders are often perceived as dramatic, emotional, and erratic Cluster C - avoidant, dependent, obsessive-compulsive, and not otherwise specified - often perceived as anxious or fearful

What type of splint is used to assist with partial motion and finger extension for someone who has a radial nerve injury?

Colditz Splint or radial nerve splint *this is a functional splint. It assists the digits with extension to release an object *some therapists Rx resting hand splint for PM use to prevent flexion contracture

Types of heat transfer used with superficial thermal therapy

Conduction (hot packs and paraffin) HEATS UP TO 1 CM Convection (fluidotherapy) radiation (laser) Conversion (ultrasound) HEATS 4-5 CM ***RELIEVES PAIN, INCREASE TISSUE EXTENSIBILITY THUS INCREASING ROM, ASSISTS WITH HEALING, DECREASES SPASMS

and Wheelchair Measurement Considerations

Considerations General. a. wheelchair should proportional person. section bariatric (1) Standard-sized chairs should person whenever possible inceased ations. expense customized chairs. 15-2. Measure on also obsere variety influence C. cushion that selected individu on posture. needs Measure widest across hips and allow space and comfr add inches. This allows clearance sides friction/rubbing the heavier clothing being cumbersome c. The client pear will femoral weight distribution (1) consider seated (eg. forward seated position). (2) Also consider room for weight-shifting mane pressure relief, possible of Pushed chair Seat depth. Measure both lower extremities (LEs) greatest posterior buttocks popliteal subtract 2 this measurement. 'table- prevents rubbing potential dect posterior region, while allowing ma swing. 4. height. Measurement the upper movemea potential independent wheelchair pep

Kitchen Considerations

Considerations old Location preparation that ual uses most frequently (i.e., oven, microwave, stove). Presence of countertop the stove and sink, between stove and refrigerator. Accessibility of food, pots, pans, prepara- tion materials. Direction opening refrigerator, cabinetry, and/ or pantry doors. Presence of charged extinguisher. 6. Presence of and/or

Isotonic exercise

Contraction with movement

Isometric exercise

Contraction without movement

Endurance/activity tolerance

Count number of repetitions per unit of time determine percent of max heart rate measure time until fatigue use MET levels

Medicare- OT and HHC

Covered if the individual is home-bound and needs intermittent skilled nursing care, PT, or ST BEFORE OT began. OT services can continue after need for skilled nursing, PT or ST ahs ended

Schizophrenia Criterion for Diagnosis

Criterion A = a presence of two or more of the following symptoms: - delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior (pos symptoms), or negative symptoms (represent a loss of absence of function) Criterion B = disturbance in one or more of function areas such as work, interpersonal relations, or self-care Criterion C = continuous signs of the illness for 6 months including at least one month of symptoms that meet criterion A

Seating and Positioning Systems Definition

Definition 1. primary unit that properly positions correctly aligns trunk and extremities.

Sensation Testing

Demonstrate with vision then occlude vision for actual testing test uninvolved side first (apply stimulus to volar and dorsal surfaces

Reminiscence group

Designed to review past life experiences to promote cognition and a sense of personal worth (current memory not necessary nor facilitated)

topographical disorientation

Difficulty finding one's way in space secondary to memory dysfunction or an inability to interpret sensory stimuli

chronic restrictive conditions

Diseases are all characterized by difficulty expanding the lungs causing a reduction in lung volumes

Peripheral nerve injury sensation testing

Distal to proximal following peripheral nerves

Flexor tendon injury

Dorsal protection splint to protect the repair site and allow for early controlled mobilization while wearing the splint

the Funding ATDS and

Funding ATDS State One Centers, VESID, OVRS pay for ATDS and EADIS, they enable work school. Private companies fund ensure ADA compliance. Private insurance, Medicare. Medicaid Compensation will possibly devices. Evaluatior 1. organizations fund ATDS and full community participation. 4. Centers for Independent and disil

Home Evaluation General Considerations***

General Considerations OTAS perform home assessments and make adap- tations, modifications, and recommendations to anticipated dwelling to increase safe, independent functioning with OT supervision 2. an individual with disability discharged to home from facility, evaluation should be discharge The person's current status (abilities and and risks in home determine need for home modifications adapta-

Occupation (define)

Goal-directed pursuits that typically extend over time. - purpose, value, meaning

CMC arthritis

Hand based thumb splint to place the CMC joint of the thumb at rest

Increase strength

High resistance low repititions

Directive groups (purpose and 5 parts)

