OTA Lab 1 Final Written Study Guide
What are the hand washing protocols with an alcohol based sanitizer?
Alcohol-based hand rub (foam or gel) is a more effective method for killing bacteria than washing your hands with soap and water. • Alcohol-based hand rubs (foam or gel) kill more effectively and more quickly than handwashing with soap and water. • They are less damaging to skin than soap and water, resulting in less dryness and irritation. • They require less time than handwashing with soap and water. An alcohol-based hand rub is the preferred method for hand hygiene in all situations, except for when your hands are visibly dirty or contaminated. you should rub your hands together when applying an alcohol-based hand rub until your hands are dry.
What's the best technique for going up and down a curb with a patient?
To step UP on a curb with a walker 1. Walk up close to the curb. 2. Place the walker up on curb. 3. Push down on walker with your hands. 4. Step up with the stronger leg. 5. Then step up with the injured leg. Alternative method to step UP on a curb with a walker 1. Back up close to the curb. 2. Push down on walker with your hands. 3. Step up with the stronger leg. 4. Then step up with the injured leg. 5. Lift walker onto the curb. To step DOWN off a curb with a walker 1. Walk up close to the edge of the curb. 2. Place walker down on the ground. 3. Step down with the injured leg. 4. Push down on the walker with your hands. 5. Then step down with the stronger leg.
Know the fire safety rules?
To use a Fire Extinguisher, remember the acronym - P.A.S.S Pull the pin. Aim the nozzle. Squeeze the handle. Sweep side to side at the base of the fire. In case of a fire, remember the RACE acronym. Rescue any persons in immediate danger. Alert others by activating alarm. Contain the emergency by closing doors. Evacuate extinguish the fire if trained and safe to do so.
Describe the difference between precautions and contraindications?
Precautions are restrictions to activities that could potentially cause harm. Contraindications are restrictions of activities that are not allowed.
Know the best positioning tips for CVA patients on the involved and uninvolved side?
Side-lying positioning Tips: - abduct the arm you are rolling towards - if the client wants to lie on the involved side, the arm should be in shoulder flexion and scapular protraction - place pillow between knees - pillows can be used to support the back to maintain position - the involved arm should be positioned on a pillow
What is forward chaining?
Forward Chaining: - The client masters the first step and then the OTA completes the rest. - The client learns to complete the next steps) until the task is completed. -make sure to practice and repeat process.
Know OTA role when it comes to bowels and bladders?
Toileting is separated into two categories: 1. Toileting. 2. Toilet Hygiene Toileting and Hygiene include these things from the OTPF -Obtaining and using toileting products. -Managing clothing. -Maintaining toilet positioning. -Transferring to and from the toilet. -Cleaning the body, caring for menstrual and catheter needs-> which includes catheters, colostomy, and suppository management. -Maintaining intentional control of bowel movements and urination. -If necessary, using equipment or agents for bladder control. Toileting also includes: -emptying one's own catheter bag. -completing self catheterization. -changing one's own colostomy bag. -managing menstrual supplies.
Know about wheelchair etiquette?
Wheelchair Do's: -Acknowledge the person rather than the disability -Ask before offering assistance -Warn the person if you are about to push them in their chair -Understand that people in wheelchairs might be very capable and independent -Pull up a chair to be at eye level if conversation becomes long -Speak to them with high respect Wheelchair Do Not's: -Don't make speed limit jokes -Don't just help with out asking -Don't assume the person needs your help -Don't speak "loudly" to the person--> they may not be deaf. -Don't lean on their chair -Don't speak to them as if they were a child Lock the brakes prior to having the client stand or sit when transferring from the wheelchair!
What is downgrading?
making a skill less challenging because it's difficult.
What is upgrading?
making a skill more challenging because it's easy.
What is an activity analysis?
-Activity Analysis is part of the OT process, allowing practitioners to understand and address the skills and external components needed for performance of any given activity. -In other words, it is the breakdown of an activity into component parts, in order to understand the demands the activity places on a client -A thorough activity analysis will allow for an understanding of the tools and equipment needed -Where and with whom the activity take place SEQUENCING -The sequence of steps and timing of those steps -The body functions and body structure required -Performance skills -How do internal and external context contribute to the activities Activity Analysis- Looks at the typical demands of an activity (Making a peanut butter and jelly sandwich we look at ROM, strength sensory)
What is backward chaining?
