OTA 130 - Test 1

Facilitating Positive Patient Encounters

•Collaborate. •Communicate. •Be empathic. •Listen without judgment. •Reframe negative views. •Involve the family when beneficial. •Engage in self-examination and stress management.

Always guard on the side toward...

which the patient is most likely to fall

Short-term positioning: sitting

- Be sure the patient is sitting with hips back and centered in the chair. - Sitting in a chair tends to be most comfortable when the normal curves of the back are supported, either by the structure of the seat or by placement of a very small bolster or towel roll behind the small of the back, and when the hips are slightly flexed, which is often achieved by elevating the feet with a small stool or rail. **If the seat is too high and the patient's feet do not touch the floor, the distal thighs are subjected to increased pressure and the low back can be stressed. ** Armrests set at the right height allow the shoulders to rest comfortably.

Short term positioning in supine

- Check to ensure the patient is positioned straight and centered on the table. - Reposition the patient as needed so that the shoulders are parallel to the hips. - Pillow under head, pillow under knees (prevent excessive lumbar lordosis), arms at side and forearms on chest. - Establish normal spinal curves to the extent possible. ** easiest way to restore normal curve of lower back is to bend the hips and knees.

Long-term positioning: sitting

- Increase frequency of repositioning - May require small lumbar roll - Approximate 90°-90°-90° position (90° hip flexion, 90° knee flexion, and neutral ankle) - Avoid sacral sitting - Support arms

Therapeutic Alliance

- Person (both clinician's perspective and patient's perspective) - Task - Environment

Preventing Pressure ulcers

- maximum of 2hr in one position in bed - max of 15min in one position while seated - reposition more frequently if patient has increased risk factors.

Eccentric

- out of center - muscle lengthening with movement - functional: setting down an object that you are holding

High Fowler's Position

- semi reclined pt. in supine - HOB is elevated 45-60 degrees - position of comfort: can increase shearing forces and promote contractures

Car Transfers: Wheelchair-to-Car

- specific technique depends on patient's capabilities and on vehicle design - this follows basic pivot-transfer principles **slide seat back and recline backrest, remove armrest and legrest on car side, position w/c in door opening and apply locks.

Seated Anterior-Posterior Transfer

-Also called "straight-on" or "front-to-back" -Typically between bed and wheelchair -Chair faces bed, and both knees extended -Often used by patients who have bilateral lower extremity (LE) transfemoral amputations or SCI -Requires good upper body strength to perform independently

Independent Sliding Board Transfer to the Left Bed-to-Wheelchair

-Angle left side of wheelchair close to bed. Secure surfaces. -Lean trunk to right. Place one end of board under left hip and other end over wheelchair seat. -Place left hand out on board, and press down with both hands. -Lift hips up and over. Repeat as needed. -Remove board.

Hemiplegia

-It is generally easier to transfer to the stronger side. -The patient may need to rely on the stronger side for a unilateral pivot -The involved UE may need to be supported. -Do not pull on patient's involved arm.

Lateral Transfer Equipment—Indications

-Moving a dependent patient from one horizontal surface to an adjacent horizontal surface (e.g., bed-gurney or stretcher-treatment table)

Total body lifts - indications

-Point-to-point transfers (seated or supine) level 3 (extensive assistance) or level 4 (total dependence) when no direct therapeutic intervention is desired in the transfer process -Lower extremity (LE) nonweight-bearing (NWB) patients who cannot perform a seated lateral transfer

Independent Lateral Seated Transfer to Left Wheelchair-to-Mat Without Board

-Remove wheelchair's armrest and leg rest. -Position left side of chair close to the mat and slightly angled. -Lean left, and place left hand on mat with room for sitting. -Place right hand on armrest. -Push down with both hands, lifting hips up and over onto mat in one motion. -Adjust position as needed.

Proper position of gait belt

-Snug around patient's waist (except in certain cases) -Fasten buckle in front of patient -Just enough room for fingers to slide in.

Positioning in a static posture:

-can be both to increase stability and to increase or facilitate mobility.

Normal spinal alignment

-cervical lordosis: slight inward curve at the neck. -thoracic kyphosis: slight rounding upper and mid back - Lumbar lordosis: mild inward curve in the lower back area.

