Chapter 16 Mastery of the Environment : Evaluation and Intervention, Major Milestones in Cognitive Development & Categories of Play, NBCOT Domain 3, NBCOT Flash Cards Set 1, AOTA NBCOT Exam Prep: Ethics, AOTA NBCOT Exam Prep, NBCOT Exam: Human Develo...

Biceps brachii

musculocutaneous nerve, flexes elbow and supinates forearm origin: coracoid process and supraglenoid tubercale insertion: radial tuberosity

Rule of Nines (adult)

9% R: arm 9% L: arm 9% for head 18% R: leg 18% L: leg 18% anterior trunk 18% posterior trunk 1% pelvis ------------------ 100% body

Wheelchair-accessible vehicle

A customized vehicle for a person who uses a wheelchair Optional features include: lowered floor in-floor or fold-out ramp automatic door wheelchair lift

Rasch methodology

A hierarchal design used to develop a linear measurement scale within a standardized assessment

Ataxia

A lack of coordination while performing voluntary movements -appears as clumsiness, inaccuracy, or instability -movements are not smooth and may appear disjointed or jerky

Standard deviation (SD)

A measure of variability that indicates the average difference between the scores and their mean. -the most frequently used measure of variability -appropriate with interval or ratio data

Assistive technology: Feature matching

A process used to determine which technologic features on an assistive device would best meet the client's needs. Should consider: environment where device will be used ability of the client to use the device transmission method required and availability of the method

Tactile defensiveness : deficits in modulation (regulation and organization)

A type of sensory defensiveness in which a person overreacts or avoids touching certain ordinary textures. (Over-sensitivity ) -demonstrates irritation and discomfort from a variety of textures such as clothing, sand, glass, glue, water, paint and/or food .dislikes brushing hair, and teeth -demonstrates various behavioral responses including: anger, hostility, temper tantrums, fear, and/or distress

episodic memory (explicit)

A types of declarative long-term memory associated with the retrieval of personal information (events, experience) -e.g food eaten for lunch, clothing worn to school, events at a party

Per diem

-A negotiated, per day fee for service. Typically used for inpatient hospital stays and skilled nursing facilities

Irritability

-A neurobehavioral impairment that results in feelings of agitation and annoyance

Seat depth (-2 inches)

-measure both LEs and take the greatest length; measure from the posterior portion of the buttocks to the popliteal fossa and then subtract 2 inches from this measurement -this prevents rubbing and potential decubiti to posterior knee region, while also allowing maximal leg swing -goal is to distribute body weight along as much of the thigh as possible

Sexual Abuse Signs and Symptoms in Elders

-report of sexual assault or rape -bruising around the breast or genital area -unexplained venereal disease or genital infection -torn, strained, or bloody underclothing

Early object use: 3-6 months (milestones in cognitive development)

-the child focuses on actions performed with the object -ex banging, shaking rattle

Early object use: 24-36 months (milestones in cognitive development)

-the child links multi-schemes; combining to make a meaningful sequence Ex. Scooping food using a spoon and feeding the doll

Empirical-inductive thinking: Concrete operations: ( Hierarchical development of cognition)

-the child solves problems with information that is obvious and present

Sun exposure and burns

-the risk for sunburn is higher -extra care to use sun screen should be taken

Self-management education

Therapeutic approach that involves: -enabling and empowering the client to independently identify issues -problem solving meaningful and realistic solutions/actions plans

Acting out behaviors in children

The expression of thoughts and feelings through maladaptive behavior instead of verbalizing Interpretation, redirection, limit setting, time-out

Standing sling

Type of sling used wit a mechanical standing aide that supports the torso to assist with a sit-to-stand transfer and maintaining and upright position in standing

Beach Wheelchair

Type of specialized wheelchair with oversized wheels that allows for ease in movement in the sand.

Lawrence Kohlberg: Level 2 (Stages of Moral Development)

Conventional morality: occurs until age 9-10 Stage 1: Social conformity: the child desires to gain the approval of others Stage 2: Law and order: rules and social norms are internalized

Boutonniere deformity

Is disruption of the central slip of the extensor tendon characterized by PIP flexion and DIP hyperextension . The PIP is splinted in extension, and isolated DIP flexion exercises are performed

Psychotropic medications

Medications used to treat psychiatric condition -acts on neurotransmitters at the synaptic junction -intended to influence behavior change

Therapeutic recreation specialist

Member of the interprofessional team who plans and implements leisure activities for clients with physical and behavioral needs

Transtheoretical Model

Model of behavior change that identifies six distinct stages people go through in altering behavior patterns; also called the stages of change model Practice model that includes the tenet that behavior change occurs in the following sequential stages: -precontemplative -contemplative -preparation -action -maintenance

Visual-perceptual processing skills

Minnesota rates of manipulation test is a standardized test to assess visual motor perception

Rancho Level VI

Mod Assist; confused, appropriate (sensical speech, performs simple tasks, attends for 30 minutes, new learning is difficult) -inconsistently oriented to person, time, and place, able to attend to highly familiar task in non-distracting environments for 30 min with mod redirection. Able to use assistive memory aides with max A, supervised for old learning (self-care), safety, risk, shows carry-over for relearned familiar task (hair bursting), max A for new learning with little carry over

Rancho level X

Mod I; purposeful and appropriate (goal directed, use of strategies, may need extra time to complete tasks) Able to handle multiple task simultaneously in all environments but may require periodic breaks, social interaction is consistently appropriate

Mirror therapy

Motor re-training method that includes using the reflection of the unaffected limb, typically used as an adjunct intervention for: -complex regional pain syndrome -phantom limb pain -hemiparesis using a reflection of an existing limb to treat phantom limb pain

Task-Oriented Approach

Motor recovery intervention approach that includes: repetition of movement during meaningful, client-centered, daily activities activity analysis and consideration for the interaction between person, environment, and occupation

Moro reflex (startle reflex)

Onset: 28wks Integration: 4-6 mths Stimulus: rapidly drop infants head backwards Response: 1. arm extension, abduction, hand open 2. Arm flexion, adduction Relevance: ability to depart from dominat flexor, posture: protective response

Landou

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

chronic obstructive pulmonary disease (COPD)

Pulmonary condition associated with limited airflow from the lungs. (poor expiratory flow rates) -Peripheral airway disease: inflammation of the distal conducting airways; associated with smoking -Symptoms: difficulty breathing, SOB during activities, dyspnea (SOB)and fatigue, persistent cough including emphysema (permanent abnormal enlargement and destruction leads to premature airway closure) and chronic bronchitis (inflammation of the tracheobranchial tree) -Interventions: smoking cessation, short/long acting B2 agonists, O2 therapy,

Self-report test

Test for collecting data on performance or behavior directly from the client, caregivers or relevant others Examples include: Ages and Stages Questionnaire Children's Assessment of Participation and Enjoyment

Allen's Test

a first line standard test used to assess the arterial blood supply of the hand [4]. This test is performed whenever intravascular access to the radial artery is planned or for selecting patients for radial artery harvesting, such as for coronary artery bypass grafting or for forearm flap elevation [

Network/snowball sampling

a form of volunteer sampling that occurs when you rely on members of a network to introduce you to other members of the network -participants provide names of other individuals who can meet study criteria

3 common phases of fracture healing

inflammation, repair, remodeling -inflammation: provides the cellular activity needed for healing -repair: forms the callus for stabilization -remodeling: deposits bone Complications of healing includes: misalignment of fracture, pain, decreased nutrition to area, and decreased healing potential -age and bone diseases can affect healing

Wound healing

initial stage of wound healing that includes: clot formation blood vessel dilation allowing neutrophils and monocytes to initiate debridement and attack bacteria changes in skin color, temperature, pain, swelling and function.

Beneficence

"Demonstrate a concern for the well-being and safety of the recipients of services" -maintaining knowledge by attending evidence-based educational session -using current and updated assessment tools to obtain accurate client data for interventions

Truth

"In all situation, therapist must provide accurate information, both in oral and written form:

Nonmaleficence

"Refrain from causing harm" -using due care to avoid harming a client when transferring from the bed to the w/c -not treating a client under the influence of drugs or alcohol

Prudence

"Use of clinical and ethical reasoning skills, sound judgement, and reflection to make decisions, within the occupational therapy practitioners are of practice

Long thoracic nerve injury

"winging of the scapula" general weakness of serratus anterior muscle (-Peripheral nerve injury)

short term memory (working memory)

(<1 min ): Type of Memory that involves storing chunks of information or facts for a limited duration of time

ischemic stroke

(Clots) in blood vessel supplying the brain is obstructed. - accounts for 87 percent of all strokes.

Above-elbow (AE)

(long or short) amputation above the eblow at any level on the upper arm

sliding transfer board

(spinal cord injuries & amputations) used for individuals who are not able to stand to transfer -place board under the gluteal region during weight-shifting, while the other end of the board is placed on the surface being transferred to -if the individual uses a tenodesis grasp (C6-C7) spinal cord injury patients or a splint, the person should weight-bear on clenched fist with wrist extended (so they don't lose tenodesis

monplegia

- paralysis restricted to one limb or region of the body

3-4 years ( Jumping and Hoping) Gross Motor Skills

-Gallops, leading with one foot and transferring weight smoothly and evenly

Shoulder: Extension Muscles

-Latissimus dorsi, -Teres major, -Posterior deltoid

Grasping skills: 8 months

-SCISSORS grasp- between thumb & side of curled index finger, distal thumb joint slightly flexed, proximal thumb joint extended

Visual Fields Test

-The complete central and peripheral range, or paNORAma of vision. (Gross measurement of visual fields) -client fixes on a central target and acknowledges the appearance of stimuli in the visual fields -Central Amsler grid: a tool used to detect vision problems resulting from damage to the macula (central part of eye) or optic nerve. May be caused by macular degeneration or other eye disease.

Hip Fractures (Etiology)

-Trauma -Osteoporosis -Pathological fractures (i.e., cancer)

11-12 months (sitting ) Gross Motor Skill

-Trunk control and equilibrium responses are fully developed in sitting position

12-16 months (symbolic play)

-basic "MAKE BELIEVE" -play primarily involves self (ex. Eating and drinking )

angina

-chest pain or pressure -in response to exertion or rest -radiates from: arms, neck, jaw, and back

Muscle grade 0 (no movement)

-no active movement noted -Zero

Developmental disabilities & Mental Illness (community mobility)

-occupational analysis of community mobility activities and context relative to clients performance abilities/deficient -modifications to match the clients abilities -passenger safety training -training and support for transportation services -opportunities to practice asocial interactions INCLUDING: muscular dystrophy, rheumatoid arthritis, stroke, and cerebral palsy

Hemiplegia

-paralysis of one side of the body

Sensory and Motor Dysfunction: evaluation of client factors and performance skills

-paralysis/weakness -severity of spasticity -gross/fine motor coordination -sensory modalities including; light touch, pain, pressure, proprioception, kinesthesia temp, gustatory, olfactory, and auditory -postural control -ROM, and MMT -skin integrity

Neonatal intensive care unit: Infants and children (community mobility challenges)

-passenger safety and education -education and resources regarding infant car seat

Rules: Concrete operations: ( Hierarchical development of cognition)

-rules are better understood, and they are also applied

Age-related vision changes and impairments

-subcutaneous fate around the eye decreases -strength of muscle, tone, and transparency of cornea decrease -sclera and iris show signs of degeneration -pupils become smaller -lens of the eye becomes thicker, more inflexible, and more opaque -eye diseases become more common -the cornea becomes thicker

Symptoms of CRPS

1. Allodynia (sensation misinterpreted as pain) 2. Hyperalgia (increased response to painful stimuli) 3. Hyperpathia (pain that continues after stimuli removed) 4. Edema 5. Contractures 6. Bluish or red shiny skin 7. Abnormal sweating and hair growth 8. Muscle spasms 9. Decreased strength 10. Low tolerance for activity

TBI: Diagnostic Testing

1. Glasgow Coma Scale (GCS) 2. Rancho Los Amigos Levels of Cognitive Functioning 3. CT scan and MRI to visualize intracranial structure damage

Finger to palm translation: manipulation skills

12-15 months; -a linear movement of an object from the fingers to the palm of the hand. -ex picking up coins

10-11 months (creeping) Gross Motor Skill

Creeps on hands and feet

11-12 months (creeping) Gross Motor Skill

Creeps well

A 360 degree turning space requires a clearance space of what?

60 x 60

Myoclonus

A brief and rapid contraction of a muscle or group of muscles

Reflective listening

A communication technique: involves confirming that a message or idea has been accurately understood by asking for validation from the client

low registration

A low level of awareness of sensory information

Judgement

A neurobehavioral ability to make safe and effective decisions on relevant information and feedback

Development of UE function

A. Head and trunk control B. Eye/hand interaction, sensory-perceptual integration C. Shoulder-scapular stability/mobility D. Humeral control E. Elbow control F. Forearm control G. Wrist control H. Thumb opposition and stability I. Palmar arches of hand J. Isolated finger control

Population health

Approach to health promotion for all those within the community being served that includes: modifying the health determinants reducing health disparities

Web Space Burn

C-splint

Stroke

CVA : cerebral vascular accident Clinical syndrome that accompany ischemic or hemorrhagic lesions including: -Cerebral Insufficiency -Cerebral Infraction -Cerebral Hemorrhage -Cerebral Arteriovenus Malformation

Handling characteristic of thermoplastic material: Bonding

Capacity of material to adhere to itself, beneficial characteristic when attaching dynamic orthotic components to an orthotic base

Environmental control unit

Computerized or mechanized systems that enable a person with physical limitations to independently control or interact within their environment, may be activated by: -voice -eye gaze -switch

Amputation: Etiology

Congenital, peripheral, vascular disease, trauma, cancer, and infection

Functional Independence Measure (FIM)

Disability measure typically used in rehabilitation settings to monitor progress and track individual or group outcomes 13 motor 5 cognitive items 7 point ordinal rating scale Score of 1 indicating complete dependence and 7 indicating complete independence

Fractures of the Forearm

Elbow: Radial head fractures account for 33% , caused by forceful loading through an outstretched hand

Affective instability

Emotional state commonly seen in borderline personality disorder, characterized by rapid mood swings usually between negative emotions such as: anger anxiety depression

Non-standardized test

Evaluation tool that measures ability or performance that is not compared to a norm or standard

Effects of dementia

Eye contact and show interest in person Positive and friendly facial expression, tone of voice Don't give orders Use short, simple words and sentences Do not argue or criticize Don't speak about person as if they are not there Create routine that uses familiar and enjoyable tasks Note effects of time of day on behavior and performance Attend to safety issues at all times

The Milwaukee Evaluation of Daily Living Skills (MEDLS) Assessments of Task Performance (Evaluation of ADLs)

Focus:

Barth Time Construction (BTC) Assessment of Occupational Performance/Occupational Roles

Focus: time usage roles and underlying skills and habits Method: The person constructs a color-coded chart, individually or in a group format, which depicts the way his/her time is spent during a typical week Population: adolescent through elder

Unstageable pressure ulcer

Full thickness tissue loss in which the base of the ulcer (wound) is completely covered by scar and slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.

Intrinsic inhibitory mechanisms

Gate control theory: transmission of sensation at spinal cord level is controlled by balance between large and small fibers.

Signs of Child Abuse

General signs include: withdrawal, nightmares, running away, anxiety and depression, guilt, mistrust of adults, fear, aggressiveness.

Myoclonic-akinetic seizure

Generalized, - Brief, invol. jerking of extremities -w/ or w/out loss of consciousness -difficult to control.

Dysphagia diet

Guidelines published by the American Dietetic Association to establish standard terminology for dietary texture modification of food for dysphagia management, levels include: Level 1: Pureed Foods Level 2: Mechanical altered Level 3: Dysphagia-advanced

Protective Responses

Help infant to learn protection from falls as well as learning early WB through extremities

tactile defensiveness

Inability of the central nervous system to regulate tactile input resulting in overreaction to ordinary touch sensations on the skin or in the mouth Behavioral manifestations may include: -extreme discomfort -emotional outbursts -aggression -anxiety

Social interaction groups

Include interventions to develop communication skills, social accept. behavior, and interpersonal relationship skills. **Can be modular or psychedu format.

Interagency team

Inclusive team of care professionals that includes the primary care team and outside agencies to optimize client outcome Beneficial during times of transition -beneficial during times of transition

Diet recommendations

Information in plan of care following dysphagia assessment that includes a prescribed diet of specific food and liquid textures and consistency, taking into consideration: diagnosis oral motor function aspiration risk cognitive function

Adaptive tools for handwriting

Instruments used during interventions in the classroom to enhance proprioceptive feedback during handwriting, examples include: felt-tip pens vibratory pens crayons (scented, glittered, glow-in-the-dark) weighted pens/pencils chalk

Erik Erikson: stage 6

Intimacy vs. isolation, 20s to 30s -establishes an intimate relationship ( partner, and family) - the capacity to love is achieved Young adult

Item bias: Testing bias

Involves clients of similar performance abilities scoring differently when the same evaluation instrument or subtest is administered

Ethical reasoning

Involves clinical decision-making based on philosophical issues including: -autonomy -beneficence -non-maleficence -occupational justice

Tenodesis grasp

Kinsesiological effect that will cause the fingers to flex when the wrist is moved from neutral to extension, and the fingers to extend when the wrist is moved from a neutral position to flexion Used as a functional advantage for clients with: spinal cord injury at the C6-C7 level radial nerve palsy

Awareness deficit

Lack of insight into a person's own functional deficits

Auscultation

Listening to internal sounds of the body with a stethoscope

implicit memory (nondeclarative/ unconscious)

Long Term Memory: automatic retrieval of motor or cognitive information required to perform actions or task - Procedural memory (skills and task)

Normal ROM for the thumb

MP flex: 0-90 IP flex: 0 to 80-90 Abduction: 0-50

Normal ROM for the fingers

MP flex: 0-90 MP hyperext: 0 to 15-45 PIP flex: 0-110 DIP flex: 0-80 Abduction: 0-25

Self-mutilation

Maladaptive coping mechanism to express feelings, includes intentional act of self-injurious behaviors of: burning cutting pricking scratching

Abraham Maslow's Hierarchy of Needs

Maslow's pyramid of basic human needs; must satisfy levels below before reaching to next; can go up and down pyramid stages

Social competence

Mastery of a complex interaction of social, cognitive, emotional, and behavioral skills needed for social adaptation, includes demonstration of effective: interpersonal communication social communication social skills

Mood stabilizing medications

Medication used in the treatment of bipolar disorder to treat symptoms of mania and depression

Anticonvulsant medication

Medication used in the treatment of seizure disorders

Antidepressants medication

Medication used to treat depression, anxiety, aggression, agitation, disturbed sleep patterns , and low mood

Professional development activity

Methods by which a certificant can accrue PDU to meet NBCOT certification renewal requirements, examples include: professional service professional workshops/courses/independent learning professional presentations fieldwork supervision publishing

Common names of immobilization orthoses

Names commonly used to describe this category of orthotic device include: volar wrist orthosis thumb spica orthosis dorsal blocking orthosis resting hand orthosis short opponens orthosis metacarpal fracture brace May be included as part of an orthotic prescription to help identify an orthosis using non-modified orthosis classification system nomenclature

Motor apraxia

Neurobehavioral deficit characterized by difficulty planning and sequencing the motor movements needed to complete a task (e.g., attempting to reposition the bristles of a toothbrush to brush teeth when moving it from one side of the mouth to the other) -inability to perform a task, and difficulty to perform a planned movement

Ideational apraxia

Neurobehavioral deficit characterized by the inability to correctly use an everyday tool or object for its intended purpose (e.g using a comb to brush teeth.) -inability to formulate an initial motor plan and sequence tasks where the proprioceptive input necessary for movement is impaired

Tonic Labyrinthine Reflex (Supine)

Onset: 37 wks Integration: 6 mths Stimulus: place infant in supine Response: increased extensor tone Relevance: facilitates total body extensor tone

Neuropathic pain

Pain as a result of lesions in some part of the nervous system; usually accompanied by some degree of sensory deficit -thalamic pain, complex regional pain syndrome type I, disorders of peripheral roots and nerves , herpes zoster , phantom limb pain, musculoskeletal pain, psychosomatic pain, headache, referred pain

medulla oblongata

Part of the brainstem that controls vital life-sustaining functions such as heartbeat, breathing, blood pressure, and digestion.

Shoulder subluxation

Partial displacement or dislocation of the glenohumeral joint, may occur secondary to the effects of weakness, muscle imbalance, and gravity Conservative interventions may include: slings, positioning devices, and taping strengthening exercises functional electrical stimulation -Incomplete dislocation of humerus out of glenohumeral joint caused by weakness, stretch, or abnormal tone in the scapulohumeral and/or scapular muscl

Evaporation

Physiological response resulting from the topical application of a vapocoolant, examples include: cold spray cooling cream

Hydraulic standing frame

Piece of durable medical equipment designed with a hydraulic lifting mechanism intended to facilitate transfers and upright positioning for individuals who have minimal use of the lower extremities

Tummy time

Placement of infant in prone position during periods of wakefulness to facilitate development of oral, fine, and gross motor skills

Normal ROM for the ankle and foot

Plantar flex: 0-50 Doris flexion: 0-15 Inversion: 0-35 Eversion: 0-20

Bilateral integration and sequencing deficit

Poor ability to coordinate both sides of the body and atypical postural and ocular mechanisms associated with signs of inefficient processing and perception of movement and body position

Construction and visuodyspraxia

Poor visual perception and visual- motor integration

Systems-Level interventions

Possible roles for occupational therapy practitioners addressing community mobility include consultation with transportation systems on issues such as design of the travel environment for accessibility and creation of eligibility determination processes for paratransit service

Lawrence Kohlberg: Level 3 (Stages of Moral Development)

Postconvential morality: age range can vary and not all adults will achieve this level

Shoulder: Horizontal Abduction Muscle

Posterior deltoid axillary nerve, horizontal abduction of the arm origin: spine of scapula insertion: deltoid tuberosity

Sit-to-stand wheelchair feature

Power-assist mechanism attached to a seating system that elevates the user to an upright position and allows for: -peer height navigation and interaction -easier transfers from wheelchair to bed

Lawrence Kohlberg: Level 1 (Stages of Moral Development)

Precoventional morality: occurs until age 8 Stage 1: Punishement and obedience: the child is obedient in order to avoid punishment Stage 2: Instrumental relativism: child makes moral choices based on the benefits to self and sometimes to others

Alginate dressing

Primary wound care dressing that can absorb large quantities of exudate.

Non-standardized sensory screening : Pain

Procedure used to screen protective sensation, includes using a safety pin to apply sharp/ blunt stimuli to the end of a pin to the fingertip Client responds with "Sharp" or "Dull"

Intervention review

Process of re-examining the intervention plan to determine its effectiveness in facilitating the client to achieve goals and achieve outcomes

Neurobehavior

Processing sensory stimuli that results in behavioral response

Volar forearm muscles innervated by the median nerve

Pronator teres forearm pronation origin: medial epicondyle and coronoid process of the ulna insertion: lateral surface of radius Pronator quadratus forearm pronation origin: distal ulna insertion: distal radius

Therapeutic UE exercises

Provide motion to further enhance performance and function to ultimately improve ADL performance -controlled AROM begins at 3-6 wks after fracture if fixation is stable Home program exercises: allows the client to continue safe exercises at home between therapy session to ensure continued progress towards goals

Fractures of the Upper Arm

Proximal humeral fractures are the most common fractures of the upper arm and may involve the articulate surface, greater tuberosity, or surgical neck Intervention: -Orthotics: (brace) can be worn to support the fracture ends -ROM: may Belgian as early as 2 wks (nonoperative) after fracture when medically prescribed -Sling is used to immobilize the fracture in non-operative treatment -ROM protocol consist of aggressive stretching and can begin 4-6 wks after the fracture as prescribed -Home exercise program is crucial for the return of motion/function in ADLs, an can include a sling for comfort and sleep for the first 6wks as needed

Task-oriented groups

Purpose is to assist the members in becoming aware of their needs, values, ideas, and feelings through the performance of a shared task.

Toddler and Infant Motor Evaluation (TIME) (Motor Assessment)

Purpose: assesses the quality of movement Method: 5 primary subject areas: mobility, stability, motor organization, social-emotional, functional performance Scoring: indicative of moderate or significant motor delay Population: Birth to 3 years 6 months

Musculoskeletal skills

Range of motion, strength, and endurance To assess if the person will be able to physical use the device to optimal capacity

Medical transportation provisions

Recipients of Medicaid may be eligible for subsidized transportation for healthcare and life maintenance trips

Correlation

Refers to the measurement of the proximity of two distinct variables

Clasp-knife rigidity

Reflexive abnormal motor response due to a cortical lesion in which a spastic muscle suddenly releases tension and gives way in response to passive stretch

9-10 months (release) Gross Motor Skill

Releases in a container with the wrist straight

CVA : Vestibular System

Results in pseudobulbar signs (dysarthia, dysphasia, emotional instability), tetraplegia

in-hand manipulation

Skill requiring control of the palmar arches of the hand to grasp and control objects Five patterns include: finger-to-palm translation palm-to-finger translation shift simple rotation complex rotation

Social skills

Skills associated with developing relationships with others involved: -interacting and expressing emotion -verbal and nonverbal communication -eye-contact -reciprocity, and empathy

Performance characteristic of thermoplastic material: Perforations

Small holes distributed throughout thermoplastic material that allow for flow to minimize risk of skin rash, sweating, and maceration

Psychosocial skills

Social interaction such as asking for assistance, obtaining need information from the right person

energy conservation techniques

Strategies to minimize fatigue by reducing task demands or amount of effort exerted during daily routines Includes: pacing planning prioritizing

Assessments of Chronic Pain : Subjective Assessments

Subjective assessments (e.g pain intensity scale) -verbal report (select the word that best describes your pain) e.g. sharp, throbbing -semantic differentiation scale (McGill Pain Questionnaire) -numerical rating scale (rating on a 1-10 scale) -visual analog scale (bisect line where your pain falls) -spatial distribution of pain (using drawings to plot location, type of pain) -visual scale (Wong-Baker faces pain rating scale)

Paraffin therapy

Supervicial, conduction, heat modality that involves use of thermostatically controlled, warmed wax and mineral oil, methaods include: immersion dip immersion pouring recommended for use as an adjunct to other occupation-based interventions

Semmes Weinstein Monofilament Test

Tactile sensory test used to assess thresholds of protective sensation by pressing or touching filaments on specific areas of the body

Sensory Skills

Tactile, pain, visual acuity determine if there is an impairment that could influence safety in the manipulation of devices

Mendelsohn Maneuver

Technique used to prolong the opening of the upper esophageal sphincter during a swallow, involves pushing the tongue into the upper palette while manually maintaining the Adam's apple in an elevated position

Self-determination

The action or process of making an informed, personal decision on how to solve a problem, overcome a barrier, make a choice, or plan for the future

Rehabilitative technology

The application of technology in the intervention of persons with disabilities with a focus on compensation, facilitation, or restoration of functional skills to support participation in occupation

True-experimental research (Quantitative)

The classic two-group design which includes random selection and assignment into an experimental group that receives treatment or a control group that receives no treatment -a cause and effect relationship between the independent variable and dependent variable is examined

Lifelong learning

The continual process of professional growth and self improvement throughout one's professional career. Includes: -self-assessment to identify ongoing learning needs -outlining and implementing a professional development -seeking current evidence to support best practice decisions

Validity

The degree to which an assessment tool measures what it claims to be measuring

Confirm ability: Trustworthiness

The degree to which the study conclusions are based on the data -obtained when data is truthful -enhanced by confirmability audit, member checking, research reflexivity, and triangulation of data

Principle 5 of Universal design Tolerance for error

The design minimizes hazards and the adverse consequences of accidental or unintended actions

Occupational therapy outcomes

The expected overall change in a clients performance and level of participation based on the intervention provided

Random Sampling

The key technique employed by survey researchers, which operates on the principle that everyone should have an equal probability of being selected for the sample. -individuals are selected through the use of a table of random numbers

homonymous hemianopsia

The loss of the right or left half of the field of vision in both eyes.

Median

The midpoint 50% -appropriate for ordinal data -measure of central tendency

Inclusive design

The needs and abilities of individuals with disabilities are considered when developing products and designing spaces

Magnification

The process of enlarging something only in appearance, using an optical device or lens, commonly used in low vision therapy to enhance vision Categories include: -lower power (e.g hand-held magnifier, reading glasses -high power (e.g closed-circuit television

Activity Synthesis: Activity analysis

The process of identifying gaps in performance and bridging those gaps by grading or adapting the activity or the environment in order to provide the "just right challenge" for the client -A component of activity analysis in which intervention activities are matched, modified, and graded to support progress towards the clients goals

Codman's pendulum exercises

Therapeutic exercise for the shoulder joint in which the client bends forward at the waist with the arm perpendicular to the floor, then rocks the body side-to-side allowing the relaxed arm to freely move in a clockwise and counterclockwise direction

external memory strategies

Therapeutic method used in neurorehabilitation to support ability to retrieve cognitive information at a later time, examples include: checklists day planner posted signs

Just right challenge

Top-down task analysis approach that involves identifying client-centered activities that: -are meaningful and contextually relevant -provide the greatest opportunity for success -maintain motivation and arousal

Stages 1: Parkinson's Disease (Hohn and Yahr's 5 stage scale)

Unilateral tremors, rigidity, akinesia, -minimal or no functional impairment

Scales of measurement

Used for quantifiable data -nominal scale -ordinal scale -interval scale -ratio scale

Professional development Unit (PDU)

Value assigned to the completion of a specific professional development activity accepted for NBCOT certification renewal, examples include: providing level I fieldwork direct supervision 1 PDU per student authoring a practice-area article in a peer-reviewed professional journal 10 PDU per article

Sheet graft

When the donor graft is removed and laid down on the receiving area as is

return-to-work program

Work rehabilitation continuum that promotes cost-effective steps for job-related goal attainment

Stage 3: Parkinson's Disease (Hohn and Yahr's 5 stage scale)

Worsening of symptoms, first sign of impairment righting reflexes -onset of disability in ADL performance, can lead an independent life

Hydrogel sheet dressing

Wound care dressing that hydrates the wound and promotes autolytic debridement

Delayed wound closure

Wound is cleaned , debriefed, and observed for 4 to5 days before suturing it closed

Primary wound closure

Wound is closed with sutures

Client record

Written documentation that contains data pertaining to the client's situation

Categories of Elderly

Young old: 65 to 74 years old Old old: 75 to 84 years old Oldest old: 85 years old and older

Normal distribution

a bell-shaped curve, describing the spread of a characteristic throughout a population

Bennett's fracture

a fracture of the base of the first metacarpal bone which extends into the carpometacarpal (CMC) joint

ADLs in rehab stage

a. Apply adaptive strategies or adaptive equipment to promote independence in ADLs and a return to a normal daily routine. b. Identify abnormal movement pattern early; client needs to relearn normal movement patterns.

Americans with Disabilities Act

aimed at allowing full participation in society for people with disabilities

Complete tarsal amputation

amputation at the ankle

Time-out: (acting behavior in children)

an intervention technique that results in behavioral changes by removing the child from a problematic situation to a specific area

Obsession

an unwanted thought or image that takes control of the mind -persistent, unwanted, and intrusive thoughts that create feelings of urgency and anxiety -psychological state commonly seen in obsessive compulsive disorder

Central or focal vision system

analyzes a visual target in terms of its details; color, shape, and texture

Wedge cushions

antithrust seats have a front that is higher than the back to prevent the individual from sliding out of their chair

Assistive Technology Devices

any item, piece of equipment or product system whether acquired commercially off the shelf, or customized, that is used to increase, maintain or improve functional capabilities of individuals with disabilities.

Domestic abuse

any physical,emotional, economic, verbal (intimidation and coercion, using children, stalking, financial, sexual, or psychological behaviors abusers use to gain and maintain control of another member of a household

Coronary Artery Disease (CAD)

atherosclerosis of the coronary arteries that reduces the blood supply to the heart muscle

Teres minor,

axillary nerve, external rotation origin: axillary border of scapula insertion: greater tuberosity

Anterior Deltoid

axillary nerve, shoulder flexion, internal rotation origin: clavicle insertion: deltoid tuberosity

Blindness

best-corrected visual acuity of 6/60 or worse (=20/200) in the better seeing eye

Central Nervous System (CNS)

brain and spinal cord, body's decision maker

Median nerve injury

carpal tunnel-like symptoms, such as palmar numbness and 1st to half of 4th digit numbness, with generalized weakness and pain

Congenital Torticollis

characterized by a unilateral contracture of the SCM muscle. causative factors include malposition in utero, breech position and birth trauma. usually dx'd within first three weeks of life. lateral flexion to same side as contracture, rotation toward opposite side. a type of dystonia

Interest checklist

client-centered instrument used for avocational pursuits to determine: current level of participation in leisure activities level of desire to perform leisure activities

Cardiac rehabilitation phase 3

community based exercise programs

Addiction

compulsive drug craving and use, despite adverse consequences -impacting personal, social, and occupational functioning with physical or uncontrollable dependence on: substance (drug, alcohol), and behavior (gambling)

Peripheral Nervous System (PNS)

cranial nerves and spinal nerves (LMN)

Material properties of low temperature thermoplastics...

elasticity, memory, bonding, durability, rigidity, perforations, finish, color, and thickness

Calendar: memory aid

external memory strategy involving a time-limited planner used to promote effective schedule management

Wall chart

external memory strategy that includes posting written instruction, steps, or illustrations of routine task, or daily activities

Coping skills groups

focuses on identifying and implementing the problem-solving and stress-management techniques needed to cope with life stressors

Ideation

formation of thoughts or ideas -cognitive ability to generate new concepts or ideas about an object or a situation

Colles fracture

fracture of the distal radius at the wrist with dorsal displacement. -most common distal radius fracture -dinner fork deformity -FOOSH (fall on out-stretched hand)

Types of splints: static

has no resilient components and immobilizes a joint or part

Bariatric wheelchairs and prescription considerations

heavy-duty, extra-wide wheelchair designed to assist mobility for individuals who are obese -ordered with special adaption -hard tires -power applications -reclining wheelchair to accommodate excessive anterior bulk

Secondary seeking: Registration

high neurological thresholds and active behavioral repossess

Poor registration: Registration

high neurological thresholds and passive behavioral responses

Kinesio tape

increases stimulation to cutaneous mechano-receptors that facilitate contraction or inhibition -elastic tape that is used to support an affected muscle during activity

Pivot Transfer

individual stands and turns to transfer surface

Low tech assistive devices

inexpensive household and/or catalog items that are readily available for use (e.g. jar opener, shoehorn, sock aid)

Wound healing phases

inflammatory, proliferative, maturation

Pre-oral phase of swallowing

involves: -smell and visual appreciation of food -stimulation of saliva -mouth and upper extremity motor movements to initiate the process of eating

Mallet finger

is avulsion of the terminal tendon and is splinted in full extension for 6 weeks

Akinesia

loss or impairment of the power of voluntary movement

Hypertrophic scar

most apparent 6-8 wks after wound closure most active in initial 4-6 months tx = compression therapy early, and continue until scar matures in 1-2 years

Dry (AMD) (Central Vision Loss)

most common type of AMD; causes deposits of yellow-colored extracellular material within the macula of the eye, causing possible atrophy of the retina and a gradual loss of central vision

Stage 1 pressure ulcer

nonblanchable erythema of intact skin -no open wounds or tears, skin redness but no blanch, warm to touch, surrounding area may feel firm or soft, and client may report pain

sinus rhythm

normal heartbeat triggered by the SA node

Releasing skills: 6-7 months

one stage transfer

Phantom limb pain (Neuropathic pain)

pain in a limb (or extremity) that has been amputated

Referred pain

pain that is felt in a location other than where the pain originates (e.g medial left arm pain with a heart attack)

Anti-tippers

prevent w/c form tipping backward or forward but, can get caught on doorsills and curbs

Occipital lobe (telencephalon)

primary visual cortex and visual association area

Abductor pollicis longus (EPL)

radial nerve, abduction and extension of CMA joint origin: middle 1/3rd of ulna and radius insertion: 1st metacarpal, radial side

Infraspinatus,

scaprascapular nerve, external rotation origin: infraspinatus fossa insertion: greater tuberosity

Supraspinatus,

scapular nerve, abduction and flexion origin: supraspinatus fossa insertion: greater tuberosity

Phantom Limb Syndrome

sensation of the presence of the amputated limb

Teres Major (shoulder extension)

subscapular nerve, adducts, medial rotates, and extends the arm origin: (proximal attachments) Lower lateral border and inferior angle of the scapula insertion:(distal attachments) Medial lip of the intertubercular (bicipital) groove of the anterior humerus.

Visual Acuity Test

tests acuity

contrast sensitivity

the ability to detect differences in light and dark areas in a visual pattern

Electric lift chair

used to assist a client with impaired mobility to transfer from sit to stand

Meshed graft

when the donor graft is "meshed" and stretched to cover a greater area of the receiving area

Secondary wound closure

wound is left open and allowed to close on its own

4-5 months (supine position) Gross Motor Skill

- Hands are together in space

Strategies to slow or reverse changes: Skeletal System Changes and Adaptions in the Older Adult

- Postural exercises: stress the components of good posture -Weight-bearing exercises (gravity-loading) can decrease bone loss in older adults e.g. walking, stair climbing (all activities performed in standing) -Nutritional, hormonal, and medical therapies

Superficial partial thickness burn:

-2nd degree burn -Involves the epidermis and upper portion of dermis (sunburn) -Appearance: red, blister, and wet -Healing 7-21 days OT Evaluation: -Occupational Profile - ROM 72 hrs post-opt -Sensation when wounds heal -Strength when wounds heal -ADLs, role asap OT Intervention: -Wound care and debridement (sterile whirlpool/ dressing changes) - Gentle AROM and PROM to tolerance -Edema control -Splinting (as needed) -ADLs, role activities

Bilateral Integration (motor development)

-9-12 months -Experimentation with movement helps stimulate the nervous system resulting in sensations that helps the child coordinate the two sides of the body

Paget's disease: hearing loss

-A common bone remodeling disorder that typically begins with excessive bone resorption in the elderly. -Bilateral progressive hearing loss is the most frequently encountered complication.

Osteogenesis Imperfecta (Diagnosis)

-Family & Medical history -Results of physician exam and medical including: x-rays, collagen and blood test

Extrinsic flexors of the hand innervated by the ulnar nerve

-Flexor digitorum profundus

Community Participation/reintegration groups

-Focuses on the identification and use of community resources (ex. leisure facilities) and development of skills (ex. the use of public transportation) to enable full community participation -May be conducted in a modular and/or psychoeducational format

Amputation: Classification and Amputations: UE Level

-Forequater: -Shoulder disarticulation: -Above elbow (AE): -Elbow disarticulation -Below-elbow (BE) -Wrist disarticulation -Finger amputation

Play groups

-Frequently used in pediatric settings for observation, assessment, and to teach and develop a variety of skills. -Provide opportunities to develop play, task, and social skills at the child's developmental level and provide a developmentally-appropriate outlet for children to express thoughts and feelings.

Goniometer

-Instrument used to evaluate joint range of motion -Accuracy is ensured through following standard procedure including: -client position -positioning of the instrument

Driving Rehabilitation

-Instrumental Activity of Daily Living (IADL) -provides mobility within one's community -allows or autonomy for self-directed activity pursuits, and engagement in life roles -requires extensive on-the-road training and behind the wheel driving in a diversity of driving environments

Interventions to prevent falls

-Intervention is based upon the determination of the individual's functional problems and the causative factors of falls as identified in evaluation -Eliminate or minimize all fall risk factors; stabilize disease states, manage medication -Improve functional mobility: 1) active or resistive muscle strengthening exercises and general conditioning exercises (GCE) to improve or maintain flexibility, strength, endurance, and coordination 2) PROM stretching as indicated to increase joint ROM 3) specific coordination training 4) neuromuscular reeducation training 5) balance training (sit and stand positions; static and dynamic; turning, walking, stairs) 6) transfer training 7) bed mobility training 8) wheelchair safety training 9) referral to physical therapy for gait/ambulation training -Provide sensory compensation strategies -Modify activities of daily living for safety; 1) order appropriate adaptive devices and train in safe use (ie. reachers, long shoe horn, stocking/sock aid, leg lifter, dressing stick, walker, baskets, etc) 2) allow adequate time for activities; instruct in gradual position changes -Teach energy conservation techniques -Communicate with family and caregivers -Modify environment to reduce falls and instability; use environmental checklist: 1) ensure adequate lighting 2) use contrasting colors to delineate hazardous areas 3) simplify environment, reduce clutter 4) firmly attach carpet 5) securely fasten handrails on both sides of stairs 6) provide light switches at top and bottom of stairs 7) install non-skid secure surface on stairs 8) install grab bars located in and out of the tubs and shower and near toilets 9) provide nonskid mats and nightlights 10) use elevated toilet seat 11) install night lights or light switch within reach of bed 12) place telephones in an easy to reach position near bed 13) replace existing mattress with one either thinner or thicker to lower or to raise bed height as needed 14) arrange furniture for easy maneuverability 15) ensure couches and chairs are at proper height to get in and out of easily 16) remove clutter and loose electrical cords 17) arrange furniture for easy maneuverability in living areas 18) store items in the kitchen on reachable shelves (between person's eye and hip level) -Provide specific safety guidelines for the individual to follow: 1) ask for assistance to transfer or ambulate. (Do not stand up alone, do not walk to the bathroom or kitchen alone, etc) 2) utilize prescribed assistive device(s) to ambulate, especially on any uneven or unfamiliar ground. Keep assistive device near at all times 3) use prescribed adaptive equipment 4) stand in place before beginning to walk to avoid dizziness from change in position and to regain balance 5) do not bend forward 6) wear supportive rubber-soled slippers or low heeled shoes 7) avoid wearing smooth-soled slippers or only socks, which makes it easier to slip -Provide psychological support and specific interventions to deal with the fear of falling: 1) acknowledge the validity of the individual's concerns 2) initiate discussion about risk factors and encourage active problem solving 3) modify activities to be safe and achievable to build confidence 4) provide activities to maintain physical conditioning to decrease risk of fear becoming a reality 5) develop a contingency plan to use in the event of a fall to maintain safety

2 years ( Jumping and Hoping) Gross Motor Skills

-Jumps down from step

3 years ( Jumping and Hoping) Gross Motor Skills

-Jumps off the floor with both feet

3-5 years ( Jumping and Hoping) Gross Motor Skills

-Jumps over objects

Hypertropic Scar

-Most common deep 3rd degree burn -Appears 6-8 wks after wound closure -One to Two years to mature -Compression garments should be worn 24 hrs a day (applied when wound is healed) (for 1-2 years until scar is matured) -Additional intervention: ROM, skin-care, ADLs, role activities, and patient/family education

Symbolic Play 18-24 months (milestones in cognitive development)

-use of non-realistic objects in pretending ex. Substituting a block for a train -uses inanimate objects to perform familiar activities ex. Doll washing itself

Problem Solving Skills: 9-12 months (milestones in cognitive development)

-uses tool after demonstration ex. Using a stick to secure a toy that is out of reach -behavior becomes more goal directed -performs an action to produce a response

presbyopia

-visual loss due to old age, resulting in difficulty in focusing for near vision (such as reading) -an inability to focus properly and blurred images, due to loss of accommodation, elasticity of lens

Inpatient rehab

3 hrs minimum of therapy per day, ADL, IADL, functional mobility, community integration Clinical setting providing intensive therapies and 24 hour nursing care to medically stable patients

wheelchair hallways width

36" wide

Normal Gestational Period

38-42 weeks; 3 trimesters

Membrane keyboard

Alternative keyboard for computer access made up of pressure pads requiring limited hand and arm strength and mobility

Group termination

A therapeutic process that brings closure to group

procedural memory (implicit)

A type of long-term memory associated with knowing how to perform learned skills and actions (skills, task) E.g. how to ride a bike, and tie your shoe. (motor skills, habits, classically conditioned reflexes)

Erik Erikson: Stage 2

Autonomy vs shame and doubt -child realizes they have control over bodily functions -self-control integrated into the personality 2-4 years

Escalating behavior

Avoid challenging behavior Maintain comfortable distance Actively listen Use calm, but not patronizing tone Speak simply, clearly, directly, avoid miscommunication Get help if above does not ease situation

Anatomy of the hand and wrist

Bones: 8 carpals, 5 metacarpals ( proximal, middle, distal), thumb (proximal, distal) Muscles: (lateral epicondyle include) anconues, brachioradialis, supination, ECRL, ECRB, ECU, ED, EDM Muscle: (medial epicondyle include) pronator teres, FCR, FCU, PL, FDS Blood supply: radial, ulnar arteries Sensory receptors: Pacinian corpuscles (vibration), Ruffini end organs (tension), Merkel cells (pressure)

Moderate Assistance

Client needs 25-50% verbal and physical assistance to complete a task

Bariatric wheelchair

Specialized wheelchair with weight capacity and size width options greater than the standard wheelchair frame. Specialized features include: reinforced cross braces and frame padded, reinforced upholstery heavy duty wheels

Vocational rehabilitation

State-supported program that provides educational and employment services to eligible recipients Services include: guidance and counseling job-skills training job placement transition services supported employment

Basal ganglia (telencephalon)

Structures in the forebrain that help to control movement -forms and associated motor system with other nuclei in the subthalamus and midbrain

Arches of the hand

Structures of the hand that must be considered when fabricating and fitting an orthosis Types include: Proximal transverse, distal transverse, and longitudinal arches

Protective factor

Factors in the social environment that support health, wellness, and preparedness for adverse or stressful events, including: access to supportive relationships and nurturing awareness of resources insight and capacity to use coping strategies

Social script

Narrative used to promote social participation or a skill to children, written from the perspective of the child, and practiced for use in a variety of contexts Typical narratives relate to: giving or receiving compliments asking for or giving help self-introductions

Clinical psychologist

Specialize in psychotherapy and cognitive behavioral therapies for clients with mental health conditions and behavioral problems

Erik Erikson: Stage 1

Trust vs mistrust, first year of life -survival and comfort needs will be met -hope is integrated into the personality Birth-18 months

body powered prosthesis

Type of upper limb prosthetic device that is operated using a harness and the movement of the body to generate forces through a cable control system -Cable attached to harness strapped around shoulders with terminal device (cosmetic or functional) -Shoulder motions generate tension on the cable to voluntarily open or close the TD

Planar foam wheelchair seat cushion

Type of wheelchair seat cushion with the following characteristics: composed of viscoelastic material lightweight and inexpensive absorbs moisture multiple density and thickness options least effective option for pressure distribution

Adaptive stroller

Type of wheeled, non-motorized transit device that provides supported positioning for children with moderate to severe disabilities; design requires others to push the device and does not enable self-initiated exploration

Brachial Plexus Injury

UE nerve injury where the signs and symptoms may impact the arm, hand, and/or wrist depending on the severity, mechanism, and anatomical location of the injury and may include: -decreased shoulder ROM -weakness or paralysis -pain

status epilepticus

a prolonged seizure or situation when a person suffers two or more convulsive seizures without regaining full consciousness -can be life threatening, sometime triggered when medication is stopped abruptly -rarely does sudden death occur, however it is possible -typically occurs with tonic-clinic seizures that are not well-controlled

Stair-climbing wheelchair

designed to navigate stairs while balancing on two wheels using sensors and gyro-scope

Arthritis

inflammation of a joint or joints Types: 1. Rheumatoid 2. Osteoarthritis

Limited setting: (acting behavior in children)

inform the child of what is premissble /unacceptable

Bladder training

is a behavioral modification treatment technique for urinary incontinence that Involves placing a patient on a toileting schedule. -used for urge incontinence in which voiding is completed at a fixed schedule

Ethical temptations

when it is difficult to follow through on a course of action that the person knows is right because he or she is tempted to go against it ( e.g client is ready to discharge, but the therapist needs extra money)

Apathy

lack of interest or emotion in purposeful activity or events in the environment, and is associated in impairment in the prefrontal cortex

Thin: dysphagia diet

liquid consistency that requires an intact swallow and includes: -water, ice chips, broth, coffee, and gelatin

Sensory avoiding

low neurological thresholds and active behavioral responses

Sensory avoiding: Registration

low neurological thresholds and active behavioral responses

Sensory sensitivity: Registration

low neurological thresholds and passive behavioral responses

Hypothalamus (diencephalon)

maintains homeostasis

Individuals with Disabilities Education Act (IDEA)

mandates that children with disabilities receive education in the least restrictive and most natural environment -inclusive models are to be used to enable the child the child to be taught in a general education class room -education must prepare a child for independent living, employment and social participation

Omnibus Budget Reconciliation Act (OBRA)

mandates that restraints cannot be used without proper justification, agreement, and documentation

What are the three major peripheral nerves?

median, ulnar, radial

wheelchair : clearance for doorways

minimum 32" Ideal 36" replacing hinges w/ offset hinges adds 1 (1/2) -2 inch in width

Space to accommodate door swing

minimum of 18" is needed for those using walkers minimum of 26" is needed for those using w/c Door handles: lever handles are more functional than round knobs

Brachioradialis

radial nerve, flexes elbow with forearm in neutral origin: supracondylar ridge insertion: distal radius

Statistical utilization review

reimbursement claims data are analyzed to determine the most efficient and cost-effective care

Dystonia

results in sustained abnormal postures and disruptions of ongoing movement resulting from alterations of muscle tone. -may be General or localized

5 stages of groups: Intervention groups types

stage 1: orientation: orienting the members to the session and each other stage 2: movement using a variety of gross motor activities designed to be stimulating and promote alertness stage 3: perceptual-motor: use brief 30 min or less activities that utilize perceptual motor skills design to be calming and increase the ability to focus stage 4: include activities to promote cognitive stimulation and organized thinking stage 5: closure of the group should consist of a brief discussion that promotes a sense of satisfaction and closure

Motor control

the ability to regulate or direct the mechanisms essential to movement -execute movement in a controlled and purposeful manner

Low vision impairment

the best-corrected visual acuity less than 6/12 (<20/40) in the better-seeing eye

Principle 4 of Universal Design Perceptible information

the design communicate necessary information effectively to the user , regardless of the ambient condition or the users sensory abilities

Range

the difference between the highest and lowest scores in a distribution -measure of variability

Visual Memory

the mental representation of information as images -the ability to capture a visual image and transfer it to short-and long-term memory for recognition and retrieval at a later time

Mode

the most frequently occurring score(s) in a distribution -appropriate for nominal data -measure of central tendency

Psychosomatic pain (Neuropathic pain)

the origin of the pain experience is due to mental or emotional disorders

Equality

the state of being equal, especially in status, rights, and opportunities. "The desire to promote fairness in interactions with others "

Skin graft: Autograft (Acute phase: 72 hrs after injury)

transplantation of the persons own healthy tissue (skin) from an unturned donor site to an injured (burned) site -autograft -split-thickness skin graft -full-thickness skin graft -meshed vs sheet graft

Commercial transportation

transportation services operated as for-profit enterprises for which people pay privately -commercial carriers (airlines, trains) -taxi services -shuttle and van services (small-vehicle fleets)

Fine motor coordination and dexterity (motor development)

using small muscle groups for controlled movements, particularly in object manipulation

Redirection: (acting behavior in children)

verbal tactic that refocuses the child on the assigned or current activity that provides cues for appropriate participation

Crossing Midline ( motor development)

9-12 months -Reaching for a toy while weight bearing on the opposing UE for balance

5-10 months (sitting ) Gross Motor Skill

(Sits alone) -(Sits alone steadily with a wide base of support -Able to play with toys in the sitting position)

Dependent

Client needs 75% ( or more) verbal or physical assistance to complete a task or is unable to perform any component of the task -patient does less than 25% of the work

Stand-by-Assistance

Client requires caregiver or practitioner assistance to be within arm's reach to safely complete a task

Supervised

Client requires occasional verbal assistance to safely complete a task

Modified Independent

Client requires use of adaptive equipment or increased time to complete a task

Independent

Client requires zero physical or verbal assistance to safely complete a task

Hip Fractures: Medical Management

Closed Reduction: (minimal displacement) Open Reduction Internal Fixation: Joint Replacement

Topographic orientation

Determination of the location of objects and settings and the route to the location -The ability to orient oneself to the surroundings using visuospatial skills -impairments may cause: difficulty with directions and navigation, and learning routes

Spaced retrieval

Cognitive intervention method in which the client is asked to recall information at expanding intervals (e.g client is asked to immediately recall names of people then recall 5 minutes later, then 10 min later a behavioral, implicit-internal memory intervention used in early- and middle-stage dementia

Attention

Cognitive process of being able to focus on specific, stimuli, task, and/or task component while disregarding irrelevant distraction, types include: -selective, sustained, alternating, and divided

Self-verbalization strategies

Cognitive strategy where an individual learns to talk out loud to regulate or control behaviors

Client education

Collaborative client-centered teaching approach used to advise a client on: plan of care and goals resources discharge planning home programs Includes assessing the ability to carry out health care recommendations

Caregiver education

Collaborative client-centered teaching approach used to advise family and relevant others on: plan of care and goals resources discharge planning home programs Includes assessing the ability to carry out health care recommendations

Fractures of the Wrist and Hand

Colles - Outstretched arms, fracture of the distal radius w/ posterior displacement, more common than smith Smith - Fall on flexed arms, fracture of the distal radius w/ anterior displacement Bennet's -fracture of the 1st metacarpal base

Grade equivalent

Compares a student's performance to a normative group of students at the same academic level

Gesture training

Compensatory intervention for neurobehavioral deficits that includes providing graded levels of task demands in two phases: transitive gesture training (client demonstrates use of common objects) intransitive gesture training (client performs pantomime gestures based on cues)

Super-supraglottic swallow

Compensatory swallowing technique used to close the airway entrance above the vocal cords, involves the following steps: Taking a deep breath Holding the breath and bearing down (as in a bowel movement) while swallowing Coughing to clear saliva or food that may have passed beyond the vocal cords

Heuristic research

Complete involvement of the researcher in the experience of the subject(s) to understand and interpret a phenomenon -aims to understand human experience and its meaning -meaning can only be understood if personally experienced

Cog-wheel rigidity

Motor dysfunction secondary to a lesion of the basal ganglia in which the muscles respond in a jerky motion when force is applied during flexion of a joint, common symptom of Parkinson's disease

Lead pipe rigidity

Motor dysfunction secondary to a lesion of the basal ganglia where during slow PROM, constant resistance is felt throughout; common symptom of Parkinson's disease

9-17 months (walking ) Gross Motor Skill

Takes independent steps, and falls easily

Rancho Level II

Total Assist; generalized response (general reflex to painful stimuli, gross body movement, not purposeful vocalization) response may be delayed

Criterion validity

When the results of an assessment predict performance ability on other assessments that measure similar constructs -predictive validity -concurrent validity

Storage (2nd stage of memory)

Where encoded information is transferred to an area of the brain for later retrieval -Brain structures: bilateral medial temporal lobe, hipppocampus

Cranial nerves V, VII, IX, X

mixed- motor and sensory involved in chewing (V), facial expression (VII). swallowing (IX, X), vocal sound (X), sensation from the head (V, VII, IX), heart vessels and lungs (IX, X) and taste (VII, IX, X)

Health Belief Model (HBM)

model for explaining how beliefs may influence behaviors -Practice model includes tenets that an individual's perception of health combined with their environment impacts the selection of behaviors that influence health

Prospective memory

remembering to do things in the future -A type of memory associated with remembering to perform an action or event planned for a future date (E.g attending a medical appointment, take meds, pay bills)

Resection

removal of part or all of a structure, organ, or tissue -surgical procedure use to remove pathological tissue, bone or organ

Environmental Theories (Aging)

-Aging is caused by an accumulation of insults from the environment

Embolism

-Blockage of a vessel by a clot or foreign material brought to the site by the blood current. -largely obstructs the flow of blood.

