NBCOT Study

correct positioning for feeding

-feet flat on floor -back supported by chair -bottom is in the back of the chair -arms supported so the shoulder girdle is stable and thighs are level

scapulohumeral rhythm

-first 30 degrees of shoulder abduction, the scapular remains stationary -for every two degrees of hflenohumeral movement, for every 1 degree fo scapulothoracic movement

superficial partial thickness burn

-first and second degree -involves the epidermis and possibly the upper dermis layer -sensation is intact -recovery is 2 weeks or earlier -no skin graft needed -can do the simswinsteen, pain scale

myopia

-nearsightedness; having difficulty seeing objects further away -common cause of impaired vision in people under 40 -can be corrected with eyeglasses, contact leses or refractive surgery

Symmetrical Tonic Neck Reflex (STNR)

-neck and arms will flex while legs extend. -everything is symmetrical, both arms are the same, both legs are the same -6-12 months

ATNR (asymmetrical tonic neck reflex)

-0-6 months (looks like dabbing) -when you turn your head your arm and leg extend in the direction that your face is turned and on the head side, arm and leg with flex -(asymmetrical both sides are not even) -will have trouble bring hand up to mouth

Early Childhood Education

-3 to 5 years: -Individualized Education Plan (IEP)

reasons someone may need a prosthetic or be an amputee

-congenital deformity -traumatic amputation; limb is severed during a traumatic accident -surgical amputation; due to infection, cancer, or other diseases

rotator cuff tears/tendoitis

-degenerative process -not all require surgery -complete tear/partial tear usually occurs with increasing age populations

role of OT in the development of a child with CP can be

-development of postural control by reducing muscle tone and improving ROM, develop antigraity trunk flexion and extension, isolated finger movements, reach, grasp, voluntary release activities, hand eye coordination, bilateral hadn't use activities, sensory integration, sensory modulation, sensory discrimination and perception, visual perception, visual discrimination, visual motor integration, prewriting/handwriting skills, enhancing or supplementing speech and writing alternatives

levels of service an OT can provide

-direct service -monitoring service (communicate with the teacher on how things are going) -consultative (consult twice a semester to follow how the chair adaptations are going) (need to be written on the IEP)

an OT is assessing a client who present with shoulder pain. the OT has the client flex their shoulder and elbow to 90 degrees concurrently. they then internally rotate the humerus on the, at which point the OT provides slight pressure. which special test is this describing

-information seeking question answer: hawkins-kennedy test

cervical rotation

0-60

shoulder extesnion

0-60

shoulder internal rotation

0-70

forearm pronation

0-80/90

forearm supination

0-80/90

shoulder external rotation

0-90

Discharge from Phase I of the MET level the patient needs to be at

3.5

at which Ranchos level is a client able to learn new things

Level 7

Parkinson's disease medication

Levodopa side effects; nausea and vomiting and dyskinesia

Transient Ischemic Attack (TIA)

Minor stroke; where neurological function is regained quickly with time -warning of a CVA

An OT communicates with a 3rd grade teacher frequently, through emails, to make sure Kelly, an 8 year old, has been following through with organization strategies with visual cues. what kind of service is this?

Monitoring service

the position of comfort is the position of deformity is something we want that has contractors? do we want their position to be comfortable?

No, we don't want the contracture begin to feel normal to them. Put them in a more functional position

MET levels are

The amount of energy it cost to complete a task as indicated by the amount of oxygen consumption it requires to complete a task

pendulum exercises

Unweighted in acute phase Do NOT activate muscles, body rocks with joint totally relaxed and bodyweight moves shoulder -good for rotator cuff injuries

third degree burn

a burn involving all layers of the skin; characterized by the destruction of the epidermis and dermis, with damage or destruction of subcutaneous tissue -involve the nerve endings therefore the pt experiences minimal pain

an OTA observes a 7 year old child with CP leaning forward in his wheelchair. As the child is at risk for falling out of his wheelchair, was is the best seating adaptation the OTA can provide for this pt

a chest harness

Solitary play

a child plays alone, unaware of any other children playing nearby

you would use a swiveled spoon for a person with tremors rather than a weighted spoon with a person with

a weak grip

If you're working with a patient at a SNF and they have COPD, what do the O2 stats need to be to take the to therapy?

at least 90%

what are some symptoms of diabetic retinopathy

blurred vision, visual field loss, floaters, poor night vision, impaired color vision, dark, patch areas of visual loss within the visual field, reduced contrast sensitivity

body on body righting

body de-rotates into alignment when a stimulus is applied to the long axis of a limb segment

Wallace Rule of Nines

formula for estimating medium to large burns in adults, determines the percentage of body surface burned by using multiples of nine; not accurate when used with children Head and Neck: 9% Each upper extremity: 9% Each lower extremity: 18% Front of the trunk: 18% Back of the trunk: 18% Genitals: 1%

temporal lobe

function: auditory, hearing

cerebellum

function: controls movement and coordination

cosmetic or passive prosthesis

has no functional parts and is made to look like the remaining limb as much as possible, including the color

you cannot do anything to a pts hand until you

have a prescription from a Dr.

coated spoon

have a vinyl coating over the boal

congestive heart failure (CHF)

heart is unable to pump its required amount of blood to meet the metabolic means of the body

individuals with multiple sclerosis you're not supposed to

heat them

Modalities for pain relief and tissue healing

heat, ultrasound, cryotherapy, paraffin, and transcutaneous electrical nerve stimulation (TENS).

Cancer patients cannot use which PAMS

heat, ultrasound, diathermy, because heat can metastasis a tumor or cancer cell -Only can use cold pack but make sure they do not have decreased sensation

after a stroke a client has difficulty orienting to relevant visual stimuli on the left side, including food on the plane and grooming items on the counter. the client completes feeding and grooming tasks swiftly and with reduced effort. what symptoms would the OTR report in the clients evaluation results

hemispatial visual neglect

saccades test

hold two different colored pencils 6--8 inches apart, about 12 inches from the face, ask patient to look at one and then the other - note the accuracy of fixation then move the pencils into another quadrant and ask again

empty can test

holding arms out at 90 degrees, taking thumb and dipping it down as if you're emptying a can

Anterior Cerebral Artery (ACA) CVA

impairments in speech, problem solving, executive functioning, personality, smell, judgement

visual hemi neglect

inability to pay attention to or notice stimuli from one-half of the visual field treatment: sitting on their affected side, place things on their affected side

performance capacity

includes the physical and mental skills needed for performance and subjective experience of engaging in occupation

volition

includes thoughts, feelings that motivate people to act and is comprised of personal causation, values and interests

ergonomic keyboard

keyboard that is curved to position the wrist and hands in neutral positions during typing tasks -used by people who type extensively to prevent repetition motion deficits

main stabilizers of the scapula

levator scapula, rhomboid, serrates anterior, and trapezius

cooking is not specifically covered by

medicare

club house setting

members, OTs, Social workers are all members of the club house -focuses on strengths instead of weaknesses -state and federally funded -OTs are most of the time not at club house settings due to the lack of funding

a pt who has had a CVA is very distractible and requires continual verbal and tactile cues to eat an entire meal. The first step in grading this self-feeding task is to

minimize extraneous visual and auditory stimuli

hunintins disease

central nervous system -start with fidgeting then become rigid like Parkinson's

spina bifida myelomeningocele

cerebrospinal fluid and spinal nerves exit vertebral column; most serious

Sideways Parachute AKA side extension reflex (protective extension sideways)

child pushed to one side they are able to extend arms off to the side -develop at 7 months

parallel p

children play with similar toys in similar ways, but not together

motor symptoms in an individual with MS

clumsiness, muscle weakness, fatigue, intention tremors

Colles fracture

complete fracture of the distal radius at the wrist with dorsal displacement -most common type of wrist fracture

CRPS

complex regional pain syndrome (formerly reflex sympathetic dystrophy)

what are the three best ways to decrease edema

compression garments, elevation, and movement (ROM)

when a child is standing holding onto the couch they are

cruising

superficial theramal agent modality

cryotherapy, hot pack, fluidotherapy

E stem

electrical stimulation

plantar reflex

elicited touching the soles of the feet. toes curl downward. (birth to 8 months)

extensor tendons

extensor digitorum communis (EDC), extensor indicis proprius (EIP), extensor digiti minimi (EDM) these tendons cross the wrist dorsally under the extensor reintiaculum

which muscles extends the thumb

extensor pollicis longus, extensor pollicis brevis

unilateral neglect

failure to respond to the control lateral side -A syndrome in which people ignore objects located toward their left and the left sides of objects located anywhere; most often caused by damage to the right parietal lobe

ACA (anterior cerebral artery) stroke

few things associated with these types of strokes; contralateral hemipersis or hemiplegia, impaired judgement, apraxia,

you are attending a workshop on the importance of prone positioning for the Covid-19 pt. during a tea break you overhear a colleague discussing a pt with some of the other workshop participants, initially, you identify which patient is being discussed as you are familiar with their cars but then this colleague states the pts full name and age. what code of ethics is being violated in this scenario?

fidelity -therapist shall treat clients, colleagues, and other professionals with respect, fairness, discretion, and integrity

a pt who has a full-thickness burn to the dorsal of the entire hand is referred to OT for ROM exercises. There is questionable tendon involvement. The best method of performing the exercises is to

flex one joint at a time while maintaining the the remaining joints in extension

Phalens test for carpal tunnel

flex the pts first flexed in a reversed prayer position with slight pressure, if numbness and tingling it is positive for carpal tunnel

the posture of a newborn is primarily

flexed; unless if a premie they will be in extension -if a premie they will be bundled up to flexion in the NICU to activate proprioception

someone with flexor tendon injury you're supposed to splint them into

flexion

flexor tendons

flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP) -long and thin in the hand compared to other areas of the body

development starts out

symmetrically ex. if a question says A symmetry look for other cues that there is something neurological going on (can be in an infant, child, or 60 year old CVA pt) cva pts faces are a symmetric

legal blindness is defined as

visual acuity of 20/200 or less in the better eye with the use of a corrective lens

a pt who has had a R CVA reports frequently losing the place on the page when reading. the most important compensatory strategy for this pt to use is

visual cueing. -such as using a ruler to keep the pts on the proper line to read, or to use their finger to follow along

simon says tests

visual memory, hand eye coordination, sequencing, visual attention

a retired surfer recently got injured and snow working with a COTA. the COTA decided to incorporate a surging task to increase range of motion because the patient loves surfing and is motivated to participate. what cognitive process has the COTA incorporated into treatment according to MOHO

volition

specific tests for edema in hand therapy will be

volunteer or centimeter tape

ways to decrease edema

movement, contrast baths, elevation, massage, and compression

every single functional grasp pattern requires

opposition; the ability to get your thumb to your pinky finger

coated spoons are used with people especially for kids who have

oral hypersensitivity

1st handwriting grasp

palmar supinate grasp

hemiplegia

paralysis of one side of the body

a pt who has had a CVA requires supervision when performing ADL's. the family is available in the evening and at night but cannot provide assistance during the day. the best discharge for this pt would be

participation in an adult daycare program

Duran protocol for tendon repair of flexors

passive flex & ext of digit 0-4.5 wks: dorsal block splint, exercises w/ PROM 4.5-6 wks: active flex & ext w/ splint 6-8 wks: tendon gliding, light activity 8-12 wks: strengthen -PAGS

An OTR receives an order to work on a non resistive exercise program with a patient who had a shoulder fracture 2 weeks ago. Initial OT treatment should include

pendulum exercises

kinesthesia

perception of the body's movement through space

myoceogravis

peripheral nervous system -affects the communication between nerve cells -wakes up in the morning with perfect energy then by lunch has droopy face and very low energy and super fatigued, once a nap is completed the body is able to resupply and she will wake up normal

which frame of reference focuses on the person, context, and task interaction?

person, environment, occupational performance (PEOP) -focuses on an interaction of person centered factors and environmental factors that either support, enable, or restrict the performance of the activity, tasks, or roles of the individual, organization, or community

5th hand grasp for a child (18-24 months)

pincer grasp

incomplete SCI

preservation of sensory and/or motor function in the lowest sacral segment

plantar grasp reflex

pressure both ball of foot causing the toes to flex -birth - 9 months

positive supporting reflex

pressure to ball of foot causing your leg to extend

palmar grasp reflex

pressure to the palm causing the digits to flex

Tertiary prevention

prevention that focuses on people who have already been affected by a disease. Goal is to improve their QOL -Preventive measures aimed at rehabilitation following significant illness. at this level health services workers can work to retrain, reeducate, and rehabilitate people who have already developed an impairment or disability. trying to improve the patients QOL and reduce the symptoms ofS a disease they already have. Seeks to reduce the effects of the disease once established in an individual

Cultural context

related to the society where individuals are raised in and at how the culture affects behavior ex. dressing up for halloween

Gillian barre syndrome pts that are recovering you can work on

remedial approaches, push the exercises, increase the activity

cones

responsible for color, fine detail, central vision (the macula has the highest concentration of cones)

an older adult client with a history of falls and glaucoma is refereed to OT for evaluation and intervention. Which strategy should the OTR teach the client to compensate for impaired vision due to glaucoma

rotate the head to choose clothing from a closet

text to speech is a

software and app that allows the use to listen to text already written on the screen -assistive technology -college study with dyslexia

8 muscles of forearm

-4: pronator teres (causes pronation and supination), flexor carpi radialis (causes flexion and radial deviation), palmaris longus (only tendon that does not go through the carpal tunnel; some people have it and some don't) causes wrist flexion), flexor cardia ulnas (casques ulnar deviation and flexion of the wrist) -1: Flexor digitorum supeficialious (goes to the middle falanx the last 4 fingers; "bye bye fist" -3: flexor digitorum profundus: goes all the way to the tips of the fingers allows you to make a deep fist, flexor pollicis longus; (flexion of the thumb), pornatnor quadrates; causes you to flip the hand over -4 superficially, 1 in the middle, 3 deep (4-1=3)

you are working in an out-patient clinic, you have a 36 year old pt who is a stenographer at a courthouse. she comes to you with complaints of pain at he elbows, difficulty with typing, and some wrist drop. her grip strength on her affected side is 50 percent

1) what is the most likely diagnosis? -Radial nerve injury = radial tunnel syndrome from compression of the radial nerve at the elbow due to 2) which assessments would be best? -Grip strength, ROM, MMT, Minnesota 3) what are some treatment options? -dynamic extension splint, MCP and PIP need to be supported. splint needs to be a long arm elbow splint due to pain at the elbow

during the initial eval of a pt who has had a right CVA, an OTR observes left shoulder elevation and elbow flexion when the pt yawns. the OTR should document this finding as a/an

associated reaction

OT Models

come after theories. You're applying a specific intervention the can be used in any setting. Help with analysis of occupational profile.

