Ther interventions Unit 3
Identify recommended adaptive devices to facilitate participation in and performance of activities of daily living for individuals with specific functional losses.
* Assistive technology- any item, piece of equipment or product system that is used to increase or improve functional capabilities of individuals w disabilities. -Adaptive equipment is used to compensate for physical limitations, promote safety and to prevent jt injury. - Other factors to consider when selecting equipment is whether the disability is short term/ long term, pts tolerance for gadgets, pts feelings about device and cost and up keep of equip.
Describe activities of daily living (ADL) and instrumental activities of daily living (IADLs) and explain how ADLs and IADLs relate to the OT Practice Framework.
ADLS and IADLS 2 of 8 broad categories in areas of occupations in which clients engage. ADLS Also called personal act of daily living (PADLS) and basic activities of daily living (BADLS) - Self care tasks such as bathing/showering, bowel and bladder management, dressing/ undressing, eating or swallowing, feeding, functional mob (transfers and bed mob), sexual activity, toilet hygiene and care of personal devices (hearing aids, orthotics and splints) IADLS More advanced problem solving skills and level skills in performance areas. - require exact funct, social skills and more complex environmental interactions. - care of others/ pets, child rearing, communication management (use of telephones, personal assistants and computers, community and mob (driving, public transportation),financial management, health management/ maintenance, home establishment/ management, religious observance and emergency maintenance. Loss of ability to care for personal needs and to manage the environ can result in loss of self esteem and a deep sense of dependence. Family roles are also disrupted as partners are frequently required to assume the function of caregiver when one loses ability to perform independently. Explains aspects of domain and process OT in regards to adls and iadls and interventions strategies for assisting clients to optimize occup perf.
Explain the purpose of performing a home evaluation and when it may be indicated.
An evaluation such as the Executive Function Performance Test can be used to assist in determining whether a person is safe to remain at home or how must Assistance is required. To help with the transition from a treatment facility to home, a home evaluation may be performed. A home evaluation can serve several functions, including assessing a home for safety and accessibility, offering a way for an OT to assess client functioning at home for safety and accessibility, offering a way for an OT to assess client function at home and determining a time when caregiver training can occur. When discharge from the treatment facility is imminent, a home assessment may be carried out to facilitate clients independence. Modifications and durable medical treatment needed. Home evaluation should be performed when the clients mobility status is stable. If the home evaluation is not possible while the client is in the hospital, the home assessment may also be referred to the home health agency that will provide services.
Spinal cord injury
C1-4 require assist for all adls except mob and communication C5 special equipment and assist C3-5 splints and arm braces or supports recommend C6 relatively independent w adaptations, devices and wrist driven decor hand splint (tenodesis. hand splint)
Describe techniques to enhance community mobility, including public transportation, community access, and issues related to driver rehabilitation
Community mobility: Planning and moving around in the community using public or private transportation, such as driving, walking, bicycling, or accessing & riding buses, taxi cabs, or other transportation systems. Public Trans: Utilizes buses, trolleys, light rail, subways, trains, cars, van pool services, paratransit services, ferries, taxies ect. -Fixed route: predetermined stops and runs on a published schedule Intervention Implication: Inform, educate and encourage client. The clients proficiency should be evaluated in actual setting in order to remediate or compensate for limited subskills. (strengthen, balance, endurance programs o enhance ambulation) OTs advise transit agencies about starting travel training programs, confer with city planners and local governments about environmental changes Processing over motor skills -Paratransit: demand response service within a prescribed geographic area, vehicle dispatch occurs only in response to the request of a qualified rider -Help is not received until curb -door service may be provided only as needed Intervention: prepare client to advocate for door to door service if they require it. . Ensure appropriate categorization of a disability, Educate to provide necessary documentation, whether a WC conforms to common ADA requirements to prescreen for balance and motor capabilities and asses clients skills Orientation to the local system, training in making a reservation and education related to service limitations. -Longer: OTs can provide cushioning, positiong devices to decrease discomfort and fatigue Instruction on planning a trip and discuss contingency and saftey