-Backward Chaining: hardest part first.... then easier -The client begins by completing the last step of the task first Then the last two steps of the task, followed by the last three steps etc. - Backwards chaining helps with clients with decreased cognitive or learning abilities because they can see the end goal -very complex.
What are recommended assistive devices for a CVA patient with balance issues?
-Canes, but specifically quad canes, Walkers, and Hemi-walkers. -Also, there's long handed reacher, dressing stick and button hook. limitations in your strength and balance will dictate which is best for you. With significant weakness or balance limitations, a wide base quad cane may be best. If your weakness and balance limitations are mild, a narrow base quad cane may be the best choice.
What are the functions of all wheelchair parts?
-Push handles allow the wheelchair to be pushed. -seat backs add support and comfort for people who use wheelchairs. -arm rests aid in balance and stability and provide support for the person's arm and hands while supporting the back. -skirt guards help keep your clothes from getting caught into the two back wheelchair wheels. -seats are for rest, providing relief, and increasing comfort. -footrest's purpose is to increase support, alleviate pressure, and enable the user to raise their leg(s) when seated in their wheelchair. -footrest plate are designed to maintain angles and stabilize proper body positions based on client's range of motion preventing injury. -casters stabilize the wheelchair. -brakes keep the wheelchair stationary when performing transfers or getting someone in or out of a wheelchair. -spokes keep the wheelchair in the round position. -hand rims are part of the wheel the user comes into direct contact with to propel the chair. It helps propel the wheelchair. -tires are used to propel the wheelchair.
What is donning?
-Putting something on. -D(on)ning meaning to put on. -Client requires mod assist to donn socks.
Know the qualities of an effective team member?
-Shows genuine commitment -Easily and quickly adaptable -Confident communication -Reliable and responsible -Actively listens -Shares opinions -Always ready to help -Supports and respects others -Takes a problem solving approach -Compromises and is flexible
What is doffing?
-Taking something off. -D(off)ing meaning to take off. -Client loses balances when doffing pants.
How do you adjust walkers and canes?
-To select the proper length for a cane, stand up straight with your shoes on and arms at your sides. -The top of the cane should reach the crease on the underside of your wrist. -If the cane is a proper fit, your elbow will be flexed approx. 30 degrees when you hold the cane while standing. -Cane length is usually about one-half the cane user's height, in inches, wearing shoes.
Know the assist levels 1-6
1= Dependent -Helper does ALL of the effort. -Patient does none of the effort to complete activity. -Or, the assistance of 2 or more helpers is required for the patient to complete the activity. 2= Substantial/Maximal Assistance (Max Assist) -Helper does MORE THAN HALF the effort. -Helper lifts or holds the trunk or limbs and provides more than half the effort. 3= Partial/Moderate Assistance - Helper does LESS THAN HALF the effort -Helper lifts, holds or supports trunk or limbs, but provides less than half of the effort. 4= Supervision or Touching Assistance (Min A) - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes the activity. -Assistance may be provided throughout the activity or intermittently 5= Set up or Clean Up Assist - Helper sets up or cleans up while the patient completes activity. -Helper assists only prior to or following the activity 6= Independent - Patient completes the activity by himself/herself with no assistance from a helper.
What is a squat pivot transfer?
A Squat Pivot Transfer|or Bent Knee Transfer is typically used with a client that needs more than minimal assist or is unable to come to a standing position.
What is a two person transfer?
A two person transfer is used if the OTA practitioner is unable to transfer a client alone, a second practitioner may be involved
Identify all the Adaptive Equipment for BADL's?