Gillian barre syndrome pts that are not recovering you will need to work on

compensatory strategies

OT interventions with ALS

compensatory; built up handles, energy conservation and work simplification techniques, transfer safety, management of dysphagia, food consistencies, liquid thickening, maintaining skin integrity, PROM, strength and endurance within current abilities, preventing contractors, dyframatic breathing, avoid cold environments that can increase spasticity, universal cuff, foot drop splint, high back and recline walker, power wheelchair with controls

your client sustained a low back injury while lifting packages at his job. he has participated in a work hardening program for 8 weeks, as the OT how will you determine his readiness to return to work safely?

complete a functional capacity evaluation

smiths fracture

complete fracture of the distal radius with palmar displacement

a pt who had a distal radius fracture reports excessive pain and burning sensation in the hand during PROM. The OTR also notes that the pt has moderate hadn't edema, shiny skin, and sweaty palms. These symptoms are most likely indicative of

complete regional pain syndrome (reflexive sympathetic dystrophy)

Primary and Most Severe Complication of distal radius fracture is

complex regional pain syndrome

a pt who had a left CVA a month ago reports constant pain in the right arm. The OTR notes that the pts right hand is hypersensitivity and the skin is mottled. this condition is indicative of

complex regional pain syndrome

Somatosensroy system

comprised of three major sensory systems that drives and supports our praxis (learn better motor planning) -tactile, proprioceptive, and vestibular (swinging, scooter board, or rolling) systems

brocas aphasia

condition resulting from damage to Broca's area, causing the affected person to be unable to speak fluently, to mispronounce words, and to speak haltingly

low vision

condition that cannot be corrected by surgery, glasses, contact lens or medicine with 20/80 or worse visual acuity

COTAS are not allowed to

conduct the initial assessment, discharge paperwork, progress notes, reassessments

visual spatial relations

ex. if you were to enter a room that you're not familiar with you will have a hard time judging how much space to walk between furniture. can not determine how far things are spaced

parksinons disease treatment

rubber shoes, avoid crowded places, weighed utensils, caregiver training, no thin liquid through straws, remove distractions, motility portions of food, soft food consistency, communication should be large paper, speak in a way for short responses, have the pt use a mirror so they can be aware of their facial expressions. for rigidity and pain use moist heat, stretch. Group therapy increase motivation, decrease bradykinesea, increases mood. timing of medication is important = medication management **high fall risks due to postural instability -they have orthostatic hypotension

the home program enable the client to perform

safe exercises at home between therapy sessions to ensure continued progress towards goals

a client reports diplopia and demonstrates asymmetrical pupil sizes and a droopy eyelid. what would be most appropriate for the OTR to evaluate

oculomotor funciton

walls and floor (kata)

of the river are the social and physical environment, and they impact the flow in the same way that the walls and floor of a real river impact its flow

parkinsons

often presents with rigidity and tremors -the neurons die. lack of dopamine is what causes the tremors -5 stages -beginning stages. the tremors are subtle (not a huge pack on function or ADLs, focus on strengthening, Big and loud program) -diagnosis does not occur until midway through the progression

population you would most likely see rotator cuff injuries

older generation due to wear and tear -or those who do a lot of overhead tasks

if you have a pt with left sided visual neglect, how would you place items for the pt with a remedial approach

on her left side

4 muscles that make up the rotator cuff

supraspinatus, infraspinatus, teres minor, subscapularis (SITS)

environmental controls

systems that operate the environmental control of a house, using adapted methods ex. alexas to turn on the lights, heat/AC, tv, answer the telephone, electronic locks, automatic locking doors, motion censored lighting for those with poor vision

a client has severe low vision secondary to diabetic retinopathy. the client wishes to independently cook family meals. which client factor would be most important to assess prior to engaging the client in a cooking activity

tactile discrimination

visual memory

the mental representation of information as images

visual memory

the mental representation of information as images -ex. a shopping list

visual memory

the mental representation of information as images -memory games, matching card games etc

treatments for CVA pts with difficulty with limb control

trunk strengthening, set-up occupations in arm length, compensatory strategies and environmental adaptations

adaptation

-compensatory -ex. providing a child with velcro or elastic shoe laces

important to monitor the electorcardiogram and blood pressure and pulse

-they can drop extremely quickly if the pt sits up too quickly resulting in passing out. -you will monitor them (while in pt) before, during, after activity, and 5 minutes after the activity

rocker knife has a

curved blade. the handle maybe similar to a table knife or maybe T shaped -rocker knives are used by people with hand weakness, arthritic deformities and people who have use fo one hand

Phase 1 of wound healing

inflammatory phase -characterized by inflammation -Begins when the wound occurs, then will last between 3-5 days -clearing of debris and preparing for wound repair -make sure the wound is healed and maybe use saline

primitive reflexes:

initiate motor responses that aren normal in an infant that occur only under stress; tired, feeling hungry -integrated as the infant gains more motor control -their emergence in adults interferes with the recovery process.

What item should an OT first address in a 60 year old forklift operator who just a had a below the knee amputation?

inspect the skin for any skin breakdowns

associated reaction

involuntary and automatic movement of a body part as a result of an intentional active or resistive movement in another body part

myocardial infarction (MI)

heart attack; death of myocardial tissue (infarction) caused by ischemia (loss of blood flow) as a result of an occlusion (plugging) of a coronary artery; usually caused by atherosclerosis; symptoms include pain in the chest or upper body (shoulders, neck, and jaw), shortness of breath, diaphoresis, and nausea

brunnstrom approach

how we see peoples tone flaccid tone to spastic tone develop synergestic patterns

visual perception

how your brain processes visual stimuli

visual recepiton

how your brain receives visual stimuli/input

Three bones that make up the shoulder

humerus, scapula, clavicle

specific tests for vascular in hand therapy will be

observing for color and trophic changes such as pulse and skin temp -test for allens test (always check the side that the pt is not having pain before checking the side they are experiencing pain)

4 types of spina bifida

occulta, closed neural tube defects, meningocele, myelomeningocele

temporal context

the expectations that people have on past experiences

peripheral nervous system

the sensory and motor neurons that connect the central nervous system to the rest of the body

Adaptive equipment

something you physically give to a patient to able them to be more independent ex. reacher, socks aid -compensation

brunstrum approach

6 stages of recovery 1) flaccidity 2) primitive synergies patterns that improve motor control 3) voluntary movements 50/50 4) more voluntary movement less synergy 5) way less synergy and more voluntary movement 6) isolated movements

Normal heart rate range

60-100 beats per minute

if somebody burns their entire UE

63%

Medicare part A covers those

65+ years and older

child starts cruising at __ months

7-10 months

with both second degree partial thickness and third degree burns the rule of thumb is

72 hours after the burn you can start a splint and ROM regime -if the client has had a skin graft you need to wait 7-10 days before splinting and ROM -skin grafts are very common with 3rd degree burns

carpal tunnel syndrome

A condition caused by compression of the median nerve in the carpal tunnel and characterized especially by weakness, pain, and disturbances of sensation in the hand and fingers -splint wrist in neutral = wrist cockup splint -first address the edema and pain then have the pt start moving

Anosognosia

A condition in which a person with an illness seems unaware of the existence of his or her illness.

Multiple Sclerosis (MS)

in different forms often have periods of exacberations and remissions -important to educate the family and caregivers about exaggerations and remissions due to the family thinking the pt faking it

cordovan stitch

ACL Level 5

Running stitch

ACL level 3

Whipstitch

ACL level 4

Phase I of MET level

ACUTE inpatient rehab/hospitalization -cardiac rehab begins in hospital recovery following a cardiac event or surgery -the patient is medically stable but is still closely monitored -vital signs taken prior to each activity, at the peak of the activity, immediately after stopping the activity, and 4-5 minutes after the activity. -The patient will be tired and weak; therefore, evaluation and intervention will be taken at bedside with activities at met level 1-2. EX. bed - wheelchair mobility, transfers from bed - chair, bath and grooming and feeding while sitting -IMPORTANT to make sure the patient is not in any pain and has a regular pulse before starting any activities. IMPORTAT PRIORITIES: Family and patient education: energy conservation, work simplification, cardiac and postsurgical precautions, and guidelines for appropriate activity levels. -improve self-care activities (ADLS) -DISCHARGE FROM PHASE I once the patient can perform at MET 3.5

disease someone might have that is affects the central nervous system

ALS

visual spatial relations

Ability to identify when one form (or part of a form) is turned in a different direction. ex: backwards letter ex of deficit: may have difficulty with right and left

sequential memory

Ability to remember a sequence or chain of letters to form a word

custom contoured cushions are

molded to fit the client

also with required brain injury

decreased postural control, ataxic motor movements (shaking hands when reaching for something), and visual impairments and sensory damage

client factors

differ across practice settings -peds; play and sensory integration -dementia patients; cognitions and memory as well as ADL status.

visual closure

difficulty finding object if in incomplete form (covered partially) -ex. a backpack that is only showing half due to a blanket being over it

dysphagia

difficulty of swallowing

2nd handwriting grasp

digital pronate grasp

second-degree non-partial thickness burn

ex. blisters from bad sunburn, or blisters from hot water -heal on their own due to no tissue being involved

ideational apraxia

ex. handing a pt a brush and the pt using it as a toothbrush -unable to idealize an object. Not knowing the purpose of an object -can follow simple tasks -issue in following a sequence of steps to follow a task

contractual apraxia

ex. if you take a pt to the fridge and ask them to make a sandwich they won't be able to figure out how to make a sandwich. they won't know how or what they would need to make one

number 1 cause of falls for the elderly is due to the

fear of falling -they over compensate and walk slower

photophobia

fear of lighting -too much lighting can actually be painful for these folks

D1 flexion

Beginning with arm at sides > flex and add shoulder - crossing midline, external rotation, supination, finger flexion. eg. pulling a sword

Behavior Model

Behavior is learned and it can be unlearned -Teach, reinforce, facilitate change EX. relaxing strategies for stress; yoga/meditation

Therapeutic use of self

Being hands on and actively participating in the clients goals

dense conective tissue (DCT)

Bone, capsule, ligament, and tendon

the COPM is the only standardized test that tells you how your patient

feels or how they are performing

occpital lobe

function: vision

terminal device (HOOK)

more functional than a hand, less cosmetic. provides better precision for small objects, better visual feedback, easier to maintain, weighs less and costs less

spina bifida occulta

most common and least severe form of spina bifida without protrusion of the spinal cord or meninges

tenodesis

functional grasp pattern typically used by those with a C6 SCI

judith is a 58 year old woman with diabetic retinopathy. She is in the early stages of visual impairment. What home modifications should the OTR recommend during this stage of her treatment?

help judith clear the clutter from her main hallway

Middle Cerebral Artery (MCA) CVA

impairments in touch, pressure, taste, body awareness, hearing, speech

developing a home program for cardiac rehab

importance of activity guidelines, pacing, social and sexual activity guidelines, risk factors of activities

associative play

Children interact, observing each other and sharing material, but their play is not yet mutual and reciprocal. -interested in joining others in their play activities

The most severe complication of hand fractures is

Complex regional pain syndrome (CRPS)

procedual justice

Complying to rules and lawas

thoracic outlet syndrome (TOS)

Compression can happen at; scalene triangle, costoclavicular space, and pec minor -vascular damage is uncommon -majority of TOSis brachial plexus related

ligaments

Connect bone to bone

OT practitioner consulted with the 1st grade teacher about 1-2x per year about a sensory diet for john who needs help organizing sensory input. The OT provided a sensory a diet with suggestions in the classroom including weighted vest, trampoline, weighted lap pad. what type of OT service is this?

Consultative service

altruism

unselfish concern for the welfare of others

Duchenne muscular dystrophy

is progressive and causes crippling and immobility.

If a five year old has primitive reflexes during the eval what does that tell you

its not typical -reflexes should integrate within the first year

MET 7-8

jogging 5 mph

Parkinson's Disease (neurons)

upper extremities will present with resting tremors, cogwheel rigidity, and gait pattern -no notice of impact of independence or function till halfway through the disease

Gillian barre syndrome is due to the

peripheral nervous system -causes demyelination

ALS

peripheral nervous system -lose control of muscles

Stage 1-3 of Dementia Interventions

planners, labels, organizers -patients will have short term memory loss and difficulty with high level IADL

unoccupied play

playing alone with little movement -seems random and without purpose. This type of play is more about observing and taking in the world around us

MMT 2-

poor - -part moves through incomplete ROM with gravity eliminated

strabismus

Crossed eyes resulting from a weakness in eye muscles

PNF

D1 and D2 patterns

receptive aphasia (Wernicke's aphasia)

Difficulty understanding verbal or written words. Impaired auditory comprehension and feedback

conceptual apraxia

Difficulty with use of tools -ex. using a toothbrush as a hairbrush -don't understand the point of a tool. if a pt saw a hammer they won't know what its for.

An OT works with 4 students in 2nd grade classroom during regularly scheduled handwriting time. The OTA would be present for the handwriting session and work directly with the children designated on IEP's. Before session, the OTA encourages warm up exercises and provides verbal cues fore beginning the assignment. What type of service is this?

Direct service

Developmental Motor coordination disorder

Dyspraxia (without the skill) AKA Dev -dysparxic child may look; clumsy, and not be able to plan out their movements, shrugging to sit on a bench and tie their shoe followed by getting on a balance beam, excessive motor delays -adaptive equipment for a pencil if they have handwriting issues,

macular degeneration (MD)

progressive blurring of visual loss of central vision (C= cones, central, color, clarity, contrast senstivity)

Adaptive Strategy

EX. using the environment or pts bodies around you to be independent ex. spinal cord pt dressing in bed with their head and upper body against the headboard to compensate for lack of trunk control

radial tunnel syndrome

Entrapment of the radial nerve in an area extending from the radial head to the supinator muscle -pt will have a burning pain in the lateral forearm non-operative treatment long arm splint with elbow flexed forearm supinated, wrist in neutral, pain free ROM, nerve glides, activity mods operative treatment: long arm splint with elbow flexed, forearm supinated, wrist in neutral for 2 weeks then wrist cock up splint for 2 more weeks, PROM and AROM pronation and supination, hand strengthening exercises at 3 week. and resistive exercises at 6 weeks.

MMT 3+

Fair full ROM against gravity min resistance

Phase 2 of wound healing

Fibroplastic/Proliferation -characterized by the presence of fibroblasts -lay down collagen and myofibroblasts that in turn can cause wound contractors Collagen is deposited in a random and disorganized fashion resulting in contractures

Bennett fracture

Fracture at base of first metacarpal

when reviewing a pts medical chart, the OT notices that the pt has abnormally high intraocular pressure. What is the pts medical diagnosis, based on this information?

