ACS, Rancho Levels,

OT in acute phase of TBI

*positioning - wheelchair, bed (pressure ulcer) *PROM *splinting/casting if spasticity *sensory stim *management of agitation track arousal and alertness (e.g. with yes/no system)

AE for C5

-mobile arm support to assist in supporting the weight of the arm during activities -Grasping and holding objects require wrist stabilization and use of an assistive device such as a universal cuff or C-clamp.

OT eval process for SCI -steps

1 -Once medical clearance is received, the top-down approach of beginning an evaluation with an occupational profile is recommended 2 - Physical evaluation begins with identifying medical precautions, including how much movement and load the client is allowed without jeopardizing spinal integrity ... do ROM and MMT

Rancho Levels 7-8

7 - Automatic and appropriate 8-10 = Purposeful

***FIM LEVELS

7 - I (NO HELPER) 6 - Mod I (NO HELPER) HELPER: 1-5 5, 4, 3 - MOD DEPENDENCE 5 - supervision 4- min assist (75%) 3 - mod assist (50-74%) 2, 1 - COMPLETE DEPENDENCE 2 - Max Assist (25-49%) 1 - Total assist (subject does <25%)

what is universal cuff used for?

A universal cuff is used when grasp ability is diminished and would not be beneficial to decrease tremor.

A client with stroke is taught to dress the weaker side first when donning a button-down shirt. The client then initiates putting the weaker lower extremity into the pant leg. What learning has occurred for the client? A. Generalization B. Transfer C. Automaticity D. Acquisition

A. Generalization ** (one TASK to another) B. Transfer (one SETTING to another) C. Automaticity D. Acquisition b - Transfer occurs when clients dress themselves at home in the same way they did in their hospital room. c - Automaticity is the ability to perform tasks with little or no contribution of consciousness; this client has not yet demonstrated automaticity. d - Acquisition is a training strategy that relies on conscious control and requires practice and drill exercises. Acquisition is a cognitive strategy, not a method of learning.

An OTR® receives orders to evaluate and treat a client with an incomplete S2 spinal cord injury. What is the BEST conclusion the OTR® can make regarding the client's recovery process? A. Recovery for incomplete spinal cord injuries is predictable and dependent on severity. B. Complete injuries are associated with better outcomes than incomplete injuries. C. Each day that goes by without return of function decreases the likelihood of recovery. D. A client's dedication or "hard work" in rehabilitation can cause nerve function to return.

A. Recovery for incomplete spinal cord injuries is predictable and dependent on severity. B. Complete injuries are associated with better outcomes than incomplete injuries. C. Each day that goes by without return of function decreases the likelihood of recovery. D. A client's dedication or "hard work" in rehabilitation can cause nerve function to return. C why D is wrong - Rehabilitation does not affect the degree of recovery, only the prevention of further deformity.

While performing PROM for a client with stroke, the OTR®; notes that the client's shoulder is resistant to flexion beyond 90°, although the client reports being pain free. What does this finding suggest? A. Shoulder subluxation is inhibiting movement. B. The scapula is not gliding to produce full flexion. C. The humerus is locked in against the acromion. D. Spasticity is preventing the shoulder from reaching full range.

A. Shoulder subluxation is inhibiting movement. B. The scapula is not gliding to produce full flexion. **correct C. The humerus is locked in against the acromion. D. Spasticity is preventing the shoulder from reaching full range. a. Shoulder subluxation would limit ROM because of the pain it causes, but this client is without pain. b. The muscles supporting the scapula have likely shortened from disuse and are limiting the full range of shoulder motion. Both the humerus and the scapula must move to support full shoulder motion. c. Mechanical joint limitations such as the humerus hitting the acromion during PROM would result in painful motion. d. Spasticity limits full ROM when velocity is a factor in movement; slow passive movement with a limitation in motion suggests that soft tissue shortening of muscles is limiting the range.

An OTR®; is positioning in bed a client who has weakness on one side of the body resulting from a traumatic brain injury. Which position is MOST appropriate for the client?