Average wheelchair width

24-26" rim to rim

Anthropometric

A measurement that refers to the size and proportions of the human body

Built environment

Architectural and design features of buildings, dwellings, or homes

3-6 months (early object use)

Banging and shaking Child focuses on actions performed with objects

12+ months (early object use)

Child acts on objects with a variety of schemes

Client-centered goals

Collaborative process of establishing goals to ensure fidelity between priorities that are meaningful and motivating to the client and the goals recommended by the therapist

Type III: Radial head fracture

Comminuted: is treated operatively, with immobilization and early motion within the first postoperative week as medically prescribed

What are the two major types of nerve injuries?

Compression Laceration: partial or complete

Dysphagia diet liquid progression

Dietary liquid modification that involves altering the viscosity of drinking liquids to decrease aspiration risk, includes the following levels (from most difficult to swallow to easiest to swallow): -thin -nectar-like -honey-like

Clinical Implications: Neurological System Changes and Adoptions in Older Adults

Effects on movement: -Overall speed and coordination are decreased -Decreased fine motor coordination -Decreased in strength -Both reaction time and movement time are increased -Speed/ accuracy trade-off: simple movements= less change, complicated movement = more preparation, and longer reaction/movement times -General slowing of neural processing: learning and memory are affected -Problems in homeostatic regulation: (stressors, heat, cold) can be harmful even life-threatening

Collaborating: Mode

Engaged the client to be: -an active participant in the intervention planning process -involved in joint decision-making throughout the therapy process

Advocating: Mode

Ensuring: -the client has access to necessary resources -the rights of the client are respected

Force measure

Environmental assessment tool for measuring push or pull force required to manage: -doors -drawers -windows

Clinometer

Environmental assessment tool used to measure lateral slope of a ramp, floor, or pathway

Self-assessment

Evaluating one's own perceived knowledge and skills related to a specific professional area of practice -results are used to identify currencies strengths and weakness (e.g. future professional development needs)

Wound healing: Maturation phase

Final phase of would healing that may continue for months or years that includes: collagen remodeling scar softens while its tensile strength increases erythema lessens

Discharge planning groups

Focus on activities to problem solve potential obstacles and identify resources for successful post-discharge community reintegration

ADL/IADL groups

Focus on development of ADL skills and IADL skills to enable independent living

durable medical equipment

Medical equipment that can be used repeatedly by individuals recovering from an illness or injury Types include: wheelchair mobility aids transfer bench shower bench bedside commode

Assistive technology

The term used to describe devices for persons with disabilities to: compensate for loss of function facilitate independence restore functional skills

Types of Quantitative Research Methods

True-experimental Quasi-experimental Non-experimental Correlation research

Tangential speech

a communication disorder in which the train of thought of the speaker wanders and shows a lack of focus, never returning to the initial topic of the conversation.

Extensor polliicis longus (EPL)

radial nerve, extension of IP joint of thumb origin: ulna, middle, 1/3rd insertion: distal phalanx of thumb

Extensor digiti minimi (EDM)

radial nerve, extension of the MCP joint of the 5th digit and contributes to extension of the IP joints origin: lateral epicondyle insertion: inserts into EDC at MCP level of the 5th digit

Extensor carpi ulnaris (ECU)

radial nerve, extension of the wrist and ulnar deviation origin: lateral epicondyle insertion: fifth metacarpal

Clinical Implication: Skeletal System Changes and Adaptions in the Older Adult

—Maintenance of weight bearing is important for cartilaginous/joint health and mobility -Increased risk of falls and fractures

8 months (release) Gross Motor Skill

-Releases above a surface with the wrist flexed

10-14 months (walking ) Gross Motor Skill

-Walking; stoops and recovers in play

3-3 1/3 years (stair climbing) Gross Motor Skill

-Walks down stairs alternating feet

2-3 years (stair climbing) Gross Motor Skill

-Walks up stairs alternating feet

Arthrodesis

-A procedure used to fuse joints

Manual portable lift

A type of lift system that requires the caregiver to pump a lever to raise and lower a client during a transfer

Proxy

A person who provides information or answers to questions on behalf of a client during an interview or on a questionnaire

Survey research

A pre-determined set of questions is used to collect information about participants including: -demographics, opinions, and level of satisfaction (e.g. customer service satisfaction survey)

Debridement

A procedure performed to facilitate would healing and involves removal of damaged or nonviable tissue Types include: surgical mechanical chemical autolytic

Hierarchy of evidence

A rating system used to classify the strength and quality of evidence when making evidence based decision in clinical practice

Randomized control trial (RCT)

A reader has design that analyzes outcomes based on specific interventions -where the design allocates subjects, by chance into a control or experimental group

Finkelstein's test

A screening test used to detect deQuervains tenosynovitis , performed by having the client grasp the thumb with the fingers into the palm of the hand then ulnar deviating the wrist -positive test elicits exquisite pain along the radial aspect of the wrist

group maintenance roles

A type of role in the group process where members contribute to the overall performance of the group Type include: -harmonizer, compromiser, follower

Hip disarticulation

Amputation at the hip joint Loss of entire lower extremity

Hemipelvectomy

Amputation of half the pelvis and entire LE

Elbow disarticulation

Amputation of the upper extremity distal to the elbow joint

Client-centered

An approach that involves learning the clients goals, needs, and priorities and applying this information to goal setting and selection of intervention activities

Arthroscopy

An endoscopic surgical procedure used to examine and treat joint injuries

Restorative program

An intensive program that reinforces carryover of new skill development to improve functional outcomes

mechanical advantage

Application of a three-class lever system to achieve efficiency and promote effectiveness of an orthosis. Typically described in terms of the length of the effort arm and the length of the resistance arm.

Berg Balance Scale (BBS)

Assess: Fall Risk ; An objective balance test used to assess static and dynamic balance abilities - 45 Increased risk of falls -valid for older adults -interpreted score indicates fall risk Max Score of 56 14 Everyday Activities = Sitting & Standing Balance, STS, SLB, Pivot Transfer, FR, Turn 360, Pick up object, Look behind shoulder, Tandem stance

Selective attention

Attention that involves focusing on a particular stimuli while simultaneously filtering out distraction

Sustained attention

Attention that involves focusing on a task over time without being distracted

Divided attention

Attention that involves shifting focus between two or more task at the same time

Cerebellum

Balance and coordination, equilibrium, and muscle tone A large structure of the hindbrain that controls fine motor skills.

Intervention plan

Based on evaluation results, includes: selection of intervention approach client-centered goals intervention activities outcome measures

Visual motor integration (motor development)

Coordinating the interaction of information from the eyes with body movement during activity -Including: visual attention, memory, discrimination, kinesthesia, position in space, figure ground, form constancy, and spatial relation

Percentile and quartiles

Describe a score's position within the distribution, relative to other scores -data is divided into 4 equal parts and position of score is placed accordingly

Gait belt

Device typically made of cotton webbing with a buckle that adjusts and locks around a client's waist, used by caregivers to provide external support to the client during transfers and ambulation

Type II: Radial head fracture

Displaced: with a single fragment, typically treated non-operatively with immobilization for 2-3 wks and early motion medical clearance

Erik Erikson: stage 8

Ego Integrity vs. Despair -the mature adult reflects on their own value, and shares with the younger generation the knowledge they have gained - wisdom is acquired Maturity

Evaluation Tool of Children's Handwriting (ETCH)

Evaluates the manuscript and cursive handwriting skills of children in grades 1 through 6. Performances-based assessment of legibility and speed of handwriting -criterion-referenced -different versions to evaluate cursive and manuscript handwriting

Ergonomic feature: Lumbar support

Feature considered in the ergonomic design of a chair or seat to maintain natural curvature of the lower back; especially beneficial when sitting for prolonged periods of time

Disparities in availability of public transportation

Fewer than 25% of U.S. rural residents are served by public transportation.

Normal ROM for the knee

Flex: 0-135

Safe patient-handling equipment

Lift systems used to prevent injury of the healthcare worker and to assist the process of safely transferring a client from one surface to another

Light weight manual wheelchair

Manual wheelchair style frame that typically weights between 25 to 40 pounds Benefits include: enhanced self-propulsion decreased strain on upper extremity ease of loading and unloading for transportation

Metabolic equivalent of task (MET)

Measurement system commonly used in cardiac rehabilitation that indicates the energy expenditure required during a physical activity or daily task, examples include: 1.0-2.5 MET's = sweeping floors 2.6-4.0 MET's = walking downstairs 4.0-6.0 MET's = weeding 6.0-10.0 MET's = jump rope

isometric contraction

Muscle contracts but there is no movement, muscle stays the same length

Orthotic pattern

Necessary first step of orthotic fabrication to ensure custom fit and design that includes: tracing the shape/size of extremity on paper prior to cutting the material using anatomical landmarks

Types I: Radial head fracture

Non-displaced ; can be treated with a long arm sling

Neuropraxia (1st degree)

Peripheral nerve injury -Seddon's classification of nerve compression where there is disruption of the myelin and spontaneous recover is expected -Interventions include: pain relief, orthotic positioning, A/AA/PROM exercises, activity modification, patient education

Types of Qualitative Research Methods

Phenomenological research Ethnographic research Heuristic research Case study

11-24 months (sitting ) Gross Motor Skill

Rise from supine by rolling to side than pushing up into sitting position

Contrast: Environmental adaption:

Solution to enhance safety and performance for client's with low vision, that includes a distinct color gradient, may be used for -visual presentations/educational materials -placement during meal time -edge of stairs

Self-Harm/Self-Mutilation

The "deliberate" destruction or alteration of one's own body tissue without conscious suicidal intent (e.g. self injurious behavior, parasuicide, self-wounding, and cutting" -coping skills to deal with maladaptive behavior/uncomfortable feelings -improve self-management (stress/emotional regulation skills -instruct in the use of alternative coping strategies (rubber band) -implement interventions (CBT) principles (pg 346) -use dialectical behavior therapy (DBT) techniques if appropriate -instructions in the use of sensory approaches (stimulation/massage) -develop problem solving skills -improve communication skills

Oculomotor control

The ability of the eyes to move in all directions and move together -impairments may cause: increased head movement, and difficulty keeping place

Therapeutic use of self

The ability to integrate empathy and effective interpersonal skills into the occupational therapy process in order to achieve an optimal working relationship with the client

Walkability assessment

The extent to which the built environment is pedestrian friendly

Physiological needs: Maslow

The most basic human needs to satisfied-water, food, shelter, and clothing.

Level 1: Hierarchy of evidence

The strongest level of evidence including: -meta-analysis of multiple randomized controlled trials (RCT) -systematic reviews with homogeneity of evidence

Synovectomy

The surgical removal of a synovial membrane that lines a joint- one use is to repair joint damage caused by Rheumatoid Arthritis.

Conduction

Transfer of energy between two connected surfaces of contrasting temperatures, examples include: paraffin wax cryotherapy hot pack

Types of CRPS

Type I: develops after noxious event Type II: develops after nerve injury

Error variance

Variables that cause a difference in standardized test scores (e.g. environmental conditions, motivation, fatigue)

Dependent transfer

Moving a client who requires physical assistance of one or two caregivers to move from one seating surface to another without mechanical assistance If completed incorrectly, poses a high risk for client and caregiver injury

Community Integration Measure (CIM)

Self-report measurement tool that assess the level and quality of community integration for adults with disabilities where higher scores indicates better community integration

Becks Depression Inventory (BDI)

Self-reporting questionnaire used to screen depression -ages 13-80 -higher score indicates greater severity of depression

Levator Scapulae

Anterior primary rami of C3 and C4 and dorsal scapular nerve (C5), Raises medial border of scapula origin: Posterior tubercles of transverse processes of C1-4 insertion: Upper part of medial vertebral border of scapula

Erik Erikson: stage 5

Identity vs. Identity Confusion -teenage begins to make choice about adult roles -resolution of identity crisis; a sense of fidelity or membership with society is integrated into the personality 10-20 (teenage years)

Ergonomics

Science involving analysis and recommendations to ensure an optimal fit between the environment, equipment, and the user Facilities optimal performance with the least risk of injury

Pain

Acute: Recent onset and usually last for a short duration Chronic: long duration and can lead to depression Myofascial Pain: specific to muscles, tendons, or fascia

Secondary driving controls Adaptations

Adaptations made to a vehicle that allow the driver to interact with features in the vehicle (e.g., turn signal, wiper blades, horn) that are not considered primary driving controls (e.g., gas, steering, break)

Chronological Age

Age of an individual since birth that is calculated by subtracting birth date from current date

Conceptual Age

Age of fetus or newborn in weeks since conception

Stroke/ CVA Non-modifiable Risk Factors

Age: risk increase with age Gender: males are at a higher risk Race: African Americans and Latinos are at greater risk Heredity: family history of heart disease Post menopausal woman

Parametric statistics testing

Based on population parameters, includes: test of significance (t-test), ANOVA, ANCOVA

Power-assist units

Battery-operated device attached to a seating and mobility system for enhancing independent mobility, types include: joysticks sit-to-stand lifters head controls

Inclusion outcome

Intended objective for providing students with disabilities least restrictive and fair access to education, includes: full participation in school activities supporting peer interactions options for general educational curriculum establishing an environment of respect and tolerance supporting interaction within the community

Team Efficacy

Interdisciplinary and transdisciplinary teams are the most common and considered the most effective in today's health care system

Group dynamics

Internal and external factors that influence functioning of a group and its outcomes

3-4 months (supine position) Gross Motor Skill

-Holds head in midline -Legs come together -Lower back is fattened against the floor

Muscle grade 4 (-)

-Holds test position against slight to moderate pressure Good (-)

Encouraging: Mode

Involves providing the client with positive support to instill confidence and hope

Elbow Flexion: Biceps and brachialis: innervated by musculocutaneous nerve brachioradialis: innervated by radial nerve

-Biceps -Brachialis, -Brachioradialis

TIA (Transient Ischemic Attack)

- "mini stroke," - caused by a temporary clot. -This is a warning stroke and should be taken seriously.

TBI Prevlance; Onset: and Prognosis

- #1 cause of death and disability than any other neurologic cause in populations under 50 -Male are twice a likely to incur a TBI -Highest risk group is between ages 15-to-29 yrs old

Superficial burn

- 1st degree burn Involves epidermis only - Min. pain/edema, no blisters - Healing: 3 to 7 days

Full Thickness Burns

- 3rd degree burns -Involves the epidermis, dermis, hair follicles, sweat glands, and nerve endings -Appearance: white, waxy, leathery, and non-elastic -Sensation: absent, requires skin graft -Hypertrophic scar -Healing time could take months

Sign and symptoms of Emotional or Mental Abuse

- Child reports being verbally or emotionally mistreated -Aggressive or acting out behavior (lying or stealing) - Shy, dependent, or defensive appearance -Verbally abusing others with language directed towards them

Taste and Smell: Sensory System Changes and Adaptions in Older Adults

-decrease in taste sensitivity -decrease in smell sensitivity -additional loss caused by smoking cessation, chronic allergies

Intrinsic Muscles Innervated by (Ulnar Nerve)

-Abductor digiti minimi -Opponens digiti minimi, -Flexor digiti minimi, -Adductor, lumbricals (ulnar side), -Palmar interossei, -Dorsal interossei

Brachial Plexus Disorder

- Secondary to traction during birth, invasion of metastatic cancer, after radiation tx secondary to fibrosis, or traction injury - Symptoms: 1) mixed motor/sensory disorders of corresponding limb 2) rostral injuries produce shoulder dysfunction while caudal injuries produce dysfunction in hand -After the age of 6 months contractures may begin to develop (Add and internal rotation), and supination of the forearm. -Positioning and ROM exercises are necessary to retain external rotation, Abd, and flexion at the shoulder and distal flexibility

PEO model: use in pediatric practice

- Family-centered approach: good fit between occupation, person, and environment = optimal occupational performance - Interventions target changes in child, occupation, and environment - Changes can occur in each level of environment (home, neighborhood, state) - Assessments and outcome measurements incorporate a broad repertoire of measures

Posterior Cord Syndrome

- Least frequent syndrome (rare) incomplete SCI -positive Romberg sign -Loss of dorsal columns bilaterally -bilateral loss of proprioception, vibration, pressure, stereognosis, 2 point discrimination; - motor function is preserved to vary degrees (ataxic gait) -pain, temperature, and touch are preserved

Two to three years (2-3 years)

- The period of refinement as the infants systems further develop, leading to improved balance and postural control. -Further development of tactile discrimination and localization lead to improved fine motor skills. - Motor planning and praxis ideation also progress during this period

Simple rotation: manipulation skills

- Turning or rolling of an object that is held at the finger pads approx. 90 degrees or less - 2-2.5 years unscrewing a small bottle cap

Grasp of cube: Neonate

- Visually attends to object, grasp is reflexive

prefrontal cortex

- controls emotion, judgement, higher order cognitive functions such as ideation and abstraction

precentral gyrus

- primary motor cortex for voluntary muscle action

Cerebral insufficiency CVA:

- transient disturbance: transient ischemic attack (TIA) - transitory stroke that lasts only a few minutes - blood supply to part of the brain is briefly interrupted - symptoms usually occur suddenly, are similar to those of stroke but do not last as long. - symptoms disappear within an hour, although they may persist for up to 24 hours - Symptoms: numbness or weakness in the face, arm or leg, especially on one side of the body; confusion or difficulty in talking or understanding speech; trouble seeing in one or both eyes; difficulty with walking, dizziness, and/or loss of balance and coordination

15 months (walking ) Gross Motor Skill

-Able to stop, start walking

PEO model: evaluation and analysis of occupational performance

-Address the occupational performance issues that the client identifies -Emphasize the environment of the individual to include where he/she lives, works, plays -Evaluation is client-centered and flexible as there is no specific evaluation -Consider the skills, abilities, task, and activities that are meaningful to the person and environment where occupational engagement occurs -Analyze each PEO aspect in relationship to the person and family -Assess potential strengths and weaknesses by conceptualizing the fit among PEO aspects

Spinal Cord injury Level (L1-L5)

-Expected functional outcome: -ambulated with AD -may use w/c for distance -Independent with loading and unloading from vehicle, driving and hand controls, and ADL and bed mobility

Spinal Cord injury Level C (1-3)

-Expected functional outcome: -ventilator dependent -TD physical assistance for BADLs, and IADLs, however client is able to direct care needs

Shoulder: flexion muscles

-Anterior deltoid -Coracobrachialis -Supraspinatus

Leading Causes of disability/chronic conditions in persons 65+ years

-Arthritis 49% -Hypertension 37% -Hearing impairment 32% -Heart impairments 30% -Cataracts 17% -Orthopedic impairments 16% -Diabetes and visual impairments 9%

Bilateral hand use: 3-10 months

-Asymmetric movements movements prevail until — months -Symmetric movement don't emerge until — months

Diagnostic Testing: Parkinson's Disease

-Cardinal signs (ex tremors) -Degeneration of dopaminergic pathways in the substantia nigra (executive function, learning, reward, and motivation) -Positive response to Sinemet (Levodopa/Carbidopa) a dopamine promoter

Leading causes of death in persons over 65

-Coronary heart disease (CHD) 31% of deaths -Cancer: 20 % of deaths -Cerebrovascular disease (stroke) -COPD Chronic pulmonary disease -Pneumonia/ Flu

Age-related Changes: Cardiopulmonary System Changes and Adaptions in the Older Adult

-Degeneration of heart muscles with accumulation of lipofuscins (brown heart) -Cardiac valves thicken and stiffen -Resting blood pressure rises

Certified othotist (CO)

-Design, fabricate, and fit orthotics for individuals to prevent or correct deformities and/or support body parts weakened by injury, disease, or congenital deformity

Oral motor control (motor development)

-Developed in the area of feeding, -Provides the foundation for early oral communication and later language development

7- 8 months (sitting ) Gross Motor Skill

-Equilibrium reactions are present -Upper body rotation/ lower body sedimentary -Protective response present while falling to the side

Spinal Cord injury Level (T2-T12)

-Expected functional outcome: -Mod I for bowel and bladder management, and bed mobility, transfers, and standing -Independent for w/c mobility, and Mod I-(I) for BADLs,

Vocational Rehabilitation Counselor

-Evaluates pre vocational skills and vocational interests and abilities via standardized and non standardized assessments to determine an individual's employability; -Provides counseling to maximize vocational potential; refers individual to appropriate vocational programming or job placement -Refers individuals to appropriate vocational programming and/or job placement

Optometrist/vision specialist

-Examines the eye to determine visual acuity, level of visual impairments, and damage to or disease in the visual system -Prescribe assistive devices (e.g. corrective lenses)

Grasping skills: 12 months

-Fine pincer grasp- between fingertips and finger nails, distal thumb joint flexed

Palmar-supinate grasp: Pre-writing skills

-Fist hand to hold pencil -wrist flexed/ slightly supinate -arms move as a unit 1-1.5 years

Thirteen to twenty-four months (13-24 months)

-Further refinement fine motor skills. -Increase in the complexity of motor planning as the child expands his/her repertoire of movement to patterns -Symbolic gesturing and vocalization promotes ideation, indicating the ability to conceptualize. - Motor planning abilities contribute to self concept as the child begins to mater the environment

Grasping skills -Natal

-Grasp of pellet (prone sitting) -No voluntary grasp

Socioeconomic Factors

-Half of older woman are widowed -Most old adults live on fixed incomes -50% of older adults have completed high school -Most non-institutional elderly live with family

Reaching skills: 4 months

-Hands come together at midline for bilateral reaching with shoulders aBducted with partial internal rotation, forearm pronation, and full finger extension

OT Evaluations and Interventions: Cerebral Palsy

-Help develop recovery skills (PEDS: playing and learning) -Muscle and joint coordination (ADLs: eating, brushing teeth, bathing etc..) -Improve physical, cognitive, and social abilities (e.g. fine motor, posture) -Address difficulties in processing sensory information

Grasping skills: 9 months

-Inferior pincer grasp-between ventral surface of thumb, and index finger, distal thumb joint extended -Beginning of thumb opposition

Grasping skills- 7 months

-Inferior scissor grasp; rake objects into the palm with addicted/flexed thumb

Cauda Equina Syndrome

-Injury at the L1 level and below resulting in a LMN lesion (lower motor neuron) -Flaccid paralysis w/no spinal reflex activity -back pain, uni/bilateral leg pain and weakness -Areflexic bowel and bladder

1-4 months (release) Gross Motor Skill

-Involuntary release

Fourth Degree Burns

-Involves fat, muscle, and bone -Electrical burn: destruction of nerve along pathway

Acute care hospitals

-Length of stay (LOS) is deterred by diagnosis and preventing symptoms (can be limited to 1-7 days) -Longer LOS requires significant documentation to justify need, and ongoing need can result in discharge to another setting -OT evaluation focuses on quick and accurate screening of major difficulties impeding function (e.g. cognition, and safe return to home setting) -OT focus includes: stabilizing the Pt, discharge planning, after care referrals, and family/caregiver education -Discharge:

Scapula: Downward Rotation

-Levator scapulae -Rhomboids (major, minor) -Serratus Anterior -Latissimus Dorsi

Role of Occupational Therapy in elder abuse

-Mandatory reporting: 1) elder abuse per se may or may not be designated as a specific crime in a state; however, most physical, sexual, and financial/material abuse are crimes in all states 2) healthcare workers are required to report suspected or observed cases of elder abuse 3) failure to report may be considered a crime 4) in most states Adult Protective Services, the area Agency on Aging, or the county Department of Social Services is designated to provide investigation and services -Occupational therapy intervention: 1) treat for physical and emotional injuries 2) develop a trusting relationship 3) assist in developing a support system 4) refer to appropriate disciplines and/or agencies

Classification of disorders in limbs :Cerebral Palsy

-Monoplegia: involves one extremity -Hemiplegia: involves UE and LE on the same side -Paraplegia: involves bilateral LE's -Quadriplegia: involves all extremities -Diplegia: involves less UE involvement and more LE functional impairments

Low Back Pain (LBP)

-Most common work-related injury -Location: Lumbar lordosis -Etiology: poor posture (seated/standing), repetitive bending (using poor boys mechanics), heavy-lifting, sleeping with poor posture -Symptoms: pain, difficulty with self-care/sleep

Subluxation of the shoulder

-Musculoskeletal condition characterized by partial dislocation of the glenohumeral joint typically caused by trauma or decreased muscle strength in the rotator cuff

4 months (release) Gross Motor Skill

-Mutual fingering in midline

What are the four basic steps of program development

-Needs assessment -Program planning -Program implementation -Program evaluation

Grasping skills - 3 months

-No attempts to grasp -Visually attends to object

Infection control : Acute phase of burns

-Non-surgical intervention: maintenance of wound care until the wound heals -Surgical interventions: escharotomy, debridement, skin grafts, autograft

Muscle grade 5

-Normal strength observed with ROM against gravity and maximal resistance -antigravity position

Sensory processing disorders: Infants and children (community mobility challenges)

-Occupational analysis between community mobility & sensory processing -education and transportation providers regarding SPD -parent/caregiver education and support -Interventions to assist children with SPD to adapt to challenges

Evaluation of UE

-Occupational profile, medical history (past, current), establish rapport -Observe posture, guarding, scars, wounds, spontaneous use of UE -Gentle palpating to check pain, adhesions, edema, use proactive nerve test (elicit symptoms) and clarify injury

Intradisciplinary team

-One or more members of one discipline evaluate -Other disciplines are not involved; -Communication is limited, thereby limiting perspectives on the case -"Team" is at risk due to narrowness of perspective -Comprehensive, holistic care can be questionable

Functional Mobility Aides

-Orthotic devices -Canes -Walkers -Crutches

Interventions: Radial head fracture

-Orthotics are used for immobilization as needed ' -ROM begin early, within the first week if medically cleared -Sling is used for TYPE 1 fractures or for comfort if the client has pain and/or is nervous in public places

Grasp of cube: 5 months

-Palmar grasp: fingers on top surfac, object presses into center of palm w/ thumb adducted

Shoulder Horizontal Adduction Muscle

-Pectoralis major lateral pectoral nerve, horizontal adduction of arm origin: medial clavicle, sternum of ribs insertion: greater tuberosity

Contrast Sensitivity Test

-Pelli-Robson Contrast Sensitivity Chart -A procedure for determining the ability to distinguish between light and dark areas; useful in the diagnosis of a cataract. -an effective way to detect changes in visual pathway that may be caused by diseases including: diabetic retinopathy, cataracts, glaucoma that effect quality of vision -helps determine changes in vision that have no affect on changes in visual acuity

Biomedical Engineer

-Person who uses engineering to solve problems in biology and medicine to improve patient care and design new medical devices

Sign and Symptoms of Neglect

-Poorly nourished appearance or inadequately clothed -Consistently tired or listless behavior -Inconsistent attendance at school -Poor hygiene or obsession with cleanliness -Left alone in dangerous situations, for long periods of time and/or at an inappropriate young age -Unable to relate well to adults or form friendships

12-15 months (release) Gross Motor Skill

-Precise, controlled release into small container with the wrist extended

Risk management

-Process that identifies, evaluates, and takes corrective action against risk and plans, organizes and controls the activities and resources of OT services to decrease actual or potential losses

10-12 months (sitting ) Gross Motor Skill

-Protective extension backwards, (bent/than straight elbow) -Able to move in/out of sitting position into other positions

6-12 months (standing ) Gross Motor Skill

-Pulls into standing position at furniture

Grasp of cube: 6 -7 months

-Radial palmer grasp: fingers are on the far side of the object pressed against the thumb and radial side of the palm. - with the wrist straight

Adhesion Capsulitis (Frozen Shoulder)

-Restrictive passive shoulder ROM (abd, flex, external/internal rotation) involving the glenohumeral ligaments and joint capsule Etiology: inflammation and immobility linked to diabetes and Parkinson's disease Symptoms: shoulder pain (at rest), sleep interruptions, pain w/ ADLs, palpitation reveals nonspecific tenderness at the shoulder. Freezing, frozen, thawing phases. Conservative Interventions: active use of shoulder through ADLs, PROM, modalities Surgical Interventions: arthroscopic surgery, and manipulation Post-operative Interventions: PROM immediately, pain relief: modalities, ADLs

TBI - Medical Management

-Resuscitation -Manage respiratory dysfunction -Cardiovascular monitoring -Surgical, pharmacological, or mechanical means to dec. intracranial pressure -Neurosurgery to manage lacerated vessels and depressed skull fractures -Pharmacological interventions: antibiotics, anticonvulsants, sedatives, antidepressants

Age Related Changes: Sensory System Changes and Adaptions in Older Adults

-Sensory deprivation, isolation, disorientation, confusion, appearance of senility and depression -Strain social interactions and decreased ability to interact socially and with the environment -Decreased functional mobility and increased risk of injury

Nurse, registered (RN)

-Serves as the primary liaison between the individual and physician

Psychological Theories (Aging)

-Stress theory: homeostatic imbalance results in changes in structural and chemical composition -Erikson's bipolar theory of lifespan and development: integrity vs despair

Lower Motor Neurons (LMN)

-Structures: Cell bodies in the anterior horn of the spinal cord -spinal nerves, the cranial nerve fibers that travel to the target muscle -Symptoms of a lesion: -flaccidity, decreased , absent deep tendon reflex (muscle stretching) , muscle atrophy

Burns Classification

-Superficial (1st degree burn) -Superficial partial thickness burn -Deep partial thickness burn -Full thickness burn -Fourth degree burn -Rule of nine

Shoulder: Rotator Cuff muscles

-Supraspinatus, -Infraspinatus, -Teres minor, -Subscapularis

Dynamic tripod grasp

-Thumb index and middle finger hold the pencil (precise opposition of distal phalanges) -wrist slightly extended, MCP joints stabilized during fine localized movements of PIP joints 4.5-6 years

Quality Improvement (QI)

-System-oriented approach that views limitation and problems proactively as opportunities to increase quality -Emphasizes prevention -Problem related to organizational improvement needs -Blame is not attributed to person

Performance assessment and improvement (PAI)

-Systematic method to evaluate appropriateness & quality of services -Interdisciplinary systems focus -Client-centered approach focusing on rights, assessment, care, and education of the person -Emphasizes organizational ethics, improved organizational performance, leadership, and management

Neonatal Period

-Tactile, proprioceptive, and vestibular inputs are critical from birth onward for the eventual development of body scheme -Vestibular system is fully developed at birth, and continues to be refined and impacted on the infants arousal level -Visual system develops, infant responds to human faces and items of high contrast placed approx. 10 inches from face

Prevention of autonomic dysrelexia

-Teach pressure relief principles -Compliance with intermittent catheterization -Well-balance diet habits -Ensure medication compliance -Educate client/caregiver how to use prevention methods; recognize cause, signs, and symptoms (e.g sweating/headaches), and intimate first procedures to deal effectively with the occurrence of the condition

Aging

-The combination of biological, psychological, and social processes that affect people as they grow older -Occurs across the life-span -Evidence of aging: decline in homeostatic efficiency, decline in reaction time -Varies among and within individuals

What is the primary difference between Medicare Part A & B

-The frequency in which the individual receives services. -Inpatient Part A coverage requires services for a minimum of 5 days per week services -Part B typically covers 3 days per week outpatient services

Alzheimer's disease

-The most common form of dementia, in which structural and chemical brain deterioration is associated with gradual loss of many aspects of thought and behavior -Characterized by a decline in memory, thinking, and performance skills in 3 stages -Mild, Moderate, and Severe -Mild: difficulty remembering new information, getting lost, challenges with money management, need for increased time to complete ADLs and routines, mood and personality changes -Mild: increased memory loss and confusion, impulsive behavior, difficulty in completing daily activities, difficulties in problem-solving, bad judgement, person may experience hallucinations, delusions, and paranoia Severe: inability to communicate, total dependence in ADLs, dysphagia (difficulty swallowing) and increased risk of aspiration, and incontinence

Health Maintenance Organization (HMO)

-The most common form of managed care. -Maintains control over services by requiring enrollees to see only doctors within the HMO network and to obtain referrals before seeking specialty or ancillary care

Love and belonging: Maslow

-The need for affection, emotional support, and group affiliation

Self-esteem: Maslow

-The need to believe in ones-self as a competent and valuable member of society

Medicare Part A (Hospital Insurance)

-The part of the Medicare program that pays for inpatient hospital, skilled nursing (SNF), home health, rehabilitation facilities, and hospice -Automatically to all who are covered by SS that meet the Medicare criteria of 65 years or older -Services have a specific time limit and also require deductibles and coinsurance payments

Lawrence Kohlberg: Social contracts (Stages of Moral Development)

-The young adult has social awareness and a awareness of the legal implications of decisions/actions

Ethical Violations

-Therapist have a professional responsibility to maintain the Code of Ethics Standards of their profession and to promote and support these standards amount their colleagues -Members should try and work on remediation good ethical issues at their setting before lodging a formal complaint through AOTA -The ethics commission had jurisdiction over the Code of Ethics Standards applies to people who were or are AOTA members when the behavior occurs

General Seizures

-Tonic-colonic seizures/ grand mal seizure -Myoclonic -akinesia seizures -

Total Hip Replacement / Arthroplasty (THR) (THA): Types

-Total hip joint implant: replaces acetabulum and femoral head -Austin Moore: partial hip replacement (replace femoral head)

Slow pain

-Transmitted over C fibers -Terminates: in the brainstem reticular formation, and excites reticular activation system (RAS) regulates wakefulness and sleep-wake transition -Function: diffuse arousal, affective and emotional aspects of pain -Also terminates in the thalamus with projections to the cortex

Fast pain

-Transmitted: over A delta fibers, -Terminates : in the brain stem reticular formation and thalamus with projections to the cortex -Function: for localization, and discrimination of pain

Total Hip Replacement / Arthroplasty (THR) (THA): Etiology

-Trauma from a fracture -Diseas, most often arthritis; surgery is then elective

Complex Regional Pain Syndrome (CRPS) (stage 1)

-Traumatic stage that typically last for up to 3 months -Symptoms include: extreme pain w/w-out movement, decreased AROM, hypersensitivity to light touch or deep pressure, pitting edema, blotchy-looking skin discoloration, shiny skin appearance, skin temperature fluctuation

0-2 months (prone position) Gross Motor Skills

-Turns head side-to-side -Lifts head and sustains in midline -Able to bare weight on forearms

Cognitive Behavior Therapy (CBT)

-Used for a diversity of clinical populations -Shown to be especially effective in the treatment of depression -Works to alter an individuals negative thoughts about themselves , the world, and the future by correcting misinterpretations of life events -CBT is also used with schizophrenic patients, anxiety, bipolar, panic, obsessive compulsive, personality, somatoform, and eating disorders -Principles Combined principles of cognitive behavior therapy and behavioral therapy> cognitive therapy: looking at a persons thought and beliefs, behavioral therapy: looks at the person's actions and attempts to change maladaptive patterns of behavior. -COGNITIVE RECONSTRUCTING IS KEY TO CBT Didactic acpects: therapist explaining the basic concepts and principles of CBT to the client. -Cognitive techniques: eliciting automatic thoughts, testing automatic thoughts, identify maladaptive underlying assumptions, and testing their validity -Behavioral techniques: used with cognitive techniques to test and challenge maladaptive and innacurate cognition's (identifying the "cognitive triad" patterns of negative thinking -The development of insight is necessary for growth and change (thinking influences behavior, changing the way people think reduces symptoms, thinking can be self regulated)

Age-related macular degeneration (AMD) (Central Vision Loss )

-a condition in which the macula degenerates, gradually causing central vision loss -A disease associated with aging that affects the macula. AMD gradually destroys sharp central vision, making it difficult to read, drive, and recognize faces. There are two forms of AMD: wet and dry. -impaired mobility -reduced ability to perform ADLs and IADLs -decreased ability to recognize faces and perform detailed work ( reading, needle point, and writing) -difficulty with social participation, due to problems with seeing facial expressions and gestures

Dyskinetic: Cerebral Palsy

-basal ganglia lesion -results in fluctuation in muscle tone. -unable to regulate muscle tone, trouble with grasping, posture, drooling, swallowing, and speech Expressions include: -Dystonia: excessive or inadequate muscle tone. -Athetosis: writhing involuntary movements which are more distal than proximal. -Chorea: spasmodic involuntary movements which are more proximal that distal and a lack of cocontractions.

6-9 months (Feeding)

-consumes soft food that resolves in mouth (can hold a cracker and suck on it) -good sitting stability -may grab food from an adults plate -recognizes strangers (developing a sense of self)

Splinting in the rehabilitation stage of burn treatment includes:

-continue anticontracture positioning to prevent contracture formation -Use a dynamic splint or serial casting to reverse disabling or disfiguring contracture formation. For the hands, attend to extensor tendon injury and webspacer contracture management

Proprioceptive processing disorder

-deficits in modulation -discrim deficits demod by poor awareness of position of body, body parts, and body schema -clumsiness, awkwardness -distractibility -motor planning and movt diffs -reliance on visual cues or other cognitive strategies to motor plan, guide movts, and perform tasks -Use of too much or too little force (e.g. stomping when walking, breaking objects unintentionally) -Poor awareness of personal space -Seeks heavy resistance and pressure

Electrical burns: high voltage

-high voltage direct current (DC) usually cause a single muscle contraction and throw its victims from the source -blunt trauma along with the burn -extensive burned areas , including organs, depending on the electrical current path from entry to exit (grounded)

13 months (Household Management Task)

-imitates housework

Stroke/CVA Medical Management

-immediate care -pharmacologic therapies - thrombolytic therapy

Petit mal seizure (absence seizure)

-occurs between the ages of 4-12 -loss of consciousness without loss of muscle tone occurs -rapid blinking and staring into space -the child does not fall, but does not recall the episode or any lapse in time

2 years (Toileting skills)

-urinates regularly

Interventions for occurrence of fall

1. check for injury: hip fracture, head injury, spinal injury cuts bruises, pain and swelling 2. check for dizziness 3. provide reassurance 4. provide first aide 5. DO NOT ATTEMPT TO LIFT THE INDIVIDUAL ALONE, GET HELP 6. solicit witnesses of fall event 7. document the incident 8. refer the individual to a fall prevention intervention program

Palm to finger translation: manipulation skills

2-2.5 years -linear movement of an object to the palm of the hand to the fingers -ex placing a coin in a slot

Creative Play

4-7 years -engages in sensory, motor, cognitive, and social play experiences; refining skills -explores combinations of actions and multiple objects -masters skills that promote performance of school work related activities -participates in cooperative peer groups

Assistive technology transmission method: House wiring

A type of assistive technology transmission method in which desired household appliances are connected EADL with hard wiring in the home

Protective sensation

Ability to accurately perceive sensory input necessary to prevent personal injury or harm (e.g., pain and temperature)

Self-awareness

Ability to identify and perceive personal strength and weaknesses that may influence -motivation to change -Metacognition -recognition of performance errors -desire to modify performance

Rigidity

Abnormal neurogenic movements resulting in reflexive posturing, inflexibility, muscular stiffness or jerky, irregular movements, types include: decorticate decerebrate cog-wheel lead pipe

Least Restrictive Environment

Academic context allowing students with disabilities to receive their education and all academic and related services in the same setting as children who do not have disabilities

PICO Method

Acronym that describes the method used to formulate a clinical or research question P - patient/population I - intervention/indicator C - comparison/control O - outcome

Sensory-seeking behavior

Actions characterized by craving input from a variety of senses and experiences, typically associated with: altered sensory processing ability challenges with regulation of arousal level atypical praxis hyper- or hypo-responsivity

Freedom to Work Act

Amended the Social Security Act to enable Americans receiving retirement Social Security (SS) benefits (currently 65 years old) to be able to work without affecting their SS income (there are no income restrictions in this amendment)

SWOT analysis

An acronym for strengths, weaknesses, opportunities, and threats, the SWOT analysis is a tool that frames the situational analysis. -used in business planning to outline a process for understanding the internal and external environment of an organization or business

Occupational dysfunction

An interruption, often caused by prolonged occupational deprivation -an inability to perform and participate in typical occupations

Activity Configuration: Activity analysis

Analysis of "the typical demands of an activity, the range of skills involved in its performance, and the various cultural meanings that might be ascribed to it" -A component of activity analysis in which all parts of an activity are considered by the practitioner

Body mechanics

Application of mechanical laws to the human body, specifically in regard to structure, function, and position of the body Use of kinesiology to promote proper alignment, position, and efficient use of the body during physical task activities, principles include: -plan movements -load close to body and bend knees when lifting -ensure solid base of support and use inertia when appropriate

Principle 7 of Universal Design Size and space for approach and use

Appropriate size and space is provided for approach, reach, manipulation, and use regardless of the users body size, posture, or mobility

Light meter

Assessment tool used for measuring ambient and natural lighting levels in context to determine areas of poor illumination that may hinder optimal occupational performance

Stage 2: Parkinson's Disease (Hohn and Yahr's 5 stage scale)

Bilateral tremors, rigidity, or akinesia -with or without axial signs, independent with ADLs and no balance impairments

Theories of Aging

Biological Theories Environmental Theories Psychological theories Sociological Theories

Sensorimotor Period ( Hierarchical development of cognition)

Birth- 2 years The child continues to progress through relative activity to mental representation, to cognitive functions of combining and manipulating objects in play

Anatomy of the Forearm and UE

Bones: radius, ulna, humerus Muscles: deltoid, triceps, anconeus, biceps brachial, brachialis, and brachioradialis Blood supply: multiple arteries such as brachial and brachiocephalic arteries

Early Mobilization Program for Extensor Tendons Zone III and IV

Boutonniere Deformity 0-4wks: PIP extension splint (DIP free) AROM of DIP while in splint 4-6wks: begin AROM of DIP and flexion and flexion of digits to the DPC

Progressive-part learning

Breaking learning task into a series of short sections -a technique for teaching skills in which the therapist breaks down a task into several steps and teaches each step individually to the client

Benign Paroxysmal Positional Vertigo (BPPV)

Brief episodes of vertigo (< 1 min.) assoc. w/position change; result of degen. of the utricular otoconia -common in older adults

Performance characteristic of thermoplastic material: Rigidity

Capacity of thermoplastic material to maintain its strength and to prevent a change in the integrity of the custom fit against force and repetitive stress, material effective to stabilize a large joint.

Anticontracture position: Anterior elbow burn

Characteristics of this anticontracture position includes: elbow joint in 5-10 degrees of flexion use of a wrist extension orthosis to prevent flexion

Social demands

Challenges and pressures present in an interactive context, that may influence task performance

Decorticate rigidity

Characteristic abnormal reflexive posturing secondary to a severe brain injury, typically in patients with a score of three on the motor section of the Glasgow coma scale, includes: flexion of the elbows across the chest adduction and flexion of the wrists flexion of the fingers extension and internal rotation of the legs plantar flexion of the feet

Anticontracture position: Burn on the dorsum of the wrist

Characteristics of this anticontracture position includes: wrist joint in neutral use of immobilization orthosis to prevent wrist extension

selection set

Choices that are available on an assistive technology device that a user may select from Types include: direct: user selects a target and controls the device as a one-step process indirect: user must complete more than one step to control the device

Restriction orthosis

Classification of an orthosis intended to limit partial mobility of one or more joints while allowing free movement through the remaining arc of motion, typically used to: allow controlled motion decrease risk of scar adhesions minimize risk of contracture improve functional use •Limit motion after *nerve* injury or repair •Limit motion after *tendon* injury or repair •Limit motion after *bone-ligament* injury or repair •Provide and improve *joint stability and alignment* •Assist in *functional use* of the hand

Personal Context

Conditions within the individual that uniquely influence occupational performance including: -stable factors (e.g age, long standing belief structure -dynamic factors (e.g pain, mood, and fatigue

Compression garment

Custom-fit garments used in a burn rehabilitation program to prevent and reduce hypertrophic scars by providing pressure over the affected area

Depressionalization Disorder

DSM-5 classification of dissociative disorders characterized by: retreating into a dreamy world without unrealistic feelings. Impaired self-awareness, disconnecting from the physical being

Somatosensory: Sensory System Changes and Adaptions in Older Adults

Decreased sensitivity of touch associated with decline of peripheral receptors, atrophy of afferent fibers: lower extremities more affected than upper

Trunk support ring

Device used in the bathtub to provide external stability of the torso for children seated upright during bathing, typically used in the presence of mild hypotonicity

System factor affecting wound healing

Diabetes, nutrition deficiency: vitamin a, C, and E zinc and copper, atherosclerosis, HIV, AIDS , medication, aging, radiation therapy

Distractibility

Disruption in the cognitive process of attention that manifests itself with inability to maintain focus on desired performance due to distractions caused by external stimuli

Activity tolerance

Duration of time a client can physically and mentally perform an activity before needing a rest break

Total Hip Replacement / Arthroplasty (THR) (THA): OT Interventions Hip Precautions; (Antereolateral)

Educate on Hip Precautions -Do not externally rotate -Do not extend hip -Precautions may vary -Instruct in using long handled equipment -Provide transfer training (tub bench, raised toilet seat, car transfer, bed and chair transfers) -Practice occupation-based activities, using proper weight-bearing status, and functional mobility device.

Work simulator

Electromechanical isotonic and isometric strengthening device used for work evaluation and intervention to improve upper extremity functional abilities [e.g., Baltimore Therapeutic Equipment (BTE™)]

Functional Electrical Stimulation

Electrotherapy to: -maintain muscle mass, gain ROM, facilitate voluntary movement, manage spasticity, Recommended for use as an adjunct to other occupational-based interventions

Activity pacing

Energy conservation technique that includes: integrating regular rest breaks into daily activities establishing daily habits and routines maintaining adequate sleep hygiene

Exercise tolerance

Energy expenditure beyond current capacity -chest pain -excessive fatigue -SOB and/or dizziness

Etiology & Symptoms; Sensory Processing Disorder

Etiology: unknown (impaired processing and sensory information and modulation of multisensory system) - Ayre's Sensory Integration and Dunn's model -2 types of neurological thresholds: High vs Low -High threshold: failure to register or respond to routine environmental sensation/ or sensation must be experience over a prolonged time period to elicit behavior -Low threshold: the minimal stimulus facilitates a behavioral response Behavioral responses -Passive: patient makes no effort to change the intensity or duration of the sensory input -Active: patient avoids or seeks to avoid sensory stimuli Neurological Threshold: A behavioral responses combined to to form 4 categories

Test-taker variables

Factors that may impact the performance results of a client during the evaluation process -(i.e. Motivation, energy level, and stress level)

Muscle grade 3 (+)

Fair (+) full ROM against gravity and slight resistance -antigravity position

Muscle grade 3 (-)

Fair (-): incomplete ROM against gravity -antigravity position

Digital-pronate grasp: Pre-writing skills

Finger used to hold pencil -wrist neutral/ slight ulnar deviation, forearm pronates -arms move as a unit 2-3 years

Normal ROM for the elbow and forearm

Flex: 0 to 135-150 Supination: 0 to 80-90 Pronation 0 to 80-90

Activity Health Assessment Assessment of Occupational Performance/Occupational Roles

Focus: time usage, pattern and configuration of activities, roles, and underlying skills and habits Methods: The person completes an Idiosyncratic activity configuration schedule by constructing a color-coded chart which depicts the way the way his/her time is spent during a typical week Population: adults through elder

Dorsal Displacement vs Volar Displacement Fractures

Fractures are either displaced or nondisplaced. A fracture with an offset of 2 mm or more in any plane or 2 mm offset involving the articular surface is considered displaced Dorsal Displacement: Examples -A Colles' Fracture -Dorsal-type Barton's is a fracture-dislocation of the dorsal rim of the radius Volar (palmar) Displacement: -Smith's Fracture -Volar-type Barton's is a fracture-dislocation of the volar rim of the radius

Oral motor dysfunction

Functional impairment of the musculature of lips, jaw, tongue, and cheeks, typically associated with neuromuscular or developmental conditions, resulting in difficulties with: eating blowing/sucking speaking

Erik Erikson: stage 7

Generativity vs Stagnation (40s, 50s) -the adult finds security in the contribution in their chosen personal/professional roles -the capacity to care is achieved Middle adulthood

Incremental gradation of occupation

Gradual increase or decrease in activity and/or environmental demands to optimize a client's performance, typically started from where the client will be successful

Handling characteristic of thermoplastic material: Memory

How material retains its original properties when reheated, recommended when frequent re-molding may be necessary

Lack of initiation/participation

ID reasons for lack of participation Motivational hints-more likely to engage in things of interest, more ownership leads to increased participation, success is motivating, fun is motivating, positive feedback, curiosity can be used to motivate, food is motivating, offer choices, encourage participant to remain in group and participate when/if ready

Resource teacher

IEP team member who provides academic support to the student -provides recommendations to the team regarding inclusion capacity, learning and/or behavioral strategies, and student-focused curriculum-based needs

Group norms

Implicit and explicit rules that govern accepted behaviors and processes in a group Can be established by the group leader or by the members themselves

Basic task skills groups

Includes intervention activities designed to develop the basic cognitive skills necessary for the completion of simple tasks (not the same as a task-oriented group--focuses on the skill not the dynamic)

Short term goal

Includes the incremental sub-steps of an expected outcome

Support group

Individuals with a common challenge who gather or communicate with each other to provide support, guidance, and/or comfort to one another

Erik Erikson: stage 4

Industry vs. inferiority (6-puberty) -a sense of security through peers -mastery of activities of child's age group -a feeling of competency is integrated into the personality Elementary school age

Wound healing: Inflammatory phase

Initial stage of wound healing that includes: clot formation blood vessel dilation allowing neutrophils and monocytes to initiate debridement and attack bacteria changes in skin color, temperature, pain, swelling and function

Mental practice / motor imagery

Intervention approach used in rehabilitation where the client creates a mental image of a desired movement and imagines performing the motion without actually moving the body part

Releasing skills: 1-4 months

Involuntary release

Dyskinesia

Involuntary, non-repetitive movement disorder affecting distal, and axial musculature in varying combinations (mostly representative of basal ganglia disorders)

Transition planning for students with an (IEP)

Legal requirement for students enrolled in special education, includes collaboration among student, and relevant others involved in supporting the student to meet post-high school goals, may include: recommendations for post school environment establishment of goals for attaining a life skill services options for supporting the students in adult life

explicit memory (declarative/ conscious)

Long Term Memory: memory of facts and experiences that one can consciously know and "declare" -Purposeful retrieval of experiences and factual information about everyday life events: Types -Episodic (events, experiences) -Sematic (facts, concepts)

Shoulder disarticulation

Loss of entire UE

Mobile arm support

Low tech adaptive typically attached to a wheelchair frame or floor stand device that supports the weight of the arm and has swivel components, used to provide assistance to weak muscles of the arm during a functional activity

Carpal Tunnel Syndrome (CTS)

Low median nerve entrapment/compression involving the palm of the hand, wrist, and the fingers, especially the thumb, index and middle (radial half) of fingers Causes: 9 extrinsic flexor tendons • (FDS) superficialis (4) flex pip joint • (FDP) profundus (4) flex dip joint & digits 2 & 3 • (FPL) pollicis longus (1) flex ip joint of the thumb •Concave arch of carpal bones •Volar roof formed by transverse carpal ligament Seen more often in woman between 40 to 60 yrs. In age Etiology: Swelling of the lining of the flexor tendons, called tenosynovitis, Joint dislocations, Diabetes, Fluid retention (pregnancy or menopause, High blood pressure, Rheumatoid arthritis, Fractures, Repetitive maneuvers, Obesity, Hypothyroidism, Trauma, Dupuytren's disease (repetition, awkward posture, vibration, anatomical anomalies, and pregnancy) Symptoms: Symptoms are often bilateral, Nocturnal Pain, Dysesthesias Diminished fine motor coordination Numbness, Tingling, , Weak grip/pinch strength, Clumsiness, dropping objects, muscle atrophyThenar weakness Mild: less than 1 yr. Night pain Moderate: 1 yr. Night pain/tingling Severe: Longer than 1yr. Night & Day pain Treatment: Positive Phalen's Test/Wrist Flex Test, Positibe Tinel's signs, Lifestyle modifications , Oral Meds, Corticosteroid Injection, Splinting (six to eight weeks/ pre-surgery) Surgery: open carpal tunnel release surgery, the transverse carpal ligament (flexor retinaculum) is cut, releasing the median nerve. Size/shape of the incision may vary Splinting: Wrist Cock-Up splint/ Neutral Wrist Splint 10 days: 48hr following suture removal, scar mobilization (massage w/ lotion) AROM and PROM Manual desensitization exercises 3wks: Gentle stretching, (ball/putty) 3-4X per day for 5min 4-6wks: Progressive strengthening hand exercises 1-3 lbs 6wks: Return to work Avoid repetitive use, high vibrations, encompass ergonomically designed hand tools

Early Mobilization Program for Extensor Tendons Zone I and II

Mallet Finger Deformity 0-6wks: DIP extension splint

Rancho Level IV

Max Assist; confused and agitated (safety and deficit awareness are major issues) purposeful attempts to remove restraints or tubes or crawls out of bed, absent short-term memory, may exhibit aggressive or flight behavior,unable to cooperate with therapy,

Leisure groups

May include the identification of interests, development of activity specific skills, identification of resources, and recognition of the importance of healthy use of unstructured time for personal well-being

Survey Instrument

Non-experimental instruments designed to measure specific characteristics -open vs closed questions -systematic differential: a point scale -librations scale: levels of agreement (usual on a 5 point scale) -multiple choice: selecting the item most reflective of participants opinion -incomplete sentences: used to fond out opinions, attitudes, personality traits, and styles of behavior Advantages: obtain a large number of participants, measure numerous variables, use data obtained in multiple ways Disadvantages: limited/poor response rate, inaccurately completed data

Motor response (GCS)

Obeys (6) Localizes (5) Withdraws (4) Flexion (3) Extension (2) None (1)

Performance Assessment of Self-Care Skills (PASS)

Observation-based rating scale used to measure assistance needed in daily living skills -contains clinic and home version -criterion-referenced -examiner rates independence, safety, and adequacy

Transition target

Occupation-based service outcomes and goals used as part of the IEP to assist a student transition from high school to adult life Focus may include: -academic achievement -employment integration -community integration -independent living

Asymmetric tonic relex

Onset: 37 was Integration: 4-6 mths Stimulus: rotate infants head and hold for 5 seconds Response: extension of extremities on the face side, flexion of extremities on the skull side Relevance: promotes visual hand regard

Tonic Labyrinthine Reflex (Prone)

Onset: 37 wks Integration: 6 mths Stimulus: Place infant in prone Response: increased flexor tone Relevance: Facilitates total body flexor tone

Quadruped tilting reflex

Onset: 9-12 mths Integration: Persists Stimulus: Position infant on all fours and slowly raise one side of the supporting surface Response: Curving of the spine towards the raised side (opposite the pull of gravity) Abduction/extension of the arms and legs Relevance: Maintains equilibrium without arm support ; facilitates postural adjustments in all positions

Alternative and augmentative communication (AAC): Pointing device

Physical input device used to point at the desired location on a standard graphic keyboard, beneficial for persons with decreased manual dexterity.