Glaucoma

combination of dementia and Parkinson's

Huntingtons disease

Phase 3 of wound healing

Maturation/Modeling phase -Maturation stage can last months - years -typically 50% of strength is regained at 6 weeks -strength will most likely return to 80% when compared to normal skin -collagen continues to cross-link and tensile strength increases

MET

Metabolic Energy Test

C1 SCI

No diaphragm control, required continuous mechanical ventilation

Volition

Personal causation values interest ex. a person valuing work -showing enjoyment and pride

lateral pinch

Prehensile pattern used to grasp a small item with the thumb opposed to the radial side of the index finger (e.g., placing a key in a lock)

Veracity

Providing correct information about OT profession and services

proper positioning of an arm while seated in a wheelchair

rest the arm on in the inclined padded arm troft to avoid shoulder traction and weight on the arm throughout the day -places in the arm in a neutral position

word prediction

software and app that predicts what the use is going to type based on the first few key strokes -people with learning disabilities or poor fine motor control will benefit from this -individuals with ASD

homonymous hemianopsia

The loss of the right or left half of the field of vision in both eyes. -vision is lost in the same half side of both eyes

An OTA is treating a carpal tunnel pt for the last time in a hand therapy clinic. the pt has met all her goals and reports decreased pain n her carpal tunnel region. the pt asks if she can continue to come into the clinic to receive paraffin because she likes how it makes her hands feel soft. if the OTA says yes, what ethical principle would she be violating

beneficence

Ranchos Los Amigos level 1

client is unresponsive

Beneficence

client safety and well-being are the primary concern

kawa model

applied to OT in 6 steps 1) appreciate the client in their context 2) clarify the context, identifying each component of the river metaphor and how it might be impacting flow 3) prioritize the issues that are most important to the pt 4)to assess the focal points of intervention by identifying what must be done with the previously identified issues in order to improve river flow 5) intervention or acting upon the plans discussed in step 4 6) evaluating the results

a pt who has deep partial-thickness burns on both thighs develops increased lower extremity edema when standing. To minimize edema, the OTR should recommend that the pt

apply compression wraps to entire lower extremities

what does a kyphotic posture look like

arched upper back

services for pediatric in the school system is always

are educationally related -OT is providing strengthening, regulation, or activities that help the child access the curriculum -educationally relevant

after a child can roll over the child can then

army crawl -belly is on the floor -prone extension

a 56 year old pt who lives with his 28 yer old daughter has recently started to experience difficulty identifying items in his pantry when a different brand is bought or the items are not facing with the label in front. Which of the following adaptations would assist the pt the most?

arrange the items in the pantry to be clearly visible and placed upright on the shelf

Ontogenic Motor Patterns (Rood Approach)

supine withdrawal, rollover, pivot prone, neck co-contraction, prone on elbows, quadruped (all fours), static standing, walking

independent living centers

clients with a combo of physical and mental health that are seeking assistance on a variety of things such as housing, income, etc. -ex. running a woman's group once a week and they are looking for assistance for childcare

difficulty with topographic skills is common post CVA

This is difficulty with finding your way through space. -pt won't be able to read a map, or can't find their way around their house or new facility

what type of joint is the shoulder?

ball and socket -glenohumeral joint

Personal context

a persons internal environment, derived from stable and dynamic factors such as sex, age, mood, and cultural identity

sheltered workshop

a protected and supervised workplace that offers job opportunities and training at a pace and level tailored to people with various psychological disabilities or developmental disabilities -basket weaving, quilt making, clothes making -simple tasks -get one on one training

Visual Motor Integration (VMI)

ability of the eye to direct the hand and requires combined perceptual and motor skills

visual discrimination

ability to compare and contrast objects

visual figure ground

ability to distinguish an object from its background -ex. finding a seasoning in the spice cabinet

stereognosis

ability to recognize objects by feeling their form, size, and weight while the eyes are closed

visual spatial

ability to understand how objects are oriented in space -ability to tell how objects relate to each other -ex. telling time on a clock

visual motor integration

ability to use both motor and visual skills in coordinating a task

what modality should the OTA avoid with a pt who has seizures

TENS

the parent of a 4 year old child who has a disability explains to a therapist that it is difficult for the child to leave home because of sitting instability on standard size toilets. the best adaptation would be for the child to

to use a portable reducer ring on the toilet

carpal bones

Some Lovers Try Positions That They Can't Handle Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate

an OT is working with a pt with diabetic retinopathy on adapting her home to compensate for low vision. Before introducing adaptations, the therapist tries several low tech and low cost interventions, including increasing the level of lighting in areas where most of the patient activities occur, reducing glare, clearing walkways and reducing clutter in the common areas in her home. after several weeks, the pt disease has progressed, and she is no longer able to read the dials on her stove. What adaptation should the OT introduce to help the pt set her stove for cooking tasks

Tactile pen marks on common stove settings

MOHO is comprised of

Volition Habituation Performance Capacity Environment

visual field neglect

absence of awareness of stimuli in a particular visual field -inability to perceive stimuli in one hemispace, contralesional to the cerebral injury.

radial head fracture

accounts for 33% of elbow fractures -caused by a forceful load through an outstretched hand

cooperative play

activity in which children actually play with one another -type of play that we learn to work with others, accept rules, and form social bonds

isotonic exercise

activity that combines muscle contraction with repeated movement

measure the widest point of the wheelchair

add 2 inches

Infraspinatus function

adducts the arm and lateral rotation of arm

a pt with heart failure lose his job as a ware house worker and has beed depressed for over 6 months. the pt would lie to receive mental health services but he only receives social security disability income and does not think he can afford it. what is the best advice an OTA can give to the pt

advise the pt to sign up for medicare part B -pts who receive social security disability income (SSDI) are eligible for medicare part B benefits for a monthly premium payment. Medicare part B covers mental health

OA (osteoarthritis)

affects bigger joints of the body due to wear and tear over time -can cause bone on bone, will need a joint replacement

a respiratory condition

affects your breathing

if someone has an extensor tendon injury what intervention

after a surgical repair are exercises to prevent adhesions, modalities heat to gradually prepare the tissue for motion, MMES to promote tendon exertion and activation, use of modalities once cleared by the physician, HEP to insure the client safety and progress towards the goal, tendon glides, ROM, strengthening until the late phase of repair 8-12 weeks after surgery

AMD

age-related macular degeneration -loss of central vision

clients feel unstable on a ___ cushion

air filled cushion

a 21 month old with severe hypotonia has significant sensorimotor deficits. The child cognition is intact, at age level. the OTR recommends a play activity to enhance cognitive abilities and provide family interaction. What object would best meet the OTs goal?

an adapted puzzle with chin-controlled switch

creeping

belly is off the floor

wrist unit

attaches the terminal device to the forearm socket. designs vary. can be pre-positioned

ASD

autism spectrum disorder -sensory deficits, impaired communication, repetitive behavior or fixed on something (ex. being fascinated and knowing so much about dinosaurs, or race cars etc.) -more common in boys than girls -TREATMENTS: social stories, role play, headphones if sensitive to loud sounds

epidermis is

avascular, outermost layer

major supinator muscle is the

bicep

LSBT big and loud

big motions and loud motion -evidence based on decreasing symptoms and slowing down progression of Parkinson's disease

ischemic CVA

blocks blood flow to the brain, causing lack of oxygen to the brain

Hemorrhagic CVA

blood vessel in the brain burst, causing blood to pool

asymatonogisa

can't figure out their body parts

subacute care

care given in a hospital or in a long-term care facility for people who need less care than for an acute illness, but more care than for a chronic illness

Median nerve injury produces

carpal tunnel syndrome (APE HAND) -symptoms, such as palmar numbness and numbness of the first digit to half of the fourth digit, with generalized weakness and pain

scotoma

clinical term for "blind spot" in the visual fields of vision loss, blurriness, or distortion

if someone has swelling would you use a hot pack or cold pack

cold pack

when assessing for stereognosis, which of the following is an appropriate choice?

cover the pts eyes, and then ask him to identify objects by touch

a therapist is treating 6 year old child who has spastic cerebral palsy and who exhibits an extensor thrust problem. the most beneficial positioning modification to promote proper sitting and alignment in a wheelchair would be

decreasing the angle of the seat to the back of the chair

rationalization

defense mechanism that offers self-justifying explanations in place of the real, more threatening, unconscious reasons for one's actions -ex. having a bad day at work and going home and taking it out on those at home and stating its becasue you had a bad day

denail

defense mechanism to justify behavior. refusing to believe or even perceive painful realities ex. staying you don't remember because im old or really tired. denying that you might have a memory impairment

global aphasia

delays and deficits in both expressive and receptive aphasia

stereopsis

depth percrption

man medication used for iontophoresis is

dexamethasone

COPD (chronic obstructive pulmonary disease)

disease with enlarged lung spaces, usually from smoking can cause shortness of breath

Boutinniere deformity

disruption of the central slip of the extensor tendon -characterized as: PIP flexion, and DIP and hyperextension. isolated DIP flexion exercises are performed -another avulsion injury

ALS and Gullian-Baree Syndrome both start

distal - proximal

PROXIMAL STABILITY GIVES

distal support

isometric exercises

exercises in which one contracts muscles but does not move body parts

crossed extension reflex

flexing one leg while the other extends

Ranchos Los Amigos level 2

generalized response to stimuli: body twitching when name is called

An OTR is evaluating the ADL skills of a pt who had a right CVA. when asked to use a toothbrush, the pt picks up the toothbrush and attempts to use it as a comb. this behavior is most likely a sigh of

ideational apraxia

you are seeing a pt with the diagnosis of cataracts. What are some symptoms the patient may have?

loss of visual acuity, visual distortion, darkening of vision, cloudy or blurry vision -lights may seem too bright or may have halo around lights -other symptoms; poor night vision, double vision, increased nearsightedness, colors may seem to fade, contrast senstivity.

therapeutic exercises provide

motion, to further enhance performance and function to improve ADL performance

oil apraxia

motor planning aspect of speech -difficulty with articulating speech due

joy stick mouse

mouse that uses a joystick instead of a cursor, the device can be operated by hand or mouth. -used by people with severe upper extremity coordination deficits or sever UE weakness -UE paralysis

when deciding down a ramp in a wheelchair

move the wheelchair backwards with all the wheelchair wheels maintaining contact with the floor

main focus of motor control approaches is for

movement

MMT 5

normal full ROM max resistance

complex regional pain syndrome

pain in the injury ( a lot of pain)

2nd hand grasp for a child (5-6 months)

palmar grasp

Early stages of Huntington Disease

personality, cognition, and mood changes

visual discrimination

recognition, matching, and categorization

nonmaleficence

refrain from causing harm to others

after the wound is closed in skin grafting what becomes the main therapy focus?

scar contractions -ROM, soft tissue massage

when fitting a client for a wheelchair you need to consider

seat width, depth, seat height, and seat back rest height

one of the biggest complaints by patients with cataracts is

seeing halos around lights

scapular wining is caused by the

serrates anterior

an OTR is working with a client who has difficulties with visual skills as a result of damage to the central nervous system. which visual skill is related to CNS damage

stereopsis

deep thermal agent modalities

ultrasound

whirlpool

used for pts for pain management, clean out infections

finding the same shape on a piece of paper is working on

visual closure

ALS takes ___ to recover

years

job site analysis/work tolerance

looks to define the actual demands of the job and involves the use of questionnaire, interviews, observations, and formal assessment completed in the real work environment. Many FCEs include a job demand analysis; does not have ergonomic evaluation -counting reps a worker completes in a shift, observing their demands of the job

Pediactric diagnosis; ABI acquired brain injury

loss of consciousness from 0 minutes - 6 + hours with post traumatic amnesia that can last from less than 1 hour - 24+ hours. -injury to the brain is acquired from non accidental trauma, motor vehicle accidents, falls, infection such as meningitis.

skin graft

transplantation of healthy tissue (skin) to an injured site

prudence

using clinical and ethical reasoning skills

sock and glove distribution (Gillian barre syndorme)

weakness usually occurs distally then proximally hands and feet first then works its way to the trunk

Guilian-Barre syndrome takes ___ to recover

weeks, months, days

PEOP

what is the environments impact on the outcome of the occupation -ex. home is very cluttered presenting a fall risk for a pt with Parkinson's disease -appropriate in a work place setting for ergonomics

outpatient cardiac work hardening when would you use it

when the pt needs to get back to their job and requires some modifications

Tonic Labryinthine Reflex (TLR)

when you have increased extension in supine and flexion when you're prone.

dyslexia

impairment of the ability to read

Multiple Sclerosis (MS)

(central nervous system problem) -eventually will get cognitive issues -persons immune system damages the myelin sheath of the nerve cells in the brain and spinal cord -function of the myelin sheath; insulates the sheath to amplify the signal. -slowly progressive disease -lower extremity weakness -in the later stages of the disease when they become depressed, cognitive problems -mornings are more difficult for them

Subscapularis function

(internal) Medially rotates the arm at GH joint

intervention for moderate hypotonia

(poor head control) (think of baby prone with head down) -best intervention put the child up on a wedge or bolster so they can develop head control

Autonomic Dysreflexia

(potentially life threatening emergency!) HOB elevate 90 degrees, loosen constrictive clothing, assess for full bladder or bowel impaction, (trigger) administer antihypertensives (may cause stroke, MI, seizure)

NDT (Neurodevelopmental Treatment)

**hands on treatment approach** -handling technqiexs to facilitate normal movement patterns

PNF

*diagonal movement patterns*

rood approach

*sensory stimulation* stretching, tapping, vibration, slow stroking. -used for anyone with neurological condition -through using sensory techniques you can get a motor response

Tonic Labyrinthine Reflex (TLR)

- 0 - 6 months - Prone position = Maximal flexor tone ( UE + LE held in flexion) - Supine position = Maximal Extensor tone ( UE + LE held in extension) If persists, it will interfere with : - Ability to initiate rolling - Ability to prop on elbows with extended hips when prone - Ability to flex trunk and hips to come to a sitting position from supine - Often causes full body extension, which interferes with balance in sitting or standing. -a typical tone -the child would look one way in supine and another way in prone

Iontophoresis Contraindications

- Damaged skin or open lesions - Allergy to medication - Impaired sensation to heat or pain stimuli - Presence of flammable sprays or solutions - Electronic implants

Ranchos Los amigos level 7

- Min assit -automatic appropriate -between stages 6-7 can start to learn new things and carry over things learned to the following day (carry over learning) can allow to start focusing on cog reintegration skills, can start reteaching the client ADLS/IADLs -functional activity: simple house hold actives such as dusting, making the bed, taking a shower

Tinels test

- Used for Dx of Carpal Tunnel Syndrome - Physician taps over the volar aspect of the pts transverse carpal ligament - Positive test will cause tingling or paresthesia into the thumb, index, middle or lateral half o the ring finger

Ranchos Los Amigos level 10

- purposeful and appropriate - mod I in all ADL/IADL -functional activities: setup environmental control units (alexa, google, siri etc.) to remind them of their appointments. - able to handle multi tasks simultaneously in all environments including new and old - may require periodic rest breaks if in stressful environment - able to create and maintain their own AE memory devices - able to take an action to avoid problems before they occur - independently think about consequences of decisions or actions - accurately estimate their abilities and adjust them to their tasks - recognize needs and feelings of others and responds appropriately - may have depression - may have moments of irritability and frustration - social interaction and behavior is consistently appropriate - OT- help them to adjust to new life, compensatory techniques for mental losses and to ensure success, return to work, resume PLOF, environmental mod, max safety, can use large calendars and reminders to help the pt

interventions for children with brain injuries

-ADL retraining with hand over hand -picture cards of proper order for putting on a shirt, pants, or take a bath -keep the environment low from distraction -increase their time to complete home and school activities -position equipment for sitting or splints -work on attention to tasks and cognitive retraining -time; to help develop some concentration -keep checklist and or journal of their day to help them develop their memory by writing out schedules -put in quadruped to have weight bearing in all extremities

type of assessments with someone who has had a CVA are

-COPM (interview) -AMPS (assessment of motor and process skills) (observational) -Kohlman evaluation of living skills (observational) -Barthel Index (observational) -NIH stroke scale

Ecology of Human Performance Model

-Choose an activity of the clients ability and grade as the clients skills increase Understanding how the environment can be adapted, modified, and restored to enable effective performance

chronic bronchitis and emphysema

-Chronic bronchitis is a clinical diagnosis: chronic cough productive of sputum for at least 3 months per year for at least 2 consecutive years. -Emphysema is a pathologic diagnosis: permanent enlargement of air spaces distal to terminal bronchioles due to destruction of alveolar walls

what are the two types of connective tissue

-loose connective tissue (ex. blood vessels, skin, and muscles) -dense connective tissue (ex. bone, capsule, ligament and tendon)

Frozen Shoulder (Adhesive Capsulitis)

-Freezing phase: pain starts with sleep and ADL tasks, client tends to limit movement due to an increase in pain -Frozen phase: this may last up to a year and compensate for GH by substituting ST motion -Tha:wing phase: can take up to 20+ months

De Quervains disease

-Inflammation of the tendon sheath of the thumb. -AKA mothers thumb -involves thumb abduction and ulnar deviation -finkelstein test; tuck thumb into palm of hand and ulnar deviating; if pain occurs then positive for de quervains -has pain over the radial styloid -thumb spica splint AKA opponens splint that includes the thumb IP because the extensor pollicis brevis. if the extensor pollicis brevis is flexed it will cause overuse of that tendon

Ranchos Los Amigos level 4 & 5

-Max asset with ADL's = able to complete at least 25% of the activity -confused agitated and confessed inappropriate non-agitated -functional activity: brushing hair or teeth with hand over hand assist

Ranchos Los Amigos level 6

-Mod assit for ADL's -confused appropriate -goal directed behavior; about place time and person -attention is 30 minutes to an activity -can focus on clear goals -functional activity: seated at table and getting simple snack or drink ready with setup

NDT approach

-Neurodevelopment treatment approach emphasizes .relearning normal movement while avoiding abnormal movement patterns. Principles include the normalization of muscle tone, avoidance of synergistic movement and incorporation of the affected side into purposeful activities. -work towards symmetry, weight bearing -2 year old child who has ATNR; handle proximally and do weight shifting to reduce tone, then weight bearing -inhibiting a typical patterns

you are completing a work tolerance screen on a manufacturing worker during their workday, you notice the worker is lifting awkward sized packages which aisles appear to be heavy in weight. while completing the writ up which detail is MOST important include in the documentation?