Bathing and showering: - long handle sponge -hand held shower hose Grooming and Hygiene: - long handle brushes--> use for those with limited range of motion or limited grasp - universal cuffs--> used to hold a wide range of ADL items for clients with difficulty grasping. -oral swabs or lemon glycerin swabs--> for clients who may not be able to brush their teeth due to decreased cognition, or are not allowed to have anything by mouth. Also, they can be used wet or dry to clean teeth, cheeks, gums, and lips. It's safer and less messy than using toothpaste. Lemon glycerin swabs are pre soaked in lemon flavor to stimulate saliva or give a fresher feeling. Upper body dressing: - dressing stick. -button hook. -both are used to compensate for dressing deficits Lower body dressing: -dressing stick. -Reacher. -sock aid. -long handle shoe horn. -elastic shoe laces. -use these because there are medical reasons as to why people can not reach down towards their lower body like a total hip replacement, while making sure they follow hip precautions (BIC). -Also, for those who have back pain, surgery, arthritis, herniated discs, spinal fractures, and spinal injuries need to use adaptive equipment. Follow BLT.
Know the sequence of events with patient care?
Before entering a patient's room, check the signage. Lookout for the following signs: -Airborne infection isolation rooms. -Contact Precautions. -Droplet Precautions. -Private rooms; negative airflow pressure if needed. -Appropriate signage alerts OT practitioners knowing which precautions to follow, and what PPE is required. Before interacting with any patient/client -Identify them as the correct person -Check wristband, confirm identity, ask name and DOB -Obtain up-to-date information about the patient -Have you reviewed the medical chart? -Consulted with Nursing staff? -Is the patient able to participate in therapy? -Were there any medical changes since you last saw the patient?
Coding for Toileting/Toilet Hygiene?
Coding Tips for (GG0130C) Toileting Hygiene • Toileting hygiene includes the tasks of managing undergarments, clothing and incontinence products and performing perineal cleansing before and after voiding or having a bowel movement. If the patient does not usually use undergarments, then assess the patient's need for assistance to manage lower body clothing and perineal hygiene. • Toileting hygiene (managing clothing and perineal cleansing) takes place before and after use of the toilet, commode, bedpan, or urinal. If the patient completes a bowel toileting program in bed, code the item Toileting hygiene based on the patient's need for assistance for managing clothing and perineal cleansing. • If the patient has an indwelling urinary catheter and has bowel movements, code the Toileting hygiene item based on the amount of assistance needed by the patient when moving his or her bowels. Toileting hygiene: Mrs. L uses the toilet to void and have bowel movements. Mrs. L is unsteady, so the OTA walks into the bathroom with her in case she needs help. The OTA has been present in the bathroom but has not needed to provide any physical assistance with managing clothes or cleansing. What would you grade Mrs. L? Discuss your rationale Coding: Would be coded/graded 04, Supervision or touching assistance. Rationale: The OTA provides supervision as the patient performs the toileting hygiene activity. The patient is unsteady and the staff provide supervision for safety reasons.
Coding for eating?
Coding Tips for Eating ( GG0130A) Eating definition: involves bringing food and liquids to the mouth and swallowing food. The administration of a tube feeding and parenteral nutrition is NOT considered when coding this activity Example 1: Mrs. K has multiple sclerosis, affecting her endurance and strength. Mrs. K prefers to feed herself as much as she is capable. After eating 3⁄4 of her meal by herself, she becomes extremely fatigued and request assistance from the CNA to feed her the remainder of the meal. How would you grade Mrs. K Coding: Would be coded/graded 03, Partial/moderate assistance. Rationale: The helper provides less than half the effort for the patient to complete the activity of eating for all meals. Example 2: The OTA opens all of Mr. S's cartons and containers on his food tray before leaving the room. There are no safety concerns regarding Mr. S's ability to eat. He eats the food himself, bringing the food to his mouth and using appropriate utensils and swallowing the food safely. What would you grade Mr. S ? Discuss your rationale Coding: Would be coded/graded 05, Setup or clean-up assistance. Rationale: The helper provides setup assistance only prior to the activity.
Coding for Upper and Lower Body Dressing?