ADLS for limited ROM or strength
Compensating for the limited rom and compensating for lack of reach of jt excursion Those who lack strength require same devices/ techniques to compensate or conserve energy Lower extremitie dressing Dressing sticks- Donn/ doff garments on feet and legs Sock aid Elastic shoe laces or velcro Reachers- picking up objects Donn pants UE dressing Front opening garments Dressing sticks- push shirt over head Large buttons or zippers or velcro Button hooks- lim finger ROM Feeding act Built up handles- accommodate lim grasp, prehension (grip or pinch) Elongated, curved handles on spoons/ forks to reach mouth Swivel spoon/ fork- compensate for lim supination Long straws, clips or cups can be used for neck, shoulder ROM limits hand to mouth or if grasp is limited to hold cup Universal cuffs- grasp very limited Plate guards/ scoop dishes- prevent food from slipping off plate Hygiene and grooming Shower hose Long handled brush/ sponge, soap on a rope Long handled comb, toothbrush, lipstick, electric razor Spray deodorant helps for distance Electric toothbrush Short teacher- reach for toilet paper Dressing sticks or clips to pull up garments Safety rails for bathtub transfers, transfer bench for safety, grab bars to prevent falls and mats to prevent slipping Functional mob Lim ROM w out significant muscle weakness Raised toilet seat- limited hip and knee motion Platform crutches to prevent stress on hand/ finger , enlarged grips on crutches, canes and walkers Home management, meal prep and clean up Used for RA w jt protection Places items low and close Non slip mats Light weight utensils Rocker knife for cutting Reacher to pick up items
Explain why it is important to consider the cultural, personal, temporal and virtual context when performing ADL and IADL assessments and training. Provide examples of specific cultural, personal, temporal and virtual contexts that an individual, a community, or population may have that can affect ADLs and IADLs. GO BACK
Context refers to situations or conditions within and around the client. Includes cultural, temporal, personal, and virtual. Cultural- customs, beliefs, act patterns, behavior standards and expect by society.
Describe the contributions of occupational therapy to the assessment of the disabled individuals driving.
Contributions of standardized testing, vehicle entry/exit and lift safety training, transfer training and functioning in the role of driver instructor, cost containment. Expanded roles are possible when intervention protocols are developed, documented and followed again under supervision of a OT. OTAs can be utilized to determine the need for progression in driver training. Administer assessments specific to the requirements of driving including vison, cognition, motor performance, reaction time, knowledge of traffic rules and behind the wheel assessments of skills. They recommend whether to continue, modify or cease driving, suggest vehicle modifications and adaptive device, provide driver retraining of specialized driver education and document all findings.
ADLS/ IADLS adressed
Dressing Feeding (NOT eating and swallowing) Personal hygiene and grooming Communication management and environ adapt Functional Mob Home management, meal prep and clean up
Quadriplegia and tetraplegia
Dressing Stable spine Clothing needs to be loose and larger as well as shoes for edema, spaticity and sores C7 independence w dressing for upper and lower C6 independent but LE may be difficult Lesions at c5-6 upper body dressing w exceptions. Difficulty w bra, tuck shirt in, fasten buttons Feeding C1-4 assist for eating Unless electrical feeding device used C5-7 arm support, universal cuff to hold utensils, non skid mat, plate guard C5 swivel spoon fork w universal cuff w min muscle funct Personal hygiene C1-7 padded shower seat C6-7 long handled sponge C5-7 cuff to hold brushes and tooth brush and electric razors Home management C6 and higher independent w adaptations, devices and safety awareness Use soap dispenser, can openers etc c5-7
Identify and discuss the stages of the teaching learning process utilized in occupational therapy.