-OT consultant situation recommend the employer purchase a scale

Glaucoma

-PERIPHERAL VISION LOSS if untreated can lead to blindness -causes increased intaocular pressure in the eye which damages the optic nerve. -intervention; teach pts to scan their environment from left - right with their central vision -permanent vision loss

Rotate cuff no tears or small tears

-PROM and AAROM are initiated -may present with limited shoulder flexion and internal rotation -phase 1: forward flexion and external rotation supine (minimizes excessive tension) -phase 2: extension, internal rotation and cross body strethces

2 important documents before an evaluation on the child refereed for special ed

-Parents consent form - medical referral

two types of sensory integration dysfunctions

-Prone of discrimination; the what of sensory integration (what am i feeling) -the modulation; the how much of sensory integration (ex. putting on socks when getting dressed and your foot feels what the sock is like and cannot modulate the feeling) ((myself as a child with the line on the toes of the socks)) these kids will be really agitated and fussy

Individuals with Disabilities Education Act (IDEA)

-Revision of the old public law, includes services to infants from birth - 3 years of age. -PART C (remember CUTE BABIES) -regular classroom with support -PUSH IN MODEL: sitting next to the child to help them have access to the curriculum -13 diagnosis: (some) deaf and blind, emotional disturbance, hearing impairment, intellectual disability, ortho impairment, TBI, speech and language, and specific learning disabilities

Ranchos Los Amigos level 8

-SBA -purposeful appropriate -functional actives: using visual cues, encouraging call bells for ADLs for safety awareness -pt is oriented but has poor judgement -self centered and do not understand other needs -supervision assistance -safety awareness, insight, and judgement can be greatly impaired leading to being a risk of injury -difficult and stubborn to work with due to being independent but having the lack of judgement -DRIVER REHAB before being able to start driving again -Cannot be left home alone

Rehabilitation Act of 1973:

-Section 504 covers children/students who do not meet the criteria to having an IEP but still need the modification to their day - (any school receiving federal aid cannot discriminate again persons who have disabilities)

Pregnant patients can use which PAMS

-hot pack, cold pack; just not near the abdomen -however be careful with heat due to women already having increased blood pressure

Ranchos Los Amigos level 9

-Stand by assist on request; providing assistance when the pt asks for it. the pt is finally able to have the judgment to determine if they need some safe assistance. -purposeful appropriate -functional activities: providing HH basis; IADLs, medication management, money management, return to leisure, hobby, work activities

ulnar nerve injury

-Two conditions: guyots canal and carpal tunnel syndrome -results in ulnar claw deformity and numbness of the ulnar side of the hand and the fifth and half of the fourth digits, with generalized weakness of the ulnar side of the hand and pain. intervention: ROM, orthotics to protect extremity from motion or allow for protective motion, HEP, tendon and nerve exercises, and strengthening

Tier 1 =

-WHOLE CLASSROOM -not physically putting your hands on a child -ex. talking to the teachers about different types of seating that we can provide in a classroom. rocking chairs, bean bag chairs, stools, etc. provides more variety in a classroom. -universal design for learning; high tech/low tech, looking at access, and informing teachers that kids all learn differently. -an OT being part of a committee that is developing an anti bullying campaign

amyotrophic lateral sclerosis (ALS)

-WITHOUT MUSLCE NOURISHMENT -disease with muscular weakness and atrophy due to degeneration of motor neurons of spinal cord; commonly called Lou Gehrig disease -distal to proximal asymmetrically -the first three stages will not have a huge impact on function -end of stage 3 beginning of 4,5,6 the clients ill be w/c or bed bound; OT INTERVENTION at this point is to provide appropriate w/c seating, bed schedule, and communication device -ALS patients DO NOT lose cognitive function at any time

interventions for someone who has CTD

-acute phase; reduction of inflammation of pain with static splinting, ice, contrast baths, ultra should, -subacute phase; slow stretching, myofascial release, proper body mechanics, static splint in areas that cause pain

some interventions for pts with cataracts

-adaptations including glasses, magnifiers, and bright lighting. Advancing cataracts that limit functional vision must be removed surgically.

other things that can be provided in a classroom for peds

-address sensory and emotional regulation and how it impacts learning -perceptual, motor, cognitive, and organization skills related to academics

rooting reflex

-age to expect: 0-3 months -a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple

swan neck injury

-another avulsion injury -injury to the MCPs, the PIPs, and the DIP joints. -characterized as: PIP hyperextension and DIP flexion and PIP is splinted in slight flexion -two common splints are the silver rings and boutonniere ((he has a lot of PIP and is dipping into the water))

treatment approach for a burn to the dorm of the hand

-avoid flexion contractors, have the splint in a little bit of flexion to stretch out the extensor muscles to prevent shortening of the tendons and muscles.

dressing a 2 year old

-can help remove untied shoes, doff a coat, locate arm holes of a shirt, pull down pants, and remove untied shoes

examples children may present with, with sensory integration dysfunctions

-clumsy behavior, poor tolerance to change; plans or routines, seek or avoid specific stimuli, poor timing of motor planning or difficulty with sequencing or following multistep directions.

three different types of fractures of the wrist

-colles -smiths -bennets

treatment techniques preprosthetic phase

-educate pt on proper hygiene and skin care -wound care -wrapping with special elastic bandages to reduce edema and shape the stump for a prosthetic -pain management and desensitization; with tapping, vibration, fluidotherapy, and weight bearing -mirror box therapy to help reduce phantom pain -scar management, deep heat with modalities such as ultrasound -ROM, PROM, and AROM to prevent joint contracture by the amputation site -strengthening; isometric exercises and general endurance exercises -motor learning and muscle re-education; therapeutic activity -IPOP Immediate post-op prosthesis

Psychiatric Rehab model

-eliminate barriers -promote well-being -develop skills to manage symptoms

cardiac rehab (in patient) phase 1 of occupational therapy intervention

-energy conservation techniques -no lifting of heavy weights -carful with reaching arms over their head

Failure to Thrive (FTT)

-environmental or medical (Children with CP due to fast metabolism) -a condition in which infants become malnourished and fail to grow or gain weight for no obvious medical reason -delays in age appropriate self care skills, play skills, -OT interventions; oral motor skills making sure they can manage food from one side to the other of the mouth, training on eating and feeding schedule, caregiver training on food additives to provide caloric intake needed, pleasurable eating environments, encourage family to have a regular eating schedule

STNR (symmetrical tonic neck reflex)

-for children with higher muscle tone or spasticity EX. brunnstrum approach; use a typical patterns and synergies to get moving... a kid bunny hopping in a clinic (uses a typical patterns to get moving)

a full thickness burn with subdermal injury

-fourth degree burn -skin layers involved: deep tissue damage to fat, muscle, or even possibly the bone -spontaneous recovery is IMPOSSIBLE -skin grafting is required -pt may not make it through this injury

ultrasound gives off ___ to heat tissue to facilitate the healing process and it is important to use ___ with it.

-gives off sound energy -gel; acts as a conductor as the acoustic energy can travel through -can use ultrasound for lateral and medial tendinitis, wrist sprains, scar management -sound frequency should be set at; 3 for the hand and UEs -do not use with someone under the age of 18 because it can stunt their growth plates and cause some type of deformity, OR on those who are pregnant

a person is 5 days post coronary artery bypass graft, he expresses anxiety about performing any type of activity and reports chest pain during ambulation, the cardiology approves activities of MET levels 2-3.

-grooming while standing at the sink

CVA related visual deficits

-homonymous hemianopsia -quadranopsia -can result in visual apraxias

Tier 3 =

-intensive 1:1 intervention -child has gone through the entire tier -follows by recommendation for special education -OT as a related service

2 common types of CVA's

-ischemic (most common of the two) -hemorrhagic

amputation management pre prosthetic phase

-manages the healing process of the amputated limb, prepares the limb for prosthetic use -provide pt with emotional support -phantom limb -manage the hygiene and wound healing at the amputation site -desensitize limb to touch and pressure in preparation fo prosthetic use -assist to shrink and shape the limb

what are the goals of the tertiary prevention

-maximize remaining capabilities -reduce or eliminate complications of an existing disease -restore health for people with existing disabilities

complications of healing a fracture are

-misaligned fracture -pain -decreased nutrient to the area -and decreased healing potential -the age and bone disease also affect healing

standardized test for vision that's best for ages 4-70 is

-motor free visual perceptual test its a non motor visual perceptual test

Occupational Adaptation Model

-not deficit based. used for those who are permanent disability or in the end stages of a permanent disease. EX. at stage 6 of ALS mastery of certain skills is more important than increasing strength. Practice model that includes three basic tenets of person, environment, and the interaction of the person and environment Adaptation is achieved once there is experience with activity modifications followed by mastery of the occupation

3 Phase of Guillain-Barre syndrome:

-onset and acute inflammatory phase: symptoms here are the worse this last 2-3 weeks. no OT during this time until the pt is stable -the plateu phase: symptoms are stabilized and this lasts for 2 -4 weeks most disabling time. focus on comfort, position, anxiety management, and handsfree communication, work on positioning the trunk and head. -Recovery phase: starts 6-12 months and can last up to 2 years. fatigue is still residual

down syndrome

-physical features: slanted eyes, protruding tongue, flat nose, fold over eyes, shortened fingers and limbs, hypotonia and hyper-extension of joints, cognitive impairments, heart defects, -OT treatment: basic ADLs, dressing, shoes with velcro, place on sides of mouth to encourage closing the mouth, repeat a lot of tasks over and over for mastery, early intervention programs and school based OTs. Teach/train problem solving tasks, cause and effect activities, organization skills, vocational and social skills.

Treatment for rotator cuff injuries

-posture reeducation -PROM, AAROM, AROM, -strengthening (if approved by physician) -PAMS (e stim) -manual therapy

when treating shoulder injuries you will treat

-posture reeducation -place them in front of a mirror while completing exercises to get visual feedback -scapular retractions

which job duties can an OTA perform in an inpatient clinic

-prepare the clinic area for a treatment session -assess a meal time feeding group -continue adaptive equipment training with pts

basic principles for a Margaret Rood technique

-provide sensory input to receive muscular reflexes (such as brushing, icing, joint compressions) -used for CP pts

End stage of Huntington's Disease

-pt will have more rigid muscle tone pattern, lost most cognition function and ability to speak

MET 3-4

-sponge bath -golfing, walking slow at 3 mph, fishing -load dishes in the dishwasher -light vacuuming and moping -can carry 10 lbs -CANNOT DO ISOMETRICS; because

MET 4-5

-standing shower (hot) -raking, weeding, table tennis, dancing -sexual intercorse -standing to transfer light items -garden -perform sitting to standing -push a lawnmower -can start increasing reps and speed -up to 2 flights of stairs slowly -treadmill at 1 mph

second-degree (partial-thickness) burns

-two layers; epidermis and dermis are involved, but the nerve endings are not involved -most painful out of the two

describe cubital tunnel syndrome

-ulnar nerve compression at the elbow -numbness and tingling/pain at the 4th and 5th finger -get the fingers into extension and wrist in neutral with a long arm splint to get the arm into neutral at the elbow

a COTA works on an inpatient neurological rehab unit. Which continuing education activities can a COTA engage in to meet the requirements for renewing his NBCOT certification

-volunteer for the local branch of the national multiple sclerosis association -read an AJOT article on neuromuscular re-education and write a report on how the information in the article has helped improve practice skills -attend a continuing education workshop on splinting for stroke pts

Types of food consistencies

-water -nectar thick; orange juice, tomato juice -honey thick; pudding, yogurt, applesauce -puree

wrist neutral position is

0-15 degrees

types of collagen

1) all hyaline and basement membrane 2) hyaline cartilage and vitreous humor 3) blood vessels 4) basement membrane 5) all tissues 6) all tissues

symptoms of complex regional pain syndrome

1) allodynia 2) Hyperalgesia 4) edema contractures 5) red or shiny skin 6) decreased strength 7) low tolerance for activity interventions: splinting; static to reduce movement to minimize pain, then dynamic to move the body part; as tolerated. edema control techniques, massage, contrast baths

you are working with a different pt who complains of pain at her elbow and wrist. she describes numbness and tingling down her arm and into her fingers. she has decreased grip strength and decreased wrist ROM

1) what is the most likely diagnosis? - carpal tunnel syndrome 2) which nerve does this involve? - Median nerve 3) what are the appropriate assessments used? -Tinels, Phalens, and 2 point discrimination test 4) what are some treatment options? -wrist cock up splint to get wrist in neutral

3rd handwriting grasp

immature static tripod or quadrupod grasp

a child who has mild figure-ground deficits is having trouble copying from the classroom chalkboard. The teacher asks the therapist for recommendations to minimize this problem. The therapists FIRST recommendation to the teacher would be

1. provide the child with a handout 2. use half of the same color for all lessons 3. clean the chalkboard frequently 4. use an overhead projector as well as the chalkboard answer 3. to prevent background clutter or white chalk buildup

when can you expect a child to start climbing stairs

19-24 months

how many professional development units (PDUs) are required to accrue during a 3 year renewal cycle for a COTA

36

Normal respiratory rate

12-20 breaths per minute

normal blood pressure

120/80

elbow flexion

135-150

dimensions for a narrow adult wheelchair

16 inches wide, 16 inches deep, 20 inches heigh

regular standard adult wheelchair

18 inches wide, 16 inches deep, 20 inches heigh

how many phases are there in the MET levels

3

acute care

24-hour skilled care given in hospitals and ambulatory surgical centers for people who require short-term, immediate care for illnesses or injuries

deep partial thickness burns typically resolve within

3-5 weeks

controlled AROM begins _______ after fracture if fixation is stable

3-6 weeks

you will need a landing at a ramps midpoint when a ramp is over

30 feet

maximum height for a customer service area musts be

31 inches for someone in a wheelchair for optimal discussion and communication

ADA requirements for door width for a wheelchair

32 inches

if somebody burns their entire LE

37%

after quadruped a child will need to learn how to get into

4 point hands and knees -creeping starts

maximum height for forward and side reaching from a seated position in a wheelchair without obstruction

48 inches

overall grasp patters are well developed by the age

5

prop sitting

5-6 months proceed, legs are wide, not the best core strength

contrast baths

A contrast bath alternates between cold and hot tubs or whirlpools. This elicits a local vasoconstriction-vasodilation fluctuation to reduce edema and restore ROM in subacute or chronic injuries. -decrease pain

diabetes mellitus type 2

A disease in which the body is unable to use glucose for energy as a result either of inadequate insulin production in the pancreas or resistance to insulin on the cellular level.

fluidotherapy

A dry heating agent that transfers heat by convection. It consists of a cabinet containing finely ground particles of cellulose through which heated air is circulated. -contraindication; open wounds

cystic fibrosis

A genetic disorder that is present at birth and affects both the respiratory and digestive systems. -mucus build up, and very salty sweat -will have enlarged heart and bowel movement problems -interventions: energy conservation by incorporating extra breaks, pictures to understand kind friendly versions of energy conservations, toileting schedules/routines,

first degree burn

A mild burn characterized by heat, pain, and reddening of the burned surface but not exhibiting blistering or charring of tissues.

