NBCOT Prep Questions
TBI can have an impact on cognition, including the following components:
- Short- and long-term memory - High-level executive functions, such as impulse control, sequencing, insight, judgment, and long-term planning - Insight - Perception (receptive and expressive communication may be impaired) - Mood (depression and mood swings are common during recovery, as are periods of anxiety or agitation)
Symptoms of upper motor neuron lesion
- Spasticity - Clonus - Autonomic dysreflexia - Overly responsive deep tendon reflexes
Benbow's developmental classification of factors that are the basis of skilled hand use
- Upper extremity support - Wrist and hand development - Visual control - Bilateral integration - Spatial analysis - Kinesthesia
Symptoms of a lower motor neuron lesion
- flaccidity - decreased or absent deep tendon reflexes - atrophy
Intrinsic Plus Splint
- wrist extended slightly (20-30 degrees), - MCP joints flexed (70-90 degrees), - full finger extension at DIP and PIP joints -Positions of safe immobilization of the hand for splinting -intrinsic plus grasp used in grasping and holding large, flat objects like books or plates.
Adjustable-tension backrest
-replaces sling backrest -tension is adjusted by loosening and tightening the strapping system; accommodates kyphosis
Begins to walk independently.
12 Months
Normal respiratory rate for adults
12-20 breaths/min
Paraffin temp and amount of dips?
125-130 degrees 8-12 dips
At what temp should a hydrocollar be maintained to safely store hot packs? 98 165 110 125
165
What age can an infant be expected to have voluntary release of an object? 4 Months 5 Months 9 Months 1 Month
9 Months
conversion disorder
A rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found.
Mini-Mental State Examination
A test that is used to measure cognitive ability, especially in late adulthood.
A COTA® is completing a functional ambulation task with a client when the client's legs begin to buckle. What is the MOST appropriate way for the COTA to manage this issue?
Lower the client onto the COTA's flexed leg, then down to the floor. The COTA may be less prone to back injury by using his or her legs to support or lower the client to the floor.
Decreased motor planning for performing a task or skill
Motor apraxia tx: generalized feedback and cues, decrease complexity of task and provide hand over hand assist as well as visual cues.
Stroke-related impairments
Motor dysfunction (hemiplegia/hemiparesis), impairment in trunk and postural control and standing activity, communication impairment
Which assessment assesses a client's visual closure, or the ability to visually identify forms or objects from incomplete presentations?
Motor-Free Visual Perception Test, Third Edition
A team comprised of different types of providers, but they continue to work separately from one another
Multidisciplinary
A 4-year-old child with right hemiparesis has a goal to pick up and hold toys using the right hand. What type of orthosis would be MOST appropriate to help reduce the child's spasticity and increase functional use of the hand?
Neoprene thumb loop splint - A neoprene thumb loop splint helps reduce spasticity and enables an optimal position to pick up and hold toys.
Over whom does the AOTA Ethics Commission have jurisdiction?
OTAs and OTs with AOTA membership at the time of an alleged incident - The AOTA Ethics Commission does not have jurisdiction over occupational therapy practitioners who were never AOTA members or who were not members when the incident in question occurred.
informal observation
Observations occur in the child's natural settings, such as at home, at school, and in the community.
Which type of occupation therapy personnel is responsible and accountable for all aspects of OT service delivery?
Occupational therapist - They are the only ones that do not require supervision
Occupational therapy driver off-road assessment
Occupational therapy practitioners use a battery of assessments to find clients' strengths and weaknesses and pinpoint areas on which to focus during rehabilitation without going on road.
Spinal shock
Occurs in the initial states of spinal cord injury and may last 24 hours to weeks; can result in the absence of reflexes below the level of injury
Cause of glaucoma
Occurs when the intraocular fluid becomes blocked, resulting in increased intraocular pressure, which in turn reduces blood flow to the optic nerve and causes loss of peripheral vision
Chaining
One step in a sequence is learned and sparks the next step until all of the steps are learned.
Which of the following is not a characteristic of rheumatoid arthritis? Periods of exacerbation and remission considered a systemic inflammatory condition more common in small joints often occurs in large joints
Often occurs in large joints
What type of splint is indicated for a median nerve injury to maintain thumb range of motion and positioning?
Opponens splint
Assessment of Motor and Process Skills
Patient chooses from 63 ADL tasks, OT observes 2-3 tasks, allows therapist to determine ability of client, while taking into account the relative challenge of each or the ADL tasks the client performed.
windswept deformity
Pelvis rotated to one side, resulting in the spine, trunk, and thighs moving to the opposite side
Stage of group development where participants work together as a cohesive unit. Conflict may be present, but it is effectively resolved (Tuckman's model)
Performing stage of group development
A COTA® 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?
Peripheral artery disease Cramping and pain when walking—also known as intermittent claudication—are caused by decreased blood flow while exercising and are common symptoms of peripheral artery disease.
An older adult client with a history of falls and glaucoma is referred to occupational therapy for evaluation and intervention. Which visual impairment should the COTA® expect as a result of the client's glaucoma?
Peripheral vision loss
Which of the following is not a principle of the neurodevelopmental treatment (NDT) approach to intervention?
Promote movements and activities that increase muscle tone - With a patient who has a CNS impairment, such as a brain injury, the NDT approach to treatment does not promote activities that increase tone, but rather seeks to normalize tone and minimize spasticity.
For a client with C5 spinal cord injury (SCI) in the acute phase of rehabilitation, what is the BEST position to place the client's forearms in?
Pronation The forearm should be pronated because clients with C5 SCI are prone to contractures in their supinators because of their inability to pronate actively.
According to AOTA's (2010) "Statement on Driving and Community Mobility," what training must an occupational therapy practitioner have to address the IADL of community mobility?
Successful completion of training as an OTR® or COTA® AOTA's (2010) "Statement on Driving and Community Mobility" states that all OTR®s and COTA®s possess the training and education necessary to address driving and community mobility as an IADL.
A COTA® asks a client with impaired balance to dust and polish a bookshelf in standing position without upper-extremity support. The COTA notes no loss of balance during reaching and bending tasks. How would the COTA appropriately grade the activity to provide the just-right challenge?
Reduce the client's base of support - A therapeutic activity in which the COTA is addressing balance in someone with deficits would likely begin with the client in a wide base of support, or with the feet hip- to shoulder-width apart. If the client can successfully participate in this IADL task with a wide base of support, the COTA may upgrade the task and have the client move the feet closer together, narrowing the base of support and increasing the challenge.
A COTA® observes that a client with Parkinson's disease has fine motor difficulties when dressing. Which strategy is BEST for improving performance in dressing?
Reduce the need for fine motor skills by eliminating clothing fasteners Eliminating clothing fasteners is a task modification that decreases the level of performance difficulty. This strategy is also the most readily manageable option for this client, because of the progressive loss of fine motor function.
A child with a sensory processing disorder and Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome) is attending a regular classroom. Which reasonable accommodation would be BEST for this child under the Individuals With Disabilities Education Act?
Reduce the number of math problems to one per page.
Walkability
Refers only to the build environment
It would be approprite for an entry level OTA to supervise which type of personell? Cant supervise anyone Rehab techs, level 1 OT students, level 1 and 2 OTA students Rehab techs, all fieldwork OT and OTA students, other OTAs Rehab techs and volunteers
Rehab techs and volunteers
RUMBA goal format
Relevant, Understandable, Measurable, Behavioral, Achievable
Allen Cognitive Level 3
Repetitive Actions-->MOD ASSIST Stitches: Imitates 3 'running stitches' Motor Actions: manipulation of familiar objects, react spontaneously to tactile stimulation Attention: 30 minutes; no written directions; increased distractability Tx: performs familiar ADL's (face washing, etc) 3=3 running
The COTA® is treating a client in the late stage of Parkinson's disease Which of the following symptoms can the COTA® expect to see?
Resting tremor, rigidity, oral motor deficits. Swallowing difficulties become apparent in the late stage of the disease because of impairments in the oral motor muscles as motor control becomes further compromised. Resting tremor is a symptom that manifests in the early stage of Parkinson's disease and continues throughout the disease course. Rigidity often onsets in the early stage of Parkinson's disease and progresses in severity in later stages.
Compensatory Strategies while driving: Night vision impairment
Restrict night driving, drive on roads with reduced speed limits, and increase following distance at night.
Compensatory Strategies while driving: Strength
Review vehicle design considerations (e.g., foot- vs. hand-operated parking brake).
A client with morbid obesity and obstructive sleep apnea is collaborating with an COTA® on improved sleep routines and positioning. What sleep position is optimal for this client?
Side-lying position with the 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.
Which is the MOST appropriate position for a client with a hip replacement to perform lower-body dressing?
Sitting on the side of the bed
An injury to the ulnar collateral ligament of the MCP joint of the thumb
Skier's thumb
In regards to Margaret Rood's phases of motor control, which term focuses on distal movement rather than proximal?
Skill
Handwriting prerequisites
Small muscle development eye hand coordination hold utensil letter identification
A client is being discharged from a rehab facility. During the discharge interview, the OTR® and COTA® ask questions such as, "Who is available to assist the client in each physical context the client needs to be in?" "When are they available?" "Who will check the Roho cushion and reinflate it as needed?" "Who will clean the cushion cover?" Under which assessment category do these questions fall?
Social context
Physical symptoms that have a psychological source
Somatic symptoms
What type of toy would be most appropriate for pediatric intervention?
Something that can be easily disinfected ex. plastic rings
A client who has a C5 spinal cord injury wants an electronic aid to daily living for operating devices in the home. Which feature is MOST IMPORTANT for the device to have?
Speech recognition - A client with a C5 spinal cord injury will not have hand or wrist function, so operating switches and other devices in the home will require a speech-recognition electronic aid to daily living.
Lumbrical bar splint
Splint to reduce MCP hyperextension and interphalangeal (IP) flexion contractures
A client in the early stages of amyotrophic lateral sclerosis (ALS) presents with weakness in the thenar eminence. During which ADL task would the COTA® MOST LIKELY observe the effect on function?
Squeezing toothpaste onto a toothbrush Typical early signs of ALS are distal, with weakness of the small muscles of the hand being the most typical initial symptom. The muscles that make up the thenar eminence are responsible for opposition of the thumb. Squeezing toothpaste and holding a toothbrush require grasp-and-pinch patterns that involve thumb opposition.
Mildred Ross: Which stage uses activities to assist in tranquility and focus following movement completion?
Stage III: perceptual motor
Forming stage of group development
Stage of group development where participants become acquainted with one another and familiarize themselves with the task (Tuckman's model)
What is the expected grasp of a writing tool for a child aged 3.5-4 years old?
Static tripod posture
Stage of group development where participants challenge one another and the leader (Tuckman's model)
Storming stage of group development
A COTA® is working with a client who has decreased visual acuity. The client is concerned about falling while walking up and down the stairs. Which of the following environmental adaptions is BEST for this issue?
Strips of various colors at the edge of each step - pick the option that is directly related to a visual impairment
Three if the rotator cuff muscles insert on the greater tuberosity of the humeral head. Which muscle inserts on the lesser tuberosity?
Subscapularis
Phases of adjustment to disability - What phase is characterized by initial feelings of acceptance of change and developing new desires or goals following the disability?
Acknowledgement
New onset of disability What phase is characterized by initial feelings of acceptance of change and developing new desires or goals following the disability?
Acknowledgment
A COTA® is working in a clubhouse with a group of clients who have mental health issues. Which leadership style would be MOST effective for the COTA® to use?
Advisor The clubhouse model puts the locus of control on the members. When designing groups, the members formulate the goals, and the COTA®, in collaboration with the OTR®, acts as an advisor.
Teach skills to identify and recognize emotions and influences on emotions.
Affective education
________ _________ includes helping children recognize their own feelings to help them respond appropriately to stressors.
Affective education
Expresses discomfort when diaper is wet or dirty; moves bowels regularly.
Age 1
Able to take purposeful steps while holding on to an adult's hands for assistance.
Age 10 months
Can sit on toilet with supervision.
Age 1½
Able to doff coat after fasteners have been unfastened; removes shoes if not tied; begins to help with pulling down pants; can locate armholes in shirt.
Age 2
Begins to show interest in toileting; can stay dry for 2 hours or more; can flush toilet independently; urinates regularly.
Age 2
Able to pull down pants with an elastic waistband
Age 2½
Tells someone when having to go to the bathroom; can be on a regular toileting schedule; may need assistance to get positioned on the toilet; wakes up dry at night; can wipe self after urinating; washes hands independently.
Age 2½
Able to don a pullover shirt with little assistance; able to put on own shoes (still needs help with tying); able to put on socks; able to zip zipper once it is engaged; able to button large buttons.
Age 3
Goes to the bathroom independently; may need assistance wiping, particularly after bowel movements; may need assistance fastening or managing some clothing items.
Age 3
Can distinguish between front and back of clothing items; can manage snaps and hooks; can unzip zipper completely; can button buttons and begins to buckle buckles; can put on mittens; dresses with supervision.
Age 3 1/2
Removes pullover garment independently; can buckle buckles; can zip zipper completely; may lace shoes (but still need assistance for tying).
Age 4
Independent with toileting, washing hands, and clothing management.
Age 4-5
Can tie and untie knots; can dress without supervision.
Age 5
Can tie bows; can manage fasteners in the back of garments.
Age 6
Able to stand while holding on to a surface or a piece of furniture; also beings to crawl.
Age 9 months
The inability to read in a familiar language
Alexia
Which type of "A FIber" sends proprioceptive information as well as somatic motor information?
Alpha
According to the EHP Model, the _________ intervention approach focuses on the client's context. Interventions are geared toward providing appropriate contexts to support the client's needs.
Alter
Which type of pressure reducing device is intended for people with, or at high risk of, developing full thickness ulcers?
Alternating and low air loss mattresses An electric bed that offers alternating firmness
After a stroke with resulting left hemiparesis, a patient does not recognize that the left arm on his bed belongs to him and not his spouse next to him. What condition does this describe?
Asomatognosia: Asomatognosia is characterized by an individual's inability to recognize that the impaired limb belongs to their body.
A COTA® is working with a client population with severe intellectual disabilities. What risk factor MOST predisposes this client population to pneumonia?
Aspiration of food Among people with severe intellectual disabilities, the most frequent cause of pneumonia is aspiration of food or liquids.
Ecological Assessments: ASD
Assess students in real-life context Knox Preschool Play Scale Transdisciplinary Play-Based Assessment School Function Assessment
When performing CPR, what is the recommended compression depth for a child that is 10 years old?
At least 1/3 the anterior/posterior depth, about 2 inches
Which condition is characterized by writhing muscle movement?
Athetosis
Allen Cognitive Level 1
Automatic Actions/Reflexive--> TOTAL ASSIST Stitches: None attempted Motor Actions: walking, eating, drinking, standing Attention Span: Seconds Tx: Sensory Stimulation
Ranchos Level VII
Automatic, appropriate: Min Assist for Daily Living Skills - Consistently oriented to person and place within highly familiar environments, Mod Assist for time - Attends to highly familiar tasks in non-distracting environment for 30 min with Min assist - Carryover of new learning (min supervision) - Initiate and carry out routine (household routine) but shallow recall of what they just did (robot-like behavior) - Superficial awareness of condition but overestimates abilities, still poor judgment (safety) and planning - Oppositional/uncooperative - Unable to recognize inappropriate social interactions
Level 7 & 8 Common theme
Automatic/purposeful
OT Code of Ethics: What principle involves maintaining confidentiality and trust between oneself and a patient, following their wishes in regard to intervention and communication.