Coding Tips for GG01030F, Upper body dressing, GG01030G, Lower body dressing, and GG0130H, Putting on/taking off footwear • For upper body dressing, lower body dressing, and putting on/taking off footwear, if the patient dresses himself or herself and a helper retrieves or puts away the patient's clothing, then code 05, Set-up or clean-up assistance. • When coding upper body dressing and lower body dressing, helper assistance with buttons and/or fasteners is considered touching assistance. • If donning and doffing an elastic bandage, compression stockings, or an orthosis or prosthesis occurs while the patient is dressing/undressing, then count the elastic bandage/compression stocking/orthosis/prosthesis as a piece of clothing when determining the amount of assistance, the patient needs when coding the dressing item. The following items are considered a piece of clothing when coding the dressing items: — Upper body dressing examples: thoracic-lumbar-sacrum-orthosis (TLSO), abdominal binder, back brace, stump sock/shrinker, upper body support device, neck support, hand or arm prosthetic/orthotic. — Lower body dressing examples: knee brace, elastic bandage, stump sock/shrinker, lower-limb prosthesis. — Footwear examples, ankle foot orthosis (AFO), elastic bandages, foot orthotic, orthopedic walking boots, compression stockings (considered footwear because of dressing don/doff over foot). • Upper body dressing items used for coding include: bra, undershirt, T-shirt, button-down shirt, pullover shirt, dresses, sweatshirt, sweater, and pajama top. Upper body dressing cannot be assessed based solely on donning/doffing a hospital gown. • Lower body dressing items used for coding include: underwear, incontinence brief, slacks, shorts, capri pants, pajama bottoms, and skirts. • Footwear dressing items used for coding include: socks, shoes, boots, and running shoes. Upper body dressing: Mrs. Z wears a bra and a sweatshirt most days while in the rehabilitation program. She requires assistance from the OTA to initiate the threading of her arms into her bra. Mrs. Z completes the placement of the bra over her chest. The OTA hooks the bra clasps. Mrs. Z pulls the sweatshirt over her arms, head, and trunk. When undressing, Mrs. Z removes the sweatshirt with the OTA assisting her with one sleeve. Mrs. Z slides the bra off once it has been unclasped by the OTA. What would you grade Mrs. Z ? Discuss your rationale Coding: Would be coded/graded 03, Partial/moderate assistance. Rationale: The helper provides assistance with threading Mrs. Z's arms into her bra, hooking and unhooking her bra clasps, and assistance with removing one sleeve of the sweatshirt. Mrs. Z performs more than half of the effort. Mr. D is required to follow hip precautions as a result of recent hip surgery. The OTA in the acute care hospital instructed him in the use of adaptive equipment to facilitate lower extremity dressing. He requires a helper to retrieve his clothing from the closet. Mr. D uses his adaptive equipment to assist in threading his legs into his pants. Because of balance issues, Mr. D needs the OTA to steady him when standing to manage pulling on or pulling down his pants/undergarments. Mr. D also needs some assistance to put on and take off his socks and shoes What would you grade Mr. D? Discuss your rationale Coding: Would be coded/graded 04, Supervision or touching assistance. Rationale: The OTA steadies Mr. D when he is standing and performing the activity of lower body dressing, which is supervision or touching assistance. Putting on and taking off socks and shoes is not considered when coding lower body dressing nor is putting on and taking off adaptive equipment associated with the foot, for example Ankle Foot Orthosis. These are considered when coding putting on and taking off shoes and socks. Mrs. F was admitted to rehabilitation for a neurologic condition and experiences visual impairment, and fine motor coordination and endurance issues. She requires set-up for retrieving her socks and shoes, which she prefers to keep in the closet. Mrs. F often drops her shoes and socks as she attempts to put them onto her feet or as she takes them off. An OTA must first thread her socks or shoes over her toes, and then Mrs. F can complete the task. Mrs. F needs the OTA to initiate taking off her socks and unstrapping the Velcro used for fasting her shoes. What would you grade Mrs. F? Discuss your rationale Coding: Would be coded/graded 02, Substantial/maximal assistance. Rationale: A helper provides Mrs. F with assistance in initiating putting on and taking off her footwear because of her limitations regarding fine motor coordination putting on/taking off footwear. The helper completes more than half of the effort with this activity.
Coding for showering and bathing?