Adapting is

Adaptive equipment -grab bars

Suck-swallow reflex

When the infant's lips are touched, the mouth opens, and sucking movements begin

ALS and Guillian Barre Syndrome

presents with both UE and LE paralysis

loose connective tissue (LCT)

skin, blood vessels, and muscle

Fidelity

Faithfulness/loyalty -respecting other professionals

Rood facilitation techniques

Fast brushing, stretch/tendon tapping, high freq. vibration, quick icing, heavy jt compression, resistance utilizing gravity or via therapist's hands

BOT Tests

Fine Motor, Coordination, Balance, Running/Agility, Strength. Common motor proficiency test -if a chid falls within -1 and +1 standard deviation the child in a typical range development. does not qualify for services. - 2- standard deviation = significant dysfunction; qualifies for services (qualifies for IEP)

elevated intraocular pressure

GLAUCOMA pressure in the eye (IOP) due to decrease citrous/aquous humor outflow -loss of peripheral vision -described as pinwheel vision (looks like fish lens) -Generally affects both eyes, however one eye can have more advanced progressive loss than the other

Tier 2 =

GROUP -at risk students screened by specialist and assigned to a group -ex. child is struggling with handwriting by breaking pencils and or paper -appropriate groups at this tier: handwriting without tears, reading, math groups -intensive group but might be only for 1 semester

Rood inhibition techniques

Gentle rocking, slow stroking over post. rami of spine, slow rolling of indiv. from supine to sidelying and back, tendinous pressure over muscle insertion, maintained stretch, neutral warmth, prolonged icing, prolonged stretch

you are working with a pt who reports having tunnel vision. what is the most likely diagnosis?

Glaucoma -pts with tunnel vision will try to compensation for their visual loss by turning their head and body around to use their peripheral vision to see -treatments; teach proper lighthouse scanning, declutter pathways in the home, and adjust lighting patterns to reduce glare

power grasp

Grasp used when stability and strength are required, involves: ulnar digits flexed and ulnar side of hand controlling the object radial digits less flexed while manipulating the object ex. using a hammer

humeral fracture is most common in the

Greater or lesser tuberosity or surgical neck

The only neurological disease that you will see an impact of function from the beginning/initial stage is

Guillian-Barre syndrome -patients will make full recovery -not progressive in nature

Habituation

Habits Roles -role changes; ex. being a mother, daughter, aunt

LSVT Big and Loud

Helps Parkinson Patients to decrease the symptoms and to slow the progression of the disease

name of the legal document in part C needed when working with a child

IFSP Individual family service plan -legal documents and the entire team assess the infant/toddler and determine if they qualify for services -OT will never see a child alone due to being a related services

Guillian-Barre Syndrome

INTERVENTIONS: -in acute phase: adaptive equipment, positioning, w/c setup, ventilator, ROM, pressure ulcers -Plateau phase: ADLs, balance, strengthening, getting back to PLOF

you are evaluating a client who recently suffered a R CVA with left sided hemiparesis. during the ADL assessment you hand them their hairbrush and notice the client is attempting to use it for dental hygiene, what is this known as?

Ideational apraxia

expressive aphasia (Broca's aphasia)

Inability to express words one wants to say (verbal or written) Limited speech; slow or takes great effort; reduced grammar; poor articulation Person knows what he/she wants to say but can't find words

Durable Medical Equipment (DME)

Includes certain medical supplies and equipment, such as ostomy supplies, hospital beds, oxygen tanks, walkers, and wheelchairs.

Landau reflex

Infant should attempt to raise the head and arch the back when placed in a prone position -developing spinal extension against gravity

HCP code for a standard wheelchair

K0001

ultra lite wheelchair code is

K0005

The best method for evaluation hadn't edema in a pt who has an infected open wound of the palm is by

Measuring hand circumference at the level of the MCP joints

OT Theories

More about the process fo understanding the topic or phenonomon. How are you going to describe it and what are the relationships that are happening between what you are observing and the setting.

ischemia stroke

Most common type of stroke, resulting from a blood clot or obstruction of an artery. Neurons lose their oxygen and glucose supply.

autonomy

OT shall respect the right of the individual to self determination, privacy, confidentiality, and consent

landau reflex

Onset age: 3-4 months Integration age: 12-24 months Stimulus: Hold infant in horizontal prone suspension. Response: Complete extension of head, trunk, and extremities. Relevance: Breaks up flexor dominance; facilitates prone extension.

what type of intervention can be used in preparation for or concurrently with purposeful and occupation-based activities, to modify specific factors that may be limiting occupational performacne

PAMS -various forms of energy to modulate pain, modify tissue healing, increase tissue extensibility, modify skin and scar tissue, and decrease edema or inflammation

Occupational Adaptation Model

Person + Environment = Mastery -initiate desire to increase the pts skills -facilitate strategy development to help the client adapt and meet goals -common in transitional times -patient wants and cares to achieve their goals

PEOP Model

Person-Environment-Occupation-Performance -Optimal fit of person and environment and occupation -Family centered and looks at how to promote change in the person. Occupation and environment to optimize the occupational performance.

Phases of Burn Recovery

Phase 1: Emergent (occurs 2-3 days after injury) Phase 2: Acute (day 2-3 till wound is closed Phase 3: skin grafting Phase 4: rehabilitaion (last from wound closure to scar maturity)

Environment

Physical environment Social environment

suck to swallow

Place examiner's index finger inside infant's mouth with head in midline. > Strong, rhythmical sucking. Relevance: Allows ingestion of nourishment. Onset: 28 wks gestation_____Integration: 2-5 mths

MMT 2+

Poor plus part moves through full ROM in a gravity-eliminated plane and less than 50% of ROM against gravity

iontophoresis

Process of infusing water-soluble products into the skin with the use of electric current, such as the use of the positive and negative poles of a galvanic machine. -can help with rotator cuff, tendinitis injuries

Service Competency

Proving that we have a certain skill set for that field of work. Your answers and scores have to match the supervising OTRs answers to get service competency. (results, answers, outcomes mean the same)

specific testing that will be conducted in hand therapy will be

ROM with goniometer

Babinski Reflex

Reflex in which a newborn fans out the toes when the sole of the foot is touched -Could see this in a 60 year old who had a stroke

Nonmaleficience

Refrain from causing harm and avoiding potential risks

RTI

Response to Intervention -written into the IDEA, as a prevention to serve large numbers of children

name the mulches that make up the rotator cuff (known to be on the test)

SITS -suparspinator -infraspinator -terres minor -subscapularis

serrates anterior action

Scapular protraction and upward rotation -can lead to scapula winging if weakened

visual perceptual skills

The ability to interpret and use what is seen in the environment. Difficulties in this area can interfere with a child's ability to learn self-help skills like tying shoelaces and academic tasks like copying from the blackboard or finding items in a busy background.

form constancy

The ability to recognize the fact that a shape remains the same despite changes in size, angle, etc.

expressive aphasia (Broca's aphasia)

The inability to produce language ( despite being able to understand language)

Raynaud's disease

The fingers, toes, ears, and tip of the nose are commonly involved and feel numb and cool in response to cold temperatures or stress. It's often accompanied by changes in the color of the skin.

MMT 1

Trace -contraction observed but no movement

you are working with a pt who recently was admitted for a hip fracture as a result of a fall in their home. the client displays some poor short term memory and limited mobility as a result. during an OT session you notice the client becomes very unfocused and complains of decreased sensation to the left side of their face and slurred speech. you notify the nurse and end the OT session. the next day the clients symptoms have resolved. what is the most likely cause?

Transient ischemic attack

hook grasp

Type of prehension grasp used to carry an item with a handle (e.g., lunchbox, briefcase) without using thumb and palm

phases of swallowing

Voluntary phases: -Oral preparatory phasen (putting food into mouth) -Oral phase (chewing and making a bolus) Involuntary phases: -Pharyngeal phase -Esophageal phase

Light Weight Wheelchair

Weighs 29-34 pounds Assists with conserving energy with prolonged use Increased ease of transport

Peripheral neuropathy

a condition affecting the nerve fibers responsible for allowing signals to flow form the brain and spinal cord to other parts of the body. Sensory, motor or automatic functions or a combination are affected. Vibration and position sense; sensitivity to temperature; numbness and tingling; abnormal sensorimotor functions; and pain to light touch which would normally be painless

augmentative communication

any device that provides a means of nonverbal communication -this is considered high tech -low tech is something you can create yourself high tech is something you have to go out and purchase -this can be used for individuals that do not have verbal communication -must have high enough perceptual and cognitive abilities

rotator cuff injury

any type of glenoidhumeral compression, -typically the supraspinatus is injured. -caused by repetitive rotation

an OTA is working at a SNF implementing intervention plans under the supervision of the OT. as a newly appointed rehab director, you review this OTA's personnel file and you notice that their license has expired. in this scenario, what should you do NEXT

ask the OTA if they have renewed their license. determine if they are aware that it is their responsibility to renew their license, by the expiration date

when testing a pts visual perceptual skills what is the best technique for an OT to use

ask the pt to pick an apple from a fruit basket

adaptive equipment

assist with completing functional ADL tasks: feeding, grooming, dressing, toileting and self-care skils ex. text to speech, long handed shoe horn, sock- aid, shower chair

body powered UE prosthesis

body motion is used to apply tension on the control cable to activate the terminal device and elbow unit -advantages: weight weight and durable, provides some sensory and proprioceptive feedback, cost effective, hook terminal device allows easy visibility of objects, can be used outdoors in extreme temperatures and conditions -disadvantages; needs a harness on the body, axillary loop may feel uncomfortable, looks unnatrual

central nervous system

brain and spinal cord

assistive technology

broad term tat can include any device that helps person to increase independence with a task ex. environmental controls, text to speech, word prediction (dyslexia pts)

dressing a 4 year old

buckle buckles, zip/unzip independently, and remove pullovers

Main diagnosing feature with MS is

decreased myelin in the brain or in the gray matter. -later on as it progresses it will realist in decreased vision and cognition due to the optic nerve and the brain gray matter decreasing. -the decreased vision is the typical first sign of MS.

Guillian Barre Syndrome

demyelination in the myelin sheath, which is where you get the paralysis -body attacks part of the peripheral nervous system -first symptoms are tingling int he legs which can spread to the upper body and arms

dressing a 3 1/2 years

do snaps, hooks, differentiate from front and back

occupational adaptation

does not focus on deficits or increasing the clients deficits -use with pts with permanent disabilities, terminal disease, neurodegenerative disease MS, parkinson

OT intervention

doing something functional with the client

errorless learning techniques

doing the activity over and over again with positive feedback until the activity is completed errorlessly

an OTR is providing education to the family of a client in the end stages of ALS which statement best describes the appropriate recommendation

ensuring the family is aware of the importance of a pressure relief schedule including scheduled out of bed times, turning times, and appropriate cushion for both the bed and the wheelchair -ALS pts do not lose cognition but the ability to communicate -bed bound in stages 4-6

skin is composed of which tow basic layers?

epidermis and dermis

a therapist is preparing guidelines for home and environmental adaptations for a pt who has mild dementia. The therapist should first recommend that the family

establish a regular daily routine for the pt

for a progress meeting in pediatrics

everyone needs to be present -the entire team needs to be called together to report the progress and or to change anything -parents need to be there

shoulder impingements

excessive and repetitive contact of the greater tuberosity of the humeral head -repetitive abduction and external rotation -subscapularis: between the coracoid process and lesser tuberosity (also identify as the impingement category)

nerve gliding

exercises that put light tension on the nerve and allows them to move through the surrounding structures -aka nerve flossing

metacognitive skills training

focuses on awareness, self monitoring, and self-regulation; helps individual recognize problems they face and form strategies to facilitate success -evidence based approach for those with TBI

the only grasp option for an individual who does not have a thumb, or doesn't have thumb to pinkie finger opposition is

hook grasp due to the absence of the thumb

a 7 year old boy who was recently injured in a MVA sustained a crush injury to his right dominant upper limb, resulting in a below elbow amputation. Post amputation, the OT is meeting with the boys parents to discuss prosthesis. what type of prosthesis should the OT recommend?

hook prosthesis -these are good for precision grasping and can keep up with the lifestyle of a child

Terminal device (voluntary opening hook)

hook remains closed by a rubber band unit tension on the cable causes the hook to open. tension on the cable is created by body movement

terminal device (voluntary closing)

hook stays open until tension on the cable causes the device to close. tension must be maintained to hold objects. hand: more cosmetic, less functional than a hook. can be voluntary opening or voluntary closing

dressing a 5 year old

how to tie and untie knots -dress without supervision

PNF (proprioceptive neuromuscular facilitation)

incorporates diagonal movements in our everyday functional activities -includes upper extremity flexion and extension -D1 flexion (brushing hair, doing makeup, putting on chapstick on opposite side) -D1 extension reversing the d1 flexion movement (ex pushing out car door) -D2 flexion (right hand with brush and brushing same side of head, doing same side of face makeup as you are holding) -D2 extension bringing the d2 flexion back down and putting it on the other side. holding bush with right hand, brushing hair on right side, placing brush down on let side

Virtual context

interactions that occur in simulated, real-time, or near-time situations absent of physical contact

vocational rehab

interest and leisure checklist -community setting for those once they transfer out of high school -developmental, cognitive difficulty, life changing injuries (CVA, SCI, TBI) pts to be set up with appropriate amount of assistance to follow up with their career goals

subscapularis action

internal rotation

specific roles of the OT

interpret data, responsible for discharge, write goals, sign off on documents, chart review, evaluations, updating and changing goals, progress notes -responsible for all aspects of the initial contact with the pt

Transient Ischemic Attack (TIA)

interruption of blood flow to the brain -mini storke

work hardening program

intervention for person with work related injury. behavioral and vocational management -functional compact evaluation; to make sure you have a good idea of their level of injury and what it can inhibit -working with injured workers -multidisciplinary; being along other injured workers -can be 6-8 hours a day for multiple weeks -within big cities -every therapist needs to be FCE certified to be able to administer an FCE

How do you want to position the hand for an orthotic after a burn?

intrinsic pulse postion -wrist extension, MP flexion, IP extension, and thumb abduction (safe position) ((know this well))

dressing a 6 year old

knows how to tie bows and shoes

Apraxia

lack of motor planning ability as a result of injury to the brain -commonly associated with stroke

Left CVA affects

language, impaired speech, motor impairment on right side

teres minor function

lateral (external) rotation of arm and stabilizes the head of the humerus

universal cuff

leather pocket that fits witting the palm of the hand. the pocket is attached to the velcro closure strap -used by individuals who have limited hand function SCI, TBI, CVA, MS

you have a pt who recently had a stroke in her L hemisphere, you want to try a compensatory approach for therapy while your pt is gardening, you decide to move her gardening tools to her __ side

left

Ice pack

less acute and chronic pain -can be placed in larger areas with 2 layers in between the icepack and skin -10 to 20 minutes no longer

cardiac rehab (out patient) phase 2 of occupational therapy intervention (MET LEVEL 1.4 - 2.0)

light weights, implement energy conservation, breathing techniques, MET levels to see what activities they can and can not do by looking at their activity tolerance