Positioning devices

-reduce or eliminate load on the tissues - help patient maintain a static position - patients using positioning devices must still be frequently repositioned and monitored

Key foundations for therapy

-respect for client -dependence --> Independence -AMAP/ANAP= as much as possible, as normal as possible. -CCDD=control centrally, direct distally -stability before mobility

Isometric

-same or equal distance -no movement -Ex: carry grocery bag on locked, bent arm

Long-term positioning: sidelying

-upper trunk typically rotated forward or backward - pillow or bolster to maintain upper trunk position - elevate uppermost arm and hand

Isotonic active - concentric

-with center -muscle shortening with movement -most common type of exercise and most commonly used in life activities

elbow extension ROM

0 degrees

intimate space distance

0-1.5 feet

Elbow flexion ROM

0-145

Shoulder Flexion ROM

0-170

shoulder abduction

0-170

radial deviation

0-20

ulnar deviation

0-30

shoulder extension

0-60

wrist extension

0-70

Shoulder Internal Rotation ROM

0-70 degrees

wrist flexion

0-80

elbow and forearm pronation

0-80/90

elbow and forearm supination

0-80/90

shoulder external rotation ROM

0-90

Personal space distance

1.5-4 feet

Fever is generally above...

100.4 degrees

public space distance

12+ feet

Normal respiratory rate

12-20 breaths per minute

Social space distance

4-12 ft

normal heart rate (pulse)

60-100 beats per minute

Normal pulse oximetry

95%-100% - mild: 91-94 -mod: 86-90 -severe: <86%

Normal temperature

96.8-99.1 deg Farenheit

Responding to Loss

Common grieving responses: ¤Fear ¤Anger ¤Guilt ¤Anxiety ¤Withdrawal ¤Depression

Base of Support

Contact area of an object with its supporting surface

3 types of exercise

isometric, isotonic-active (concentric), eccentric

Supine high risk areas for ulcers

occiput scapula spinous processes elbows (olecranon) sacrum/coccyx ischial tuberosity lateral malleoli heels ** HEELS AND SACRUM ARE ESPECIALLY HIGH RISK IN SUPINE **

Seated high risk areas for pressure ulcers

occiput (tight chair) scapula spinous process elbow sacrum ischial tuberosity heels

orthostatic hypotension

Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions. **usually happens within 3 min of standing or supine to sit. heart may not pump sufficient blood against resistance of gravity

Long-term positioning: Supine

Different than short term positioning - HIPS and KNEES are in full extension or slightly flexed to prevent flexion contractures Pillow support under calves with suspension of heels, and support of arm up off mattress Supine positioning with pillows. Note the left heel protector, the support under the calves, and the neutral position of the glenohumeral joint achieved by raising the arm up off the mattress.

Post-CVA Positioning: Supine

Example of supine positioning for a person with CVA. Notice the use of pillows under the legs for heel protection and to guard against contractures. Also notice the right arm (hemiplegic side) slightly elevated in a supported position. Small pillow under shoulder blade, elevate arm/hand, pillow under legs for heel protection

Post-CVA Positioning: Sidelying

Examples of side-lying positioning for a person with CVA. (a) The hemiplegic arm (left side) is supported to keep the hand from falling forward and below the level of the heart. The knees and ankles are cushioned to guard against pressure ulcers. The right arm (nonhemiplegic) is positioned slightly forward to prevent direct pressure through the shoulder and arm, reducing nerve compression and limiting the risk of the arm "falling asleep." (b) Alternative positions of the arms. (c) Posterior view showing support for the trunk that allows the patient to maintain a comfortable full or partial side-lying position.

3 muscle grade

Fair Complete ROM against gravity

3- muscle grade

Fair minus Incomplete ROM against gravity (>50%)

3+ muscle grade

Fair plus Compete ROM against gravity with slight resistance

FWB

Full Weight Bearing (100%)

external vs. internal forces

Internal: Forces produced by the body External: Forces acting on the body that originate from outside of the body

Long-term positioning: prone

Least common choice. Must make sure patient airway is clear. Place cushion under head, abdomen, and hips. Arms can be overhead or abducted. Patient may also lie in 3/4 prone as long as have additional support on anterior body surface.