12- 15 months (early object use)

Placing a baby in a carriage and then pushing the carriage Child links schemes in simple combinations

Muscle grade 2 (+) (test movement)

Poor (+) complete ROM in gravity-minimized plane -antigravity position

Muscle grade 2 (-) (test movement)

Poor (-) able to initiate movement in gravity-minimized plane

Somatodyspraxia

Poor ability to conceptualize, plan, and execute motor actions associated with signs of poor perception of touch and body position

Community Resources

Public and private services available in a client's community aimed to: enable participation in meaningful occupations provide ongoing social support provide outreach based on needs

Non-standardized sensory screening: Touch Awareness

Procedure includes swiping a fingertip with a cotton ball, pencil eraser or other small object Client responds with a "Yes" or "No"

Non-standardized sensory screening

Process used to obtain a general understanding of a client's ability to perceive sensory input, includes screening for: Touch awareness Pain awareness Temperature awareness Proprioception Kinesthesia Lacks inherent reliability and validity

Professional Certification

Process where the individual demonstrates the knowledge required to perform specific job-related tasks identified as delineated through the outcomes of a practice analysis study

6-9 months (early object use)

Pulling turning poking tearing Child explores characteristics of objects an expands the range of the scheme

Beery-Buktenica Developmental Test of Visual Motor Integration (Visual Motor and Visual Perception Assessment)

Purpose: Assessment of visual motor/visual perception (classroom screening tool) Method: Child copies 24 geometric forms that are sequenced according to difficulty until 3 fails (than discontinue) Scoring: Average scores between 80-120; average percentile 25-75 based on percentile rank and age equivalency Population: 2 years to 100 yrs

Liar that scale

Question as on a survey that includes response options that progress in linear direction (i.e never, to sometimes, to always

Assistive technology transmission method

Refers to the signal communication between a piece of assistive technology (EADL) and an household appliance Options include: radio frequency wireless technology infrared frequency house wiring ultrasound

Clinical reasoning

Reflective and cognitive process whereby the practitioner integrates information from all aspects of care and interactions to problem solve and understand application of best practice

Case study research

Research that includes a qualitative analysis of a individual or group -collecting data without manipulation of an independent variable -commonly used to analyze the effects of new interventions -may include: observation, interviews, and records

Rancho level IX

SBA on request; purposeful and appropriate actions (shifts btwn tasks for 2 hours; assist to adjust to life demands, emotional and behavioral issues possible) Independently shifts back ad fourth between task and completes them accurately for at least two consecutive hours, may have low frustration tolerance, and able to self monitor appropriateness of social interaction with SBA

Metacognition

Self-awareness of one's own cognitive performance ability and capacities and the need for strategy use Frequently impaired in clients with executive dysfunction

Metacognitive Strategies

Self-management method that includes the ability to identify cognitive challenges during day-to-day activities and to create strategies that can be duplicated over time

Two-point discrimination test

Sensory screening test involves applying pressure to the fingertips with client vision occluded, typically using a commercially available disk or caliper with two tips spaced from 1-10 millimeter intervals, responses to pressure indicate functional sensation as follows: 1-5 mm = Normal 6-10 mm = Fair 11-15 mm = Poor One point perceived = Protective sensation only No points perceived = Absent protective sensation

Tendon gliding exercises

Series of hand exercises intended to prevent tendon adhesion and preserve tendon excursion, includes the following: straight fist: Composite MCP and IP joint extension -hook fist: MCP joint extension with IP joint flexion -intrinsic-plus: MCP joint flexion with IP joint extension -straight IPs: MCP and PIP joint flexion with DIP joint extension -full fist: Composite MCP and IP joint flexion

Prosthetist

Specialize in evaluation, fabrication, and custom fitting of artificial limbs

Eye opening (GCS)

Spontaneous (4) Responds to voice (3) Responds to pain (2) none (1)

Scope of practice

Standards published by AOTA that describes -domains of practice, evaluation and intervention process -educational requirements for the OTR and OTA -supports state laws and regulations governing the practice of occupational therapy

Organizational procedure

Step-by-step performance, expectations, and actions that need to occur in order to abide by polices outlined for a workplace

Stress management

Strategies to promote relaxation and reduce symptoms of stress and anxiety, techniques include: - deep breathing - muscular relaxation - visualization

Anchoring technique

Strategy used in visual scanning training where a visual cue (e.g., a solid line or a bright colored, thin strip) is placed in the impaired field of view and the client is encouraged to scan to the visual cue

CVA : Anterior Cerebral Artery (ACA)

Stroke results in contralateral hemiplegia, grasp, reflex, incontinence, confusion, apathy, and/or mutism

Advisor style: Group leadership style:

Style of group leadership used with group members who are functioning at a high cognitive level Features include: - occur in community (health & wellness groups) -members are responsible for the functioning of the group -leader offers guidance and direction as needed

Facillitative Style: Group leadership style:

Style of group leadership used with group members who are functioning at a higher cognitive level Feature include: -group leader acts as an educator and resource -group members contribute to group decision-making process under the guidance of the leader

Job Analysis

Systematic evaluation of cognitive, psychological, physical, and social aspects of job demands to -facilitate client return to work -match a rehabilitation worker to a job -identify musculoskeletal risk factors

Desensitization

Systematic intervention for decreasing hyper-responsiveness to aversive stimuli, may be used in -mental health interventions for anxiety disorders -hand therapy for nerve hypersensitivity

Right-Left Discrimination

The ability to differentiate one side of the body from the other -impairments may cause: decreased ability to follow directions, and difficulty with spatial relation (inability to accurately use the concepts of right and left)

Rancho Level III

Total Assist; localized response -withdrawal or vocalization to painful stimuli, blinks when strong light crosses visual field, responds to discomfort by pulling tubes or restraint, may responds to some persons (especially family or friends)

Convection

Transfer of energy from a circulating source in contact with a body part, examples include: Fluidotherapy whirlpool

Elbow Extension: innervated by radial nerve

Triceps elbow extension origin: infraglenoid tuberosity, posterior humerus, distal to lateral head insertion: olecranon

Grab bar

Type of durable medical equipment designed to mount to a bathroom wall or to be secured to the side of the bathtub, used to provide a safe, stable surface to hold onto during BADL in the bathroom

Transfer tub bench

Type of durable medical equipment that is portable and designed to be positioned in a standard bathtub to increase safety and independence for getting in and out of the tub, optional features include: adjustable legs padded seat cut-out seat back and armrest suction feet drainage holes

Three-in-one commode

Type of durable medical equipment that is portable and designed to increase safety and independence, designed to be used as a/an: -bedside commode -shower seat -elevated toilet seat

Principle 3 of Universal Design Simple and Intuitive use:

Use of the design is easy to understand, regardless of the users experience, knowledge, language skills, or current concentration level

Elastic force

Used as part of a mobilization orthosis to influence tissue response Common devices used for this purpose include: -rubber bands -wrapped elastic cord -spring coils

Orthotic fabrication

Used as prescribed by the physician for safe splinting and functional splinting. Material should be chosen to fit the client and the condition Thermoplastic and casting orthotics are commonly used to provide support for healing structures

Random practice

Varied sequencing of different motor skills in the same training session -method of learning that involve learning skills associated with a task in a varied order

First Trimester of pregnancy

Vision: eyelids are fused Taste: taste buds develop Movement: sucking, hiccups, fetal breathing, quick limb movement, positional changes, 7 1/2 weeks: bends neck and trunk from perioral stroke

Sports wheelchair

Wheeled mobility device specifically designed to enhance maneuverability and speed during athletic and leisure activities, features may include: -light-weight frame -specially designed wheels -all-terrain options -overall stability

Floor Effect

When an assessment instrument is not able to measure any additional performance differences at the bottom of the rating scale

Ceiling effect

When an assessment instrument is not able to measure any additional performance differences at the top of the rating scale

Construct validity

When an assessment tool measures specific contracts (e.g. fine motor skills) consistent to hat it claims to measures

Seat height (+2 inches)

_Measure from the popliteal space to the bottom of the client's heel. -Footrests should have a 2-inch clearance from the floor. -Knees and ankles should be positioned at 90 degrees; measure from the distal thigh to heel -Footrests should have 2" clearance from the floor, so cushion selected will affect this measurement -Standard height: 19.5" -Hemi-height: 17.5" -Super-low: 14.5"

Purposive sampling

a biased sampling technique in which only certain kinds of people are included in a sample -individuals are purposely and deliberately selected for a study (e.g. all consumers of a program for a QI study)

Psychiatrist

a physician who can diagnose and treat mental health and psychiatric disorders

Utilization review

a plan to review the use of resources within a facility to determine medical necessity and cost efficiency.

Cognitive Behavioral Therapy (CBT)

a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior) -Intervention with basic tenet that a change in thinking or in assumption will result in a change in behavior Commonly used with client who have: anxiety, substance abuse, and mood disorder

edema management

a. Elevation of extremities b. AROM exercises, if movement is allowed c. Wrapping with elastic bandage, unless bulky wound dressing is used

Tachicardia

abnormally rapid heart rate or resting heart rate >100bpm

Mobile arm support

allows for use of UE with proximal weakness to engage in feeding and other activities

Knee disarticulation

amputation at the knee joint

Below elbow (BE) "long or short"

amputation below the elbow at any level of the forearm

Below Knee Amputation (BKA) transtibial

amputation below the knee at the level of the calf. (most common)

Wrist disarticulation

amputation distal to the wrist joint. Loss of entire hand

Above Knee Amputation (AKA)

amputation of a leg above the knee at the level of the thigh

Binge eating disorder

an eating disorder in which people overeat compulsively -excessive intake and weight gain, with maladaptive coping mechanism to deal with stress, anxiety, or depression

Test of significance

an estimation of true differences, not due to chance; a rejection of the null hypothesis • alpha level: pre-selected level of statistical significance (most commonly 0.05 or 0.01: indicates that the expected difference is due to chance, e.g. at 0.05, only 5 times out of every 100 or a 5% chance, often expressed as a value of P

Goal Attainment Scaling (GAS)

an evaluation tool that attains clients' goals for intervention and measures goal attainment and intervention outcomes after a specified time period

Retrospective review

audits of medical records after intervention were rendered -method to ensure appropriate care was given

Power card

autism spectrum disorder intervention for social skills -having the client list the steps of a desired behavior on a card with pictures that shows the clients special interest or hero

Emotion charades

autism spectrum disorder intervention for social skills -having the client role-play an emotional expression and asking the client to identify the emotion

Video detective

autism spectrum disorder intervention for social skills -presenting a mute video clip to the client, who must identify and interpret the emotions expressed through nonverbal behavior

36-42 months (early object use)

child links schemes in to a complex script

Errorless learning

cognitive intervention method in which the task or activity is set up so that the client does not make an error, may be useful -for clients with severe memory impairments -during skill training ensures success, early immediate prompts, prompts faded over time, decreases frustration/increases motivation

Augmentative and Alternative Communication (AAC)

communication strategies and devices used to supplement or replace speech Needs to consider: -speed at which message is conveyed -portability: ease to use in a variety of environments -accessibility: ability to independently use -dependability: quality, durability, and warranty/ service record

Blocked practice

consistent practice/ repeated performance of same motor skill -method of learning that involves practicing the same skill or task over and over

Types of wheelchair features available

control mechanism: brakes and anti-tippers propulsion methods: one arm drive, use of hand rim projections, motorized, use of lower extremities to propel personalized features: lap-trays, backpacks, medical equipment, hard tires

Sensory-Based Motor Disorder

deficits in proprioceptive/vestibular systems, dyspraxia, postural disorders/low muscle tone impacting on stability

adjustment to death & dying

denial, anger, bargaining, depression, acceptance -denial: refuse to accept or address reality of illness -anger: agree as person accepts the reality of impending death -bargaining: in an attempt to gain control -depression: begins to identify feelings of loss and become depressed -acceptance: recognition of impending death he/she begins to make plan and think about the future for self and family

Sports wheelchair

designed for racing, cycling, basketball and other competitive sport: -typically ULTRALIGHT

dysphonia

difficulty producing speech sounds, usually due to hoarseness

isometric exercise

exercise in which muscle tension occurs without a significant change in muscle length -muscle or muscle group and the joint angle do not move when the muscle(s) acting on the joint are contracted

Manual Ability Classification System (MACS)

for children with CP which describes 5 levels of manual ability/ gross motor performance in everyday functional task.

Carpal fracture

fractures to individual carpal bones -the most common is a scaphoid fracture -lunate fractures are associated with Keinbock disease

Stage 3 pressure ulcer

full thickness tissue loss with visible fat -open wound that looks like a crater -wound extends into the fat layer but not to the tendon, muscle, or bone

Record review

gathering relevant information to support a safe and effective therapeutic process -Example: medical charts, lab reports, prior therapy notes, reports from interprofessional members

Atherosclerosis

hardening of the arteries, and thickening of the internal layer of blood vessel wall from accumulation of lipids (fats), platelets, plaques and other debris. -Prognosis: good with early detection and treatment -Non-modifiable risk factors: age, sex, race, family history -Modifiable risk factors: smoking, high BP, high cholesterol levels, and (LDL) lipoproteins, stress -Contributing factors: diabetes, obesity, sedentary lifesyle etc. 2 or more risk factors increase CAD

Swan neck deformity

hyperextension of PIP joint and flexion of DIP joint Injury or the MCP, PIP, or DIPJ characterized by PIP hyperextension and DIP flexion; the PIPJ is splinted in slight flexion

Prevocational groups

identification of personal skills, limitations, and interests and the development of work habits and behaviors

Pharyngeal phase of swallowing

involves: -soft palate elevation -larynx and hyoid elevation and protration -cessation of airflow to prevent aspiration -vocal cord closure when whole bolus is moved through the pharynx phase in which the involuntary swallowing reflux begins and the bolus is carried through the pharynx to the top of the esophagus; the entrance to the trachea (larynx) closes; and the soft palate lifts and closes off the entrance to the nose

Oral phase of swallowing

involves: -using cheek and tongue muscles to retain bolus centrally -posterior migration of bolus Compression of bolus against hard palate. Tongue retracts, forcing bolus into pharynx & helping to elevate soft palate so bolus does not enter nasopharynx. Oral phase is only phase of swallowing that can be consciously controlled.

Personal transportation

means of moving about in the community using either one's own bodily capacity or vehicular or nonvehicular transportation technology -Private automobile -Other motorized or non motorized vehicles (golf cart, bike, scooter, skateboard) -Walking and other non vehicular travel (running, skiing skating

Nominal scale

measurement in which numbers are assigned to objects or classes of objects solely for the purpose of identification Ex. Numbers are assigned to runners (7, 8, 3, 5, 9 finish line

Lumbricals (radial side)

median nerve, MCP flexion and extension of the IP joints origin: tendons of the flexor digitorm profundus , index and middle fingers (radial and palmar sides) insertion: radial side of digits II and III into extensor expansion

Spina bifida cystica

more severe type of spina bifida that involves protrusion of the meninges, spinal cord, or both -meningocele: protrusion of the sac through the spine, contain cerebral spinal fluid and meninges; however does not include the spinal cord -symptoms: does not appear with symptoms impacting on function as the spinal cord itself is not entrapped -myelomeningocele: protrusion of a sac through the spine containing cerebral spinal fluid and meninges as well as the spinal cord or nerve roots -symptoms: sensory and motor deficits occurring below the level of the lesion and/or LE paralysis and/or deformities, incontinence, ulcer, deep vain thrombosis -most commonly located in the lumbar region, but can occur at any point in the spine -lesions of S2-S4 result in bladder and bowel problems : sensation to urinate, urinary sphincter problems, incomplete emptying of the bladder, constipation

Spina bifida occulta

most common and least severe form of spina bifida without protrusion of the spinal cord or meninges -a bony malformation with separation of the vertebral arches of one or more vertebrae with no external manifestations; may not be discovered until late childhood Occult spinal dysraphism: a fatty benign tumor, or dimple covering the site are present Symptoms: (diplomyelia) may result in the spinal cord being split, tied down and tethered leading to neurological damage and developmental abnormalities

OTA

occupational therapy assistant -no formalized OT education -may provide non-skilled support to the OTR and therapy process -under the direction and close supervision of the OTR and OTA practitioner

Stage 2 pressure ulcer

partial thickness skin loss involving epidermis, dermis, or both -exposed dermis, open wound that looks like a scrape, blister, tear -client reports pain and tenderness, warm to touch, and localized edema

Types of Child Abuse

physical, sexual, emotional, neglect

Arousal

physiological state of being engaged with the environment and responsive to sensory stimuli -is a requisite for being alert and attentive

Encoding (1st stage of memory)

processing of information into the memory system -Brain structures: language area's (Broca's and Wernikicke's area , frontal lobe, visual system Stages of memory including: encoding, storage, retrieval

Peripheral or ambient visual system

provides background information about one's position in relation to the environment and is quick to detect motion

Handling

providing physical support and cueing to manually guide the torso or limb into functional movements patterns support is graded on based on the amount of assistance the client needs

Cranial nerves XI, XII

pure motor innervating sternocleidomastoid, trapezius, and tongue

Subscapularis

scapular nerve, internal rotation origin: anterior surface of scapula insertion: lesser tuberosity

Systematic sampling

selected from a population list by taking individuals at specified intervals (e.g every 100th person)

Cognitive flexibility

the ability to switch focus as needed to complete a task -Component of executive functioning: the ability to think about various ideas simultaneously and switch between different ideas

Muscle tone

the state of balanced muscle tension that makes normal posture, coordination, and movement possible -amount of tension in a muscle while at rest

Confabulation

the unintended false recollection of episodic memories -Memory impairment that causes people to share false details of situations, memories of past events, or personal information without the intention to deceive

Suicidal Ideation

thinking about suicide, usually with some serious emotional and intellectual or cognitive overtones -Thought process associated with the act of suicide, often associated with depression, anxiety, and mood disorder -feeling of helplessness and isolation -low self-esteem and psychological distress

Dorsal interossei

ulnar nerve, adbuction , MCP flexion and extention of IPJ of of digits II through V origin: Bipennate from inner aspects of shafts of all metacarpals insertion: Proximal phalanges and dorsal extensor expansion on radial side of index and middle fingers and ulnar side of middle and ring finger

Palmar interossei,

ulnar nerve, adduction, MCP flexion and extension of IPJ of digits II through V origin: 1st palmar, ulnar surface of 2nd metacarpals 2nd palmar: radial surface of 4th metacarpal 3rd surface: radial surface of 5th metacarpal insertion: Bases of proximal phalanges, extensor expansions

test of significance

A statistical technique intended to provide researchers with confidence that their results are, in fact, true and not the result of sampling error. -compare two group means and identify a difference at a selected probability level (e.g .05)

Psychodynamic/Psychoanalytic: Evaluation

Appropriate individuals for therapy are non-psychotic with mild to moderate psychopathology, well integrated egos, and the capacity for introspection and insight Interventions -projective and functional task are used to promote self-awareness and the identification and exploration of intra- psychic content -by bringing unconscious conflict to consciousness intrapsychic content can lead to intra-psychic conflict resolution

Complete phalanges amputation

amputation of toes

Scanning training

Intervention for visual field deficits to structure a visual search and increase awareness of blind spots, may include: progression of clinic activities to contextual task performance visual anchoring change in head and body position

Principle 1 of Universal Design Equitable Use:

: the design is useful and marketable to people with diverse liabilities

Hypo-responsiveness

A form of sensory modulation in which the central nervous system is slow to register or process sensory input Behavioral characteristics include but are not limited to lack of response to: socially-relevant signals painful stimuli alarms and flashing lights

Universal Design Learning (UDL)

A framework that guides the design of educational curriculum and environments to support optimal academic outcome for all students in the classroom

Reliability

When an assessment tool produces consistent results when the same client is retested on separate occasions while external factors remain the same

Finger amputation

amputation of digits at any level

-Brachialis,

musculocutaneous nerve, elbow flexion, and forearm pronator origin: distal 2/3rd of humerus insertion: ulnar tuberosity

3 1/2- 5 years ( Jumping and Hoping) Gross Motor Skills

-Hops on one foot

Autonomy and Confidentiality

"Respect the right of the individual to self determination" -respect the rights of the client to refuse to participate in OT services -safeguarding the privacy of clients by complying with HIPPA regulations

Procedural Justice

"Therapist shall comply with institutional rules, local, state, federal, and international laws and AOTA documents applicable to the profession -learn about laws and regulations that have an impact on the provision of OT services -follow reimbursement guidelines for different payer sources

Veracity

"Therapist shall provide comprehensive, accurate, and objective information when representing the profession" -ensuring that documentation is accurate and truthful -avoiding plagiarism of others work

Fidelity

"Therapist shall treat colleagues and other professionals with respect, fairness, desertion, and integrity -treating co-workers, clients, and other health care workers respectfully, such as by not divulging personal information to others

Social Justice

"Therapist will provide services in a fair and equitable manner" -assist at a health fair to promote the health of members in the facility or community -treating clients fairly no matter what their gender, age, ethnicity, or marital status

Three to seven years (3-7 years)

- Child is driven to challenge his/her sensorimotor competencies through roughhouse play, playground activities, games, sports, music, dancing, arts and crafts, household chores, and school tasks -These activities provide the child with opportunities to promote social development and self-esteem

Volar surface of hand (Burns)

- Wrist in 0-30 degrees extension -MCP joints in neutral to slight extension and abducted (monitor collateral ligaments -IP joints in full extension -Thumb abducted and extended

7 months (creeping) Gross Motor Skill

-Crawls forward on belly

Early Mobilization Program for Extensor Tendons Zone V, VI and VII

0-2wks volar wrist splints with wrist in 20*-30* of extension, MCP's in 0*-10* of flexion and IPj in full extension 2-3 wks: shorten splints to allow flexion and extension of IPj 4wks: remove splints to begin MCP active flexion and extension 5wks: begin active wrist ROM. Wear splint in between exercise sessions 6wks: discharge splint

Wheelchair pathways and walkways , and ramps

1. 48'" wide 2. 36" wide with non-skid surface on upper and lower level 3. ratio of slope to rise is 1:12 (1" of vertical rise needs 12" of ramp 4. railing should be between 29" to 36" high 32" (average) 5. 4 x 4 landing are required for excessively long ramps 6. 90-degree sharp turns require 4 x 4 landings, 7. 180-degree turns require 4 x 8 landings

Osteogenesis Imperfecta (Medical Management)

1. Care of broken bones 2. Dental acre of brittle teeth 3. Medication for pain 4. Surgery -fix/prevent bone malformations -"Rodding" metal rods are put inside the long bones

compression fracture of the spine

1. Mechanism: forced flexion of the spine. 2. Signs/Symptoms: sudden pain, loss of ROM, possible crepitus, numbness in area of associated dermatome. -causes: decreased bone density, trauma from vertical force, spinal tumor, infection

Wheelchair: Maximum height for reaching forward, sideways, countertops

1. from sitting is 48' and at least 15' is needed to prevent tipping 2. 48" and when an obstruction is present 46" 3. 31"

Average wheelchair length

42-43"

Mallet Finger

A deformity of the finger (distal interphalangeal DIP joint) caused when the tendon that straightens your finger (the extensor tendon) is damaged Typically, the DIP can be passively corrected to neutral, but the Ct is actively unable to extend it Etiology: • Rupture or laceration of the extensor digitorum tendon at the DIP • Hyper flexion of the extensor digitorum tendon during sports (softball etc) • DIP: hinge joint/bicondylar/capsular ligaments Causes: When the extensor tendon is cut or torn from the attached bone, causing the end of the finger to droop down and cannot be straightened • Blow to the finger w/ flexion force or by axial loading while DIP is extended • This condition is sometimes referred to as baseball finger • A fracture may occur w/ this injury Symptoms: Pain, Swelling around DIP Joint, DIP cannot straighten voluntarily, can be straightened w/ PROM, PIP joint extends Treatment: Test: Scrubbing Rug -Nonsurgical (usually w/ no fracture) -6wks continuous splinting (at all times) -6wks nighttime splinting Surgical -DIP Fixation: Metal pin across the DIP joint (internal splint) -Fracture Pinning -Finger Joint Fusion Splinting: Stack Splint (tip of the finger needs to be in hyperextension)

First STEP Screening Test for Evaluating Preschoolers (Development Assessment)

A developmental checklist and rating scale which identifies preschool students at risk and in need of more comprehensive evaluation. Looks at 5 domains of IDEA: cognition, communication, physical, social and emotional, and adaptive functioning -Method: Table Top tasks administered w/ social emotional and adaptive behavior checklists for examiner, parent, caregiver, and teacher to fill out -Scoring: Each domain is scored and converted to composite scores to determine appropriate levels or if child is at risk -Population: 2 years, 9 months through 6 years, 2 months

Occupational alienation

A disconnect between an individual and participation in meaningful activities (e.g. an older adult in a nursing home immersed in non-preferred activities -a disconnect between an individual and a fulfilling environment (e.g. a refugee living in a new culture)

Tier 2 service RTI framework

A framework that focuses intervention on student who are underperforming academics;y or h=who have behavioral concerns

pop-over or seated sitting

A full stand position is not required and is used for those with decreased endurance and/or WB precautions

nonparametric statistics

A statistical method wherein the data is not required to fit a normal distribution. Often used ordinal data. Good for ranks. Inferential. -testing not based on population parameters; include the test of significance based on ordinal and nominal data)

Phenomenological research

A study of one or more persons and how they make sense of their experiences -minimal interpretation by investigator -meanings can only be ascribed by patients

Wheelchair Tiedown Occupant Restraint System (WTORS)

A system used to secure a wheelchair to the floor of a vehicle (i.e., wheelchair tiedown) and to safely restrain the occupant (i.e., occupant restraint) in the wheelchair. must meet the Society of Automotive Engineers standards

redirection

A technique used to determine the extent to which a client has learned a particular skill that involves having the client perform the skill after observing task performance by the therapist

Assistive technology transmission method: Infrared frequency

A type of assistive technology transmission method in which desired household appliances are connected to EADL with infrared light transmission.

Assistive technology transmission method: Radio frequency

A type of assistive technology transmission method in which desired household appliances are connected to EADL with radio frequency waves

Mechanical debridement

A type of debridement that involves actively removing damaged or nonviable tissue Types includes: hydrotherapy we-to-dry dressings wound irrigation followed by suction

Wheelchair accessory: Footrest

A wheelchair accessory that supports a client's lower extremity; selected style depends on the needs of the user Options include: fixed - provides support for the lower extremity swing-away, detachable - allows the chair to be positioned in close proximity to the transfer surface elevating - adjustable height to address position needs

dressing stick

Adaptive device comprised of a 19-26-inch (48-66 cm) long dowel with a reinforced hook on the end, designed to aid in putting on or taking off clothing, for individuals with limited reach or decreased mobility of the lower extremities

Universal cuff

Adaptive device for persons with limited or no grip, designed to be secured with an elastic strap around the hand and contains a fixed pocket in which the handle of an eating utensil, toothbrush or other ADL device can be inserted for use

Built-up handles

Adaptive devices for persons with weak grip or decreased active ROM of the digits, designed to enlarge the handles of commonly used small-handled ADL devices such as pens, toothbrushes, eating utensils

Sensory re-education

Active training strategies used in the presence of a peripheral nerve injury or after a brain injury to enhance sensory awareness or compensate for lack of sensation, distinct categories include: protective sensory re-education discriminative sensory re-education

Primary driving control adaptations

Adaptations made to a vehicle that allow the driver to perform key functions of driving Includes: accessing the gas pedal maneuvering the steering wheel accessing the brakes

Activity modification

Adaptions to activities or tools to: -promote a lifestyle change -facilitate independence -reduce injury or health-related risk

Aging in place

Allows an older adult to reside in their home as long as possible or desired

Sensory Model: Evaluation

Assessments include: The Adolescent/Adult sensory profile and Allen Cognitive Level Screen ACLS-5 Interventions: -sensory based interventions in mental health practice settings including an alterantive to the use of physical restraints (ex. Snoezelen rooms, comfort rooms (calm/alert) Pt's with psychiatric illness/autism, and dementia)) -Psychosocial education to increase personal knowledge on how to self-modulate -Sensory diet including altering/calming stimuli, and heavy work patterns

systematic lupus erythematosus (SLE)

Autoimmune inflammatory disease affecting the joints, skin, blood cells, and vital organs -Characterized by a distinct butterfly-shaped facial rash that crosses both cheeks -Common in woman and people of non-white ethnic backgrounds -Symptoms may be acute, chronic, or episodic and may include one or more of the following: joint pain and swelling, skin lesions, fatigue, Raynaud's Phenomenon (discoloration of the fingers and/or the toes after exposure to changes in temperature (cold or hot) or emotional events.), dyspnea (SOB) , alterations in cognition

Cognitive Behavior Therapy (CBT): Evaluation

Beck Depression Inventory: BDI-2: THE PRIMARY INITIAL EVALUATION TOOL. a self-completed questionnaire that assess level of depression. The evaluation of cognition is frequently completed by occupational therapist Intervention postulates for change are used to guide the intervention process. Approaches using CBT emphasize the following: -client/therapist identify current problems and potential solution -use active/collaborative therapist/client interactions (ESSENTIAL PART OF THERAPY) -help client learn how to identify distorted/unhelpful thinking patterns, recognizes/change inaccurate beliefs related to others -gain insight/acquire skills that "MAXIMIZE" client functioning and QoL through coping skills and meaningful healthy occupations. -COGNITIVE REHEARSAL -ROLE PLAYING -VISUAL IMAGERY

Tics

Brief, rapid, involuntary movements, often resembling fragments of normal motor behavior. Tend to be stereotyped and repetitive, but not rhythmic.

Erik Erikson: stage 3

Initiative vs. Guilt -social skills and gender role identity -a sense of purpose is integrated into the personality Age 3-5

Mobilization orthosis

Classification of a custom-made or prefabricated orthosis intended to move one or more joints using applied, controlled tension, typically used to: promote tissue remodeling elongate/stretch adhesions substitute for weak or absent motion provide resistance for strengthening

Comminuted Fractures

Comminuted fracture implies at least three fracture fragments, the fracture lines of which interconnect. The individual fracture lines that form the comminuted fracture may be transverse, oblique, or spiral. Comminuted fractures are generally caused by high-energy trauma, as typified by automobile accidents, and are a common type of animal fracture Comminuted fractures are difficult to reduce and fix because they have no inherent stability. Constant external traction and alignment or internal fixation is required.

PRECEDE-PROCEED Model

Consists of eight phases that provide a framework for intervention. It is an educational and ecologic model that incorporates planning for evidence-based best practices, interventions, and integration of evaluation methods for improvement of quality. -A multi-dimensional health promotion model structured for assessing health and QoL and to guide health promotion programming designed to meet these needs

Physical environment

Context(s) that support or hinder occupational performance and participation include: -built surroundings (e.g. home, workplace, cement walkway) -natural surrounds (e.g. hills, plants, trees)

Continuing education Unit (CEU)

Credit assigned by the International Association of Continuing Education (IACET) to the completion of 10 contact hours of an organized continuing education/training experience, typically administered by a qualified instructor

Sign and Symptoms of Elder Abuse

Definitions vary; however there are 3 basic categories: A. Domestic Elder Abuse B. Institutional Elder Abuse C. Self-neglect or self-abuse 1. Physical Abuse 2. Sexual Abuse 3. Emotional/psychological Abuse 4. Neglect 5. Financial or material exploitation

Evaluation groups

Designed to gather information about the individual's task and group interaction skills that can be used to establish goals and plan intervention

Hammock chair

Device used in the bathtub to safely position a child in supine for bathing, typically used in the presence of poor trunk and head control

Assistive technology: Output

Devices that communicate the outcome of data processing from an information processing system, examples include: -braille -voice

Cerebral infraction (stroke)

Due to either embolism or thrombosis of the intro or extracranial arteries

Osteogenesis Imperfecta (Classification)

Eight main types classified by the genes that are involved: -Types 2, 3, 7, and 8: severe symptoms -Types 4, 5, and 6: moderate symptoms -Type 1: mild symptoms

Activity planning

Energy conservation technique that involves looking ahead days, weeks or months to develop a strategy for organizing and scheduling tasks based on occupational roles, priorities, task demands and expected energy expenditure levels and includes time for rest and recovery

Tendon Repairs OT Goals

Facilitate wound/tendon healing 1) Increase tendon excursion 2) Improve strength at repair site 3) Increase joint ROM 4) Prevent adhesion's formation 5) Facilitate resumption of meaningful roles, occupations and activities

Barrier free design

Environmental plan that eliminates physical obstructions, allows for optimal performance and access for individuals with disabilities

12 months (standing ) Gross Motor Skill

Equilibrium reactions are present with standing

Multicontext approach

Expectation that task modifications/cognitive strategies should be applicable and be practiced in multiple contexts where the client has performance demands Based on the Dynamic Interactional Model of Cognition

Long term goal

Expected outcome of the intervention plan that is measurable and includes a timeframe for completion

Gravitational insecurity

Extreme fear and anxiety that one will fall when one's head position changes or when moving through space, resulting from poor vestibular and proprioceptive processing.

Ergonomic feature: Seat backrest

Feature considered in the ergonomic design of a chair to ensure best possible postural support, that: provides sufficient width for the back is adjustable for height and angle supports the natural curvature of the spine

Rear-wheel drive wheelchair

Feature of a powered wheelchair in which the casters are located at the front of the chair and the drive wheels located towards the rear of the chair, designed to enhance maneuverability when using hand-operated controls Good option for use over rough terrain

Front-wheel drive wheelchair

Feature of a powered wheelchair in which the casters are located toward the rear of the chair and the drive wheels located at the front of the chair, designed to enhance maneuverability up and down sloped terrain May be more difficult to maneuver at higher speeds

Drive wheel position

Feature of a powered wheelchair that influences the maneuverability, stability, traction, and performance of the chair on a variety of terrains/surfaces, types include: rear-wheel mid-wheel front-wheel

Mid-wheel drive wheelchair

Feature of a powered wheelchair that requires a third set of stabilizing caster wheels, designed with smaller turning radius which increases overall maneuverability

Normal ROM for the hip

Flex: 0-120 Ext: 0-30 Abd: 0-40 Add:0-35 Internal rotation: 0-45 External rotation: 0-45

Normal ROM for the shoulder

Flex: 0-170 Ext: 0-60 Horizontal abd: 0-40 Horizontal add: 0-130 Internal rotation 0-70 External rotation 0-90

Hamilton Depression Rating Scale Assessments of Cognition/ Sensory Processing

Focus: measures the severity of illness and changes over time in individuals diagnosed with a depressive illness. Method: Information is gathered through interview and consultation with family, staff, and other informed individuals. Clinician rates the information obtained relative to 17 symptoms and characteristics Scoring: Items are rated 0-2 (0=absent, 1=trivial, 2=present, (0-4) indicates: absent, trivial, mild, moderate, severe Population: individuals with a diagnosis of mood disorder

Stage 4 pressure ulcer

Full-thickness tissue loss with exposed bone, tendon, or muscle -tunneling or undermining may both be present

Motor coordination

Function of the cerebellum that indicates ability to different muscle groups to work smoothly together to allow for desired rate of movement

Medial Epicondylitis

Gofers or Baseball Elbow Pain from the elbow (to the wrist on the inside (medial side) of the elbow, on the same side as the little finger. inflammation of the flexor pronator muscle mass originating at the medial epicondyle of the elbow. Etiology: Caused by damage and/or excessive force to the tendons that bend the wrist toward the palm. Muscles involved: • Flexor carpi radialis* • Pronator teres* • Flexor carpi ulnaris • Flexor digitorum superficialis Causes: Swinging a golf club or pitching a baseball. • Serving with great force in tennis or using a spin serve • Weak shoulder and wrist muscles • Frequent use of other hand tools on a continuous basis Symptoms: The pain can be felt when bending the wrist toward the palm against resistance, or when squeezing a rubber ball usually felt in the inner aspect of the elbow. Pain occurs in the flexor pronator tendons (attached to the medial epicondyle) and in the medial epicondyle when the wrist is flexed or pronated against resistance. Treatment: Rest (modification of activity) Resistive exercises (later) Ice pack application (to reduce inflammation) Strengthening exercises Anti-inflammatory medicine Bracing Corticosteroid injections Surgery (rare) Splinting: Counter force strap on medial elbow two fingers width away from medial epicondyle. Cushion placed on muscle belly of forearm flexors

Discussion-Oriented group

Group in which peers interact and engage with each other while learning skills of personal growth Type include: -stress management -sleep hygiene education -advocacy training -caregiver support

Health promotion

Increasing the individuals awareness of risk factors and behavioral changes that influence health, encourage self-management, and facilitate wellbeing

4-5 years (Toileting skills)

Independent in toileting

Cardiac rehabilitation phase 1

Inpatient: begins with acure illness and ends with discharge promote rest and ensure limited mobility assistance needed for ADLs Next step in phase 1 is independent ambulation of patient in room to bathroom, encourage progressive ambulation in hallway, usually 50, 100, and then 200 feet three times a day. Assess vitals

Cognitive compensatory strategies

Internal or external methods to maximize cognitive performance where strategy training may be a 3 phase process: acquisition application adaptation

Carrying skills

Involves a combo of movements of the shoulder, body & distal joints of the wrist & hand to hold the item, making appropriate adjustments as necessary to maintain this hold

Narrative reasoning

Involves approaching current problems and barriers a client faces as part of the client's overall life journey -framing the client's situation and future through storytelling

Level 4: Hierarchy of evidence

Level of evidence that includes: -studies conducted with a non-experimental design -single subject case studies -cohort studies

Rancho Level V

Max Assist; confused, inappropriate, non-agitated (short attention span of 2-3 minutes, needs step-by-step instructions, and responds inappropriately) -alert, not oriented to person, place, and time, often demonstrates inappropriate use of objects without external directions, may be able to perform previously learned task when structured and cues provided, unable to learn new information Able to respond appropriately to simple commands consistently with external structures and cues

Wheelchair measurements: Seat depth

Measurement used as part of a comprehensive wheelchair prescription, determined by measuring from the base of the posterior aspect of the buttocks to the popliteal fossa, then subtracting 1-2 inches (2.5-5 cm) Recommended to measure each leg individually

Wheelchair Measurement: Armrest height

Measurement used as part of a comprehensive wheelchair prescription, determined by measuring from the seat surface to the olecranon process with elbows flexed at 90 degrees

Wheelchair measurements: Seat width

Measurement used as part of a comprehensive wheelchair prescription, determined by measuring the widest point across the hips when client is in sitting then adding 2 inches (5 cm)

Ultrasound (US)

Mechanical acoustic modality that uses energy conversion to influence: tissue length pain inflammation tissue healing Recommended for use as an adjunct to other occupation-based interventions

Montreal Cognitive Assessment (MoCA)

Mild cognitive dysfunction; Attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking calculations and orientation -administered to the adult population to identify mild cognitive impairments -pencil-paper task and verbal task -score ranges from 0-30; 26 or greater is generally considered normal (TBI)

Rancho level VII

Min Assist; automatic appropriate (actions more appropriate to situation, breakdown of skills in times of stress, able to complete self-care routines, STM deficits) Consistently oriented to person, time, and place, able to attend to highly familiar task in a non-distraction environment for at least 30 min with min A Min A for new learning, demonstrates carry-over of new learning, unrealistic planning for the future, unable to think about consequences of decision or action, able to recognize inappropriate social behavior

Adaptive writing surfaces for the classroom

Modification made during handwriting interventions often involving a slant-board, upright easel, or white board to enhance upper extremity control for: manipulation of a writing instrument promoting upright posture tracking of the hand's movement during writing

Explicit instruction

Most direct level of graded cueing that includes instruction in the next step required for a given activity (e.g., "Now that you've finished bathing, it's time to dry your feet")

Clinical Implications: Cognitive Changes and Adaptions in the Older Adult

Older adults utilize different strategies for memory : context based strategies vs. memorization (young adults)

Universal Design Principle: Simple and intuitive use

One of the seven guiding principles for universal design whereby the design of products and environments is easily understood by all potential users.

Universal Design Principle: Equitable use

One of the seven guiding principles for universal design whereby the design of products and environments is useful and marketable to potential users of varying abilities

Galant relfex

Onset: 32 wks Integration: 2 mths Stimulus: hold infant in prone suspension, tap spine with finger from shoulders to butt Response: lateral trunk flexion and wrinkling of the skin on stimulated side. Relevance: lateral trunk movement necessary for trunk stabilization

Palmar Grasp

Onset: 37 wks Integration: 4-6 mths Stimulus: place finger in infants palm Response: finger flexion: reflexive grasp Relevance: increases tactile input on the palm of the hand

Neck righting reflex

Onset: 4-6 mths Integration: 5 years Stimulus: Place infant in supine and fully turn head to one side Response: Log rolling of the entire body to maintain aligning with the head Relevance: Maintains head/body alignment; initiates rolling (first a Bulgarian effort)

Backward parachute (protective extension backward)

Onset: 9-10 mths Integration: Persists Stimulus: Quickly but firmly tip infant off-balance backward Response: Backward arm extension or arm extension to one side and spinal rotation Relevance: Protects body to prevent a fall; unilaterally facilitates

Labyrinthine/optical (head) righting

Onset: birth-2 mths Integration: persists Stimulus: Hold infants suspended vertically and tilt slowly (about 45%) to the side, forward, or backward Response: Upright positioning of the head Relevance: Orients head in space; maintains face vertically

Verbal Response (GCS)

Oriented - 5 Confused conversation - 4 Inappropriate words - 3 Incomprehensible sounds - 2 None - 1

Cardiac rehabilitation phase 2

Outpatient begins after discharge and continues through convalescence at home.

Job demands

Performance components of the specific physical, cognitive, and social task demands of a job

Executive Function Performance Test (EFPT)

Performance-based assessment that evaluates executive function and amount of cueing required during functional activities -administered to adults population -observation of 4 independent living task: preparing oatmeal, managing medication, paying bills, and using the telephone

Electrotherapeutic physical agent modalities

Physical agent modalities (PAM) that require essential knoweldge of electrical principles, electrode selection and placement, indications, and contraindications, examples include: neuromuscular electrical stimulation (NMES) functional electrical stimulation (FES) transcutaneous electrical nerve stimulation (TENS)

Non-standardized sensory screening : Proprioception

Procedure used to determine the ability to sense joint position, involves moving a joint in a specific position and asking the client to replicate the position with the contralateral extremity

Stage 4: Parkinson's Disease (Hohn and Yahr's 5 stage scale)

Requires help with some or all ADLs -unable to live alone without some assistance, able to walk and stand unaided

Directional hypothesis

Research question in which the researcher is able to predict if outcomes related to variable manipulation will be positive or negative (i.e., single-tailed)

Systematic Review

Rigorously analyzing research studies in the literature with a focus on: -a specific topic question -collecting data based on specific research criteria -coding and evaluation of data -interpretation of results -summarizing findings

Accessibility Standards: Ramp slope

Rise to run gradient recommended as an alternative to stairs for facilitating accessible entry into homes or buildings (e.g., 1 inch (2.54 cm) of rise should have 12 inches (30.5 cm) of length)

Group leader

Role in a therapeutic group that includes: facilitating participation and process defining expectations and norms teaching needed skills guiding actions toward achieving desired outcomes

Ulnar Nerve Laceration

Sensory Loss: Ulnar aspect of palamr/dorsal surface -Ulnar 1/2 of ring and pinky finger Motor Loss: low lesion of wrist (adduction/abduction of MCP) (MCP flexion of digits 4 & 5) (flexion/Adduction of the thumb) (abduction, opposition, flexion of pinky) Motor Loss: high lesion; same as above w/ FCU flex towards ulnar wrist, and flex of DIP ring and pinky finger) Deformity: claw hand, flatten metacarpal arch, Froment's sign test of the wrist (o test for palsy of the ulnar nerve) Functional Loss: loss of power grip, dec pinch strength Dorsal protection splint with wrist positioned in 30* of flexion if low lesion -Include elbow (90* flexion) if high lesion -MCP flexion block splint

Modified Ashworth Scale (MAS)

Spasticity scale (measures degree of spasticity during passive stretching) 0 = NORMAL 1 = Slight increase in muscle tone with a catch and release OR minimal resistance at end of ROM 1+ = Slight increase in muscle tone with catch followed by minimal resistance through rest of ROM 2 = More marked increase in tone through most of ROM 3 = Considerable increase in tone, passive movement difficult 4 = Affected part rigid Can do at many joints (elbow, wrist, fingers, thumb, hamstrings, quads, gastroc, soleus) NO SPINE

Errors

Standard error: the results of sampling error Type I error: the null hypothesis is rejected by the researcher when it is true Type II error: the null hypothesis is not rejected by the researcher when it is false

Cryotherapy

Superficial, conduction, cold modality that may be used to address: spasticity pain edema recommended for use as an adjunct to other occupation-based interventions.

Bay Area Functional Performance Evaluation (BAFPE)

Standardized assessment tool administered to adults who have mental health conditions, neurological impairments, and intellectual disability -measure affective cognitive, and performance ability -contains 2 subtest; Task-Oriented Assessment (TOA) and Social Interaction Scale (SIS

Dorsal forearm muscles innervated by the radial nerve

Supinator forearm supination origin: lateral epicondlye and ulna insertion: radius

Orthotic Nomenclature: Modified Orthosis Classification System

System used to describe an orthosis for outpatient billing and reimbursement purposes based on the Health Common Procedure Coding System (HCPCS), typically corresponds to a specific "L" code Replaces the traditional term "splints with orthotics

Stand-pivot transfer

Technique for moving a client from one seating surface to another using the following procedures: properly positioning the client for the move assisting the client to standing having the client shuffle both feet toward the transfer surface slowly lowering the client onto the transfer surface

Sliding board transfer

Technique for moving from one seating surface to another used by individuals who have adequate UE and trunk strength but minimal to no functional use of the LE to move Involves using a specially designed device positioned under the thighs and on the transfer surface.

Ecology of Human Performance Framework

The Ecology of Human Performance framework (EHP) focuses on the relationship between several important constructs in occupational therapy; they are person, context, task, performance, and therapeutic intervention, in order to get a throughout understand of human occupation. The person construct is one's experience and his/her sensorimotor, cognitive, and psychological skills and abilities. Then the person construct is surrounded by a circle symbolizing this person's context (including temporal, physical, social, and cultural contexts). In his/her environment, there are many tasks (objective sets of behaviors necessary to accomplish a goal), symbolized by little circles outside and within the context, which are available to the person. The person has the opportunities in performing multiple tasks in which he/she participate in among the available tasks, based on one's skills, abilities, and environmental cues and features. By using the contextual lens (resulting from the individual's own experiences and perceptions about his/her physical, social, and cultural features of the current performance settings) in the interaction with person's skills and abilities, the resultant scope of action is called the "performance range". This framework considers life role among the task. Each life role has a unique constellation of tasks and some roles have overlapping tasks. Depending on the individuals' skills, experience, desires, demand from the contexts, persons with the same role may have different tasks. The person who is unable to notice all environmental cues and support, or has limited skills. For example, limited physical capacity has a narrower performance range. Occupational therapists evaluate the client's performance with consideration of the contextual information. Therapeutic interventions include "establish/restore", "alter", "adapt", "prevent", and "create", each of which may intervene the person, context, and/ or the task. The intervention is a collaboration among the client, family, and the therapist, in order to enhance individuals' occupational performance.

Figure-ground discrimination

The ability to focus on a single detail in a busy background -impairments may cause: difficulty locating items in a cluttered space, finding information on a blackboard, and locating a person in a crowd

visual attention deficits

The ability to maintain one's gaze on a visual stimulus Deficits: lack of awareness of information registered in the visual cortex Assessments: 1.Cancellation tests, 2. biVABA, 3. Figure and shape copying tests, line bisection test

Bariatrics

The area medicine that evaluates, treats, and engages in clinical studies related to persons with morbid obesity (i.e body mass index of 40 or more)

Livability assessment

The extent to which a community fulfills principles outlines by the National Council on Disability regarding physical, social, and transportation environments

neuromuscular skills

Tone, coordination for ability to utilize all lives rhythmically in mobility and environmental manipulation

psychosocial rehabilitation model

Treatment delivery model where services are delivered in the community to individuals who have a mental illness to promote recovery and social inclusion

Early intervention

Treatment delivery program where family-centered services are delivered to infants and toddlers in natural settings to support development and minimize delays

Relaxation breathing

Used to reduce levels of automatic arousal and support the exposure protocol, also may be used alone to help manage panic attacks or other symptoms of anxiety Used to control SOB and decrease rate of respiration with the following steps: -exhale completely -deeply inhale while counting -exhale slowly while counting at a rate greater than during inhalation -repeat at comfortable rate then return to normal breathing

Evaluation of Fall Risk

Vision: presbyopia (decreased acuity), reduced night vision, and depth perception Vestibular: vertigo, postural sway Age related changes: decreased response time, dec. endurance and strength, difficulties in rising from a chair and maintaining gait speed Pathological states: congestive heart failure, arrhythmias, arteriosclerosis, atherosclerosis, diabetes mellitus Med side-effects: delirium, dementia, anxiety, depression Prior falls, and fear of falling

Content validity

When the items in an assessment are an accurate representation of all aspects of the domain being tested

Organizational policy

Written statement that outlines specific expectations and standards related to day-to-day work activities

Ratio scale

a quantitative scale of measurement in which the numerals have equal intervals and the value of zero truly means "nothing"

Structures Interview

a research procedure in which all participants are asked to answer the same questions

Mean

average of all scores -most frequently used measure of central tendency -appropriate for interval or ratio data

Dyspnea

difficulty breathing (SOB) -Impaired breathing in response to activity or at rest that may require medication attention, modification to activities, instruction in breathing techniques (pursed-lips), dyspnea control posture

Presbyopia

difficulty focusing on near objects

Rheumatoid Arthritis (Stages)

here are four distinct stages of RA progression, and each has their own treatment courses. Stage 1: This is early stage RA. This stage involves the initial inflammation in the joint capsule and swelling of synovial tissue. The swelling causes the symptoms of joint pain, swelling, and stiffness. Stage 2: In the moderate stage of RA, the inflammation of the synovial tissue becomes severe enough that it creates cartilage damage. In this stage, symptoms of loss of mobility and decreased joint range of motion become more frequent. Stage 3: Once the disease has progressed to stage three, it is considered severe RA. Inflammation in the synovium is now destroying not only the cartilage of the joint but the bone as well. Potential symptoms of this stage include increased pain and swelling and a further decrease in mobility and even muscle strength. Physical deformities of the joint may start to develop as well. Stage 4: In the end stage of RA, the inflammatory process ceases and joints stop functioning altogether. Pain, swelling, stiffness and loss of mobility are still the primary symptoms in this stage

Oral preparatory phase of swallowing

involves: -voluntary intake of food into mouth -bolus formation with saliva -chewing with molars and activation of buccal muscles to prevent pocketing -bolus movement to the center of tongue .