Autonomy
Compensatory Strategies while driving: Contrast sensitivity impairment
Avoid area, time of day, and other conditions (e.g., cloudy or rainy weather) with poor contrast.
Compensatory Strategies while driving: Glare recovery
Avoid night driving
Klinefelter's syndrome
Boys with this syndrome have learning disabilities and emotional and behavioral problems; they are tall, slim, have small genitalia, and are unable to father children.
A client served 18 months in a forensic facility and was released to a halfway house; the client is now participating in a community reentry program. Which of the following areas of occupation would be the best focus for an occupational therapy program?
Budgeting and shopping skills Community reentry should focus on engaging the client in the community with the skills needed to successfully live free from incarceration.
Which component of dressing or piece of equipment would be least helpful in improving independence in dressing for a patient with Parkinson's disease? Long Handled Shoe Horn Elastic shoe laces Button closures Velcro closures
Button closures
Which type of splint is indicated for a swan neck deformity?
Buttonhole splint
CARE Documentation
C- Clarity A - accuracy R - relevance E - exception (Documentation should include unusual occurrences during the intervention session)
COAST method
C-Client O-Occupation A-Assist level S- Specific condition T- Timeline
Marginal manual wheelchair user
Can propel a manual wheelchair for short distances; tolerates only limited use because of upper extremity overuse injury, upper body weakness, lack of endurance, or respiratory problems, may at times use manual or power wheelchair
Common lower extremity deformities and manifestations of rheumatoid arthritis
Claw toe, hammer toe, cock-up toe, hallux valgus (bunion) are associated with this condition.
Claudia: Cognitive Level 6—planned actions
Client is independent. Disability is absent.
Formal observations
Clinical observations are a specific set of observations that allow the occupational therapy practitioner to make some inferences about how the child's CNS is functioning.
Which form of range of motion exercise is commonly performed following shoulder surgery and uses gravity and weight shifting to assist with gentle pendulum movements?
Codman's Exercise
Cognitive-behavioral strategy in which the practitioner teaches skills to recognize faulty or anxious thinking
Cognitive restructuring
Teach skills to recognize faulty or anxious thinking.
Cognitive restructuring
The rotating of stiffness and looseness in a muscle during attempts at PROM is called
Cogwheel rigitity
What term describes the percentage or dollar amount an individual is responsible for paying for each health care service received?
Coinsurance
What is the BEST compensatory strategy a COTA® can apply to address the on-road performance of a client with visual field deficits?
Compensate with extra head turns and frequent eye movements.
General vocational evaluation
Comprehensive assessment to evaluate a person's potential to do any type of work. It is used to determine one's aptitudes, abilities, and interests to explore all reasonable options for work
Which is the correct sequencing for CPR when performing on an adult or child?
Compressions, airway, breathing
Driving Health Inventory
Computer based assessment, assesses domains of vision, cognition, and motor function as they pertain to increased crash risk
Person capabilities
Concept that includes performance patterns, performance skills, and client factors
chronic obstructive pulmonary disease (COPD)
Condition with damage to the alveolar wall and inflammation of the conducting airways
A blending of all forms of clinical reasoning to flexibly respond to changing conditions and to predict client futures
Conditional reasoning
blending of all forms of reasoning to flexibly respond to changing conditions and predicting client futures
Conditional reasoning
An OTA is educating a family on home modifications to allow wheelchair access for a family member who has sustained a spinal cord injury. What is the minimum width doorways should be in order to provide adequate clearance?
Correct answer: 32" Doorways should be a minimum of 32" wide and ideally 36" wide. Wheelchairs are typically 24"-26" wide.
An OTA is providing education on home modifications to allow for wheelchair access. The homeowner is going to widen existing narrow doorways. What is the ideal doorway and hallway width?
Correct answer: 36" Doorways should be at least 32 inches wide; however, the ideal width is 36 inches. The hallways should be 36" wide to allow self-propulsion without scraping hands on the walls. Wheelchairs are typically 24"-26" wide.
Which method of supervision is considered an indirect form of supervision of an OTA by an OT? Phone calls co-treating a patient reviewing a plan of care observing intervention
Correct answer: Phone calls Indirect supervision is supervision that is not provided in person, such as that provided through phone conversations or written notes or emails.
An OTA is educating a mother about development of fine motor hand skills in her infant. The infant is 10 months old. What grasp is expected to be used to pick up a small object?
Correct answer: Pincer grasp At 10 months old, the infant uses a pincer grasp, picking up small objects between the finger pads. The thumb is beginning to demonstrate DIP flexion at this stage.
An occupational therapy assistant is working with a patient following a burn who is complaining of intense pain requiring pharmaceutical pain control. What is the most likely degree of burn?
Correct answer: Second degree A second degree burn has intact nerve sensation and can have high-intensity pain. A first degree burn is a minor burn that typically involves only moderate discomfort. Both third and fourth degree burns involve lack of sensation due to the depth of the burn causing damage to nerve endings.
Which type of burn is characterized by redness and blistering of the skin?
Correct answer: Superficial partial thickness burn A superficial partial-thickness burn is a second degree burn that affects the epidermis and the superficial dermis.
A COTA® is working with a client for safety in community mobility. The client is using a front-wheeled walker (FWW) and had a left total knee replacement 3 days ago. What client ability is the MOST important area to address in treatment intervention?
Crossing the crosswalk in a timely manner before the light changes. This is a time sensitive task and should be assessed during intervention.
(Grasp - cube/ball) 4 Months
Crude Palmar Grasp (Ulnar Palmar Grasp) The object is held in the ULNAR side of the palm, which is why the grasp is sometimes referred to as the ulnar palmar grasp. There is no active thumb movement
Peripheral nerve injury that is characterized by sensory changes along the ulnar nerve pathway, as well as elbow pain and a weak grasp
Cubital tunnel syndrome
Which PNF movement involves extension of the shoulder that progresses toward the same side of the moving arm, with an ending position of shoulder extension, abduction, and internal rotation?
D1 Extension
Which movement pattern involves scapula abduction and upward rotation and shoulder flexion, adduction, and external rotation?
D1 Flexion
Which PNF movement involves extension of the shoulder that progresses towards the opposite side of the moving arm, with an ending position of shoulder extension, adduction, and internal rotation
D2 Extension
Which PNF movement pattern involves the scapula in adduction and upward rotation and a shoulder in flexion, abduction and external rotation?
D2 Flexion
Hemi-inattention
Decreased search to left field; right hemisphere deficit. INTERVENTIONS: a. Provide bilateral activities b. Guide the affected side through the activity c. Increase sensory stimulatioin to the affected side.
What is the amount that a person has to pay for health care services prior to a third party covering costs?
Deductible
A COTA® 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 situation?
Defer the client's participation in occupational therapy until later, because the client is medically unstable. Ventricular tachycardia of more than 100 beats per minute can cause sudden cardiac death. Therapy should be deferred until the client is medically stable.
The therapist summarizes feedback and recommendation for improved task performance at the end of a session. What type of feedback is this?
Delayed feedback
Which type of "A fiber" sends sensory information related to pain and temp?
Delta Fibers
Clinical features of vascular dementia
Dementia characterized by cognitive decline similar to AD but often less severe memory involvement; gait disturbance; and abrupt or stepwise (rather than continuous) decline
In regards to neurons, which structure receives information?
Dendrite
To facilitate participation in familiar daily living tasks by clients with dementia, what would be an appropriate INITIAL stage of intervention?
Develop strategies to simplify familiar tasks. Task simplification is a primary intervention used with clients with dementia to maintain independence in daily living tasks.
A COTA® is working with a client in the active phase of C6 spinal cord injury. What is the MOST IMPORTANT treatment activity to consider?
Developing pressure relief methods
According to the taxonomy of groups described by Anne Mosey, which type of group focuses on improving social interaction between participants incrementally as group and task demands progress?
Developmental groups
the most widely used medication by therapists using iontophoresis because of its anti-inflammatory properties.
Dexamethasone
Compensatory Strategies while driving: Reaction time
Drive on roads with reduced speeds, avoid driving in peak traffic times or congestion, and increase the following distance.
Influenza requires what type of precautions?
Droplet
common symptom of ASD and may result in impaired judgment.
Executive function deficit - knowing when to get on or off the bus at the right time.
Cardiac rehab: Key outpatient (Phase 2) OT intervention components
Exercise and activity to tolerance with progression of MET levels; education in risk factor modification; evaluation for psychosocial issues; work hardening are intervention components for this stage of cardiac rehab.
Provide exposure involving gradual introduction of feared events and rewards for brave behaviors.
Exposure to fears and contingency management
Which motion is most restricted with adhesive capsulitis (frozen shoulder)?
External Rotation - very limited active and passive ROM within the glenohumeral joint.
OT Code of Ethics- Which principle discusses how a clinician should treat patients and coworkers?
Fidelity
An OTR® is observing a child with visual figure ground difficulties during an evaluation. Which daily activity could the OTR ask the child to do during the observation to better understand the child's figure ground difficulties?
Find a soup spoon in an unorganized silverware drawer - Figure ground perception is the ability to distinguish the foreground from the background. Asking the child to find a soup spoon in an unorganized drawer is an appropriate task to observe as part of an assessment for figure ground difficulties.
The infant is 12 months old. What type of grasp is expected to be used to pick up a small object?
Fine pincer grasp Uses the fingertips and flexed thumb DIP.
An OTR® asks the COTA® to have the client's caregiver complete a proxy assessment of the client's driving skills. What assessment would be BEST for the caregiver to complete?
Fitness-to-Drive Screening Measure (previously known as the Safe Driving Behavior Measure)
Which muscle may be affected by weakness in the hand due to dysfunction of the ulnar nerve? Abductor pollicus brevis Flexor digiti minimi Opponens pollicus Radial side of the lumbricals
Flexor digiti minimi
Which reflex occurs to protect from negative stimulation on the plantar surface of the foot?
Flexor withdrawal
What modality transfers heat through convection?
Fluidotherapy
An OTA is working with a patient with diabetic neuropathy. WHat is an essential component of protective education?
Foot care and inspection
Type of symptom magnification in which the person consciously attempts to convince those working with him or her of the reality of symptoms for positive gain
Game player
Which type of "A Fiber" sends motor planning information to muscles for movement?
Gamma
Ranchos Level II
Generalized response: Total Assist - Generalized reflex response to pain - Responds to repeated auditory stimuli with increased or decreased activity - Responds to external stimuli with generalized, gross body movement and/or non-purposeful vocalization - Responses may be significantly delayed.
A COTA® who works with adult clients with mental illness attends an introductory workshop on guided imagery. The COTA wants to begin applying the skills obtained from the workshop with clients. For which type of disorder is guided imagery an appropriate intervention technique?
Generalized stress disorder Guided imagery is a type of mindfulness technique that encourages relaxation. It is an evidence-based strategy that has been found to be effective with people with stress-related disorders. The technique allows clients to practice skills in a situation with less pressure than might be encountered in a real situation, which gives them the ability to approach the real-life situation with less anticipatory stress and strategies to cope with stress as it arises.
Which joint must be assessed for subluxation in the recovery from CVA?
Genohumeral Joint - Shoulder
Allen Cognitive Level 4
Goal Directed/Familiar Activities-->MIN ASSIST Stitches: imitates 3 'whip stitches' Sensory: Responds to Visual Stimuli Tx: Visual cues to complete tasks, matching, several step-tasks, simple crafts (2-3 steps); NO NEW LEARNING/GENERALIZATION Attention Span: Hours 4=1 task plus 3 whip
sets five levels of performance ranging from −2 to +2; 0 is set as the expected outcome; negative levels are understood as less than or much less than the expected outcome, and positive levels are understood as exceeding or greatly exceeding the expected outcome.
Goal attainment scaling (GAS)
What characteristic of group design describes what each individual should obtain by participating in the group?
Goals and anticipated outcomes
What is the appropriate muscle grade for a pt that presents with no muscle tension or flaccidity on the affected side?
Grade 0
After a stroke, a patient displays the ability to move the elbow through the full range of motion in a gravity eliminated plane without any tension but is unable to move through a full range of motion against gravity. What is the appropriate muscle grade?
Grade 2 - If a muscle is unable to move through the full ROM against gravity than it must be lower than a 3.
ulnar compression at wrist, positive tinel's sign, symptoms on ulnar side conservative: neutral wrist splint, work mod post-op: edema, AROM, gliding, strengthen grip (2-4 wks), sensory re-ed
Guyon's canal
What is the primary therapeutic treatment to normalize movement in a patient when using NDT? Verbal feedback Handling Diagonal patterns seated therapeutic exercise
Handling
A client has been referred to occupational therapy for a wheeled mobility assessment. The client has a standard wheelchair (K0001), which he can propel, but wants the OTR®-COTA® team to recommend a power wheelchair so that he can visit around the neighborhood with greater ease. His wife states that she is able to push him in the neighborhood if he needs help, but he tells the OTR®-COTA® team that he needs to get out of the house alone. Why is the client ineligible for a Certificate of Medical Necessary for a power wheelchair?
He is able to propel a standard wheelchair.
Huntington's disease (HD)
Hereditary neurological disorder that leads to severe physical and mental disabilities; causes progressive loss of nerve cells in the brain over time, affecting movement, cognition, emotions, and behavior
Which type of amputation includes the entire leg up through the femur?
Hip Disarticulation
A patient has hemiplegia secondary to having a recent CVA. The patient is nearing discharge from an inpatient rehabilitation facility to live at home with a spouse. What is MOST IMPORTANT to educate the patient and spouse about prior to discharge from the facility?
Home modifications needed to maximize mobility and safety - The client may have physical and cognitive deficits that remain at discharge; identifying environmental home modifications to improve safety at home is an important component of the discharge plan.
What modality transfers heat through conduction?
Hot packs, whirlpools, and paraffin
What concept presides during the associated stage of learning?
How best to perform a new skill
Canadian Model of Human Occupation (CMOP)
Human spirit is the central organizing structure of the person. Physical, cognitive, and affective factors also are found within the person in the CMOP.
Rapid Pace Walk
In this timed clinical test, clients are instructed to walk 10 feet up and 10 feet back as fast as they feel safe and comfortable. This test is used as a measure for postural instability and gait disturbance.
Which of the following symptoms is a COTA® likely to observe in a client in a hospital setting during the plateau phase of Guillain-Barré syndrome?
Inability to communicate vocally Because of paralysis of muscles in the head and neck, spoken communication is often impaired in the plateau phase of Guillain-Barré syndrome.
Compensatory Strategies while driving: Neglect
Increase insight into and impact of neglect on driving; if unable to adequately compensate, client will need to refrain from driving.
Which of the following is a function of the parasympathetic division of the autonomic nervous system? Decrease flow of saliva Increase blood pressure Increases peristalsis elevates heart rate
Increases peristalsis
Allen Cognitive Level 5
Independent learning/Exploratory --> self control/inclusive reasoning stitches: imitates 'simple cordovan stitch' using trial and error X 3 stitches Alters actions with overt trial and error; poor organization, planning, and socialization Tx: Concrete tasks; NEW LEARNING AND GENERALIZATION
a written document detailing the student's academic needs and functional goals in that setting
Individualized education program (IEP)
makes available a free appropriate public education to eligible children with disabilities throughout the [United States]
Individuals With Disabilities Education Act (IDEA)
Air fluidized beds are indicated for
Individuals who are experiencing full thickness ulcers that do not heal.