Highly structured, assist low func. patients in developing basic skills. Kathy Kaplan. - Each session divided into 5 parts, 15 min. review of session by leaders - Part 1: orientation to purpose/goals - Part 2: review of names/intro of new members - Part 3: warm-up activities to make members comfortable and engage them in group - Part 4: one or more activ. designed to address the goals of the group and needs of members - Part 5: activities designed to give meaning to activities and closure to group

Community participation group

Identification and use of resources - May be modular or psychoeducational format

pneumonia

Inflammation of the lung tissue caused by infection usually from bacterial, viral, or fungal.

variable motionless tasks

Involve interacting with a stable and predictable environment, but specific features of the environment are likely to vary between performance trials

Common types of compression garments

Isotonic glove tubigrip ace wraps custom made coban wrap (wrapped distal to proximal)

Seating and Positioning Systems Goals

LEnhance posture. 2. Provide stability, control, and comfort. Promote proximal stability. pressure relief support. Allow proper positioning and correct alignment of trunk and extremities. 6. Decrease muscle contracture, deformity, and decubiti. Increase sitting tolerance and energy level. visual readiness and use extremities in ADL. 9. Increase function and participation.

individual function Purposes Environmental Evaluation Intervention

Lientify and prioritize needs, goals, desires, blem areas individual with disability within his/her environments. huablish the regarding everyday functional activities within his/her environment. functional use devices being considered lor particular individual facilitate mastery the environment.

Types of sensory testing

Light touch, localization, pain, temperature, stereognosis, moving two point discrimination, static two point discrimination, proprioceptive position sense, kinesthetic movement sense

Michigan Hand Outcome Questionnaire

Looks at client perceptions of unilateral and bilateral functional activities. also addresses perceptions of pain level, ability to participate in household and school activities, and appearance

motor apraxia

Loss of access to kinesthetic memory patterns so that purposeful movement cannot be achieved because of defective planning and sequencing of movements even though the idea and purpose of the task is understood; althought sensation, movement, and coordination are intact

anomia

Loss of the ability to name objects or retrieve names of people

Lumbricals (radial side)

MCP flexion & extension of IP joints Origin: tendons of index & middle fingers Insertion: radial sides of digits II & III

Lumbricals (ulnar side)

MCP flexion & extension of IP joints of ring and little finger - Origin: tendons of flexor digitorum profundus for digits IV, V - Insertion: radial side of ring and little finger into extensor expansion

CAUTION!

Manual edema mobilization and retrograde massage are contraindicated when cardiac edema is present

Sensory re-education

Massage, textures, vibration, desensitization review safety precautions *loss of protective sensation: high risk for injury- must avoid use of hands where vision is occluded *impaired discriminative sensation has protective sensation, but cannot distinguish between objects when vision is occluded

9 Hole Peg Test

Measures finger dexterity -the time fo each hand to place 9 pegs in a square board and remove them is the score *purdue is preferred over 9 hole because it is unilateral and bilateral. It is also more reliable

Medicare - OT in SNFs

Medicare covers OT in SNFs if the patient requires skilled nursing or skilled rehabilitation (OT, PT, ST)

Medicare vs. Medicaid

Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income.

Mobility and Mobility Aids

Mobility Overview 1. Functional mobility involves "moving one place another (during mobility, wheelchair mobility, and wheelchair, bed, toilet, tub/shower, floor). Includes functional transporting objects" Functional mobility prerequisite work/school 3. Evaluation includes perfor- mance assessment determine potential ability mobility (including sensation, percep- tual, musculoskeletal, cognitive, psychosocial areas).

What type of splint is used to hold the thumb in opposition to use during functional activity for someone with a median nerve injury?

Opponens splint, C-Bar, or thumb post splint -a thenar webspace is used to prevent thumb adduction contracture

Opponens Pollicis

Opposition Origin: bones of the hand Insertion: first metacarpal

Opponens Digiti Minimi

Opposition of the pinky Origin: Hook of hammate & flexor retinaculum Insertion: 5th metacarpal

What is habituation?

Organized, recurrent patterns of behavior; comprised of roles/habits

What is the pattern of origin for extensor muscles?

Originate farther up the arm, lateral epicondyle or radius/ulna

What is the pattern of origin for the flexor muscles of the hand?