TENS unit

lighter uint of E-stem. -pts can buy and use it at home safely to help decrease pain -more used for pain -contraindicated for someone with epilepsy, or with a pacemaker, do not use them over open wounds -NOT safe for someone with history of seizures -used to prevent (CRPS) chronic regional pain syndrome

what wound an OT first consider when helping a pt with low vision use a computer more effectively to search the internet?

lighting in the room

Ranchos Los Amigos level 3

localized response to stimuli: ex. when name is called pt will turn their head to look toward stimuli

left brain functions

logic, science, words and language, math, detailed oriented, and safe

what pathology does the speeds test test for?

long head of the biceps and superior gleaned labrum

Stage 4-6 of Dementia Interventions

long term memory loss, difficulty with basic ADLs

what nerve is involved with scapular winging

long thoracic nerve

an OTA has an idea of starting a drivers training program for pts with hand and UE injuries. before implementation of this program, what is the first thing the OTA should do

look at evidence-based practice to determine a need

Menieres disease

may cause dizziness and vertigo -disease of the inner ear causing vertigo symptoms -no cure but can be prescribed medications

hunningtons disease

may present with dystonia and actesia -combination of dementia and Parkinson's -5 stages -stage 1: no dystonia or agstesia (notice personality and cognitive changes) -can be diagnosed quickly because you are 50% able to pass it onto your offspring; being genetic (genetic testing can be done to determine if you carry the gene or not) -progressive -middle stages; dramatic movement patterns -end stages; pt goes into a rigidity pattern, unable to move or communicate effectively -mood, personality, and cognition are noticed first

an OT completes an evaluation with a 6 year old child and the results indicate that the child has deficits in visual discrimination affecting handwriting. Based on this information, what strategy might the therapist include in the intervention plant o best address visual discrimination.

multi sensory writing techniques to reinforce correct letter formation and to emphasize the differences between similar letters

common causes of rotator cuff tears

muscle imbalances and casual tightness

problems that occur in basic brain injury inquire

not being able to brush teeth, unable to write, bruising hair, delay in processing written or verbal instructions.

radial nerve palsy

occurs after an acute injury -ex. motor vehicle accident, fallen and hung on with their arm and the radial nerve got stretched out form the injury

a 4 year old with spastic CP and maximum extensor tone is seen by an OTR in his home, 1x/week. After preschool his mother voiced concerns about maintaining her childs seated position in his w/c. what is the best w/c modification to recommend, to optimize the childs siting position?

place a wedge in the seat, with the narrow end of the wedge to the rear of the seat -this wedge placement will reduce the hip angle, by creating more hip flexion, to help inhibit extensor patterns.

an OTR working in the NICU setting is teaching a other how to position her neonate for bottle feeding. Which position provides the safest method of bottle feeding for a premature infant who is 32 weeks gestational age?

place the infant, swaddled in a side lying position, calling the bolus to pool in the neonates cheek if fatigue develops. -this is the normal position for breastfed infants and is helpful in coordinating suck-swallow-breating with many premature infants.

shoulder unit

places and positions an entire prosthetic arm

MMT 2

poor minus movement through full ROM gravity eliminated

your brachailis causes

portion and supination

if a child is only being seen primarily by OT they are being seen at a

private clinic

cataracts

progressive opaqueness of the lens, resulting in blurred vision

Americans with Disabilities Act of 1990 (ADA)

prohibits discrimination in employment transportation, accessibility and telecommunications

which direction does a baby first role?

prone - supine

treatments for loss of trunk control for a CVA pt

proper positioning, mirror for visual feedback, trunk control, dynamic weight shifting,

Collage is a

protein that is primarily structural component of connective tissue

what are some examples of how you could assess the different components of vision and ocular motor skills

pursuit/tracking, convergence (the alignment of the eyes in near sightedness), saccades, peripheral vision, visual field

dressing a 1 year old the child can

push their legs through pants and push their arms into their shirts -remove socks and shoes

after sitting unsupported the child will get out of sitting by getting into

quadruped -helps with high tone or low tone -they will rock a lot

4th hand grasp for a child (10-18 moths)

radial digital and immature pincer grasp

3rd hand grasp for a child (6-9 months)

radial-palmer grasp

12 muscles on the back of the arm and forearm are

radius

form constancy

recognizing forms and objects as the same in various environments, positions, and sizes

form constancy

recognizing forms and objects as the same in various environments, positions, and sizes -recognize objects despite change in size/location

scapular plays a major role in

shoulder function

work conditioning program

single discipline approach -in rural areas -less intense than work hardening; see therapy twice a week for 45 minutes

modification for pt with decreased core strength?

sit on wedge that will activate core strengthening -KEY: environmental modifications; changing a doorway or building a ramp, incline board for a table top

a therapist completes a work site eval fora s excretory who has developed bilateral carpal tunnel syndrome. the therapist notes that the secretary's work area has poor ergonomic design. to reduce the risk factor associated with the pts symptoms the therapist should recommend

sitting at 90 degrees with wrist in neutral 90 90 90

when a 8 month old is sitting they are

sitting without support -have enough spinal extension, and core stability -start doing hand or finger feeding

largest organ on the body

skin

right CVA affects

spacial perceptual, more impulsive, left side motor impairments

client with mild to hight tone post CVA a ___ splint may be beneficial

spasticity splint

MET 5-7

splitting wood, shoveling snow, walking 4-5mph, cross country skiing, occasional lifting (50-100lbs) -BEGIN NORMAL ACTIVITIES

Huntington's Disease

starts in the basal ganglia

what two join are under the most stress if a person has a hunch-over posture

sternalclavicular and acromioclavicular joints

treatment for MS

strengthening to maintain what they have, activity modification, use of adaptive equipment, cognitive memory aids once their cog goes -Clear the pathways of their homes, use bright contrasting tape of stairways, large print and buttons for adaptive strategies, sensory reeducation, use thermometer or test the temperature with the unaffected limb to check the temp of water. for cognition do demanding tasks in the morning. recommend gentle exercises such as yoga and aquatic exercises, use resting splints, teach energy consecration and fatigue management.

secondary complications that may need to be addressed with a CVA pt is

subluxation, edema management, contractor prevention

for the depth of the wheelchair you

subtract 2 inches from the butt to the back of the knee

interactive reasoning

takes place during face-face interactions with the pt and clinical. used to engage the pt in the treatment, to know the person as a person, understand the disability form the pts point of view, and to match the treatment goals and strategies to the pt with their disability, communicate a sense of acceptance, construct a shared language of actions and meanings, determine the treatment are going well

education and risk factor modification

teach the pts proper breathing techniques, using adaptive equipment so they are not increasing risk factors of falling or stress on their heart

forward chaining

teaching a child the first step to an activity and gradually move on to another step until they area all mastered and the child can compete the task

a pt with saccades will demonstrate

the ability to gaze rapidly form one fixation point to another even when the targets are changing position on a vertical or horizontal axis without undershooting or overshooting tastes and without difficulty finding the target

visual closure

the ability to identify tow objets that are the same even if part of one is missing

form constancy

the ability to notice that tow objects are the same even if they are different in size, color etc

visual memory

the ability to remember visual information

figure ground

the ability to see an object on top of a background color or scene

visual acuity

the ability to see fine detail -treatements; contrast colors, tactile cues such as built up stickers or notches etc., certain location for specific objects, put a rubber band on the shampoo so the pt can detect the difference between shampoo and conditioner, simplified grooming and hygiene routine

visual spatial

the ability to understand where objects are in relation to each other

phantom limb usually occurs at

the distal end of the extremity

after head lifting (Peds) what are they doing with their forearms

they are propping on forearms -gives you a base of support and the child gets to lift their head more -develop spinal extension

secondary prevention

those preventive measurers that lead to early diagnosis and prompt treatment of a disease, illness or injury to prevent more severe problems developing. Trying to detect a disease early and prevent it from getting worse. -occurs in the form of screenings

Praxis

to conceive (have the idea), organize, and carry out love motor actions -knowing what to do and how to do it -sensory over responsive (the kid who doesn't like tags, socks, and slight sounds set them off etc. = low threshold), OR -sensory under responsive (kids with syndromes; down syndromes, hypotonic, ex. kids who never cry, fall and hit their head and don't cry, serious issue because can get burns from hot water = high threshold

pre-vocational training

to work on the skills to find and obtain a job with help provided to obtain those skills and and to find work for those who are unable to find it on their own -appropriate for middle school and high school students -teaching the students life skills; ADLs, IADLs, balancing a checkbook or shopping on a budget -identifying areas of interest with work, career, or education (what are the students going to do when they transfer out of high school out of their IEP and into the community)

1st hand grasp for a child (3-5 months)

ulnar-palmar grasp

to achieve independence in oral hygiene, an individual who has complete C6 quadriplegia would most likely benefit form a/an a) universal cuff b) electric toothbrush c)built-up handle toothbrush d) long opponent splint

universal cuff they still do not have finger motion

Cognitive behavioral Model

unlearning negative thinking habits -work on environmentally triggered thoughts. -eliminate maladaptive thinking (negative beliefs about self) good way is to journal and identify anxiety triggers

what are the 6 types of play

unoccupied, solitary, onlooker, parallel, associative, cooperative

right brain function

uses feelings, spatial perception, risk taking

Forward parachute AKA forward extension reflex (protective extension forward)

when a child is falling forward they extend their arms out infant of them -develops at 6 months

federal alcohol syndrome

when the mother excessively drinks while pregnant that results in birth defects; neural, fascial, cranial, cardiac abnormalities. Poor coordination and fussy child, deficits in processing and visual impairments -monitor vital signs, wheelbarrow walking, obstacle courses, to help develop coordination, deep pressure manage and cuddling activities to help calmness, gross motor activities to help body awareness; tug of war, riding races, hanging on a bar, visual motor activities; blocks, stringing beads. Visual perceptual; number letter recognition, and hidden toys.

after propping on forearms the child can

work on propping up on extended elbows -trying to reach out for toys

how to determine the length of a ramp. 5 steps and each have a 7 inch rise. 5 X 7 = 35

1 foot of ramp for every rise -35 feet long

6 stages of ALS

1) Can walk independent with ALDs with some weakness 2)can walk with moderate weakness 3) can walk with severe weakness 4) need a wheel chair and some assistance with ADLs and severe leg weakness 5) require a wheelchair, total assistance with ADLs and severe arm and leg weakness 6) Confined to the bed with total assist with ADLs

a COTA is working with a C8 SCI client, during upper extremity exercises the client reports feeling dissy and has a headache the cota notices they re very sweaty. what should the COTA do IMMEDIATELY?

1) sit the client upright to prevent the blood rushing to the clients heart due to already incensed blood pressure THEN take the client blood pressure

RA (rheumatoid arthritis)

Autoimmune disease that attacks body own tissue and goes through exacerbations and remissions -affects small joints, ulnar drift of the hands -splint; Volar in extension splint -intervnetion; education and activity modification

if a client cannot cognitively follow a protocol the limb will be

casted

the OT is the only one seeing a student in the 5th grade

would never happen due to an education based setting and the child must be seen by a psychologist, social worker, PT, ST, and OT.

Can a COTA provide standardized testing in the schools?

yes, if they have competency -The OTR will interpret it

a new technician is hired to work in the rehab department. is an entry level OTA allowed to supervise this technician

yes, once the entry-level OTA shoes service competency to a supervising OT

you receive a friend request on facebook from a pt whom you are currently treating. you accept this request and tell the pt that you area only friends on FB but the pt soon starts posting comments and pictures about you and their OT sessions. are any code of ethics being violated in this scenario?

yes. altruism -this concept is reflected in actions and attitudes of commitment, caring, dedication, responsiveness, and understanding

MMT 0

zero -no muscle contraction

shoulder flexion

0-180

Occupational respective

incorporating activity to influence behavior -using an activity to influence behavior

diabetic retinopathy

referred to Swiss cheese vision or cow patch vision -symptoms: difficulty focusing/fixating on an object, loss of color vision, impaired contrast senestivity

a pt would like to continue to pursue his hobby of watercolor painting. The pt complains of cleared vision and the inability to distinguish between different colors. What is the best adaptation to assist this pt.

increase background contrast

Public Law 94-142

require schools to provide free and appropriate public education to every child ages 5-21 with special needs. This law evolved into today's Individuals with Disabilities Education Act (IDEA).

Autonomy and Confidentiality

respect the right of the individual to self determination

Diabetes mellitus type 1

insulin is functionally absent due to destruction of beta cells of pancreas; where insulin would normally be produced. starts in children ages 4 or older, adolescense. symptoms include polyuria, polydipsia, polyphagia, nausea, weight loss, fatigue, blurred vision, and dehydration

an OTA has been treating a pt who sustained a TBI 14 months ago. form the beginning, the pt identified cooking a meal as a ian goal that she wanted to achieve. the pat has progressed to making a multi-step hot meal and is looking forward to preparing a special meal for her friends and family for dinner. As the OTA and pt have known one another for over a year, the pt feels comfortable enough to invite the OTA to the festive meal she will be preparing. what ethical principle will the OTA be violating if they decide to go to the pts home for dinner?

Justice -shall promote fairness and objectivity in the provision of OT services.

large key keyboard

is a keyboard with enlarged keys, sometimes color coded -could use it for coordination deficits, improves visibility for people with low vision

if you have a pt with left sided visual neglect, how would you place objects with a compensatory approach

on her right side

Windswept deformity

Pelvis rotates laterally to one side, resulting in the spine, trunk, and thighs moving to the opposite side

ipsilateral

on the same side of the body -ex. injury to right side of the brain, and the right side of the body lacks typical function

Huntington's Disease

Progressive neuro disorder -poor concentration, psychiatric symptoms, depression, involuntary movement, difficulty swallowing, cognitive symptoms, executive functioning, and poor posture will decrease Think of it as a mixture combo of Parkinson's Disease and Dementia -can be diagnosed early on -is genetic

certain assessments the COTA can complete

once competente can observe findings and results and interpret it to find out what the needs are for the pt -COTAs can administer standardized tests to determine the pts cognitive function

onlooker play

a child watches other children play

stages of dementia: middle

confused increasing disorientation

elbow unit and hinge

connects the socket to the upper arm with a triceps pad. hinge is either flexible or rigid. may have an sternal or external locking mechanism for positioning of the elbow

dermis is

contains blood vessels, nerves, hair follicles, and sweat glands

when assessing a pt for an evaluation with a amputation evaluate the pt with

one hand or one arm techniques AND with the use of the prosthetic

effects of CVA on the right side of the hemisphere

contralateral hemiplegia, left side neglect, difficulty swallowing, short attention span, denies deficits, more impulsive, visual spatial skills, short attention span, poor body awareness, emotional ability

The OT visits each kindergarten classroom at the beginning of the year, to screen students on grasp patterns. Claydoh exercises are nice to the teacher, for encouraging hand development. Which Tier is this?

Tier 1; the whole calssroom

A COTA leads an "engines group" for 3 students who are struggling with regulation during afternoon class time, 1x/wk for two months. which tier is this?