STORCH infections
Infections transmitted from mother to child syphilis, toxoplasmosis, other, rubella, cytomegalovirus, herpes
(Grasp - tiny objects) 9 Months
Inferior pincer grasp A small object is held between the ventral surfaces of the thumb and index finger. This is when you begin to see the thumb moving from adduction to opposition
(Grasp - tiny objects) 7 Months
Inferior scissors grasp Tiny objects are brought into the palm with flexed fingers in a raking motion
A COTA® is educating a client about what to expect in the process of wound healing after surgery. What are the expected phases of wound healing in the order they occur?
Inflammation, proliferation, and remodeling
which approach to treating cognitive-perceptual deficits focuses primarily on providing extrinsic verbal cues during task performance?
Information processing Approach
Regarding lateral and medial epicondylitis, what is the specific location of the injury?
Injury at the tendon origin due to repetitive use
Compensatory Strategies while driving: Sensation (e.g., proprioception)
Install hand controls. A left foot accelerator with right accelerator guard is occasionally recommended but requires extensive retraining for establishing a new motor plan.
Compensatory Strategies while driving: Flexibility
Install swivel seats, use a transfer device, or install an eight-way adjustable seat.
A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft taken from the thigh was placed on the mid-forearm 3 days postinjury. When all the wounds are closed and the graft is stable, what is the BEST intervention to prevent hypertrophic scar development?
Jobst or other custom made pressure sleeve with inserts - When most of the wounds are closed, a Jobst or other pressure garment is the best choice to prevent hypertrophic scarring. Adding inserts increases the effectiveness of compression therapy.
A client provides a gift to every person in the department, including the COTA® who worked with the client. This gift is consistent with cultural practices of the client and is valued at less than $5.00. Which ethical principle BEST helps determine whether it is appropriate for the COTA to accept the gift?
Justice
OT Code of Ethics - Which principle involves providing equal care throughout assessments and intervention regardless of the person, and maintaining compliance and accountability in regard to documentation and OT related legislation
Justice
The pencil rests against the radial side of the ring finger, and the pads of the fingers control the movement; the thumb is not opposed to the index finger and rests on the distal interphalangeal joint.
Lateral quadrupod
The pencil rests against the radial side of the middle finger, and the pads of the fingers control the movement; the thumb is not opposed to the index finger and rests on the distal interphalangeal joint.
Lateral tripod
Stiffness and immobilty in an affected arm during attempts at PROM is called
Lead pipe regidity
Compensatory Strategies while driving: Stereopsis or depth perception
Learn to use environmental cues (e.g., stop lines or the tires of the car ahead), expand the following distance behind other vehicles, and limit driving in low-light conditions if experiencing difficulty or severe impairment.
Legibility components of handwriring
Letter formation alignment spacing sizing slant word legibility formula: total # of readable words divided by total # of words written
Which Rancho level is the most dangerous?
Level IV
Visual Acuity can be Assessed as Follows
Lighthouse Near Visual Acuity Test Snellen E chart or the Tumbling E chart for distance visual acuity
Compensatory Strategies while driving: Attention: sustained, selective, alternative, or divided
Limit driving to familiar areas and to roads with reduced speeds, and avoid peak traffic hours or complicated intersections.
Compensatory Strategies while driving: Visual information processing speed
Limit driving to familiar areas and to roads with reduced speeds, and avoid peak traffic hours or complicated intersections. Driving is not appropriate if skill is significantly impaired.
Compensatory Strategies while driving: Memory
Limit driving to familiar areas, drive in the daytime, and use a navigational system. Notify designated contact about expected destination, route, and anticipated time of return prior to driving.
Compensatory Strategies while driving: Information processing
Limit driving to familiar areas, drive in the daytime, avoid peak times or complicated intersections, and minimize distractions and conversations.
The extent to which a community fulfills six core principles: (1) provides affordable, appropriate, and accessible housing; (2) provides accessible, affordable, reliable, and safe transportation; (3) adjusts the physical environment for inclusiveness and accessibility; (4) provides work, volunteer, and educational opportunities; (5) ensures access to key health and support services; and (6) encourages participation in civic, cultural, social, and recreational activities.
Livability
Ranchos Level III
Localized response: Total Assist - W/D or vocalization to pain - Turns toward or away from auditory stimuli - Blinks when strong light crosses visual field - Follows moving object w/in visual field - Responds to discomfort by pulling tubes/restraints - Responds inconsistently to simple commands - May respond to some persons (family, friends) but not others
Chronic bronchitis
Long-term inflammation of the bronchioles with dyspnea
An OTR® is evaluating a child with Down syndrome for dressing ability. The child requires adaptions to perform the task successfully. Which adaptation might the OTR recommend to help the child learn how to don socks independently?
Loops sewn in socks - Loops sewn in socks would be appropriate for a child with Down syndrome to compensate for decreased fine motor skills.
________________________ and _________ can help older adults to reduce osteoporosis.
Low impact weight bearing exercises and education.
At which spinal cord injury level will a patient be able to be independent in all self-care after instruction by the OT team? C2 T6 C5 C7
T6
Part of the Military Health System and provides "coverage for active-duty service members, retirees, their families, survivors, and certain former spouses"
TRICARE
According to the taxonomy of groups described by Anne Mosey, which type of group uses task performance to improve an individual's awareness of emotion, needs, and ideals?
Task-oriented group
Which lobe is responsible for auditory function?
Temporal Lobe
lateral epicondylitis
Tennis elbow, caused by repetitive wrist extension
What type of splint is indicated for a C6-C7 spinal cord injury?
Tenodesis splint At this level a person can use wrist extension or grasp an item.
An 85-year-old client cannot access fixed-route transit and has chosen to use a supplemental transportation program operated by volunteer drivers. What characteristics of such a program might make it more appealing to this client?
The "Five As": Availability, accessibility, acceptability, affordability, and adaptability
used to assess central visual fields
The Amsler grid
the most widely used disability measure in rehabilitation medicine and captures many basic disability areas.
The FIM
An OTR®; is working with a child diagnosed with anxiety disorder. The child exhibits an increased sense of fear and anxiety during novel situations that significantly impedes participation in many school activities. The OTR decides to use a cognitive reframing approach to intervention. Which intervention applies the cognitive reframing approach?
The OTR facilitates the child to talk about and rate his or her fears.
Person-Environment-Occupation-Performance (PEOP) Model
The PEOP Model emphasizes the essential interaction among the person; performance of a desired, meaningful occupation; and the context in which the person engages in the occupation.
scaffolding
The practitioner helps the client by doing parts of the task that are too hard, but then has the client do the rest, so that the task may be completed
What would be considered the first line of treatment in the acute setting for the medical management of a cardiovascular accident (CVA)?
Thrombolytic agents Thrombolytic agents are the first line of treatment in the acute management of CVA to dissolve the clot that is blocking the flow of blood through its vessel.
A client with spinal cord injury has been on bedrest for several days. The COTA® is preparing to begin mobility activities with the client. What device is best to use for mobilizing the client?
Tilt-in-space wheelchair - Orthostatic hypotension often occurs with deconditioning from bed rest, and a tilt-in-space wheelchair allows the client to be reclined quickly if the client's blood pressure drops too low in sitting.
Completion of screening after the client has received an offer of employment that is contingent on passing the screening
Timing for work tolerance screening
The opponens digiti minimi is innervated by the ________ nerve.
Ulnar nerve - controls opposition of the 5th finger
A COTA® is working with a client presenting with a claw hand deformity who has both decreased grip and lateral pinch strength. Before reading the medical notes, what type of injury would the COTA® suspect?
Ulnar nerve injury
What modality transfers heat via conversion
Ultrasound
Any accommodation that would be unduly costly, extensive, substantial, or disruptive or that would alter the nature of the operation of the business
Undue hardship (ADA definition)
Guidelines from the Equal Employment Opportunity Commission (EEOC) to ensure that fair employee selection processes; they apply to new employees, workers returning to work after an injury or illness, and workers with disabilities
Uniform Guidelines on Employee Selection Procedures
During a journal reading activity led by the COTA®, a client becomes very emotional when disclosing sensitive personal feelings on how the client's family perceives the client's admission to the mental health facility. Several other clients recognize that they share the same feelings and perceptions, which makes the client feel better. According to Yalom's therapeutic factors in groups, what curative factor is this?
Universality
What concept presides during the cognitive stage of learning?
What is the desired skill
When to administer oxygen
When O2 sat drops below 90%
Work conditioning/work hardening
Work hardening is an outcomes-focused, individualized, interdisciplinary program that addresses the medical, physical, psychological, behavioral, functional, and vocational components of employability and return to work. Work hardening relies heavily on actual task replication.
Transverse hemimelia
amputation of a limb segment across the central area; it is common for bilateral or hemilateral presentations
isometric exercise
an exercise in which muscles contract but very little body movement takes place
Symes amputation
ankle disarticulation
Cluster B
antisocial, borderline, histrionic, narcissistic
Myelomeningocele
birth defect caused when the backbone and spinal canal do not close before birth
Conditional reasoning
blending of all forms of reasoning to flexibly respond to changing conditions and predicting client futures
When the left side of the heart fails
blood flows back into the lungs, causing difficulty breathing, anxiety, and cerebral hypoxia.
intrauterine fracture
bone is broken in utero
Marginal ambulatory user
can walk short distances; may need a wheelchair on occasion, especially outdoors; can benefit from intermittent use of a power mobility device such as a scooter
Functional capacity evaluation
capabilities for demands of specific job
Primary progressive
deterioration from beginning
Rett's Syndrome symptoms
deterioration of language (6 mth-1 yr level), stereotypical nonpurposeful hand movements (skin integrity compromised), hypotonic muscle tone progresses to spastic & rigid, muscle waste & scoliosis, irregular breathing patterns, seizures
Fitness-to-Drive Screening Measure
developed for caregivers to rate the driving ability of the person for whom they care.
Warren's model for assessment
developmental framework for intervention that consists of a hierarchical model, with each skill building on the preceding skill.
absence seizure
form of seizure consisting of momentary clouding of consciousness and loss of awareness of surroundings lasts around 30 seconds and may be mistaken for day dreaming
Explicit norms
formally communicated rules that govern behavior of group members
Kyphosis = ________ slide in w/c
forward
Spondylolisthesis
forward slipping of one vertebra over another
comminuted fracture
fracture in which the bone is splintered or crushed
Wedge cushion (antithrust seats)
front higher than back to aid in preventing forward sliding
Thumb abduction splint to prevent thumb adduction contracture
functional C
Wrist extension splint to prevent wrist drop
functional splint with 45 degrees of wrist extension worn during the day
tonic-clonic seizure
generalized seizure in which the patient loses consciousness and has jerking movements of paired muscle groups
Children seeking proprioceptive input may try to..
get their needs met by engaging in roughhousing and other activities that provide them with deep-pressure input
Medial epicondylitis
golfer's elbow Caused by repetitive wrist flexion
hierarchy of functional return
gradation from gross to fine motor, from less to more resistive, from skill to speed focused, and from simple to complex
Syringomyelia
growth of a cyst in the spinal cord
Histoid neoplasm
growth resembles the tissue around it
Performance patterns
habits, routines, roles, rituals
Work readiness program
help individuals who want to work identify vocational options that match their interests, skill, and abilities.
neoprene thumb loop splint
helps reduce spasticity and enables an optimal position to pick up and hold toys.
Kawa Model
how culture has an impact on mental health intervention. Cultural safety is a key component of the model; healing must come from within a safe cultural context; groups engage participants in activities to help them more effective participate in the groups in their lives and deal with the rocks and sticks in the river, which represent the challenges they face and interfere with the flow of their life; looks at the past, present, and future, KAWA = river in japanese
Prepositioning training
identification of the optimal position of each positioning unit (e.g., wrist, elbow) to perform an activity or grasp an object
Handwriting readiness: 2 years
imitates horizontal, vertical , circular marks
presbyopia
impairment of near objects is poor
Akinesia
inability to initiate movement
Dysdiadochokinesia
inability to perform rapid alternating movements
Agraphia
inability to write in a familiar language
Low technology
includes inexpensive items that are readily available commercially (e.g., jar opener, sock aids, reacher).
Malingering
is the deliberate or conscious faking of symptoms and disability in order to achieve personal gain through avoiding work or responsibility.
Totally or severely mobility-impaired user
is unable to self-propel a manual wheelchair; is dependent on a power chair or attendant
Social competence
knowledge of skills in sociolinguistic (e.g., turn taking, initiating a conversation) and sociorelational (i.e., understanding the interaction between people in conversation) areas
Ataxia
lack of muscle coordination
Red flags associated with a TBI
loss of consciousness, lethargy, confusion, severe headache, nausea, vomiting, and speech or motor impairment.
Akinetic seizures
loss of muscle tone for more than 30 minutes
Dynamic splinting
may involve metal and loop components; angle of pull needs to be 90 degrees for most effective outcome
Assessment of Readiness for Mobility Transitions (ARMT)
means of assessing the readiness of older adults to make transitions regarding their mobility, such as driving cessation. Understanding how a client perceives transitions in community mobility allows the practitioner to use the most appropriate approach to address these changes
Ishihara Color Test
measure of color perception tests for red or green color deficiencies
Symbol Digit Modalities Test
measures divided attention
Wechsler Digit Symbol test
measures visual perception, motor and mental speed, and visual-motor coordination
Goal of home assessment
modification of the environment, context, and activity demands to support client's safe and independent occupational performance at home
Akathisia
motor restlessness The person needs to be in constant motion (rocking, marching or other types of movement) Making them do FINE motor tasks can be very difficult for them. Gross motor activities and having them move around as much or as little as they want is effective.
Performance skills
motor skills, process skills, social interaction skills
isotonic exercise
movement in which muscles shorten (contract) and move
Convergence
muscle action of the eyes that moves them inward
Neoplasty
surgical procedure to remove the growth and reform or restore the body parts that were affected
arthroplasty
surgical repair of a joint
linguistic competence
thorough understanding of the AAC device's symbol system and rules of organization
Clarifying
to clear up any confusion by summarizing what the client has said in clear, concise statements
Restating or paraphrasing what the client says
to confirm the accuracy of what the practitioner understood
Reflecting
to confirm the implied feelings in what the client has communicated
Erb-Duchenne palsy
trauma to superior trunk of brachial plexus Waiter's Tip
Altruism
unselfish regard for the welfare of others
Implicit norms
unspoken, unwritten standards of behavior for a group of people
Serial casting
use of fiberglass or plaster of paris materials to position clients with increased tone and over time to stretch out soft tissue contractures
Diagnostic reasoning
use of investigative reasoning and analysis of the cause and nature of conditions
Interactive reasoning
used during the face-to-face experience with the client to get the client's perspective on the illness, injury, or disability and to involve the client in the goal making for the intervention plan.
psychodynamic theory
used primarily in contemporary mental health interventions and within occupational therapy as a mechanism for improving self-identity and interpersonal relationships.
Narrative reasoning
used to make sense of people's particular circumstances
Client factors
values, beliefs, spirituality, body functions, body structures
Ayres Sensory Integration
vestibular, tactile, proprioceptive are emphasized
Supplemental transportation
volunteer, nonprofit, or community-based transportation options serving older adults and people with disabilities who either are unable to use existing transportation services or desire more flexible travel options
Turner's syndrome
webbing of the neck, congenital edema of the extremities, and cardiac problems.
Justice, again
Promote fairness and objectivity in the deliverance of OT services
A client arrives at the occupational therapy clinic 10 minutes late for a session crying uncontrollably. When the COTA® attempts to engage the client in conversation, the client responds, "I don't want to talk about it. Is that so bad?" Which response would be MOST effective?