Originate in the bones of the hand and insert on fingers

Increase ROM

PROM, passive stretching, heat or other thermal agents, joint mobilization is performed before passive ROM but is a speciality area*, pendulum exercises, manual stretching, HEP, splinting, equipment, tendon gliding, blocking exercises, functional use, Preperatory methods, purposeful and occupation based activities

Symptoms of late stage PVD

Pain at rest, muscle atrophy, tropic changes (hair loss, skin and nail changes)

phases of OT cardiopulmonary rehabilitation

Phase 1: inpatient rehabilitation/hospitalization stage (acute) Phase 2: outpatient rehab/convalescence stage (subacute) Phase 3: maintenance/training stage (community exercise programs)

signs and symptoms of emphysema

Primary complaint of dyspnea on exertion Wheezing Prolonged expiratory phase Pursed lip breathing Barrel chest Forward leaning posture Presence of chronic cough

Purposeful Activities

Processes that are directed toward a desired and intended outcome and require energy and thought to engage in and complete

Myocardial infarction (MI)

Prolonged ischemia, injury, and death of an area of the myocardium caused by occlusion of one or more of the coronary arteries; results in necrosis of heart tissue.

Which nerve only innervates extensor muscles of the hand?

Radial

Spinal cord injury sensation testing

Proximal to distal following dermatome pattern

Pulmonary edema Pulmonary emboli Pleural effusion Atelectasis

Pulmonary edema: excessive seepage of fluid from pulmonary vascular system not interstitial space. May lead to alveolar edema. Pulmonary emboli: thrombus from peripheral venous system becomes embolic and lodges into pulmonary circulation Pleural effusion: excessive fluid between visceral and parietal pleura. Atelectasis: collapsed or airless alveolar unit, caused by hypoventilation

Transfers

Purpose 1.la move from one surface to another and eflec- Uvely,

Stereognosis

Recognition by touch of common objects (scoring is based on the number of correct objects) a second set of identical common objects should be used for individuals with expressive aphasia

Types of Wheelchairs

Refer to Table descriptions general types of wheelchairs and indications/contraindications use.

Brunnstrom

Reflexive --> volitional stages for hemiplegia: 1) flaccidity 2) minimal volitional movement 3) marked spasticity 4) movement begins to deviate from synergy 5) movement differs greatly from synergy 6) spasticity absent 7) normal synergies principles: - focused on facilitating recovery thhrough a specific sequence - treatement focused on the promotion ofmovement from reflexive to voitional - following the onset of hemiplegia through in a stereotypical fashion were identified by Brunnstrom

Funding for Driver Rehabilitation

Rehabilitation VESID, OVRS, and DVRS pay driver rehak tion it will enable to go work or sho 2. Private insurance, Medicare, Medicaid, and Wed Compensation will possibly reimburse ce driver rehabilitation devices/adaptations.

Telecommunications Act of 1996

Required providers of telecommunications systems and manufacturers of telecommunications equipment to make services and equipment useable by and accessible to individuals with disabilities, if at all possible (i.e. cell phones, pagers, call waiting, caller ID, and operator assistance)

Tonic Labrinthine - Supine

STIMULUS: - Place infant in supine RESPONSE: - Increased extensor tone FUNCITONAL SIGNIFICANCE: - Facilitates full-body extensor tone; allows posture to adapt to that of the head ONSET AGE: - >37 weeks gestation INTEGRATION AGE: - 6 months

Bronchopulmonary Dysplasia (BPD):

Respiratory disorder often as a result of barotrauma (1) high inflating pressures (2) infection (3) meconium aspiration (4) Asphyxia The walls of the immature lungs thicken, making the exchange of oxygen and carbon dioxide more difficult

Flaccidity

Resting/functional hand splint to prevent joint contracture and hold the hand in a position of function until muscle return occurs commonly worn at night and periodically through the day

D2 extension

Scapula abducted and downwardly rotated, shoulder extended adducted internally rotated, elbow toward flexion, forearm pronated, wrist flexed toward ulnar side, fingers flexed adducted, thumb flexed abducted and opposed.

Development (define)

Sequential changes in the function of an individual - qualitative or quantitative - influenced by biological determinants and bio-psychosocial environmental experiences

Modular group

Sessions rotated in way that indiv. can join at any time and still cover each topic (e.g. Independent Living Skills group that addresses nutrition 1st session, money manage. 2nd session, transportation 3rd, then cycle begins again)

Borg rate of perceived exertion

a self-report rating scale which ranges from no exertion at all (i.e., sitting or lying) to maximal exertion (i.e., hard work is not advisable)

Swan neck

Silver ringers, buttonhole/hyper extension block splint or digital dorsal splint in slight PIP flexion to place the PIP joint in slight flexion to prevent further development of swan neck deformity