Dependency Levels and Recommended Lift Assists

Level 4--Total dependence—no manual lifting; use sling lift Level 3--Extensive assistance—no manual lifting; use sling lift, stand lift Level 2 or 1--Limited assistance or supervision—use mechanical lift, transfer board, walker, gait belt, possibly some manual lifting Level 0--Independent—typically no mechanical assist needed

linear vs angular

Linear = in a line, pulling a rope. Angular = Rotational, pushing on edge of a book - both are used with Pt. care, interactions, turning Pt. in bed, pushing w/c.

hypoxia

Low oxygen saturation of the body, not enough oxygen in the blood

0 muscle grade

No muscle contraction seen or felt

Most supportive to least supportive devices

Parallel bars Walker Bilateral axillary crutches Bilateral forearm crutches Hemi walker Quad cane Single-point cane

2 muscle grade

Poor Complete ROM, no gravity

Horizontal Seated Transfers

Primary action occurs at the hips: -Sliding board lateral transfers -Lateral transfer without board -Anterior-posterior transfers

Which of the following two types of upper extremity synergies are described in Brunnstrom's Stages of Motor Recovery? a). flexion and abduction b). all the above c). flexion and extension d). extension and adduction

c). flexion and extension

Which of following indicate Normal Range of Motion for the joints noted: a). shoulder abduction 0-90 degrees, elbow flexion 0-140 degrees and wrist flexion 0-70 degrees b). shoulder flexion 0-170 degrees, elbow flexion 0-140, wrist extension 0-70 degrees c). shoulder extension 0-150 deg, forearm supination 0-50 degrees, and wrist flexion 0-30 degrees

b). shoulder flexion 0-170 degrees, elbow flexion 0-140, wrist extension 0-70 degrees

Ms. Juice is gaining some motion and strength back on her right side after having a CVA two weeks ago. She is able to bear weight on her left side and is now starting to bear some weight on her right side. Which transfer technique would you choose for her? a). sliding board transfer b). stand pivot transfer c). squat pivot transfer d). total body lift - hoyer lift transfer

b). stand pivot transfer

How much ROM is normal in shoulder abduction a. 120 deg b. 170 deg c. 90 deg d. all the above are within normal ROM

b. 170 deg

Where do you line up the axis of the goniometer when measuring elbow extension and flexion? a. ulnar styloid b. olecranon c. lateral malleolus d. medial epicondyle

b. olecranon

judgement

ability to make realistic decisions

insight and awareness

ability to monitor, correct, and regulate behavior

sequencing

ability to organize activity in logical and timely steps

praxis

ability to plan and perform purposeful movement

stereognosis

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

abstract thinking

ability to see the relationship between items, discriminate details

The role of an OTA in joint measurement:

based on service competency, state regulations, and facility policy

True or false: chair-toilet transfers are the most stressful

TRUE

True or false: non-verbal communication makes up the majority of our communication with clients

TRUE

True or false: The therapeutic alliance between patient and practitioner can be strengthened through the person, the task, and the environment.

TRUE **it serves as the foundation for all successful OT interventions

proprioception

The ability to tell where one's body is in space.

Ms. Smith demonstrates total limb movements in flexion or extension and is unable to isolate individual joint motions. She demonstrates the full flexor synergy pattern when trying to move her arm to her face. Which level of Brunnstrom's Stages of Motor Recover would she fall under? a). normal movement b). beginning of synergy pattern, reflex response c). spasticity - mass responses d). flaccidity

c). spasticity - mass responses

constructional apraxia

The inability to draw, copy, or construct designs

Zero Lift Equipment and Use—Vertical Lifting

Total body lifts -Powered ceiling hoists -Portable floor-based lifts ("Hoyer") -Manual -Battery-operated Hybrid lifts—freestanding with overhead frame and tracking system

1 muscle grade

Trace contraction felt, no motion

Cerebellar Disorders

Tremor Dyssynergia Dysmetria Dysdiadochokinesia Rebound phenomenon Asthenia Motor impersistence Ataxia

Guarding During Gait

Typically behind and slightly to the weaker side Control points: pelvic and shoulder girdles For gait requiring hands-on guarding, one hand is typically grasping the gait belt and the other hand hovers at the contralateral shoulder.

stairs

UP with the GOOD and DOWN with the BAD. **the AD generally moves with the involved LE ** -going up, guard from behind -going down, guard in front

Up and Down Curbs With Walker

When ascending a curb, the walker must be advanced first, followed by stronger LE. The patient must lean forward for effective push through UEs prior to lifting weaker LE. Descending follows typical pattern for descending steps.