"It must be very difficult." "It must be very difficult" acknowledges the client's feelings without being judgmental and lets the client know that the COTA sees that client is upset.
Kawa metaphor
"Our life flow is like a flowing river, and many times the flow of life becomes obstructed. The goal of occupational therapy is to enhance and facilitate life flow."
The four essential components of a comprehensive behavioral support plan are...
(1) a functional assessment of behavior, (2) use of multiple interventions, (3) application of the plan throughout the day, and (4) elements that reflect the values and resources of the child and the person providing support.
Steps in developing a professional development plan
(1) reflect on current performance to date and determine learning needs on the basis of the self-assessment results; (2) review progress toward previous professional development goals; (3) ascertain what resources exist to meet identified professional development goals; (4) modify previous professional development goals and set new ones; (5) take action to meet professional development goals; and (6) document completed professional development activities.
Claudia: Cognitive Level 5—exploratory actions
- Caregiver standby or supervision is needed for cognitive assist. - Client learns through visible, concrete, and meaningful stimuli. - External cueing can be used.
Claudia: Cognitive Level 2—postural actions
- Client requires maximum cognitive assistance. - Client's thinking is highly disorganized. - Attention involves internal cues. - Motor actions are one step, imitated, near reflexive, and familiar, and they involve gross motor patterns. - ADLs can be accomplished by imitating the caregiver (e.g., washing the face).
Claudia: Cognitive Level 4—goal-directed activity
- Client requires minimum cognitive assist. Attention is directed to visual and tactile cues. - Client is able to understand cause and effect. - Client can no longer problem solve. - Client can follow two- or three-step activities. - Activities should be simple, concrete, and supportive of desired social roles. - Labels and pictures can be used as reminders. - Task setup for bathing and grooming is required. - Client can eat independently, but supervision is needed on amount of food eaten. - Client needs protection against safety hazards and wandering. - Client needs 24-hour supervision.
Claudia: Cognitive Level 3—manual actions
- Client requires moderate cognitive assistance. - Attention should be directed to tactile cues (e.g., familiar objects; Lewis, 2003, p. 134). - Goals are not related to outcomes. - Motor actions are limited to one-step, familiar, and action-oriented activities. - Client cannot learn new behaviors.
Claudia: Cognitive Level 1—automatic actions
- Client requires total cognitive assistance. - Attention is limited to subliminal internal cues. - Motor actions are in response to one-word, near-reflexive directions (e.g., "sip"). - Client needs monitoring to ensure adequate nutrition. - Client needs assistance with ambulation and transfers. - Client needs passive, active, or assistive ROM for prevention of bed sores, osteoporosis, infections, and contractures.
Group Design Includes
- Needs Assessment, - Choice of a Model or Frame of Reference - Development of a Group Protocol
Ranchos level I
- No response (sounds, hearing, touch, pain) - Requires total assistance
TBI may affect motor function in the following ways.
- Paresis or paralysis of one side of the body, depending on the location of the brain injury (common) - Spasticity - Ataxia or decreased coordination - Dysphagia or difficulty swallowing - Vision and hearing changes (including loss, in some cases)
Reynaud's Disease
-a disorder of blood vessels supplying the skin -most often affects the skin in the fingers/toes in young women - Cryotherapy is contraindicated because Reynaud's is exacerbated by cold temps
atlantoaxial instability (AAI)
-common with down syndrome -can lead to dislocation, SCI, neurological problems -should not hyperflex neck or do front rolls
rational intervention (RI)
-zones for behavior: green, yellow, red -matching, facilitation, monitoring, gentle correction (reminding, altering environment), moderate correction (giving child a break, redirection), strong correction (time out, physical mgmt)
Elbow Flexion ROM
0-150
Shoulder Abduction ROM
0-180
Shoulder Flexion ROM
0-180
Cervical Extension ROM
0-45
Cervical Flexion ROM
0-45
Cervical Lateral Flexion ROM
0-45
Shoulder Extension ROM
0-60
Shoulder Internal rotation ROM
0-70
Shoulder internal rotation ROM while abducted
0-70
Forearm pronation/supination ROM
0-80
Shoulder External rotation ROM
0-90
Shoulder external ROM when tested against gravity
0-90
Shoulder external rotation while abducted
0-90
When testing shoulder external rotation, what is the typical expected ROM? 0-60 0-70 0-170 0-90
0-90
Name 2 sternal precautions following cardiac surgery
1. No reaching overhead 2. No stretching pec muscles
Reddened areas that last more than ____________ are indicative of pressure in the prosthetic device that will eventually cause skin breakdown.
20 Minutes
What is the recommended wearing schedule for compression garments to manage hypertrophic scarring?
24 hrs a day for 1-2 years.
What age can a child be expected to don shoes and socks? 5 4 3 2
3 years
At what age should it be expected that a3 child can cut along a line and also cut out a triangle?
3-4 yrs
Maximum rise for any run
30 inches
At what age can a child be expected to donn shoes and socks correctly and consistently?
4 Yrs
What is the appropriate work bench height for doing heavy work when standing?
4-6 inches below the elbow
What is the farthest a person can typically reach if they are seated in a wheelchair and nothing is blocking them?
48 Inches, 46 if something is blocking them.
Cognitive Linguistic Quick Test
5 cognitive domains (attention, memory, executive function, language, visuospatial fields) for adults with neurological impairment
At what age can a child be expected to sit with arms propped forward?
5-6 months
When should a patient begin strength training following a surgical rotator cuff repair?
6 weeks post op return to work 8-12 weeks
Able to bear weight through both lower extremities; also begins to transition from sitting to kneeling.
7 Months
At what age can a child be expected to sit unsupported?
8 months
An OTR® supervises a COTA® who works with a group of adults who are continuing their recovery from alcohol and drug addiction by living in a halfway house. The OTR® suggests that the COTA® become familiar with a particular group intervention in working with these clients. What type of intervention would the OTR® MOST likely suggest?
A 12step self-help group Most substance abuse programs include one or more self-help groups that use a classic 12step process. Most substance abusers seek help through self-help groups. Occupational therapy practitioners working with this population are likely to become involved in facilitating or supporting these groups.
Active terminal device
A body-powered, externally powered (through electrical connection or electromyographic [EMG] signals), or hybrid-powered hook or realistic-looking hand that assists with functional activities
Intentional Relationship Model
A conceptual practice model that thoroughly explains the relationship between the practitioner and the client
strain
A condition resulting from damaging a muscle or tendon
An occupational therapy group for adults who are working on regaining occupational engagement 1 year post stroke is designed to include sessions on community mobility and to address participants' stated concerns regarding use of assistive devices in public places. Which activity would BEST address these goals?
A field trip to the mall involving public transportation and practice using assistive devices best combines the goals for community mobility and use of assistive devices in public places.
Which type of chair is MOST appropriate for a client with hip replacement?
A firm-based chair with armrests - A firm-based chair with armrests is recommended for clients with hip replacement; chairs with cushions or rocking functions may negatively affect hip precautions because of variability in surface.
A client who uses an ultra lightweight wheelchair asks whether the chair can accommodate a wraparound lapboard. The COTA® is not familiar with this type of lapboard. Who on the rehabilitation team would be the BEST person for the COTA® to consult to obtain this information?
A medical equipment supplier
Clinical pathway
A method of outlining a patient's path of treatment for a specific diagnosis, procedure, or symptom
A COTA® is working in an inpatient psychiatric setting where the average length of stay is 5 days. Which group activity would be MOST appropriate for patients with depression?
A parallel group in which each participant completes his or her own solid-color ceramic tile trivet Simple and concrete activities are most appropriate for clients hospitalized with depression. For the trivet activity, the solid color removes the need to make decisions about color and pattern, the trivet provides clear physical boundaries, and gluing the tile onto the backing is simple and concrete. Participation in a parallel group minimizes the need for social interaction but allows physical proximity to others.
What is the correct CPR sequence for a neonate?
ABC - Airway, breathing, compressions
early stage of dementia
ADLs remain intact, memory loss impairs IADLs, may be disoriented traveling away from home, work performance impaired, driving eval needed
During Type 1 (traumatic stage) CRPS, treatment should focus on management of pain and edema along with ____?
AROM
What is an appropriate intervention for an immobilized ulnar fracture?
AROM distal and proximal to the immobilized injury
used to determine baseline sensory and motor control performance for clients with spinal cord injury.
ASIA Scale
Cerebral arteriovenous malformation
Abnormal, tangled collections of dilated blood vessels that result from congenitally malformed vascular structures Congenitally = presented at birth
Just right challenge
Activities that are neither too difficult nor too easy for child to complete
Children with typical CNSs will seek out the sensory input that they need to organize themselves and to help them achieve their goals.
Adaptive response
Compensatory Strategies while driving: Pain
Add auxiliary or larger mirrors, and ensure proper adjustment of mirrors; backup cameras can assist with neck pain or reduced neck flexibility.
Assessment of driving-related skills
Addresses domains required for driver fitness: vision, cognition, and motor function
Which contracture can occur following a burn to the axilla? Adduction Abduction Flexion External rotation
Adduction
New onset of disability What phase is characterized by being the final stage and involves the individual accepting the changes and developing a positive outlook on how to return to necessary and desired roles and activities?
Adjustment
If an OTA is able to elicit a babinski sign in an adult male patient, it is indicative of?
An Upper motor neuron lesion
A COTA® is using Fidler's task-oriented group as a context for treatment to help participants explore healthy ways to deal with conflict. Which of the following activities would be BEST for this group?
An activity that is challenging and likely to cause tension among members A task-oriented group presents opportunities for participants to practice situations they may encounter in daily life. A group environment in which conflicts are likely to occur can help participants practice resolving conflict in appropriate ways.
Which high school extracurricular activity would a youth with oppositional defiant disorder be MOST likely to succeed at?
An art program with well-established boundaries in which students are encouraged to pursue their own interests - The art program has the fewest rules, the greatest degree of individual choice, and the potential for the least amount of authority or adult direction.
Establish, restore
An intervention approach designed to change client variables to establish a skill or ability that has not yet developed or to restore a skill or ability that has been impaired focus on the child's skills and abilities; the therapist establishes skills
Primary Prevention
An intervention to at-risk individuals or groups prior to an adverse event. ex. skin checks and foot care to a patient who just recently received a diabetes diagnosis.
What is it called when a person doesn't realize they have a significant motor impairment?
Anosognosia
During an occupational therapy intervention session, which approach would pose the biggest barrier to engaging in a client-centered process with an adult client who is able to converse?
Asking too many closed-ended questions Questions that have a simple yesno or single-word answer do not capture the essence of an individual client as an occupational being. Although closed-ended questions might be helpful in filling out an assessment tool with single-word answers, they prevent the client from conveying his or her perspective, which is the core of client-centered practice.
hich is the most common type of shoulder dislocation?
Anterior Dislocation
Which hand deformity is characteristic of an atrophied thenar eminence and inability to abduct the thumb?
Ape hand deformity
Shaping
Approximations of a desired behavior are reinforced or rewarded to facilitate the acquisition of the behavior.
How does the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; AOTA, 2008) define community mobility?
As moving around in the community or using public or private transportation, such as driving, walking, bicycling, and using buses, taxicabs, or other transportation systems
Finger-to-Nose Test
Ask the person to close their eyes and to stretch out the arms. Then ask person to touch the tip of their nose with each index finger, alternating hands and increasing speed.
toe movement elicited by manipulation in a neurologic test performed on the sole of the foot to indicate injury to the brain or spinal nerves
Babinski sign
A COTA® is working with a child in a treatment session focused on using constraint-induced movement therapy within the context of an art project. Why does the COTA® anticipate that this treatment will be effective?
Because the COTA® is forcing the child to use the affected extremity
An 18-year-old client is admitted to an inpatient psychiatric hospital. The psychiatrist describes an uninterrupted 18-month period of illness that includes visual and auditory hallucinations. What type of issues would the COTA® expect to see when the client attempts to do a task?
Behavioral outbursts when frustrated with a project During task performance, clients with symptoms of schizophrenia can show elevated levels of frustration during challenging tasks.
OT Code of Ethics: What principle involves ensuring you are qualified to provide treatment?
Beneficence
Occupational therapy personnel shall terminate occupational therapy services in collaboration with the service recipient is what principle of Ethics?
Beneficence
Which type of "A Fiber" send sensory information related to light and deep touch?
Beta
An occupational therapist is instructing a patient with a spinal cord injury in adaptations for bathing independence. At what level of spinal cord injury is a patient able to be independent in bathing with use of a handheld showerhead and a tub bench? C4 C7 C6 C5
C7
provides health care to 9.4 million children in low-income families with incomes too high to qualify for Medicaid
CHIP (Childrens Health Insurance Program)
Driving Habits Questionnaire
Captures information about avoidance behaviors that are often identified as compensatory strategies in older drivers
A client with advanced amyotrophic lateral sclerosis (ALS) presents with a stiff forward-flexed neck that is at risk for developing a contracture and impairing social participation. Which intervention would the COTA® use to BEST prevent a contracture?
Caregiver training on gentle neck stretching and how to help the client don a soft cervical collar
Which peripheral nerve injury can result in sensory changes in the 1st-4th digits?
Carpal tunnel syndrome
Difficulty tolerating glare from lights is characteristic of _________
Cataracts
Macula
Central portion of the eye that is responsible for providing the fine detail required for near-distance activities, including reading
Associative phase of handwriting
Child begins self monitor, visual cues are essential
cognitive phase of handwriting acquisition
Child understands the demands of handwriting
A COTA is facilitating a group therapy session focused on social skills training that comprises five children with autism spectrum disorders. The facility uses the Self-Determination Model for group therapy sessions. Which approach applies this model?
Children are facilitated to make choices, indicate their own activity preferences, and problem solve during therapy sessions.
hyporesponsivity
Children demonstrate a pattern that looks as though they fail to orient to stimuli.
hyperresponsivity
Children demonstrate a pattern that looks as though they overorient to stimuli.
Which condition is characterized by quick spastic movements?
Chorea
A COTA® is working with 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?
Chronic bronchitis A client with chronic bronchitis will have poor oxygenation, resulting in a bluish tinge to the skin and lips, along with edema.
Which type of splint is indicated for spasticity?
Cone Splint
_______________, in which the practitioner identifies the client's behavior in an effort to help the client self-manage his or her behavior, is an appropriate interpersonal strategy when dealing with clients with mental illness. _________________ may include limit setting.
Confrontation
Which tool should the COTA® use to assess peripheral visual fields in a client with low vision?
Confrontation testing
Level 4-6 common theme
Confused (not much learning)
Ranchos Level VI
Confused, Appropriate: Mod Assist - Inconsistently oriented to person, place, time - Able to attend to highly familiar tasks in a non-distracting environment for 30 min with Mod redirection - Vague recognition of staff - Uses memory aide with Max Assist - Emerging awareness of appropriate response to self, family, basic needs - Mod assist to problem solve - Supervised for old learning - Shows carryover for relearned familiar tasks (self-care) - Max assist for new learning with little or no carryover - Unaware of impairments, disabilities, safety risks - Consistently follows simple directions - Verbal expressions appropriate in highly familiar and structured situations
Ranchos Level V
Confused, Inappropriate, Non-Agitated: Max Assist - Alert, may wander randomly or with vague intent of going home - Not orientated to person, place, or time - Unable to learn new information - Frequent brief non-purposeful sustained attention - Requires structure and cues for performing simple commands (no structure/cues = random, non-purposeful), conversing (no structure/cues = inappropriate and confabulatory), performing previously learned tasks (no structure/cues = inappropriate use of objects)
Ranchos Level IV
Confused/Agitated: Max Assist - Alert and in heightened state of activity - Purposeful attempts to remove restraints or crawl out of bed - May perform motor activities but w/o purpose - Aggressive/Flight behavior - Mood swing with no apparent relationship to environment - Unable to do self-care - Unaware of present events - Reacts to own inner confusion, fear, disorientation - Brief non-purposeful sustained, alternate, divided attention - Absent STM
A client with Parkinson's disease is experiencing bradykinesia and reports decreased ability to move from sitting to standing. What strategy should the COTA® recommend?