Engage in teaching activities for the following reasons: Help clients relearn skills that have been lost as a result of illness or injury Develop alternative or compensatory strat for performing valued act or occup Develop new perf skills to support role perf in the context of a disabling condition Provide therapeutic challenges that will help to improve perform skills to support participation in areas of occup Instruct family members or caregivers in act that will enhance the pts independence and/ or safety in daily occup Phases of learning: 3 phases Acquisition phase: learning, during initial instruction and practice is often characterized by numerous errors of performance, as the learner develops strategies and schemata for how to successfully complete the task. Retention phase:demonstrated during subsequent sessions when the learner demonstrates recall or retention of the task in a similar situation. Generalization or transfer phase: (transfer of learning) seen when the learner is able to spontaneously perform the task in different environments, such as the client who is able to correctly apply hip precautions at home Maximize learning process by identifying activities that have meaning or value to client/family, provide instruction tailored to the needs of the individual and the task, structuring the environ to facilitate learning, provide reinforcement and grading of act to establish intrinsic motivation, structuring feedback and practice to facilitate acquisition, retention and transfer of learning and helping clients develop self awareness and self monitoring skills.
Identify safety issues in functional ambulation.
Functional ambulation- component of funct mob, describes how a person walks while achieving a goal. Ex carrying a plate to the table or carrying groceries from the car to the house Safety issues: Loss of mobility, decreased safety (increased fall risk), and insufficient endurance. Dx that impacts safety- amputation of LE, CVA, brain trauma/ tumor, neurological disease, spinal cord injury total hip and knee replacement .
Define functional mobility.
Functional mobility- combines the act of walking w ones enviorn (home, work etc) with other activities chosen by the individual. Can be used w aids such as walkers, canes or crutches. In an upright position walking. Doing housework, carrying and preparing food to a table etc
Describe a client centered approach to evaluation, and explain why it is an important consideration in ADL and IADL training. GO BACK 162
Goal: is for client/family to learn to adapt to the life changes or situations and participate as fully as possible in their occupations. A comprehensive evaluation includes assessing client factors, performance skills, they physical and social environment and clients contextual framework. "supporting health and participation in life through engagement in occupation" Collaborating with the client to determine what he or she wants and needs to do to support to health and participation Collaborates with client centering the occupational therapy process on the clients priorities and fostering an active participation toward the outcome. Evaluation consists of creating an occupational profile and a performance analysis of skills and patterns and the factors that that influence performance. An occupational profile describes the clients history, patterns of daily living interests, values and needs. It is important to establish STG/LTG based on the assessment and on the clients priorities and potential for independence.
List examples of how difficulties in performance skills can affect ADL and IADL abilities.
Habits: acquired tendencies to respond and perform in a certain consistent ways in familiar environments or situations. Automatic behaviors. Routines are patterns of behavior and actions that observable and repetitive. EX: before going to bed, many people perform series of steps to prepare Performance skills: abilities clients demonstrate in the actions they perform Motor/praxis: reach, bend down to retrieve a pot or maintain balance while performing ADL A client w/difficulty with the cognitive skill of sequencing the steps of a task may have difficulty taking a shower.
Hemiplegia or one UE
Hemi, unilateral amputations, fractures, burns and peripheral neuropathic conditions Balance, sensory, perceptual, cog and speech disorders affected Apraxia- difficulty motor planning, remembering and learning new motor skills Use of one extremity is reduction in work speed an dexterity Hemiplegia problems are balance and precautions to sensory, perceptual and cog losses Dressing Seated Use of reacher *begin w affected extremity when donning .Use unaffected for doffing Feeding Difficulty using one hand to stabilize objects and perform another task Use of rocker knife use wrist flex and exten Plate guards Difficulty opening packages and require training Hygiene and grooming Electric razor, shower seat, bath mat, long handled sponge, safety rails, soap on rope etc Toileting Bedside commode, grab bars, toilet paper on unaffected side Meal prep etc Stabilizing difficult Cutting board with pins, suction cups, rubber mats, can openers, electrical appliances
Identify and discuss stages of teaching learning process utilized in OT
Identify an activity that has meaning or value to the client and or family-The OT explores which occupations have the greatest value to client. Engagement in these can serve both as outcomes of intervention and as activities used in intervention process. The client will be motivated in the therapy process. * Verbal instruction: is an effect for conveying information. to individuals or groups. Verbal cues can be used to provide reinforcement Provide reinforcement, the next step in sequence. * Visual: effective for clients who have cognitive or attention deficits and difficulty processing verbal language as well as for tasks that are complex. OT demonstrates activity and client observes and follows. OT can repeat demonstration Other examples include drawings, photos * Somatosensory instruction: use of tactile, proprioceptive and kinesthetic cues to guide the speed and direction of movement. Manual guidance is a form of somatosensory instruction that is especially effective for procedural learning such as the process of weight shifting and postural adjustment. Hand over hand assistance is effective in teaching to clients with cognitive or sensory processing Environment-minimal visual distraction when teaching and then more distraction as client becomes more proficient Reinforcement/Grading- Social, tangible, visible. Completion of task is intrinsic reinforcement Structure feedback and practice-Intrinsic feedback is generated by individuals sensory systems. Extrinsic feedback is info from outside source Self awareness and self monitoring-knowledge and regulation of personals cognitive processes and capacities is metacognition
Define, describe roles and benefits of Intraprofessional and collaborative relationships relationship in health care.