A. Supine with head supported on a pillow with arms abducted B. Side lying with affected extremity on top placed on a pillow C. Supine without a pillow to support head with arms abducted D. Side lying with affected extremity on top resting on abdomen B is correct -why: Side lying allows for normal postural positioning to minimize the effects of increased muscle tone. The use of a pillow under the top upper extremity allows the shoulder to be positioned in neutral. why a, c and d are incorrect: A, C: Supine position is likely to increase extensor tone, which does not support the goal of normalizing muscle tone. If a client needs to be positioned in supine, a small pillow should be used to keep the head in midline. D: Side lying allows for normal postural positioning to minimize the effects of muscle tone. When the affected extremity is positioned on top, it should be supported on a pillow to prevent horizontal adduction.

ACS Level VI - Planned Actions

Absence of disability & client is independent. The person can think of hypothetical situations and do mental trial and error problem solving

A client with stroke is receiving occupational therapy services to increase independence with feeding, grooming, hygiene, and toileting. What should the OTR®; FIRST consider in determining the client's needs?

Assessing the client's base of support is the first consideration in determining sitting and standing ability for ADLs. C. The client's base of support for upright postural ability

ACS 5.0

At Level 5, clients are more aware of the social and physical consequences of their action, and verbal praise may be a more useful strategy. continuous neuromuscular adjustments

Rancho Level 7

Automatic, appropriate - behaves appropriately and is oriented to place and routine but frequently displays shallow recall -requires Min A -new learning with Min supervision -attend to a familiar task for 30 minutes -monitor accuracy and modify tasks with min A -may be unrealistic in planning for their future -not aware of how other people feel -may not be aware of appropriate social behavior -new learning with carryover A Level VII client has limited distractibility and is capable of carrying out a intelligible conversation despite minimal confusion

ACS Level III - Manual Actions

Begins with the use of the hands to manipulate objects. The individual may perform a limited number of tasks with long-term repetitive training. i. Client requires moderate cognitive assistance. ii. Attention should be directed to tactile cues (e.g., familiar objects; Lewis, 2003, p. 134). iii. Goals are not related to outcomes. iv. Motor actions are limited to one-step, familiar, and action-oriented activities. v. Client cannot learn new behaviors. vi. Adapted activities should be used that reinforce the connection between predictable tactile effects on the environment and client actions (e.g., walking, washing cars, drying and wash- ing dishes, wiping countertops, vacuuming). vii. Client needs a routine. viii. Client should avoid sensory overload. ix. Client is able to wash hands and face and brush teeth. x. During grooming and bathing, items should be presented to client one at a time, in sequen- tial order of use. xi. Client requires 24-hour supervision.

types of aphasia -broca's (think BE) -wernicke's (think WR) -anomic

Broca's aphasia (expressive): broken speech; slow, labored speech with frequent mispronunciations Wernicke's aphasia or receptive aphasia: speech may be fluent (expressive is okay), but is often meaningless or nonsensical Anomic aphasia: difficulty finding words

ACS Level I - Automatic Actions

Characterized by automatic motor responses and changes in the autonomic nervous system. Counsciousness to the external environment is minimal. i. Client requires total cognitive assistance. ii. Attention is limited to subliminal internal cues. iii. Motor actions are in response to one-word, near-reflexive directions (i.e., "sip"). iv. Client needs monitoring to ensure adequate nutrition. v. Client needs assistance with ambulation and transfers. vi. Client needs passive, active, or assistive ROM for prevention of bed sores, osteoporosis, infections, and contractures. vii. Client is dependent on caregiver for ADLs. viii. Environment should be consistent, familiar, and modified to elicit orienting experiences. ix. Client requires constant 24-hour supervision. x. This level is the terminal phase of this disease, but death usually occurs before the last stage of this level

ACS Level IV - Goal Directed Actions

Characterized by carrying out simple tasks through to completion. The individual relies heavily on visual cues. He/she may be able to carry out established routines but cannot cope with unexpected events. i. Client requires minimum cognitive assist. ii. Attention is directed to visual and tactile cues. iii. Client is able to understand cause and effect. iv. Client can no longer problem solve. v. Client can follow two- or three-step activities. vi. Activities should be simple, concrete, and supportive of desired social roles. vii. Labels and pictures can be used as reminders. viii. Task setup for bathing and grooming is required. ix. Client can eat independently, but supervision is needed on amount of food eaten. x. Client needs protection against safety hazards and wandering. xi. Client needs 24-hour supervision.