Consistent use of a short self-cue, such as "rise," each time the client needs to stand Teaching self-cuing is useful in helping clients initiate movement to minimize the effects of bradykinesia.
Documents the occupational therapy practitioner's contact with a client; interventions used during the session; client's response to the intervention; instruction, training, and education given; and telephone calls or meetings that relate to the client (AOTA, 2018b).
Contact Note
Developmental Groups: The group involves participants working together and focus on building comradery and interaction
Cooperative group
In regard to fiscal management of a therapy department, which term describes money for therapy services that is still unpaid to the facility?
Correct answer: Accounts receivable Accounts receivable describes money that has yet to be paid to a facility for services completed.
When assessing spasticity in a patient, which score is appropriate for an individual whose tone restricts any movement according to the Modified Ashworth Scale? 0 3 1 4
Correct answer: 4 According to the Modified Ashworth Scale, a score of 4 characterizes tone that is severe enough to restrict movement, as in a contracture. Tone is ranked on the scale according to its severity level, with a score of 4 being the highest and a score of 0 being the lowest (or normal muscle tone).
An OTA is assisting a patient in obtaining an appropriate ramp for the home. In order to successfully complete a 90-degree turn on a ramp with a wheelchair, what minimum size landing is required?
Correct answer: 4' x 4' landing If the ramp changes direction, a landing is required for turning space. A 4' x 4' landing is necessary to complete a full 90-degree turn in a wheelchair. A 4' x 8' landing is appropriate for a 180-degree turn. The other options are too small to complete a full turn in a wheelchair.
What grade of muscle grade is appropriate for a shoulder flexion that moves through the full range of motion and maintains the testing position throughout full force from the clinician?
Correct answer: 5 If a clinician can apply full force to the tested muscle, and the muscle can also move the limb through full range of motion, the appropriate grade is a 5.
Which of the following upper extremity conditions is a result of median nerve injury? De Quervain's Syndrome Dupuytren's Disease Skier's Thumb Ape Hand deformity
Correct answer: Ape hand deformity Ape hand deformity is characterized by IP flexion in the digits and atrophy of the thenar eminence and is caused by a median nerve injury.
Which hand deformity is caused by a median nerve injury that results in the patient's inability to perform second and third digit MP flexion?
Correct answer: Benediction sign The benediction sign is caused by a median nerve injury at a proximal origination. As a result, the patient is unable flex the 2nd and 3rd digits at the MP joint when attempting to make a fist.
Which hand deformity is caused by ulnar nerve injury and results in the inability to extend the IP joints in the 4th and 5th fingers?
Correct answer: Claw hand Claw hand is caused by an ulnar nerve injury and is characterized by the inability to extend the 4th and 5th digits at the PIP and DIP levels.
In regards to Margaret Rood's phases of motor control, which term describes a balance of opposing muscles movements? Co-contraction Reciprocal inhibition/innervation Heavy work skill
Correct answer: Co-contraction Co-contraction describes contraction of muscles with opposing movement patterns in order to maintain a steady position.
An occupational therapy assistant is working with an abuse recovery group. A vendor contacts the therapist offering to speak to the clients during an OT group session. What is the best response?
Correct answer: Decline the offer; an outside visitor would violate member confidentiality It is essential to maintain the confidentiality of all members of a group.
An OTA is treating a patient in a neurologic care center to improve her functional performance with self-care. The OTA is assessing neurologic symptoms during treatment. Which of the following symptoms is not indicative of an upper motor neuron lesion? Autonomic Dysreflexia Spasticity Clonus Diminished deep tendon reflexes
Correct answer: Diminished deep tendon reflexes Diminished deep tendon reflexes are a symptom of a lower motor neuron lesion.
Which approach to treating cognitive-perceptual deficits focuses on the transfer of therapeutically learned skills to real-life situations and environments? Neurofunctional Approach Dynamic Interactional Approach Info processing approach Compensatory/Adaptive/Functional Approach
Correct answer: Dynamic Interactional Approach The Dynamic Interactional Approach focuses on helping an individual transfer skills learned therapeutically into real-life situations and environments. Treatment design progressively alters and upgrades tasks until they become comparable to typical situations.
Which type of splint is appropriate for a brachial plexus injury?
Correct answer: Flail arm splint A flail arm splint is indicated for a brachial plexus injury and provides support for the affected arm from the shoulder down.
A person who has a low level of arousal will have improved attention in all of the following contexts except: In a loud room In a Warm room When provided something to touch When participating in physical activity
Correct answer: In a warm room A warm environment will promote relaxation and further impair arousal and attention.
Which two muscles of the rotator cuff are involved in shoulder external rotation?
Correct answer: Infraspinatus and teres minor Both the infraspinatus and the teres minor control shoulder external rotation. The subscapularis controls internal rotation. The supraspinatus controls abduction and flexion.
The occupational therapy assistant must educate a patient and assist in anti-contracture positioning after a burn. What position is most appropriate to reduce the likelihood of contracture after a burn to the anterior neck? Lie supine without pillow support Lie supine with two pillows to support the neck chin-to-chest position whatever position is most comfortable
Correct answer: Lie supine without pillow support After a burn to the anterior neck, a contracture can occur in neck flexion if proper positioning precautions are not taken. Lying supine without pillows provides for more next extension to prevent prolonged positioning in neck flexion.
A patient with Parkinson's disease is having difficulty with dyskinesia. What is this likely attributed to?
Correct answer: Medication side effects Medications used to treat Parkinson's disease come with associated side effects as the body's response to medication changes during the course of the disease. Dyskinesia can appear in response to the medication's growing inconsistency in managing symptoms.
Where should ultrasound never be used? Over a spain Over a growth plate Over tendonitis Over a wound
Correct answer: Over a growth plate Ultrasound is contraindicated over a growth plate, where new bones are growing.
What is an appropriate anti-contracture positioning for a patient who has a burn to the volar aspect of the hand?
Correct answer: Palm extension splint A palmar contracture can occur following a burn the volar aspect of the hand. To reduce the risk of contracture in the palm, a palmar extension splint is recommended to maintain positioning.
Which type of prevention intervention describes nursing staff developing a bed positioning rotation schedule for an individual who has developed a bedsore?
Correct answer: Tertiary prevention Tertiary prevention is addressing a health issue when it arises to reduce the consequences it will have on an individual. An example is developing a positioning rotation schedule and providing therapy services for bed mobility to an individual who shows development of a bedsore.
An occupational therapy assistant is teaching self-care to a person who has a C2-C3 level spinal cord injury. What is this patient's highest level of independence for bathing?
Correct answer: Totally dependent in all self-care tasks, but is able to instruct others in how to perform the tasks A patient with a spinal cord injury at levels C1-C4 is totally dependent in all self-care tasks. However, the patient should be educated on how best to direct others to perform their care. A patient with a spinal cord injury at level C5 requires moderate to minimal assistance with bathing. A patient with a spinal cord injury at level C6 requires minimal assistance using a handheld showerhead and a tub bench. Transfers are completed via a slide board. A patient with a spinal cord injury at level C7 is independent with bathing using a handheld showerhead and a tub bench. At this level, the patient can make an independent transfer onto the tub bench.
In an effort to ensure cost-effective health care, a third-party payer is attempting to determine if provided intervention was needed. This is called a:
Correct answer: Utilization review A utilization review assesses whether the intervention provided was actually needed. This type of review places strong emphasis on reviewing intervention to assist with managing the cost of health services provided.
The style of a specific task plays a major part in determining the ability to learn a motor skill. Which is an example of a continuous task?
Correct answer: Walking Continuous tasks are ongoing tasks that do not end until the performer decides the task is completed. General walking is an example of a task that is ongoing until the individual decides to finish walking.
Which is not a general intervention strategy for impaired alertness or arousal? Work on fine motor activities Increase environmental demands Work on gross motor skills Provide opportunities for sensory processing and stimulation.
Correct answer: Work on fine motor activities When treating an individual with impaired alertness or arousal, the therapist should aim to increase environmental demands that may be interesting to a patient;
The __________ intervention strategy of EHP is meant to be used at the population level rather than at the client level. Strategies and programming are applied in a larger contexts, not with individual clients.
Create
A COTA® is reading the occupational therapy intervention plan for a client with Stage IV amyotrophic lateral sclerosis (ALS). On what will the home environment goal MOST LIKELY focus?
Creating a safe and accessible living space Someone with Stage IV ALS is likely to have severe weakness in the lower extremities, causing an inability to ambulate. Working with a client and his or her family to create a safe, accessible living environment is the best option;
Type of clinical reasoning that uses investigative reasoning and analysis of the cause and nature of conditions
Diagnostic reasoning
Which describes the groups that determine the amount of payment a facility receives for health care services they provide to a specific individual?
Diagnostic related groups - based on a persons diagnosis
Gower's sign
Difficulty rising to standing position; has to walk up legs using hands; occurs in Muscular dystrophy Duchenne's muscular dystrophy
One of the most common types of sensory integrative dysfunction is...
Difficulty with tactile discrimination and perception
What type of grasp should be expected for a child who is 2-3 years of age?
Digital pronate grasp
Combines the worker's impairment and the impact of that impairment on the worker's ability to perform the preinjury job or any job
Disability rating
What type of task has a predictable starting and end point and are completed in their entirety.
Discrete tasks (answering a phone call)
A COTA® working in a skilled nursing facility is attending a weekly multidisciplinary meeting. The nurse reports that a resident not on the occupational therapy caseload is having increasing difficulty with balance. As a result, the resident's self-care activities are becoming unsafe. What should the COTA® do in this situation?
Discuss the resident's status with the OTR®, who can screen for needed services
A COTA® is preparing a forearm splint for a client with a high complete spinal cord injury. What surface of the client's forearm should the base of the splint rest upon?
Dorsal The splint should be dorsal, rather than volar to ensure maximal sensory feedback while the forearm is resting on a surface.
Which type of splint is indicated for a flexor tendon injury?
Dorsal protection splint
Which hand disorder is characterized by finger flexion contractures secondary to thickened fascia?
Dupuytren's disease
Which approach to treating cognitive perceptual deficits focuses on the transfer of therapeutically learned skills to real life situations and environments?
Dynamic Interactional Approach
What is the expected grasp of a writing tool for a child aged 5 years old?
Dynamic Tripod posture 4.5-6 years old
The pencil rests against the distal phalanx of the radial side of the ring finger, and the pads of the fingers control the movement; the thumb is opposed to the index finger.
Dynamic quadrupod
The pencil rests against the distal phalanx of the radial side of the middle finger, and the pads of the fingers control the movement; the thumb is opposed to the index finger.
Dynamic tripod
What is described as decreased accuracy when reaching toward an item, such as reaching to brush a dog and missing the neck, and hitting the nose?
Dysmetria
Compensatory Strategies while driving: Executive Functions
Education and training may improve ability to appropriately respond to situations
Developmental groups: A group that has individuals work together on larger tasks to encourage interaction between participants
Egocentric cooperative group
condition in which alveoli rupture or enlarge, lungs lose elasticity
Emphysema
A client who has undergone electroconvulsive therapy (ECT) in the early morning arrives for an evening occupational therapy task group in an inpatient psychiatric unit. What is the COTA®'s BEST choice for working with the client at this time?
Encourage the client to choose one of the available tasks to work on during the group. ECT is immediately followed by a short, required bed rest, especially if residual symptoms include headache, nausea, and dizziness; regular activities can then be resumed.
A COTA® is working with a child on toilet training. The child is 2½ years old and has an intellectual disability. Which of the following strategies is appropriate to include during intervention?
Encourage the use of a toileting schedule
What strategy might a COTA® appropriately recommend to caregivers of a client with Alzheimer's disease to assist with fall prevention?
Engage the client in daily, structured activity.
During a multidisciplinary continuing education course on sensory integrative dysfunction, a COTA® learns about a specific brushing protocol to reduce tactile defensiveness. The COTA® wants to use this protocol with several children currently on the caseload. What initial step MUST the COTA® take before this can be done?
Ensure the protocol is within the scope of practice for a COTA® - Interventions must be within the scope of practice to ensure that services remain within the domain of occupational therapy practice
According to the taxonomy of groups described by Anne Mosey, which type of group assesses a task and the social interaction abilities of potential participants?
Evaluation groups
For an individual who is wheelchair-bound, what is the recommended frequency of weight shifting to reduce the likelihood of skin breakdown?
Every 30 minutes for 30 seconds
process of sending a motor plan to the brain, comparing previous performance, and detecting potential errors in the plan before or after execution
Feed forward praxis
Workers at a meat processing plant are participating in a back injury prevention program. Which factor should be stressed as presenting a major ergonomic risk?
Forceful exertions Forceful exertions (e.g., heavy lifting, twisting through the spine) are an ergonomic risk factor.
Which type of amputation includes the entire arm as well as the clavicle and scapula? Elbow disarticulation Shoulder disarticulation Above-elbow amputation forequarter amputation
Forequarter amputation
An OTR® is evaluating a child with scoliosis for dressing ability. The child is wearing a spinal orthosis and requires adaptations to perform the task successfully. Which adaptation might the OTR recommend to help this client don a shirt independently?
Front-opening garment
Which classification of burn affects the nerve ending and is characterized as a "third degree burn"
Full thickness burn
Which burn appears as white, waxy, and leathery?
Full thickness burn (third degree burn)
Ape hand deformity
IP flexion in the digits and atrophy of the thenar eminence and is caused by a median nerve injury.
profound intellectual disability
IQ below 25; requires caregiver assistance for basic tasks; also generally has neuromuscular, orthopedic, or behavioral deficits
severe intellectual disability
IQ between 25 and 40; able to communicate and perform some basic ADLs and health habits; often requires support to complete routines
moderate intellectual disability
IQ between 40 and 55; able to learn academic skills to at least the second-grade level; able to perform unskilled as well as some skilled work tasks
mild intellectual disability
IQ between 55 and 70; able to learn academic skills at the third- to seventh-grade level; able to work with minimal support
Goal of occupational or activity analysis
Identification of the demands of occupations and activities on the client
What is the FIRST step in the process of designing a group protocol for clients with mental illness?
Identify a problem and the factors that will motivate the people in the group to change. Motivation to change is regarded as an initial step in developing a group protocol. It requires identification of a problem and interaction with potential group members to determine what will promote change.
A student in the second grade has mild cerebral palsy. During a session, the student tells the COTA® about wanting to play computer games, "like other kids." After consulting with the OTR® about this, what action should the COTA® take NEXT to determine if this is an appropriate activity to include as part of the student's school-based occupational therapy intervention?
Identify the impact of computer use on curriculum-based activities - Services provided in a school setting need to be educationally based activities that facilitate the child's ability to learn. The use of the computer in this situation must relate to a curriculum activity that meets the child's educational outcomes. If other students are playing computer games in the classroom to meet educational needs, then this would be an appropriate activity.