Learning a diff point of view, add thoughts to your tool box, Improve patient care
List five examples of client factors that may have limitations that can impact performance in occupations and discuss how each can affect an ADL and IADL. GO BACK
Limited ROM and strength Incoordination 1) Limited endurance can inhibit someone from attending to task for a period of time 2) Decreased strength in hand can inhibit someone from cooking 3)Poor Judgement can cause someone to make poor decisions when cooking 4) a person with decreased shoulder range may have difficulty in donning a shirt or reaching into a kitchen cabinet to retrieve supplies for cooking 5)Perception/discrimination of sensations can be harmful for someone when cooking, bathing 6) consciousness can be harmful for someone when driving
Physical deficits addressed
Limited ROM or strength Incoordination Hemiplegia/ one extremity Paraplegia Quadriplegia Low Vision Bariatric (large size body)
Explain how to record levels of independence and summarize the results of an ADL/IADL evaluation.
Must be defined and specified. Independent- pt independently perform the act without cuing, supervision or asset w/wout assist devices, task completed safely. MODIFIED INDEPENDENCE, used if PT requires assist devices or performs the act at a slower speed Supervised- general super, not hands on, may require verbal cue for safety. OT feels comfortable being greater than arms length away at times Standby assist (SBA/ contact guard assist) client requires caregiver or someone to provide hands on guarding to perform task Minimal assist- client performs 75% or more of the task. Requires 25% phy or verbal assist Max assist- pt performs 25-49 % of task, pt requires 51-75% phy or verbal assist Dependent- pt requires more than 75% phy or verbal assist, does less than 25%
Discuss the role of the occupational therapy practitioner in functional ambulation.
OT assist people w/mobility restrictions to achieve maximum access to environments and objects of interest to them. OT provide remediation and compensatory training. OT must asses clients physical, perceptual, cognitive, functional and social capabilities, activities most values and environments most used. Communicate w/family Physical capabilities to be considered are whether client has endurance
Discuss considerations for selecting adaptive equipment for performance of ADLs and IADLs. significant
OT must complete a through assessment to determine functional problems and causes of problems Consider practical solutions first, before settling up equipment. - avoid the cause of the problem-use a compensator technique or alternative method - get assistance from another person -modify the environment. Is disability LT or SH, clients tolerance for gadgets, feelings about the device, cost, upkeep
Demonstrate ability to assign an accurate FIM score to an assigned patient case study.
On notes taken in class
Discuss What is meant by pacing and grading instruction?
Pacing- Pacing is used to decrease task demands by building in breaks and self-monitoring fatigue. Grading- Modifying for clients maximum performance.
List seven techniques to promote good sleep hygiene techniques that will optimize conditions to facilitate sleep.