skin blanching

When pressed, healthy, lighter colored skin will blanche and quickly return to healthy pink. ** if skin does not blanche, it indicates compromised tissue **

Cachexia

a condition of physical wasting away due to the loss of weight and muscle mass that occurs in patients with diseases such as advanced cancer or AIDS

Alex is slumped over in his wheelchair with his foot outward and his arm hanging over and to the side. Which body part would you position first to allow for better sitting posture and to allow for "control central, direct distal"? a). His pelvis b). His arm c). His neck d). His leg

a). His pelvis

Which of the following is NOT part of normal spinal alignment positioning? a). Lumbar Kyphosis b). Cervical Lordosis c). Lumbar Lordosis d). Thoracic Kyphosis

a). Lumbar Kyphosis

Mrs. Flower needs to be positioned in bed supine with the head of the bed lower than the foot of the bed after her abdominal surgery. Which special position is this called? a). Trendelenburg position b). semi-reclined position c). Reclined position d). High Fowler's position

a). Trendelenburg position

This type of tremor is present in the absence of voluntary movement, occurring when the patient is not moving. How would the OTA describe her objective observations in his or her note. a). a resting tremor b). ataxia c). dysarthria d). an intentional tremor

a). a resting tremor

attention

active process of relevant focus

orientation

awareness of person, place, and time

venous thrombosis

blood clot or thrombosis in a vein - with immobility, small clots can grow and can cause partial or complete occlusion of the vein.

Mrs. Knight has to be positioned in long term sitting. Which of the following is the best position for her? a). 60 deg hip flexion, 90 deg knee flexion, 90 deg or neutral ankle b). 60 deg hip flexion, 90 deg knee flexion, 60 deg ankle flexion c). 90 deg hip flexion, 90 deg knee flexion, 90 deg or neutral ankle

c). 90 deg hip flexion, 90 deg knee flexion, 90 deg or neutral ankle

The stages of upper extremity motor control return following a stoke/CVA range from (Flaccidity) to (Normal Tone). Which neuropathic treatment approach method is associated with this scale? a). PNF b). Sensorimotor - Rood c). Brunnstrom d). NDT - Bobath

c). Brunnstrom

Mr. Bell is progressing from using a quad cane to using a straight cane for ambulation during his ADLs. Which of the following are correct with fitting of a straight cane? a). the handle is aligned with the wrist crease or ulnar styloid process as the patient stands in a relaxed position. b). in the ready position, the cane should be slightly forward and to the side c). all of the above d). the elbow should be in about 20-30 degrees elbow flexion.

c). all of the above

Tony has undergone a Right Total Hip Arthroplasty and is now working on ascending and descending stairs. His bedroom at home is upstairs and he is practicing to be safe and functional for his return home. How would you best explain to him how to ascend the stairs? a). up with the cane first then his left foot holding on to the railing. b). up with is left foot first than his right foot, holding on to the walker. c). up with his left foot first then his right foot, holding onto the railing d). up with his right foot first then his left foot holding on to the railing.

c). up with his left foot first then his right foot, holding onto the railing

Which MMT grade is defined as less than full ROM (greater than 50%) against gravity? a. 2-/5 b. 4+ c. 3-/5

c. 3-/5

Abnormal spinal alignment

cervical kyphosis: forward head, hump in the back of neck = Dowagers Hump - in older women - secondary to osteoporosis bone weakness and degenerative disc disease (compression fractures in back bones)

COPD

chronic obstructive pulmonary disease. **mild hypoxia common, ask their norm.

In the therapeutic alliance what THREE components are present? This alliance serves as the foundation for all successful OT interventions. a). Person, Occupation, Task b). Person, Place, Environment c). Person, Environment, Function d). Person, Environment, Task

d). Person, Environment, Task

Prone high risk areas for pressure ulcers

ear side of face chin anterior shoulder iliac crest knees dorsal feet

Sidelying high risk areas for pressure ulcers

ear side of face humeral head (shoulder) hip/greater trochanter outer knee lateral femoral condyle inside of knee (medial malleolus)

what is the most common type of contractures?

flexion contractures

4 muscle grade

good complete ROM against gravity with moderate resistance

How do you grasp a gait belt?