Coding Tips for GG0130E, Shower/bathe self • Shower/bathe self includes the ability to wash, rinse and dry the face, upper and lower body, perineal area and feet. Do not include washing, rinsing and drying the patient's back or hair. Shower/bathe self does not include transferring in/out of a tub/shower. • Assessment of Shower/bathe self can take place in a shower or bath, or at a sink (i.e., full-body sponge bath). • If the patient bathes himself or herself and a helper sets up materials for bathing/showering, then code 05, Set-up or clean-up assistance. • If the patient cannot bathe his or her entire body because of a medical condition, then code Shower/bathe self, based on the amount of assistance needed to complete the activity. Mr. Y has limited mobility resulting from his multiple and complex medical conditions. He prefers to wash his body while sitting in front of his sink in his bathroom. Mr. Y washes, rinses, and dries his face, chest, and abdomen. A helper assists with washing, rinsing, and drying Mr. Y's arms/hands, upper legs, lower legs, buttocks, and back. What would you grade Mr. Y ? Discuss your rationale Coding: Would be coded/graded 02, Substantial/maximal assistance. Rationale: The OTA completed more than half the activity. Bathing may occur at the sink. When coding this activity, do not include assistance provided with washing, rinsing, or drying the patient's back.
Identify all the Durable Medical Equipment for BADL's?
Durable medical equipment is any medical equipment used to aid in a better quality of living Pertains to Toileting: - 3:1 commode, toilet aid, toilet buddy, bidet, drop arm commode, grab rails Pertains to showering: -shower chairs go inside the shower. -tub transfer chair/bench goes outside. -grab bars. -walk in tubs. -facility shower chairs. -3:1 Commode can be used as a beside commode, a raised toilet seat over the toilet, and can be used to sit on the shower. -Drop arm commodes allow the arm to drop out of the way to facilitate the ease of a squat pivot transfer, or for a client who needs a sliding board who has paraplegia, lower extremity amputation, and overall weakness with decreased mobility. -Bariatric Durable Medical Equipment is for clients who require specialized equipment for care, and to avoid safety risks. Bariatric Durable Medical Equipment is wider, heavier, and can be difficult to maneuver even for the client. Clients homes needs to be assessed (doorways and doorframes) to ensure the equipment will be functional within the space provided. Also, the condition of the home can stand with the extra weight of the equipment. -Grab rails can be a good recommendation for home use.
Know about wheelchair safety?
Elements of safety for the wheelchair user and practitioner include the following: 1. Brakes should be locked during all transfers 2. The patient should never stand on the footplate 3. In most transfers, it is an advantage to have the footrest swung out of the way 4. If you are pushing the wheelchair, the patient's elbows should not be protruding from the arm rest and not dangling down towards the wheels 5. Inform the patient before you are moving the them, check position of feet and arms before proceeding 6. To push a patient up a ramp, the person pushing should move in a normal, forward direction. If the ramp is negotiated independently, the patient should lean slightly forward while propelling the wheelchair up the incline 7. To push the patient down the ramp, a person should tilt the wheelchair backwards by pushing down on the tilt bars to balance the position (approx. 30 degrees) The caregiver should ease the w/c down the ramp in a forward direction, while maintaining the chair in a balanced position. • The care giver can also move down the ramp backward while the patient maintains some control of the large wheels to prevent rapid backwards motion. This is especially useful if there is a steep grade 8. To go up a curb, the practitioner will approach from a forward position, tipping the wheelchair back and pushing the foot down on the tipping levers, thus lifting the front casters onto the curb and pushing forward. The large wheel will be in contact with the curb and roll on with ease as it is lifted slightly on the curb 9. Going down a curb should be approached in a backwards position. The practitioner will position the wheelchair on the edge of the curb. Standing below the curb, the practitioner will guide the large wheels off the curb by slowly pulling the wheelchair backwards until it starts coming off the curb. After the large wheels are safely on the street surface, the parishioner can tilt the chair back to clear the casters to the street surface and then turn around
Identify remedial and compensatory approaches for ADL's like dressing?