A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft taken from the thigh was placed on the mid-forearm 3 days postinjury. To minimize the risk of graft rejection in the initial phase (7 days postinjury), what strategy should the client be instructed to perform?
Immobilization using the elbow extension splint and avoiding forearm movement - During the initial phase postskin graft operation, it is important to maintain immobilization for 2-7 days or per the physician's specific instruction.
Percentage of whole-body function; focuses on the permanent quantifiable physical loss related to an injury when the worker is at the maximum medical endpoint and often determines a final monetary settlement for an injured worker
Impairment rating
What is the role of the Joint Commission?
Improving health care services
A client with multiple sclerosis (MS) states that fatigue is negatively affecting work performance. What is the BEST action for the COTA® to take next?
Instruct the client to complete a journal identifying energy levels for tasks in preparation for collaborative COTA® and OTR® treatment planning. Further evaluation is needed to determine appropriate interventions; this approach goes beyond typical energy conservation education and involves the COTA® and OTR® working with the client to identify the specific work tasks that cause fatigue. Work tasks must be identified before determining work demands.
A COTA® is instructing a client post-hip surgery on after-toileting cleansing while adhering to appropriate hip precautions. What method is the BEST to prevent further injury?
Instruct the client to wipe between the legs while seated on an elevated toilet seat. All hip replacement clients should wipe between their legs in a sitting position to observe hip precautions.
This model of occupational therapy practice describes a triad among client, occupational therapy practitioner, and occupation;
Intentional relationship Model
A team comprised of different types of providers who complete therapeutic assessments and treats separately but have a greater level of communication among each other in order to work together toward a group or patient.
Interdisciplinary
A team comprised of different types of providers who complete therapeutic assessments and treatments separately, but have a greater level of communication among each other in order to work together toward group or patient goals.
Interdisciplinary team
A type of team that consists of solely one type of provider
Intradisciplinary
A COTA® completes a home assessment of a person with Parkinson's disease who lives at home but has begun to have mobility challenges. Which intervention is BEST to facilitate lifestyle changes to improve safety?
Introduce use of a rhythmic beat to facilitate mobility
Model of Human Occupation (MOHO)
Is perhaps the best-researched model of practice in occupational therapy. Model of practice that views occupation in terms of volition, habituation, performance, and environment.
A student in the second grade has sensory modulation disorder. When handwriting in class the student consistently places excessive force on the pencil, causing the pencil point to break. Which activity would provide the child with proprioceptive input for regulating the amount of pressure applied to the pencil during handwriting?
Kneading modeling clay with both hands on a desktop - Proprioceptive input is provided through firm pressure to skin or joints, which the student would receive from kneading modeling clay.
Claudia Allen Cognitive Disability Theory
L1: automatic: total assist, reflexive response to 1 word cue L2: postural: max assist, 1 step familiar motor control, imitation L3: manual: mod assist, tactile cues, 1 step with familiar activities L4: goal-directed: min assist, visual & tactile cues, 2-3 step, labels & pictures, 24 hr supervision starts L5: exploratory: supervision, external cues, 4-5 step L6: planned: independent, no disability
What modality transfers heat through radiation?
Laser
Which is not a type of electrical stimulation application? lontophoresis TENS Laser HVGS
Laser
Which strategy is the LEAST appropriate technique for managing escalating behavior? Outline expectations for the patient listen to concerns and complaints speak in a soft and low voice Maintain eye contact in close proximity to the patient
Maintain eye contact in close proximity to the patient
Which psychiatric condition is MOST frequently seen as interfering with the occupational engagement of a client with cardiac disease?
Major depression
What skills might a client with middle-stage dementia have difficulty performing on the basis of typical psychosocial or cognitive abilities present during this stage of dementia?
Managing finances
Because the client is able to walk around his home he does not qualify for a ___________________.
Manual Wheelchair
What type of therapeutic practice style is being used when the clinician provides only momentary rest breaks during an intervention?
Massed practice Patient spends very little time resting and most of the time practicing.
Developmental Groups The most advanced type of group in regard to social interaction and ability to work together cohesively to complete multiple tasks
Mature Group
The writing utensil is stabilized by distal phalanges of the thumb, middle, and index finger; the ring finger may also be used; the wrist is slightly extended, and the supinated forearm rests on the table.
Mature grip
The abductor pollicus brevis, opponens pollicus, and the flexor digitorum superficialis are all innervated by the ________ nerve.
Median nerve
Considered the "hospital insurance" part of Medicare. It covers part of the expenses for inpatient stays in hospitals, short-term stays at skilled nursing facilities (SNFs) for more acute conditions, hospice, and some services in home health (Medicare.gov, n.d.-b). It generally does not require individuals to pay a monthly premium because payroll taxes for individuals or their spouses have already paid for it
Medicare Part A
Considered the "supplementary medical insurance" part of Medicare. It covers some of the costs for outpatient care, such as physician visits and occupational therapy services, some home health services, and some supplies and equipment
Medicare Part B
A COTA® is treating a client with decreased digital range of motion and minimal subacute edema of the same hand. After ascertaining that there are no contraindications to modality use, which preparatory method is the BEST choice for before therapeutic activities?
Mild, superficial heating application to the hand and digits - Heating between 71.6°F and 105.8°F increases lymph flow and helps soften tissues to promote increased range of motion. Heating does not exacerbate minimal edema.
A supportive orthosis that holds up an affected arm via a sturdy through that is usually connected to a wheelchair
Mobile arm support - Enables the person to use the affected arm for functional tasks by providing both shoulder and forearm support
What is the first step in treating later epicondylitis?
Modify home and work activities This will reduce the likelihood of further tendon inflammation.
RA occurs more often in smaller or larger joints?
More common in small joints
Snellen fraction
Most common visual acuity measurement
A COTA® is working in an inpatient setting with veterans who have upper-extremity amputations. Each morning the rehabilitation team, consisting of physician, nurse, psychologist, social worker, OTR,® COTA, physical therapist, and orthotist, come together to discuss their patients' progress toward the goals set within their individual disciplines. What type of team is this?
Multidisciplinary team - A multidisciplinary team is an interprofessional team composed of individuals representing the professional disciplines that serve the client.
For a client with an L2 spinal cord injury, which statement BEST describes the muscle segments below the injury level 1 to 2 months postinjury?
Muscles are spastic. Usually flaccid initially but 1-2 months post they will become spastic.
Type of clinical reasoning that focuses on understanding people's illness as it relates to their particular life circumstances
Narrative reasoning
(Grasp - tiny objects) 12 Months
Neat (fine) pincer grasp - tip to tip a small object is held between the tip of the opposed thumb and the index finger. This ability allows for precise prehension of tiny objects.
A summer picnic has been planned for clients in a day treatment program for people with mental illness. Before leaving, what medication-related precaution should the COTA® review with the clients?
Need to protect oneself from direct sun when taking psychotropic medications Photosensitivity is a side effect of many psychotropic medications. Avoiding direct exposure to sun is essential.
Which approach does not use reflexive movement when developing normal and functional movement patterns? Propriceptive neuromuscular facilitation (PNF) Neurodevelopmental treatment (NDT) Brunnstrom approach Margaret Rood approach
Neurodevelopmental treatment (NDT) The NDT approach seeks to prevent the appearance of primitive reflexes and abnormal movement patterns
When treating an individual with a cognitive-perceptual deficit, which approach focuses on realistic and practical life skills training?
Neurofunctional approach
What is the appropriate anti-contracture positioning for a patient who has a burn to the dorsal aspect of the wrist?
Neutral wrist Contracture in wrist extension can occur following a burn to the dorsal aspect of the wrist.
OT Code of Ethics - Which principle describes not hurting your patients emotionally or physically in regard to intervention and relationships?
Nonmaleficence
Which of the following is an operational concern in group planning? - Number of group leaders - Cognitive ability of participants - individual safety concerns - functional independence of participants
Number of group leaders This is the only choice thats directly related to group logistics
Which type of splint is indicated for radial nerve palsy?
Outrigger extension splint
A supportive orthosis that places the affected arm in a sling that is suspended by a bar over the person's head.
Overhead suspension sling - used therapeutically to provide proximal support for an activity using the arm/hand
Which type of splint is indicated for boutonniere deformity?
PIP extension splint
What is not a contraindication for physical agent modalities? Decreased sensation Cancer Pacemaker pain
Pain
(Grasp - cube/ball) 5 Months
Palmar Grasp The object is in the CENTER of the palm. All the fingers are flexing as a unit and the object is tightly held against the center of the palm with an adducted thumb.
What contracture can occur following a burn to the volar aspect of the hand?
Palmar contracture
An intrisic hand muscle that is innervated by the ulnar nerve
Palmar interossei
What is the expected grasp of a writing tool for a child aged 1-1.5 years old?
Palmar supinate grasp
Which lobe of the brain is responsible for processing sensory information?
Parietal Lobe
The segmentation of a skill in order to complete the entire task via a series of parts
Part practice
An OTR®; is evaluating a child who is depressed and suicidal after experiencing severe bullying in school. On interviewing the child, the OTR identifies that the child's sense of self-efficacy and personal capacity have been severely affected, and the child does not want to go to school anymore. Using a Model of Human Occupation theoretical framework, which component of the child's volition should the OTR work on as a primary concern?
Personal causation Personal causation is defined as one's sense of self-competence and effectiveness while engaged in occupations. Because the child's self-efficacy and personal capacity have been severely affected, it is best to address the child's personal causation as a primary concern.
What is the correct word root for a term describing the diaphram?
Phren- The phrenic nerve innervates the diaphragm
Cardiac rehab: Key community (Phase 3) OT intervention components
Physician referral, stress test, continuation of Phase 2 activities and progress as tolerated, with less therapy supervision and in community settings are intervention components for this stage of cardiac rehab.
What is the name of the innermost layer that covers the brain?
Pia Mater
(Grasp - tiny objects) 10 Months
Pincer grasp - pad to pad A small object is held between the pads of the opposed thumb and the index finger.
Allen Cognitive Level 6
Planned Actions absence of disability. can think of hypothetical situations and do mental trial & error problem solving.
Allen Cognitive Level 2
Postural Actions/Gross Body Movement-->MAX ASSIST Stitches: Unable to imitate/complete 'running stitch' Motor Actions: Approximate imitations, Pacing, bending, stretches Attention Span: Minutes Tx: gross motor games, dance
Repetition of behaviors that is necessary to improve, for example, range of motion, strength, and endurance
Practice
_________ ________ _________enables the COTA to incorporate knowledge about the client's contexts. By knowing features of the child's classroom context, the COTA may be able to identify reasons for the frequent bathroom breaks.
Pragmatic clinical reasoning
A COTA® is treating an inpatient who has myasthenia gravis and is preparing for discharge to live alone at home. What information is MOST IMPORTANT for the COTA to discuss with the patient?
Precautions against overexertion, emotional stress, and fluctuations in temperature
When working to improve coordination, the focus should be on Athletic events general ROM gross motor activities precision
Precision
The whole hand or extended fingers and a pronated forearm are used to hold the writing utensil; the writing movement comes from the shoulder.
Primitive grip
Type of clinical reasoning that considers and uses intervention routines for identified conditions
Procedural reasoning
What concept tells a new therapist the amount of billable intervention they need to complete during a day?
Productivity Standards
Which word is the best to describe a patient is improving and justifies continuing care? Progressed in balance Maintained ROM Minimal Change Requires repetition
Progressed in balance
Cardiac rehab: Key inpatient (Phase 1) OT intervention components
Progression of ADLs and activity according to metabolic equivalent (MET) levels; monitoring for activity intolerance; development of a home program are intervention components for this stage of cardiac rehab.
What type of group has individuals work on small similar tasks that require a small amount of interaction?
Project Groups
What role do state regulatory boards play in the role of OT?
Protect the public, oversee the ethical and legal practice of OT, and handle complaints
A client with multiple sclerosis (MS) is experiencing memory deficits that are hindering the client's ability to take medications accurately. Which intervention is the MOST appropriate to support performance in medication management for this client?
Provide the client with written directions for medication management The use of memory aids, such as written directions, has been shown to improve cognitive function for clients with MS, and providing written directions can promote independence and accuracy in managing medications.
Cognitive-behavioral strategy in which the practitioner educates child and family about the disorder.
Psychoeducation
A COTA® uses cognitive-behavioral interventions in psychosocial practice with clients with stress and anxiety disorders. What intervention is the COTA MOST likely to use?
Psychoeducation that provides resources and information about the client's illness and ways to cope with it
A school-age child is learning to dress independently. The COTA® plans to use backward chaining methods to teach the child to zip and unzip a front-opening jacket. Which step of the task should the child complete FIRST when using this technique?
Pull the fastened zipper tab from the top of the jacket downward - During backward chaining, the COTA® assists with the majority of the task completion (zipping the jacket) and allows the child to complete the last step of the process (e.g., unzipping the jacket) independently.
Which type of ultrasound is indicated for decreasing inflammation and promoting healing? Continuous or pulsing?
Pulsed ultrasound this type of ultrasound does not produce heat which typically execrates inflammation.
What design characteristic of a group describes why it was developed? Rationale Purpose Criteria for membership Method
Purpose
Ranchos Level VIII
Purposeful, appropriate: SBA - Consistently oriented X3 - Completes familiar tasks 1 hour in distracting environments - Recalls and integrates past and recent events - Learns new activities and can continue w/o supervision - Uses memory devices for daily schedule, to do lists with SBA - Initiates and carries out familiar personal, household, community, work and leisure routines with SBA and can modify with min assist - Depression, irritability, low frustration tolerance, argumentative, self-centeredness persists
(Grasp - cube/ball) 8 Months
Radial Digital Grasp The object is held between the opposed thumb and the pads of the radial fingers
Which peripheral nerve injury occurs due to compression on a nerve that results in wrist drop?
Radial Nerve Palsy
(Grasp - cube/ball) 6 Months
Radial Palmar Grasp The object is held in the RADIAL side of the palm. The thumb will oppose and actively press the object into the radial side of the palm against the radial fingers.
The extensor pollicus longus and extensor pollicus brevis are both innervated by which nerve?
Radial nerve - is a muscles action is extension, it is innervated by the radial nerve with the exception of the lumbricals and interossei
A client has visual acuity of 20/200 in the right eye and 20/400 in the left eye. With what technology will the client MOST likely be able to operate a microwave with a flat panel?
Raised dots on the panel - the vision is so bad that vision aides will not help at all
(Grasp - tiny objects) 6 Months
Rake grasp Baby contacts smaller objects using raking motion with fingers extended
Which activity would a client with age-related macular degeneration likely have difficulty performing?
Reading printed material - Difficulty reading printed material is a characteristic feature of age-related macular degeneration because of the gradual loss of ability to see clearly and development of a dark or empty area in the center of the vision.
When treating a client in a skilled nursing facility, the COTA® notes that the client's skin has a yellowish cast, the fingernail beds are bluish in color, and the client has noticeable edema in both lower extremities. What condition would MOST likely cause these symptoms?
Right-sided congestive heart failure When the right side of the heart fails, blood flows back into the venous system. Symptoms of right-sided heart failure include cyanotic nail beds, jaundice, and lower-extremity edema.
An inhibitory splint used to decrease spasticity (high tone) in the hand
Rood Cone
Which is the method for assessing burn wound size?