grasp gait belt from underside with fingers pointing toward patient's head to assist with activities such as standing, turning, and walking.

incontinence

inability to control bladder and/or bowels

Dyscalculia

inability to perform calculations

executive functioning

includes goal formation, planning, and effective performance

goniometer

instrument used to measure joint angles

primitive reactions:

involuntary -rooting -suck and swallow -moro -palmar grasp -plantar grasp -positive supporting reflex -asymmetrical tonic neck reflex -symmetrical tonic neck reflex -tonic labyrinthine reflex -landau -babinksi

problem solving

involves the processing of information to plan and evaluate

Ischemia

lack of blood supply. **tissues begin to die

abduction wedge

large and small triangular foam wedges are used when the client is supine to maintain the LEs in the abducted position

contractures

limitations in joint motions caused by shortening in the structures of the ligaments, tendons, and muscles

NWB

non-weight-bearing (absolutely no weight on leg)

5 muscle grade

normal complete ROM against gravity with full resistance

PWB

partial weight bearing - percentage of body weight is usually 20-50%

Temporary static stability:

positioning pt. to keep them from falling out of bed, or to receive txs (sacral wounds)

Mobility Assistive Equipment (MAE)

restores the client's ability to participate in mobility-related activities of daily living (MRADLs)

memory

retention and recall of information

Normal blood pressure

systolic: 100-120 mmHg Diastolic: 60-80mmHg

CoM moves towards...

the added weight. Example: cast on R leg = CoM on R side R leg amputation = CoM on L side

mass

the amount of matter in an object, segment, or body is composed (remains the same regardless of the environment)

ROM

the extent of movement that occurs at a joint

ideaomotor apraxia

the inability to perform an action on command that can be performed automatically

dressing apraxia

the inability to plan and perform a sequence needed to dress

TTWB

toe touch weight bearing- foot contacts ground for balance only, up to 20% of body weight

Center of Mass (CoM)

the point around which all weight is evenly distributed; also called center of gravity - in standing, and typical body, it's in pelvic region, just anterior to S2

WBAT

weight bearing as tolerated - limited only by patient tolerance (usually 50-100%)

Therapeutic exercise

"When used in OT, therapeutic exercise should be used to remediate sensory and motor dysfunction, augment purposeful activity, and prepare the patient for performing a functional occupation" p. 214/217, Early

Repositioning in sitting

"as is the pelvis, so is the head." ** position pelvis, most central part of body, then distal parts **

Loads and Loading

*Tension - stretch or lengthen *Compression - push together, opposite of tension *Axial Compression - directed along the long axis of the structure (spine or extremity) *Distraction - pull apart *Shear - two forces in contact but moving in opposite direction *Bending - tension & compression combined *Torsion - twist force *Combined loading- two or more loading mode

Short-term positioning: side lying

- Ensure that the patient is centered and straight on the bed or table, decrease pressure on greater trochanter (hip), moves hip slightly forward or backward - pillow under head and small roll under waist ** The most common side-lying position is with the underside leg straight and the hip and knee of the top leg flexed. Pillow under head, pillow between legs, (top leg slightly forward) The underside arm is positioned forward of the body, and the top arm rests gently on a pillow placed in front of the chest and abdomen. **

Positioning after a LE amputation

- Keep the hips in neutral rotation - extend the knee - minimize sitting time with the knee flexed - avoid pressure on nonhealed surgical sites

ambulation aids include:

- LE orthotics, such as ankle-foot orthoses (AFOs) and knee-ankle-foot orthoses (KAFOs) -cane -walker -crutches

Positioning: After Total Hip Replacement

- PRECAUTIONS FOR A POSTERIOR APPROACH - Avoid hip flexion beyond 60 to 90° - Avoid hip adduction past 0° - Avoid hip internal rotation past 0° PRECAUTIONS FOR AN ANTERIOR APPROACH - Avoid hip extension past 0 - Avoid hip adduction past 0 - Avoid hip external rotation past 0

Positioning after a CVA with Hemiplegia

- Prevent contractures. - Prevent wrist and hand edema. - Avoid distraction of the hemiplegic shoulder. Common pattern of contracture development -Scapular retraction -Shoulder adduction, flexion, and internal rotation -Elbow, wrist, and finger flexion -Hip adduction, flexion, and internal rotation -Knee flexion -Ankle plantar flexion

Long-term positioning

- Safety: open airways, avoids falls, accommodate medical limitations - prevention: prevent development of pressure ulcers, contractures, and edema; promote efficient function of bodily systems. - Comfort: good spinal alignment and cushioning; relieve stress on joints

Short-term positioning: Prone

- Straight and center of table, shoulders parallel to hips, pillow (too many can increase cervical lordosis) - small pillows under head, stomach and feet = improved spinal alignment. Arms at side or overhead "stick up position" ----- -The patient on the right is positioned to accommodate her shortened hip flexors.