Prepare a quiet environment -Do not use alcohol to fall asleep -Avoid medicines -limit liquids -avoid stimulating activities -no caffeine -create sleep wake cycle by using an alarm clock
Discuss the difference between procedural and declarative learning
Procedural Learning: occurs for tasks that are performed automatically without attention or conscious through such as many motor and perceptual skills. Procedural knowledge is developed through repeated practice EX: how to maneuver a wheelchair -Individuals w/ limitations in cognition or language can demonstrate Declarative Learning: creates knowledge that can be cognitively recalled. Learning a multistep activity such as tying a shoelace or performing a transfer is often facilitated if the client can verbalize the steps of the task while completing it. Learning can be demonstrated by verbally describing steps. Through repetition of an activity, declarative knowledge can become procedural as it becomes more automatic and les cognitive attention. Mental rehearsal can be effective technique. However because of cognitive requirements, clients with cognitive or language deficits may not be able to express
Sleep across the age Span
Research shows that age is the strongest and most consistent factor that affects sleep stages. The biggest difference in sleep stages is in newborn infants who enter from wake to sleep through the REM and NREM but they cycle through the phases in 50-60 min. instead of abt 90 min. in adults. Dep or slow wave sleep is max. in young children but decreases with age in quantity and quality. EX: children may be difficult to arouse when they are in deep SWS in the first cycle where as an adult may be easier to wake Adsolesence:require more sleep then adults. Evidence shows that teens need 9-9.25 hrs of sleep a night to maintain optimal alertness. Teens also have been shown to have a phase delay in the circadian timing system which means their biological clocks alert them to stay up late and sleep in later. Adults(20-60yrs old) sleep patterns don't change as rapidly as during childhood. However there are consistent trends that occur in sleep patterns such as decreased % of time in stages 3 and 4 particularly in men/ Sleep efficiency also decreases as one ages. Sleep efficiency is measured by dividing the actual time one is asleep by the amount of time one is in bed. Sleep efficiency is about age 45 86% and declines to 79% for those over 70. Brief arsouals are also more common w/elderly. Older adults may also have an advanced sleep phase meaning that they may get sleepy in early evening and early awaking
Define sleep architecture and describe how it changes across the life span.
Sleep architecture represents the cyclical pattern of sleep as it shifts between the different sleep stages, including non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. Sleep architecture allows us to produce a picture of what our sleep looks like over the course of a night, taking into account various depths of sleep as well as arousal to wakefulness. Sleep architecture can be represented by a graph called a hypnogram. There are generally four to five different sleep cycles during a given night and each of the different cycles lasts from about 90 to 120 minutes. Early in the night, you may transition from lighter sleep stages (called N1 sleep) to deeper, slow-wave sleep (called N2 and N3 sleep). REM sleep may appear, and it becomes more common during the latter part of the night, alternating with N2 sleep. REM sleep, also known as Rapid Eye Movement sleep, is the deepest state of sleep. How it changes across lifespan: As we get older, both the amount and the quality of our sleep may change. Slow-wave sleep often decreases as we get older and lighter N1 sleep increases. As a result of this shift, it becomes easier to awaken throughout the night and harder to fall, and stay asleep at night. As a result, more time may be spent awake, leading to insomnia, and a host of other potential problems. Often, people are then forced to take naps during the day in order to make up for lost sleep. Sleep disorders such as sleep apnea may lead to disruptions of the natural sleep architecture with frequent arousals leading to numerous sleep stage shifts and abnormal cycling of sleep.
Describe the difference between sleep and rest.
Sleep: a natural periodic state of rest for the mind and body in which the eyes usually close and consciousness is completely or partially lost so that there is a decrease in bodily movement and responsiveness to external stimuli Rest: quiet and effortless actions that interrupt physical and mental activity resulting in relaxed state
ADLS paraplegia
Stable spine needed or appropriate orthotic or stabilization device Use wc Dressing Start w socks, undergarments, braces, slacks, shoes, pants Underwear may be eliminated due to skin break down Begin training in bed but once strength, endurance and balance improve can dress in wc Feeding No problems. Just access for wc Hygiene/ grooming No problems .May use teacher to grab items Shower hoses,long handled brushes, soap on a rope, transfer tub bench, mats, grab bars, remove doors in bath tub, padded commode, keep items in reach and catheterization Use if long handled mirror to do skin checks as well as checks on seats to not get scratches or skin tears Home management, meal prep, clean up Access for we to move in. Work heights, space to move, storage areas etc