Rule of Nines
In 2005, Congress passed a federal transportation bill, SAFETEA-LU, which included funding for a program that encouraged children (including those with disabilities) to bike and walk to school, acted to reduce air-polluting traffic near schools, and encouraged healthy lifestyles from a young age. What was the name of this initiative?
Safe routes to school
(Grasp - tiny objects) 8 Months
Scissors grasp A small object is held between the thumb and the lateral side of the index finger. The index finger here will be slightly curved
A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft taken from the thigh was placed on the mid-forearm 3 days postinjury. The client would like to return to softball practice as soon as possible. What would be the BEST activity during the initial phase of rehabilitation?
Scar massage followed by interactive, virtual-reality computer sports games - Taking into consideration the client's previous occupation as a softball player, virtual-reality computer sports games can involve similar sports movements and be motivating. However, because newly healed skin might split open as a result of overstretching or shearing force during movement, it is important to perform scar massage with a lubricant before activity.
For a client with multiple sclerosis, which compensatory cognitive strategy would BEST aid in performance of daily activities?
Schedule demanding tasks at intervals throughout the day Spreading demanding tasks throughout the day allows for rest periods to promote cognitive ability. Clients with multiple sclerosis typically have greater cognitive abilities in the morning and after rest breaks.
What grasp is expected to be used to pick up a small object at 8 months old?
Scissors grasp
A student in preschool has hypotonia with poor trunk control and good head control. The student wants to join peers when sitting on the floor during story time. Which position is BEST for supporting the student when participating in this classroom activity?
Seated in a floor sitter that has a corner-shaped backrest and pelvic straps - Corner chairs position the child in an upright seated position by providing trunk support, and the seated position facilitates placement of the upper extremities in a position for function.
A client has fair (3/5) muscle strength of the shoulder flexors and is participating in a strengthening program. Which position and movement pattern would be MOST EFFECTIVE for initially increasing strength of the client's shoulder flexors?
Seated, moving the arm in a sagittal plane - Moving the arm in the sagittal plane will allow active movement against gravity, which in turn will facilitate the client's current strength with full active motion against gravity.
Which type of prevention strategy is used when staff at a skilled nursing faculty make daily skin checks on their residents to prevent bedsores from developing?
Secondary Prevention This is finding health issues BEFORE they become severe
Which test assesses a client's ability to visually select features that differentiate objects?
Selective attention
A COTA® chooses to incorporate the use of a variety of experiences, different media, and novel instructional materials during a handwriting intervention session. Which model of practice is guiding the COTA®'s intervention?
Sensorimotor - A sensorimotor approach to handwriting would include the incorporation of a variety of sensory experiences, different media, and novel instructional materials during a handwriting intervention session. It would also include offering the child multiple different writing tools, writing surfaces, and positions for writing.
What type of task is comprised of a sequence of movement patterns that in their entirely complete a task (ex. completing a transfer)
Serial task
__________ is a typical pharmacological treatment for depression.
Sertraline (Zoloft)
A COTA® is conducting the first session of an occupational therapy group for adolescents with oppositional defiant disorder in an inpatient behavioral treatment center. Which activity is a priority?
Set ground rules with clear expectations Clients with oppositional defiant disorder need clear rules about what behaviors are acceptable and not acceptable. Expectations for participation in the group need to be made explicit.
Successively approximating or learning intermediate behaviors that are prerequisite components of the final behavior is part of the ________ technique.
Shaping
Which type of amputation includes the arm through the humerus?
Shoulder disarticulation
A COTA® observes as a client with multiple sclerosis (MS) demonstrates ataxia in the upper extremities when reaching for an item on the table. Which intervention is BEST to modify tabletop activities to control ataxia in task performance?
Support the arms and trunk against the table Supporting the arms and trunk against the table provides three points of stability against a stable surface, offering optimum support for task performance.
A client is a hands-dependent sitter. What goals would the OTR®-COTA® team have for such clients when providing a positioning and seating system?
Support the pelvis and trunk to free the hands for activities - Hands-dependent sitters require the use of one or both hands to maintain an upright seated position. Positioning must begin with the pelvis and trunk; if they are supported, the client will not need to use the hands to sit upright.
An OTR® and COTA® team begin to recognize the need for a program to promote work participation for the young adults with mental illness they serve. Which statement MOST accurately reflects the evidence about developing such a program?
Supported employment programs with a "place-and-train" perspective are more effective than other vocational approaches. Current rehabilitation focus is on the place-and-train supportive employment approach, and evidence supports its use.
Which behavioral symptom might a client with early-stage dementia display?
Suspicion - A client with early-stage dementia might become suspicious; it is common for clients to think misplaced items have been stolen or that their spouse may be unfaithful.
A COTA® is treating a client who works on an assembly line. The client presents with symptoms of cubital tunnel syndrome. In educating the client, what position does the COTA® advise the client to avoid?
Sustained elbow flexion Sustained elbow flexion provokes symptoms of cubital tunnel syndrome.
Which common deformity of RA is characterized by PIP hyperextension and DIP flexion?
Swan neck deformity
In regard to the autonomic nervous system. which division handles the "flight or fight response" of increasing heart rate and blood pressure?
Sympathetic division
Get Up and Go
The TUG involves timed performance of getting up from a chair, walking 10 feet, turning around, and walking back to sit down again; it is an indicator of fall risk. The TUG was derived from the GUG, which is an observational rating of fall risk using a score ranging from 1 to 5.
Visuocognition
The ability to manipulate and integrate visual input with other sensory to gain knowledge, solve problems, formulate plans, and make decisions.
executive functioning
The ability to set priorities or make decisions.
In group design the RATIONALE is...
The benefit of the group to its members
Context
The broad construct that encompasses environmental factors and personal factors
A COTA® is working in a cardiac rehabilitation program. Of the four clients on the COTA's caseload, which client would require a longer warm-up and cool-down period during exercise and activity sessions?
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.
A COTA® is working with an adult male client with an incomplete spinal cord injury. The client has expressed some concern regarding his ability to sexually perform with his partner. Which statement regarding the client's sexual function is MOST accurate?
The client's sexual drive and need for emotional intimacy has not been altered.
Vocational evaluation
The comprehensive assessment of vocational aptitudes and potential, using information about a person's past history, medical and psychological status, and information from appropriate vocational testing, which may use paper and pencil instruments, work samples, simulated work stations, or assessment in a real work environment.
cognitive-behavioral theory (CBT)
The focus of therapy is to increase awareness of—and eventually change—cognitive distortions to ultimately alter behavior and the emotional impact on function. Intervention strategies include goal setting, homework, mindfulness, and restructuring cognitive thoughts
Personal causation
The individual's sense of his or her own competence and ability to be effective.
Which of the following is an example of person first language? The Total knee replacement The Bipolar patient The cerebral palsy student The patient with multiple sclerosis
The patient with multiple sclerosis - it is important to not introduce someone solely based on their diagnosis and have the person come before the disease.
A COTA® has been teaching visual scanning techniques to a patient who has a CVA. When documenting progress, what information is BEST to include in the Objective section of a SOAP note?
The patient's ability to use the techniques and level of assistance needed during a specific dressing activity - The Objective section provides concise information that reports what was observed and what occurred in the session; reporting the assistance levels and the techniques used for dressing is appropriate for the Objective section.
Lordosis (as it relates to seating)
The pelvis rotates anteriorly, increasing the curvature of the lumbar spine; clients tend to use the upper extremities for support.
Assessment of rules of the road and sign recognition
The practitioner assesses the areas of symbolic recognition, reasoning, and judgment pertaining to driving rules and statutes that are specific to states.
The COTA® and a Level II Fieldwork OTA student at a long-term care facility observe a new resident moving his wheelchair forward by gripping the front of the pushrim and giving it multiple tiny pushes. The COTA® asks the student, "Why do you think he is pushing his wheelchair that way?" The student observes a bit longer and responds:
The seat back is too high When the seat back height is above the lower angle of the scapula, it can prevent adequate shoulder extension, which is necessary for contacting the pushrim.
An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The COTA; is assisting the OTR in writing the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." How should the timeline (or T) part of this goal be modified to make it more measurable?
The timeline should specifically reference the anticipated discharge date.
Letter-number cancellation
These assessments test visual scanning and selective attention as a client scans a grouping of letters and has to select and draw a line through the targeted letter
Which term describes the agencies and companies that cover the majority of costs for health care services?
Third party payers
Short Blessed Test
This brief 6-item assessment is used to identify cognitive function related to dementia. The test assesses the domains of memory , orientation, and concentration.
Montreal Cognitive Assessment
This brief assessment of cognitive function includes the domains of memory recall, visuospatial abilities, and executive function. It includes a clock drawing test.
Cognitive Behavioral Driver's Inventory
This computer-based neurocognitive battery is validated for people with traumatic brain injury and is designed to assess the cognitive and behavioral skills required for driving.
A COTA® is treating a client for agoraphobia and feels frustrated that the client is not making faster progress. The COTA discusses the client's case with a work colleague over lunch at a fast-food restaurant. The COTA does not use the client's name but does repeat verbatim statements made by the client. What can you conclude about the ethical nature of the COTA's conversation?
This is not ethical. You cannot disclose any confidential information about a patient regardless of the setting or if the name was used or not.. It can only be done if the person you are talking to has a say in the decision of the person being discussed or the person is in immediate danger.
Alternating Foot-Tap Test
This test is a measure of lower limb mobility, as required of a driver to move his or her right foot from the gas pedal to the brake pedal.
RT-2S Brake Reaction Time Tester
This timer measures the time required to move the foot from the accelerator to the brake in response to a red-light stimulus. A yellow-light version is also available.
SAFER Driving
This workbook helps clients look at their driving knowledge and skill in relation to their health conditions and medications.
According to the taxonomy of groups described by Anne Mosey, which type of group requires conversation about participants interestes, thoughts, or concerns that are not manifest within the group?
Topical Groups
Level 1-3 Common theme
Total assistance
During the occupational therapy evaluation, an OTR® has determined that a visually impaired client can no longer drive. What should the treating COTA® expect the OTR® to include in the occupational therapy intervention to help this client be independent in the use of community mobility?
Train the client and the client's family or support system in the use of the most appropriate transportation options.
A team that works on treatments and assessments together and as a unit to achieve what is best for the patient
Transdisciplinary
A team comprised of different types of providers who work to complete assessments and treatments together and as a unit to achieve what is best for the patient.
Transdisciplinary team
Stage of group development where participants reflect on their history, evaluate what went well and what caused problems, and adjust themselves as a group in response to this review (Tuckman's model)
Transforming stage of group development
The writing utensil is held with flexed fingers with pronated forearm and radial side down and then progresses to a supinated forearm position.
Transitional grip
What main neuromusculoskeletal feature is a client with multiple sclerosis likely to exhibit that a COTA® should consider during intervention?
Tremor when moving the extremities to reach Intention tremor is commonly seen in people with MS.
What type of driving adaptation is used for someone with weak or absent grasp?
Tri-pin
A COTA is treating a client who is in a vegetative state after a traumatic brain injury (TBI). The OTR®; has identified the need to use restorative strategies with the client. Which restorative strategy is MOST appropriate for this client?
Upright positioning strategies in a wheelchair to normalize muscle tone and facilitate arousal Positioning a client with a TBI upright in a wheelchair provides optimal positioning to minimize abnormal tone and increase stimulation to the client's visual and vestibular systems.
A client has nocturnal urge incontinence secondary to Parkinson's disease. Which environmental modifications would be MOST BENEFICIAL for promoting the client's safety for nighttime toileting?
Urinal and a bedside commode - Using a urinal and bedside commode allows a client to void quickly at the bedside when urge incontinence occurs and would avoid the client having to hurry to the bathroom and risk a fall.
Compensatory Strategies while driving: Coordination
Use a vehicle with automatic transmission, power brakes, and cruise control.
Compensatory Strategies while driving: Endurance
Use a vehicle with automatic transmission, power brakes, and cruise control; plan the route in advance; and take ample rest breaks. Consider hand controls if lower body endurance is inadequate for sustained braking.
Compensatory Strategies while driving: impaired visual acuity
Use corrective lenses, drive on reduced speed roadways (required in many states with reduced acuity limits), and limit driving to daylight only and good weather only.
What has the AOTA Ethics Commission recommended that occupational therapy authors do to avoid plagiarism in the electronic age?
Use electronic tools to check content for possible plagiarism
Compensatory Strategies while driving: Peripheral field deficits
Use prism lenses, and compensate with extra head turns and expanded-view rear and side mirrors.
Compensatory Strategies while driving: Visual field cuts or scotomas
Use prism lenses, compensate with extra head turns and frequent eye movements, and restrict driving at night or at high speed.
Compensatory Strategies while driving: Pursuits, saccades, and scanning
Use proper visual search patterns and efficient scanning techniques. Instruct in systematic sequential strategies to perform driving maneuvers (e.g., when changing lanes, use the acronym SMOG: Signal, look in side Mirror, look Over your shoulder, Go
Prudence
Using clinical and ethical reasoning skills, sound judgement, and reflection to make decisions in professional and volunteer roles
The practice of a skill through varying methods, potentially to increase the ability to transfer the skill. ex. practicing a sit to stand on various surfaces and settings
Variable practice
OT Code of Ethics- Which principle decribes maintaining honest and truthful documentation? (billing time, treatment provided)?
Veracity
Which principle of the OT Code of Ethics states that documentation should be accurate?
Veracity
A client with low vision has difficulty with functional mobility, especially in dynamic environments, and becomes anxious when moving into an unfamiliar environment. What type of vision loss does this client most likely have?
Visual field deficit
Clients who leave a workplace because of impairments can receive assistance from _____________________ to return to that or another workplace.
Vocational rehab
A client in the burn unit sustained deep partial-thickness burns to the bilateral dorsal hands 1 week ago. What is the BEST position for splinting to prevent deformity?
Volar hand splint with wrist in 30 extension, MPs in 70 flexion, and IPs in full extension - When a burn occurs on the dorsal surface of the hand, it has potential to form a claw-hand deformity. The intrinsic-plus position is the best splinting position to prevent contracture
A COTA® is working with a client in an outpatient center who has been diagnosed with Raynaud's syndrome affecting the fingers. What home program instruction is MOST appropriate for a client with Raynaud's syndrome?
Wear gloves when exposing the fingers to cold. Raynaud's syndrome disrupts blood flow to the digits in vasospastic attacks. The client needs to be educated to wear gloves when exposing hands to the cold, such as reaching into a freezer.
After a CVA, an individual is unable to understand and comprehend what the hospital staff and their family is saying to him. What is the impairment called?
Wernicke's Aphasia
A COTA® is working with a client who has chronic congestive heart failure. The client is displaying limited tolerance for light to moderate homemaking activities. Which compensatory strategy would be BEST for the OTR® to demonstrate to the client to improve tolerance to these activities?
Work simplification techniques For clients who show limited endurance for or tolerance of activities, work simplification techniques can improve their ability to complete tasks independently.
What is an appropriate anti-contracture position for a burn to the volar aspect of the wrist?
Wrist cock up splint
epiphyseal fracture
a break at the location of the growth plate, which can affect growth of the bone
Cognitive reframing
a cognitive-behavioral therapy that uses positive self-talk to remove self-defeating and negative thoughts.
Down Syndrome
a condition of intellectual disability and associated physical disorders caused by an extra copy of chromosome 21.