Trendelenburg position

- Supine and HOB is lower than foot of bed. - abdominal and gyn sx.

Restraints

- Use only when absolutely necessary. - Use the least restrictive device (LRD). - Fasten with quick-release buckles or knots. - Monitor patients closely.

Energy Cost of Assistive Devices

- gait deviations tend to increase energy expenditure - older adults tend to expend more energy walking long distances than younger adults - using standard walkers require more energy than using rolling walkers or canes

The person (patient's perspective)

-Cultural differences - Responding to loss - Stages of response to injury or disability - Spirituality

Evaluating functional use of the limbs

-The occupational therapist can use observation or structured tests, such as the functional independence measure (FIM) or physical performance test -The levels of functional assist must be established before setting goals ¬ Minimal stabilizing assist ¬ Minimal active assist ¬ Maximal active assist ¬ Incorporation of the involved upper extremity into all bilateral tasks

Clinician Assistance in Sliding Board Transfer

-Typically guard from front if patient is unable to reliably maintain balance. -Assist with hip movement by gripping lateral aspects of gait belt or trousers, sides of draw sheet, or under ischial tuberosities. -Several small moves may be needed to complete transfer.

Brunnstrom's Stages of Recovery

1. Flaccidity 2. Spasticity Appears (dealing with spasticity 3. Increased Spasticity 4. Decreased Spasticity 5. Spasticity Continues to Decrease (complex movement combinations) movement combinations) 6. Spasticity Decreases and Coordination re-appears (spasticity disappears) 7. Normal Movement Patterns (normal function returns)

conditions for stability

1. The BoS is larger (compared to smaller). 2. The LoG, that is, gravity's line of action acting on the object's CoM, is at or near the center of the BoS. 3. The distance between the CoM and the BoS is shortened, and the CoM is lower and closer to the BoS.

Conditions for mobility

1. The BoS is smaller in area. 2. The LoG is allowed to move beyond the center of the BoS. 3. The distance of the CoM above the BoS is greater.

active vs. passive ROM

Active = the patient performing the motions themselves Passive = the practitioner completely assisting the motions being accomplished

FIM

Functional Independence Measure *Measures independence for self-care, including sphincter control, transfers, locomotion, communication, and social cognition

Proper body mechanics

Keep back straight, bend at knees, keep wide stance, and keep objects close to body.

2- muscle grade

Poor minus incomplete ROM, no gravity

2+ muscle grade

Poor plus incomplete ROM against gravity (<50%) or complete ROM against slight resistance

Preventing Edema and Cardiopulmonary Complications

Position distal extremities at or above the level of the heart. Vary demand on the heart by including more upright positioning. Vary positions to promote lung drainage.

The OTA is guarding a patient during a transfer from bed to the bathroom and is using a gait belt. The patient is using the walker and is requiring Minimal Assistance. Where does the OTA guard from when ambulating to the bathroom? a). behind the patient and slightly to the weaker side with control to the pelvic and shoulder girdles b). in front and slightly to the weaker side, with control to the shoulder and hand. c). behind the patient and slightly to the stronger side, with control to the pelvic and shoulder girdles.

a). behind the patient and slightly to the weaker side with control to the pelvic and shoulder girdles