Grooming and Hygiene: -By remediating client deficits that prevent the client from performing G & H skills. (improving ROM, strength and coordination to reach a clients face for brushing teeth, face washing) -By compensating client deficits that prevent them from performing G & H tasks (using adaptive equipment, such as a built-up handle on a toothbrush so they can grip the handle) long handle brushes, universal cuff, oral swabs, lemon glycerin swabs Upper body dressing: -compensating- dressing stick, button hook Lower body dressing: -remediate: ROM, strength and coordination, activity tolerance -compensating: dressing stick, Reacher, sock aid, long handle shoe horn, elastic shoe laces Bathing and showering: -remediating-ROM, practicing coordination, strength and activity tolerance, help with safety awareness, help in energy conservation - compensating: long handle sponge , hand-held shower hose, shower bench, grab bars, and shower chairs Toileting: -remediating: ROM, strength and coordination, activity tolerance -compensating: 3:1 commode, toilet aid, toilet buddy, bidet, drop arm commode, and grab rails
Define Grooming and Hygiene?
Grooming: -Activities associated with making one's appearance look neat.. -Examples are: brushing hair, putting on makeup, and clipping your nails. Hygiene: -Activities associated with the cleanliness of the body with intent toward health. -Examples are: flossing, brushing your teeth, and washing hands.
What are the hand washing protocols with soap and water?
Hand hygiene is often not practiced: ◦ Immediately before touching a patient, performing an invasive procedure, or manipulating an invasive device • Also. after touching contaminated items or surfaces, or removing gloves, even if you didn't touch the patient or surfaces while you were there. Practicing good hand hygiene: • HANDWASHING Steps: 1 Wet hands with water. 2 Apply soap. 3 Rub hands together for at least 15 seconds, covering all surfaces, focusing on fingertips and fingernails. 4 Rinse under running water and dry with disposable towel. 5 Use the towel to turn off the faucet.
Coding for oral hygiene?
Oral hygiene: Ms. T is recovering from a severe traumatic brain injury and multiple bone fractures. She does not understand how to use oral hygiene items nor does she understand the process of completing oral hygiene. The OTA brushes her teeth and explains each step of the activity to engage cooperation from Ms. T; however, she requires full assistance for the activity of oral hygiene. What would you grade Ms. T ? Discuss your rationale Coding: Would be coded/graded 01, Dependent. Rationale: The helper provides all the effort for the activity to be completed
Know positioning tips and what it promotes?
Positioning will help your clients prevent: Pain, stiffness and discomfort Skin breakdown (decubitus ulcers, bed sores) Contractures and deformities Use positioning knowledge to promote: Improved function with ADL'S Better recovery from illness or debilitation Prevent other medical complications Bed-level supine positioning tips: - Maintain alignment of the head, trunk, hips, and lower extremities - Float heels off the bed by placing pillows under the calves or using waffle boots - Make sure there is an even distribution of weight between both sides - Use under pads to assist in aligning patient - Make sure the client is not lying on wrinkled clothes or raised edges - If the upper or lower extremities are swollen, use a pillow/cushion to elevate - The client should avoid gravity-dependent position - If a client wants to lie on their involved side, the arm against the bed should be positioned in shoulder flexion and scapular protraction Side-lying positioning Tips: - abduct the arm you are rolling towards - if the client wants to lie on the involved side, the arm should be in shoulder flexion and scapular protraction - place pillow between knees - pillows can be used to support the back to maintain position - the involved arm should be positioned on a pillow Wheelchair-level positioning tips: -Body alignment in the sitting position is crucial for our clients. Know the proper alignment. Assess the key areas for alignment -Is the trunk in alignment? -Is the pelvis tilted? -Are the lower extremities supported and positioned correctly? -Are the upper extremities supported and positioned correctly? -remember 90,90,90 Also, promote the anterior tilt of the pelvis. It is extremely important. Lower extremity positioning -are the knees about hip joint level? -are feet flat on the footrest or footplate? -does the client need to elevate lower extremities. -Remember 90,90,90 Support upper extremity position and consider the involved side -Is the arm rest height appropriate. -Is the client aware of their upper extremity? -What is supporting the upper extremity? -If a client's arm is paralyzed, they will need proper support.