ACS Level II - Postural Actions

Characterized by movement that is associated with comfort. There is some awareness of large objects in the environment, and the individual may assist caregiver with simple tasks. -Client requires maximum cognitive assistance. -Client's thinking is highly disorganized. -Attention involves internal cues. -Motor actions are one step, imitated, near reflexive, and familiar and involve gross motor patterns -ADLs can be accomplished by imitating the caregiver (i.e., washing the face) -Spontaneous behaviors are common -Client is able to eat finger foods -Client paces and wanders. -Client should be taken to the restroom every 2 hours. -Client requires around-the-clock supervision

T3 - wheelchair

Clients with T3 spinal cord injury are generally independent in their wheelchair mobility; recommendations include a rigid or folding lightweight wheelchair. An OTR® is discussing wheelchair options with a client with incomplete T3 spinal cord injury. The client asks whether the purchase of an electric wheelchair should be considered. How would the OTR® BEST respond? A. Electric wheelchairs are useful for long distances, although a manual wheelchair can promote improved function. B. Electric wheelchairs are very expensive and may not be covered by primary payer sources. C. Electric wheelchairs are large and bulky and will prevent accessibility in the home and community. D. Electric wheelchairs may stunt future progress in rehab. A is correct

what movements should be emphasized in shoulder/scapula for hemiparesis?

Clients with hemiparesis should be encouraged to move the upper extremity with external rotation, shoulder flexion within 90°, and scapular protraction to allow for optimal motor recovery by promoting soft-tissue elongation.

Rancho Levels 4-6

Confused

Rancho Level 6 -assistance level

Confused, appropriate -exhibits goal-directed behavior but is dependent on external input for direction -requires Mod A -attend to a highly familiar task for up to 30 minutes -vague recognition and emerging awareness of self/others

Rancho Level 5 -assistance level

Confused, non-agitated, inappropriate -appears alert with fairly consistent reactions, although increased complexity of commands causes more random responses -requires Max A -wandering about, not knowing where they are going -vague intention of going home -inappropriate use of objects -able to perform highly familiar tasks with enough structure and cues provided *client is highly distractible and displays severe memory impairment but can respond to simple commands

OT in inpatient rehab phase of TBI

For clients who demo stimulus-specific responses. - clients generally at Rancho Level V and higher. focus is on: motor (motor learning/skill acquisition, compensatory); vision e.g. for neglect (compensatory); cognitive (e.g. memory); speech (expressive aphasia); dysphasia bed mobiliity, wheelchair, transfers etc agitation

2 Assessments of consciousness for TBI (2)

Glasglow coma scale and rancho levels

Intervention focus for CVA

Intervention should focus on improving participation in occupations through early ADL training using both compensatory and remedial approaches -Tasks that emphasize performing an occupation allow the client to feel a sense of competence in engaging in tasks again. *Environmental and activity considerations are addressed using the task-oriented approach UE: cimt used Emerging techniques for upper-extremity function include electrical stimulation, mental practice and imagery, robot-assisted therapy, virtual reality, mirror therapy,

Scoring Allen Cognitive Test (Level 2 through Level 6)

Level 2: unable to imitate the running stitch Level 3: able to imitate the running stitch, three stitches Level 4: able to imitate the whip stitch, three stitches Level 5: able to imitate the single cordovan stitch using overt trial and error methods, three stitches Level 6: able to imitate the single cordovan stitch using covert trial and error methods, three stitches https://www.youtube.com/watch?v=kqbi6kBbK5g

Rancho Level 3

Level III—Localized response: reacts specifically to stimuli, though inconsistently Localized response -requires total assistance -may turn to or away from painful/auditory stimulus -may blink when light passes through visual field -may even be able to follow/track moving object -responding directly to stimulus A Level III client inconsistently responds to stimuli and would not be capable of intelligibly responding to simple commands.