Tier 2. due to it being a group of 3 students

Parkinson's (hypokinetic disorder)

onset is after the age 40 -slowly progressive -occurs in the basal ganglia -cardinal signs: tremors, rigidity, cogwheel, led wheel, loss of voluntary movement, propulsion, mask like face, -primary symptoms; resting tremors (early signs) its the pill rolling movement increase with stress and decreases with stress, muscle rigidity, cogwheel, freezing, postural instability -secondary symptoms; gate dysfunctions= stiff short steps, fine motor coordination is impaired, decrease executive function, visual spatial dysfunction, flat effect, dementia

habituation

organized recurrent patterns of behaviors and is comprised of habits and roles

fractures of the upper arm

proximal humeral fractures are the most common fracture of the upper arm and may involve the articular surface, greater or lesser tuberosity, or surgical neck ROM can begin 2 weeks after if prescribed, aggressive stretching 4-6 weeks if prescribed

progressive cerebellar degeneration

results in loss of balance and coordination. A sip-and-puff control switch would allow control of the power wheelchair without the client needing to use coordination.

rods

retinal receptors that detect black, white, and gray; necessary for peripheral and twilight vision, when cones don't respond

role of OT with down syndrome pts

pts with down syndrome may have poor muscle tone effecting strength and endurance. Short fingers effecting gross and fine motor activities. Decreased sensory processing. -improve pts handwriting, communication skills, sensory processing

before cruising the child needs to

pull into kneeling

a retired client in the mid stages of dementia would display the most difficulty with the following

recounting their daily routine of their past week -because it is a short term memory

purpose of a wheelchair cushion is to

redistribute pressure on the sitting surface

Guillian Barre Syndrome

paralysis occurs distal to proximal -fast onset -neurons mutate (damaged neurons) at rapid pace which causes the rapid onset of paralysis -hallmarck sign is muscle belly tenderness

signs and symptoms of MS

parenthesis = pins and needles is the most important heat is important due to not being able to feel heat and cold, vertigo is another sensory disturbance

Kleinert Protocol for tendon repair of flexors

passive flex w/ rubber band, active ext to hood of splint 0-4 wks: dorsal block splint w/ wrist flex 4-7 wks: dorsal block splint w/ wrist in neutral 6-8 wks: remove splint, AROM, tendon gliding, light activity 8-12 wks: strengthen -4=FLEX, 7=NEUTRAL, 6=REMOVE, 10=STRENGTHEN

In-hand manipulation skills

pick up and manipulate objects with one hand -5 types of in hand manipulation skills -finger to palm (picking up coins on a table) -palm to finger (move coins from palms to fingers to place coins in vending machine) -shift (pick pencil up in the middle, and moving fingers down to correct pencil grasp) -simple rotation (flip pencil up onto hand to get correct hand placement) -complex rotation (twirl the pencil to get into perfect hand pencil grasp)

when a school based OTA has a student prone-prop positioned it is due to

poor core stability

a child who is struggling to keep up with their written work at school due to an immature static tripod pencil grasp the OTA should

practice moving coins from their fingertips to palm and palm back to their fingertips

MOHO (model of human occupation)

"How do values, roles, volition, and habituation affect social participation?" Client centered model, how the client interact with the environment- Motivation based -intrinsic desire -assessments like role check lists or vocational questionnaire for work

A transition plan for as student with an IEP must be addressed and implemented by what age?

-16 years -start talking about it at 14 years of age; start asking them where they want to work when they grow up to help them accomplish their future.

3 different types of radial head fractrues

-1st: nondisplaced; treated with a long arm sling -2nd: displaced with single fragment; treated non operatively with immobilization for 2-3 weeks and early motion with medical clearance -3rd: communited; treated operatively with immobilization and early motion within the first post operative week as medically prescribed

Macular degeneration has ___ types

-2 types; wet and dry -CENTRAL VISION LOSS -intervention; teach scanning from left - right with peripheral vision -permanent vision loss -WET MACULAR DEGENERATION is more serious

OT consultant

-ergonomic category -job cite analysis and seeing how you can decrease the rate of injuries -provide education and information; not hands on treatment for diagnosis -in the school setting; cannot perform screens. need permission from parents, school, and physician first. Can provide education that can benefit the entire classroom. lighting, seating setups, pencil grips etc. -work setting OTs can perform work tolerance screens

glaucoma treatments

-eye drops -visual scanning patterns/visual sweep techniques -electronic magnification devices -environmental modifications; night vision is typically severely impaired -pt education -psychosocial impact

If a child has weakness at trunk and neck with decreased head control interventions could be

-incline board on desk, prone prop on wedge, upright at easel/chalkboard -Answer; prone prop on wedge, over a bolder, or over your leg and have them playing with some toys to help them develop cervical/spinal extension.

Wrist held in flexion with poor grasping of tools

-incline board on desk, prone prop on wedge, upright at easle/chalkboard -Answer; incline board on desk; allows for wrist extension

weakness at shoulder

-incline board on desk, prone prop on wedge, upright at easle/chalkboard -Answer; upright at chalkboard, allows shoulder flexion against gravity

posterior cerebral artery CVA

-includes control of the cerebellum -impairments in vision, coordination, body awareness, balance

what are some examples of modified independent activities form a cognitive and memory standpoint (ranchos los amigos levels 9 & 10)

-increased time to process the steps and compelte and activity -enlarged calendars, alexas, etc

three common phases of fracture healing

-inflammation: provides cellular activity needed for healing -repair: forms the callus for stabilization -remodeling: deposits of the bone

your client presents to you with scapular winging and difficulty with forward flexion. their MMT score for shoulder internal rotation is 4-. which muscle is the likely culprit?

-information seeking question answer: serrates anterior

you're treating a client with a diagnosis of de quervains tenosynovitis. you've fabricated a thumb spica splint, given them gentle stretching exercises for their HEP, and advised them to use ice and rest intermittently throughout the day. They report they are still experiencing 7/10 pain with use and 5/10 pain at rest. which intervention would be best to implement next?

-intervention based question -Perform a work tolerance screen ((because their work activities might be what is causing the pain. can provide ergonomic))(((this is an OT intervention)))

describe the difference between lateral and medial epicondylitis

-lateral epicondylitis: Inflammation of the muscle attachment to the lateral epicondyle of the elbow. Often caused by strongly gripping. Commonly called tennis elbow. -medial epicondylitis: too much wrist flexion resulting in inflammation and micro tears from repetitive motions. AKA golfers elbow -treatment options for people with either: rest the joint and tendons, ice massage for 3-5 minutes in one compensated area, static splint, KT tape,

what is the difference between requiring SBA at level 8 vs asking for SBA at level 9 with ranchos los amigos levels

-level 8 pts are required SBA due to the lack of safety awareness, insight and judgement to their own deficits. Making sure someone is home to remove hazards and barriers -Level 9 pts will call someone to help them to make sure they have reminders and a second eye for potential hazards. ex. leaving the stove on

your client was involved in a motorcycle accident 10 days ago, with resultant brachial plexus injury. he presents for evaluation with wrist drop and no active movement at the MCPs and thumb. which treatment option would be best for the OT to initiate first?

-looking for an OT intervention ANSWER: Fabricate a high profile dynamic splint with wrist in slight extension (20 degrees), and MCPs and thumb in extension. ((allows the client to work on regaining wrist movements))

a cota is working with a client with a diagnosis of primary progressive Multiple sclerosis (SPMS), on sink side grooming tasks. the client displays fatigue, decrease UE strength, and intention tremors. which adaptive strategy would be best when completing teeth hygiene

-prioritize problem order: pain, highest impact on function = intention tremor -having the client stabilize there hands on the sink applying pressure through the UEs prior to completing each step in the task (this will stop the tremors)

treatment techniques for prosthetic phase

-pt education on parts and functions of prosthetic, don and doff, how to maintain the prosthetic, and hygiene of the prosthetic and limb -help the pt build tolerance while wearing the prosthetic -application of the prosthetic with ADLs and IADLs

in a SNF for a pt recovering from a hip total hip replacement their wheelchair should include

-reclining back -pommel cushion -elevating footrests

which OT treatment techniques fall under the level of intervention of Purposeful Activity

-retraining a woman with a TBI in self-feeding skills -helping a woman with RA increase endurance during a light housekeeping tasks -setting up an activity of building a bird house for a man recovering form Guillian-Barre syndrome

deep partial thickness burn

-second degree burn -hair follicles and sebaceous glands remain intact -involves the epidermis and deeper protein of the dermis -spontaneous recovery 3-6 weeks, but skin grafting may occur to expedite would closure -precaution: deep partial thickness burns may convert to a full thickness burn -once closed up and healed you can take volumetric edema measurements. If not healed you can use tape measurements

test used to evaluate a child in the school

-sensory profile -visual motor (VMI ages 2-99) -motor (bot assessment) all about precision fine motor; ages 4-21 -IQ testing by psychologist

Public Law 94-142 (Education for All Handicapped Children Act)

-served students ages 5-21 (school children) -Individual Education Program (IEP) -PROVIDES: transportation, PT, OT, ST, assistive technology, psychological services

MET 1

-sitting down in a chair while brushing a teeth -grooming while sitting -sitting on a shower chair with WARM water (hot water effects your MET level because it increases your heart rate) -seated at a table to prepare light meals -seated while washing dishes -slow walking or activities while seated -desk work

examples of standardized tests we may use for vision are

-star cancellation test -motor free visual perceptual test -developmental test of visual perception -test of visual perceptual skills -Beery-Buktenica developmental test of visual motor integration

full thickness burn

-third degree burn -skin layers involved: epidermis and entire dermis -includes hair follicles, nerve endings -what can you expect to treat during therapy sessions? ROM, edema control -spontaneous recovery is IMPOSSIBLE -skin grafting is required

your client underwent RTC (rotator cuff repair) repair 4 weeks ago with subscapularis pinning. their surgeon has cleared them form AAROM exercises. which activity would be best

-wiping the countertops after dinner ((its waist height allowing for an gentle activity on a nice smooth surface that has AAROM, keeps the arms close to the body))

Classic burn deformity of the hand

-wrist flexion -MP hyperextension -IP flexion -Thumb adduction -Flattened palmar arch

dressing a 3 year old

-zip/unzip with setup -unbutton large buttons -don a shirt with a little help and put on shoes -can doff pants independently

Shoulder Abduction

0-170/180

cervical extension

0-45

cervical flexion

0-45

lateral cervical flexion

0-45

Stages of Dementia

1. No Impairment 2. Very Mild 3. Mild 4. Moderate 5. Moderately Severe 6. Severe 7. Very Severe

MMT 4

GOOD full ROM against gravity Mod resistnace

specific tests for strength within hand therapy will be

MMT, dynamometer, pinch gauge meter

legal blindness

coined by the IRS for people with visual acuity of 20/200 or worse in order to able to grant or deny benefits based solely on acuity

Ecology of Human Performance Model

Studying of organisms and their environment -Person + Task + context = performance Interventions to promote performance: establish and restore skills, adapt/modify, alter optimal context, prevent problems, create opportunities

Myasthenia gravis

a chronic autoimmune disease that affects the neuromuscular junction and produces serious weakness of voluntary muscles of the cranial muscles -occurs more in women than in men -progressive -proximal more than distal asymmetrically -death usual occurs due to respiratory failure -signs and symptoms: muscles progressively week during activity, facial muscles are impaired, proximal limb weakness -hallmark sign = fatigue, ptosis = drooping of the eyelid

coronary artery disease (CAD)

a condition affecting arteries of the heart that reduces the flow of blood and the delivery of oxygen and nutrients to the myocardium; most often caused by atherosclerosis

intellectual disability

a condition of limited mental ability, indicated by an intelligence score of 70 or below and difficulty in adapting to the demands of life; varies from mild to profound -delayed in play skills or ADLS, or play skills and home chores, etc.

ideomotor apraxia

a condition where a person plans a movement or task, but cannot volitionally perform it. Automatic movement may occur, however, a person cannot impose additional movement on command -if you ask a pt to put a jacket on they may not be able to figure out the motor movements in that time. however if they need to put on a jacket on their own they can figure it out and put it on. difficulty on the spot

you are evaluating a client who recently suffered a CVA with hemiplegia. he presents with UE flaccidity, expressive aphasia, and suspected subluxation. Which intervention would be best to implement first

a hemi arm support, instruct nursing staff in appropriate wear schedule and don/doff procedure

Transitional employment

a mock employment setting that allows a person with a disability to practice parts of a particular job position -hands on training to experience in real time of their job of interest. ex. setting up a client who is interested in cosmetology with success to see the real outcome of the job) -does not require college education, but requires certification and a certain amount of hours ex. dental hygienist assistant, nursing aid

20/20 vision

a person who can read what the average person can read at 20 feet has 20/20 vision

attention-deficit/hyperactivity disorder (ADHD)

a psychological disorder marked by extreme inattention and/or hyperactivity and impulsivity -can be a primary condition or diagnosed with other developmental or psychiatric disorders -establish routines that are consistent -teach completing tasks -eliminate background noises, limit distractions -verbal directions; be clear and short and understandable -write notes or checklists so they can keep track of what they have completed -encourage the child to reply verbally due to writing being a challenge -face them towards walls instead of windows or doors while in the classroom to minimize distraction -yoga to help the body relax -deep pressure input

pursed lip breathing

a technique of exhaling against pursed lips to prolong exhalation, preventing bronchiolar collapse and air trapping; done to increase expiratory airway pressure, improve oxygenation of the blood, and help prevent early airway closure.

supraspinatus function

abduction of arm

which muscle abducts the thumb

abductor pollicis longus

snuffbox

abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus

When the tendon separates from the bone and its insertion and removes bone materials from the tendon

avulsion -ex. mallet finger intervention for mallet finger is full extension for 6 weeks

Modifying

changing things ex. modifying a wheelchair appropriately for a patient

a middle aged client has macular degeneration resulting in moderate visual impairment. the client works as a data entry clerk and wants to continue working but is having difficulty seeing the computer screen. the OT will be adapting the clients work computer with new software to improve accessibility. what computer feature of this new software would be most effective for this client

character enlargement

Cryotherapy

cold packs, ice massage with ice circular things -especially for lateral and medial epicondylitis -do not with pts that have Raynauds Disease, and open wounds, DPT pts, and peripheral nerve injury pts.

ecology of human performance

choosing an activity according to your clients ability and grading as they improve. adaptive equipment and compensatory techniques will be used

Developmental Coordination Disorder

clumsiness, excessive delayed motor development that negatively infuses ADLs or school -not related to any other diagnosis -OT TREATMENT: recommending pull over garments or elastic paints until the child can manage buttons. provide alternatives to using fork and knife by having the meals prepped for the child, adaptive scissors for cutting, provide activities to develop bilateral hand use such as throwing balls, beading

which frame of reference focuses on changing distorted thinking in order to change maladaptive behavior and emotions?

cognitive behavioral frame of reference

The manager of a large OT department is planning to expand the inpatient cardiopulmonary rehabilitation program to include outpatient services. What is the MOST RELEVANT information to include in the proposal to the hospital's administrative board? A. Data on the inpatient rehabilitation program's outcomes B. Statistics on physicians referrals to the acute unit and the average inpatient length of stay C. Literature on cardiopulmonary rehabilitation across the continuum of care.

data on inpatient rehab programs outcomes

what diagnosis experience photophobia

diabetic retinopathy and glaucoma

Parkinson's and primary progressive MS

diagnosis of this disease does not occur until midway through the disease -primary progressive MS can occur for years before diagnosis due to the remission

dysphagia

difficulty swallowing

Dyspraxia

difficulty with motor planing movements, especially complex or new movements

Contraindicators of heat

don't use on pts with RA, burns, those who are pregnant

diplopia?