Abductor pollicis brevis

median nerve, abducts thumb origin: scaphoid, trapezium insertion: base of proximal phalanx

Flexor digitorum profundus (FDP

median nerve, flexion of DIP joints to digits II and III (see ulnar nerve for digits IV and V) origin: proximal 2/3rds of the ulnar and interosseous membrane insertion: distal phalanx

Proximal fracture

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

Community Mobility

moving around in the community and using public or private transportation, such as driving, walking, bicycling, or accessing and riding in buses, taxi cabs, or other transportation systems

Coracobrachialis

musculocutaneous nerve, flexes and adducts arm origin: coracoid process insertion: medial aspect of deltoid

Cranial nerves I, II, VIII

pure sensory carry special senses of smell, vision, hearing, and equilibrium

Tetraplegia

paralysis of all four limbs; aka quadriplegia

Monoplegia

paralysis of one limb: can affect the arms, legs, and facial muscles

Door-to-door

passengers may be assisted from the doorway of their point of origin to the entrance to their destination but are not assisted to enter

Cranial nerves III, IV, VI

pure motor, controlling eye movement and pupillary constriction

Ethical distress

when it is difficult to follow through on what the person knows is the right course of action because of policies or procedures occurring at the organizational or facility level (e.g client needs treatment in the evening but the facility is closed)

OT Role in addressing community mobility

-Viewed as an IADL performance area in the OT domain and practice framework -To be addresses by OT's and OTA's an an enabler of other occupations -Should be conferred across all practice settings , and flow a process consistent with with that outlines by ATOA -Can be address through assessments including: occupational profile, analysis of occupational performance, intervention planning, implementation an review, and determination of outcomes

Grasp of cube: 3 months

-Visually attends and may swipe -Sustained voluntary grasp is possible only upon contact, ulnar side used -No thumb involvement, wrist flexed

Releasing skills: 7-9 months

-Voluntary release

11 months (walking ) Gross Motor Skill

-Walking with one hand held -Reaches for furniture that is out of reach -Cruises in either direction , no hesitation

18-24 months (stair climbing) Gross Motor Skill

-Walks up stairs/ down stair while holding on

2-2 1/2 years (stair climbing) Gross Motor Skill

-Walks up stairs/ down stairs without support, marking time

8-18 months (walking ) Gross Motor Skill

-Walks with two hands held

Treatment for LE Amputations

-Wrapping to shape residual limb and decrease swelling -Desensitization -Strengthening (UE) with the focus on triceps -Transfer training, stand pivot -ADL training; LE dressing is the most difficult -Standing tolerance -W/C mobility

Hand Splints (Burns to the hand)

-Wrist in 20-30 degrees of extension -. MCPs in 70 degrees of flexion -. IPs in full extension -. Thumb abducted & extended

Problem Solving Skills: 18-21 months (milestones in cognitive development)

-attends to shapes of things and uses them appropriately -think before acting -uses tools to obtain a favorite object -begins to replace trail and error with a thought process in order to obtain a goal -operate a mechanical toy ex. An on-off switch

18-21 months (problem-solving skills)

-attends to shapes of things and uses them appropriately -thinks before acting -uses tool to obtain a favored object -operates a mechanical toy (ex on-off switch) -predicts effects or presume causes -BEGINS TO REPLACE TRIAL AND ERROR WITH THOUGHT PROCESS IN ORDER TO OBTAIN GOAL

7-9 years (Household Management Task)

-begins to cook simple meals -puts clean clothes away -hangs up clothes -manages small amounts of money

Cerebral Hemorrhage Stroke

-bleeding from a ruptured blood vessel in the brain associated with the cerebrum - secondary to hypertension or aneurysm

Hemianopsia

-blindness in one half of the visual field of one or both eyes

Problem Solving Skills: 36-48 months (milestones in cognitive development)

-builds a tower of 9 cubes, demonstrating balance and coordination -organizes objects by size and builds a structure from a mental image

36-48 months (problem-solving skills) 3 +YEARS

-builds a tower of nine cubes demonstrating balance and coordination -organize objects by size, and build a structure from a mental image (ex. LEGO)

24-30 months (problem-solving skills)

-builds with block horizontally and vertically

3 years (Household Management Task)

-carries things without dropping them -puts toys away (w/ reminders) -wipes up spills

Cranial nerves III, VII, IX, X

-carry parasympathetic components, including controlling smooth muscle of the inner eye (III), salivatory and lacrimal glands (VII), parotid gland (IX) muscles of the heart, lungs, and bowel (X)

Classification: Preoperational period ( Hierarchical development of cognition)

-categorizes objects according to similarities and differences

5-7 months (Feeding)

-cereal and baby food from spoon -good head stability, trunk stability is developing -attends to effects produced by actions. ex. Hitting a spoon -plays with caregiver during a meal

Ataxic Cerebral Palsy

-cerebellum lesion -results in hypotonia and ataxic movements. -problems w/ balance, coordination, fine motor, tremors, and clapping -Primitive total patterns of movement. Classification is according to level of severity.

Frontal lobe (telencephalon)

-cerebral cortex: emotional /impulse control -motor function -short-term memory, initiation, and executive function (organization, planning, problem-solving), and sexual behavior -Broca's area "motor aspect of speech (left side)

Spina Bifida

A congenital defect that occurs during early pregnancy when the spinal canal fails to close completely around the neural tube resulting in a protrusion -certain medications and lack of folic acid may induce neural tube defects. -classification, prognosis and degree of impairment is dependent on the level of the lesion and the extent of tissue involved. -including: occulta, cycstica,

Continuous Quality Improvement (CQI)

A continuous improvement in the quality of the product or service being delivered -a managerial method used to evaluate the effectiveness and efficiency of procedures and processes -used to foster an ongoing commitment to: resolution of problems, customer satisfaction, organizational learning, data driven decisions, training for all levels of the organization, data driven decisions and measurable outcomes

Palmer crease

A crease on the hand that indicates areas of the joint mobility and must be considered when fabricating fitting and orthosis -Any of the several flexion creases normally found on the palm of the hand, occurring proximal to, but as a consequence of flexion at, the metacarpophalangeal joints

Control Interface

A device that allows a client to interact with assistive technology

Pivot disc

A device used for a standing transfer with a client who is able to stand but who cannot pivot. The disc rotates to pivot the client.

Diabetic retinopathy (Fluctuating Vision Loss)

-changes in blood vessels of the retina that swell and leak fluid (and/or) grow abnormal new blood vessels growth on the surface of the retina disease of the retina in diabetics characterized by capillary leakage, bleeding, and new vessel formation (neovascularization) leading to scarring and loss of vision -fluctuates and includes blurred vision, reduction in contrast, sensitivity, decrease in ability to drive at night, decrease in color discrimination, patchy spots, visual field slows, and total blindness

Epilepsy

-chronic state of recurrent seizures

Emergent Phase: Evaluation and Intervention

-clinical observation on joints affected (E) -informational gathering of prior functional status (E) -splinting and anti-deformity positions (I) -intrinsic plus for hands (I) / opposite clients posture -extension for the neck, elbow, and knees -shoulders in abduction -hips in extension -anti-frog leg and anti-for drop for LE

inflammatory wound healing phase

-clotting and vasoconstriction -white blood cell migration and red lease of histamine and prostaglandin that causes vasodilation and increased tissue permeability

Older adults facing driving cessation (community mobility challenges)

-community mobility alternatives, education, and resources -psychosocial support -travel training

Proliferative phase of wound healing

-fibroblast are stimulated to synthesize collagen -cross linkage of collagen increases tensile strength of repaired skin by 80% -tissue granulation form new collagen and blood vessels -myofibroblasts connect to the wound margins -wound contraction last 5 days to 2-3 wks -linear wounds: heal quickly -rectangular wounds: heal moderately -circular wounds: slowest to heal

Problem Solving Skills: 6-9 months (milestones in cognitive development)

-finding objects after watching it disappear ex. Toy covered by a cloth -uses movements as a means to an end ex. Rolling to secure toy -anticipates movement of objects in space ex. Looking towards trajectory of objects circling the child head -attends to consequences of actions, ex. Banging to and realizing it makes noise -child repeats actions to repeat consequences ex. Banging toy to hear noise

3.5 years (Self-dressing skills)

-finds front of clothing -unzips the front of a jacket -puts on mittens -buttons up to 3-4 buttons -dresses with SUP (needs help with front/back)

6-9 months (problem-solving skills)

-finds objects after watching it disappear (ex. toy covered by cloth) -uses movements as a means to an end (ex rolling to secure toy) -anticipates movements of objects in space (looks towards the trajectory of objects that circle the head) -banging a toy and realizing it makes noise (attends to consequences and actions) -banging a toy to hear noise (repeats actions to react consequences )

9-13 months (Feeding)

-finger feeds self a portion of the meal -able to isolate radial fingers on smaller objects -difficulty attending to events outside of visual space (ex. Position of spoon) -prefers to act on objects rather than be a passive observer

Interventions for seizure disorder

-first aide procedures : remove dangerous objects, -protect patient from harm without interfering with movements, -raise the bed rails, do not place anything in the patients mouth, -turn the person on there side, and allow the seizure to happen protecting the head and extremities from injury -monitor the improving mental state, but if breathing stops assume rescue breathing is needed. Call for medical attention

legrest

-fixed: minimal benefit; seen in older w/c or rentals -swing-way: allows feet to be placed on the floor for transfers -detachable: allows for safe path for transfers elevating: allows for edema control and reduction

Footplates

-fixed: minimal benefit; seen in older w/c or rentals -swing-way: allows feet to reach the floor -heel-loop: prevents feet from slipping off the footrest -ankle strap: prevents slipping off foot rest

armrest

-fixed: minimum benefit; seen in older w/c or rentals -detached: helpful for transfers -desk arm: allow for moving closer to work surface -full arm: allow for holding a lap tray/ easier transfers -wraparound: reduces the width of the w/c by 1' inch

Emergent phase 0-72 post injury (burns)

-focus on sustaining life -controlling infection -managing pain -universal precautions of medical staff and family -Including: IV, intubation, escharotomy, fasciotomy , wound dressing with antimicrobial ointment for infection control

Model of Human Occupation (MOHO): Evaluation

-focus on the individuals occupational history, goals, volition, habits, and occupational performance -Assessments include (OCAIRS, OSA), but any instruments that provides pertinent information about the environment and the person may be used Interventions: -focus on occupational engagement and include activities that are purposeful, relevant, and meaningful to people and their social context

Heterotopic ossification

-formation of bone in abnormal areas (typically in soft tissue around joints) -common areas include: elbow, knee, hip, and shoulder -loss of ROM is rapid, and pain is localized and severe -hard end feel during PROM activity -usually requires surgical intervention if functional activity is limited

Cognitive and Perceptual Dysfunction: evaluation of client factors and performance skills

-foundation of visual skills including: acuity, visual fields, ocular range of motion, accommodations, pursuits, saccades -pervasive impairments: decreased arousal, alertness, selective/sustained attention, impaired judgement, confusion, motivation -impact of specific deficits including: ADLs, IADLs, mobility, apraxia, spatial neglect, body neglect, preservation, spatial relation dysfunction, agnosias, organization and sequencing, and memory loss

Subdermal burn

-fourth degree -full-thickness burn with damage to underlying tissue such as fat, muscle, and bone -charring is present, exposed fat, tendons, or muscles -if electrical (destruction of nerves along the pathway are present) -peripheral nerve damage significant -surgical intervention is required for wound closure or amputation -potential for hypertrophic scar is extremely high

3 years (Toileting skills)

-goes to the bathroom independently; seats him/her self on the toilet -may need help with wiping

Transdiciplinary Play-Based Assessment (TPBA) (Play Assessment)

-Purpose: measures child's development, learning style, interaction patterns, and behaviors to determine need for assistance -Method: non-standardized play assessments employing teams observation based on 6 phases, and developmental domains including: cognitive, social-emotional, communication, language, and sensorimotor -Scoring: a program of play is developed including developmental levels, family assessment, and intervention to appropriate activity environment -Population: infancy to 6 years

Sensory Profile (SP) and Infant/Toddler SP

-Purpose: measures reactions to daily sensory experiences Method: obtains caregiver's judgment and observation of a child's sensory processing, modulation, and behavioral and emotional responses in each sensory system via a caregiver questionnaire -Scoring: differences indicate which sensory system is hindering performance. Can be used for intervention planning Population: Infant/Toddler SP: birth - 36 months

Outpatient and community reintegration phase

-Scar management : compression therapy, conditioning, splinting and positioning exercises (maturation 1-2 years) -Community reentry: improve skin tolerance, promote ROM and strength tolerance, adapt activity demands and environment -Psychosocial adjustment: address post traumatic stress, disfigurement & contracture, counseling, support groups, training in pain management, relaxation and stress management

Full Thickness Burns (Evaluation & Interventions)

-grafting ROM (5-7 days post-operative) Occupational Profile -ROM 72 hrs post-operative -sensation when wounds are healed -strength, when wounds are healed -ADLs and meaningful roles, activities ASAP Post-operative interventions: -72 hours: dressing changes, splints at all times -5-7 days: begin AROM, light ADL and meaningful activities, sterile, whirlpool -Over 7 days: PROM as tolerated, ADL and meaningful activities -When wounds are healed, use massage -Order compression garments -Provide otoform/elastomer inserts -Strengthening

Interventions for Driving Rehabilitation

-hand controls: replace accelerators and brake foot petals -steering knobs: one-handed steering control w/ either standard round knob (individual w/ one UE) or "ring" to accommodate a prosthesis -petal extension: if feet do not reach the standard petal

Otosclerosis: hearing loss

-hardening of the bony tissue of the middle ear -immobility of the stapes results in profound conductive hearing loss

myocardio infarction

-heart attack -block flow of the blood to the heart muscle -resulting in damage to the heart

Suicide: OT intervention

-identify the motivation behind the suicidal intent and the alternatives -develop a contract for safety (what the individual should do if experiencing ideational suicidal thoughts) plan/intent - problem solving skills/stress management techniques to increase resilience/ability to manage life stressors -identify positive goals and interest to increase motivation/recovery -identify personal positive attributes/support system to increase hopefulness -provide activities that produce successful outcomes and a visible end-product to promote positive thinking -provide activities designed to express validation of feelings -moderate physical activities to elevate mood -develop skills that increase functional performance -activities that are future-oriented -provide patient/client family education

Aphasia

-impairment of language -usually caused by left hemisphere damage - damage either to Broca's area (impairing speaking) -Wernicke's area (impairing understanding).

hemianesthesia

-inability to feel sensations from touch on one side of the body.

Glaucoma

-increased intraocular pressure results in damage to the retina and optic nerve with loss of vision -Results in early loss of peripheral vision (tunnel vision)

Glaucoma (Peripheral Vision Loss)

-increased intraocular pressure results in damage to the retina and optic nerve with loss of vision -two types are the most common: primary open angle, angle closure -deficits in task and activities

Tilt-in-space wheelchair

-indicated for pressure relief or for an individual with severe extensor spasms that may throw him or her out of the chair; entire seat and back tilt back to maintain a normal seat to back angle

1 year (Toileting skills)

-indicates discomfort when wet/soiled

Tier 3 service RTI framework

-intense 1:1 interventions are provided at the individual level -may include further evaluation to determine need for additional services

Pain and burns

-interferes most with the rehabilitation process -respect pain -break through pain relief can aid ago plain evil with therapy program -educate on the importance of ROM exercises and activity -teach proper skin acre and lubrication to avoid mace ration -reinforce pain management and stress reduction management techniques

Tier 1 service RTI framework

-interventions are focused at the systemic level for all students in general education -includes universal screenings and interventions

Test-taker bias: Person-related testing bias

-involves actions of the client (i.e by providing false or misleading information) on the test

Evaluator bias: Person-related testing bias

-involves actions of the evaluator (i.e by imposing personal expectations) on the test

Informed consent

-involves ensuring the client understands the possible risk and benefits of intervention -allowing the client to make an educated decision -having the client grant permission to willingly proceed

Standardized sample

-large sample of people who represent the intended population for a test (norm group)

The Safety, Accountable, Flexible, Efficient, Transportation Equity Act: (SAFETEA-LU Act)

-legislation that funded the safe routes to school program , and provided 100% federal funding to create a safe environment surrounding schools and encourage children to bike and walk to school as part of developing a healthy lifestyle

Cataracts (Central Vision Loss)

-lens become more opaque (cloudy) -reduction of light going into the retina -reduce visual acuity -blurred vision -decreased ability to distinguish colors -decreased ability to drive at night -distortion of images -increased glare sensitivity -difficulty distinguishing similarly colored objects from the background (contrast sensitivity )

symptoms of muscular dystrophy

-low muscle tone and weakness -abnormal movement patterns -delayed developmental milestones -difficulty with oral motor feeding, necessitating a tube -deformities of extremities and spine -difficulty with breathing which may require tracheostomy's, ventilators, and frequently results in death

4 years (Household Management Task)

-makes cereal and retrieves dry snacks - helps with sorting laundry

Progressive Supranuclear Palsy (PSP)

-manifested by loss of voluntary, but preservation of reflexive eye movements, tremor, bradykinesia, rigidity, postural instability, dystonia, and dementia (Sometimes confused with Parkinson's disease) -People with PSP usually need a walking aid, such as a cane or walker, within 3-4 years of the first symptoms of the disease. With good care and attention to medical needs, nutritional needs, and safety, a person with PSP can live many years. The typical lifespan from first appearance of symptoms is about 6-15 years. Occurs in later middle life

Pruritis (persistent itching)

-may lead to skin maceration and re-opening of wounds -use compression garments, lubrication, cold packs and antihistamine medication may alleviate itching

Public transportation (community mobility)

-means of moving more than one person at a time from point to point, and is available to all citizens of any area and funding, at least in part by taxes. 2 types include: fixed-route transportation, and paratransit transportation

Seat width (+2 inches)

-measure the widest aspect of user's bottom or hips and thighs for maximum seating space add aprx 2 inches. - will provide space for clothing and clearance of trochanters from armrest side panel, ease re-positioning, transfers, and avoid rubbing/pressure/friction

Occupational Therapy Interventions (Pain)

-physical agents, modalities, massage in preparation for activities -teach proper positioning techniques -Splint Pt in resting position -Gentle ROM -Teach relaxation exercises -Use proper body mechanics during self-care, work, leisure -Correct environmental factors (seating and standing posture) -Modify activities and provide ADL training and AE as needed -Provide alternative exercise programs

2 years (Household Management Task)

-picks up and puts toys always (w/ reminders) -copies parents cleaning activities

Premotor cortex

-planning and movement including Broca's araes" motor aspect of speech

Prefixes and suffixes of paralysis

-plegia: paralysis -cardio: heart -hemi: one side -para: legs -Quadra/tetra: all 4 limbs -mono: one limb

Muscle grade 2 (test movement)

-poor strength observed where movement is noted only in gravity-minimized plane Poor: incomplete ROM in gravity-minimized plane

Physical Abuse: Signs and Symptoms in Elders

-reports of being physical mistreated -bruises, black eyes, welts, and/or lacerations -rope marks and/or signs of restraint -bone and skull fractures , sprains or dislocations -open wounds, cuts, and untreated injuries -internal injuries/bleeding -broken eyeglasses -under-dosing or over-dosing -a sudden change in behavior -caregiver refusal to allow visitors to see the elderly person

Emotional/Psychological Abuse: Sign and Symptoms in Elders

-reports of being verbally or emotionally abused -extremely withdrawn and non-communicative or non-responsive behavior -unusual behavior (sucking, bitting, or rocking)

Financial or Material Exploitation: Sign and Symptoms in Elders

-reports of financial exploitation -changes in bank accounts or banking practices -additional names on an elders bank signature card -unauthorized withdrawal using an ATM card -unpaid bills despite the availability of funds -discovery of a forged signature -sudden appearance of relatives claiming rights to decisions, money, and possessions -unexplained transfers of funds -the provision of unnecessary services

Assessments of behavior

-result in agitation, restlessness, and/or wandering include: -pain, physical discomfort -hunger, thrust, need to toilet -loneliness, fear, boredom -unfamiliar environemt

Contracture: burn-related complications and management

-results from tight scar bands, hypertrophic scar or prolonged immobilization -address anti-contracture positioning, exercise and activity programs, serial splinting (prevent reverse deformity)

Examples of correlation research

-retrospective: investigates data collected in the past -prospective: investigates and records present data -descriptive: investigates several variables at the same time, and determines existing relationship among the variables -predictive; used to develop predictive models

Wheelchair Users: Infants and children (community mobility challenges)

-safe school bus transportation -education and support regarding vehicle restraints -parent and caregiver education regarding safe community mobility -passenger safety

Remodeling phase of wound healing

-scar tissue matured and contains collagen fibers that are broken down and remodeled. -phase last 2wks to 1-2 years -hypertrophic and keloid scars can form -wearing compression garments helps collagen fiber realign in a linear/lateral orientation -dynamic splints, and serial casting, PROM, positional stretching, NMES, and gel pads help decrease hypertrophic scarring

15-18 months (Feeding)

-scoops food with spoon and brings it to mouth -shoulder and wrist stability demonstrating precise movements -experiments to learn rules of how objects work -internalizes standards by others on how to play

Advantages of standardized testing 1

-scores can be understood by inter-professional teams -tools care often widely available -uniform administration, scoring, and interpretation of results -can help monitor progress over time -can contribute to quality improvement and evidence-based practice

Deep partial-thickness burns

-second degree -epidermis and the deep dermis layer; hair follicles, and sweat glands -severe pain even in light touch -erythema is present with or without blisters -high risk of turning into full-thickness burns due to infection -grafting may be considered to prevent wound infection -may experience impairments of sensation -potential for hypertrophic scar is high Healing time varies between 3-5 wks

Superficial partial-thickness burns

-second degree -epidermis and upper dermis layer -significant pain; wet blisters and erythema are present -healing time 1-3 weeks

Impact of occupational performance -seizures

-seizure disorder and/or the anticonvulsive medication(s) are prescribed to control the seizures, and may effect the patient alertness and learning potential. -The amount of brain damage incurred by the seizure can influence performance in all areas of occupation

Offensive behavior (physical or verbal)

-set limits and immediately address the behaviors -reasons why the behavior is not acceptable should be made clear and presented in a manner that is non-confrontational or judgmental -consequences of continuing the behavior should be made clear

1.5 years (Toileting skills)

-sits on the toilet when placed there with SUP

Rehabilitation phase: healing & closure of wounds

-skin conditioning -scar management -therapeutic exercises and activities -splinting -ADLs -client education to aid transition from hospital to home

Full-thickness skin graft (FTSG) (Acute phase: 72 hrs post burn)

-skin graft that consists of the entire epidermis and dermis -plus a percentage of fat layer are taken from the donor site -chances of graft survival is less -the outcome is functionally and cosmetically better if graft adherence occurs

Dysarthria

-slurred speech: -Weakness in the muscles used for speech

Presence and location of grab bars

-soap dish and towel rack are not grab bars -for rental homes, landlord's agreement is needed to install grab bars

Walkers

-standard: requires the person to have fair balance and the ability to lift device with UEs to advance -hemi-walker: for those who do not have the ability to use 2 hands -side-stepper: a walker situated on a non-affected side of a person -rolling walker: for those who cannot lift a standard walker due to UE weakness or impaired balance -walker bags, trays and baskets to assist in transporting personal items

Canes

-straight: one leg -wide based quad cane (WBQC): one shaft is connected to a four-pronged base to increase stability when a person is not able to balance on a straight cane -narrow based quad cane (NBQC): same premise as WBQC, but prongs are situated closer together for a client who may not require as much support

Unilateral neglect

-syndrome in which people ignore objects located on either side of the body -most often caused by damage to the right parietal lobe (right MCA) (left-neglect)

Early object use: 12 + months (milestones in cognitive development)

-the child acts on objects with a variety of schemes

Problem Solving Skills: 24-30 months (milestones in cognitive development)

-the child begins to relate experiences to one another, based on logic and knowledge of previous experiences -the child can make a mental plan of action without acting it out -can see the relationships between experiences ex. If the ballon is popped it will make a loud noise.

Early object use: 8-9 months (milestones in cognitive development)

-the child combines objects in relational play, such as objects in containers

Inventions of new means through mental combinations: Sensorimotor Period (Hierarchical development of cognition)

-the child demonstrates insight and purposeful tool use -problem solving options (18-2 years)

Problem Solving Skills: 24-27 months (milestones in cognitive development)

-the child discriminates size

Early object use: 6-9 months (milestones in cognitive development)

-the child explores characteristics of objects and expands range of schemes -pulling, turning, poking, tearing

Early object use: 12-15 months (milestones in cognitive development)

-the child links schemes and simple combinations -ex. Placing a baby in a carriage, and pushing the carriage

Early object use: 36-42 months (milestones in cognitive development)

-the child links schemes into complex scripts

Early object use: 9-12 months (milestones in cognitive development)

-the child notices the relation between complex actions and consequences such as opening a door -ex. Pushing a train or rolling a ball.

Tertiary circulation reaction: Sensorimotor Period (Hierarchical development of cognition)

-the child seeks out new schemes, with improved gross and fine motor abilities Tool use begins ( 12-18 months)

Conservation: Preoperational period ( Hierarchical development of cognition)

-the end product of the preoperational period -the child I'd able to recognize the continuities of an object or class of objects in spite of apparent changes

Sensorineural: hearing loss

-the most common form of hearing loss, also called nerve deafness; caused by damage to the cochlea's receptor cells or to the auditory nerves -noise damage, trauma, disease, drugs, arteriosclerosis

Full-thickness burns

-third degree -epidermis and dermis; hair follicles, sweat glands, and nerve endings -burn is pain free, no sensation to light touch -burn is pale and nonblanching -requires skin graft -potential for hypertrophic scar is extremely high

6 years (Self-dressing skills)

-ties bow -snaps back snaps

5 years (Self-dressing skills)

-ties/unties knots -dresses unsupervised

Mechanism of burn facts : Chemical

-tissue necrosis rather than direct heat -degree of tissue injury is dependent upon to its of chemical and exposure time -alkali is usually more severe than acid burns

Types of wound dressing: emergent phase of treatment for burns

-topical antibiotics -biologic dressing: 2 types -Xenografts: bovine skin, processed pig skin -Allograft: human cavdaver skin -Non-biological skin-substitute dressings- biosynthesis products such as Biobrane

Muscle grade 1 (no movement)

-trace movement observed and palpated -no active movement noted, but muscle contraction is observed or palpated

acute phase- 72 hours after injury or until wound is closed (may be days or months)

-treatment focuses on infection control (non-surgical, or surgical) -grafts: removal of dead tissue, and replacement of skin (or substitutes) over the wound -biological dressings: used to cover the wound -psychological support -team communication

Reaching skills: 6 months

-unilateral reaching with increased dissociation of body sides

18-24 months (symbolic play)

-use of non-realistic objects in "PRETENDING" (ex. Substituting a block for a train) -inanimate objects perform familiar activities (ex. Doll washing itself)

Control infection in the emergent phase of treatment for burns

-use skin as an environmental barrier to protect against bacterial invasion -close open wounds to prevent chances of bacterial infection -use wound dressing products to protect against infection -superficially debride the wound and provide comfort

Reclining wheelchair

-used for individuals who are unable to independently maintain an upright seating position

Harness

-used to position a person lacking sufficient trunk control -arm troughs to position and support a flaccid UE and prevent edema through elevation (LAPBOARDS serve the same purpose)

9-12 months (problem-solving skills)

-uses a tool after demonstration -behavior becomes more goal directed -performs and action to produce a response

Coordination of secondary schemata: Sensorimotor Period (Hierarchical development of cognition)

-voluntary movement in response to stimuli that can not be seen such as in objects permanence Early development of decentered thought (9-12 months)

Secondary circular reactions: Sensorimotor Period (Hierarchical development of cognition)

-voluntary movement patterns emerge due to coordination of vision and hand function -early awareness of cause and effect develop (5-8 months)

Hemmorrhage stroke

-weakened blood vessel ruptures. -two types of weakened blood vessels include: - aneurysms and arteriovenous malformations (AVM). -The most common cause of hemorrhagic stroke is uncontrolled high blood pressure.

Exploratory Play

0-2 years -engages in play experiences through which the child develops a body scheme -sensory integrative /motor skills develop -play mostly with parents/ caregivers

Exploration play

0-2 yrs -child engages in play experience -sensory integration and motor skills are developed -child plays mostly with PARENTS and CAREGIVERS

Role of Occupational therapy in domestic abuse

1). develop a trusting relationship 2) use the RADAR approach R= routinely ask, A= affirm and ask, D=document objective findings A= assess and address the persons safety, R= review options and referrals Areas to discuss with the person being abused -stress and safety, fear and abuse, family, friends and support network, emergency plan -provide interventions for physical and emotional injuries and develop the skills needed to live an independent empowered life -inform the supervisor and.or treatment staff -manditory reporting is required

1. Where does motor development occur? 2. How does motor development progress? X2 3. In what manner does motor development occur, and with what 2 periods? 4. When do sensitive periods of motor development occur?

1. Cephalocaudal/proximal to distal direction 2. Gross to fine motor / stability to controlled mobility 3. Spiraling manner with periods of equilibrium to disequilibrium 4. when the infant/child is affected by the environmental inputs

Status post CVA

1. may need education regarding proper positioning of upper extremity to increase awareness, minimize pain, decrease swelling, and promote normalization of tone. 2. May also require use of pillows between knees while in sidlying to increase comfort and promote proper positioning.

Surgical and postoperative phase

1. postop. immobilization -immobilization is important after skin graft for adherence: between (3-10 days) -immobilization for donor site (2-3 days) - walking not resumed until 5-7 days after grafting in LE 2. postioning - anticontracture positioning -goal is to promote the greatest surface area for graft placement 3. exercise - movement of uninvolved extremities should be continued -start with AROM right after immobilization period to avoid shearing of new graft

Symbolic Play

2-4 years -engages in play experience through which the child formulates, test, classifies, and refines ideas, feelings, and combined actions -associated with language development -uses objects that are manageable in terms of symbolization, control, and mastery -mostly involved in parallel play with peers, and becomes more cooperative

Symbolic play

2-4 yrs -child engages in play experiences formulating test, classifies, and refines ideas, feelings, and combined actions -the form of play associated with language development -objects are manageable in terms of symbolization, control, and mastery -child is most involved in PARALLEL play

Patterns of splints include the following criteria:

2/3 width of extremity, half circumference of the bone, marking bony landmarks, extending 1/2-2/3 in. past the fingertips and thumb. May add closed-cell padding before conforming splint, and for hand splints ** maintain longitudinal, distal, proximal, and transverse arches

Creative Play

4-7 yrs refine skills, cooperative peer groups -child engages in sensory, motor, cognitive and social play experience -child explores combinations of actions on multiple objects -child begins to master skills that promote performance of school and work related activities -child participates in cooperative groups

Games

7-12 years -plays with rules, competitions, social interaction, and opportunities from development skills -participates in cooperative peer groups with a growing interest in competition -friends become important for the validation of play

Games

7-12 yrs -child plays with rules, competition, social interaction, and opportunities for developing skills -child participates in cooperative peer groups with a growing interest in competition -friends become important for validation of play

Strategies for resolving ethical problems

-Determine type of problem (issue, distress or dilemma) -Identify the specific ethical or legal issue -Find the facts and additional information need to obtain a solution to the problem -Determine the people or organization involved that may influence the issue/resolution -Formulate a possible resolution -Identify the resources available to assist in resolving the issue -Determine the best course of action and the rational for taking that action -Identify what happens after the best course of action is taken to determining whether it was the best choice

Releasing skills: 0-1 month

-Development progresses from no release

Hospice

-Acceptance criteria is based on terminal illness that has a life expectancy of 6 mths or less -OT evaluation is focused on determining the individuals occupational functioning and physical, psyosocial, spiritual, and environmental needs that are most important to the client. -OT intervention focuses on maintenance/control over life, engagement in meaningful occupations, QoL, reduction/removal of distressing symptoms, environmental modifications, caregiver/family education

PEO Model: Evaluation

-Address the occupational performance issues that the client identifies -Emphasizes the environment of the individual to include where they live, work, and play (there are no specific evaluations) Interventions -Consider the transactional relationship of occupations with people and their environment to address issues/goals -Recognize the temporal nature of occupational performance as the person, environment , and occupations are constantly changing

Corrected Age

-Adjusted age applied to premature infants -Used to consider achievements of developmental milestones -Calculated by subtracting the weeks of prematurity from chronological age

Audiologist

-Administers assessments to determine an individuals auditory acuity, level of hearing and impairment in the auditory system

PEO model: Intervention

-Consider the transactional relationship of occupations with people and their environment to address occupational performance issues and goals -Recognizes the temporal nature of occupational performance as the person, his/her environment, and occupation as constantly changing -Offer many avenues for change -Support a family-centered approach -Recognizes the influence of culture and value in implementing the evaluation process -For evaluation/intervention of older children, support their values and perceptions as individual and in the context of family and community -Consider environment as both an area for evaluation and a change element for intervention

Medical coverage of durable medical equipment, prostheses, and orthotics

-Covered if used in clients home and is reasonable to treat an illness/injury or to improve function -A physician prescription is needed and must include diagnosis, prognosis, and reason for need

18-23 months (stair climbing) Gross Motor Skill

-Creeps backwards down stairs

15 months (stair climbing) Gross Motor Skill

-Creeps up stairs

9-10 months (walking ) Gross Motor Skill

-Cruises around furniture, and can turn slightly in intended direction

8 months (walking ) Gross Motor Skill

-Cruises sideways

Scissor skills 6-7 years

-Cuts complex figure shapes.

Gastrointestinal Changes : Other Systems Changes and Adaptions in the Older Adult

-Decreased salivation, taste, smell, inadequate chewing, & poor swallowing reflex may lead to poor dietary intake/nutritional deficiencies -Esophagus: acid reflux and heartburn, hiatal hernia common -Stomach: decreased digestion and absorption, indigestion common -Decreased intestinal motility, constipation common

5-6 months (standing ) Gross Motor Skill

-Decreased support needed to stand may be held up by arms or hands -Bounces in standing position

Vestibular processing disorder

-Deficits in modulation -hypersensitivity to movt, aversion to movt impacting on the sympathetic system -Hyposensitivity to movt; indiv seeking intense vestibular stim w/o c/o feeling dizzy and tendency to be a thrill seeker -gravitational insecurity: excessive fear during typical activs, esp when feet off ground, when moving backwards/upwards in space, walking on uneven terrain, jumping, getting on/off elevators, using any moving playground equip, handling minimal heights -vestibular discrim deficits: symptoms demonstrated on a SUBTLE level -low muscle tone -postural-ocular deficits -decreased balance and equilibrium reactions -deficits in bil coord -low endurance -deficient motor planning/sequencing -behavior responses: diff with attn, organization of beh, communication

Outcomes of poor nutrition in the elderly

-Dehydration is common in the elderly, resulting in fluid and electrolyte disturbances: 1) thirst sensation is diminished 2) may be physically unable to acquire/maintain fluids 3) Environmental heat stresses may be life threatening and should be treated as medical emergencies -Diets are often deficient in nutrients, especially vitamins A and C, B12, thiamine, protein, iron, calcium, vitamin D, folic acid, and zinc -Increased use of alcohol or taste enhancers (eg. salt and sugar) influences nutritional intake -Drug/dietary interactions influence nutritional intake (eg. reserpine digoxin, anti-tumor agents, and excessive use of antacids)

Forearm: Muscle Actions

-Deltoids: Anterior: shoulder flexion, medial rotation , Middle: shoulder abduction , Posterior: extension, lateral rotation -Triceps: Elbow: extension, adduction -Anconeus: Elbow: extension -Biceps brachii: Forearm supination -Brachialis: Elbow: Prime mover of flexion -Brachioradialis : Elbow: flexion

Nurse Practitioner

-Depending on the state's scope of practice, can serve as primary care provider, prescribe medication, and complete referrals for occupational therapy and other rehabilitative services

Workers' Compensation

-Designed to compensate employees who have job related injuries or illness -Include cash benefits and medical benefits including OT services

Certified prosthetist (CP)

-Designs, fabricates, and fits prosthesis for individuals to ensure proper fit and to promote functional abilities

Procedure for developing a group

-Conduct a needs assessment to identify intervention needs -Develop the protocol -Present the protocol to the treatment team or program administrators -Select potential members who would benefit from the group -Meet with each potential member to explain the purpose and circumstances of the group -Hold introductory sessions of the group and revise the protocol as needed

Assessments of Pain

-Determine location of pain -Evaluate intensity (0-10 scale) -Identify time of day the pain is most intense -Determine onset and duration of pain (gradual vs sudden) -Determine the length of time patient has been experiencing pain -Common descriptors: sharp, throbbing, tender, burning, shooting, aching

Stroke/CVA diagnosis

-Diagnosed clinically using symptoms as a guide to lesion location. -Infraction visualized using CT scan (May initially read negative) -Arteriography -PET and SPECT scanning is used to distinguish between infarcted and non-infarcted tissue -MRI: ruled out other conditions and screens for acute bleeding -Diagnostic Testing -ECG: To detect arrhythmias -Echocardiography : used to evaluate presence of cardiac emboli and cardiac disease - Blood work to rule out metabolic abnormalities

Assessment of Nutrition

-Dietary history: patterns of eating, types of food -Psychosocial: mental status (SLUMS TESTING), desire to eat, depression, grief, social isolation, social support -Body composition -Weight/height measures -Skin fold measurements ( triceps/scapular skin fold thickness) -UE circumference -Dental and periodontal diseases, fir or dentures -Ability to feed self: mastication, swallowing, hand/mouth control, posture, physical weakness and fatigue -Integumentary: skin condition, edema -Compliance to special diet -Functional Assessment: BADLs, feeding, overall exercise/activity level, amount and type of social participation.

Methods of supervision

-Direct: face-to-face contact between supervisor and supervisee (includes co-treatment, observation, instruction, modeling, and discussion) -Indirect: non face-to-face contact between supervisor and supervisee (includes electronic, written and telephone communications)

Individuals with Disabilities Education Act (IDEA)

-Directly addresses the students functional performance along with academic performance -Requires that all students with disabilities be assessed in compliance with the No Child Left Behind Act

Osteogenesis Imperfecta (Etiology)

-Disorder caused by the dysfunction of one of several genes responsible for producing collagen to strengthen bones -The genes responsible for OI can be inherited from one or both parents -In some cases, the OI genes responsible for collagen begin to malfunction after the child is conceived.

Occupational Therapy Interventions: Median Nerve Laceration

-Dorsal protection splint; wrint in 30* flex if there is a low lesion, include elbow w/ 90* flex for high lesion -Begin A/PROM of digits w/ wrist in flex position 2wks post-opt, scar management -AROM of wrist 4wks; include elbow if high lesion -Strengthen at 9wks, Spinting w/ C-bar to prevent thumb add contrature, sensory re-education (Semmes-Weinstein)

Complex Regional Pain Syndrome (CRPS) (stage 2)

-Dystrophic typically last from 6-9 months after injury or trauma -Symptoms include: extreme pain, hypersensitivity, brawny edema, skin redness and warm to touch, bony demineralization, muscle atrophy, and joint contracture

OT Interventions :Pain

-Educate about contributing factors -Assist in identifying and responding adaptively to pain behaviors (positive reinforcers, educational support) -Assist with developing strategies and using techniques to manage pain —Teach coping skills/stress management/ assertive communication -Provide relaxation training (deep breathing, guided imagery) (yoga, tai chi, ai chi) -Refer to other professionals for direct pain -Establish a realistic daily activity program (improve overall levels of conditioning) (energy conservation techniques)

OT Conservative Treatment: Cubital Tunnel Syndrome

-Elbow splint to prevent positions of extreme flexion (especially at night) -Elbow pads to decrease compression of the nerve when leaning on the elbow -Activity/work modifications -Surgical interventions: decompression or transposition -Positive operative treatment: edema control, scar management, AROM and nerve gliding (2wks post-opt), strengthening (4wks post-opt) -MCP flexion splint if clawing noted

Personal Payment and "Pro Bono" care

-Individuals without health insurance or with no coverage for rehabilitation services may elect to pay for OT out-of-pocket -Services of OT in non-medical settings (e.g. wellness and prevention programs) are generally not covered by insures (private pay) -"Pro-Bono", free, and/or reduced rate care may be supported by the individual therapist's personal donation of services or through philanthropic donations

Six to twelve month ( 6-12 month)

-Infant becomes more mobile -Development of fine motor planning skills -Development of midline skills and eventually crossing midline -Development of sound for the purpose of communication -Primitive self-feeding occurs

6- 11 months (sitting ) Gross Motor Skill

-Infant can get to sitting position from prone position

Spinal Cord Injury (SCI) Medical Management

-Prevention of further cord damage via stabilization -Traction and rest for unstable injuries -Surgery with internal fixation -Diuretic prescription to decrease inflammation -Bladder care -Decubiti prevention -Control of autonomic dysreflexia and orthostatic hypotension -Prevention of thrombus formation -Treatment for heterotopic ossification

Oral Motor Development

-Prior to 33 weeks gestation, an infant is fed by nonoral means -At 35 weeks of gestation or after: jaw and tongue movements are strong enough to allow for feeding -40 Weeks of Gestation: rooting reflexes, gag and cough reflex are present for up to 4 months, protecting the airway and decreasing the chances of aspiration -At 4-5 months: munching occurs, consisting of a phasic bite and release of a soft cookie -6 Months: strong up and down movement of the tongue -7-8 Months: beginning of mastication of soft and mashed foods with diagonal jaw movement -9 Months: lateral tongue movements make mastication of soft and mashed foods effective, able to drink from a cup; however, jaw is not firm -12 Months: jaw is firm, there is rotary chewing allowing for a good bite on a hard cookie -24 Months: able to chew most meats and raw veggies

Mulitidisciplinary Team

-Professionals from different disciplines -Conducting assessments and interventions independent from one another -Formal communications occur between disciplines -Each member has a primary allegiance to his/her discipline -Limited communication/ lack of understanding of different perspectives -Resources and responsibilities are individually allocated between disciplines -Competition among teams members may develop

Complications: Cerebral Palsy

-Seizures occur in 50% of children -Language and cognitive deficits occur in 50-75% of children - including: language deficits, difficulty coordinating breathing/swallowing, dysarthria, aphasia -Visual impairments occur in 40-50% of children including: strabismus (crosseyed), nystagmus (involuntary eye movements) , myopia (nearsightedness) , hyperopia (farsightedness), presbyopia (decreased elasticity of the lenses causing difficulty in accommodation focusing on objects nearby, and focusing from near to far) -Feeding disturbances (e.g difficulty swallowing and chewing) -Diminished sensation is common in plastic hemiplegia

18 months (walking ) Gross Motor Skill

-Seldom falls -Runs with eyes on the ground

School Function Assessment (SFA)

-Purpose: assess and monitors functional performance in order to promote participation in a school environment (Does not measure academic performance) -Method: criterion referenced-questionnaire that assesses: level of participation, type of support currently required, and performance on school related task -Scoring: 2 mechanisms: 1. Basic level: low score indicates a performance that does not meet expectation, Advanced levels: 0 to 100 and indicates appropriate grade level functioning

Test of Playfulness (ToP) (Play Assessment)

-Purpose: assesses a childs playfulness based on observations according to 4 aspects of play -Method: behaviors are based on : intrinsic motivation, internal control, disengagement from reality, and framing. Extent, intensity, and skill fullness of play are observed and rated -Scoring: 25% percentile or below indicates the need for intervention -Population: 15 months to 10 years

Test of Visual-Motor Skills (TVMS) and : Upper Level (TVMS-UL) (Visual Motor and Visual Perception Assessment)

-Purpose: assesses eyes hand coordination skills for copying geometric designs -Method: copy and draw geometric designs that sequentially become more complex, 23 geometric forms scored for 8 possible error (16 in TMVS-UL) for 9-22 possible errors . W/ test behavior being documented -Scoring: scores are translated into motor age, standard scores, and percentile ranking. Information is used to establish a treatment plan. -Population: (TMVS) 2 to 13 years, (TMVS-UL) 12 to 40 years

Play History (Play Assessment)

-Purpose: assesses play behavior and play opportunities -Method: primary caregiver provides information about a child in 3 categories including: general info, previous play experience, and actual play that occurs over 3 days -Scoring: description of play is obtained, and play dysfunction is determined. A treatment plan is developed based on strength and deficits -Population: children and adolescents

Test of Visual Perception Skills (3rd edition ) (TVPS-3) (Visual Motor and Visual Perception Assessment)

-Purpose: assesses visual perception skills and differentiates these from motor dysfunction (motor response not required) -Method: 7 visual perception skills including: visual memory, visual-spatial relationship, visual form constancy, visual sequential memory, visual figure-ground, and visual closure (behavior observed during the test is recorded) -Scoring: visual perceptual problems are determined by standard scores below 80 and percentile ranks below 25%. Information is used to establish intervention programs, and deficits which impact learning -Population: 4 to 19 years

Developmental groups

-Purpose: assist members to acquire&develop group interaction skills; offer 5 Levels of Interaction: 1) Parallel groups-individ tasks w/minimal interaction 2) Project groups-conisist of common, short term activities requiring some interaction & cooperation 3)Egocentric cooperative groups-req joint interaction on long-term tasks,BUT completion of task isn't focus, members JUST BEGINNING to express their needs & wants & address those of others 4)Cooperative groups-learn to work cooperatively, not specifically to complete a task but to enjoy each others company & meet emotional needs 5)Mature groups-responsive to all members needs & carry out a variety of tasks. Good balance btwn carrying out task & meeting members needs

Child Autism Rating Scale (CARS) (Psychological and Cognitive Assessments)

-Purpose: determines the severity of autism, and distinguishes child with autism to those with developmental delay -Method: observational tool is used to rate behavior 15 descriptive statements including: characteristics, abilities, and behaviors that deviate from the norm -Scoring: below 30 = no autism, 31 to 36.5 = mild to moderate autism, 37 to 60 = severe autism -Population: children age 2 years who have mild, moderate, or severe autism

Motor-Free Visual Perception Test-Vertical (MVPT-V) (Visual Motor and Visual Perception Assessment)

-Purpose: evaluation of individuals w/ spatial deficits due to hemi-field neglect or abnormal visual saccades -Method: 36 items vertically placed are used to assess spatial-relationship, visual discrimination, figure-ground, visual closure, and visual memory (including motor components) -Scoring: raw score are translated into perceptual ages/quotients, inadequate performance is determined as a score of 85 or less -Population: children and adults with visual field cuts or without visual impairments

Radial Nerve Laceration

-Sensory loss: high lesions at the level of the humerous (fingers 1,2,3, and radial side of ring) -Motor loss: low lesion at the level of the forearm (wrist exten due to impaired ECU) (MCP extension) (thumb exten) -Motor loss: high lesion at the level of the humerous (all of the above including brachioradialis) (maybe loss of triceps/ elbow exten) -Functional loss (inability to exten digits/drop objects) -Deformity: wrist drop OT Interventions: Dynamic exten splint, ROM, sensory re-education, home program, activity modifications

Scapula: Upward Rotation #2

-Serratus Anterior long thoracic nerve, stabilize the scapula during elevation and to pull the scapula forward and around on the thoracic cage. origin: ribs 1-8 and aponeurosis of intercostals insertion: superior and inferior angles of scapula and vertebral border of scapula

Pastoral care

-Serves as the spiritual advisor to the individual, his/her family, caregivers, and the team

5-6 months (prone position) Gross Motor Skills

-Shifts weight on forearms and reaches forward -Bears weight and shifts weight on extended arms -Equilibrium reactions are present

Physical reaction to disability

-Shock: initial reaction (emotional numbness, reduced speech/mobility -Anxiety: a panic-stricken reaction to the seriousness of the situation -Denial: retreat from the realization/seriousness of the situation -Internalized anger: resentment and bitterness (blaming) -Externalized anger: attempts to retaliate (aggression) -Acknowledgement: the 1ST STEP TOWARDS ACCEPTANCE (identification of values and goals) -Adjustment: an emotional acceptance of the situation and reintegration into identified roles (positive sense of self)

Reaching skills: 9 months

-Shoulder: flexion, external rotation -Elbow: extension -Forearm: supination -Slight wrist extension begins to emerge

Scissor skills 2-3 years

-Shows an interest in scissors -Holds & Snips with scissors -Opens & closes scissors in a controlled fashion

8-10 months (sitting ) Gross Motor Skill

-Sits well without support -Variety of side positions , including "w" sit and side sit -Difficulty with fine motor task

Skin conditioning in the rehabilitation stage of burn treatment includes:

-Skin lubrication- should be performed several times daily to prevent dry skin from splitting because of shearing forces or over stretching during movement or exercise -Use skin massage to desensitize the hypersensitive grafted sites or burn scars. Massaging a tight scar band can reduce shearing forces and prevent splitting of immature or problematic scar tissue -Use sunblock or avoid unprotected sun exposure

5-6 years ( Jumping and Hoping) Gross Motor Skills

-Skips on alternating feet, maintaining balance

Casters

-Solid core: are the best for indoor smooth surfaces

Spinal Cord Injury (SCI) Specific Symptoms

-Spinal Shock (4-8 wks) all reflex activity is obliterated below level of injury presenting as flaccid paralysis -Sensory deficits may be partially lost or complete -Paraplegia/Quadraplegia: loss of tone below the level of the transection -Loss of bowel/bladder control -Loss of temperature control below the lesion -Decreased respiratory function -Sexual dysfunction -Changes in muscle tone (spasticity; upper motor neuron lesion/ Flaccidity: in lesions below L1) -Loss of motor function resulting in tetraplegia (quadriplegia) or paraplegia may be complete or incomplete

First six month (6 months)

-Vestibular, visual, and proprioceptive system lay the foundation for postural control facilitating a stead visual field -Tactile and proprioceptive system lay the fountain for the development of sensory motor skills -Visual and tactile system continue to develop and allow the child to reach out and grasp objects, a foundation for hand-eye coordination -Movement patterns progress from reflective to voluntary and goal-directed

Leg lifter

Assistive device used to move the LE into bed or raise the leg when in bed, constructed of a sturdy fabric with loops on both ends; smaller loop is used as a handle and the larger loop is placed around the foot for lifting

Parkinson's Disease

A neurodegenrative disorder of the central nervous system that affects movement, often including tremors with deterioration in the substania nigra -idiopathic, slowly progressive, and degenerative with onset of symptoms usually after 40 -affects the nerve cells in the brain that produce dopamine. -Parkinson's disease symptoms include muscle rigidity, tremors, and changes in speech and gait. After diagnosis, treatments can help relieve symptoms, but there is no cure.

Specificity: Assessment responsiveness:

A test ability to accurately detect functional and performance abilities (i.e true negative)

Sensitivity: Assessment responsiveness

A test ability to accurately detect impairments or decreased performance abilities (e.g true positive)

Nectar thick: dysphagia diet

A thickened liquid consistency for safer swallowing that is a progression from thin liquid -may be natural or thin liquid prepared with thickening gel or powder, such as -tomato juice, fruit nectar, and egg nog

Assistive technology transmission method: Ultrasound

A type of assistive technology transmission method in which desired household appliances are connected to EADL through sound frequencies

Surgical debridement

A type of debridement that involves surgically removing damaged or nonviable tissue with a sharp instrument.

sematic memory (explicit)

A type of declarative long-term memory associated with the retrieval of common knowledge including vocabulary and general facts, (facts, concepts) (e.g colors, names of political leaders, capitals of countries)

Parallel group

A type of group in which members work or play independent of each other with little to no interaction

Project group

A type of group in which there is specific, outcomes-based activity or project -group members have some interaction through sharing and cooperation

Standing-aid lift

A type of lift system that assists the client to transfer into a standing position

Stratified sampling

A type of probability sampling in which the population is divided into groups with a common attribute and a random sample is chosen within each group -selected from a population's identified subgroups based on a pre-determined characteristic (e.g. by diagnosis) that correlates with the study

Portable lift

A type of safe patient-handling equipment that can beasily moved from one location to another Types include: manual portable lift electric portable lift

Overhead track lift

A type of safe patient-handling equipment that is a combination of an overhead railing system and an electric lift system used to transfer a client from one surface to another

Wheelchair accessory: Armrest

A wheelchair accessory that supports a client's upper extremity; the selected style depends on the needs of the user Options include: fixed - provides support for the upper extremity flip back - allows for sliding board transfer desk length - provides easier access to a table standard length - allows the client to use UE to assist in sit-stand transfer

Wheelchair accessory: Lap tray

A wheelchair accessory used for various purposes, including: upper extremity positioning and support solid surface to perform functional activities

Assessment of Preterm Infants' Behavior (APIB) (Neonates)

A widely used behavioral tool specifically designed to document the spectrum of full-term as well as preterm newborn infants' neurobehavioral functioning. -Purpose: assess infant's pattern of developing behavioral organization in response to increasing sensory and environmental stimuli -Method: Behavior checklist and scale -Population: Pre-term and full-term infants -Score: Scores reflect the degree of facilitation provided by the examiner; Function and integration of the physiological, motor, state, attentional/interactive, and regulatory systems are determined; eye movements and asymmetry of performance are measured

Bayley Scales of Infant Development (BSID) (Development Assessment)

A widely used standardized test conducted to measure infant/ toddler development/cognitive abilities, such as intelligence. Purpose: Evaluates 5 domains, (performance-based) 1. Cognitive, 2. Language, 3. Motor, 4. Social-emotional, 5. Adaptive behavior skills Method: Select age appropriate items from each domain, parents answer 2 questionnaires Population: 1 to 42 months Score: qualitative descriptors and performance levels of each domain, use the results to plan interventions for any detected delays

Automaticity

Ability to perform activities using an automatic response or habit, involves less attention to detail of the procedural steps intervention strategies may include -linking a new activity with an existing one -ensuring consistency in instruction, step, and environment

Generalization of skills

Ability to transfer a newly learned skill across a variety of contexts and activities, facilitated by: -maintaining client motivation -contextually relevant practice -direct exposure to a task

Ataxia

Abnormal movement pattern secondary to cerebellum lesion, resulting in lack of smooth coordination muscle movements, behavioral manifestations include: -slurred speech (dysarthria) -difficulty with alternating movements ( dysdiadochokinesia) -staggered gait (ataxic gait) -swallowing difficulties (dysphasia) Overshooting/undershooting suring reach (dysmetria)

Control group

The participants in an experiment who are as much like the experimental group as possible and who are treated in every way like the experimental group except for a manipulated factor, the independent variable. -they closely match the experimental group but don't receive the study protocol -used for comparison to help isolate the independent variable

Natural settings

The physical and social environment in which a client typically participates in meaningful occupations

Credibility: Trustworthiness

The researchers level of confidence that his/her findings truthfully reflect the reality of the study participants and the study context -no preconceived notion about the study -enhanced through varied field experience including: journaling, sampling, triangulation of data, interviewing techniques, and member checking

Universal design

The term used to describe feature considerations for products and spaces that are intended to benefit users of most sizes and abilities without special adaptation or modification

Community programming

Theory driven, evidenced-based programs for members of the target group or population developed in response to results of the community health needs assessment

Applied Behavior Analysis (ABA)

Therapeutic approach used to enhance school function, positive behaviors, and socialization through intensive therapy consisting of reinforcement and daily structure

Mechanism of burn

Thermal: heat, cold, scold, flame Radiation: sunburn, x-ray, radiation therapy for cancer patients Chemical: acid, alkali Electrical: high and low voltage

Honey thick: dysphagia diet

Thickened liquid consistency so that it drips from the spoon for safe swallowing, progression from nectar-thick that may be prepared with thickening gel or powder

Preservation

Thinking or talking about the same thing repeatedly with the biliary to independently redirect, may occur following a TBI (brain injury) or cognitive dysfunction

Melbourne Low Vision ADL Index

This tool assesses the impact of a person's visual impairment on ADLs and IADLs

Latissimus dorsi (shoulder extension)

Thoracodorsal nerve, Extends, adducts, and medially rotates the arm; draws the shoulder downward and backward (crucial in maintaining balance.) origin: T6-T12. L1-L5, sacral vertebrae, ribs 9-12, iliac crest and inferior angle of scapula insertion: intertubercular groove of the humerus adduction: performing a pull-up or chin-up or when pulling a heavy object down from a shelf above one's head extension: swinging the arms while walking as well as during rowing exercises. medial rotation: folding the arms or touching the elbow on the opposite arm.