Rancho Level 2

Level II—Generalized response: exhibits inconsistent and nonpurposeful reactions to stimuli Generalized response -requires total assistance -gross reflex motor response to pain (same general response for pain despite type/location of stimuli) A Level II client responds to stimuli only through physiological changes, gross body movement, or vocalization

Rancho Level 4

Level IV—Confused/agitated: -has heightened state of activity with severely decreased ability to process information -requires Max A -alert, in heightened state -don't know where they are or why they are there -confused, doesn't know time, doesn't recognize people coming in or out -may try to crawl out of bed -may try to remove/pull out or off constraints -moody, aggressive, "flight" behavior, happy one moment then upset the next -little short attention -difficult treatment (unable to cooperate)

Rancho Level 1 Descriptive measurement of awareness and cognitive function after traumatic in- jury

Level I—No response: is completely unresponsive to any stimuli presented No response -requires total assistance -appears asleep -no response to sound, touch, pain, etc.

Rancho Level 8-10

Levels VIII-X: Purposeful and appropriate: is alert and oriented and able to recall and integrate past and recent events. Each level (VIII, IX, and X) represents a decreasing need for assistance with routine daily living skills. -requires SBA -attend to and complete a task for up to an hour in even a distracting environment -can use assistive memory devices (to-do lists, etc.)

what is mobile arm support used for?

Mobile arm supports or slings are used to improve mobility of the upper extremity during activities and would not be beneficial to decrease tremor.

GCS motor responses

Motor responses ▪ No response (1 point) ▪ Rigid and extended response to pain (decerebrate posturing; 2 points) ▪ Flexion (decorticate posturing) in response to pain (3 points) ▪ Pulls part of body away in response to pain (4 points) ▪ Purposeful movement to painful stimulus (5 points) ▪ Obeys commands to perform various movements (6 points)

An OTR® is working with a client who has had a cerebrovascular accident (CVA). One of the client's goals is independence in baking activities. Which modality intervention is BEST used to decrease shoulder subluxation of the nonpainful hemiparetic arm during this task? A. Ultrasound B. Fluidotherapy C. Neuromuscular electrical stimulation (NMES) D. Conventional transcutaneous nerve stimulation (TENS)

NMES can be used during an activity to decrease shoulder subluxation post CVA. incorrect- A, B: Ultrasound and fluidotherapy cannot be used during an activity and do not increase functional control of muscles. D: TENS can be used during an activity but is typically used for pain and edema control.

grafting precautions

Once the skin has been grafted, the wrist and hand should be protected for 5 to 7 days until the staples are removed. No AROM, PROM, or functional use of the hand should occur during this time. Splinting the hand in the safe position allows the graft to take and the wound to heal and prevents deformities The postoperative phase of care is 5-10 days post-skin graft operation. During this phase, it is important not to disturb the grafted area so that graft adherence will occur. However, to prevent deformity from scar tightness and shrinkage, it is important to position the arm in antideformity position

ACS Level V - Exploratory Actions

Overt trial and error problem solving. New learning occurs. This may be the usual level of functioning for 20% of the population. i. Caregiver standby or supervision is needed for cognitive assist. ii. Client learns through visible, concrete, and meaningful stimuli. iii. External cueing can be used. iv. Client explores the effects of self-initiated motor actions on physical objects. v. Client uses overt trial-and-error problem solving. vi. Client can follow a four- to five-step process and learn new concrete ideas. vii. Client has difficulties with judgment, reasoning, planning, semantic memory, and episodic memory. viii. Client abilities include performing dressing, eating, and grooming activities without assistance

Medical management of burn Surgical and post op phase OT role

Postoperation immobilization period a. Immobilization is important after skin graft operation to allow for graft adherence. -a period of immobilization is enforced immediately after grafting to allow for graft adherence; therefore, no PROM or AROM is allowed during the postoperative phase. OT role - positioning, exercise and activity (after immobilization period, gentle AROM to avoid shearing of new grafts) - After post-graft operation immobilization, begin with AROM initially, and resume PROM after graft adherence has been confirmed.

how often should pressure relief be performed?

Pressure relief should be performed every 30 minutes to prevent skin breakdown.