Spasticity

Spasticity splint or cone splint to prevent joint contracture

Types of Angina

Stable: classic exertional angina - exercise or activity. relieved with rest and sublingual NO Unstable: Coronary insufficiency at rest w/o any precipitating factors or exertion. Pain difficult to control. Platelet aggregation. Variant: caused by vasospasm of coronary arteries in absence of occlusive disease. Responds to NO or calcium channel blocker

Serial static splint

Static splint or use of casting material that is remolded to address changes in joint motion

Cock-Up Splint

Support the wrist and 10° to 20° of extension to prevent contracture; allows the digits to function, used with carpal tunnel syndrome

Wheelchair Mobility Training

Systems Train transfer wheelchair to diverse surfaces, See section transfer training. Instruct in basic maintenance of wheelchair parts 13. Developmental considerations. children early independence with wheelchair mobility in their environment. b. Discourage use strollers that prevent child independent propulsion.

Ultrasound application

TYPES: continuous (thermal effects) and pulsed (non thermal effects) benefits: 1. Increases tissue extensibility 2. Reduces pain 3. Increases blood flow and tissue permeability 4. Reduces muscle spasms 5. Reaches deeper tissues (up to 5 cm) benefits of pulsed ultrasound: 1. Decreases inflammation 2. Heals tissue ***RED FLAG*** CONTRAINDICATIONS: DO NOT USE WITH PEOPLE WHO ARE PREGNANT OR HAVE AN ACTIVE MALIGNANT TUMOR, SOME JOINT REPLACEMENTS, THROMBOPHLEBITIS, FRACTIONS, INFECTIONS, OR OVER THE SPINAL CORD DO NOT APPLY TO THE AREA NEAR A PACEMAKER, GROWTH PLATES, AND OR BREAST IMPLANTS. DO NOT USE ON VERY OLD OR YOUNG

What is performance capacity?

The physical and mental skills needed for performance and the subjective experience of engaging in occupation

Evaluation

The process of obtaining and interpreting data necessary for understanding individual, system, or situation OTA contributes - assist with collection of data once service competency is est. with supervision from OTR - assists with determining assessments for eval (baseline function, environmental context, temporal context) - OTA/OTR collab together and with client/family

Isometrics are contraindicated for persons with hypertension and cardiovascular problems because

They can increase blood pressure and heart rate- they should be avoided

Fetal sensorimotor development - olfactory

Third Trimester: Nasal plugs disappear, some olfactory perception

Elements of a group protocol

Title/name, purpose, rationale, theoretical base/ frame of reference, criteria for membership, goals/ anticipated outcomes, methodology/format, role of therapist, quality assurance

Bed Mobility

Transfers of the operated hip, which may cause disloca- tion. (2) May require use abductor pillow between lower extremities prevent adduction of operated b. Status cerebrovascular (CVA). May need regarding proper position- ing minimize decrease swelling, and promote normalization tone. (2) May also require of pillows while promote positioning. post extremity increase awareness, side lving e-lying increase comfort and c. Status post amputation lower extremity. (1) training regarding of pillows prevent edema lower extremity. (2) May need training to provide passive stretching shortening contracture, would make training difficult and painful. limb while bed prevent to: Bed mobility aids. a. Hospital beds, usually with bedrails and elevating head and foot surfaces. Bedrails can with rolling, positioning sleep, and assuming short-legged position. attached assuming long-legged posi- tion. c. Hoyer lift/trans-aid: hammock device attached or lift systems transfer individuals who dependent. Bedpans and urinals decrease need rolling

Rood's disease:

Vertebral collapse caused by TB resulting in compression of the spinal cord. a. cervical spinal lesions can result in hand functional impairment, sensory impairment, postural changes b. Thoracic spinal lesions can result in paraparesis, neurogenic bowel/bladder, altered mobility, and altered activity of daily living activies c. space-occupying lesions in the brain produce stroke-like symptoms.

Cognitive Performance Test

Was designed to assess the func. perf. of indiv.'s w/Alzheimer's disease; the focus is on the identification of effects that particular deficits have on ADL perf.

Flexor carpi radialis (FCR)

Wrist FLEXORS innervated by the MEDIAN nerve. Origin: Medial epicondyle Insertion: second and third metacarpal, base Function: Flexion of the wrist and radial deviation

Flexor carpi ulnaris (FCU)

Wrist FLEXORS innervated by the ULNAR nerve. Origin: Medial epicondyle and proximal two-thirds of the ulna Insertion: Pisiform and fifth metacarpal Function: Flexion of the wrist and ulnar deviation.

supraglottic swallow

_______ ______ technique includes to voluntarily close/protect the airway during food intake