Trustworthiness criteria

To attain rigor in qualitative research, trustworthiness of the study should be critiqued, and strategies to increase trustworthiness should be used. -Credibility -Transferability -Dependability -Confirmability

Paratransit services ( community mobility)

Transportation alternatives operated by the transit system for clients who have functional impairments that limit their access to regular services -Most typically offered in the form of a van, shuttle, or micro bus bus services that pick-up riders outside of their house and take them to specific locations. Some services offer customized assistance, however most require that the rider by functionally able to meet the vehicle at the street

Fixed-route transportation (community mobility)

Transportation alternatives with a fixed route and schedule for travel between destinations. Fixed-route transportation is most typically offered in the form of bus, subway, train, and light rail. Performance skills required:

Demand-responsive

Transportation is provided between a specific point of origin and specific destination requested by the traveler. Demand-responsive service travels on a requested as opposed to a fixed route but may require advance reservations and may or may not include physical assistance for the client.

Spinal Cord Injury (SCI)

Trauma tas a result of compression, shearing force, and/or contusion -Secondary to motor vehicle accidents, penetration wounds (gunshot/ knife), sport injury, or fall -Non-traumatic cord injury may be the result of tumor, or progressive degenerative disease

Dignity

Treating each client respectfully as an individual by enabling the client "to engage in occupations that are meaningful....regardless of level of disability"

Telehealth

Treatment delivery model that involves delivery of professional services using telecommunication technology when the practitioner and client are in different settings

School-based therapy

Treatment delivery model where educationally-relevant services are delivered to students in the school environment

Home health

Treatment delivery model where services are delivered in the client's home, if the client meets the definition of "home-bound" and requires medically necessary skilled services

Air-filled wheelchair seat cushion

Type of wheelchair seat cushion with the following characteristics: bladder design with adjustable inflation level provides even distribution of pressure relief lightweight design feature potential for air pressure variability inherent in overall design

Gel-filled wheelchair seat cushion

Type of wheelchair seat cushion with the following characteristics: -contains viscous filling -minimizes shear forces -provides effective equal pressure distribution -heavier and harder to maintain -may cause moisture build-up

Caster cart

Type of wheeled seated mobility device that enables a child with limited lower extremity function navigate on flat surfaces, can be self-propelled, with option for battery operated joystick, may be difficult to maintain upright sitting for children with tight hamstrings or LE contractures

Guyon's Canal Syndrome: (Ulnar Tunnel Syndrome)

Ulnar and Nerve Compression/Entrapment at the wrist (rare peripheral nerve neuropathy) C8-T1 of the brachial plexus Etiology: injury through compression, inflammation, trauma or vascular insufficiency: Hook of Hamate fracture, tumor, (repetition, ganglion pressure/cyst, and facia thickening, positive tinel's sign, symptoms on ulnar side) Hypothenar Hammer Syndrome (HHS) is a unique mechanism of ulnar nerve injury secondary to ulnar artery thrombosis and/or aneurysm Symptoms: sign and symptoms can be purely motor, purely sensory, or mixed. Hypothenar atrophy may be present in advance stages numbness and tingling, and pin & needles feeling in the ulnar nerve distribution on the hand (ring & pinky). Before progressing to a loss of sensation and/or impaired function of the intrinsic muscles of the hand that innervate the ulnar nerve. Risk: cyclist, Treatment: depends on duration/ severity of symptoms conservative: neutral wrist splint (nighttime 12wks), work/activity modification (avoiding mechanical compression/ repetitive stress of canal) Surgical intervention: decompression post-op: edema, AROM, gliding, strengthen grip (2-4 wks), sensory re-education

Cubital Tunnel Syndrome

Ulnar nerve entrapment which occurs when the Ulnar nerve in the arm becomes compressed or irritated Usually is felt in the ring and small finger. Second most common sight of nerve compression Etiology: Pressure or stretching of the ulnar nerve ; Elbow (also known as the "funny bone" nerve), The ulnar nerve can be compressed at the (the groove between the medial epicondyle and the olecranon of the ulna) at the elbow. Higher level Causes: Prior fracture or dislocations of the elbow Bone spurs/ arthritis of the elbow Swelling of the elbow joint Cysts near the elbow joint Repetitive or prolonged activities that require the elbow to be bent or flexed Symptoms: Pain (pin/needles), positive Tinsel's sign at elbow • Loss of sensation • Tingling • Weakness (of power grip) • Parathesis, atrophy (FCU & FDP to digits IV and V) • Numbeness Advance Stages: weakness and atrophy at the hypothenar muscles and thumb abductors Abductor digiti minimi, Flexor digiti minimi brevis Opponens digiti minimi Treatment: Non-surgical treatment: Non-steroidal anti-inflammatory medicines, Bracing or splinting, Nerve gliding exercises. Surgical Treatment, Ulnar nerve anterior transposition, Medial epicondylectomy, Cubital tunnel release Cubital tunnel release. In this operation, the ligament "roof" of the cubital tunnel is cut and divided. This increases the size of the tunnel and decreases pressure on the nerve Splinting: Elbow flexion block splint Gel padding Elbow positioning 30-40 degrees of extension 3-5 days: dressing removed, edema control Active and gentle PROM exercise (elbow, forearm, and wrist) 10 min 2hrs per day 10-14 days: 48hrs after sutures removed (scar massage), manual desensitization exercises 6 wks: progressive strengthening exercises (1lb) 6-8 wks: may return to normal use

Common names of restriction orthoses

Names commonly used to describe this category of orthotic device include: buttonhole PIP extension orthosis anticlaw buckle orthosis MCP joint ulnar deviation orthosis Meunster orthosis May be included as part of an orthotic prescription to help identify an orthosis using non-modified orthosis classification system nomenclature

Esophageal phase of swallowing

Phase of swallowing that is highly influences by client's positioning and involves: -return of upper esophageal sphincter to tonic state -passage of food through the esophagus to the stomach phase in which esophageal peristalsis carries the bolus through the esophagus and LES and into the stomach

Common names of mobilization orthoses

Names commonly used to describe this category of orthotic device include: tenodesis orthosis radial nerve palsy orthosis palmar abduction orthosis dynamic flexion assist orthosis interphalangeal flexion orthosis May be included as part of an orthotic prescription to help identify an orthosis using non-modified orthosis classification system nomenclature

Orthotic Nomenclature: Anatomical descriptors

Naming convention used to describe the anatomical location of an orthosis for outpatient billing and reimbursement purposes, based on the Healthcare Common Procedure Coding System (HCPCS) Examples include: elbow wrist hand finger orthosis (EWHFO) wrist hand finger orthosis (WHFO) hand finger orthosis (HFO)

Social story

Narrative used to promote social participation or a skill to children, written to prepare children how to act and respond in a variety of contexts Consists of four types of sentences: descriptive directive perspective control/affirmative

Unilateral spatial neglect

Neurobehavioral deficit characterized by the inability to interact with stimuli on the contralateral side to a brain lesion (e.g., bumps into walls with the affected side of body) Interventions may include: awareness training limb activation lighthouse strategy partial visual occlusion scanning techniques videotaped feedback environmental adaptation

Developmental dyspraxia

Neurodevelopmental disorder (also called developmental coordination disorder) - Characterized by: clumsiness and poor coordination motor planning deficits learning difficulties perceptual deficits (visual and motor)

total hip replacement precautions

No flex hip flex past 90, no ADD or crossing legs, no IR or ER rotation , no hip pivots, sit only on raised services, sit to stand with hip slightly ABD & extended, no side lying -Bed mobility: DO NOT roll on non-operated side (may result in IR) /dislocation

Rancho Level 1: No Response

No response: total assistance -complete absence of observable change in behavior when presented visual, auditory, tactile, proprioceptive, vestibular or painful stimuli

Quasi-experimental research

Non-randomized research study design used to determine whether an intervention or program has a causal impact on participants

Autonomic Dysreflexia (Irritants)

Normal cause pain to areas below the spinal injury: -Bowel: constipation/impaction -Bladder infection, UTI, blocked catheter -Skin: irritation, decubitus ulcers, ingrown toenails, burns -Sexual activity: over stimulation, pelvic pain, menstrual cramps, labor and delivery -Other: heterotopic ossification, skeletal fractures, and appendicitis

Functional Capacity Evaluation (FCE)

Objective evaluation process, also referred to as work capacity evaluation/assessment, to determine functional and physical abilities related to essential job tasks

Wrinkle Test

Objective measure of sympathetic responses used to test peripheral nerve function by immersing client's hand in warm water for approximately 5 to 15 minutes

8-9 months (early object use)

Objects in container Child combines objects in relation to play

Continuing competence

Obligation to enhance professional knowledge and skills on an ongoing basis to deliver best practice services and protect stakeholders, may include: -engaging in professional development -assimilating evidenced based information -acquiring a new practice-related skill

Home Environment Assessment Protocol (HEAP)

Observation and interview-based assessment used to identify need for home modification -given to caregiver of clients who have dementia -scored on safety hazards, functional adaptions, clutter and comfort

Canadian Occupational Performance Measure (COPM)

Occupational performance evaluation and outcome measurement tool that measures perceived capacity and satisfaction in the areas of self-care, productivity, and leisure

Hearing: Sensory System Changes and Adaptions in Older Adults

Occur as early as age 40, and effecting a significant number of elderly -Hearing loss in men is twice the rate than in woman, and also starts earlier

Feeder chair

Positioning aid that provides trunk support for feeding or other short term activity adjustability allows for upright or reclined position

rooting reflex

Onset: 28 wks - 3 mths Stimulus: stroke at the corner of the baby's mouth, lip (upper/lower) Response: tongue, mouth, and head towards the stimulus (nipple) searching for and locating feeding source Relevance: Allows searching for and locating feeding sources

sucking and swallowing reflex

Onset: 28wks Integration : 2/5 mths Stimulus: Place index finger inside of mouth w/ head in midline Response: strong rhythmical sucking Relevance: Allows ingestion of food

Non-standardized sensory screening: Stereognosis

Procedure used to determine the ability to identify small objects, includes occluding the client's vision and placing a common object in the hand (e.g., coin, block, safety pin, screw, sponge) and asking the client to identify the object one at a time

Non-standardized sensory screening : Kinesthesia

Procedure used to determine the ability to sense joint position in space, involves moving a joint in a specific direction and asking the client to identify which direction the joint is being moved

Non-standardized sensory screening: Temperature awareness

Procedure used to screen discrimination of warm and cold stimuli, includes touching skin in an alternative manner with tubes filled with warm and cold water Client responds with a "Warm" or "Cold"

Professional licensure

Process by which a profession is regulated by a government agency at the state level in order to protect the public from unqualified practitioners Sets forth a high standard of professional conduct to which licensed personnel are held accountable

OT program evaluation

Process of assessing the quality of professional service and specific programs in relation to: -effectiveness -efficiency -outcomes

Traumatic Brain Injury (TBI)

Open- penetration of the skull . -Closed- rapid acceleration or deceleration of brain, or blunt external force -Coup- tissue injury at the point of impact -Countrecoup- tissue damage at the opposite pole, and different diffusely along the frontal and temporal lobe Injury can occur from a variety of occurrences including: Skull fracture, Closed head injury, Penetrating wounds of the skull and brain

Orthotic devices

Orthosis used to prevent contractures and provide stability to joints involved -AFO: ankle-foot -KAFO: knee-ankle-foot -HKAFO: hip-ankle-knee-foot

Monitoring

Process of continually reviewing the effect of interventions on the client to determine if services should continue or if modifications to the plan are needed

Home modification process

Process of identifying and eliminating structural barriers in the living environment to improve accessibility and support engagement in occupation

Caregiver adaption

Process of modifying perception, action, and skills, by the person providing care, based on the needs of the recipient of care

Performance appraisal

Process of receiving formal feedback on job performance from a supervisor. Including: -establishing expectations and career goals -accomplishment review

Peer review

Process of receiving verbal or written feedback from colleagues regarding job performance -may be used to enhance the self-assessment process, and/or integrate a continuing competency plan

Work conditioning

Program focusing on returning a client to work, may: -include restoring ability and capacity associated with work related tasks -precede work hardening program

Age Discrimination in Employment Act of 1967

Prohibits discrimination against workers over the age of 40 and restricts mandatory retirement

Dialectical Behavior Therapy (DBT)

Promising treatment for borderline personality disorder that involves exposing the client to stressors in a controlled situation, as well as helping the client regulate emotions and cope with stressors that might trigger suicidal behavior. -A form of cognitive behavior therapy based on the tenet that emotional states are affected by cognitive processes, intervention may include: -mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness

Caregiver Strain Index (CSI)

Questionnaire administered to caregivers to identify potential concerns related to the caregiver role -given to caregivers who provide assistance to an older adult -a score of 7 or higher indicates need for further assessment

Group task roles

Roles that individuals in a group assume to accomplish task related to the overall objective for the group Type: information provider/ seeker, energizer, recorder, leader/facilitator

Rancho level VIII

SBA; purposeful and appropriate actions (attends to task in distracting environment for 1 hour, more flexibility in thinking and better problem solving, low frustration tolerance) Consistently oriented to person, time, and place, independently attends to and completes familiar task for 1 hour in distracting environment, uses assistive memory devices (to do list), and record critical information for later use with SBA, requires no assistance once new task/activity is learned, my exhibit expression, irritable, able to recognize inappropriate social behavior and takes corrective action with min A

Axillary Nerve Injury

Saturday night palsy, crutches, fracture of surgical neck of humerus weakness of the abduction of shoulder -Peripheral nerve injury characterized by hyperesthesia (increase in sensitivity) on the lateral aspect of the shoulder and weakness of the deltoid and tres minor

Primary Literature

Scientific literature that includes original research studies or sources of information

Secondary Literature

Scientific literature that summarizes, references, or analyses original sources of information

Would healing: Profliferation

Second stage of wound healing that begins by day three after injury, includes: would revascularization scab formation would re-epithelialization (new skill layer) fibroblasts initiating contraction erythema and beginning of scar formation

Manic or monopolizing behavior

Select or design highly structured activities that hold the individual's attention and require a shift of focus from patient to patient Thank individual for participation and redirect attention to another group member Limit setting

Manual wheelchair

Self-propelled or attendant-pushed wheelchair available with a wide variety of customizable options: frame type, size, and weight wheel type and axle location foot (unilateral or bilateral) or arm propulsion accessories for positioning.

Transparent film dressing

Semi-occlusive wound care dressing that can be used as a primary or secondary dressing and act as a waterproof barrier

Presbycusis : hearing loss

Sensorineural hearing loss associated with middle and older ages; characterized by bilateral hearing loss, especially at high frequencies at first, then all frequencies; poor auditory discrimination and comprehension, especially with background noise; tinnitus

0-3 months (standing ) Gross Motor Skill

Takes some weight onto legs when held into standing position

Pre-driving task

Task that are completed prior to operating a motor vehicle (e.g. getting to the vehicle, transferring into the car, manipulating the key for functional use, opening and closing car door(s), loading the mobility device(s), adjusting seat and controls, and securing the seat belt

Scar management

Technique best used six to 12 weeks after would closure to minimize the risk of adhesions, contracture, hyperthrophy or hypersensitivity. Interventions include: mobilization orthoses (e.g., applying sub-maximal stretch) massage (e.g., graded vibration, manual) desensitization (e.g., graded touching, textures) ROM (e.g., active exercise and passive stretch) thermal modalities (e.g., ultrasound, moist heat)

Pursed lip breathing

Technique used to control dyspnea/shortness of breath by inhaling through the nose, with mouth closed, followed by slow exhale through pursed lips -A technique of exhaling against pursed lips to prolong exhalation, preventing bronchiolar collapse and air trapping; done to increase expiratory airway pressure, improve oxygenation of the blood, and help prevent early airway closure.

Passive stretch

Technique used to slightly increase the length of muscle fibers: achieved either mechanically (e.g use of orthoses) or manually (e.g slow and controlled PROM -Stretch requiring an assist from an external source (gravity, a partner, or some other source

Compensatory swallowing maneuvers

Techniques recommended to facilitate safe swallow during the pharyngeal phase (only considered with clients who are alert, attentive, and able to follow directions), examples include: chin tuck Mendelsohn maneuver supraglottic swallow super-supraglottic swallow

Joint protection strategies

Techniques used to minimize stress or prevent excessive forces on a joint during daily tasks Principles include: using the largest joint possible for the task sliding items and performing tasks bilaterally modifying the environment considering adaptive equipment

Guillain-Barre Syndrome (GBS)

Temporary paralysis caused by an autoimmune attack on peripheral myelin (demylenating cranial nerves), causing weakness (starting at the feet) and usually ascending paralysis of the limbs, face and diaphragm -Etiology unknown, but may occur after infectious disorder, surgery, or an immunization -Affects both males and females at any age, and recovery can take 2-3 wks after first symptoms -Symptoms inlcude: acute, rapid, progressive forms of weakness, numbness, and burning pain (polyneuropathy) including distal sensory loss (parethesias) (acute 2-4weeks, plateau for a few days or weeks with a progressive recovery in 2 years -Pt may complain of painful extremities, and may experience deep tendon loss, respiratory failure, dysphasia, and respiratory support (severed case

Friction Force (Ff)

Term used in orthotic fabrication that describes the amount of force generated by the orthotic materials and the amount of contact force, typically lessened by using: smooth thermoplastics proper-fitting straps rounded edges foam-lining or gel padding stockinette

Intrinsic-plus position

Term used in orthotic positioning, commonly referred to as the "anti-deformity" or "safe position" of the hand, intended to place the MCP joint collateral ligaments in an elongated position to reduce contracture risk Consists of: wrist in neutral or slight extension finger MCP joints in 75-90o of flexion finger IP joints in complete extension thumb in abduction and opposition

Orthotic Nomenclature: Design descriptors

Terms traditionally used to describe characteristics of orthotic devices that may be included as part of an orthotic prescription to help identify an orthosis using non-modified orthosis classification system nomenclature, examples include: digit-based forearm-based hand-based arm-based thumb-based digit-based digit-based

Stereopsis

The ability to see 3-dimensional objects and perceive depth, may be impaired by: -monocular vision: having no vision in one eye with adequate vision in the other (one blind eye) humans hav binocular vision -strabismus: crossed eyed -eyes don't look exactly in the same direction at the same time (impacts: reaching for objects, and reading)

Sensory Modulation Disorder

The inability of the CNS to regulate responses to sensory inputs from common stimuli resulting in hyper-responsive, hypo-responsive, and sensory seeking behaviors

Mechanical lift transfer

Use of a hydraulic or powered frame in conjunction with a hammock-like seat to move a client requiring maximum physical assistance from one surface to another

Psychiatric Rehabilitation

_Eliminating barriers and promoting health ans wellness -The goal is to help individuals develop the skills necessary to compensate for, adapt to, and/or control the influence symptoms have on function, including any disabilities caused by social or environmental barriers -Principles: include individualization, client involvement, partnership with service providers, community -based services, strengths-focused , situational assessments, holistic approach, vocational focus, skills training, environmental modifications, evaluation of outcomes -Evaluation: real life situations that will provide accurate data specific to an individuals environment, and activity at a moment in time, Individuals with a mental disability have to make a conscious effort to overcome it. The effort include acknowledging one has a disability and overcoming stigma or other barriers that may hinder recovery. Intervention: Assist the individual with psychiatric disabilities to perform all skills needed to live and work in the community at their highest functional level with the least amount of professional support. Restoring function and role performance in the community. Interventions take place where the person chooses to live, work, and socialize. Day program include clubhouses; where the goal is to improve QoL by instilling self-worth and determination in its members. Vocational rehabilitation: a natural activity where individuals are capable of achieving success. (supported services as needed on the job or as a consultation

Eating disorder

a category of mental disorders characterized by severe disturbances in eating behavior -A serious emotional and. Physical disorder including extreme preoccupation with food, body image, and weight -Intervention: cognitive behavior therapy, group therapy, and family therapy

ideomotor apraxia

a condition where a person plans a movement or task, but cannot volitionally perform it. Automatic movement may occur, however, a person cannot impose additional movement on command

Delusion

a false belief, often of persecution or grandeur, that may accompany psychotic disorders -unfounded belief contrary to the reality of the situation or environment, may be a symptom of schizophrenia

Akathisia

a feeling of muscle quivering, restlessness, or inability to sit still -allow the person to move around as needed if it can be without causing distractions -keep in mind participation on many levels/forms can be beneficial -select gross motor activities whenever possible

multidisciplinary team

a group of professionals from different disciplines who function as a team but perform their roles independent of one another -regular communication regarding client progress in discipline specific goals occur through written and verbal methods

Interval scale

a scale of measurement in which the intervals between numbers on the scale are all equal in size Ex. Performance rating on a 0 to 10 scale 8.2, 9.1, 9.6

Ordinal scale

a scale of measurement in which the measurement categories form a rank order along a continuum Ex. Rank order of winners (3rd, 2nd, 1st finish line

Pain

a sensory and emotional experience associated with actual or potential tissue damage

Sociological Theory (Aging

a set of ideas that explains a range of human behavior and a variety of social and societal events -Activity theory: socially active older persons exhibit improved adjustment to the aging process -Disengagement theory: distance or withdrawal from society -Dependency: increasing reliance on others for meeting physical and emotional needs

Denver Developmental Screening Test (DDST) (Development Assessment)

a standardized task performance and observation screening tool Focus: Early identification of children at risk for developmental delay in 4 areas: 1. Personal-social, 2. Fine motor-adaptive, 3. Language, 4. Gross motor skills Method: 125 test items, are administrated below the child chronological age with sequential progression towards higher items until child fails 3 items. Behaviors are observed during the screen, questionnaire for home/environment screening Population: 1 month to 6 years Score: Test scores indicate the chronological age (appropriate/delayed), screening allows for performance based on normal/abnormal 4 areas

Null Hypothesis (H0)

a statement that the performance of treatment groups is so similar that the groups must belong to the same population; a way of saying that the experimental manipulation had no important effect -predicts outcomes related to the manipulation of variables

Analysis of Variance (ANOVA)

a statistical technique that determines whether three or more means are statistically different from one another -used to compare two or more treatment groups or conditions at a selected probability level

Fasciotomy (emergent phase)

a surgical incision through the fascia to relieve tension or pressure

Skilled nursing facility

a type of nursing home that provides the most intensive nursing care available outside of a hospital -subacute inpatient setting providing medical services and rehabilitation for up to 100 days for clients with hospital-related medical conditions

Privacy circle

intervention that addresses social skills by teaching the client about social boundaries through use of concentric circles - (e.g family and close friends are identified in an inner circle to the client and a customer at a grocery store are place in an outer ring to the client

Procedural reasoning

involves using evidence-based evaluation methods and interventions techniques to support progress towards improving occupational performance

Flexor pollicis longus (FPL

median nerve, flexion of IP joint of thumb origin: radial, middle 1/3rd insertion: distal phalanx of thumb

Flexor digitorum superficialis (sublimis) (FDS)

median nerve, flexion of PIP joints origin: medial epicondyle insertion: middle phalanx (2 slips)

Opponens pollicis

median nerve, opposition of thumb origin: trapezium, flexor retinaculum insertion: first metacarpal

Flexor pollicis brevis: superficial head

median nerve, thumb MCP flexion, deep head innervated by ulnar nerve origin: trapezium, trapezoid, capitate and flexor retinaculum insertion: base of proximal phalanx, radial side of thumb

Visual Scanning

movements of the eyes from one location or object to another, the ability of the eyes to systematically search -impairments may cause: decreased visual attention, difficulty reading and navigating

Interpersonal events

naturally occurring communications, reactions, processes, tasks, or general circumstances that take place within the context of the client-therapist interaction -that can strengthen or weaken a therapeutic relationship

Avulsion injuries

occur when the tendon separates from the bone and its insertion and removes bone material with the tendon

Neuromas

painful nerve endings that adhere to scar tissue -very painful and hypersensitive

contralateral hemiplegia

paralysis occurring on 1 side of the body opposite to side of brain lesion

Anxiety Disorders

psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety -emotional condition characterized by an abnormal reaction, overwhelming fear and uncontrollable thoughts resulting in a physiological response impacting daily function

Personality Disorders

psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning -disturbance of personality traits, behaviors inconsistent with societal norms and expectations, problems with interpersonal relationships

Extensor pollicis brevis (EPB)

radial nerve, extension of MCP and CMC joints of thumb origin: radius, middle 1/3rd insertion: proximal phalanx of thumb

Extensor indicis proprius (EIP)

radial nerve, extension of MCP joint of the 2nd digit and contributes to extension of the IP joints origin: ulna, middle 1/3rd insertion: inserts into EDC at MCP level

Extensor digitorum communis (EDC)

radial nerve, extension of MCP joints and contributes to extension of the IP joints origin: lateral epicondyle insertion: medial band to middle phalanx and lateral band to distal phalanx

Extensor carpi radialis brevis (ECRB)

radial nerve, extension of the wrist and radial deviation origin: lateral epicondyle insertion: 3rd metacarpal, base

Extensor carpi radialis longus (ECRL)

radial nerve, extension of the wrist and radial deviation origin: supracondylar ridge of the humerus insertion: 2nd metacarpal, base

Quantitative Research

research that collects and reports data primarily in numerical form -Development of specific question: very specific, detailing the exact variables to be studied -Selection of the research design: the design is highly standardized -Observation: structured and formalized -Written questionnaires: structured

Qualitative Research

research that relies on what is seen in field or naturalistic settings more than on statistical data -Development of specific question: a broad question called a "query" is used to develop specificity over the course of the study -Selection of the research design: the design is more fluid -Observation: unstructured and ever-changing according to the contexts and results of the observations -Written questionnaires: unstructured

Reflective Stage: Sensorimotor Period ( Hierarchical development of cognition)

scheme begin in response to reflexes: 1 month

Phantom Limb Pain

sensation of the presence of the amputated limb but is also painful

Specific assessments for wheelchair prescription

sensory: risk for ulcer (special seat and cushion) neuromuscular: poor trunk control requires postural supports musculoskeletal: physical limitations (power wheelchair prescription)

Mobility management

services that promote collaboration and cooperation among transportation providers and connect clients to those providers

Best-corrected vision

sharpest, clearest vision attainable by the client, under the best circumstances, using vision out of the best eye, with standard corrective lenses (glasses or contacts)

Travel Training

short-term, direct, and intensive training to teach older adults and people with disabilities to use fixed-route public transportation safely and independently

Contemplation stage: Transtheoretical Model

stage of change in which people are considering changing behavior in the next 6 months -Client starts to weigh the pros and cons of change and considers making changes in the future

Maintenance stage: Transtheoretical Model

sustained change over time; begins 6 months after action has started and continues indefinitely -Client is committed to maintaining behavior change and is working to prevent relapse

Craig Handicap Assessment and Reporting Technique (CHART)

the CHART measures participation after disability (encompassing the role of an individual in the larger community); the CHART is made up of 32 questions and covers six domains (Physical, Independence, Cognitive, Independence, Mobility, Occupation, Social Integration, and Economic Self-Sufficiency) Website on p.472 -Measure the extent to which a clients disability impacts level of participation in everyday life activities

Principle 2 of Universal Design Flexibility in use:

the design accommodates a wide variety of individual preferences and abilities

Restlessness

the inability to rest or relax as a result of anxiety or boredom. A neurobehavioral impairment that results in a decreased ability to remain still or relax

Accomodation

the process by which the eye's lens changes shape to focus near or far objects on the retina

Activity Analysis

the process in which the steps of an activity and its components are examined to determine the demands on the client -Process of identifying task demands and abilities required to perform the task, and/or the environmental factors affecting performance

long-term memory (life-time)

the relatively permanent and limitless storehouse of the memory system. Includes knowledge, skills, and experiences. -Strong information for an extended duration of time includes: episodic, sematic, and procedural

Dynamic Systems Theory

the view that development is a self-organizing process, in which new forms of behavior emerge through consistent interactions between a biological being and cultural and environmental contexts -includes an appreciation for transactional relationships between person, environment, and occupational performance to support participation (versus a hierarchal model)

Self-Determination Theory (SDT)

theory of human motivation in which the social context of an action has an effect on the type of motivation existing for the action -Autonomy over selection of life roles and activities -Perceived success -Being connected with an effective social network to gain results in satisfaction

Interpretation (acting behavior in children)

therapist puts words to the observed behavior enabling the child to appropriately express the feelings he or she is experiencing

Thalamus (diencephalon)

two gray matter nuclei deep within the brain, responsible for relaying sensory information to the cortex

Emotional lability

unstable and rapidly changing emotions and mood -A neurobehavioral impairment characterized by a rapid change in mood that is often disproportionate to the circumstances or the expected emotion

Bed rope ladder

used to assist with sitting up from the supine position, secured at the foot of the bed and positioned within reach of the client

Convenience sampling

using a sample of people who are readily available to participate -participants are selected who meet population criteria based upon availability to the research

Supplemental transportation

volunteer, nonprofit, or community-based transportation options serving older adults and people with disabilities who either are unable to use existing transportation services or desire more flexible travel options -Senior friendly transportation: 5 "A's" availability, acceptability, accessibility, adaptability, and affordability -Supplemental transportation for seniors is important because most U.S. older adults who cease driving, ride as passengers in private automobiles rather than use public transportation

Life skills group

Group intervention approach to address acquisition of or barriers to specific skills that promote participation in occupation, may include practical exercises related to: - daily living tasks - conflict resolution - anger management - communication skills - time management - responsibility - clarification of values

Social skills group

Group intervention approach with focus on interactive activities that may address: empathy development relationships with others nonverbal and verbal communication skills social interactions

Muscular Dystrophies/Atrophies

Group of degenerative disorders resulting in muscle weakness and decreased muscle mass due to a hereditary disease process, -Due to absent muscle protein product, dystrophin and begins in infancy/childhood, and adulthood -Average age of diagnosis is 5 years unless this is a known family history -Progress may be rapid and fatal(frequently results in death), or may remain stable throughout life -Major types include: Duchenne's, Becker, Arthrogryposis, Limb-girdle, Spinal, Congenital myasthenia gravies , Charots-Marie-Tooth disease, Myopathies -Symptoms include: low muscle tone, weakness (contributed to abnormal movement and deformities of extremities and spine), delayed developmental milestones, difficulties with oral motor feeding, difficulty with breathing (may require tracheostomies/ventilator) -Medical Management: prevention of skin breakdown and decubitus ulcers

Internal memory strategies

Group of techniques to aid in mentally organizing cognitive information for retrieval at a later time Therapeutically used in conjunction with external strategies, examples include: visual imagery grouping similar information mnemonically

Advocacy

Guiding individuals or groups to independently learn information, communicate opinions and needs, secure necessary services, and influence change

Sensorimotor group

Intervention used in primarily in pediatric and geriatric settings, includes the provision of sensory experiences through movement or play in a therapeutically structured group

Muscle grade 3

-fair strength observed where movement is noted against gravity Fair: full ROM against gravity with no resistance applied -antigravity position

Social autopsy

intervention technique in which a client is asked to reflect on a social event to consider behaviors and motivations associated with the situation

Scale and thermometer

intervention technique that addresses self-regulation skills that can assist a client in recognizing, quantifying, and describing energy level and emotion

Assessment of the travel context : General consideration

- assessing travel contexts when considering the IADL of community mobility including: available transportation options, accessibility of resources, and policy reviews

Anterior Cord Syndrome

- caused by flexion injuries - occurs when 2/3 of the anterior cord is lost - loss of motor function, pain, pinprick and temperature sensation lost bilaterally below the lesion* (*flaccidity* below the lesion) -proprioception and light touch are preserved

Dietician/clinical nutritionist

- evaluates individuals nutritional status and dietary needs - provides nutrition therapy for diseases such as diabetes and preventative counseling for issues such as obesity

Wound classification

-Pressure ulcer staging system ;1-4 -Burn degrees 1-4 levels including Rule of 9 or Lund -Browder chart -Marion Laboratories : wound description by color, including red, yellow, and black

5-6 months (release) Gross Motor Skill

-Two stage transfer, taking hand grasp before releasing hand lets go

Stroke/ CVA Modifiable Risk Factors

- hypertension -obesity -cardiac disease -sedentary life style -arterial fibrillation -stress -diabetes mellitus -high cholesterol -smoking -alcohol abuse -hyperlipidemia

Cerebral Arteriovenous Malformation (AVM)

-Abnormal, tangled collections of dilated blood vessels -result from congenitally malformed vascular structures

Bilateral hand use 12-18 mo

-Uses both hands for different functions

Anticontracture position: anterior neck burn

Characteristics of this anticontracture position includes: neck in extension do not use a pillow when supine in bed use a neck collar or neck extension orthosis

Central Cord Syndrome (Syringomyelia)

- Incomplete SCI - commonly occurs in elderly) -most common form of SCI: w/ loss of arm/hand sensation -related to arthritis and *hyper extension of the neck* - *Bilateral loss of pain & temperature* - *Flaccidity of the UE (affects UE more than LE)* -Resulting from hyperextension injuries and presenting as more UE deficits

Smith's Fracture

(2nd most common distal radial fracture) Ventral displacement Known as a reverse Colles' fracture, these fractures are extra-articular transverse fractures Etiology: Complete fracture of the distal radius with palmar displacement of the distal fragment. - young males (most common) and elderly females 1, -Osteoporosis can increase likelyhood Causes: • Fall onto a flexed wrist • Direct blow to the back of the wrist -Car crash, Fall off bike Symptoms: -Numbness, Tingling, Pink finger, Wrist appears bent in wrong angle Treatment/Splinting: Depends on the type of fracture, stability and ability to successfully reduce the fracture. • In most cases, these fractures can be treated with closed reduction and cast application • Internal fixation to hold the fragment in alignment for healing (If the fracture can be reduced but remains unstable, or cannot be reduced): Wrist-cock-up splint (Type I) extra-articular transverse fracture through the distal radius most common: ~85% (Type II) intra-articular oblique fracture equivalent to a reverse Barton fracture ~13% (Type III) juxta-articular oblique fracture uncommon: <2%

Trigger Finger

(Digital Stenosing Tenosynovitis) of the finger flexors most commonly the A1 pulley. Characteristic symptoms is an inability to perform smooth digital flexion/extension most often involving the ring and thumb (trigger thumb) , but can occur in all other fingers Etiology: The A1 pulley becomes inflamed or thickened, making it harder for the flexor tendon to glide through it as the finger bends. Over time, the flexor tendon may also become inflamed and develop a small nodule on its surface. When the finger flexes and the nodule passes through the pulley, there is a sensation of catching or popping. This is often painful. Woman/Children are more likely than men to develop trigger finger, and differential diagnosis including flexor tendon masses medical conditions: diabetes and rheumatoid arthritis, gout, carpal tunnel syndrome, and Dupuytren's Contracture and/or forceful activities: repetition and use of tools that are placed too far apart may be associated Conservative Treatment: hand-based volar splint (MCPJ extension 0* neutral position/ IPJ free), scar massage, edema control, tendon gliding, activity/work modifications: avoid gripping, perform hook-fist exercises w/ splint 20 reps. Night gutter splints are used to correct contracture. Operative Treatment: Surgical release of the A! pulley

Skier's Thumb

(Gamekeeper's Thumb) Rupture of the ulnar collateral ligament of the MCP joint of the thumb -Trauma to the thumb, due to sudden and forced stretching in an outer direction (fall onto an outstretched hand) -etiology: Acute injury to a ligament of the thumb, and often seen among skiers. Most common cause is falls while skiing with the thumb held in a ski pole Symptoms: Tenderness, Swelling, Bruising: (along the inner aspect of the thumb at the first knuckle), Loss of side-to-side stability Thumb will be unstable at the 1st knuckle (if torn) Conservative treatment: • Thumb splint (4-6wks) • AROM and pinch strengthening (6wks) • ADLs: that require opposition and pinch strength Post-operative Treatment: • Thumb splint (6wks), AROM, PROM can begin at (8wks), and strengthening at (10wks) Thumb immobilization splint w/ CMC joint in 40 degree of palmar abduction Post-operative treatment: thumb spiinting (thumb immobilization splint) for 6wks followed by AROM. PROM (8wks) and strengthening at 10wks

0-3 months (sitting ) Gross Motor Skill

(Held in sitting position) -Head bobs -back is rounded -Hips are apart -sits with less support

5-6 months (sitting ) Gross Motor Skill

(Supports self in sitting) -Sits alone momentarily -Sits by propping forward on arm -Protective response present when falling to the front

Rheumatoid Arthritis (RA)

(autoimmune disease) -Systemic, chronic disease that symmetrically affects many joints. (most commonly small joints) synovial inflammation (synovitis) Etiology: Unknown: 2 main theories (1) Infection theory (2) Autoimmune theory Affects woman more than men between 40-60 yrs of age. with individualized therapeutic treatment. Most commonly affects the joints of the hands, feet, wrists, elbows, knees and ankles Symptoms: pain, stiffness, limited ROM, fatigue, weightless, swelling, deformities, (ulnar deviation & subluxation) (Boutonniere deformity) (Swans Neck deformity) limited/diminished ability to perform ADLs -Characterized by remissions and exacerbation -Begins in the acute phase as an inflammatory process of the synovial lining

Superficial burn

- 1st degree -superficial epidermis -pain min to mod; w/ no blisters or erythema -healing time is 3-7 days

Charcot-Marie-Tooth disease

- A degenerative nerve disease that usually appears in adolescence or early adulthood. - A group of hereditary disorders that damage the nerves in the arms and legs. -Typically occurs in teenage years or earlier

Functional impairments related to aging changes

- Ability to see close objects and coordinate eyes decreases - Images become blurrier - Ability to see at night decreases - Eyes adapt more slowly to light-dark conditions - Contrast sensitivity decreases - The ability to view objects with low light decreases - The ability to distinguish certain colors diminishes - Visual fields become narrower

Psychoeducational groups

- An intervention approach that uses a classroom format and principals of learning to provide info to members and to teach skills. - Teacher/student relationship - Uses homework assignments

Terminal devices (TDs)

- Function to grasp and maintain hold on an object - The two main types of TDs are the hook and the hand: 1) voluntary opening (VO) = hook remains closed until tension is placed on cable and then it opens 2) voluntary closing (VC) = hook remains opened until tension is placed on cable and then it closes - Determination of the most appropriate TD is based upon the person's interests, roles, and preferences (TDs can be interchangeably used with prosthesis if the shaft size is the same)

Prosthetic Treatment

- Functional training with prosthesis: practice engagement in activities of interest and occupational role activities - Donning and doffing the prosthesis - Increased prosthetic wearing tolerance - Individualize treatment to enhance physical and psychological adjustment

State Regulatory Board and Relationship to Ethics

- If the board investigates a complaint and finds the practitioner violated the state's regulations, it may discipline the practitioner in a variety of ways, including sanctions: disciplinary actions including; supervision, continuing education on specific topics, fines, educational meetings, review of records, suspension of state license, certificate, or registration; and revocation of the ability to practice in that state

Hip Fracture: Precautions

- Weight-bearing (WB) status & ROM determined by MD, -Time frames determined by MD

Multiple Sclerosis (MS)

- most commonly diagnosed Neuro-Degenerative white mater lesions: causing destruction of the myelin sheath on neurons in the CNS and its replacement by plaques of sclerotic (hard) tissue -A disease in which the immune system eats away at the protective covering of nerves, resulting nerve damage disrupts communication between the brain and the body. -Occurs most often between the ages of 20 and 50 (often diagnosed in 30's) -Symptoms include: multiple varying neurological symptoms and sign, usually with remission and exacerbation (onset is gradual) -abnormal sensation w/ tingling and/or pricking (paresthesia) in one more extremities, weakness, clumsiness, diplopia (eye patch), partial blindness, involuntary eye movement (nystagmus), eye pain, emotional disturbances, balance loss and/ vertigo bladder dysfunction, memory loss, spasticity, ataxia, weakness, gait instability, feast fatigue, hemiplegia (one-side), quadriplegia , management of bowel and bladder may require catheterization -causing fluctuation in energy levels

Cerebral Palsy (CP)

- neurological condition caused by brain injury or malformation occurs while the brain is developing (before, during, or following birth) causing impaired: movement in gross/fine motor, coordination, reflexes, posture, balance, and oral motor function -characterized by lack of muscle control/ partial paralysis, -caused by injury and/or a brain defect or lesion present at birth or shortly after -Common cause include: is lack of oxygen, intracranial hemorrhage.s -Detected usually by 12 months of age, may present as hypotonia, development of spasticity -Child may present with: - primitive reflexes and automatic reactions, -hyperresponsive reflexes, clonus, variable tone, -asymmetry, involuntary movements, feeding difficulties (oral motor impairments), -cognitive and developmental delay -Location and severity of the lesion determines the type of cerebral palsy: spastic, dyskinetic, ataxic, jerky muscle spasm, difficulty with bodily movements

Primary open-angle glaucoma (POAG) (Peripheral Vision Loss)

- progressive condition and the most common cause of irreversible blindness -a normal appearing anterior chamber angle and raised intraocular pressure (IOP) with no other underlying disease -fluid build-up that cause pressure inside the eye to rise to a level that may cause damage to the optic nerve (vision loss may result)

Symbolic Play 12-16 months (milestones in cognitive development)

-"make believe" play primarily involving self Ex. Eating, sleeping

Deep partial thickness burn

-2nd degree burn -Involves the epidermis, deep portion of dermis, hair follicles, and sweat glands -Appearance: red to white, and elastic -Sensation may be impaired -Potential to convert to full thickness burn due to infection - Healing 21-35 days OT Evaluation: -same as Superficial OT Intervention: -Wound care and debridement (sterile whirlpool/ dressing changes)

CVA: Middle cerebral artery (MCA)

-: contralateral hemiplegia, hemianesthesia, homonymous, hemianopsia, -left middle cerebral: aphasia and apraxia -right middle cerebral: unilateral neglect and spatial dysfunction

Arthrogryposis Multiplex Congenita (AMC)

-A condition characterized by a generalized lack in the newborn of muscular development and growth, with contracture and deformity at most joints detected at birth and associated with loss of anterior horn cells -It is the most common form of arthrogryposis. -UE positions of rest include: shoulder: internal rotation, elbow: extension, wrist: flexion -LE position of rest include: hip: flexion and internal rotation, and club feet -Condition may be stable, mildly progressive, or may improve -Related problems include: congenital heart defects, spinal defects, severe contraction/ rotation of the neck involving the diagram

Spinal Muscular Atrophy (SMA)

-A disease that robs people of physical strength by affecting the motor nerve cells in the spinal cord, taking away the ability to walk, eat, or breathe. - Caused by a decrease in motor neuron protein - It is the number one genetic cause of death for infants. Depending on Type 1-4 -Symptoms include: weakened of the voluntary muscles of the shoulder, hips, thighs, and upper back (spinal curvature) -Type I: birth/infancy known as Werdnig-Hoffman disease with a life expectancy of 2 years -Type II: children: detected at 6mth to 3 years of age with a life expectancy of early childhood -Type III-IV: older children, later onset with a less severe form . Type IV: adolescent or adult: later onset, less severe form

Congenital myasthenia gravis

-A disorder involving transmission of impulses in the neuromuscular junction -Onset starting near birth and occurring more frequently in males

Dialectical Behavior Therapy (DBT)

-A form of CBT Addresses suicidal thoughts, actions, and self injuring behaviors A form of therapy used to treat BORDERLINE PERSONALITY DISORDER (due to suicidal thinking and behavior) -Also used to treat patient that have depression, substance abuse issues and/or eating disorders Evaluation: -begins with a DMS diagnosis -A variety of psychological evaluations may be used, including those that address personality -teaching assertiveness, coping and interpersonal skills - a strong therapist-client relationship is essential ( rapport is used for validation as well as confrontation)

Proffered Provider Organization (PPO)

-A form of managed care that is similar to an HMO but usually offers greater choice of providers, as choices increase, percentage of payment decreased

Vision: Sensory System Changes and Adaptions in Older Adults

-A general decline in visual acuity; gradual prior to 60, rapid decline between ages 60 to 90. -Visual loss may be as much as 80% by age 90

macular degeneration (MD)

-A gradually progressive condition in which the macula at the center of the retina is damaged (decreased blood cells) , resulting in the loss of central vision -Increased sensitivity to glare, difficulty adjusting to light changes , and may progress to total blindness

Managed care (MCO's)

-A health care system whose goals are to provide cost effective quality care. -Managed care organizations include: HMO's and PPO's

Americans with Disabilities Act of 1990

-A law passed in 1990 that requires employers and public facilities to make "reasonable accommodations" for people with disabilities and prohibits discrimination against qualified persons with disabilities in employment, transportation, accommodation, telecommunication, and public services Reasonable accommodations: -modification of equipment or devices -provision of ancillary aids or services -modification of part-time work schedules -improvement of existing facilities so that they are usable to persons with disabilities

Documentation Guidelines

-A legal record of the clients condition, evaluation, and re-evaluation results, and the course of therapeutic interventions, and response to those interventions from referral to discharge (including EHR) -All documentation must be current, accurate, charted objectively, written legibly, no criticize, don't destroy documentation, and don't leave vacant lines. -Person first language should be used at all times (e.g person's with dementia) -The blocking out or deflection of information is unexcitable, and errors must be crossed out with a line, initialed, and dated (black/blue ink) -OT notes and records are legal documents, and are therefore subject to subpoena

shift: manipulation skills

-A linear movement of an object on the finger surface to allow for repositioning of the object to the fingers pads. 3-5 years: separating 2 pieces of paper 3-6 years; rolling a piece of clay into a ball 5-6 years: shifting on markers/pencils

Pronator Teres Syndrome (Proximal Volar Forearm)

-A median nerve compression between the two heads of the pronator teres -Etiology: repetitive pronation/supination and excessive pressure on the volar forearm -Symptoms: CTS symptoms, along w/ aching pain in the proximal forearm -Positive Tinel's signs at the forearm, w/ no nighttime symptoms Conservative Treatment: elbow splints at 90* w/ forearm in neutral -Avoid repetitive forearm activities w/ pronation/supination Surgical Interventions: decompression -Positive operative Treatment: AROM, nerve gliding exercises, strengthening (2wks post-opt), sensory reeducation, work/activity modification

Physical Therapist (PT)

-A medical professional who attempts to reduce dysfunction in the musculoskeletal system by improving joint mobility, muscle strength, balance, and coordination; also called a physiotherapist -Evaluates clients' physical motor skills

fibromyalgia syndrome

-A musculoskeletal pain and fatigue disorder that can vary in intensity. -widespread pain accompanied by tenderness of muscles and adjacent soft tissue -nonarticular rheumatic disease of unknown origin

Physiatrist

-A physician who specializes in physical medicine and rehabilitation with the focus on restoring function -Diagnosis and medically treats individuals with musculoskeletal, neurological, cardiovascular, pulmonary, and/or other body systems disorders

Psychologist

-A professional with a Ph.D in psychology -Evaluates psychological and cognitive status -Provided individuals, couples, family, and group supportive therapy, cognitive retraining, and behavior modification

Life-Style Performance Model

-A psychosocial frame of reference Developed by Gail Fidler -Principles: -The Life-Style Performance Model seeks to identify and describe the nature and critical "doing" elements of an environment that support and foster achievement of a satisfying productive life-style -It proposes a method for looking at the match between that environment the individual's needs -Four hypotheses are proposed: 1)"Mastery and competence in those activities that are valued and given priority in one's society or social group have greater meaning in defining one's social efficacy than competence in activities that carry less social significance" 2) "A total activity and each of its elements have symbolic as well as reality-based meanings that notably affect individual experiences and motivation" 3) "Mastery and competence are more readily achieved, and the sense of personal pleasure and intrinsic gratification is more intense, in those activities that are most closely matched to one's neurobiology and psychological structure" 4) "Competence and achievements are most readily seen and verified in the end-product or outcome of an activity; thus the ability to do, to overcome, and to achieve becomes obvious to self and others" (Fidler, 1996, pp. 115-116) -Performance and quality of life can be enhanced by an environment that provides for ten fundamental human needs -Performance is measured in the quality of functioning in four domains: 1) self-care and maintenance; 2) intrinsic gratification 3) service to others 4) reciprocal relationships

Standard score

-A score used in standardized testing -Also referee to as (Z-value) and (Z-scores), that is used to make comparisons across variables and across populations or individuals

Medicaid: (Aid for Families with Dependent Children)

-A state/federal health insurance program for persons who have income that is below threshold and.or have a disability -Although occupational therapy is recognized as a covered service under Medicaid, it is an optional, rather than mandatory, benefit for states to include in their programs. -As long as states cover certain "mandatory benefits," they can also choose whether to provide other "optional benefits," like OT, PT, and SP or leave them out of their Medicaid program.

Athroplasy

-A surgical procedure used to rebuild or replace a synovial joint

Peer review

-A system in which the quality of work of a group of health professionals is reviewed by their peers

Intervention Group Types

-ADL/IADL groups, Basic task skill groups, Community participation/reintegration groups, Coping skills groups Discharge planning groups, Goal setting groups, Play groups Pre-vocational groups, Psycho-educational groups, Reminiscence, Self-awareness, Sensory awareness, Social interaction groups

Acute Phase: Evaluation and Intervention

-ADLs, psychosocial aspects, communication, cognition, ROM, muscle strength, and pain (E) - splinting and positioning in anti-deformity positions (I) -edema control (I) -early participation in ADLs, (I) -client and caregiver education (I) -anti-contracture positioning: critical because the position of greatest comfort to the patient is usual the position of contracture

Intrinsic Muscles Innervated by the (Median Nerve)

-Abductor pollicis brevis -Opponens pollicis -Flexor pollicis brevis: superficial head -Lumbricals (radial side)

Stereognosis

-Ability to perceive and identify an object by touch without visual or auditory cues by using tactile information to provide cues through texture, size, spatial properties, and temperature. (e.g identify a light switch in a completely dark room ) -also known as haptic perception or tactile gnosis (parietal lobe lesion) Stereognosis Test: determine whether or not the parietal lobe of the brain is intact

0-3 months (supine position) Gross Motor Skill

-Able to turn head from side-to-side

Bilateral hand use 2.5 years

-Able to use 2 hands for very different functions emerge

Home Healthcare

-Acceptance for services is based on presence of a medical or psychiatric condition that does not warrant hospitalization, and/or a condition that still has remaining symptoms requiring active treatment -Treatment is usually provided in 60-minute sessions, once a day for up to 5 days a week -Length of stay (LOS) is deterred by diagnosis, presenting symptoms, response to treatment, insurance, and pay per services fees. -OT evaluation is focused on client factors, functional performance skills/deficits, patterns, areas of occupation, and roles for expected environment -OT intervention focuses on engagement/implementation in treatment planning, functional improvement in areas of occupation, remediation of performance skills, education of client/family and caregiver, environmental modifications, increasing ability to resume roles, and prevention of hospital admission avoidance of institutional placement

Early Admission Programs

-Acceptance is based on "at risk" of infant to toddler under the age of 3 -Acceptance includes: birth complications, developmental delay, failure to thrive, substance abuse, birth-adolescents teen mothers, established disability and/or diagnosis -Length of service provision: qualifying infants/child family service plan is completed by the service coordinator after a review with family and in collaboration with intervention team -6 mth review are submitted by all professionals to determine if services should continue -OT evaluation focus is on 5 developmental areas including: cognition, physical, communication, social-emotional, and adaptive -OT intervention focus includes: cognitive/process, psychosocial. Communication/interaction, and sensorimotor skills development development of play, ADLs, family education, advocacy and training -Transition planning from early intervention to preschool is essential

Vocational program

-Acceptance is for the development of specific vocational skills (ongoing structure, support and/or supervisor to maintain employment -Length of stay (LOS) is determined by agency's funding and attainment of goals (e.g. rehabilitation workshop, supportive employment) -Transitional employment programs are generally time limited (3-6mths) with-discharge to competitive/supportive employment, or rehab workshop -OT evaluation focus is on the individuals functional skills and deficits related to work in current/expected vocational environment -OT intervention focus is on remediation of underlying performance skills, deficits, and compensation for client factors that effect work performance. Development of general work abilities an specific job skills is warranted. -Discharge: is not always a goal

Wellness and prevention programs

-Acceptance is most often by individual self-referral to meet a personal need, or by institutional provisions of a program members or employees -Developed to serve populations that are considered at risk or in office/residential community settings -OT evaluation focuses on risk factors for illness and disabilities, functional skills and deficits, and roles that are required/expected in that environment -OT intervention focuses on prevention and health promotion, and can range from traditional OT to contemporary areas of concern.

Schools

-Acceptance of OT is as related to educational setting -The child requires special education services, and OT will enable the child to benefit from special education -Referrals are received from previous agency that provided early intervention services, the child's teacher, and/or school study team - LOS is dependent on : If OT services can improve the child's ability to participate in education-related activities and allow full access to the general education curriculum, services can be continued -Assessment of the child's functional developmental level contributes to the Functional Behavioral Analysis -OT evaluation focus is based on the education model to address functional performance along with academic performance using both corrective and compensatory methods. Performance skills deficits are treated to improve the child's ability to participate and perform education-related activities . Skills in performance areas of ADL, school and play are developed to improve the childs ability to participate in the school setting

Recovery Model

-Active use of the recovery model can help practitioners -empower people by fostering their intrinsic motivation to redefine self and establish a sense of hope for the future -PRIMARY FOCUS: improve QoL and the ability to attain desired life goals through self-advocacy -Principles -Conceptualize recovery from illness / a journey of healing and transformation that enables an individual with mental health problems to live a meaningful life in a community of their choice A model that is patient/consumer-centered, hopeful and empowering, and emphasizes the person and the future rather than the illness and the present. Major concepts that guide recovery include: Self-direction (identify own goals and personal track to recovery) Individualized/person-centered: recovery is unique to the person Empowerment: people take control over their lives through educated decision making that impacts their recovery Holistic: recovery includes "mind, body, and spirit, and community Nonlinear: episodes can distract recovery/ learn to get back on track Strength-based: recovery build/exercises the individuals strength Peer-support: relationships with others who have lived the experience in supporting recovery principles are formed Respect: based on the premise of social acceptance of self and others (including: society, community, and service providers

OT Evaluation (Osteogenesis Imperfecta)

-Activities that can be safely pursued -Environmental risk factors

inflammatory response: acute vs sub-acute wound healing

-Acute : 24-48hrs to 7 days -Sub-acute: 7 to 14 days -Local signs include: redness, swelling, heat, and pain -Systemic signs include: fever and leukocytosis (A high level of white blood cells in the blood.)