What's the de-slouching position and technique? Know the position you want to adjust the patient's body parts?
Pulling a person up who is slouched in a wheelchair: 1. First Method- Using an under-pad: This method is used if the person is sitting on an under-pad (Chuck pad) or a draw sheet. A) Lock the brakes on the chair. B) Stand behind the chair. C) Using both hands grab a hold of the under-pad from behind the client where the pad is visible in the space between the seat and the seat-back. D) Firmly pull the pad toward you to reposition the client's on the seat. 2. Second Method: Using the client's arms This method is generally comfortable for clients and minimizes discomfort or bruising from grasping them under the arm pits. A) Starting position: Client is slouched in the wheelchair. B) Reach under the client's axilla of one arm to grasp the client's wrist on the opposite side. C) Therapist then reaches under with their other arm to grasp the opposite side wrist (this hand position maximizes skin contact to spread force over more surface area which reduces the chance of bruising or pain). D) Pull the client up in the chair. *Contraindications: not appropriate for any client with weight bearing restrictions of the upper extremity (fractures, fresh shoulder surgery, etc.). 3. Third Method: Standing in front of the client A) Client is slouched in chair. B) Place client's feet on the floor and therapist blocks client's knees with their own. C) Lean client forward by placing hands on top of their shoulders. D) Reach under client's arms, place palms on their back E) Rock the client forward in order to lift the buttocks slightly off of the seat while therapist pushes their knees against client's knees to scoot them back. *Contraindications: not appropriate if the client has any weight bearing restrictions of the lower extremities (fractured hip or knee), or certain hip precautions such as not being allowed to flex the hip past 90 degrees (which is common after a hip replacement surgery).
What is the difference between a compensatory and remedial approach?
Remediating is when a client has deficits that prevent the client from performing skills. Reasons can be or biomechanics. You can remediate by working on strength, Range/passive range of motion, weight exercises, stretching, accuracy, speed, and coordination. Compensating means that they may not be able to fix it, hence the adaptive equipment.
Sliding Board Transfer?
Sliding board transfer board is used when there are uneven surface heights, a large gap between surfaces, and the client has good upper extremity difference strength but are paralyzed, or have lower muscle weakness or debilitation that prevents them from using their lower body. OTA's will need to help if client's don't have enough strength in their upper body and cannot bear full weight.
Stand Pivot Transfer?
Stand Pivot Transfers are primarily used with a client that requires less assistance min A) and is able to step with lower extremities when standing.
What is the hemi-technique?
The hemi technique is when you one handed dress and you use this technique for clients with CVA (stroke patients). Also, for patients whose whole one side of the body is paralyzed (hemiplegia). Hemi Dressing : Always dress the affected extremity first 1. place the affected arm on the lap. 2. bunch up the sleeve, place over the affected hand and wrist. -It may be helpful to lean slightly forward with affected arm reaching towards the floor, between the knees while bringing the sleeve up over the arm. 3. Be sure to bring the sleeve up and over the elbow to the shoulder. 4. Place the non affected limb in the other sleeve and pull up over the head if using a pullover shirt. Hemiplegic Undressing Pull Over Shirt: -non affected limb is removed first -you can also remove the shirt by reaching the back of the shirt and pulling it over your head. -then the non affected limb and then the affected limb. One handed or hemi technique button down shirt: Always dress the affected extremity first a. Place the affected arm on the lap b. Bunch up the sleeve, place over the affected hand and wrist. (It may be helpful to lean slightly forward with affected arm reaching towards floor, between the knees, while bringing sleeve up over the arm) c. Be sure to bring the sleeve up and over the elbow to the shoulder d. Take the shirt and bring around the backside to insert the non affected limb into the other sleeve e. Adjust shirt by pulling it down and adjusting sleeves f. May want to use non affected hand to pull the shirt tight and then place the affected limb on top of shirt bottom to align so client can button (If unable to button you may offer and demonstrate button hook) Lower Body Dressing: For clients suffering from a CVA lower body dressing is best accomplished from a seated position a.. using a dressing stick, put it on the waist band and glide effected foot in using dressing stick b. pull pants over leg c. do the same for the other leg d. pull pants up as far as possible e. stand and pull up pants ( can be done if they have good balance, if they don't may need walker)
Know Mosey's teaching and learning process?