What is a neurodegenerative disease?
a disorder characterised by a progressive decline in the structure, activity and function of brain tissue
Oppositional Defiant Disorder (ODD)
a disorder characterized by age-inappropriate and persistent displays of angry, defiant, and irritable behaviors
Outcome and Assessment Information Set (OASIS)
a form that helps provide information about reimbursement of services in a home health setting
Phocomelia
a fully or partially formed distal extremity and absence of one or more proximal segments.
confrontation test
a gross measure of peripheral vision
Organoid neoplasm
a growth that is similar to an organ in the body
Visual field deficit results in
a narrowing of visual search and scanning, slowing of scanning to the blind side, missing or misidentified visual detail, and reduced visual monitoring of the hand. The primary activities affected are functional mobility, reading, and writing. Anxiety is common in people with visual field deficit because of challenges using scanning and visual search to negotiate environments.
Toxoplasmosis
a parasite that is most commonly transmitted from pets to humans by contact with contaminated animal feces
status epilepticus
a prolonged seizure or situation when a person suffers two or more convulsive seizures without regaining full consciousness
Congenital syphilis
a syphilis infection in a newborn baby resulting from transmission from an infected mother
OT for hearing loss
a. Use sensory integrative therapy. b. Support vestibular function. c. Maximize use of residual hearing. d. Encourage age-appropriate self-care skills. e. Enhance fine motor coordination and skills. f. Maximize oral-motor coordination. g. Maximize visual processing, integration, and perception. h. Encourage socialization and peer interaction. i. Use backward chaining, in which the therapist performs the first several steps of the task and allows the child to complete the last step of the task j. Use forward chaining, in which the therapist encourages the child to complete the first step of the task, and they practice this step until it is mastered and therapist completes last steps.
Visual discrimination
ability to compare and contrast objects
Dysplasia
abnormal development of tissue
transhumeral
above elbow
transfemoral
above knee
Providing training in safe handling techniques to properly position and move the affected upper extremity is the most important approach to
addressing shoulder subluxation
If the group is mature and has high verbal abilities, the practitioner's leadership style is
advisory— that is, he or she works alongside the group participants in a coaching capacity. Advisory leadership enables group members to perform at their highest capacity
Pulls off shoes, removes socks
age 1
Personal factors
age and life-cycle stage, occupation, economic situation, lifestyle, personality and self-concept
visual attention
alertness, selective attention, visual vigilance, divided or shared attention
Late stage of dementia
all occupations lost, dependent in ADLs, unsafe to ambulate, communication lost
Light- or modified-duty programming
allows a worker to temporarily perform job duties with less physical demand
Instrumental Activities of Daily Living
are activities that "support daily life within the home and community." - Care of others, including selection and supervision of caregivers - Care of pets and animals - Child rearing - Communication management, including use of writing tools and technology - Driving and community mobility - Financial management - Home establishment and management - Meal preparation and cleanup - Religious and spiritual expression - Safety and emergency maintenance - Shopping
Useful Field of View
area from which one can extract visual information in a single glance without turning one's head or moving one's eyes Determines crash risk
Decorticate rigidity
arms adducted and flexed, wrists and fingers flexed; legs extended, internally rotated, plantar-flexed
Decerebrate rigidity
arms stiffly extended, adducted, internally rotated; legs stiffly extended, plantar-flexed
Specific vocational evaluation
assesses a person's readiness to return to a particular occupation
Optec Functional Visual Analyzer
assesses a variety of visual skills by providing a series of illuminated slides addressing areas such as depth perception, acuity, contrast sensitivity, phorias, glare recovery, and color perception and recognition
Guillain-Barre syndrome
autoimmune condition that causes acute inflammation of the peripheral nerves in which myelin sheaths on the axons are destroyed, resulting in decreased nerve impulses, loss of reflex response, and sudden muscle weakness
Cluster C
avoidant, dependent, obsessive-compulsive
Lifestyle Performance Model
balance between reciprocal interpersonal relatedness (connection to others), intrinsic gratification (fun and pleasure), societal contribution (activities that benefit others), and self-care and self-maintenance (care of oneself and surroundings); to improve quality of life
transradial
below elbow
transtibial
below knee
transmetatarsal
below the ankle
transmetacarpal
below the wrist
greenstick fracture
bending and incomplete break of a bone; most often seen in children
Diagnostic symptoms for __________________________ are self-mutilation and destruction, unstable mood, and fears of abandonment that lead to instability.
borderline personality disorder
Which deformity of RA is characterized by PIP flexion and DIP hyperextension?
boutonniere deformity
macular degeneration
breakdown or thinning of the tissues in the macula, resulting in partial or complete loss of central vision
Manual wheelchair user
can propel a manual wheelchair with both upper extremities, both lower extremities, or one upper and one lower extremity or is pushed by an attendant or caregiver
Secondary progressive
cessation of fluctuations with slow deterioration and progression
Mutilans deformity
characterized by very floppy joints with shortened bones and redundant skin; caused by reabsorption of bone ends; most common in the MCP, PIP, radiocarpal, or radioulnar joints
Autonomous phase of handwritining
child can perform handwriting w/ minimal conscious attention
Peer-Mediated Intervention Model
children are partnered with peers who can affect positive behavioral changes.
Typical antipsychotics
chlorpromazine, haloperidol, fluphenazine
MS: Relapse-remitting
clearly defined relapses of acute worsening of neurological function followed by partial or complete improvement and then stable periods of remission between attacks"
symptom minimizer
client who keeps symptoms hidden so he or she can return to normal activity or avoid appearing weak
Paratransit
clients who have functional impairments that have limit their access to regular fixed-route services (van, shuttle); pick up riders outside their homes and take them to specific locations; require advance reservations; Eligibility: inability to navigate the fixed-route transportation system, unavailability of the public transportation system at the time or place a person with a disability needs to travel, impairment-related inability to board or disembark at a specific location (ADA)
The _______________________ frame of reference uses the client's strengths to allow for function. An example of a _____________________ intervention is training caregivers to provide appropriate environmental supports for the client.
cognitive disability
The _____________________ frame of reference works on the thoughts and reactions related to environmental triggers. Through journaling and reflection, the client can identify triggers that cause the anxiety to escalate.
cognitive-behavioral
Choreoathetosis
combination of chorea and athetosis constant fluctuations from low to high tone
Positive reinforcement
commonly thought of as a reward, is a favorable outcome that occurs after the desired behavior (e.g., praise, increased privileges, a "high five").
Soft neoprene splints to position thumb and forearm
commonly used with clients with rheumatoid arthritis or cerebral palsy to increase functional use of the hand
Hand rim projections
compensate for weak grasp in moving the wheelchair
Amyotrophic lateral sclerosis
degenerative disorder of motor neurons in the spinal cord and brainstem
livability
concept that extends beyond specific types of physical access or design to encompass all aspects of community life that may invite participation by all community dwellers, regardless of age or ability.
Amelia
congenital absence of one or more limbs
Procedural reasoning
consideration and use of intervention routines for identified conditions
Systems-level interventions
consultation with transportation systems on accessible design, creation of legislation, etc.
Myclonic seizures
contractions of single muscles or muscle groups
Handwriting readiness: 4-5 years
copies a cross, square, diagonal, some letters
Handwriting readiness: 5-6 years
copies a triangle, prints own name, most letters
Handwriting readiness: 3 years
copies veritcal, horizontal line, and circle
Diabetic retinopathy
damage to the retina as a complication of uncontrolled diabetes Syndrome causing fluctuating vision, blurred vision, peripheral vision loss, decreased constrast sensitivity, difficulty with night driving and color discrimination
strabismus
crossed eyes
dyskinesia
difficult or painful movement
Anomic aphasia
difficulty finding words
Dysarthria
difficulty forming words
Dyslexia
difficulty reading
dyspraxia
difficulty with planning movements, especially complex or new movements
What is the expected grasp of a writing tool for a child aged 2-3 years old?
digital-pronate grasp
If participants have low cognitive abilities, the occupational therapy practitioner's leadership style should be more
directive— that is, he or she provides more directions and structure and is more prescriptive in directing the way group activities unfold
Decreased coordination of movements
dysmetria
macrodactyly
enlarged digits - difficulty with fine motor
Social-Cognitive Intervention Model
facilitates learning of behaviors by observing the behavior of others.
If the group demonstrates fair to good insight and motivation, the practitioner's leadership style should be
facilitative— that is, he or she allows participants to take responsibility for some group activities while maintaining control over goals and decision making.
Hyperopia
farsightedness
Create, promote
focus on populations; the therapist creates an intervention Create a parenting class to help first-time parents engage their children in developmentally appropriate play; Provide a falls prevention class to a group of older adults at the local senior center to encourage safe mobility throughout the home
Object perception
form constancy, visual closure, visual-figure ground
Prader-Willi Syndrome (PWS)
individuals with Prader-Willi syndrome often present with food-seeking behaviors, which might make waiting to eat until lunchtime difficult.
Encephalitis
inflammation of the brain
Skier's Thumb
injury to the ulnar collateral ligament of the MCP joint of the thumb.
Paratonia
involuntary resistance to passive movement of the extremities
tactical level
involves decisions made during driving maneuvers, including making left- hand turns, slowing to accommodate weather conditions, or deciding whether to pass a vehicle.
operational level
involves decisions made to control the vehicle safely by executing the necessary visual-motor or coordination skills.
strategic level
involves higher-level decision making to determine trip goals, mode of travel, and navigating or mapping routes.
Tactile defensiveness
is an extreme reaction or overreaction to tactile input. Light touch may be particularly noxious
Gravitational insecurity
is an over responsivity to vestibular input; children with this type of dysfunction may be extremely scared of movement and may move carefully.
Clonus
muscle spasm or twitching
myopia
nearsightedness
Anterolateral approach
no external rotation; no extension; no adduction of affected hip joint
Dimensions of doing
occupational participation, occupational performance, occupational skill
Postprandial orthostatic hypotension
occurs when a person goes from supine to standing shortly after eating a meal.
Transitional programs
offered during a transition period when the client is able to complete some but not all job tasks. Such programs may encompass job coaching, education, instruction, and monitoring of the company's return-to-work programs. Transitional programs provide clients the opportunity to use environmentally focused interventions to facilitate return to work.
pelvic obliquity
one side of the pelvis is lower than the other
Prosthesis control training
operation of each component of the upper limb prosthesis
Children seeking vestibular input may be...
reckless or risk takers; they may need a lot to get going.
Type of pain that appears in the anatomical areas associated with a pathological condition; appears in response to stress related to force, repetition, or position; increases with increased stress; and is accompanied by observable physical responses
pain associated with a true pathological condition
De Quervain's syndrome
pain at the radial styloid and affects comfortable use of the thumb for functional tasks. It is caused by inflammation of the tendons in the thumb, the abductor pollicis longus, and the extensor pollicis brevis.
intermittent claudication
pain in the leg muscles that occurs during exercise and is relieved by rest
fribromyalgia
pain in the muscle fibers
Trail Making Test, Parts A and B
paper and pencil assessment measuring cognitive flexibility, motor control, perceptual complexity, visual scanning and executive function
Porteus Maze Test
paper and pencil tracing activity is correlated with on-road driving performance.
Cluster A
paranoid, schizoid, schizotypal
Which division of the autonomic nervous system returns the body to a stable condition? Lowering HR and blood pressure as well as increasing peristalsis and flow of saliva
parasympathetic division
Nonrestorative sleep, fatigue, and pain interfere with the client's ability to
pay attention and remember day-to-day events.
Glaucoma patients lose
peripheral vision
Environmental factors
physical, social, and attitudinal elements that surround the individual.
A _____________ chair can be used to alleviate orthostatic hypotension
reclining back - It can allow the client to move slowly and in stages while letting the blood pressure adjust to the change.
Hill holder
prevents the chair from going backward down a grade
Progressive relapsing
progressive disease from onset but without clear acute relapses
A leader of a psychodynamic group may select activities using
projective media, such as clay, magazine collages, painting, and poetry.
Group dynamics
properties of a group that emerge from the interactions among group members
Job coaching
provides an appropriate level of support on the basis of individual needs in the work environment; it may include job training or assistance for job task completion
Paraxial deficiencies
proximal segments of the limb are correctly developed but either the medial or lateral side of the rest of the limb is missing
The __________________ frame of reference suggests that unresolved childhood events are the reason for dysfunction. A ___________________ intervention is usually discussion based.
psychodynamic
Fasciculation
rapid continuous twitching of resting muscle without movement of limb
Elements of therapeutic use of self
rapport, empathy, sympathy, pity
Passive Terminal Device
realistic, nonfunctional hand worn for cosmetic purposes
Pragmatic reasoning
reasoning that assumes the truth of an idea can be validated by its practical outcome
Modification of the occupation
reduction of the demands of an occupation for example, use of contrasting colored materials to help a client who has visual impairments complete a weaving activity.
Behavioral Intervention Model
reinforcements and rewards are used to facilitate behavioral changes.
symptom misinterpreter
responds to physical changes in the body in an extreme manner because of difficulty processing sensory and kinesthetic input or unrealistic belief systems about the manner in which the body works
Inertial forces
result from rapid acceleration and deceleration of the brain inside the skull, resulting in a shearing or tearing of the brain tissue and the nerve fibers.
Hemorragic stroke/CVA
results from subarachnoid and intracerebral hemorrhage
Handwriting readiness: 10 - 12 montha
scribbles on paper
What is not an appropriate anti-contraction position in which to place a patient who has a burn to the anterior aspect of the hip? Knee immobilizers Prone position BLE weights placed on mid-thigh seated in wheelchair with feet on leg rest
seated in wheelchair with feet on leg rests This promotes hip flexion and may lead to a hip flexion contracture.
Visual imagery
seeing in the absence of a visual stimulus
Mobility management
services that promote collaboration and cooperation among transportation providers and connect clients to those providers
Travel training
short-term, direct, and intensive training to teach older adults and people with disabilities to use fixed-route public transportation safely and independently
Athetosis
slow, writhing involuntary movements
Festinating gait
small rapid steps resulting from a forward-tilted head and trunk posture
Professorial speech
speech with little regard for the interest of the listener
DriveABLE
standardized eval to determine driver competence.
Vocational rehabilitation programs
state and federally funded agencies that provide job training and placement services to people with disabilities.
five stages of tendon gliding
straight, hook, fist, tabletop, straight fist
Spondylosis
stress fracture of the dorsal to transverse process
sprain
stretching or tearing of ligaments
operational competence
technical skills needed to operate the AAC system accurately and efficiently
Travel training and travel instruction
terms used generally to describe the process of educating people with disabilities to use fixed-route public transportation.
Contrast sensitivity
the ability to detect differences in light and dark areas in a visual pattern " different shades of grey on a background" Crucial for environment navigation
Visual attention
the ability to search, scan, and identify an object and filter out unnecessary details
Empathy
the ability to understand and share the feelings of another
Universal Design
the creation of settings and equipment that can be used by everyone, whether or not they are able-bodied and sensory-acute
Diplopia
the perception of two images of a single object
Heterotopic Ossification
the presence of bone in soft tissue where bone normally does not exist
Visual perception
the process of being able to understand what is being seen.
Psychoeducation
the process of educating patients about research findings and therapy procedures relevant to their situation
Negative reinforcement
the reinforcement of a response by the removal, escape from, or avoidance of an unpleasant stimulus
Perseveration
the uncontrolled continuation or repetition of a motor action or task. - bring attention to the perseverated behavior - provide redirection when perseveration persists in activity - design intervention to include repeated performance of specific skills
Dupuytren's Disease
thickening of the fascia within the hand that causes the affected fingers to form flexion contractures.
Primary healing
when a surgeon can secure bone fragments using a plate, screws, or both.