Radial Nerve Palsy

-Acute trauma or compression of the radial nerve Etiology: Saturday Night Palsy, Honeymoon Palsy, or Crutch Palsy, caused by stress and/or compression as a result of humeral fracture Symptoms: Numbness/sensory loss/ weakness of muscles from the triceps down to the fingers •Problems extending the wrist or fingers, and supinator •Pinching and grasping problems •Wrist drop - MCP's and thumb are affected when the wrist hangs limply and the patient cannot lift it Conservative Treatment: Dynamic extension splint, work/activity modifications, strengthening (wrist/finger) extensors when motor function returns Surgical Intervention: decompression Post-operative Treatment: ROM, nerve gliding exercises, strengthening (6-8wks post-opt), ADLs and meaningful activities Splinting: •Custom made: Dorsal forearm-based dynamic splint •Colditz's low profile splint (daytime ware) dominant hand •Wrist-cockup splint (nighttime ware) dominant hand

Chorea

Brief, purposeless, involuntary movements of the distal extremities an face -usually considered to be a manifestation of dopaminergic overactivity in basal ganglia -Related health conditions: Cerebral Palsy, Huntington's Disease

Forensic settings

-Admission is due to engagement in criminal activity by a person. The person can be remanded to a variety of settings depending on the nature of the crime and if he/she has a psychiatric diagnosis: 1) jail - a city or county facility which is the individual's first entry into the criminal justice system and the placement for those convicted of crimes with sentences of less than a year 2) prison - a state or federal facility for individuals found guilty of crimes with sentences greater than a year 3) forensic psychiatric hospital or unit - a specialized hospital or unit within a hospital which provides inpatient psychiatric care for individuals convicted of a crime and found guilty but mentally ill or not guilty by reason of insanity -Length of stay (LOS) is determined by court-ordered directives and criminal sentences -The availability and quality of services varies greatly from none in most jails to extensive in some forensic hospitals -Due to serious gaps in mental health services, the incarceration rate of persons with mental illness has increased significantly (eg. a homeless person with schizophrenia steal food due to hunger) -OT evaluation and intervention focus: 1) determination of individual's competency to stand trial, in forensic psychiatry settings 2) areas similar to those described under Rehabilitation Hospitals to develop community living skills needed for successful community reintegration upon release 3) facilitation of skills and provision of structured programs to enable the person to function at his/her highest level within their current environment since discharge may be delayed or not possible, depending on the nature of the crime 4) restoration of competency to stand trial in forensic psychiatry settings

Residential programs

-Admission is for a developmental, medical or psychiatric condition that has resulted in functional deficits that impede independent living but are not severe enough to require hospitalization -Programs are on a continuum from 24-hrs supervised quarter way houses, half-way houses, group homes, supportive apt, bi/weekly "check-ins" -OT evaluation focus is on assessment of the individuals skills from living in the community, determination of the social /environmental resources/support needed to maintain the persons current expected living environment -OT intervention focus includes consultation and/or supervision of resident program staff, remediation of underlying performance skills/deficits and compensation for client factors that affect independent living skills, ADL training, adaption, environmental modifications -Discharge: referral to appropriate residential services

Rehabilitation hospital

-Admission is for a disability that is medically stable but which has residual functional deficits requiring skilled rehabilitation services -LOS is determined by presenting deficits and rehabilitation potencial (can range from week to months) -OT evaluation/intervention focus on all functional performance skills, patterns, areas of occupation, and roles required in expected environment -Interventions include: compensatory strategies, AE training to promote independence, modification of the discharge environment to enhance function, and client, family, caregiver education -Discharge:

Long-term hospitals

-Admission is for a medical or psychiatric diagnosis that is chronic with the presence of symptoms that cannot be treated on an outpatient basis -Length of stay (LOS) is determined by diagnosis and presenting symptoms: 1) LOS can range from a month to years 2) documentation requirements supporting need for increased LOS are dependent upon institutional, third-party payer, and/or state guidelines 3) LOS in private long-term hospitals is determined by insurance coverage. When coverage is expended, an alternative discharge environment is needed for the client (a state run long-term hospital; a skilled nursing facility; home or supportive residence) -OT evaluation can be extensive due to increased LOS -OT intervention focus: 1) functional improvements in performance skills and patterns and areas of occupation 2) development of compensatory strategies for residual deficits and client factors 3) maintenance of quality of life 4) development of skills for discharge to the least restrictive environment -Discharge:

Adult day care

-Admission is for adults and elders with chronic physical and/or psychological impairments, and/or for individuals who are frail but semi-independent -OT evaluation is focused on the individuals functional skills and deficits in areas of occupation, home, and the adult day centers environment -OT intervention is focused on maintenance of the healthy, functional aspect of the individual, and adaption to impairments. Engagement in purposeful activities, education of client/family and/or caregiver, and modification to the day care environment/home environment to maximize the persons comfort in, mastery of, and control of these environments

Long-term acute care hospital (LTAC)

-Admission is for chronic or catastrophic illnesses or disabilities that require extensive medical care and/or dependency on life support or ventilators (patients often have multiple diagnoses with major complications) -The average length of stay is greater than 25 days to maintain Medicare certification -OT evaluation and intervention is often limited by the population's severe and complex medical needs: 1) for all clients, evaluation and intervention is concerned with palliative care and the prevention and treatment of complications (eg. positioning to prevent decubiti and contractures) 2) for individuals who are cognitively intact, the focus of evaluation and intervention is mastery of the environment and the attainment of client-centered goals -Discharge:

Partial hospitalization programs (PHPs) / Day hospital programs

-Admission is for medical or psychiatric condition that has been sufficiently stabilized to enable the individual to be discharged home or to a community residence. -Length of stay (LOS) can vary from 1 week to 6 mths -Treatment is up to 5 days per week with multiple interventions scheduled each day -OT evaluation is focused on functional skills , deficits, performance areas, and occupational roles -OT intervention is focused on functional improvements in areas of occupation, roles, remediation of performance skills, and development of community living/support for participation

Outpatient/ambulatory care

-Admission is for medical or psychiatric conditions that is not serious enough to warrant hospitalization or for a condition that has subsided to enable the individual to be discharged from a hospital but remaining symptoms require active treatment -Treatment is provided in short 30-60 minute sessions once a day 5 days a week -Length of stay is determined by diagnosis, preventing symptoms, resonate to treatment, and insurance coverage -OT evaluation focus is based on individual client factors, functional assets and deficits in performance skills/patterns. -OT intervention focuses on treatment planning, re-evaluation, and discharge. Remediation of performance skills/deficits, functional improvement in performance areas and occupational roles, compensatory strategies for deficits, and client/family caregiver education

Sub-acute care / Intermediate Care Facilities (ICF)

-Admission is for medical or psychiatric diagnosis that has progresses from an acute stage but not stabilized to treat in out-patient -Length of stay (LOS) is determined by diagnosis and presenting symptoms (can range from 5-30 days) -Longer LOS requires sig. documentation to justify further need for further hospitalization and can result in discharge to another setting -OT evaluation can include in-depth assessments and through observation of clients functional performance -OT interventions focus on functional improvement in performance skills, and areas of occupation (ADLs/IADLs), treatment planning implementation, re-evaluation, and discharge. -Discharge:

Skilled Nursing Facility (SNF)

-Admission is for medical pr psychiatric diagnosis that is chronic and requires skilled care, but the individuals illness is stable with no acute symptoms -Length of stay (LOS) can range from 1 month to the individuals lifetime (several factor influence (LOS)) progression of illness, support, insurance -OT evaluation is guided by Medicare standards: for individual w/out rehab potential intervention is based on palliative care, and maintenance of QOL -Discharge:

Prevocational programs

-Adolescents or adults who require intervention to develop skills that are prerequisite to work -Length of stay (LOS) is determined by agency funding and person's attainment goals -OT evaluation focus is on the individual's task, skills, social interaction skills, work habits, interest, and aptitude's -OT Intervention focus is on improvement in evaluation focuses -Discharge: to a vocational program , school, and/or work setting

Self-actualization need: Maslow

-After obtaining all the previous milestones, and a individual development of creativity etc. the need to achieve one's highest potential

Low Vision

-Age-related changes in vision that occur gradually over time -occupational therapy with older adults who have low vision works to enhance their independence and functioning during the performance of meaningful occupations

Third party payer

-Agencies and companies who are the primary reimburses for health care in the U.S (e.g Blue Cross). HMO's and PPO are also third party payers

5-8 months (prone position) Gross Motor Skill

-Airplane posture in prone position; chest and thighs lift off surface

Interdisciplinary team

-All disciplines relevant to the case at hand agree to collaborate for decision making -Evaluation and intervention is still conducted independently within defined areas of each profession's expertise. However, there is a greater understanding of each discipline's perspective -Members are directed toward a common goal and not bound by discipline line-specific roles and functions -Members tend to use group process skills effectively (eg. during team treatment planning meetings) -The exchange of information, prioritization of needs and allocation of resources and responsibilities are based on members' expertise and skills, not on "turf" issues

Clinical Implications/ compensatory strategies: Somatosensory

-Allow extra time for response with increased threshold (pain) -Use touch to communicate : maximize physical contact (e.g. rubbing, stroking, tapping) -Teach compensatory strategies to prevent injury to anesthetic limbs -Provide assistive devices and environmental modifications as need for fall prevention -Provide feedback devices as appropriate

Post seizure care

-Allow individual to rest or sleep after seizure -Notify physician, parents, guardians, caregivers, or designated emergency contact person that a seizure has occurred. -Observe safety precautions if individual seems groggy, confused, or weak following seizure. -As a therapist, always be sure to document any seizure activity along with behavioral changes.

OT Aide Roles

-Although OT aides are not considered OT practitioners, according to AOTA Standards of Practice, the use of OT aides has increased in response to changes in the health care system (ie. pressures to control costs have resulted in the delegation of non-skilled tasks to aides) -OT aides can be delegated non-skilled tasks by OTAs or OTs (non-skilled tasks aides may perform include routine maintenance and clerical activities, preparation of clinic area for intervention, and/or specified, supervised aspects of a treatment session [eg. contact guarding a client while therapist teaches transfers]) -The OT is responsible for the determination and delegation of the client and non-client task an aide performs and the outcome of the activities including supervision and documentation.

Hunington's disease (Chorea)

-An genetically inherited condition in which nerve cells in the brain break down over time. (Autosomal dominant disorder) -It typically starts in a person's 30s or 40s (middle age) -Characterized by repetitive, rapid, jerky involuntary movements that appear well-coordinated (choreiform movements), and progressive intellectual deterioration -Psychiatric disturbances: (thinking and reasoning) personality changes, manic depressive symptoms, alteration in mood, changes in cognition -Interventions include: focus on supporting engagement in occupation, environmental modifications, assistive devices, augmentative communication devices, dysphagia management, cognitive strategies, seating and mobility, and caregiver training

Myasthenia Gravis

-An inherent disease caused by an autoimmune attack on the acetylcholine receptors of the postsynatic neuromuscular junction -A chronic autoimmune neuromuscular disease that causes weakness in the skeletal muscles, which are responsible for breathing and moving parts of the body, including the arms and legs. -Occurs at any age, but most often affects younger woman and older men - Prognosis varies, but is usually a progressive disabling process (death may occur from respiratory complications) -Symptoms include: ptosis (drooping of eyes), dysathria (difficult speech), dysphagia (difficult swallowing), and proximal limb weakness) -in relapse periods: Quadriparesis (a condition characterized by weakness in all four limbs)develops, and life threatening respiratory muscle involvement may occur

Medical management: Cerebral Palsy

-Anti-spasticity drugs (benzodiazepines) -Medication to reduce tremors and relax muscles (baclofen pump) -Medication to relax muscles (dec. stiffness and increase controlled movement) (botulinum toxin aka BOTOX) -Orthopedic management to address scoliosis and joint contractures -Surgery to decrease contracture and improve functional movement (e.g dorsal rhizotomy surgery) -Medication for seizures (as needed) -Dietary interventions and special feeding techniques to regulate/eliminate medical complications

Interventions for oral motor control

-Appropriate positioning : neutral pelvic alignment and trunk stability (in lap/chair) -Avoid head extension to prevent asphyxiation (closing the airway -Hand positioning of the caregiver -Facilitate lip closure; slight upward pressure to the index finger under the child lip -Facilitate jaw closure; under the jaw -Inhibiting tongue thrust -Facilitate swallow by lip closure; slight downward pressure of the spoon on the middle aspect of the tongue -Facilitate chewing; placing between the gums and teeth -Decreased tactile sensitivity prior to feeding; use firm pressure, encourage sucking, chewing, rubbing gums, palate, and tongue. Promote oral exploration of toys, NUK, tooth brush using various textures of food -Thick foods are easier to swallow and manage if tongue thrust is present -Major role of the therapist is to assist the caregiver in providing a pleasant social atmosphere for feeding using positioning and handling techniques -Promote eye contact and bonding in a relaxed environment

Social worker

-Assess clients social history and psychological functioning via clinical interviews and structured assessments -Assist clients, and family with accessing social support services (home care) and obtaining reimbursement/funding -Provides individual, couple, and family counseling -Contributes to discharge and completes task needed for implementation of discharge orders (e.g. application to a SNF)

Clinical Implications/ compensatory strategies : hearing loss

-Assess for hearing acuity, speech discrimination/comprehension, tinnitus, dizziness, vertigo, pain -Assess for use of hearing aides -Minimize auditory distractions, work in a quiet environment -Speak slowly and clearly, directly in front of the person at eye level -Use nonverbal -Provide written directions

Clinical Implications/ compensatory strategies : Taste and Smell

-Assess for identification of odors, taste (sweet, sour, bitter, salty) (temperature, touch) -Decreased taste can lead to poor diet and nutrition -Assess for decreased home safety: (e.g. gas, smoke)

Clinical Implications/ compensatory strategies : Sensory System Changes and Adaptions in Older Adults

-Assess for visual deficits: acuity, peripheral vision, light and dark adaption -Maximize visual function: assess for the use of glasses, environmental adaption -Work in adequate light, increase intensity, reduce glare, avoid abrupt changes in light -Use large, high contrast print for written material -Provide magnifying glasses to view objects and complete task -Provide an eye patch for diplopia -Stand directly in front of the person at eye level when communicating with her/him -Assist in color discrimination: (use warm colors: yellow, orange, red) for identification and color coding -Provide other sensory cues when vision is limited (e.g. verbal description) -Provide safety education to reduce fall risk

Fixed-route transportation (OT intervention and evaluation)

-Assess in real community setting -Use remedial and compensatory strategies (Family and caregiver education on use of strategies )

Goals and intervention for nutrition and the elderly

-Assist in monitoring adequate nutritional intake -Assist in maintaining nutritional support: 1) refer to dietitian, nutritional consultants and/or nutritional education programs as needed 2) make recommendations for home health aide to assist with grocery shopping and meal preparation 3) refer to elderly food programs: home delivered, ie. "meals on wheels"; congregate meals/senior center daily meal programs; federal food stamp programs -Maintain physical function and promote adequate activity levels -Maintain independence in food preparation and self feeding: 1) teach work simplification and energy conservation techniques to maximize function 2) modify environment and adapt activities to enhance mastery and ensure safety

Complex Regional Pain Syndrome (CRPS) (stage 3)

-Atrophic stage last several years or more after injury or trauma Symptoms include: decrease in pain intensity, irreversible changes in skin and joints, persistent edema-unresponsive to intervention, bony demineralization, severe muscle atrophy, and joint contractors

Myasthenia Gravis (MG)

-Autoimmune neuromuscular disorder characterized by weakness and rapid fatigue of voluntary controlled muscles - The condition is caused by a breakdown in communication between nerves and muscles. -Occurs at any age but most often affects younger woman and older men -Prognosis varies, but usually is a progressive disabling process (death may occur from respiratory complications) -Symptoms include: drooling eye (ptosis), double vision (diplopia), muscle fatigue after exercise, unclear speech (dysarthria) dysphasia, and proximal limb weakness -In relapse periods quadriparesis may develop, and life threatening respiratory muscle involvement may occur. -Interventions include: energy conservation techniques, work simplification education, sleep hygiene strategies, assistive devices, activity modification and adaption

Hip Fracture: Complications

-Avascular necrosis: of the femoral head is a relatively uncommon complication following an extracapsular hip fracture. Although it can occur following fixation of unstable 3-part or 4-part intertrochanteric fractures with significant posteromedial and posterolateral comminution, it remains a rare complication. -Non-union: When a broken bone fails to heal it is called a "nonunion." A "delayed union" is when a fracture takes longer than usual to hea -Degenerative joint disease: he most common type of hip arthritis is osteoarthritis a serious condition. While it is not "curable," it most certainly is treatable using activity modifications, medications, and/or injections. If those interventions don't work, hip replacement surgery often will relieve the pain associated with hip arthritis.

Interpersonal reasoning

-Based on the Intentional Relationship Model -The process in which the therapist actively analyzes interpersonal events during the client-therapist relationship to decide best course of action

Sign and symptoms of Sexual Abuse

-Child reports being inappropriately approached, touched, and/or assaulted -Abuse may be physical, (touching) and/or non-physical (indecent exposure), or violent (rape) with emotional and physical indicators -Precocious sexual behavior or knowledge -Copying adult sexual behavior -Inappropriate sexual behavior ( kissing) -Soreness or injury around the genitals -Reluctance or refusal to let caregivers wash parts of the body -Sexual Play

Sign and symptoms of Physical Abuse

-Child reports of being physically abused (mistreated) -Unexplained injuries -Repeated injuries -Abrasions and lacerations -Small circular burns -Burns with a donut shape on the buttocks (indicates scolding) -Friction burns (rope burn) -Unexplained fractures -Denial, unlikely explanations, or delay in treatment from caregiver

Psychodynamic/Psychoanalytic

-Based on the work of Freud A. Freud, Jung and Sullivan -Principles -All behavior is largely determined by unconscious psychological forces and internal processes. Interactions among these forces creates behaviors thoughts and emotions Narcissistic Mechanisms -Denial, Projection, Splitting, -Denial: failure to acknowledge the existence of some aspect of reality that is apparent to others (alcohol abuser) -Projection: attributing attributes or on acknowledge feelings, impulses or thoughts to others ( someone who feels guilt attributes what others say as blaming him/her) -Splitting: Rigid separating of positive and negative thoughts and of feelings (seeing people as all good or all bad when variation of behavior are anxiety provoking) Immature Mechanisms -Passive-aggressive: patient shows aggression towards others which is indirectly or unassertively expressed (Pt is late but gets angry at therapists) -Regression: returning to an earlier stage of development to avoid the tension and conflict of the present one ( Pt becomes needy/ childlike) -Somatization: The conversion of psychological symptoms into physical ones (an unhappy marriage causes patient back pains) Neurotic Mechanisms -Rationalization: Creating self-justifying explanations to hide the real reason for one's own or another's behavior (parent believe a lazy child is not working because the job market is low) -Repression: Blocking from consciousness painful memories and anxiety provoking thoughts -Displacement: redirecting an emotion or reaction from ones object to a similar but less threatening one ( child gets angry with parents and hits younger sibling) -Reaction formation: the switching of unacceptable impulses into the opposite ( hugging someone you would like to hit) Mature Mechanisms -Humor: using comedy to express feelings and thoughts without provoking discomfort in self and others (making fun of yourself) -Sublimation: redirecting energy from socially unacceptable impulses to socially excepted activities (anger channeled into aggressive playing of a sport) -Suppression: consciously or semi/consciously avoiding thinking about disturbing problems, thoughts, or feelings (cleaning while waiting on serious medical results)

Paratransit services (occupational therapy evaluation and intervention )

-Be familiar with policies of the local transit company -Orient and assist the client with the application process -Assist with planning for ride reservation , and safety preparedness

3-4 months (standing ) Gross Motor Skill

-Bears some weight on legs -Head is in midline -Legs are apart and turned outwards

Hip Fractures : OT Intervention

-Bed mobility and bedside ADLs -UE strengthening -Functional mobility and transfer with appropriate weight-bearing status and functional mobility device (e.g. walker, crutches) -The functional mobility device is determined by the Pt's weight-bearing status -Educate in, and practice use of assistive devices for home use (e.g. shower chair, commode seat) -Practice occupation-based activities (e.g. meal prep) using proper weight-bearing status and functional mobility devices

9 months (prone position) Gross Motor Skill

-Begins to dislike prone position

Symptoms: Parkinson's Disease

-Begins with a resting "pill roll" -Cardinal signs include: "Bradykinesia" (slowness of movement)tremors, rigidity, resistance to PROM, akinesia, instability, festinating gait, falling backwards/forwards, mask face, or micrographia (abnormally small , cramped handwriting and/or progressively small handwriting)

Clinical Implications: Cardiopulmonary System Changes and Adaptions in the Older Adult

-Cardiovascular responses to exercise -Maximum heart rate declines with age -Cardiac output decreased 1 % per year after age 20 -Orthostatic hypotension -Increased fatigue

Complications: Fractures of the Wrist

-Carpal Tunnel Syndrome: results in compression of the median nerve as it runs through the carpel tunnel -CRPS Complex Regional Pain Syndrome is the primary and most severe complication to the distal radius

Age Related: Skeletal System Changes and Adaptions in the Older Adult

-Cartilage changes: decreased water; becomes stiffer -Loss of bone mass and density: peak bone mass at age 40 years (between 45 to 70 bone mass decreases) -Intervertebral disc: flatten, less resilient due to loss of water content (30% by age 65) -Senile postural Changes: 1. Forward: head, Kyphosis of thoracic spine, Flattening of lumbar spine, Hip and knee flexion contracture

Aging Changes

-Cellular changes: 1) increase in size; fragmentation of Golgi apparatus and mitochondria 2) decrease in cell capacity to divide and reproduce 3) arrest of DNA synthesis and cell division -Tissue changes: 1) accumulation of pigmented materials, lipofuscins 2) accumulation of lipids and fats 3) connective tissue changes: decreased elastic content, degradation of collagen; presence of pseudoelastins -Organ changes: 1) decreased functional capacity 2) decrease in homeostatic efficiency -Gerontology: the scientific study of the factors impacting the normal aging process & effects of aging -Geriatrics: the branch of medicine concerned with the illnesses of old age and their care -Ageism: discrimination and prejudice leveled against individuals on the basis of their age - 1) isolates elders socially 2) permits attitudes and policies that discourage elders from full participation in work, leisure and other meaningful occupations 3) perpetuates fears of aging 4) diminishes quality of life

Spinal Cord Injury (SCI) : Clinical Syndromes

-Central Cord -Brown-Sequard (Hem-section of cord) -Anterior Cord -Posterior Cord Conus Medullaris -Cauda Equina Syndrome

Preprosthetic Treatment

-Change of dominance activities, if needed -ROM of uninvolved joints -Prepare limb for a prosthesis -Desensitization -Wrapping to shape and shrink the residual limb: 1) wrap distal to proximal 2) tension should decrease with proximal wrapping -ADL training, including education in skin care -Supportive counseling to facilitate adjustment -Individualize treatment to enhance physical and psychological adjustment

Integumentary Changes: Other Systems Changes and Adaptions in the Older Adult

-Changes in skin composition: 1) dermis thins with loss of elastin 2) decreased vascularity; vascular fragility --> easy bruising (senile purpa) 3) decreased sebaceous activity and decline in hydration 4) appearance - skin appears dry, wrinkled, yellowed, and inelastic; aging spots appear (clusters of melanocyte pigmentation) 5) general thinning and graying of hair due to vascular insufficiency and decreased melanin production 6) nails grow more slowly, brittle and thick -Loss of effectiveness as protective barrier: 1) skin grows and heals more slowly, less able to resist injury and infection 2) inflammatory response is attenuated 3) decreased sensitivity to touch, perception of pain and temperature --> increased risk for injury from concentrated pressures or excess temperatures 4) decreased sweat production & loss of sweat glands --> decreased temp regulation and homeostasis

Age-related Changes: Pulmonary System

-Chest wall stiffen, declining strength of respiratory muscle results in increased work to breath Loss of lung elastic recoil, resulting in decreased lung compliance -Decline in total lung capacity: residual volume increased, vital capacity decreases Oxygen tension falls with age

Grasping skills: 10 months

-Pincer grasp- between Israel paddy of thumb and index finger -Thumb opposed

Evaluation of driver ability

-Clinical screening of performance skills, prerequisite abilities, and client factors -Visual-perceptual: intact acuity, night vision, contrast sensitivity, peripheral field, scanning, spatial relations, and depth perception are needed to access essential vision input and to accurately interpret the driving environment (color recognition is not a state mandated requirement as color blindness can be readily compensated for while driving) -Cognitive-perceptual: intact orientation, alertness, memory, ability to shift attention, problem solving, response time, topographical orientation, sign recognition, and knowledge of 'rule of the road' are required to drive safely and appropriately for different driving conditions, and to anticipate the actions of other drivers on the road and the consequences of one's own actions -Motor: adequate range of motion, strength, endurance, and response time are needed for basic vehicle control including accurate steering to remain in lane and make turns, and for smooth acceleration and braking -Psychosocial: the presence of impulsive and/or agitated behaviors, and/or psychiatric symptoms such as, suicidal intentions, delusions and hallucinations can affect an individual's ability to drive safely -Side-effects of medications can affect motor performance, alertness, attention, judgement, and reaction time -Past driving experiences (which can range from none, to poor, to competent) can influence the individual's potential to drive with a disability -OTs can perform clinical screenings for all of the above factors that can affect driving without additional specialized training (if screening identifies areas requiring further evaluation, the OT should refer the individual to a driving rehabilitation specialist -On-the-road evaluation: there are two levels of driving that must be considered when evaluating a person's abilities when they are behind the wheel and actually driving -Operation: the ability to steer, brake and turn -Tactical: the ability to respond to changes in road conditions and traffic/driving risks -The ergonomics of driving should also be assessed to increase safety and prevent discomfort. Considerations include: 1) seat position in relation to visibility of car's endpoints 2) positioning of the seatbelt and shoulder restraint 3) access to foot pedals and/or steering column controls 4) airbag clearance of 12 inches between the person and the steering wheel in case of airbag deployment -The person's ability to manage automotive emergencies and obtain assistance should also be assessed

Medical Treatment: Fractures

-Closed Reduction: stabilization including: short arm cast (SAC), long arm cast (LAC), splints, slings, or fracture brace -Open Reduction Internal Fixation (ORIF) include: nails, screws, plates, or wire -External Fixation -Arthrodesis: fusion -Arthroplasty: joint replacement

10-14 months (release) Gross Motor Skill

-Clumsy release into small container; hand rests on the edge of the container

Fixed-route transportation ( performance skills required)

-Cognitive skills: ability to consider transit option, read schedules, figure out routes, calculate time (arrival & departure) use stop request control -Motor and praxis skills: ability to walk (step-on/off), maintain balance, postural control -Sensory perceptual skills: ability to identify obstacles, judge spatial relationships, and gaps between vehicles and side walks -Emotional regulation skills: ability to adjust to crowded environments and handle unexpected events -Communication and social skills: ability to ask for directions and obtain information

Paratransit services (performance skills required)

-Cognitive skills: ability to plan, make reservations, and problem-solve for late/canceled ride -Motor and praxis skills: ability to get on/off of vehicle, and from door to curb with limited/no assistance. Postural control during ride -Sensory-perceptual skills: ability to judge spatial relationships, and navigate between vehicle, curb, and side walk -Communication and social skills: ability to communicate needs over the telephone, reserve services, communicate destination/individual needs

Performance skills required (personal transportation)

-Cognitive skills: pathing finding abilities including selecting alternative routes , pedestrian safety (sidewalk, crossing street, marked crosswalks) safety and judgement including: cross signals, checking traffic, and multitasking -Motor praxis: ability to walk on uneven surfaces, inclines, walk around obstacles, step up/down from curb, carry items while navigating, cross an intersection within a required time, and maintain sufficient endurance -Sensory-perceptual skills: ability to identify traffic, judge spatial relationships at the curb.sidewalk, maintain topographical orientation -Emotional regulation skills: ability to adapt to crowds, observe road safety precautions, and handle unexpected events -Communication and social skills: ability to multi-task, maintain social conversation and observe road safety, ask for direction, and social etiquette

Most Common UE Fracture

-Colles Fracture: dorsal displacement -Smith's Fracture: volar displacement -Carpal Fracture: scaphoid bone (60%) of carpal fractures due to poor blood supply -Metacarpal Fracture: classified according to (head, neck, shaft, and base). boxer's fracture of 5th metacarpal (ulnar gutter splint) -Proximal Phalanx Fracture: common in thumb(1) and index (2) finger w/ loss of PIP A/PROM Distal Phalanx Fracture: Mallet Finger involving the extensor -Elbow Fracture: involves radial head and may result in limited forearm rotation -Humerus Fracture: displacement vs non-displacement

Complete vs Incomplete Fractures

-Complete Fractures: fractures where the parts of the bone that have been fractured are completely separated from each other. There is complete separation of the cortex circumferentially single fracture: bone is broken in one place into two pieces comminuted fracture:bone is broken or crushed into three or more pieces compression fracture:bone collapses under pressure nondisplaced fracture: bone breaks into pieces that stay in their normal alignment displaced fracture: bone breaks into pieces that move out of their normal alignment segmental fracture: bone is broken in two places in a way that leaves at least one segment floating and unattached Incomplete Fractures: A minor fracture is also known as an incomplete fracture. Where the bone doesn't break completely. Often occurs in children hairline fracture: bone is broken in a thin crack greenstick fracture: bone is broken on one side, while the other side is bent buckle or torus fracture: bone is broken on one side and a bump or raised buckle develops on the other side

Strategies to slow or reverse changes: Pulmonary System

-Complete a cardiopulmonary assessment prior to commencing an exercise program -Individualized exercise prescription is essential -Choice of training program is based on : fitness level, prescience or absence of cardiovascular disease, and musculoskeletal limitations -Walking, chair, and floor exercises, yoga, Taichung and modified strength/flexibility calisthenics -Consider pool programs for persons with musculoskeletal and neurological impairments -Aerobic training programs can significantly improve cardiopulmonary function in the elderly -Improve overall daily activity levels for independent living

TBI: Symptoms

-Concussion: Post-traumatic loss of consciousness -Cerebral contusion/laceration/edema accompanied by surface wounds and skull fractures A variety of symptoms can result including: hemiplegia or monoplegia and abnormal reflexes, rigidity, fixed pupils, coma, changes in vital signs

7-8 months (prone position) Gross Motor Skill

-Pivots in prone position - Moves to prone position to sit

Tires

-Pneumatic: cushioned ride. shock absorbent -Semi-pneumatic: airless, less maintenance, good cushioning -Solid core: min maintenance, spoked or mold wheels

Reauthorization and Amendment of Individuals with Disabilities Education Act

-Emphasizes that the purpose of the Individualized Education Plan (IEP) is to address the child's unique needs as related to his/her disability and decide how these needs can be served so the child has full access to the general education curriculum and can participate in the general education classroom -Clarifies that the individual education plan (IEP) can include consideration of assistive technology and behavioral interventions, strategies, and supports (an area in which OT can offer a great deal) -States that IEP planning team is open to related personnel at the request of the parent or school, in addition to the regular education teacher, if the student is in a regular education class -States that the education the student receives should prepare him/her for independent living and employment in adult life: 1) transitional planning begins at the age of 14 (or younger if indicated) to help the student plan a course of study that will lead to post-school goals 2) transition services begin at the age of 16 (or younger if indicated) to provide student with a coordinated set of services to attain post-school goals (these services can include community experience, specific instructions, and/or ADL and vocational assessment and intervention) 3) the student must be invited to attend IEP meetings that discuss his/her transition planning and services to allow for self-advocacy and self determination 4) this transition plan must be updated annually with appropriate service revision provided -Maintains the established definition of related services (including OT) -Expands orientation and mobility services by broadly interpreting them to include all children with disabilities -Students with disabilities may be punished in the same manner as other students for serious offenses (ie. carrying illicit drugs or a weapon). However, disciplinary prevention measures are stressed -Educational and related services still must be received by the child even if he/she is removed to an alternative placement -Clarifies early intervention services and systems (mandates an Individual Family Service Plan (IFSP) for children 0-2 years of age; OT is identified as a primary early intervention service

7-8 months (supine position) Gross Motor Skill

-Equilibrium reactions are present

Spinal Cord injury Level C (5)

-Expected functional outcome : -independent in respiratory function with reduced vital capacity, may need assistance for productive cognitive -TD for bowel and bladder management, and bathing -Assistance for grooming with AE -Independent for self-feeding with AE

Spinal Cord injury Level (C7-T1)

-Expected functional outcome: -(A) for bowel and bladder management -some (A) for standing -Mod I for bed mobility and transfers, for BADLs -Independent for respiratory function, and driving w/ modifications

Spinal Cord injury Level C (4)

-Expected functional outcome: -initially ventilator dependent, but progresses to breathing independent with reduced vital capacity -TD for BADLs and IADLs, however able to direct care needs -power wheelchair with adaption for independence in mobility -TD for bed mobility and transfers

Spinal Cord injury Level C (6)

-Expected functional outcome: -TD for standing -Assistance for BADLs, transfers and bed mobility with AE, outdoor w/c propulsion in manual wheelchair -TD to min A for bowel and bladder management with AE -Independent in respiratory with reduced vital capacity, with (A) for productive cough

Rehabilitation Act of 1973

-Extended protection to those with physical or mental handicaps -Prohibits discrimination on the basis of disability in any program or activity that receives federal funding -Requires all federal agencies to develop action plans for hiring, placement, and advancement of person's with disabilities

Wrist extensors innervated by the radial nerve

-Extensor carpi radialis brevis (ECRB) -Extensor carpi radialis longus (ECRL) -Extensor carpi ulnaris (ECU)

Extrinsic extensor muscles of the hand innervated by the radial nerve

-Extensor digitorum communis (EDC) -Extensor digiti minimi (EDM) -Extensor indicis proprius (EIP) -Extensor polloicis longus (EPL) -Extensor pollicis brevis (EPB) -Abductor pollicis longus (EPL)

Hip Fractures (Types)

-Femoral neck fracture -Intertrochanteric fracture -Subtrochanteric fracture

Strategies to slow or reverse changes: Neurological System Changes and Adoptions in Older Adults

-Fix any medical problems: improve cerebral blood flow -Improve health: diet, smoking cessation -Increase levels of physical activity: may encourage neuronal branching, slow rate of neural decline and improve cerebral circulation -Provide effective strategies to improve motor learning and control -Allow for increased reaction of movement times: this will improve motivation, accuracy of movement -Allow for limitations of memory: avoid long sequences of movement -Allow for increased cautionary behaviors: provide adequate explanation, demonstration when teaching new movement skills -Stress using familiar well learned skills : repetitive movements

Frame

-Fixed: minimal benefit; seen in older w/c or rentals -Folding: easy storage and facilitates mobility in community -Weight: ultra light, heavy duty, lightweight, standard, active duty

Wrist flexors innervated by the ulnar nerve

-Flexor carpi ulnaris (FCU)- flexion of wrist and ulnar deviation origin: medial epicondyle and proximal 2/3rd of the ulna insertion: pisiform and 5th metacarpal

Extrinsic flexor muscles of the hand innervated by the median nerve

-Flexor digitorum superficialis (sublimis) (FDS) -Flexor digitorum profundus (FDP) -Flexor pollicis longus (FPL)

Sign & Symptoms: Sensory Processing Disorder

-Fluctuating extreme responsiveness: stress and frustration in ADLs -Difficulty interacting in the environment: including play, learning, social situation, while engaging other developmental health activities -Difficulty conceiving, planning, sequencing, or executing novel actions -Poor initiation of activities (ideation) generating ideas -Difficulty with goal-directed actions on the environment (adaptive response) -Under responsitivity to over-responsitivity of multi-sensory processing and sensory seeking -Tactile processing dysfunction including: deficits in modulation, deficits in tactile discrimination

Sensory Integration: Practice Applications

-Focus on enhancing independence in life skills using principles of sensory integration. - Provide opportunities for engagement in sensorimotor activities rich in tactile, vestibular, and proprioceptive input. -Design the therapeutic environment to tap into the child's inner drive to play. -Create playful activities that challenge the child's skills and astutely observe the child's ability to process and use sensory information -Communicate with the childs parents and teachers to ensure that the therapeutic process is aligned with goals at home an school

Role Acquisition: Evaluation

-Focus on gathering data indicative of function/dysfunction in the above categories Intervention: -Focus on the acquisition of the specific skills an individual needs in order to function in their environment -Any treatment activities or strategies that employ the teaching-learning principles are acceptable

Cognitive Disabilities : Evaluation

-Focus on identifying current cognitive abilities/ implication for performance, independence, and need for assistance -observation for functional task is emphasized -use of evaluation tools includes : The Allen Cognitive Level Screen-5 (ACLS-5), The Routine Task Inventory, The Cognitive Performance Test: assess functional performance of patients with Alzheimer's Disease Interventions: -select activities based on individuals highest cognitive level -focus therapy on maintaining individuals highest level of functioning -make environmental changes /adaptions to compensate for deficits and allow the greatest degree of independence -Meet with the caregiver and/or family to understand the Pt's deficits

Occupational Adaption: Evaluation

-Focus on occupational environment, role expectations and the individuals potential for adaption, and the best means for adaption to occur Intervention: -focus on increasing the skills needed for occupational adaption -address both the individual and the environment

Specific OT roles and supervisory guidelines - Fieldwork educator

-Functions as the manager of Level I and/or II fieldwork in a practice setting, providing students with opportunities to practice and implement practitioner competence -Entry Level OTs and OTAs may supervise Level I fieldwork students -OTs with one year practice-based experience may supervise OT Level II students -OTAs with 1 year of practice experience may supervise OTA Level II fieldwork students -Three years of experience are recommended for individuals supervising programs with multiple students and multiple supervisors

Biological Theories (Aging)

-Genetic theory: genes are programmed to modulate aging changes -Hayflick limit theory (Doubling/biologic theory: functional deterioration in cells is due to a limited number of genetically programmed cell doubling -Free radical theory: highly reactive and toxic forms of oxygen damage, decrease, and interfere will cells resulting in aging/mutation -Cell mutation: leads to exponential cascade of abnormal proteins and aging changes -Hormonal Theory: functional decrement in neurons and their associated hormones lead to aging changes -Immunity theory: Autoimmune disease increased with age

Muscle grade 4

-Good strength observed with full ROM against gravity and moderate resistance -antigravity position

Brown-Sequard Syndrome

-Hemi-section of the cord -rare neurological condition (hemiparaplegia) - ipsilateral (same side) spastic paralysis, -loss of position sensation -loss of discriminative touch - contralateral (opposite side) loss of pain and loss of thermal sense

Lower Extremity Level of Amputation

-Hemipelvectomy -Hip disarticulation -Above-knee amputation (transfemoral) -Knee disarticulation -Below-knee amputation -Complete tarsal -Partial tarsal -Complete phalanges

Occupational Therapy Evaluations: Fractures

-History: mechanism of injury and fracture management -Testing: X-rays, MRI, and CT Scans -Edema control, and pain management -ROM: AROM -Do not assess PROM or strength without physicians orders unless Pt has a humerus fracture which often begins with PROM or AAROM -Consider sensation -Roles, occupations, ADLs, and activities related roles

Assessments of Chronic Pain

-History: to Determine chief complaint -Localization: chronic pain is poorly localized unlike acute pain -Identify nature of pain: constant vs intermittent -Determine stimuli/ activity (cause) -Use a subjective assessment -Physical examination -Assess degrees of suffering, and functional changes -Assess consequences of pain : behavioral impact (depression, and anxiety) and/or prescription drug use

Muscle grade 4 (+)

-Hold test position against moderate to strong pressure Good (+)

In-hand manipulation with stabilization

-Holding several objects in one hand and manipulation the objects while holding the others stable -Picking up a penny with the thumb and forefinger while storing white storing them in the ulnar side of the same hand 6-7 years

5 years ( Jumping and Hoping) Gross Motor Skills

-Hops in a straight line

2 1/2 + years ( Jumping and Hoping) Gross Motor Skills

-Hops on 1 foot a few steps

Sensory Integration: OT Evaluation

-Identify strengths of the child and family -Identify occupational dilemmas, an determine if they may be related to sensorimotor deficits -Conduct formal and informal assessments of sensory and motor skills abilities -SIPT: Sensory Integration and Praxis Test; considered the gold standard -Sensory Processing Measure: parent, teacher, or self-report assessment of sensory processing skills -Sensory Profile: parent, teacher, or self-report that includes measures of sensory over/underresponsivity -Clinical observation of sensory integration

Strategies to slow or reverse changes: Cognitive Changes and Adaptions in the Older Adult

-Improve health: Correct any medical problems -Assess needed pharmacological changes: drug re-evaluation -Reduce chronic use of tobacco and alcohol —Correct nutritional deficiencies -Increase physical activity: keep mentally engaged "Use It or Lose It", Maintain an engaged lifestyle, -Use cognitive training activities -Provide multiple sensory cues to compensate for decreased sensory processing/loss and maximize learning (VI, TI, Visual Instructions) -Provide stimulating enriching environment -Reduce Stress: provide counseling and family support

Strategies to slow or reverse changes: Muscular System Changes and Adaption in the Older Adult

-Improve health: correct medical problems that cause weakness -Improve nutrition -Address alcoholism/substance abuse -Increase level of physical activity -Do isometric and progressive resistant exercises -Do high intensity training programs -Provide flexibility and ROM programs to increase functional activity -Tissue heated prior to stretching are more distensible e.g warm pool

Patterns of abuse

-Impulsive abuse: a sudden attack of rage, which may be regular or random -Premeditated abuse: during which the abuser is cool and calculated

Sensory awareness groups

-Includes activities to promote sensory functions and environmental awareness

Self-awareness groups

-Includes such activities as values clarification, awareness of personal assets, limitations, and adaptive/maladaptive behaviors; and the individual's impact on others

Reversibility: Concrete operations: ( Hierarchical development of cognition)

-Increased spatial awareness

OT developmental evaluation - Developmental History

-Information regarding the mother's pregnancy and specifics of birth history: 1) Apgar score of the infant's heart rate, respiration, reflex irritability, muscle tone, and color at one, five, and ten minutes after birth, measures on a scale of 0,1, 2 2) number of weeks premature, adjusted age 3) number of days/weeks in incubator, intubated and/or on ventilator, or nasogastric tube -Medical history: admissions and lengths of hospitalizations for illness, disease, surgery, and medications -Developmental history considering important developmental milestones, times of achievement, and any difficulties/problems surrounding attainment -Parent interview to address the above, and the parent's perspective on developmental progress and/or concerns, home situation, family history, school history, support systems, and insurance coverage

Conus Medullaris

-Injury of the sacral cord and umber nerve roots -results in LE motor and sensory loss and areflexic bowel and bladder -If the lesion is in the sacral segments, reflexes may be occasionally preserved

Fracture Types

-Interarticular vs Extraarticular Fractures -Closed vs Open Fractures -Dorsal Displacement vs Volar Displacement Fractures -Mid-shaft vs Neck vs Base Fractures -Complete vs Incomplete Fractures -Transverse vs Spiral vs Oblique Fractures -Non-Displacement vs Displacement Fractures -Comminuted Fractures

Renal, urogenital changes

-Kidneys: loss of mass and total weight with nephron atrophy, decreased renal blood flow, decreased filtration - 1) blood urea rises 2) decreased excretory and reabsorptive capacities -Bladder: muscle weakness; decreased capacity causing urinary frequency; difficulty with emptying causing increased retention 1) urinary incontinence common, affects older women with pelvic floor weakness and older men with bladder or prostate disease 2) increased likelihood of urinary tract infections

Parietal lobe (telencephalon)

-Knowledge of numbers, and other relations -manipulation of objects -visual spatial processing (right) - primary sensory cortex for integration of sensation -praxis (left) -receives fibers conveying touch, proprioceptive, pain, temperature sensation from the opposite side of the body

5-6 months (supine position) Gross Motor Skill

-Lifts head independently -Brings feet to mouth -Able to reach for toys with 1-2 hands

CVA : cerebrovascular accident (stroke)

-Loss of blood flow to the brain which leads to loss of brain function -Loss of 1/2 visual field in each eye (nasal half of one eye and temporal half of other eye) Medications: impaired or fuzzy vision may result with antihistamines, anti-psychotics, anti-depressants, steroids

Heat intolerance and burns Why does it occurs? What accommodations may be required?

-Loss of the ability to sweat may occur as a result of loss of sweat glands with split-thickness skin graft -Special accommodations and modifications may be required at home or in the work or school environment

Osteogenesis Imperfecta (Sign & Symptoms)

-Malformed bones -Short, small body -Triangular face -Barrel-shaped rib cage -Brittle bones that fracture easily -Multiple fractures as the child grows -Developmental growth problems -Loose joints -Sclera of the whites of the eye look blue or purple -Brittle teeth -Hearing loss (often starting in the 20s or 30s) -Respiratory problems -Insufficient collagen

Role of Occupational Therapy in elder abuse

-Mandatory reporting: 1) elder abuse per se may or may not be designated as a specific crime in a state; however, most physical, sexual, and financial/material abuse are crimes in all states 2) healthcare workers are required to report suspected or observed cases of elder abuse 3) failure to report may be considered a crime 4) in most states Adult Protective Services, the area Agency on Aging, or the county Department of Social Services is designated to provide investigation and services -Occupational therapy intervention: 1) treat for physical and emotional injuries 2) develop a trusting relationship 3) assist in developing a support system 4) refer to appropriate disciplines and/or agencies

Role of Occupational therapy in child abuse

-Mandatory reporting: 1) the Child Abuse Prevention and Treatment Act (CAPTA) was originally passed in 1974 and most recently amended in October of 1996 2) all states must have child abuse and neglect reporting laws to qualify for federal funding under CAPTA 3) all states require reporting of known or suspected cases of child abuse or neglect by healthcare providers. Standard or reporting may vary 4) failure to report suspected child abuse may be considered a crime 5) in most states, good faith reporting is immune from liability 6) all states require reporting to be made to a law enforcement agency or child protective services -Occupational therapy intervention: 1) treat physical injuries, emotional injuries, and developmental delays 2) develop a trusting relationship with child and non-abusive caregivers 3) provide support to non-abusive caregivers 4) refer to appropriate disciplines and agencies

Occupational Therapy Role: Types of Abuse

-Mandatory reporting: Child Abuse Prevention and Treatment Act (CAPTA) report to law enforcement -All states require reporting of known or suspected cases of child abuse and/or neglect by health care providers -Therapist should immediately report any and all concerns to the supervisor, and be prepared to follow-up as necessary -Failure to report suspected child abuse may be considered a crime

Scissor skills: 3-4 years

-Manipulates scissors in a forward motion -Coordinates the lateral direction of the scissors -cuts a straight forward line -Cuts simple geometric shapes

Age Related Changes: Muscular System Changes and Adaption in the Older Adult

-May be due to decreased activity levels and disuse -Loss of muscle strength: peaks at age 30 and remains fairly constant until age 50 after which their is accelerated loss -Loss of power: decline due to losses of speed -Loss of skeletal muscle mass: (atrophy) both size and number of muscle fibers decrease by age 70 -Changes in muscle fiber composition -Changes in muscle endurance

Development of Sensorimotor integration - Prenatal period

-Prenatal period -Neonatal period -First six months (6 months) -six to twelve months (6-12 months) -Thirteen to twenty-four months (13- 24 months) -Two to three years (2-3 years) -Three to seven years (3 -7 years)

Determination stage: Transtheoretical Model

-Preparation stage Stage at which the client is committed to action and works with the clinician to develop a plan for change. -Client has decided that changing behavior is beneficial for the future and is actively preparing to take steps towards making positive lifestyle changes

Duchenne muscular dystrophy (DMD)

-Most common form of muscular dystrophy, typically in boys and detected around 3 years of age -An inherited disorder/ condition with symmetrical muscular weakness and wasting of pelvic, shoulder, and proximal limb muscles (atrophy) -Symptoms include pseudohypertrophy (enlargement of calf, forearm, and thigh muscles give the appearance of a muscular healthy child -Weakness of the proximal joints progress to significant functional mobility impairments including: -Abnormal gait due to LE muscle weakness with frequent falls (abductors, gluts), and difficulty achieving standing position (proximal muscle weakness) -Weakness occur in all voluntary muscles including the heart and the diaphragm -Individuals rarely survive beyond the age of 20's

Amyotrophic Lateral Sclerosis (ALS) (Lou Gehrig's Disease)

-Motor neuron (UMN/LMN) disease with unknown etiology -More prevalent in men occurring at an average age of 57 quick progressing -Characterized by progressive degeneration of corticospinal tracts and anterior horn cells -Death usually occurs in 2-5 year from the time of diagnosis. However, it varies greatly: -Symptoms include: muscle weakness, atrophy that begins dismally and asymmetrically. characterized by stiff muscles, muscle twitching, and gradually worsening weakness due to muscles decreasing in size. Difficulty in speaking or swallowing is the initial symptom in the bulbar form of the disease with excessive salavation -Difficulty with the articulation of lanaguage (dysarthria), and swallowing (dysphasia) -The progression of severity is rated by the ALS Functional Rating Scale -There is no specific treatment to slow the disease progression, however treatment is aimed at secondary complications such as spasticity, prevention of aspiration, decubiti, contractures, and pain management.

Clinical Implication: Muscular System Changes and Adaption in the Older Adult

-Movement becomes slower -Increased complaints of fatigue -Connective tissue becomes denser and stiffer -Decreased functional mobility -Gait may become unsteady

Classification of peripheral nerve injury

-Neuopraxia (1st degree) mildest form of injury -Axonotmesis (2nd degree) usually the result of more severe crush or contusion injury -Neurotmesis (3rd degree) "to cut" most severe injury caused by trauma or complete loss of sensory and motor function

Glasgow Coma Scale (GCS)

-Neurological scale which provides objective methods to record the conscious state of a person -Used for initial evaluation and continuing assessment to determine a person's level of consciousness after a head injury -identifies level of consciousness and measures severity - delineates a range of points for three test: eye (4), verbal (5), and motor (6) response Individual test scores as well as the total GCS score are documented ex. GCS 11 = E4 V3 M4 @ 11:30 pm -Highest total 15 (fully conscious person) -Lowest total 3 (deep coma or death) - GCS <8 severe -GCS 9-12 moderate -GCS >13 minor

Complications of Terminal Devices

-Neuromas -Skin breakdown -Phantom limb syndrome -Phantom limb pain -Infection -Knee flexion contractures in transtibial amputation -Psychological impairments due to shock/grief

0-1 months (release) Gross Motor Skill

-No release, grasp reflex is strong

Age-related Changes: Cognitive Changes and Adaptions in the Older Adult

-No uniform decline in intellectual abilities through-out adulthood -Changes do not typically show up until the mid 60's -Significant decline affecting everyday life does not show up until the 80's -Terminal drop: the most significant decline in measures of intelligence occurs in the years immediately preceding death -Impairments are typically noted in short-term memory, long-term memory is retained. -Factors affecting older adults in learning include: increased cautiousness, anxiety, sensory deficits, pace of learning (slow), interference from prior learning

Interventions and Strategies for Low Vision

-Non-optical devises: large print , computer adaption ( electronic magnification) -Contrast to improve visibility: colors that contrast (black-white) to help objects standout from the background, bold-line paper, and pens -Reduce visual and physical clutter and improve organization to increase safety and ease when locating items (ex. Pill organizer) -Modifications to the environment: increased lighting, educate on home modification to reduce falls (reduce clutter, scan the environment) -Refer Pt's to low vision specialist (as needed) to determine the appropriate optical devices -Instruct on use of prescribed optical devices: ensure use, appropriate lighting and distance. Magnification (ex. large print, digital books) -Teach clients how to maximize the use of their remain vision : eccentric viewing ( central vision loss: rotate their head or turn truck to use peripheral vision) (peripheral vision loss: rotate more to ensure they are seeing the entire visual field) -Teach clients how to scan in an organized manner to help identify hazards in the environment or locate desired objects -Teach clients how to use their other senses to compensate for vision loss: use tactile markers (bump dots), writing guides, auditory or talking devices -Perform diving assessments for adults who have stable vision impairments -Educate on fall prevention strategies -Educate and refer to appropriate community resources:

Home Care

-OT in home care is covered if the individual is home-bound and needed intermittent skilled nursing care, PT, or ST before OT began -OT services can continue after need for other services has ended - A home-bound patient may leave the house for medical appointments (e.g. dialysis) and non-medical short-term appt/events (e.g. hair dresser) -An initial assessment visit (comprehensive) using the Outcome and Assessment Information Set (OASIS) must be completed to verify the person's eligibility for Medicare benefits, and continuing need for home care including the patients nursing, medical, social rehab and discharge needs -OT can complete the initial OASIS if the need for OT establishes program eligibility, completed 48 hrs of referee or 48 hrs of person's return home

Hospice care

-OT is provided to person's who are certified terminally ill (medical prognosis of fewer than 6 mths to live) -Services are provided to enable a patient to maintain functional skills and ADL performance and/or to control symptoms

Skilled Nursing Facility (SNF)

-OT services are covered if the patient requires skilled nursing or skilled rehabilitation ( ie. OT, PT, SP) on a daily basis (minimum 5 days) -Reimbursement is based upon resource utilization groups (RUGs)

local factors affecting wound healing

-Presence of foreign debris -Necrotic tissue or eschar -Infection with Staphylococcus: pus, pain, purulent drainage, and odor -Repeated trauma, decreased blood supply, and hypoxic tissue

7-9 months (release) Gross Motor Skill

-Press down on surface to release

OT assistant (OTA) information

-OTAs are graduates of ACOTE accredited technical educational programs which are generally 2 years in duration, resulting in an Associate's degree or a Certificate -An OTA can expand their role by establishing service competency -Service competency is the ability to use the specified interventions in a safe, effective, and reliable manner, (ie. the OTA and OT can perform the same or equivalent procedure and obtain the same results) -OTAs who establish service competency do not become independent; they continue to work under the OT's supervision -OTA's primary role is to implement treatment -OTAs can contribute to the evaluation process but they cannot independently evaluate or initiate treatment prior to the OT's evaluation -OTAs can contribute to development and implementation of the intervention plan and the monitoring and documenting of the individual's response to intervention under the OT's supervision -OTAs can be activities directors in skilled nursing facilities (SNFs) and can supervise OT aides -AOTA supports the independent practice of OTAs with advanced level skills who work for independent living centers (state licensure laws and scope of practice legislation may supersede this recommendation)

Deep Partial- Thickness Burns (Evaluation & Interventions)

-Occupational Profile -ROM 72 hrs post-operative -sensation when wounds are healed -strength, when wounds are healed -ADLs and meaningful roles, activities ASAP Intervention: -wound care, dressing changes , debridement, sterile, whirlpool -gentle AROM and PRPOM to the patients tolerance -edema control -splinting if necessary -occupational roles activities ADLs -strengthening when wounds heal

Superficial Partial Thickness Burn (Evaluation & Interventions)

-Occupational Profile ROM 72 hrs post-operative -sensation when wounds are healed -strength, when wounds are healed -ADLs and meaningful roles, activities ASAP Intervention: -wound care, dressing changes , debridement, sterile, whirlpool -gentle AROM and PRPOM to the patients tolerance -edema control Splinting if necessary ADLs and role activities

Evaluation : Low Vision

-Occupational Profile: general information, medical records, interviews, questionnaires and standard or structured assessments -assessments and testing -Melbourne Low Vision Index -Canadian Occupational Performance Measure: semi-structured interview that identifies a Pt perception of performance in all areas, and rates importance of activity to the person and how the Pt's perception of performance changes over time -ADLs and IADLs -Visual acuity test -Visual fields test -Contrast sensitivity test -Environmental assessments: examine lighting, contrast of items, glare, identify optical and adaptive aides their uses and effectiveness

Occupational Therapy Evaluation: Arthritis

-Occupational profile ROM: Focus on AROM, avoid PROM in inflammation stage, note deformities and nodules Muscle strength: avoid muscle testing unless physician requested, -Document strength in relation to function, -Check grip strength (use sphygmomanometer) -ADLs: note deficits related to pain, limitation in motion, deformity, weakness, or fatigue -Use pain scale -Edema: volumeter or tape measure

Assessments of Community Mobility

-Occupational profile: include consideration of community mobility relevant to the client, context, and leading analysis of occupational performance. refer client to a certified driver rehab specialist for further assessment of driving skills ( as needed) -Assessment of skills and capacity to travel: measures of client factors, performance skills, and contexts of the clients engagement in community mobility to determine need ( factors that limit driving ability, may affect the use of public transportation) -Assessment of readiness for mobility Transitions: assess the readiness of older adult to transition into community mobility, use the most appropriate approach to address these changes

6-7 months (release) Gross Motor Skill

-One stage transfer, taking hand and releasing hand perform actions simultaneously

Body righting (on body) (BOB)

-Onset age: 4-6 months -Integration age: 5 years -Stimulus: place infant in supine, flex one hip and knee toward the chest and hold briefly -Response: segmental rolling of the upper trunk to maintain alignment -Relevance: facilitates trunk/spinal rotation

Sideward parachute (protective extension sideward)

-Onset age: 7 months -Integration age: persists -Stimulus: quickly but firmly tip infant off-balance to the side while in the sitting position -Response: arm extension and abduction to the side -Relevance: protects body to prevent a fall; supports body for unilateral use of opposite arm

Closed vs Open Fractures

-Open Fracture (compound fracture) a fracture in which there is an open wound or break in the skin near the site of the broken bone. Most often, this wound is caused by a fragment of bone breaking through the skin at the moment of the injury. Cause: high-energy event—such as a gunshot or motor vehicle accident. can also result from a lower-energy incident, such as a simple fall at home or an injury playing sports. -Closed Fracture: a broken bone that does not penetrate the skin. May still require surgery from proper treatment, but most often this surgery is not an emergency and can be performed in the days or weeks following the injury. ex: broken wrist, hip or ankle fractures, and spinal compression fractures.