Mr. Loose recently had a CVA and is having limitations with joint motion caused by shortening in the structures of the ligaments, tendons and muscles from increased muscle tone (holding his hand in a flexed position). Which of the following defines this symptom? a). contracture b). pain c). flaccid d). edema

a). contracture

Mr. Who recently had a below the knee amputation and is seated in a chair, the pillow support is under his thigh instead of under his whole leg. Which symptoms can this position cause? a). edema, knee contracture b). increased range of motion c). all the above d). increased flexibility

a). edema, knee contracture

Manual Muscle Testing is appropriate for patients who demonstrate abnormal increased muscle tone? a). false b). true

a). false

Rolling walkers require more energy expenditure than standard walkers. a). false b). true

a). false

Mr. Frank is positioned in a long-term Supine position. Which areas are the most susceptible to pressure sores when in this position? a). sacrum/coccyx, heels, ischial tuberosity b). anterior shoulder, sacrum/coccyx, heels c). ischial tuberosity, sacrum/coccyx, knees

a). sacrum/coccyx, heels, ischial tuberosity

The OTA is treating a patient with a lower spinal cord injury and is a paraplegic. Which type of transfer would be most appropriate, safe and functional? a). sliding board transfer b). total body lift - hoyer lift transfer c). stand pivot transfer d). squat pivot transfer

a). sliding board transfer

Movement is regarded as a function of the interaction between the patient's neuromuscular system, the environment, the patient's cognition and the task. a). true b). false

a). true

The agonist is the muscle that contracts to create movement at a joint. a). true b). false

a). true

Mr. White is required to use an assistive device to walk after his Total Hip Replacement. Which ONE of the following would give him the greatest BoS? a). walker b). quad cane c). crutches d). cane

a). walker

How much ROM is normal in an elbow flexion? a. 140 b. 120 c. 100 d. 0

a. 140

What muscle grade is defined as moving through full ROM in a gravity eliminated plane? a. 2/5 b. 3/5 c. 4/5

a. 2/5

body scheme

awareness of the position of the body and its parts in relation to themselves and the environment -left-right discrimination -unilateral inattention or neglect -finger agnosia

The OTA is testing MMS in the patient's shoulder and observes that she is able to move her shoulder through partial ROM with gravity eliminated. Which muscle grade would she document in her note? a). 1 b). 2- c). 4- d). 3-

b). 2-

Which muscle grade does this description describe: Complete ROM against gravity, but no resistance? a). 4, Good b). 3, Fair c). 2, Poor d). 5, Normal

b). 3, Fair

Which of following is the type of range of motion described as "the range of motion that is required to accomplish everyday activities."? a). Self ROM b). Functional ROM c). PROM d). AROM

b). Functional ROM

Which of the following statement is NOT true regarding manual muscle testing? a). examiner stabilizes proximal parts b). OTA stabilizes distal parts and test should be performed with gravity minimized or eliminated. c). assesses general strength and if possible, the test is performed against gravity.

b). OTA stabilizes distal parts and test should be performed with gravity minimized or eliminated.

It is the OTAs responsibility to facilitate a positive patient encounter. Which of the following helps create this positive experience? a). collaboration b). all the above c). non-judgmental listening d). good communication e). involvement of the family f). empathy

b). all the above

The OTA is planning on transferring a CVA patient from the bed to the wheelchair. Which of the following are reasons why the use of gait belts is so important when transferring a patient? a). When used correctly they can prevent falls. b). all the above c). Using gait belts is a good example of using proper body mechanics as it can provide the OT with a better mechanical advantage to assist the transfer. d). They are safer than holding onto the patient's clothing.

b). all the above

The CoM (Center of Mass) of a patient with a lower leg amputation is distributed towards: a). the center of his body b). his normal leg side c). his amputation leg side.

b). his normal leg side

Mrs. Smith had knee surgery and her weight bearing (WB) status is PWB. She is using a standard walker as her assistive device. This weight bearing restriction would allow her to bear how much weight on her legs when the OTA is assisting her in walking to the bathroom for morning ADLs. a). limited only by patient's tolerance - usually 50-100% b). percentage of patient's body weight - 20-50% of weight. c). 0% foot and toes do not touch the ground. d). the patient may touch the foot of the ground for balance assistance only. e). foot may rest on the floor but the extremity is not bearing weight.

b). percentage of patient's body weight - 20-50% of weight.

Which of the following describes an increase in muscle tone in both the agonist and antagonist muscles? a). hypertonicity b). rigidity c). spasticity d). hypotonicity

b). rigidity

This transfer is best used for patients who are unable to bear weight on their lower extremities during a dependent transfer, and who cannot preform a seated lateral transfer. a). sliding board transfer b). stand pivot transfer c). total body lift - hoyer lift transfer d). squat pivot transfer

c). total body lift - hoyer lift transfer

When determining which mobility procedures to use in patient care, what is the first question you should consider? a). Which movement will be easiest for the patient? b). Which movement does the patient want to practice? c). How much assistance will be required for the maneuver? d). What am I trying to accomplish with the maneuver?

d). What am I trying to accomplish with the maneuver?