Describe the role of the OT practitioner in rest and sleep
Therapeutic use of self: "mindful empathy" which is observation of emotions, needs and motives while being objective. BE more knowledgeable, model good sleep practices so they are alert, safe and functioning. Examine own values about sleep/rest. Develop cultural competency is a central skill using oneself therapeutically. therapeutic use of occupations and activities: ADL: consider optimal times. Consult with other members to ensure they are sleeping, keep track of sleep using a chart. Schedule naps. Dressing: Dissuade use of Pj during day Hygiene/Grooming: Routine Bed positions/mobility/bedding: Train in bed positioning, comfort, optimal bed for skin protection, breathing, mobility, easy access environment: Extra blankets, quiet, non stimulated Transfers: appropriate times for catheterization, bowl program, ensure equipment, showering/bathing: perhaps shower morning, safety eating/meals: to ensure daily rhythms, encourage meals out of bed Home safety evolution: ensure home is safe for transfers, toileting, ambulation at night, equipment needs. Bed placement, nightlights, call bells Other activities: prep activities, outside Community mobility pain: Splint schedule, exercises are performed at time that will optimize sleep Cognitive strategies to manage negative anxiety thoughts. EX: ill never sleep again" Training in cognitive behavior therapy Consultation: OT can provide consultation in institutional settings where a 24 hr on schedule is frequently in place. Consult w/treatment team and staff about providing an optimal sleep environment for clients at night. Discuss w/team the necessity for middle of night nonurgent blood pressure readings, sponge baths and blood draws and recommend they be avoided. Provide training to nightshirt aids, nurses, orderlies and caregiver in bed mobility. OT can consult in worksite settings and can meet w/manages and administrators about sleep for optimal functions and safety Encourage balance in life for more productive and safe workforce. Settings that employ shift workers(hospitals, factors, airlines) of drowsy driving Education: to have a strict visitation schedule and disuse too many visitors at night or during scheduled rest times which may interrupt rest/sleep when one is in an acute hospital setting. Provide staff how to best facilitate sleep in settings(earplugs, eye mass, encouraging regular nocturnal sleep time, long daytime naps) Encouraging medical staff to min. nighttime bathing, dressing changes of wounds ect. inform college students about consequences
ADLS for incoordination
Tremors, ataxia, athetoid, CNS disorders such as Parkinson's, MS, CP, head injuries Must be taught energy conservation and work simplification tech to prevent fatigue Major problem are safety, stability if gait and obj to complete task Stabilizing the arm or propping elbow reduces incoordination to accomplish gross and fine motor .Weighted devices can help as well Dressing (should be seated for balance problems) Large buttons, velcro, weighted button hook Elastic shoes laces, elastic waist bands, velcro closures, bras w front openings Feeding Plate stabilizers, no skid mats Plate guard/scoop dish Weighted or swivel utensils for stability or add weight to wrist Long straws, weighted cups Mechanical self feeding device Personal hygiene Razor, lip stick, toothbrush, soap etc attached to a cord to reduce dropping Electric toothbrush and razor Weighted wrist cuffs helpful Roll on deodorant better than spray Suction brush to clean nails or dentures Emery board for clipping/ filing nails Non skid mats, bathtub seat more safe * require supervison assist during bathing Meal prep, home management,clean up Prepped/ pre cut foods Easy open Containers, jar opener Heavy utensils, mixing bowls pots and pans Non skid mats Electrical appliances- microwaves etc Adapted cutting board w pins Heavy dinnerware
Contrast various methods of teaching and match these to characteristics of individual learners
Verbal instruction: is an effect for conveying information. to individuals or groups. Verbal cues can be used to provide reinforcement Provide reinforcement, the next step in sequence. Visual Instruction: effective for clients who have cognitive or attention deficits and difficulty processing verbal language as well as for tasks that are complex. OT demonstrates activity and client observes and follows. OT can repeat demonstration Other examples include drawings, photos Somatosensory instruction: use of tactile, proprioceptive and kinesthetic cues to guide the speed and direction of movement. Manual guidance is a form of somatosensory instruction that is especially effective for procedural learning such as the process of weight shifting and postural adjustment. Hand over hand assistance is effective in teaching to clients with cognitive or sensory processing
Describe five negative consequences of poor sleep and rest on daily occupations.
hypertension -decreased postural control -possible obesity and diabetes -falls -adults poorer health, physical function, cognitive function and increased mortality