Grasp of cube: 4 months

-PRIMITIVE SQUEEZE grasp- visually attends to object, approaches if within 1 inch, contact results in hand pulling the object back to squeeze precariously against the other hand or body, no thumb involvement

Evaluation of Feeding

-Parent interview including parent's concerns, feeding history, behavior during feeding, weight gain or loss. -Medical and developmental history. -Observation of feeding including postural control, oral sensitivity; motor control of the jaw, lip, tongue, and cheek; and coordination and endurance of all. -Recommendation for videofluoroscopy swallow study especially if the child has a high rise of aspiration.

OT Evaluation : Sensory Processing Disorder

-Parents/Caregiver: medical and developmental history -Teacher interview: school performance, play and behavior (SPM) Sensory processing measure -Formal Assessments: Sensory Profile -Formal Assessment of Clinical Observation: using Ayres unpublished and nonstandardized tools -Standardized Assessments: or tactile processing, vestibular/proprioceptive processing, visual perception

Neurotmesis (3rd degree)

-Peripheral nerve injury -Seddon's classification of completely severed nerve where recovery will not occur unless surgically repaired -Intervention: pain relief, orthotic positioning, controlled motion exercise and neural gliding exercises, scar and edema management, compensatory techniques, and patient education

Role Acquisition

-Psychosocial Frame of Reference -Developed by Anne Mosey -Principles: -Intervention is focused on the acquisition of the specific skills an individual needs in order to function in his/her environment -The individual employs task and social skills to meet the demands of personally desired and necessary roles -Performance is addressed through function/dysfunction continuum in seven categories: 1) task skills 2) interpersonal skills 3) family interaction 4) activities of daily living 5) school 6) work 7) play/leisure/recreation -Temporal adaptation addresses the individual's temporal orientation and ability to organize his/her use of time in a need-satisfying manner -The principles of learning are used to promote skill development -General postulates for change are provided to guide the treatment process -Specific postulates are provided for each of the continuums

Forms of community mobility

-Public transportation -Personal transportation -Commercial Transporttaion -Supplemental transportation

8-9 months (standing ) Gross Motor Skill

-Pulls to a standing position by kneeling , than half kneeling

9-13 months (standing ) Gross Motor Skill

-Pulls to a standing position with legs only, no longer needs arms -Stands alone momentarily

Participation Scale (P Scale)

-Purpose: A measure of restrictions in social participation related to community mobility, access to work, recreation and social interaction with family, peers, neighbors, etc. -Method: 18 item questionnaire addressing the 9 domains of participation including: self-care, mobility, social interaction -Scoring: score range from 0 to 90, scores above 12 indicates a need for intervention -Population: 15 years and older with physical disabilities

Neurological Assessment of Pre-term and Full-term New-born Infant (NAPFI) (Neonates)

-Purpose: A rating scale consisting of a brief neurological examination incorporated into routine assessments (incubated/ventilated if handling can be tolerated) -Method: Administered in a sequence: 1st quiet sleep state, 2nd items not influenced by state, 3rd awake state -Population: Premature and full-term newborn infants -Score: scores are based on 6 grading of states, interpretation: a pattern of responses to reflect neurological function and identify deviations Habituation, movement and tone, reflexes, and neurobehavioral responses including state transition, level of arousal and alertness, auditory and visual orientation, irritability, consolability, and cry are assessed.

Coping Inventory and Early Coping Inventory (Psychological and Cognitive Assessments)

-Purpose: Assess coping habits, skills, beahviors, including effectiveness, style, strengths, and vulnerability's to develop intervention plans for coping skills -Method: Coping inventory-questionnaire; (coping w/ self-environment) based on 3 items: productive, active, and flexible Early coping-questionnaire; (effectiveness of behavior) based on 3 items: sensorimotor organization, reactive behavior, and self-initiated behavior, 4 to 36 months -Scoring: Determines the level of adaptive behavior and if intervention is needed (coping profile) -Population: CI: 15 years and above, ECI; 4 to 36 months

Erhardt Developmental Vision Assessment (EDVA) and Short Screening Form (EDVA-S) (Visual Motor and Visual Perception Assessment)

-Purpose: Behavior rating scale to determine visuo-motor development; assesses eyelid reflexes, pupillary reactions, doll's eye responses, and voluntary patterns -Method: 271 test items organized into 7 clusters presented sequenced developmentally, a response is scored for each eye -Score: Responses are scored normal, well- integrated, emerging, or not present. Developmental levels are provided for each cluster, and a final developmental level is estimated. Finding will determine indication for ophthalmic evaluation -Population:* Birth to 6 months; since 6 month is considered norm, it can be used to assess older children

Preschool Visual Motor Integration Assessment (PVMIA) (Visual Motor and Visual Perception Assessment)

-Purpose: Evaluate visual -motor integration and visual perceptual skills of preschooler including: perception in space, awareness of spatial relationships, color and space, discrimination, matching, and the ability to reproduce what is seen -Method: 2 performance subtest, and 2 behavioral observations checklist -Scoring: Fine motor skills, and visual perception abilities are examined separately (percentile ranking) impairments are indicated by standard scores below 80 and percentile scores below 25% -Population: preschoolers aged 3.5 to 5.5 years

Revised Knox Preschool Play Scale (RKPPS) (Psychological and Cognitive Assessments) (Play Assessment)

-Purpose: Observe of play skills to differeintiate developmental play abilities, strengths and weakness, and interest areas -Methods: admin in a neutral indoor/out-door environment with peers, observation completed in 6 mths increments to age 3. With 4 dimensions of play including: Space management, material management, pretense/symbolic (imitation), participation -Scoring: behavioral description factors from each of the 4 dimensions, means scores provide a play age indicative of play maturity. Useful for children that are not appropriate for standardized test -Population: 0 to 6 years

Peabody Developmental Motor Scales (2nd ed.) (PDMS-2) (Motor Assessment)

-Purpose: Standardized assessment of gross and fine motor development of children with motor, speech, and/or hearing and language disorders -Method: Gross/Fine Motor subtest that measure reflexes, control, locomotion, manipulation, grasp, and visual motor integration. One level below the child's expected motor age (basal age level), discontinued w/ 3 consecutive zero scores -Score: To acquire a developmental profile, strengths/weakness identified; percentiles obtained. Useful for planning/implementing training -Population: Birth to 6 years

Motor-Free Visual Perception Test (MVPT-3) (Visual Motor and Visual Perception Assessment)

-Purpose: a standardized, quick evaluation to assess visual perception (including motor components) using 5 areas: spatial relation, visual discrimination, figure-ground, visual closure, and visual memory -Method: Num. of item administered depends on age 4-10 (items 1-40), 10 years or older (items 14-65) -Scoring: raw score are translated into perceptual ages/quotients, and determined as a standard score of 80-120 (percentile rank 25-75%) -Population: children and adults aged 4 years to 95 years

Sensory Profile: Adolescent/Adult

-Purpose: allows clients to identify their personal behavioral responses and develop strategies for enhanced participation -Method: a questionnaire measures the participants to daily sensory experiences -Scoring: difference indicate which sensory system is hindering performance -Population: 11 to 65 years

Recovery Model: Evaluation

-Quality of Life Interview Measures the persons level of functioning using objective-based questions and life satisfaction using subjective-based questions (assess the persons living situation, daily activities, family, and social relationships, fiances, work/school issues, health, leisure, safety, and QoL -Oregon Quality of Life Questionnaire Measures adjustment in relation to how an individual's needs are met in combination with the demands society places upon them -The Empowerment Scale Measures a central component of recovery, including the following ares: self-esteem, power, activism, control and anger Results can be used to develop strategies for regaining control over one's life -Intervention/development/implementation of a Wellness Recovery Plan (WRAP) is an essential part of the recovery plan -Storytelling is a means of decreasing stigma and supporting others by sharing experiential life experiences

Interventions : Fracture of the Wrist

-ROM is allowed in the early phase of healing and repair -Orthotics: used to protect the extremities from motion or allow protect of motion -Home program: is provided to increase progression towards goals and outcome between therapy sessions -Exercises: used to facilitate movement and improve performance including :AROM, blocking exercises tendon and nerve glides, and strengthening -Modalities: are used to prepare tissue for work and assist with pain relief and tissue healing

Grasp of cube: 8-9 months

-Radial digital grasp: objects are held with the opposed thumb and fingertips -Space visible between -Wrist visible

Grasping skills- 6 months

-Raking and contacting objects

Sampling Mehthods

-Random , Systematic, Stratified, Purposive, Connivence, Network/snowball

7-10 months (creeping) Gross Motor Skill

-Reciprocal creep

Peripheral Neuropathies

-Regional losses of sensory and motor function most often resulting from nerve trauma or compression -Multiple nerves may be affected in cases of collagen vascular disease, metabolic diseases (diabetes), or infection (Lyme disease)

Person-related testing bias : Testing Bias

-Related to the actions of the evaluator or the client that influence the outcome of an evaluation or test -Must be controlled to achieve optimal results in standardized and non-standardized testing Types include: -evaluator bias -test-taker bias

Releasing skills: 9 months

-Release by full arm extension -Refinement of release continues up to age four with the attainment of graded release

No Child Left Behind Act (2001)

-Requires the states to set standards and measurable goals that can improve individual outcomes in education. -A general education law which emphasizes standard-based education -Considers OT to be pupil services personnel and sets no requirements for OT services

Spinal Cord Injury (SCI) Complications

-Respiratory complications, decreased vital capacity, pneumonia -Decubitus ulcer formation -Orthostatic hypotension: an excessive fall in blood pressure upon assuming the upright position -Deep vein thrombosis -Autonomic dysreflexia: an abnormal response to a noxious stimulus results in extreme rise in blood pressure, pounding headache, and profuse sweating. This complication is deemed a medical emergency if not reversed (by removing the stimulus) quickly -Urinary tract infection/ loss of bowel & bladder control -heterotopic ossification, the formation of bone in abnormal anatomical locations

Clinical Implications: Pulmonary System

-Respiratory response exercises -Clinical signs of hypoxia or blunted -Cough mechanism is impaired Gag reflex is decreased, increased risk of aspiration

Prenatal period

-Responds first to tactile stimulation -Reflex development -Innate tactile, proprioceptive, and vestibular reactions

Total Hip Replacement / Arthroplasty (THR) (THA): OT Evaluation

-Review precautions and weight-bearing status before evaluation -Complete an Occupational Profile -Assess ADL: focus on dressing, bathing, and transfers -Assess ROM, and strength of UE -Conduct other assessments as needed (eg. cognitive)

Hip Fractures : OT Evaluation

-Review precautions and weight-bearing status before evaluations -Occupational role requirements and expectations -ADLs: focus on dressing, bathing, and transfers -ROM and strength of UE -Conduct other assessments as needed (e.g. cognitive)

9-18 months (sitting ) Gross Motor Skill

-Rise from supine position by rolling over to stomach than pulling up into four point position

Sustaining life in the emergent phase of treatment for burns

-Risk of dehydration via evaporation -hypothermia or hyperthermia (an inability to perspire to cool the body surface or contain heat) -fluid resuscitation- leakage of plasma and blood volume and decreased cardiac output -cardiopulmonary stability: achievement is very important if the respiratory tract has sustained a smoke inhalation Injury -escharotomy and fasciotomy; surgical excision of incision

3-4 months (rolling ) Gross Motor Skill

-Rolls from prone position to the side accidentally -Rolls from supine position to side

5-6 months (rolling ) Gross Motor Skill

-Rolls from prone to supine position -Rolls from supine position to prone

6-14 months (rolling ) Gross Motor Skill

-Rolls segmentally with the roll initiated by the head, shoulder, or hip

Complex rotation: manipulation skills

-Rotating an object 360 degree -Turning a pencil over to the eraser side -6-7 years

Anatomy of the Shoulder

-Rotator cuff muscles -Shoulder flexion muscles -Shoulder abduction muscles -Horizontal abduction muscles -Horizontal adduction muscles -Shoulder extension muscles

21-24 month (problem-solving skills)

-SHAPE SORTER -matches circle, square, triangles and manipulates objects into small openings

Becker muscular dystrophy (BMD)

-Very similar to Duchenne, but less severe, slower progressing, and less predictable -Symptoms include: loss of motor function (hips, thighs , pelvic area, and shoulders), and enlarged calves -Survival can be into late adulthood, normal lifespan can be obtained if there is minimal cardiac involvement

Occupational Therapy Interventions :Arthritis

-Splinting: rest hand splints (acute phase), wrist splints, ulnar drift splints to prevent deformities, silver ring splints (boutonniere/swan deformity prevention), dynamic MCP extension splints (for radial pull post-opt MCP athroplasties), hand-based thumb splints for CMC arthritis. -Joint Protection Techniques -Energy conservation techniques -ROM: focus on AROM, PROM. pain free exercises -Heat Modalities: hot packs before exercise, but not during inflammation stages -Paraffin wax -Strengthening: avoid during inflammation stage, or with positions of deformity -ADLs: purposeful occupation-based w/ joint protection and energy conservation techniques. -Adaptive Equipment: to prevent deformity, decrease stress on small joints and inc. reach

Lateraling (motor development)

-Stable by age 5 years however strong preference can be seen earlier -Handedness

5-10 months (standing ) Gross Motor Skill

-Stands while holding onto furniture

Funding for ATDs and EARLs

-State Vocational Services for Individuals with Disabilities (VESID) -Office for Vocational Rehabilitation (OVR) -Division for Vocational Rehabilitation 1. Will pay for ATDs and EARLs if they enable the person to go to work and school 2. Will pay for driver rehabilitation if it will enable the person to go to work or school

Medical Treatment of CRPS

-Stellate or sympathetic blockers (injection into the front of the neck or lumber region of the back to block pain) -Intrathecal analgesia: pain meds placed in the spinal canal -Removal of neuroma: surgery to remove thickening nerves

Upper Motor Neurons (UMN)

-Structures: nerve cell body/fibers in the spinal cord (except the anterior horn cell) -includes: gray and white matter affecting motor function, and cranial nerve nuclei -Symptoms of a lesion: -increased deep tendon reflex, spasticity, clonus, babinski sign, autonomic dysrelexion, emergence of primitive reflexes, and flaccid at the level of the lesion, increased tone

The supervision continuum

-Supervision occurs along a continuum that includes close, routine, general, and minimum -Close: daily, direct contact at the site of work -Routine: direct contact at least every 2 weeks at the site of work, with interim supervision occurring by other methods such as telephone or written communication -General: at least monthly direct contact with supervision available as needed by other methods -Minimal: provided only on a needed basis, and may be less than monthly -Formal supervision can be supplemented by functional supervision, which is the provision of information and feedback to coworkers (a sharing of expertise) -The degree, amount, and pattern of supervision required can vary depending on the practitioner's competence, service demands, state laws and licensure requirements, facilities procedures, complexities of client needs, and caseload characteristics and demands (ie. an OT assistant providing services to an acutely ill person with rapidly changing status on an inpatient until will require a closer OT/OTA partnership than an OT assistant providing services to a more stable client in a long-term care residential facility) -The supervising occupational therapist determines the type of supervision that is most appropriate -Ethically, the OT supervisor must ensure that the type, amount, and pattern of supervision match the supervisee's level of role performance -OT aide supervision may be intermittent or continuous depending on the task being performed (intermittent supervision is sufficient for non-patient related tasks. It requires periodic discussion, demonstration, or contact between the supervisor and aide on at least a monthly basis; continuous supervision is required for patient-related tasks. A supervisory OTA or OT must be within auditory and/or visual contact in the immediate area of the aide during the aide's task performance -Continuous supervision is required for client related task

Shoulder: Abduction Muscles

-Supraspinatus -Middle deltoid axillary nerve, abduct the arm origin: acromion insertion: deltoid tuberosity

Total Quality Management (TQM)

-The creation of an organizational culture that enables all employees to contribute to an environment of continuous improvement to meet or exceed consumer needs

Safety needs: Maslow

-The need for physical and psychological security

Medicare Part B

-The part of the Medicare program that pays for outpatient physician services, and other professional services, durable medical equipment, and other supplies. -Considered a Supplemental Insurance Program and must be purchased as a monthly premium -Services have no specific time limit and require a 20% co-payment -Prescription by a physician or furnished according to physician-approved plan of care -Services must be reasonable and necessary for treatment -Diagnosis can be physical physical, psychiatric, or both (no diagnostic restrictions for coverage)

Static tripod grasp

-Thumb index and middle finger hold the pencil (crude approximation) -hand moves as a unit 3.5-4 years

4-8 months (release) Gross Motor Skill

-Transfers objects from hand to hand

Transverse vs Spiral vs Oblique Fractures (complete fractures)

-Transverse Fracture: Tranverse fracture implies a fracture line that is transverse to the long axis of the bone. Transverse fractures may be relatively smooth or may be rough or have deep teeth on the fractured surfaces. Most are caused by bending forces. Roughness simplifies anatomical alignment and increases the likelihood of rotational stability once reduced. Once these fracture fragments have been reduced, fragment override should not occur Spiral Fracture: Spiral fracture indicates a fracture line that spirals along the long axis of the bone; it is caused by torsional twisting or rotational forces. Spiral fractures tend to have extremely sharp points and edges, which frequently accompany soft tissue trauma or an open fracture. Reduction of spiral fractures is difficult without constant traction or internal fixation, since these fractures tend to override and rotate into deformity Oblique Fracture: Oblique fracture implies a fracture line that is oblique to the long axis of the bone. The two cortices of each fragment are in the same plane without spiraling. The edges of an oblique fracture may be rough but are usually smooth. The cortical edges are flat, rather than sharp. These fractures generally result from bending, with superimposed axial compression. As a result of the obliquity of the fracture line, this fracture tends to override or rotate unless traction is maintained throughout the period of healing

Scapula: Upward Rotation #1

-Trapezius (upper, middle, lower) elevates, depresses, rotates, and retracts the scapula, or shoulder blade spinal accessory nerve (CNXI) origin: U: occiput and ligamentum, M: spinous processes of T1 to T5, L: spinous processes of T6 to T12 insertion: U: lateral 1/3rd of the clavicle, M: acromion and spine of scapula, L: medial end of spine of scapula

Occupational Therapy Interventions: Types of Abuse

-Treat physical and emotional injuries, -Treat developmental delays -Develop trusting relationships with children and non-abusive caregivers -Provide support to non-abusive caregivers -Refer to appropriate disciplines and agencies

Releasing skills: 5-6 months

-Two stage transfer

OT Conservative Treatment: Carpal Tunnel

-Wrist splint in neutral: at night, and during the day if performing repetitive activities -Median nerve gliding exercises and differential tendon gliding exercises -Activity modifications: avoid extreme positioning of rest flexion w/ without repetitive finger flexion, and w/ a static grip -Ergonomic: appropriate work station design (most common work related injury of UE) -Surgical intervention: Carpal Tunnel Release (CTR) -Positive operative treatment: edema control, elevation, retrograde massage, compression gloves and/or contrast baths -AROM, nerve and tendon gliding exercises, sensory reeducation, strengthening of the the armed muscles (6wks post-operative)

Seizure Disorder

-a temporary disturbance in brain activity causing nerve cells to fire excessively, interfering with normal brain function -seizures a typically idiopathic and, can be hereditary -often associated with other conditions: oxygen depreciation (birth), head injury, cerebral palsy, stroke, Brian tumor, neurological disorders, hydrocephalus, metabolic disorders, infection, meningitis, encephalitis, congenital infections, and rubella

48-60 months (problem-solving skills)

-able to utilize spatial awareness , cause-and-effect, and mental images in problem-solving

Loridosis (swayback)

-abnormal anterior thoracic curvature - causes: arthritis, muscular dystrophy, dwarfism -anterior pelvic tilt

Wet (AMD) (Central Vision Loss)

-abnormal blood vessels grow under the macula and can leak blood and fluid into the macula ,impairing central vision. -as the macula is displaced, straight lines may look wavy -this type progresses more quickly

Dysrhythmia

-abnormal heart rhythm aka Arrhythmia -irregular heart beat 4 main categories -premature beats (fast) -bradyarrythmia (slow) -supraventricular arrhythmia (top) -ventricular arrhythmia (bottom)

Scoliosis

-abnormal lateral curvature of the spine(s-shaped) -musculoskeletal disorder w/ side-ways curvature -most often occurs during growth spurts just before puberty -causes: cerebral palsy, muscular dystrophy -3% of adolescents

Kyphosis (hunchback)

-abnormal posterior thoracic curvature -adolescents and young adults

Stroke/ CVA symptoms

-abrupt onset -usually unilateral neurological signs (weakness, vision loss, sensory changes) -symptoms progress over several hours to two days -specific symptoms are determined by site of infarct and involved artery

OT intervention: Psychological Reaction to Disability

-acknowledge the individuals loss -identify what the individual is able to do -assistance in the individuals active role in shaping his/her life -use a person-centered approach based on the empowerment theory -reduction of limitations based on changes to the physical/social environment -development of skills (stress management/cognitive re-framing) altering cognition of mal-adaptive thoughts -development of peer support

OT Interventions (Osteogenesis Imperfecta)

-adaptions & assistive devices -fabrications to facilitate participation in ADLs -environmental modification for safety -preventative positions and protective splinting pads -activities to increase muscle strength -weight-bearing activities to facilitate bone growth -health education to promote healthy lifestyle (diet/weight control) (avoid smoking, caffeine, alcohol, steroids) (exercises: swimming, walking, water therapy) -Family, caregiver, teacher education about proper handling (et. everything above)

Gestational Age

-age of the fetus or newborn in weeks, from first day of mothers last menstrual cycle

Client education in rehab stage

-aid in the transition from hospital to home -independent skin care protocol -understanding of wound-healing process -compression therapy and positioning (apply garments and splints) -preservation of independence in ADLs and IADLS with continuing exercise and activity program

Stroke/CVA -Immediate Care

-airway maintenance -adequate oxygenation -IV fluids, alternative seating routes -decubiti prevention -treatment of underlying cardiac dysfunction (dysrhythmias)

Brake extensions

-allows a person with limited range in the UE to independently manipulate the w/c brakes

Head support

-allows from improved eye contact, communication, feeding assistance, as the head is kept in the neutral position

Electrical burns: low voltage

-alternating currents (AC) is more dangerous than direct current (DC) at the same voltage -alternating currents (AC) causes greater muscle contraction, and make it more difficult to release the electrified object

Meunière's Disease : Vestibular/Balance Control

-an inner ear disorder that causes episodes of vertigo (spinning) -characterized by tinnitus, dizziness, and a sensation of fullness or pressure in the ears and/or hearing loss

spinal Cord Injury (community mobility challenges)

-analysis of sensorimotor demands that intersect with the clients functional presentation of (SCI) -determination of community mobility options relative to performance capabilities -travel training -collaboration with transit providers regarding wheelchair safety and restraints

interventions (address agitation/wandering): behavior

-approach person from front at eye level -communicate calmly (simple instructions) -distract with an activity or topic -re-direct back to desired location -camouflage doors, exits, elevators (mirrors, stop signs, wall paper/blinds) -put tape on floors or planters to mark the end of the hall -install locks or velcro doors -use door alarms, personal alarms, or monitor devices -rearrange furniture to deter wandering -provide comfortable seating (rockers, and footstools)

Wheelchair Mobility Training

-assess cognitive and physical abilities -determine goals for community mobility -check w/c and seating system for fit -instruct in proper seating posture -instruct in pressure relief (push-ups, weight-shifting, leaning to one side, then the other) -transverse over different surfaces (carpet, asphalt) -ascend and descend inclines -negotiate lips and curbs -train in how to transfer from w/c to diverse surfaces

6-8 months (Feeding)

-attempts to hold a bottle (monitored for safety) -object permanence is emerging and infant anticipates food/bottle -easily distracted by stimuli in the environment (siblings/noise)

Reporting Ethical Violations

-complaints can be initiated by an individual or a group of people both within and outside the AOTA by submitting a complaint form located on the AOTA website -A letter will be sent educating the person involved about the ethical issue if the behavior does not warrant sanctions -If unethical conduct has been determines, the commission may impose sanctions Reprimand: Private letter of reprimand from the commission Censure: A public, formal notice of disapproval of the behavior Probation of membership: disciplinary actions and sanctions Suspension: for a predetermined time period Permanent revocation of AOTA membership

6 years (Household Management Task)

-completes household chores -cleans sink -washes dishes with help -crosses street safely

Dysphagia

-condition in which swallowing is difficult or painful (23) -may cause sensory, motor, and behavior dysfunction

Psychosocial adjustment

-contracture, disfigurement, and pain are primary stressor -depression, anxiety, and post-traumatic stress disorder and withdrawal reaction are common psychological reactions -aid in re-establishing the parent and child relationship post-burns -pre-discharge plan should include a community-based therapist to help child with re-adjustment issues

Right Hemisphere of Brain

-controls movement of the left -responsible for interpreting perceptual information -interprets emotional messages -processes information in a holistic manner -damage results in left-neglect -receive sensory information from the left -interprets spatial information -impairments result in impulsive behavior -function includes facial recognition and visual memory -damage causes slow cautious behavior decreased insight into deficits

10-12 years (Household Management Task)

-cooks simple meals -begins doing laundry -sets the table -washes the dishes -care for pets )w/ reminders)

1 -year (Self-dressing skills)

-cooperates with dressing (holds out arms and feet) -pulls off shoes, and removes socks -pushes arms through sleeves and legs through pants

High tech assistive devices

-costly devices that may require custom order and may require specific training to use (e.g. environmental control units (ECU), augmentative and alternative communication devices (AAC), and computers

Hallucinations: managing problem behaviors

-create an environment free of distraction that trigger hallucinatory thoughts and interfere with reality based activity -use highly structured simple, concerte and tangible that hold the clients attention -if the person begins to hallucinate; re-direct him/her to reality-based thinking ans actions

Split-thickness skin graft (STSG) (Acute phase: 72 hrs post burn)

-cutting the skin from a donor site and using a graft mesher to expand the graft. The graft is then transplanted on to the surgical site. Nervous System and Sense Organ -full dermal and partial dermal layer are taken from the donor site -chance of graft survival is high

diabetic retinopathy

-damage to the retina as a complication of uncontrolled diabetes -central vision is impaired, vision is blurred; complete blindness is rare

spondylisis

-degenerative process that occurs in the spine -typically occurs with osteoporosis -symptoms: pain, neurological changes, and motor impairment

24-30 months (Feeding)

-demonstrates an interest in using fork to stab at food such as pieces of fruit -tolerates various food textures -expresses wants verbally -has an increased desire to copy others

Under-responsitivity: (regulation and organization)

-diminished sensory registration and responses -patient does not respond to normal levels of tactile inputs , and may seek disproportionate amounts of stimuli to gain environmental information (-e.g excessive touching of people and objects)

12-14 month (Feeding)

-dips spoon in the food -begins to place and retrieve objects -recognizes that objects have function and uses them appropriately (spoon) -interested in watching family routine

Assessment consideration w/c (seating/positioning)

-distinguish between flexible deformities (changes can be made) and fixed abnormal postures and deformities (changes cannot be made -elevate the pelvis first -> LE -> trunk -> UE -> head & neck and feet as stability is required prior to mobility -proximal control allows for better distal function

Delusions: managing problem behaviors

-do not attempt to refute the delusion -redirect the individuals thoughts to reality-based thinking and actions -avoid discussions/experiences that validate/reinforce delusions

Documentation and Intervention

-document the eval process -document recommended ATD w/ rationale for each (justification) -needs and goals -functional status, abilities, limitations -based on school, work, leisure status and needs -justify cost-effectiveness and recommended equipment

Adults with dementia (community mobility challenges)

-driving cessation -education regarding alternative means of transportation -family/caregiver education and support

Well elderly and community dwelling older adults (community mobility challenges)

-education and resources regarding options within the community - personal safety during community mobility -age-related changes in function and intersection with community mobility

Edema management ( acute phase)

-elevation of extremities -AROM exercises -wrapping with elastic bandage

Psychosocial Dysfunction: evaluation of client factors and performance skills

-emotional/ affective disturbance, euphoria, apathy, depression, aggression -coping mechanisms -adaption to change in occupational role functioning or to difficulty in assuming roles

Environmental Modifications for Cognitive and Sensory Deficits

-environment needs to be familiar, consistent, and predictable -provide structure: to increase orientation time, place, person, and situation -remove clutter: to decrease extraneous stimuli -provide visual reminders/ tactile cues: to decrease confusion, increase awareness, and facilitate independence -keep things in the same place for consistency and ease use restraint reduction techniques; if the person is confused, agitated, and/or wandering -increase awareness of potential resources (to client/family) -make home modification to ensure safety

Back height

-measurement is based on need for postural stability, UE movements, and potential for independent w/c propulsion -take measurement from seat surface (including the cushion) upward to one of the following depending on trunk control, activity level, strength, and size of person with disability a. mid-back under scapula: 1-2 " below b. mid-scapula or axilla c. top of the shoulder -lower back height can increase functional mobility as in sports chairs a. lower back height can increase back strain -higher back height may be needed if poor trunk stability a. if back height of chair is extended, potential problems must be recognized 1. added back height may prevent the individual from locking onto the push handle for stabilization and/or weight bearing 2. added back height may increase difficulty of fitting chair into car or van

Club house programs

-membership is open to adults and elders with a current medical illness or history of mental illness -The daily schedule is organized around the "work-ordered" day (work hours) to engage members and staff in running the club house -OT evaluation and intervention is not provided in a formal manner and is integrated into the club house model

Indicators for group intervention

-more cost effective -effective at assisting members to learn to live in social environments -takes advantage of group dynamics and therapeutic milieu -groups that are facilitated in a therapeutic manner by an OT are inherently curative

Tonic-clinic seizure (grand mal)

-most common type of seizure -brief warning including: numbness, taste, smell, or other sensations -tonic phase: loss of consciousness , stiffness, irregular breathing, drooling, pale skin, occasional bladder/bowel incontinence -colonic phase: alternating rigidity and relaxation of muscles

Spastic: Cerebral Palsy

-motor cortex lesion -results in spasticity with flexor and extensor imbalance -jerky movements leads to problems w/ BADLs and writing Expressions include: -Hypertonia: increased muscle tone -Hyperflexia: Increased intensity of reflex response

TBI: Hemiplegia vs Monoplegia

-muscle weakness and partial paralysis on one side of the. Body

Disadvantages of standardized testing 1

-must be combined with qualitative and other assessment methods to complete a comprehensive evaluation -multiple internal and external variables can impact performance on test and affect results -rigidity of administration may negatively influence the results

spinal stenosis

-narrowing of the interveterbal foreman -compressing the nerve as it exits the spinal column -symptoms: pain, parehesa, muscle weakness, and sensory changes

Anti-contracture positions (Acute phase of burns)

-neck: neutral to slight extension -chest and abdomen: truck -extension, shoulder-retraction - axilla: shoulder-abduction 90 degrees, external rotation -elbow: extension -forearm: neutral to supination -wrist: dorsal wrist (neutral to 30 degrees extension), volar wrist ( 30-45 degrees extension) -hands: MCPs (70 degree flexion), IPs (extension, thumb: abduction and extended) -hips: 10-15 degrees abduction, neutral extension -knee: extension (anterior burnL slight flexion) -ankle: neutral to 5 degrees of dorsiflexion

Stroke/ Cerebral Vascular Accident (CVA) Prevalence, Onset, and Prognosis

-occurs every 40 seconds -every four minutes someone dies of a stroke - third largest cause of death -The prevalence is 7,200,000 based on current data

Thrombosis

-occurs when a thrombus, or blood clot, develops in a blood vessel and reduces the flow of blood through the vessel.

Testing bias

-occurs when administering a standardized or non-standardized assessment Types include: -person-related bias -item related bias -environment bias

Hypothyroidism: hearing loss

-occurs when the thyroid does not produce enough thyroxine hormone, causing fatigue, depression, forgetfulness, and weight gain -both hyper/hypothyroidism have been linked to hearing loss.

Cataracts

-opacity of the lens; most commonly resulting from denaturation of the lens protein caused by aging. -surgery is an effect treatment

Prerequisite skills for using scissors

-open and close a hand -isolate or combine the movements of the thumb, index, and middle fingers -use hands bilaterally; one hand cuts using the scissors, while the other hand stabilizes the item being cut -coordinate arm, hand, and eye movements -stabilize the wrist, elbow, and shoulder joints so that movement can occur at the distal joints -interact with the environment in the constructive developmental play stage

Chronic pain

-pain that persist beyond the usual course of healing -symptoms present for greater than 6 mths for which the underlying pathology is no longer identifiable or may never be present

Occupational Therapy Interventions: Death & Dying

-people vary in the way they go through each stage -people may stop at any stage and stay in (e.g. denial) as they preferred coping strategy -the need of loved ones must be considered -OT should assist the individual in coping with each stage without pushing for progression into the next stage 1. assist the individual in maintaining as much control and independence as possible 2. respond honestly and at the appropriate depth to questions 3. assist in developing coping skills 4. encourage positive life review and support legacies 5. assist the individual in pursing interest and maintaining meaningful roles 6. incorporate family and friends in the treatment process 7. therapist should not deprive the individual of hope

Psychosocial Evaluation (areas addressing during evaluation)

-performance skills -client factors -identification of roles and behaviors that are required of an individual either by society or for the achievement clients desired goals -precautions and safety issue such as suicidal and/or aggressive behavior -history of behavior patterns -individuals goals, values, interest, and attitudes -consideration and involvement of family, caregivers, and significant others -presenting problems and issues identified by the client -desired outcomes

Managing Pain: emergent phase of treatment for burns (Emergent phase)

-pharmacological: the use of narcotic analgesics -pain management for any associated injuries, such as organ injuries or fractures

General Interventions/Treatment Guidelines

-positioning: seated, wheelchair, and bed positions (mobility)including pressure reduction and relief -postural control training for seated and standing activities -motor learning approaches -motor control retraining/relearning (functional integration ) -specific ADL training/retraining/adaption -prescription of assistive devices and technology -splinting for contracture prevention and/or enhancement of function (e.g. tenodesis splint) -family and caregiver education -cognitive-perceptual retraining/compensation in context of functional activities -visual skills retraining/adaption (e.g diplopia) -Interventions for sexual dysfunction -bowel and bladder training with AE and techniques -skin care education -durable medical equipment -sensory re-education, compensation, safety training -development of coping strategies -community reintegration -work hardening programs -collaboration with educational teams for children

Therapeutic exercise and activity in rehab stage of burn healing

-progressively graded to retain strength and activity tolerance -educate client on performing skin lubrications and massage as pretreatment skin care before exercise and activity program -include daily stretching, resistive exercises, activity tolerance, and coordination activities

Symbolic Play 12-18 months (milestones in cognitive development)

-project "make believe" play on objects and others -uses a variety of schemes in imitating familiar objects

12-18 months (symbolic play)

-projects "MAKE BELIEVE" play on objects and others (ex. Playing doctor) -imitating family activity (child uses a variety of schemes)

interventions (address contributing factors): behavior

-proper positioning -appropriate safe resources of nourishment and hydration -adequate and client-directed toileting routine -active listening (attention to underlying feelings) -family/peer visits -pet therapy -social and leisure activities -exercise/ other outlets to combat restlessness -night-time activities -eliminate loud speakers or other extraneous noise -provide a structured home-like environment

seat belts

-provide safety during mobility and functional activities -attach at the hip level not the waist -extend across the hip into the lap at a 45-degree angle

Acute Pain

-provoked by noxious stimulation ( actually/potential tissue damaging event) -stimulant can be mechanical (pinching) chemical (acid), thermal (high/low temps) -associated with underlying pathology (injury, acute inflammation, or diseases) -signs include: sharp pain, and sympathetic changes (inc. heart rate, BP, pupil dilation, sweating, hyperventilating, anxiety, and protective behavior

5 years (Household Management Task)

-puts away toys neatly -makes sandwiches -makes bed -puts dirty clothes in hamper -answers the telephone correctly

4.5 years (Self-dressing skills)

-puts belt in loops

3 years (Self-dressing skills)

-puts on pull-over shirts with min A -puts on shoes without fasteners -independently pulls down pants - zips and unzips jacket once on track

Temporal lobe (telencephalon)

-receives and process auditory stimuli -Wernicke's area for language comprehension -long-term memory/ receptive language (left temporal lobe) -processing sensory, visual auditory

Left Hemisphere of Brain

-receives sensory from the right -interpreting written language -Broca's and Wernicke's aress -damage results in language impairments -lesion results in aphasia and agraphia -specialize in the production of language -controls movement of the right side -function includes math and logic -process information in a linear sequence

Problem Solving Skills: 12-24 months (milestones in cognitive development)

-recognizes operations of several mechanisms -the child matches circle, squares, and triangles and manipulates objects into small openings ex. Shape sorters

12-15 months (problem-solving skills)

-recruits the help of an adult to achieve a goal -activate a simple mechanism -turns and inspects objects -uses a trial and error approach to new challenges

Problem Solving Skills: 12-15 months (milestones in cognitive development)

-recruits the help of an adult to achieve a goal -attempts to activate a simple mechanism -child turns and inspects object -uses a trail and error approach to new challenges

Indicators for 1-to-1 intervention

-refusal to attend groups -inability to tolerate group interactions -behaviors that would be disruptive to the goal of the group -suicide precautions, or clients that are a danger to themselves and others -when addressing issue that are specific to that patient/client only

2.5 years (Toileting skills)

-regular toileting with occasional daytime accidents -verbalizes that he/she needs to sue the bathroom -may need reminders to go to the bathroom

27-30 months (problem-solving skills) 2+ YEARS

-relate experiences to one another, based on the logic and knowledge of previous experiences -makes a mental-plan of actions without acting on it -child can see a relationship between experiences (ex if the ballon popped it will make a loud noise)

Escharotomy and Debridement (Acute phase: 72 hrs after injury)

-removal of burned or dead skin, allowing for new vascularized skin to close up the wound

2 . 5 years (Self-dressing skills)

-removes pants with elastic waist -puts on front button coats/ shirts -unbuttons large buttons

4 years (Self-dressing skills)

-removes pull-over garments independently -buckles shoes or belt -zips jacket zippers -puts on socks correctly -puts on shoes with assistance in tying laces

2- years (Self-dressing skills)

-removes unfastened coat -removes shoes if laces are untied -finds arm holes in pull-over shirts

Neglect: Sign and Symptoms in Elders

-reports of being mistreated -dehydration, malnutrition, untreated bedsores, and poor personal hygiene -unattended or untreated health problems -hazardous or unsafe living conditions

Diaphragmatic breathing

A breathingexercise that helps strengthen your diaphragm, an important muscle that helps you breathe. Breathing technique used to control SOB with the following steps: -placing hand on abdomen -inhale to fill the lungs with a slow and deep breath -pay attention to chest moving slightly and abdomen rising -exhale while abdomen relaxes

Smith's fracture

A complete fracture of the distal radius with (volar) palmer displacement -falling backwards

Occupational deprivation

A condition in which an individual is unable to participate in meaningful life activities due to external factors -(e.g. poverty, local regulations, refugeeism)

Repetitive strain injury

A condition that occurs due to repeated use, excessive force or vibration, or sustained strain on body structures

Timed voiding

A bladder-retraining program to reduce urgency, frequency and urinary incontinence. -toileting is scheduled at fixed time intervals

Frustration

A negative emotional state that occurs when one is prevented from reaching a goal. -results in the resistance to participate in an activity and provokes the desire to stop engagement in an activity

Multiple Sclerosis Symptoms: Four Patterns

A disease in which the immune system eats away at the protective covering of nerves. resulting nerve damage disrupts communication between the brain and the body. -woman are 2-3 times more likely to be diagnosed with MS than men -Characteristics symptoms include: inflammation of the CNS, positive babinski signs, intension tremors, vision loss, pain, fatigue, impaired coordination, and intermittent visual changes. Advance stages cause plaques in the spinal cord -Relapse remitting: Most people with multiple sclerosis -- around 85% -- have this type. They usually have their first signs of the disease in their early 20s. After that, they have attacks of symptoms (called relapses) from time to time, followed by weeks, months, or years of recovery (called remissions). -Secondary progressive: After living with relapsing-remitting MS for many years, most people will get secondary progressive MS. In this type, symptoms begin a steady march without relapses or remissions. (In this way, it's like primary progressive MS.) The change typically happens between 10 and 20 years after you're diagnosed with relapsing-remitting MS. -Primary progressive: In primary progressive multiple sclerosis, the disease gradually gets worse over time. There are no well-defined attacks of symptoms, and there is little or no recovery. In addition, MS treatments don't work as well with this type of MS. About 10% of people with MS have this type. -Progressive relapse: No two people are likely to have the same set of MS symptoms in the same way. Some problems may come and go or happen once and not again. The way MS affects you depends on which areas of your brain or spinal cord have damage from the disease.

Medicare: Elderly health care

A federal program of health insurance for persons 65 years of age and older The part of the Medicare program that pays for hospitalization, care in a skilled nursing facility, home health care, and hospice care. -Largest single payer of OT services -Individuals of all ages with end stage renal disease/ permanent kidney failure -Persons with long-term disability (e.g. ALS, MS) receiving government benefits for 24 mths or retired railroad works

Splint: orthopedic device

A flexible or rigid appliance used to protect and maintain the position of an injured extremity. -designed, fabricated, or selected in conjunction with a client to temporarily support, protect, or immobilize a body part -categorized as articular or non-articular according to the location, direction, purpose, type, or number of joints included - Splints are used to in able participation and valued occupation, and can be comfortable, lightweight, aesthetically pleasing, and convenient

Hyper-responsiveness

A form of sensory modulation in which the central nervous system registers or processes sensory input at a heightened state Behavioral characteristics include an overwhelming response to or avoidance of: social situations noises textures

Altered Mental Status (AMS)

A general term that refers to a decrease in cognitive function, feelings of confusion, change in behavior, and/or agitation; may indicate a transient or acute condition (such as delirium or stupor) or chronic condition (such as dementia)

Down Syndrome (Trisomy 21)

A genetic disorder caused by the presence of all or part of a third copy of chromosome 21. -characterized by mild to moderate intellectual disability, physical developmental delays, low muscle tone, and characteristic facial features

Egocentric-cooperative group

A group in which members focus on completing a project or activity over several sessions -group members choose levels of interaction with each other, which is often based on the need to complete various aspects of the project

Occupational imbalance

A lack of balance or disproportion of occupation resulting in decreased well-being -an unbalance between productivity, leisure, and rest that negatively impacts health and well being

Triangulation Research Method

A method used by qualitative researchers to check and establish validity in their studies by analysing a research question from multiple perspectives in order to arrive at consistency across data sources or approaches

Person Environment Occupation (PEO) Model (Dunbar, 2007): Concepts and assumptions

A model that emphasizes occupational performance that is shaped by the interaction between the person, environment, and occupation The three domains are dependent and effected by each other -Person: personal characteristics of the client (role, self-concept, cultural back ground, personality, health, cognition, physical performance, and sensory capabilities -Environment: cultural, social, institutional, socio-economic, psychological, organizational, and physical components of the clients surroundings -Occupation: self-directed, functional task and activities. A group of task that a person engages in and meets his/her self-maintenance, expression and fulfillment -Occupational performance: outcome of the transactional relationships among P-E-O. Dynamic in nature and necessarily changes across the lifespan . Occupational performance represents the congruence, with the higher level of congruence the quality of occupational performance is increased and vice versa.

Tethered cord syndrome

A neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. These attachments cause an abnormal stretching of the spinal cord -visible signs: hairy patch of skin, hemangioma, and/or dimple of the lower spine -difficulties with bowel and bladder control, gait disturbance, and/or deformities of the feet, low back pain, scoliosis, may result -symptoms may be exacerbated with pregnancy or with age due to spinal stenosis Medical Management - neonatal: protect the sac from rupture, and infection -If hydrocephalus occurs a shunt may be used. if the shunt becomes blocked intracranial pressure can cause mental retardation (symptoms include increased head growth and soft spots on the forehead

Open-ended interview

A non-standardized and unstructured the of interview that allows the client to openly share information and the interviewer to ask follow-up questions customized based on the client's responses

reality orientation

Intervention method used for persons with cognitive impairment that includes routine and consistent reminder of: -time, date, and weather -current location -familiar names -roles of people in their support network

Lateral Epicondylitis (Tennis Elbow)

A painful condition involving the tendons that attach to the bone on the outside (lateral) part of the elbow. Your dominant arm is most often affected; however both arms can be affected. Etiology: The muscle involved in this condition: • Extensor carpi radialis brevis • Extensor carpi radialis longus • Extensor carpi ulnaris • Forearm tendons — often called extensors Commonly affects individuals between 30 and 50 years old. Can occur in all ages and in both men and women Causes: inflammation of the tendons that join the forearm muscles on the outside of the elbow • Overuse: "repetitive" gripping and grasping, pushing, pulling, lifting activities • Trauma: a direct blow to the elbow may result in swelling of the tendon that can lead to degeneration. • Can occur without any recognized repetitive injury. This occurrence is called "insidious" or of an unknown cause Symptoms: Pain in forearm, distal and anterior to lateral elbow -Worse with extension of wrist and gripping and supination -TTP over lateral elbow Develop gradually: Pain, Burning, Weak grip strength Treatment: Initially RICE, NSAIDs and activity modification • Rest • Staggered exercise programs (stretching wrist extensor muscles) • Non-steroidal anti-inflammatory medicines. • Brace • Steroid injections • Extracorporeal shock wave therapy • Open/ Arthroscopic surgery Splinting: Counter force strap on lateral elbow two fingers width away from lateral epicondyle. Cushion placed on muscle belly of forearm extensors.

Work performance measurement

A part of the vocational rehabilitation process that includes evaluation of a client's ability to perform demands of the workplace

Substance use disorder

A pattern of long-term maladaptive behaviors and reactions brought about by repeated use of a substance -In which the individual is reliant on the use of substances for non-medical purposes. -May lead to physical and psychological addition -Interventions: cognitive behavior therapy, 12-step programs, pharmacotherapy

Neuromuscular Electrical Stimulation (NMES)

A physical agent modality that provides electrical stimulation to a peripheral nerve Potential use include: strengthening muscles, increase ROM, decrease spasm, manage edema Recommended for use as an adjunct to other occupational-based intervention

Randomization

A process of randomly assigning subjects to different treatment groups -by chance, without influence -provides the best statistical confidence in research studies

Age-equivalent score

A score that compares a child's performance to others in the same age range

Chi-square test

A significance test used to determine if a linear relationship exists between two variables measured on interval or ratio scales. -a non-parameter significance test used to compare data in the form of frequency counts occurring in two or more mutually exclusive categories

Case study research

A single subject or group of subjects is investigated in-depth -the purpose can be descriptive, interpretive, or evaluated -very easy to use in most practice settings

Enthographic research

A study of patterns and characteristics of a cultural group, including values, roles, beliefs, and normative practices -use of extensive field observations, interviews (face-to-face), participant observation, examination of literature and material, and cultural immersion are used -used in healthcare to understand insider perspective to develop meaningful services (e.g. study of nursing homes)

Osteotomy

A surgical procedure used to change the length or position of a bone

Inter-professional collaboration

A team approach that involves multiple service providers and the client working together to support progress towards a common intervention outcome

interdisciplinary team

A team of healthcare providers that collaboratively determine client goals with discipline specific interventions being combined with use of complimentary, shared approaches

Health literacy

Ability of a consumer to obtain, read, and understand resources in order to make informed health care choices

Early participation in ADLs ( acute phase )

A. apply adaptive strategies, AE or both (ADLs and encourage movement) B. ROM program and activity tolerant ( no passive or active ROM with exposed tendons or recent graft) -use visual imagery and relaxation to minimize pain (REST PAIN), and address fear C. increase functional strength, endurance, and decrease edema. ( allow pt. to control time limit on painful tx. sessions) D. treat 30 minutes after pain med. E. apply compression wrapping to provide adequate vascular support to LE before walking, standing, and prolonged sitting to avoid pooling of fluid and blood. Caregiver and Client Education (IMPORTANT) -states of burn recovery -importance of independent activity and exercise participation -pain management techniques

Trunk stability

Ability of the core musculature to maintain posture and stability, influences the quality of movement of the extremities during activities

Functional performance

Ability to carry out daily living task

Barthal Index continued - reliability, MDC, validity, concerns

ADL rating scale based on a clients current level of function Features include -ability to rate 10 activities in areas of ADL and mobility -can be completed through self-report or interview of a caregiver -receiving a higher score indelicate greater level of ability Reliability: test- retest = .89 (chronic stroke), Interrater - .85 (neuro rehab) MDC (minimal detectable change) - need 4 points to show change and be confident it wasn't a measurement error Validity: 0-20 unfavorable outcome, ie death, 21-60 LTC or needs more rehab, >60 discharge to home. Concerns: not as accurate for pts with cognitive or communication issues, does not measure IADL

Visual skills training

Interventions for impairment of the peripheral or central visual field (e.g., visual strategies and visual scanning training) and for central visual field defects (e.g., eccentric viewing training)

Rotator Cuff Tendonitis

Action: abd, flex, external/internal rotation Function: control of humerus head Site of impingement: corachoaromial arch Etiology: inflammation of a group of muscles (supraspinatus, infraspinatus, subscapularis) in the shoulder together with an inflammation of the lubrication mechanism called the BURSA. Cause: repetitive overuse, curved/hook acromion, weak cuff, weak scapula muscles, ligament/capsule tightness. Conservative Treatment: activity modification until pain subsides, educate in sleeping posture (avoid overhead/ add and internal rotation), dec pain (positioning, modalities, rest), restore ROM, strengthening below shoulder, ADLs task training) Surgical Interventions: athroscopic surgery, open repair Post-operative interventions: PROM (0-6wks) progress to AA/PROM, ice/progress to heat, strengthening (6wks post-opt) begin w/ isometric, progress to isotonic (below shoulder), activity modifications, light ADLs, leisure/work 8-12wks post-opt

Sensory-seeking behavior

Actions characterized by craving input from a variety of senses and experiences, typically associated with: altered sensory processing ability, challenges with regulation of arousal level. atypical praxis, hyper- or hypo-responsivity Generating additional sensory inputs to compensate for weak processing in a particular sensory system (prevalent in autism)

Finger blocking exercise

Active exercise that involves isolating a specific joint of the hand by supporting the digit just proximal to the joint being moved, used to: target a specific joint restore strength prevent adhesions enhance tendon glide

Reminiscence group

Activities are designed to review past life experiences to promote cognition and a sense of personal worth **Current memory not required

Rocker knife

Adaptive eating utensil designed to enable one-handed cutting, may be beneficial for persons with hemiplegia, peripheral nerve injury or other condition resulting in a non-functional grasp of one hand

Swivel utensil

Adaptive spoon or fork with a moving component designed to minimize food spillage, may be beneficial for persons with decreased forearm supination or intention tremors

Formal Operation: (Hierarchical development of cognition)

Ages 11 through teen years -hypothetical-deductive thinking; is the ability to analyze and plan -The child uses logic to hypothesize many ways to solve problems, and can draw from past and present experiences to imagine what can have an effect on future situations

Preoperational period ( Hierarchical development of cognition)

Ages 2 to 7 years Divided into 2 phases -Preconceptual phase: child expands vocabulary and symbolic representations (2-4 years) -Intuitive though phase: child imitates, copies, or repeats what is seen or heard, and basis conclusion on what they believe to be true rather than on logic. Inductive reasoning denotes a transition to the next stage (4-7 years) Child progresses from dependence or perception, and egocentric orientation to logical thought, for problem solving Child enjoys symbolic and verbal play

Concrete operations: ( Hierarchical development of cognition)

Ages 7-11 years The child uses logical thinking on observed or mentally represented objects, enjoying games with rules which helps the child adjust to social demands

Constraint-Induced movement therapy

An evidence-based intervention approach to therapy for recovery of movement after stroke or injury in which the person's unaffected limb is constrained while he is required to perform tasks with the affected limb. -facilitates functional use of the affected limb This therapy involves constraining movements of the less-affected arm, usually with a sling or mitt for 90% of waking hours, while intensively inducing the use of the more-affected arm. Concentrated, repetitive training of the more-affected limb is usually performed for six hours a day for a two to three week period. Compliance of the patient for the rigorous restraint and training schedule, as well as the required intensity of therapy provided by therapists in a clinical setting, are important issues to consider.