Glasglow coma scale scores

Quantifies the severity of TBI and predicts outcome; scores range from 3 to 15 ● Scores above 14 indicate a minor brain injury. ● Scores between 9 and 12 indicate a moderate brain injury. ● Scores below 8 indicate a severe brain injury.

why is supine lying in bed not good for TBI

Supine position is likely to increase extensor tone, which does not support the goal of normalizing muscle tone. If a client needs to be positioned in supine, a small pillow should be used to keep the head in midline.

SCI level functions T1-6 T 6-12 L1-5 S1-5 T1-6 medical management etc

T1-6: arms unaffected T6-12: core control L1-5: kick S1-5: skip i. Medical management: respiration capacity and endurance may be compromised; independent in personal care; partial assistance for heavy-duty domestic care ii. Movement: normal upper-extremity ROM and strength iii. Nervous system: little bowel or bladder control iv. Mobility: independent transfers; may use manual wheelchair or may stand in stand- ing frame or walk with braces; may drive with hand controls

3 Areas assessed through Glasglow coma scale

Three behavioral areas assessed: (1) motor responses to pain, (2) verbal responses, and (3) eye opening

Rancho Level 1-3

Total assistance

Medical management of burn Acute phase - 72 hours after injury or until wound is closed (may be days or months) OT role

Treatment focuses on infection control and grafts (removal of dead tissue and replacement of skin or substitute over the wound); biological dressings may also be used to cover the wound. OT role - splinting and positioning in antideformity positions, edema management, early par- ticipation in ADLs, and client and caregiver education

Stages of TBI primary secondary

a. Primary: at the moment of impact b. Secondary: several days to many weeks after injury

ACS 2.4

aimless walking

An OTR® receives evaluation orders for a client who has recently experienced a traumatic brain injury. The client only opens the eyes when the OTR® applies a mild pinch to the client's arm. What score should the OTR® give the client on the Glasgow Coma Scale (eye-opening response category)? A. 7 B. 3 C. 2 D. 4

c - 2 Because the client is currently responding to pain only, the OTR® would give the client a 2 for the eye-opening response category.

Decerebrate rigidity

client's lower and upper extremities in a position of spastic extension, adduction, and internal rotation. **only diff is flex vs ext

ACS 4.4 *example

completing goal Clients at Mode 4.4 will be able to locate clothing and initiate dressing at a customary time of the day and dress in sequence. Clients may wear the same clothing over and over again because they like it and have worn it before.

autonomic dysreflexia

concern for T6 and above (T7 no longer a concern) Autonomic dysreflexia may be addressed by standing the client up, loosening restrictive clothing or devices, and checking the catheter for obstruction. Establishing new routines and habits for bowel and bladder elimination is essential to minimize risk of infection and decrease the occurrence of autonomic dysreflexia

ACS 5.6

considering social standards of context

ACS 5.8

consulting with others

ACS 4.2

differentiating features

ACS 2.6

directed walking

ACS 5.2

discriminating between parts of an activity

ACS 3.2

distinguishing objects At Mode 3.2, clients will need cues to sequence through a dressing routine.

Working on posture for CVA: postural adaptation

facilitate postural stability while seated and standing -seated - reaching activities -standing - e.g. washing dishes/kitchen activities (provide support of countertop); work on equilibrium *Postural stability is essential to performing many ADLs, and hemiparesis influences the client's ability to maintain postural stability at the edge of the bed. -so e.g. can - Train the client in postural activity at the edge of the bed to increase supported sitting

Medical management of burn Emergent phase - 0-72 hours after injury OT role

focus on sustaining life, controlling infection and managing pain OT role - splinting in antideformity positions

SCI L 1-5

forward motion of legs think "kick" *hip flexion, knee extension, dorsiflexion" can walk with supports

ACS 2.8

grabbing

ACS 3.0

grasping objects Imitation of the practitioner's actions occurs at Level 3

Ideal seated posture for a client with hemiparesis

hips flexed at 90° with shoulders over hips and arms relaxed in lap; the upper extremities should not be used to provide support in sitting.