There are 14 of them. 1. Use good communication skills with your clients. -Maintain comfortable eye contact--> culture can affect it. -Use professional posture/ body language -Ask open ended questions but also feel it out--> get details and ask specific questions to get certain answers, while also getting to know them. 2. Accept the client for who they are. -Check your biases and judgment at the door -Maintain professional interactions. 3. Provide the "just right" challenge. -Start at the client's current level so your client will be successful. -Remember everyone learns at different rates. -example is riding ski slopes. You have to start at the bunny slope and then progress. Don't start at an advanced slope. 4. Consider the clients cultural and environmental factors. -could these influencers effect negatively or positively? -age, gender, heritage, and culture. -need to make it valuable. 5. Communicate effectively, clearly and concisely * Volume (how loud you speak), pace, tone (auditory delay; cognitive), does the client need glasses (wears glasses to see lips) or a hearing aid? 6. Engage the client's active learning * Is the client involved in making decisions regarding their treatment? Goals? Empower them to do so -Therapeutic use of self. 7. Make learning pleasant and positive -Safety is always addressed in first treatment -Provide opportunities to make errors La educate on safe -Provide reinforcement so the client wants to learn more 8. Provide opportunities for trial and error * Allow the clients to use their problem solving skills 9. Provide opportunities for practice and repetition to master skills -examples include dressing, transferring, and tying shoes. 10. Encourage client's to set their own goals one sets goals * This helps with motivation and responsibility 11. Always review the purpose of your activity by pointing out what was learned and check the understanding of learned task or material * Education will be provided for staff, family and caregivers -practice in different settings -transfer what you learn in school and clinical settings. 12. Learning moves from simple to complex -upgrading to advanced skills, downgrading if too difficult. -upgrading if something is too easy, make it harder. -Downgrading if something is too hard, make it easy. 13. Encourage creative problem solving -empower learning to think outside the box. 14. Everyone handles stress and anxiety differently. -learning can be frustrating, so watch for signs that learning may be causing stress and help your client process this stress.
Know the different types of wheelchairs needed for various patients?
There are two basic types of wheelchairs: 1. Manual Wheelchair. 2. Power Wheelchair. There are two different types of manual wheelchairs: 1. Standard Adult Manual Wheelchair -wheels are large to be able to push yourself. 2. Transport Wheelchair -wheels are small so this chair is intended to be pushed by others. Different types of manual wheelchairs: 1. Standard Size -18 inch seat width. 2. Bariatric Size -B is for Big -Variable width starts at 20 inches and goes as wide as 30 inches. -Rear axle is moved forward to offset gravity. 3. Narrow Size: -16 inch seat width. Different types of wheelchairs: 1. Standard Back. 2. High Back. -needed for those who are tall, or for those who have neck or spina injuries. 3. Low Back. Folding Wheelchair vs. Rigid Frame: Folding wheelchairs are able to be folded and take up much less space when they are folded, which makes them easier to store and transport. Folding wheelchairs have adjustable foot placement and increases independence. Rigid frame wheelchairs on the other hand require a big vehicle like a van to transport it from one location to another. Rigid frame wheelchairs are in a fixed foot placement position. Rigid frame wheelchairs promote efficiency of propulsion due to their light-weight design and minimization of moving parts, which allows for more efficient propulsion. Wheelchair Arm Rest Options: 1. Removable or swing away. 2. Full length. 3. Desk arms allow wheelchairs to get closer to a table. Wheelchair Foot Rest Options: 1. Removable or swing aways. 2. Elevating Leg Rest. 3. Adjustable height. Power Wheelchairs & Motorized Wheelchairs:
Know the purpose of the desk or cutaway arms on a wheelchair?
allows you to get closer to a table to be more functional for eating and such.
What's the "just right challenge"?
• The "Just Right Challenge" is an activity that is just slightly above what a client is currently able to easily do, but it requires a little bit more of a challenge to strive for improvement.