Your patient is a 64 year old man who had a stroke and has severe right upper extremity weakness as a result. His right hand has become very edematous. Which of the following is the best position for the patient's right arm to aid in the management of his edema? a). With the forearm supported on the armrest while he is sitting in a wheelchair. b). By his side with his fingers extended and his palm facing up while he is supine c). Across his chest while he is lying on his left side. d). With the hand on a pillow, higher than the heart, while he is supine.

d). With the hand on a pillow, higher than the heart, while he is supine.

Mrs. Clone is a new patient in the acute care hospital setting who recently had a CVA . Her left side is affected with decreased muscle tone noted as well as inability to actively move her left arm or leg. How would you describe this type of abnormal tone? a). spasticity b). rigidity c). hypertonicity d). flaccidity

d). flaccidity

Mr. Klein is able to actively supinate his forearm to 30 degrees when trying to turn a door knob. How would the OTA describe this amount of AROM? a). within normal limits at 30 degrees. b). limited, normal is 40-50 degrees. c). limited, normal is 60-70 degrees. d). limited, normal is 80-90 degrees.

d). limited, normal is 80-90 degrees.

Which of the following is an example of an internal force commonly used when assisting patients with movement? a). friction b). ankle weights c). gravity d). muscular tension

d). muscular tension

When communicating with a patient during a treatment session, which type of communication is the majority of our interactions? a). verbal communication b). visual communication c). auditory communication d). non-verbal communication

d). non-verbal communication

Frank has been diagnosed with a TBI and is now transferring on to the toilet. He is able to bear some weight on his legs but unable to stand up completely. Which transfer technique would you choose for him? a). total body lift - hoyer lift transfer b). stand pivot transfer c). sliding board transfer d). squat pivot transfer

d). squat pivot transfer

Graphesthesia

identification of numbers and letters when they are written on the skin

zero lift policy

•Mechanically assisted lifting when objective is to move a patient •Occupational Safety and Health Administration (OSHA): manual lifting of residents should be minimized in all cases and eliminated when feasible. •Legal requirement in many states

Muscle strength vs. endurance

• To ↑ strength - high-load, low-repetition • To ↑ endurance - low-load, high-repetition • Typically need to work on both, so they vary from day to day

The Person (clinician's perspective)

•Professionalism •Common biases •Avoiding judging patients •Responding to inappropriate behaviors •Effective communication •Stress and stress management

THA Posterior Approach

•Scoot forward in chair without trunk flexion beyond 60 to 90 degrees. •Extend knee of involved LE prior to standing. •Avoid forward trunk flexion beyond 60 to 90 degrees before rising. •Pushing to standing without trunk flexion is very difficult. •Avoid internal rotation of involved hip during pivot. •Avoid forward trunk flexion beyond 60 to 90 deg. during sitting.

Unilateral Limited WB

•Slide the affected LE forward prior to rising. •Hold NWB limb slightly off the ground during pivot. •Pivot on uninvolved LE through a series of small hops. •Extend knee of involved LE prior to sitting.

Squat-pivot vs. Standing-pivot Transfer

•They differ in amount of uprightness the patient achieves. •They can differ in hand placements. •Patient may pause when upright in stand-pivot transfer.

The Task

◻Collaboration in setting goals ◻Motivating and engaging patients ◻Patient education ◻Patient adherence ◻Challenging patient encounters

Professionalism includes

◻Consistent with Core Professional Values ◻Working collaboratively with health-care team ◻Balancing compassion and objectivity

The patient has a right to:

◻Engage fully in treatment decisions. ◻Receive full information disclosure. ◻Maintain confidentiality of health-care information. ◻Be respected and not discriminated against.

The Environment

◻In assessing and modifying the patient care environment, we must address the following aspects of their environment: ◻Sensory (light, noise, temperature, activity, etc.) shouldn't detract from therapeutic interaction ◻Social (include people whose presence supports patient's well-being) ◻Safe/secure (privacy, modesty, and physical protection) Many patients have previously experienced traumatic assaults, and seemingly ordinary environmental aspects can trigger fearful responses.