Subdermal burn

i. Full-thickness burn with damage to underlying tissue such as fat, muscles, and bone. ii. Charring is present; may have exposed fat, tendons, or muscles. iii. If the burn is electrical, destruction of nerve along the pathway is present. iv. Peripheral nerve damage is significant. v. Requires surgical intervention for wound closure or amputation. vi. Potential for hypertrophic scar is extremely high.

Full-thickness (third-degree) burn

i. Involves the epidermis and dermis, hair follicles, sweat glands, and nerve endings. ii. Burn is pain free, no sensation to light touch. iii. Burn is pale and nonblanching. iv. Requires skin graft. v. Potential for hypertrophic scar is extremely high.

Deep partial-thickness (deep second-degree) burn

i. Involves the epidermis and the deep dermis layers, hair follicles, and sweat glands. ii. Pain is severe, even to light touch. iii. Erythema is present, with or without blisters. iv. Burn has a high risk of turning into a full-thickness burn because of infection; grafting may be considered to prevent wound infection. v. Client may have impairment of sensation. vi. Potential for hypertrophic scar is high. vii. Healing time varies from 3-5 weeks. With any burn deeper than a deep partial-thickness burn, sensory impairment may occur. Sensory testing for peripheral nerve damage should be performed as soon as the wounds are closed.

. Superficial partial-thickness (superficial second-degree) burn

i. Involves the epidermis and upper dermis layers. ii. Pain is significant; wet blistering and erythema are present. iii. Healing time is 1-3 weeks.

Burns: a. Superficial (first-degree) burn

i. Involves the superficial epidermis. ii. Pain is minimal to moderate; no blistering or erythema (skin redness). iii. Healing time is 3-7 days.

SCI S 1-5

i. Medical management: independent in personal care; partial assistance for heavy- duty domestic care ii. Movement: normal upper-extremity ROM and strength; some loss of function in hips and legs iii. Nervous system: little bowel or bladder control iv. Mobility: independent transfers; likely able to walk with assistance or aids, though slowly and with difficulty; may drive with hand controls and load wheelchair into car independently s4-5 - bowel can be okay

SCI C5

i. Medical management: low stamina, but breathing with diaphragm; complete assis- tance for personal and domestic care ii. Movement: full head and neck; ability to raise arms and flex elbows (no extension) iii. Nervous system: sympathetic nervous system compromised; possible autonomic dysreflexia; no bowel or bladder control iv. Mobility: electric wheelchair with hand controls

SCI C7 -note AE for grasp/dexterity C8 pretty much the same

i. Medical management: low stamina, but breathing with diaphragm; limited assistance for personal care; partial assistance for heavy-duty domestic care ii. Movement: full head and neck; ability to raise arms and flex and extend elbows; wrist flexion and extension; partial finger movement iii. Nervous system: little bowel or bladder control iv. Mobility: independent transfers; electric wheelchair with hand controls; manual wheelchair for short distances; may drive with hand controls AE: - the patient's limited grasp and dexterity --> "Fasten hook-and-loop straps to secure the paddle to the hand" would allow the patient to engage in table tennis (note - the partial intrinsic muscle innervation is the reason for limited grasp) -At C7 the patient will have limited grasp and dexterity to maintain a tenodesis grasp on the paddle during the dynamic interaction of table tennis -The patient has **full movement at the thumb**, so a splint to support the thumb is not indicated

SCI C6

i. Medical management: low stamina, but breathing with diaphragm; moderate assis- tance for personal care; complete assistance for domestic care ii. Movement: full head and neck; ability to raise arms and flex elbows (no extension); some wrist extension iii. Nervous system: little bowel or bladder control iv. Mobility: electric wheelchair with hand controls; manual wheelchair for short dis- tances; may drive a vehicle with hand controls wheelchair - power recliner with arm

SCI T1-5

i. Medical management: respiration capacity and endurance may be compromised; independent in personal care; partial assistance for heavy-duty domestic care ii. Movement: normal upper-extremity ROM and strength iii. Nervous system: little bowel or bladder control iv. Mobility: independent transfers; manual wheelchair; may drive with hand controls

SCI C1-C4

i. Medical management: respiratory assistance required; complete assistance for per- sonal and domestic care ii. Movement: limited head and neck movement; tetraplegia iii. Nervous system: sympathetic nervous system compromised; possible autonomic dysreflexia; no bowel or bladder control iv. Mobility: electric wheelchair with sip and puff possible

Athetosis

involves slow movements of the face, tongue, or limbs.

decorticate rigidity

involves upper extremities in spastic flexed position with internal rotation and adduction and the lower extremities in spastic extended position with internal rotation and adduction.