double vision

5th handwriting grasp (4+ years old)

dynamic tripod grasp or dynamic quadrupod grasp

4th handwriting grasp

dynamic tripod or quadrupod grasp

effects of CVA of the cerebellar

dysarthria, ataxia, balance deficits

1 foot of ramp length for

each inch of rise

diabetic retinopathy treatment

eccentric viewing -skin integrity ((they usually have neuropathy, tactile cues such as braise will not work)) -community resource training -diet and nutrition

macular degeneration interventions

eccentric viewing techniques; method of scanning peripheral visual fields to optimize vision using another point in the retina that has not been damaged by AMD AKA psuedofovea training -environmental modifications; optimize lighting, decrease clutter, increase contrast/high contrast -pt education -community resource training/support groups -psychosocial impact

a client who recently suffered a CVA with dominant upper extremity hemiparesis wishes to be more independent with self feeding skills. you offer them built up utensil and scoop plate, in between feeding sessions you work on increased AROM, and strength of the dominant UE. which FOR does this treatment approach follow

ecology of human performance

which frame of reference fits the following scenario: an OTR is working with a client in the mid stages of Parkinson's disease. they display difficult with fine motor tasks ADL/IADLs, specifically their resting hand tremors inhibit their ability to initiate self feeding, grooming, and teeth hygiene. the OTR recommends the client use weighted utensils for self feeding, and a weighted electric tooth brush for hygiene. prior to competing sink side grooming tasks the pt completes a series of repetitive large movement UE exercises, as part of the formal HEP

ecology of human performance -choosing an activity based on the clients level of ability and grading the activity as the clients deficit increases or decreases. -can use adaptive or compensatory approaches. Focusing on increasing the clients deficit through rehab (just right challenge)

strategy for meds could be

education or a concept ex. educating caregiver on sensory diet

treatments for increased fall risk for a CVA pt

education, dynamic weight shifting, set-up occupations in arm length

what are the movements of the scapula

elevation/depression, protraction/retraction, internal rotation/external rotation, anterior/posterior rotation tilt

upper arm socket

encases and supports the residual limb. May have a harness or may be self supporting

forearm socket

encases and supports the residual limb. may have a harness or be self supporting. design varies depending on the length of the residual limb

during an evaluation with a 20 year old man who recently suffered a TBI as a result of an MVA with reported LOC states " i don't see the point on OT, there nothing you can do to help me" which of the following is he displaying a. executive function disorder b. rationalization c. denial

executive function disorder -results and is directly linked to the TBI -the other two answers result to mental health -weed out mental health disorders from actual cog disorders

the director of rehab asks a newly hired OTR to provide occlusion to a client who is experiencing diplopia to enable the client to more fully participate in rehab. Which action should the OTR take first in repost to request

explain to the director tat occlusion (eye patch) can be provided only user the direction of a physician or CLVT specialist

ipsilateral neglect

failure to respond to the same side ex. right sided CVA pt will have Right side neglect

MMT 3

fair part moves through compelete ROM against gravity

MMT 3-

fair minus part moves thought more than 50% against gravity

psychoanalytic theory

focuses on the role of a person's unconscious, as well as early childhood experiences -the early life relationships that mold you -how your personality was molded based on prior persona conflicts

stages of dementia: early

forgetfulness-increased frustration and anger lack of interest in life short term memory isolation confabulation (fabrication of an event) recognizing a problem exist

carpal fracture

fractures to individual carpal bones -most common is the scaphoid -kind box disease is a result to the injury of the lunate

frontal lobe

function: planning, learning new tasks, executive functioning

parietal lobe

function: sensory somatic system, smell, taste

a pt recovering from an acute myocardial infarction is referred to a therapist for an ADL evaluation. during the eval, the pt fatigues quickly and develops shortness of breath. the therapist initial goal of treatment should be to facilitate the pts

functional capacity for activities

what condition damages the optic nerve, causes increased pressure in the eye, and results in tunnel vision?

glaucoma

joints that are associated with the shoulder

glenohumeral, acromioclavicular joint, and the sternoclavicular joint.

an 8 year old with developmental coordination disorder is seen in the outpatient clinic to support praxis and develop functional skills. which action would the OTA provide at the next session for building motor planning skills?

help the child set up a trapeze, to then swing and drop into a pool of balls -this activity is rich in tactile, proprioceptive, and vestibular input which supports the development of praxis.

MCA (middle cerebral artery) stroke

hemiplegia in arm face and tongue, aphasia

visual closure

identifying forms or objects from incomplete presentations

Backwards Parachute AKA backward extension reflex (protective extension backwards)

if falling backwards a child can extend their arms back to catch themselves -develops at 10 months

visual hemiattention

in attention because they cannot see it when working with them have them look toward the neglected side -treatment; scanning

Acalculia

inability to do math

constructional Apraxia

inability to follow sequential steps in an activity -doing things out of order

ataxia

inability to perform coordinated movements

dressing apraxia

inability to plan and perform the motor acts necessary to dress oneself

aphasia

inability to produce speech

alexia

inability to read

astereognosis

inability to recognize objects by sense of touch ex. reach into purse and find keys just with touch

receptive aphasia (Wernicke's aphasia)

inability to understand spoken or written words

an OTR determines that a pt who has had a L CVA and who uses a wheelchair could safely retrieve items in the kitchen by using a reacher. The most effective instruction technique would be to

incorporate the use of a reacher in assisting with meal preparation

a therapist is instructing a pt who has a complete C6 quadriplegia to use a wash mitt and hand-held shower for increased functional independence in bathing. it would be most effective to

incorporate the use of the equipment when practicing bathing

nystagums

involuntary, jerking movements of the eye

trackball mouse

is connected to sensors within the mouse that detects its movement. thumb/fingers are use to move the cursor on the computer screen. ex. used by people with upper extremity coordination deficits, limited AROM, or UE weakness -someone with ALS, MS, weak dexterity

proximal fracture

metacarpal fracture, such as a boxer's (4th and 5th finger) fracture

A dementia patient will not get the diagnoses of Dementia until

midway through

Dementia and Hunningtons disease

mood changes and changes in personality are often the first sign

Mid stages of Huntington Disease

movement changes occur -INTERVENTIONS: caregiver training, skin checks, feeding options

working with a pt with RA. the pt works in the kitchen of a local restaurant and he has identified that trueing the knobs of the stoves and the taps fo the sinks, exacerbates his pain. which type of movements should the pt focus on using while working in the kitchen in order to protect his joints

movements that place the MCP joints in radial deviations instead of ulnar deviation

MS

multiple sclerosis -demolization of gray matter -fatigue and muscle weakness -primary progressive: remissions and exacerbations (pts get very fatigue and weak then get better) and secondary progressive: which is exacerbations only and at the end of the exacerbations that is their new baseline -can result in slower paralysis -cognition and vision decline due to decreased gray matter

precautions for ALS

muscle strengthening, aspiration and choking, pressure sores due to lack of movement, do not overwhelm the pt, consider the price of equipment

Those with MS will have

muscle weakness, fatigue(primary and secondary), decreased strength, vision, cognition, movement, balance, have periods of exacerbation and remission, and then feel better -therefore people with MS will believe they were sick and that they got better. -occurs more in women from 20-40 years of age

the muscles on the front of the arm are

musculocutaneous

tenodesis

natural flexion and extension of the head due to stretching and tightening of the tendons in the forearm

scapular winging

occurs when an injury to the long thoracic nerve weakens or paralyzes the serratus anterior muscle, causing the medial border of the scapula to rise away from the rib cage

Parkinsons disease

neurons die possible decrease in dopamine

presbyopia

normal loss of near focusing ability that occurs with age. -far sightedness; make things closer to the eyes difficult to see -most people begin effects of by age 40 when they have difficulties reading text messages or smaller print

NDT

normalizing tone, how to increase or decrease tone tone to increase handwriting (decrease tone do weight bearing for kids pushups, bear crawls etc)

E-stem

not contraindicated form someone with epilepsey -safe to use on someone who has a history of seizures -can use on someone with wrist drop to stimulate the muscles into extension. -do not use over opened wounds

specific tests for coordination will be

o'conner dexterity test (most common) 9 hole peg test (most common) Minnesota rate of minuplation test perdue peg board test

Performance Capacity

objective components subjective experience

An OTR is working with a client in their home, their diagnosis is a T8 SCI they sustained 1 year ago. They have been focusing on increased independence with accessing the community. The client lives 3 blocks from their work, where they work in an office building call center. The client expressed the desire to get to work quicker and since it is only 3 blocks away would like to self propel instead of accessing pubic transportation. Once in the office building the clients office is on the 8th for so would need to access the elevator and through doorways. The building was built in the early 1900's and is not in compliance with ADA. the OT suggests a light weight wheelchair, driving gloves, and a long handled stick for light switches and elevator buttons as they are not within reach. what model is being demonstrated

occupational adaptation

hemorrhagic stroke

occurs when a blood vessel in the brain leaks or ruptures; also known as a bleed

a third grade student with autism struggles with putting caps on markers and erasing during spelling tests. His teacher notices increased frustration during desk work. Which graded activity can address the students dexterity at the next OT visit.

practice moving coins from fingertips to palm and pam to fingertips -in-hand manipulation skills are essential components for fine motor skills, needed to manipulate objets and include translation, shift and rotation. the coin activity of translation would e the first place to begin to address in-hand manipulation skills, followed by rotation activities.

when a child who has a neurological impairment is placed prone on an oversized ball and the ball is rocked forward, an attempt is being made to elect a/an

protective extension response -try to protecting themselves from falling

veracity

provide comprehensive, accurate, and objective information when representing the profession

Social Justice

provide services in a fair and equitable manner

a client in the beginning stages of Huntingtons disease is displaying difficulty with their morning ADL routine. which of the following treatment options would be best for the OT to implement first

providing the client with a poster consisting of pictures of the order fo the clients sink side grooming routine start to finish

churches do not have to comply to ADA standards however a ___ does have to comply to ADA standards

restaurant

client with flaccid to mild tone post CVA a ___ splint may be beneficial

resting hand splint

Motor learning approach

retraining the neurons to require new skills -doing a task and as you're doing the task you're going to train your body to respond to how you're doing the task -hands on approach -think skill acquisition Three stages: -cognitive stage: figure out how you do a task -associative stage: refining the task and becoming more proficient -autonoma stage: the task becomes automatic

you have a pt who recently had a stroke in her L hemisphere, you want to try a remedial approach for therapy while your patient is gardening you decide to move their gardening tools to their__ side

right side

effects of CVA on the left side of the hemisphere

right side neglect, apraxia, difficulty with math, acts slowly and cautious, language, logic, sequencing, pt will be overly cautious

pelvic position while seated in a wheelchair

slight pelvic anterior tilt for maximal postural positioning

recommendation

something functional you give to your patient when you're not with them ex. HEP handout, training caregiver

swivel utensils

spoon/forks constructed with a larger or built-up handle that contains a swivel point in the end close to the bowel -the spoon swivels to keep the utensils level to prevent spills -could be sued for those who have Parkinson's tremors and weak grip strength

weighted utensils

spoons, forks, and knives with large handles that have weights inside weight utensils help increase proprioceptive input. in turn, this helps reduce tremors and improve fine motor control

angled utensils

spoons/forks constructed with an angle that bend to bowls -those who have difficulty with supination -typical angle is 45 or 90 degree -people with limited UE ROM especially those with limited supination

Dementia

stage 1-2 are unnoticed -gets diagnosed within the later stages -later stages pts can have difficulty with depth perception -mid stages (stage 3-4); official diagnosis; has short term memory issues

5 clinical stages of Parkinson's

stage 1: unilateral signs and symptoms typically tremors and acognisia with no or minimal loss of function stage 2: bilateral signs and symptoms, balance is not affected but there's problems with trunk mobility and postural reflexes stage 3: impaired balance secondary to postural instability leads to mild and moderate impairment to function stage 4: decreased postural stability, decreased function, impaired mobility and they need assistance with ADLs due to poor fine motor dexterity stage 5: total dependence for mobility and ADLs

backward chaining

teaching the child the last step of an activity until mastered and working his/her way up step by step until the activity is complete. ex. therapist does step 1, 2 and the client does step 3, then the next day the therapist does step 1, and the client does step 2,3.

figure ground

the organization of the visual field into objects (the figures) that stand out from their surroundings (the ground).

figure ground

the organization of the visual field into objects (the figures) that stand out from their surroundings (the ground). -finding milk in a fridge

COPM (Canadian Occupational Performance Measure) Assesses

the outcome measure designed to assess clients outcomes in the area of self-care, productivity, and leisure. It is a 5 step process

sensory integration

the process by which the brain combines information taken in through the senses; sight, touch etc. to make a whole

first signs of ALS and Gullian-Barre syndrome are

tingling and numbness in hands and feet

an outpatient OT is developing an intervention plan for a client with primary open angle glaucoma. what would be the best option to include in the intervention plan for this client

training on rotation of head and trunk to scan environment during functional mobility activiteis

a pt who had a CVA has fair dynamic sitting balance but is unable to complete bathtub transfers safely without assistance. the therapist should recommend this pt us a a) bathtub board b) wheeled shower-commode chair c) transfer tub bench d) commode placed inside the bathtub

transfer tub bench

a pt who has a right hemiparesis is being discharged home forma rehab unit in one week. the pt completes self-care and mobility activities form a manual wheelchair. the bathroom safety equipment for this pt to use to get in and out of the bathtub would be a a) transfer tub bench b) shower chair c) grab bar

transfer tub bench

you have a 19 year old student in the 12th grade with a history of intellectual and learning differences. they currently have an IEP, and are receiving OT services. Which program best fits their needs when transitioning form high school to the communit

transitional employment -hands on training to get us ready for a specific career

ligament that compresses the median nerve that gets released for carpal tunnel syndrome

transverse carpal ligament

cumulative trama disorders (CTD)

trauma to soft tissues caused by repeated force -overusing or repetitive strain -not a diagnosis

Parksinson's Disease

treatment can include big and loud program

Guillian Barre Syndrome

treatment often includes imunotherapy -can make a full recovery -can be completely paralyzed and then return back to normal by replacing the bad neurons with normal neurons

two types of complex regional pain syndrome

type 1: develops after a crazy event type 2: develops after a nerve injury

Psychodynamic Model

unresolved childhood events can cause dysfunction -discussion based -more long term -good for task oriented group -all the different changes while growing up that could cause dysfunction from unresolved childhood events

a 68 year old woman with macular degeneration likes to knit in her study at night while sitting on her armchair next to an exposed floor lamp. However, she finds it progressively difficult to perform the activity. what would be the best recommendation the OT should make to continue performing the patients activity.

use a lame shade with enough height to flood her area and decrease glare

Evaluation

used to measure the impairment or condition that a client has to know what steps to take to address the issues of the patient -paints a picture of the client

Ice massage

used with an acute phase of injury for a small area that is in pain. EX. lateral and medial epicondylitis -place 3-5 minutes NO LONGER, can cause burns

myoelectric prosthesis

uses EMG signals to activate electric components embedded inside the prosthetic socket that are in contact with the patients skin. The components pick up EMG signals as the muscles contract. The signals are amplified and relayed to the electrical terminal device, wrist unit, and or elbow unit -advantages; increased grip force up to 25 lbs, ability to use overhead, minimal effort needed to control, can control more closely, corresponding to human physiological control -disadvantages; cost of prosthesis is expensive, frequent maintenance of repair, fragile nature of glove and frequent replacement , lacks sensory feedback, weights more

adaptive stragegy

using your body or the environment to compensate

spina bifida meningocele

vertebrae don't completely enclose spinal cord, cerebrospinal fluid exits through opening, but no nerves

Cataracts

visual loss of visual acuity -intervention; use magnify glass, provide contrasts, good lighting for compensation

after cruising a child can

walk with hands held

using the KAWA model incorporates identifying each component of the river metaphor and how it might be impacting "flow". which metaphor specifically relates to a patients social and physical environments

walls and floor

contralateral hemiparesis

weakness of opposite side of the body (if CVA is on left side of the brain then right side of the body is affected)

hemiparesis

weakness on one side of the body