ACS 1.4

locating stimulation

CVA -impairments/functional limitations

motor dysfunction on side opposite the lesion -impairments in trunk and postural control that increases risk for falls, limits functional activity, and decreases independence in ADLs -Impairment in standing activity that affects weight bearing, weight shifting, and stepping and increases risk for falls -speech -neglect (perceptual) -attention, sequencing (think that it's kind of their motor planning that's affected), etc -figure ground UE: -Subluxation in the glenohumeral (shoulder) joint - pain -->person doesnt move -edema, shortening of muscles, damage to joints b/c of lack of control and sensation *motor learning big in stroke

which approach to intervention for CVA is huge?

motor learning

ACS 3.6 *example with dressing and bathing

noting effects on objects -At Level 3.6, the client will be able to wash most distal portions of the body and those that are easily seen but will not always follow the sequence thoroughly. The client may quit before completion and may have difficulty with measuring soaps, lotions, and deodorant. At Mode 3.6, clients must be trained to initiate dressing at the customary time of day.

ACS 2.0

overcoming gravity Guiding the client through the physical actions of an activity is required at Level 2

Assisted stand pivot

performing a functional transfer with a client with CVA, the OTR® blocks the client's affected knee and instructs the client to reach for the desired surface and move toward the stronger side

ACS 4.6

personalizing

ACS 1.8

raising body parts

Zone of partial preservation -for complete or incomplete injuries?

refers to complete injuries that have some innervation of dermatomes below the level of injury. Strengthening muscles in the zone of partial preservation for complete injuries may dra- matically improve functional performance.

ACS 1.2

responding to stimulation

ACS 2.2

righting reactions

ACS 1.6

rolling in bed

ACS 4.8

rote learning

ACS 5.4

self-directed learning

ACS 4.0 *examples

sequencing ***** able to don clothing slowly but has difficulty with fasteners or fails to see errors in the back (i.e., not tucking in the shirt) a client would attend to visible sensory cues and ignore what is not in plain sight (e.g., not tucking in the back of the shirt). Visual cues are significant at Level 4. Keeping items in plain view and minimizing clutter in the environment will facilitate this client's performance of self-care tasks. At Levels 4.0 and 3.8, the client will typically recognize the need for a bath and will bathe thoroughly as long as no major problems develop during the bathing process (i.e., lack of soap).

what position is good in bed for clients with TBI

sidelying

ACS 3.4 -example for bathing

sustaining actions on objects At Level 3.4, the client will typically wash/bathe only areas easily seen and reached. The client may wash one area repetitively and may forget to rinse or dry off.

generalization intervention approach for cva

the ability to take a strategy used with one task and apply that strategy to a new task.

ACS 3.8 *examples

using all objects At Levels 4.0 and 3.8, the client will typically recognize the need for a bath and will bathe thoroughly as long as no major problems develop during the bathing process (i.e., lack of soap).

ACS 1.0

withdrawing from noxious stimuli

AE for C6/C7

wrist-drive wrist-hand orthosis (or tenodesis splint) is useful in maximizing pinch strength for buttoning - palmar cuff buttonhook -->C6 SCI may not be able to grasp a buttonhook with the fingers, so a palmar cuff would provide the needed grasp.

GCS Verbal Response Scores

▪ No response (1 point) ▪ Incomprehensible speech (2 points) ▪ Inappropriate words (3 points) ▪ Confused conversation but able to answer questions (4 points) ▪ Oriented to person, place, and time (5 points)

GCS Eye Response Grading

▪ No response (1 point) ▪ To pain only (stimulus not applied to face; 2 points) ▪ When asked with loud voice (3 points) -requires the client to respond to verbal command or speech ▪ Spontaneous—opens eyes on own (4 points) -requires the client to open the eyes and to blink at baseline.