Response to Intervention (RTI)

An evidence-based model used to identify and reduce the impact of academic or behavioral concerns on students learning needs within the education system. Includes -a multi-tiered framework -outlines the deliver of client-centered education and intervention for all students -response to intervention is analyzed and used to determine of more intensive services are required

Quasi-experimental research (Quantitative)

An independent variable is manipulates to determine its effect on a dependent variable but there is a lesser degree of researcher control and/or no randomization -used often in healthcare research in which it is unethical to control or withhold treatment

Sensory Diet : Sensory Nourishment

An intervention program that involves provision of individualized sensory experiences and activities throughout the day to support optimal functioning of the child with sensory integration challenges -The use of sensory activities or exercises to calm certain sensory needs. Ex: activity schedule, replacement behavior that serves the same purpose -To have an optimal effect on the development, learning, and behavior, the sensory input must be actively organized and used by the child to act and respond to the environment -Adaptive response: the child organizes a successful, goal directed action on the environment, and he/she successfully meets some of the challenges presented . In making adaptive responses, the child is an active doer, and not a passive recipient

behavioral modification

An intervention strategy used to shape behavior; typically associated with providing a combination of positive negative reinforcement

Complex Regional Pain Syndrome (CRPS)

An uncommon form of chronic pain that usually affects an arm or leg. Complex regional pain syndrome typically develops after an injury, surgery, stroke or heart attack, but the pain is out of proportion to the severity of the initial injury, if any. Pain disproportionate to an injury that is either sympathetically maintained or independent of the sympathetic nervous system (reflex sympathetic dystrophy)

Shoulder Dislocation

Anterior dislocation: is most common Etiology: trauma, repetitive overuse OT Intervention: Regain ROM (avoid combined ABD & ER w/ ant dislocation, pain mgmt, strengthen rotator cuff

Stroke/CVA -Phamacologic Therapies

Anti-thrombotic therapy (antiplatelet and anticoagulantion) e.g. aspirin, heparin

Transition team

Persons involved in progressing a student to meet post-high school goals, -includes the student and relevant others such as: family OT caregiver PT special ed team speech vocational counselor supported employment rep

9-12 months (early object use)

Pushing a train or rolling a ball Child notices the relation between complex actions and consequences (e.g. opening a door, placing lids on containers)

24-36 months (early object use)

Putting food in a bowl, scooping the food using a spoon, and feeding a doll. Child links multi-scheme combo in to a meaningful sequence:

Temperament

Behavioral attribute of personality that influence social interactions in nine areas: level, rhythmicity, approach or withdrawal, attention span, threshold of response, distractibility, adaptability, intensity of response, and quality of mood

Cultural context

Beliefs, customs, and values that are shared by individuals within a group or community, and that influences activity choice

Anticontracture position: Burn of the axilla

Characteristic of this anitcontracture position includes: shoulder joint in 120 degrees of abduction with slight external rotation use of an orthosis or wedge to prevent shoulder adduction

Anticontracture position: Burn on the volar surface of the hand

Characteristics of this anticontracture position includes: MCP joints in slight hyperextension use of a palm extension orthosis to prevent cupping of the hand

Anticontracture position: Burn on the dorsum of the hand

Characteristics of this anticontracture position includes: MCP joints in the 70-90 degrees in flexion with IP joints in full extension and thumb in opposition maintain ROM of first web space use of a functional hand orthosis to avoid claw hand deformity

Total Hip Replacement / Arthroplasty (THR) (THA): Surgical Procedure

Cemented vs Uncemented: -Cemented: Cemented THA use polymethylmethacrylate (PMMA) to function as a grout, producing an interlocking fit between cancellous bone and prosthesis -Uncemeted: Uncemented hips rely on biological fixation of bone to a surface coating on the prosthesis Anterolateral vs Posterolateral (common) -Anterolateral: Candidates for this approach are not significantly overweight, have no femur deformities, and normal pelvis anatomy. This is a technically challenging procedure. Higher risk of femur fracture due to more difficult exposure. Higher risk of injury to lateral femoral cutaneous nerve, which may cause numbness in the outer thigh. -Posterolateral: The majority of patients are a candidate for this type of surgery. It is the most common approach and provides the greatest patient safety. Very low risk of fracture due to easier exposure. Very small (less than 1%) risk of sciatic nerve damage from excessive retraction during surgery.

Decerebrate rigidity

Characteristic abnormal reflexive posturing secondary to a severe brain injury, typically in patients with a score of two on the motor section of the Glasgow coma scale, includes: adduction and extension of the arms next to the body pronation of the forearms flexion of the wrists and fingers extension and internal rotation of the legs plantar flexion of the feet

Sensory Discrimination Disorder

Child has difficulty interpreting qualities of sensory stimuli Subtypes: Visual, Tactile, Vestibular, Proprioception, Taste/smell A problem in recognising / interpreting differences or similarities in the qualities of stimuli. It is commonly seen with problems in processing sensations from touch, muscles and joints [proprioception] and head movements [vestibular or inner ear sensations]. Common signs: Bumps or pushes others, Grasps objects too tightly or uses too much force, Frequently drops things or knocks things over, Mouths, licks, chews or sucks on non-food items, Craves movement - e.g., likes to spin self around, Afraid of heights / swings / slides, Has poor balance

Immobilization orthotic

Classification of a custom-made or prefabricated orthosis intended to prevent movement of one or more joints, typically used to: maintain tissue length preserve joint alignment maintain/protect a fracture reduction protect a healing/repaired nerve or tendon

Minimal Assistance

Client needs 25% (or less) verbal and physical assistance to complete a task

Maximal Assistance

Client needs 50-75% verbal or physical assistance to complete a task

Teacher coaching

Collaborative process in which the OT practitioner assists the educator to assimilate curriculum-based learning or behavioral strategies in the least restrictive environment for supporting students' participation in occupation

Chin tuck

Compensatory swallowing maneuver that involves moving the chin towards the chest while swallowing, protects the airway and reduces the risk of aspiration

Supraglottic swallow

Compensatory swallowing technique used to close the vocal cords before and during swallow, involves the following steps: -Taking a deep breath -Holding the breath while swallowing -Coughing to clear saliva or food that may have passed beyond the vocal cords

Feeding trial

Completed by a dysphagia specialist to determine clinically appropriate food (purees to solid/regular diet) and liquid (water/thin to honey-thick) Requires careful monitoring for effectiveness of swallow and signs of aspiration through: auscultation palpation

Occupational Profile

Completed during evaluation and refines throughout Intervention used to gain and understanding of the clients level of performance and participation in occupation -client identified priorities

Body-powered terminal device

Component attached to the distal end of a prosthesis that is operated by forces generated by the body and enables a person to hold and stabilize objects, types include hand and hook designs with voluntary opening or voluntary closing features

Falls prevention program

Comprehensive approach to reduce incidence of falls through programmed instruction that includes: exercise recommendations home modification education risk factor identification medication management

Teacher consultation

Conference with educators to support a student's participation in curriculum-based activities related to: -classroom performance -barriers and facilitators in the school -adaptive teaching/learning strategies -educational goals

Stage 5: Parkinson's Disease (Hohn and Yahr's 5 stage scale)

Confined to a wheelchair or bed, maximally assisted

Mealtime environment

Contextual setting specifically designated for eating based on temporal, physical, cultural and social factors Important consideration when planning feeding interventions with clients

Thalamus pain (Neuropathic pain)

Continuous intense pain occurring on the contralateral hemiplegia side, as a result of a stroke involving the ventral posterolateral thalamus; poor rehabilitation potential

Standing Tilting Reflex

Onset: 12-21 months Integration: Persists Stimulus: After positioning in standing, slowly raise one side of supporting surface Response: Curving of spine toward raised side (opposite to pull of gravity); ABD/extension of arms and legs Relevance: Maintain equilibrium without arm support; facilitate postural adjustments in all positions

Orthosis

Custom-made or prefabricated device (brace/splint) used to immobilize, mobilize, or restrict one or more joints, typically used -maintain alignment -promote healing -improve function -restrict motion -prevent contractures -correct deformities

Wheelchair accessories

Customized components considered during the wheelchair assessment and prescription process to ensure the wheelchair fits the individualized needs of the client Options include: style of armrest and footrest lap tray, seat belt, anti-tip devices brake style and extensions trunk and neck support cushion and pressure-relief systems.

Therapeutic sensory diet

Customized program designed to help regulate responses to a variety of sensory input Typically used as an adjunct intervention for children with: autism spectrum disorder sensory modulation disorder sensory seeking behaviors attention deficit hyperactivity disorder

Prosthetic functional use training

Intervention program for clients who have an upper limb deficiency or amputation, includes education on the use of harness and cable controls or myoelectric components and terminal device, emphasizes activities for: -bilateral and unilateral use of limbs -automatic movement patterns -spontaneous movements -performance in daily activities

Normal ROM of the thoracic and lumbar spine

Flex: 0-80 Ext: 0-30 Lateral flex: 0-40 Rotation: 0-45

Normal ROM for the wrist

Flex: 0-80 Ext: 0-70 Ulnar deviation 0-30 Radial deviation0-20

Deficits in tactile discrimination

Difficulty interpreting tactile information in a precise and efficient manner. -Contributes to impaired body scheme/somatodyspraxia (a disorder in motor planning d/t poor tactile perception and proprioception) -Contributes to awkwardness in fine/ gross motor tasks and -Impaired manipulation skills, visual perception, and eye-hand coordination Difficulty with localizing tactile stimuli: -Impaired stereognosis , decreased fine motor and eye-hand coordination skills demonstrated by difficulties with writing, cutting with scissor and knife.

Spinal Cord Injury (SCI) Classification, Signs, and Symptoms

Degrees of impairment and severity are graded using the ASIA Impairment Scale A= "complete" Pt has no sensory or motor function is preserved in the sacral segment S4-S5 B= "incomplete" Pt has sensory but no motor function preserved below the neurological level and extends through the sacral segments C= "incomplete" Pt's motor function is preserved below the neurological level, and majority of key muscle groups below have muscle grade > 3/4 (less than) D= "incomplete" Pt's motor function is preserved below the neurological level , and majority of key muscle groups below have muscle grade </= 3/4 (greater than) E= "normal" Pt has normal sensory and motor function

Pureed: dysphagia diet

Dietary food texture modification described as smooth, uniform consistency for safer swallowing that requires very little chewing ability includes: -pudding and plain yogurt -smooth apple sauce -whipped potatoes

Vestibular/Balance Control: Sensory System Changes and Adaptions in Older Adults

Degenerative changes in otoconia of utricle and saccule; loss of vestibular hair-cell receptors, decreased number of vestibular neurons; VOR gain decreases; begins at at 30, accelerating decline at ages 55-60 resulting in diminished vestibular sensation.

Osteoarthritis (OA)

Degenerative joint disease; that most often affects middle-age to elderly people. It is commonly referred to as non systemic, and "wear and tear" of large weight bearing joints, involving the hyaline cartilage, joint lining, ligaments, and bone. The cartilage that cushions the ends of bones in your joints gradually deteriorates (bone-on-bone) Etiology: genetic, (cumulative) trauma, tenderness, stiffness, inflammation, endocrine and metabolic diseases. Grating sensation. You may hear or feel a grating sensation when you use the joint Symptoms: pain, stiffness, limited ROM, bone spurs (Heberden's nodes at the DIPj) (Bouchard's nodes at the PIPj)

Wrist flexors innervated by the median nerve

Flexor carpi radialis (FCR) flexion of the wrist and radial deviation origin: medial epicondyle insertion: 2rd and 3rd metacarpal, base Palmaris longus (PL) flexion of the wrist origin: medial epicondyle insertion: palmar aponeurosis

Ecological Model of Sensory Modulation Disorder

Describes individuals' unique response to interactions between external and internal dimensions of sensory processing in the context of their lives. -External dimensions include: culture, relationship, and chosen task -Internal relationship include: sensation, emotion, and attention Difficulty with modulation can either result in: -problems with social and environmental interactions -problems with self-regulation due to a mismatch between the intern/external environment and activities Sensory processing nosology classifies symptoms into categories: -modulation disorder include (SMD): overresponsitivity (SOR), underresponsitivity (SUR), seeking/craving (SS) -motor disorder include (SBMD): dyspraxia (coordination), postural disorders -discrimination disorder include (SDD): visual, auditory, tactile, vestibular, proprioceptive, taste, smell

Practice act

Describes the legal parameters of service delivery the professional is permitted to undertake within the terms of their state/jurisdiction, typically grounded by the professional scope of practice and includes requirements for: -scope of practice (legal definition) -referral -licensure -continuing competence -supervision

Play space

Designated social or physical environment designed for children to foster: -exploration -development -socialization

Cognitive Disabilities Model

Developed by Claudia Allen Designed for clients with cognitive impairments. -Based on stages of cognitive development as described by Piaget -Cognitive abilities is determined by biological factors and the potential for improvement is dictated by those factors -Functional behavior is based on cognition -If the persons cognitive level cannot change, adapt the activity or the task to provide opportunities for the individual to succeed -Cognitive performance is based on a continuum divided into 6 levels that are further divided into modes: -Level 1 : Autonomic actions: automatic motor responses and changes in the automatic motor system Level 2: Postural action: movement that is associated with comfort, their are some awareness of large objects in the environment and the individual may assist the caregiver with simple task -Level 3: Manual Action: Beginning to use hands to manipulate objects (running stitch) with long-term repetitive training the patient may be able to perform a limited number of task (ex. sanding bookends) -Level 4: Goal Directed actions: The ability to carry simple task through until completion (Pt relies heavily on visual cues). My be able to perform established routines, but cannot cope with unexpected events (ex. sorting laundry) -Level 5: Exploratory actions: overt trial and error problem solving "New learning occurs" the usual level of functioning for 20% of the population (cordovan stitch) -Level 6: Planned actions: the absence of disability. person can think of hypothetical situations and do mental trial and error problem solving

Model of Human Occupation (MOHO)

Developed by Gary Kielhofner based on Mary Reilly : Occupational Behavior Model -Principles: -Occupation is dynamic and context dependent -Personal occupational choice and engagement in occupation shape the individual -3 elements are inherent to humans: Volition, Habituation, and Performance capacity -Volition: thoughts and feelings that motivate people to act: including: personal causation, values, and interest Habituation: organized, recruiting, patterns of behavior including: roles and habits Performance capacity: the physical and mental skills needed for performance and the subjective experience of engaging in occupation -The environment impacts individuals through opportunities, demands, resources, and constraints it provides (1) the environment is divided into physical and social components.Each component is influenced by the culture (s) in which it takes place

Occupational Adaptation (OA)

Developed by Janette Schkade & Sally Schultz -Prinicples -Occupational adaption: concerned with the process that the individual goes through to adapt to their environment -Consist of 3 elements: person, occupational enthronement, and the interaction between the two -Outcomes of the interaction between the two is referred to as the occupational response Assumptions: -Occupation provides the means by which humans adapt to changing needs and conditions, and the desire to participate in occupation is intrinsic motivational force leading to adaption -occupational adaption is a normative process that is pronounced during periods of transaction . The greater the adaptive transactional need, the greater the importance of the occupational adaption process, the greater the likelihood the process will be disrupted

Ecology of Human Performance (EHP)

Developed by Winnie Dunn -Principles -Emphasizes the role of the individual's context (i.e. culture, physical, and social environment), and how the environment impacts the person and their task performance -This model is applicable to people across the lifespan -The four main constructs of this model include: person, task, context, and their transaction -11 assumptions include -Ecology: the interaction between person, and environment -Performance is understood by looking at the relationship between person, context, and task -Performance occurs when a person acts to engage in task within a context

Assistive Technology: Input controls

Devices used to enter data and perform control functions on computers or other electronic devices, examples include: -joy stick -trackballs -touch screens

Restrictive repetitive acts

Diagnostic feature of autism spectrum disorder that involves repetitive movements or actions Examples include: flapping arms, rocking, spinning, banging head

Mechanically altered : dysphagia diet

Diet in which the consistency and texture of food are modified, making it easier to chew and swallow, described as moist, semi-solid consistency for safer swallow that requires some chewing ability includes: -cottage cheese, ripe banana, moist meat loaf, scrambled eggs

Dupuytren's contracture

Disease of the fascia of the palm and digits Thickening and shrinking of the fascia of the palm with fingers being drawn into a flexed position -develops cords and bands that extend into the digits -results in flexion deformities of the digits -etiology: unknown -conservative treatment: not successful -surgical treatment: (surgical release); faciotomy with Z plasty, Aponeurotomy, McCash Procedure (open palm) Risk Factors: • Age: 50 and older • Sex: Men are more likely to develop Dupuytren's Disease • Ancestry: Northern European descent are at higher risk • Tobacco and alcohol use • Diabetes causes increased risk OT Treatment: -Dynamic flexion splinting wound care (dressing changes), edema control (elevation above heart) extension splint: worn all the time, except during ROM, and bathing A/PROM and progressive strengthening scar management OT-based task; emphasis on flexion (gripping), and extension (release) Ring (4) and pinky (5) finger are most commonly affected. Middle finger (3) may also be involved. Can occur in both hands, but usually affects one hand more severely

Colles Fracture

Distal radius fracture (FOOSH injury) Dorsal displacement Occurs when the area of the radius near the wrist breaks Most common distal radius fracture Etiology: Complete fracture of the distal radius w/ dorsal displacement of the distal fragment and radial shortening. Broken end (fragment) of the radius tilts upward. Possibly the ulnar styloid may be fractured A low energy, (silver/dinner fork deformity) Causes: Usually occurs in Pts. 50 years old that attempt to break a fall onto an outstretched hand •Common in patients with postmenopausal women osteoporosis (elderly females) •High impact trauma: sports, motorcycle/car accidents. (younger Pts.) 50 or older or High impact trauma Symptoms: Pain (dorsal wrist) • Tenderness/ Bruising • Swelling (edema) • Dec. ROM/ strength • Deformity "dinner fork" (wrist hangs in odd or bent way) • Increased angulation of the distal radius • Inability to grasp objects Mild: Closed reduction Severe: Open reduction, external/internal fixation Depends on angulation and displacement of the bone Treatment: Depends on type of fracture and age of Pts. • Casting Surgical Treatment • External fixation, • Internal fixation, • Percutaneous pinning, • Bone substitutes. (osteotomy) Early Rehabilitation • Mobilize the wrist (7-8) external/internal fixation plate Wrist cock-up splint

Rhomboids (major, minor)

Dorsal scapular nerve ( C4 and C5), Retract scapula and rotate it to depress glenoid cavity; fix scapula to thoracic wall Origin: Minor: nuchal ligament and spinous processes of C7 and T1 vertebrae; Major: spinous processes of T2 - T5 vertebrae Insertion: Medial vertebral border of scapula from level of spine to inferior angle

Total Hip Replacement / Arthroplasty (THR) (THA): OT Interventions Hip Precautions; (Posterolateral)

Educate on Hip Precautions -Do not flex beyond 90* -Don't abduct or cross legs -Do not internally rotate -Do not pivot at hips -Sit only on a raised chair or raised toilet seat -Transfer from sit to stand by keeping operated hip in slight abduction and extended out in front

Intraarticular vs Extraarticular Fractures

Elbow fractures are divided into three categories that are subdivided based on their location and type: -Intraarticular fractures: have multiple classifications based on location of fracture within the capsule and the pattern of the fracture. ex. Boxer Fracture, Capiteller and Trochlear fractures -Extraarticular fractures: involve the medial/lateral epicondyles and supracondylar regions. Extra-articular fractures that extend distally along the supracondyles become intracapsular ex. Bennett's Fracture Dislocation, Smith's Fracture.

Social context

Elements within and surrounding a client that influence interpersonal and individual behaviors during occupational performance

Angle closure glaucoma (Peripheral Vision Loss)

Emergency, acute condition in which aqueous fluid becomes blocked, quickly raising intraocular pressure -a rapid or sudden increase in intraocular pressure (IOP) within the eye, due to aqueous fluid build-up that drains out of the normal eye (not tears) -peripheral vision may be lost with each attack

Omnibus Budget Reconciliation Act (OBRA) of 1990

Emphasized attending to residents rights, autonomy, etc. for nursing homes that receive money for MCR/MCD pts; calls for comprehensive resident assessment system (Minimal Data Set - MDS): eval/treat conditions found follow specific guidelines called Resident Assessment Protocols (RAPS), structured apporach to assessment is Resident Assessment Instrument (RAI); individualized care plans must be est. within specific time frames; restraint reduction. -Applied to all nursing home receiving federal money for Medicare or Medicaid patients

Enhanced lighting

Environmental solution for low vision that may include lighting customization: consistent with a person's visual abilities in context according to ambient conditions based on results of an analysis of the desired occupation

Electronic aids for daily living

Equipment that allows an individual with mobility impairments to operate devices in the environment Examples include: remote control for radio wireless technology used to turn off lights switch to open doors

Assistive technology: Control Enhancer

Equipment used to improve the control an individual has for using direct selection assistive technology Types include: -postural supports (e.g., laptray, lateral supports) -hand/arm devices (e.g., orthotic, strap, pointer) -head-mounted devices (e.g., stick, pointer, headrest)

sleep hygiene

Establishing physical and environmental conditions for effective rest and sleep, interventions may focus on: activities performed prior to sleep sleep schedules and routines ambient conditions of the bedroom

Standardized test

Evaluation tool administered under standard procedures and scored against specific guidelines

Model of Human Occupation Screen Tool (MoHOST)

Evaluation tool based on the Model of Human Occupation that is designed to assess a clients occupational functioning in the areas of volition, skills, habituation, and the environment

pelvic floor exercises (Kegel exercises)

Exercises that improve the strength of pelvic floor muscles and consist of repetitive contractions of muscle groups. -used for stress incontinence in which muscles surrounding the pelvic cavity are strengthened by completing a daily exercise regimen

Swans Neck Injury (Condition/Location)

Finger postures w/ PIPj hyperextension and DIPj flexion. The MP is flexed, and the finger appears zigzag Synovitis of the flexor tendon can erode the PIPj volar plate which normally helps PIPj hyperextension Etiology: Injuries: • DIP: terminal extensor tendon is disrupted (stretched/ruptured) leading to PIP hyperextension • PIP: Lateral bands are dorsally displaced, causing PIP hyperextension, therefore DIPj is flexed (FDS has been rupture/lengthened Causes: Rheumatoid Artthritis -Chronic PIPj swelling loosens the volar plate -Ligament tears/weaking (palm side of middle joint of the finger) -Tears of the tendon that flexes middle joint Symptoms: -Difficulty bending middle joint -Snapping sensation (during bending) -Stiffness (due to long lasting deformity) Treatment: Nonoperative Treatment -Splinting (PIP in slight flexion) Operative Treatment -FDS tenodesis or VP advancement procedures Splinting: • Dorsal blocking splint • Figure 8 splints • SIRIS (silver ring splint Splinting is used to prevent hyperextension at the PIPj and to promote PIP flexion Surgery: -Digit-based dorsal PIP splints 20-30 degrees of flexion -Pin site care -Wound care

Normal ROM the cervical spine

Flex: 0-45 Ext: 0-45 Lateral rotation: 0-45 Rotation: 0-60

Life-Style Performance Model: Evaluation

Focus on obtaining an activity history and style performance profile related to the four skills domain: 1. self-care and maintenance, 2. intrinsic gratification, 3. service to others, 4. reciprocal relationship. -environment factors are explored A. intervention: address 5 main main questions that identify the focus of intervention 1. what does the person need to be able to do, 2. able to do 3. unable to do?, 4. what interventions are needed, and in what order, 5. what characteristics, patterns of activity, and environment that will enhance the persons QoL B. Focus on interventions and activities that promote performance in the 4 domains are acceptable

Occupational Self Assessment Assessment of Occupational Performance/Occupational Roles

Focus: A self-report checklist of individual's perceptions of efficacy in areas of occupational performance and their importance Method: 2-part self report. Clients are given a list of 21 everyday activities Scoring: A 4-point scale to rate how well they do each activity to assess occupational competence. A 4-point scale to report how important the activity is to assess the value of the occupation. Population: adults 18 years or older

The Kohlman Evaluation of Living Skills (Kels) Assessments of Task Performance (Evaluation of ADLs)

Focus: Determination of an individual's knowledge and/or performance of 17 basic living skills needed to live independently in five main areas (self-care, safety and health, money management, transportation and telephone, work and leisure. A score of "independent" or "needs assistance" Population: Adolescents and adults in acute psychiatric hospitals, elders, and those with a diversity of diagnoses.

Barthel Index Evaluation of Activities of Daily Living (ADLs)

Focus: Measurement of a person's independence in basic ADL and functional mobility before and after intervention and the level of personal care needed by the ct. Method: direct observation of task performance, interview, and MR review. 10 items (ex. feeding, transfer, grooming, toileting, bowel/bladder control, bathing, dressing, walking, climbing) Population: Adults and elders with physical disabilities and/or chronic illnesses, typically used in medical model settings

Kitchen Task Assessment (KTA) Evaluation of Activities of Daily Living (ADLs)

Focus: Measurement of the judgment, planning, and organizational skills used to perform a simple cooking task Methods: pre-test of washing hands is used to determine baseline abilities , introductions on cooking pudding, assistance as needed to facilitate successful performance Scores for 6 categories (initiation, organization, performing all steps, proper sequence, judgment and safety, completion of task) 0=independent 3=totally dependent Population: Adults with Alzheimer's and cognitive dysfunction/ or other populations with cognitive dysfunctions

Activity Card Sort (ACS) Assessment of Occupational Performance/Occupational Roles

Focus: The identification of a person's level and amount of involvement in instrumental, leisure, and social activities Method: 89 cards that represent real people engaging in activities, Pt is asked to sort cards according to level and amount of involvement (e.g. never done, gave up doing, do less than in the past, do the same, do more than in the past.) Scores: used to monitor changes in activity participation over time by comparing previous to current activity participation ASC can be used for initial assessment, goal setting, and intervention planning.Can be used to build routines comprised of meaningful Population: originally developed for older adults with dementia

Comprehension Occupational Therapy Evaluation Scale (COTE scale Assessments of Task Performance

Focus: a structured method for observing and rating behaviors and behavioral changes in the area of general, interpersonal, and task skills (7 items address general behaviors such as apperance, punctuality, and activity level, 6 items address interpersonal behavior such as cooperation, sociability, and attention-getting behavior. 12 items address task behavior Method: The individuals behavior is observed during a therapeutic session as the individual completes a task. (behavior is rated by the therapist according to specific criteria Scoring: Each item is rated on a scale of (0 normal) to (4 severe) results are used to plan treatment and assist with discharge planning Population: adults with acute psychiatric diagnosis

Adult/Adolescent Sensory Profile Assessments of Cognition/ Sensory Processing

Focus: allows client to identify their personal behavioral responses to daily sensory experiences and develop strategies for enhanced participation There are 4 quadrants: -Low/Poor registration: (high/passive) missing stimuli, respond slowly -Sensory seeking: (high/active) pursuit of stimuli, intelligence -Sensory sensitivity: (low/passive) distractibility, discomfort w/ stimuli -Sensory avoiding: (low/active) acting to reduce/prevent exposure to stimuli Method: complete 60-item questionnaire about an individuals reactions to daily sensory experiences via self-report Population 11-65 years +

Elder Depression Scale Assessments of Cognition/ Sensory Processing

Focus: assess depression in the elderly Method: 30 item checklist that looks at the presence/characteristics associated with depression Scoring: Items are scored (yes) or (no), a score of 10-11 indicates depression Population: older adults

Allen Cognitive Level Screen-5 (ACLS-5) Assessments of Cognition/ Sensory Processing

Focus: assess the cognitive level of the individual according to the Allen cognitive level Method: Requires the performance of several leather lacing stitches following instructions and/or demonstrations Allen's Cognitive Levels: (a) Level 3: running stitch (b) Level 4: whipstich (c) Level 5: cordovan stitch Population: adults with psychiatric or cognitive dysfunction (Alzheimer's)

Role Checklist Assessment of Occupational Performance/Occupational Roles

Focus: assesses self-reported role participation and the value of specific roles to the individual Method: checklist is completed individual alone with the therapist . PART 1: identify the major roles that have been part of his/her life in the past, present, and anticipated future (e.g. student worker etc.) PART 2: ask the person to identify the degree to which he/she values each role. Scoring: totals of roles are scored, and the data collected can be further discussed with the person and used to address goal identification and treatment planning, QoL, and discharge planning Population: adolescent through elder individuals with physical or psychological dysfunction

Bay Area Functional Performance Evaluation (BAFPE) Assessments of Task Performance

Focus: assesses the cognitive, affective, performance, and social interaction skills required to perform ADLs. Methods: brief interview, (TOA), (SIS) The Task Oriented Assessment (TOA): measures cognition, performance, affect, qualitative signs, and referral indicators through the completion of 5 standardized time task. (sorting shells, block design, draw-a-person, bank deposit, house floor plan) The Social Interaction Scale (SIS): assesses general ability to relate appropriately to other people within the environment through observations of the individuals Scores: TOA and SIS scores are not combined, but are used as indicators of overall functional performance, providing information about the person's cognitive, affective, social, and perceptual motor skills Population: adults individuals with psychiatric, neurological or developmental diagnosis

Adolescent Role Assessment (ARA) Assessment of Occupational Performance/Occupational Roles

Focus: assesses the development of internalized roles within family, school and social settings Method: a semi-structured interview that follows an interview guide to generate discussion in the areas of family, school performance, peer interactions, occupational choice and work. Population: adolescents age 13 to 17

Safety Assessment Scale (SAS)

Focus: assesses the potential safety risks of people with dementia who live at home Method: observation of a person and a caregiver interview are conducted in the home 1) A short version of 19 questions is used to screen for safety risks 2) A long version of 32 questions is used to make recommendations and plan interventions to decrease safety risks Scoring and Interpretation: a rating scale of always, most of the time, occasionally or never is used. The results are used to help caregivers diminish safety risks in the home Population: Older adults with cognitive impairments (dementia) living at home (normal as well)

Assessment of Motor and Process Skills (AMPS) Evaluation of Activities of Daily Living (ADLs)

Focus: assessment of effectiveness or safety of a person's ADL task performance, including personal activities of daily living (PADLs), instrumental or domestic activities of daily living (IADL), and some leisure activities Methods: Interview to determine 3-5 task that are relevant/challenging. Observation of the client's quality of performance of selected ADLs, task according to standards. requires therapist to complete a special AMPS training Scoring: 16 motor skills, 20 process skills on a 4pt scale 1=deficit, 4=competent understanding nature of difficulty, level of challenge, and quality of performance of each task. Population: anyone with a developmental disability age older than 2 yo. with a diagnosis that causes functional limitations in ADLs

Klein-Bell Activities of Daily Living Scale (K-B Scale) Evaluation of Activities of Daily Living (ADLs)

Focus: assessment of independent functioning in activities of daily living (ADLs) as evidenced by achievements of 170 items in six areas Scoring: "failed" or "achieved" if task is performed independently w/without AE Population: 6 mths old to the elderly with any diagnosis (physical. psychosocial, cognitive, and/or developmental

Katz Index of ADL Evaluation of Activities of Daily Living (ADLs)

Focus: assessment of level of independent functioning and type of assistance required in six areas of ADL: bathing, dressing, toileting, transferring, continence, and feeding. Method: Evaluator observes activity performance or interview the individual about performance Scoring and Interpretation 1) Evaluator rates each of the six activities as independent, some assistance required, or dependent 2) Specific criteria for each rating are provided for each activity 3) The individual ratings for the 6 activities are converted into a global letter score A = Independent in all 6 activities B = Independent in any 5 activities C = independent in all but bathing and one other activity D = Independent in all but bathing, dressing and one other activity E = independent in all but bathing, dressing, toileting and one other activity F = independent in all but bathing, dressing, toileting, transfers and one other activity G = dependent in all activities Population: adults and elders with chronic illness

Projective Assessments

Focus: based on the psychodynamic/psychoanalytic models, theses assessments allow clients to project intrapsychic content for discussion and resolution in therapy by bringing unconcious intrapsychic conflicts to consciousness through the completion and processing of an activity Methods: projective assessments (House-Tree-Person, Draw-A-Person, and Kinetic Family Drawing, The Magazine Picture Collage (most typically used by occupational therapist applying the psychodynamic frame of reference (a) clients are given materials and magazines and asked to make a collage. ask to make a title (b) while the client completes the task the therapist observes ( fine motor, attention span, ability to follow directions, organizational ability, and obtain projective content through the clients comments and picture selection Population: children, adolescents, survivors of traumatic events and any

Goal Attainment Scaling (GAS) Assessment of Occupational Performance/Occupational Roles

Focus: facilitates active participation in goal-setting process by having the individual and.or caregivers identify desires intervention outcomes for the client that are personally relevant to them (GAS assesses the individuals attainment of these goals and relevant changes in occupational performance. Method: a personal interview is used during goal setting and post-treatment sessions (no scoring protocol) Population: older children adolescents, adults and caregivers of younger children and/or adults who are unable to participate in an interview

Occupational Performance History Interview-II (OPHI-II) Assessment of Occupational Performance/Occupational Roles

Focus: gathers information about an individuals life history, past and present occupational performance, and the impact of the incidence of disability, illness or other traumatic events in the person's life. Method: information is gathered using a semi-structured interview format> questions address daily routines (roles, activity choices, life choices, occupational behavior settings) Scoring: therapist rates clients occupational identity, competence, and impact of the person's occupational behavior settings. Ratings is used to identify the individuals life history pattern. Population: individuals who are able to participate in a comprehensive interview from adolescents to elders -Not recommended to be used with children less than 12 yo

The Safety Assessment of Function and Environment for Rehabilitation (SAFER)

Focus: identifies possible safety concerns in the home environment and assesses if the person is able to respond to safety situations Method: interview and observation conducted in the home. 128 items covering possible safety concerns are addressed (e.g. living situation) Scoring: 3 columns (addressed, not applicable, and problem) Population: Used with home residing clients of all ages

Canadian Occupational Performance Measure (COPM) Assessment of Occupational Performance/Occupational Roles

Focus: identifies the individual's perception of satisfaction with performance and changes over time in the areas of self-care , productivity, and leisure Method: semi-structure interview identifies the individual's perception of his/her occupational performance in: self-care, productivity, and leisure. Score and interpretation: items are rated on a scale of 1 to 10, which 10 being the highest. Scores are used to identify treatment focus, treatment outcomes, and individual satisfaction Population: individuals over the age 7 or parents of small children

Beck Depression Inventory-II (BDI-II) Assessments of Cognition/ Sensory Processing

Focus: measurement of the presence and depth of depression Method: completed as a questionnaire, where the individual rates their feelings relative to 21 characteristics associated with depression. Scoring: 0 to 3 with 3 being the most severe, the higher the score indicates a higher level of depression Population: adolescents and adults

Fall Efficacy Scale (FES)

Focus: measures a person's fear of falling during non-hazardous ADLs (e.g. BADLs, meal prep, and functional mobility) Method: the person's level of perceived self-efficacy at avoiding falls is measured by asking how confident the person feels about completing the FES activities without falling Scoring: Likerat scale 1-4 persons level of concern Population: community dwelling older adults with/without a history of fear of falling

FIM System and WeeFIM System Evaluation of Activities of Daily Living (ADLs)

Focus: the assessment of severity and disability as determined by what the individual actually does and the amount of assistance needed by the individual to compete each task 6 performance areas are assessed: self-care, bowel/bladder management, mobility, communication, social cognition Method: observation of activity performance with/without assistance WeeFIM: caregiver interview is used to obtain data (6 mth -7 yo) 1-7 score graded on dependent-independent and the amount of assistance needed for task performance. Results indicate patients level of disability Population: WeeFIM 6mths -7yo, FIM adults with disabilities who are not functionally independent for the FIM

Cognitive Performance Test (CPT) Evaluation of Activities of Daily Living (ADLs)

Focus: the assessment of six functional ADL tasks that require cognitive processing skills based on Allen's Cognitive Disabilities Model. Dressing, shopping, making toast, making a phone call, washing and traveling Method: Standardized administration procedures are followed for each task. asks the individual to do each task, providing demonstration, reassurance, cueing, more directions and/or the addition or elimination of sensory cues, if needed to facilitate task performance Scoring/Interpretation: 1) scoring guidelines according to Allen's levels are provided for each task 2) Level 1 represents the lowest functional level and level 6 represents the highest 3) Total test scores range from 6 to 35 4) Average task performance score can be determined by dividing total test score by 6 . 5) CPT scores are used along with Allen's model to determine a person's capabilities and needs in other ADL tasks and his/her ability to live independently Population: adults and elders with psychiatric and/or cognitive dysfunction

Cognitive skills

Following directions, memory, and judgement assess is a person is aware of limitations and able to follow and recall directions regarding operation of assistive technology and w/c and the safe use of devices

Advanced: dysphagia diet

Food texture modification described as soft consistency, that requires more advanced chewing ability includes -baked potatoes with skin, moist pancakes, then sliced meat

Angle of application

Force or torque applied to a joint using the dynamic component of a mobilization orthosis, ideally 90 degrees to body segment being moved

transcutaneous electrical nerve stimulation (TENS)

Form of electrotherapy used as a component of a comprehensive pain management program Techniques of application include: sub sensory sensory motor Recommended for use as an adjunct to other occupation-based interventions

Hospice

Form of palliative care in which physical, emotional and spiritual services are provided for terminally ill clients and caregivers, can be provided in: -client's home -LTC centers -SNF -hospice centers

Service competence

Formal process used to assess and document the competency of a COTA to perform specific components including: -evaluation, administration of standardized assessments, and/or provide advanced intervention techniques or methods

Charot-Marie-Tooth Disease

Hereditary motor and sensory neuropathies,(involving the peripheral nerves), and typically occurs in teenage years or earlier - a group of varied inherited disorders of the peripheral nervous system -characterized by progressive loss of muscle tissue (weakness) and touch sensation across various parts of the body. -typically autosomal dominant and assoicated with scoliosis and foot deformities. .

Executive function

High level cognitive process that includes: planning and organizing regulatory control problem solving and working memory

Transferability: Trustworthiness

How well other researchers can fit a studies finding into a similar context: the "goodness of fit" between the context of two studies. -sufficient descriptive data to allow comparison by other researchers -can be enhanced with dense description of the study's participants and contexts

Neck vs Mid-shaft vs Base Fractures

Humerus Fracture: -Neck (proximal) Humerus Fractures: Fractures of the proximal humerus typically occur as the result of a trauma,There are several treatment options for these fractures, but the most common are non-surgical treatments. Typically classified as non-displaced or displaced, and therapy will typically begin 1 to 4 weeks following the surgery, depending on the specific surgical intervention required -Mid-Shaft Humerus Fracture: typically does not involve the shoulder or elbow joints. This type of fracture represents about 3% of all broken bones. The most common cause of a humeral shaft fracture is a fall, but high-energy injuries (motor vehicle collisions, sports injuries) and penetrating trauma (gunshot wounds) also can cause this injury. l Treatment: most common are non-surgical treatments Base (distal) Fractures: a break in the lower end of the upper arm bone (humerus). A fracture in this area can be very painful and make elbow motion difficult or impossible. Most distal humerus fractures are caused by some type of high-energy event—such as receiving a direct blow to the elbow during a car collision. Treatment for a distal humerus fracture usually involves surgery to restore the normal anatomy and motion of the elbow OT Treatment: ROM, manual therapy, strengthening, modalities, and functional training

Video modeling

Intervention technique frequently used to teach a specific motor or social skill by having a client/child watch a video of the skill being performed then attempting to imitate the task

Chaining

Intervention technique that includes completion of one step of the task at a time and sequentially adding additional steps once performance is achieved includes: -forward chaining -backward chaining

Occupational Therapy Interventions: Fractures

Immobilization phase: Stabilization and healing are the goals -AROM of joints above/below stabilized part -Edema control: evaluation, retrograde massage, and compression garments -Light ADLs and role activities with no resistance, progress as tolerated Mobilization phase: Consolidation is the goal - Edema control: evaluation, retrograde massage, contrast baths, and compression garments -AROM, then progress to PROM when approved by physician (4 to 8 wks), exceptions are humerus fractures which often begin with PROM or AAROM -Light functional/purposeful activities -Pain management: positioning and physical agent modalities -Strengthening: begin with isometrics when approved by physician.

Dependability: Trustworthiness

Inclusion if the full range of data, including: outliers or atypical findings -obtained when all participants experiences/perspectives are considered important and reported -enhanced by peer review, member checking, code recode procedures, and step-wise replications

Occupational marginalization

Ineffective ability to make personal choices or decisions regarding participation in meaningful occupations

Community-based needs assessment

Initial step in community health programming to identify the needs of the community in order to determine: -goals and objectives -outcome oriented activities -program focus

Scar management in the rehab stage of burn healing

Initiate compression therapy for both edema control and scar compression -Temporary interim pressure bandages or garments *Elastic bandages *EM Corban (EM) wrapping of fingers *Elasticated tubular support bandages *Thigh-high or knee-high thomboembolism-deterred hose *spandex bicycle pants *Isotonic gloves with impression silicone (otoform), elastomor, closed-cell, silicone pad inserts -Measurement for custom-made compression garment *Use of compression garment is indicated for all donor sites, grafted sites, and burn wounds that take more than 2 weeks to heal spontaneously -Custom-made pressure garment and insert *custom-made pressure garment are constructed to provide gradient pressure starting at 35 mmHg distally *Garment should be worn 24 hours daily except during bathing and other skin care activity *Minimum of 2 sets of garments should be affected for changing and laundry *Conformers added under garments to distribute pressure more evenly

Joystick

Input device consisting of a handle that pivots on a base allowing multi-directional control, often used to operate a power wheelchair, computer, or remote-controlled toys Types include: -proportional (continuous) -switched (discrete)

Occupational risk factors

Internal and external conditions that impact health and wellness outcomes -and/or influence an individual's ability to fully engage or participate in meaningful life activities and occupations

Interview & Outcome Measures: Hand and UE

Interview: Ask questions about pain levels chart (1-10), splints, functional use, ADLs, and checklist to uncover dysfunction Outcome measures include: Quick Disabilities of Arm, Shoulder, and Hand Questionnaire (DASH) before and after therapy - a 30-item questionnaire that looks at the ability of a patient to perform certain upper extremity activities.This questionnaire is a self-report questionnaire that patients can rate difficulty and interference with daily life on a 5 point Likert scale. -The QuickDASH is an abbreviated version of the original DASH outcome measure. In comparison to the original 30 item DASH outcome measure, the QuickDASH only contains 11 items. It is a questionnaire that measures an individual's ability to complete tasks, absorb forces, and severity of symptoms The QuickDASH tool uses a 5-point Likert scale from which the patient can select an appropriate number corresponding to his/her severity level/ function level

Hemiballismus

Involuntary flinging motions of the extremities, -the movement is often violent with wide amplitudes of motion -they are continuous and random and can involve proximal and/or distal muscles on one side of the body

Pragmatic reasoning

Involve consideration for the practical aspects of services delivery including: -reimbursement -competency of the therapist -available resources and equipment

Conditional reasoning

Involves clinical decision-making based on a broad view of the situation and consideration of the client's -personal belief structure and value system -social, cultural, and temporal context

Non-verbal communication

Involves conveying a message without the use of words, and may include: -facial expressions -tone of voice -eye contact

Interactive reasoning

Involves interacting and connecting with the client to collaboratively solve problems and identify solutions

Instructing: Mode

Involves providing education to support the client to: -learn new information -follow a specific protocol or precaution -know the effect of thoughts and behaviors on performance

Environment bias: Testing bias

Involves the degree to which the testing context is similar to the natural setting in which the task is typically performed

Problem-solving: Mode

Involves using interpersonal skills to support the client to: -identify an alternative solution -determine pros and cons to current behaviors

Empathizing: Mode

Involves validating the client's concerns and verbalizing an understanding of the situation

Performance patterns

Language included in the OTPF that describes the frequency and level of participation in occupations including -habits, routines, roles, and rituals

2-3 months (standing ) Gross Motor Skill

Legs may give way when he'd into standing position

Level 3 : Hierarchy of evidence

Level of evidence includes -validity of results are threatened -results from a non-randomized research study that has a control group and an intervention group but research subjects have not been randomized to each group

Level 5: Hierarchy of evidence

Level of evidence that includes: -no research component -offers information about a particular topic -includes qualitative research and expert opinions

Level 2: Hierarchy of evidence

Level of evidence that includes: -results of a single randomized controlled trial (RCT) that have an effective research design and appropriate sample size

Forequater Amputation

Loss of clavicle, scapula, and entire UE

Wheelchair Measurement: Seat height

Measurement used as part of a comprehensive wheelchair prescription, determined by measuring from popliteal fossa to the bottom of the heel

Wheelchair Measurement: Mid height back

Measurement used as part of a comprehensive wheelchair prescription, determined by measuring from the seat surface to the inferior angle of the scapula

Re-evaluation

Measuring performance change during the occupational therapy process to determine: -effectiveness of intervention -need for modification to the intervention plan -appropriateness of proceeding or discontinuing services

Antipsychotic medications

Medication used to treat psychotic symptoms such as mania, agitation, hallucinations, and delusions

transdisciplinary team

Members support and enhance the activities and programs of other disciplines to provide quality, efficient, cost-effective service; role blurring accepted -Members are committed to ongoing communication, collaboration, evaluation, and shared decision making for the patient -Evaluation and intervention are planned cooperatively. Role blurring is accepted

Sensory Models

Mental Health -Based on the work of Jean Ayres (sensory integration) -Includes: sensory; integration, processing, motor model, defensiveness, modulation, and sensory based treatment -Includes a brushing pattern along with a sensory diet -Winnie Dunn : -sensory seeking: HIGH/ ACTIVE -sensory avoiding: HIGH/PASSIVE -sensory sensitivity: LOW/ACTIVE -sensory registration: LOW/PASSIVE -Approaches include the use of sensory-related assessment tools, activities, modalities, environmental modifications, assistance in learning to self-regulate through the process of self-organization and positive change . requires the use of strength-based, person-centered, relationship centered models of care

Meta-analysis

Method of combining and contrasting qualitative results from various studies without statistical synthesis of the results -used to find patterns and relationships

Coping strategies

Method of dealing with a challenging psychological situation, strategies may be: adaptive (e.g., humor, positive thinking) maladaptive (e.g., substance use, avoidance)

Task simplification

Method of grading activity to allow the capacity of the client to match activity demands, may involve: breaking an activity into smaller parts eliminating steps of an activity modifying objects used during the activity

Qualitative research

Method of inquiry that assist the researcher in gaining an in-depth understanding of attitudes, concerns and behaviors -may include: interviews, observations, and focus groups

Quantitative research

Method of inquiry that attempts to answer a hypotheses using statistical analysis -may include: experimental studies, customer surveys, and goal audits

Professional development portfolio

Method of organizing professional self-assessment and development information, sections may include documentation of: -learning priorities, needs and goals -professional development activities completed -ongoing service competence

Volumetric Displacement

Method used to measure and monitor UE edema, involves using a commercially-available water tank Steps include filling the tank with water, immersing the hand and distal forearm into the tank, then measuring the amount of water displaced after immersion Comparisons are made between two hands Should not be used for clients with open wounds, external fixators, percutaneous pins, or casts

Occupational-based goal

Methods of indicating. Measurable functional outcome based on clients needs and priorities -includes a timeframe for completion

Edema management

Methods used to reduce interstitial accumulation of fluid in the extremities secondary to surgery, trauma or a disease process, may include: a. Elevation of extremities b. AROM exercises, if movement is allowed c. Wrapping with elastic bandage, unless bulky wound dressing is used limb elevation cryotherapy compression retrograde massage manual edema mobilization purposeful activity/movement

General Assessments of Mental Health Status

Mini Mental State Exam, short portable mental status questionnaire -a widely used, quick screening test of cognitive functioning The Saint Louis University Mental Status -developed as a screening tool for detecting mild cognitive impairment in a veteran population, however, it is now used in several other patient populations. Shown to be superior to the Mini-Mental State Exam (MMSE) in the detection of early dementia.l.

Adaptive positioning

Modifications made to the position of a client during an activity to optimize trunk stability and postural alignment, intended to improve: upper extremity control range of vision swallowing ability interactions within the environment May include using different positions (e.g., sitting instead of standing), low technology devices (e.g., lapboards, pillows, towel rolls), or high technology (e.g., customized cushions, wheelchairs, or orthotics

Overview and contributing factors to poor nutrition in the elderly

Often linked to health status and poverty rather than age: -Many older adults have primary nutrition problems. -Nutritional problems in the elderly are often linked to health status and poverty rather than to age itself: 1) chronic diseases alter the overall need for nutrients, the abilities to take in and utilize nutrients, energy demands, and overall activity levels (eg. Alzheimer's disease, CVA, and diabetes) 2) limited, fixed incomes severely limit food choices and availability -There is an age-related slowing in basal metabolic rate and a decline in total caloric intake; most of the decline is associated with a concurrent reduction in physical activity (both undernourishment and obesity exist in the elderly and contribute to decreased levels of vitality and fitness) -Contributing factors to poor dietary intake: 1) decreased sense of taste and smell 2) poor teeth or poorly fitting dentures 3) reduced gastrointestinal function (decreased saliva; gastromucosal atrophy; reduced intestinal mobility; reflux) 4) loss of interest in foods 5) isolation, lack of social support, no socialization during meals, loss of spouse, loss of friends 6) lack of functional mobility (inability to get to a grocery store to shop; inability to prepare foods)

Universal Design Principle: Flexibility in use

One of the seven guiding principles for universal design whereby the design of products and environments accommodates for a wide range of individual preferences and abilities

Universal Design Principle: Low physical effort

One of the seven guiding principles for universal design whereby the design of products and environments allows for efficient expenditure of physical energy

Universal Design Principle: Perceptible information

One of the seven guiding principles for universal design whereby the design of products and environments communicates necessary information effectively to the users, regardless of the ambient conditions and users's sensory abilities

Universal Design Principle: Tolerance for error

One of the seven guiding principles for universal design whereby the design of products and environments minimizes risk of injury or unexpected circumstances.

Universal Design Principle: Size and space for approach and use

One of the seven guiding principles for universal design whereby the design of products and environments provides for sufficient size and space for approach, reach and manipulation for users of varying sizes, abilities, and levels of mobility.

Traction Reflex

Onset age: 28 wks gestation Integration age: 2-5 months Stimulus: Grasp infant's forearms and pull-to-sit. Response: Complete flexion of UE. Relevance: Enhances momentary reflexive grasp.

Plantar Grasp Reflex

Onset age: 28 wks gestation Integration age: 9 months Stimulus: Apply pressure with thumb on the infant's ball of the foot. Response: Toe flexion. Relevance: Increases tactile input to sole of foot.

Downward parachute (protective extension downward)

Onset age: 4 months Integration age: Persists Stimulus: Rapidly lower infant towards supporting surface while suspended vertically. Response: Extension of the lower extremities. Relevance: Allows accurate placement of lower extremities in anticipation of a surface.

Symmetric Tonic Neck Reflex

Onset age: 4-6 months Integration age: 8-12 months Stimulus: Place infant in crawling position and extend head. Response: Flexion of hips and knees. Relevance: Breaks up total extensor posture; facilitates static quadruped position. By this age infant is crawling and starting to walk

Prone tilting

Onset age: 5 months Integration age: Persists Stimulus: After positioning infant in prone, slowly raise one side of the supporting surface. Response: Curving of the spine towards raised side (opposite pull of gravity); abduction/extension of arms and legs. Relevance: Maintain equilibrium without arm support; facilitate postural adjustments in all positions.

Forward parachute (protective extension forward)

Onset age: 6-9 months Integration age: Persists Stimulus: Suddenly tip infant forward towards supporting surface while suspended vertically. Response: Sudden extension of upper extremities, hand opening, and neck extension. Relevance: Allows accurate placement of UE in anticipation of surface to prevent a fall.

Supine tilting and Sitting tilting

Onset age: 7-8 months Integration age: Persists Stimulus: After positioning infant in supine or sitting, slowly raise one side ot the supporting surface. Response: Curving of the spine towards raised side (opposite pull of gravity); abduction/extension of arms and legs. Relevance: Maintain equilibrium without arm support; facilitate postural adjustments in all positions.

Complex Regional pain syndrome (Neuropathic pain)

Pain maintained by efferent activity of sympathetic nervous system. Characterized by abnormal burning pain, hypersensitivity to light touch, sympathetic hyperfunction (coldness, sweating) associated with traumatic injury

Brain

Paired hemisphere that consist of 6 lobes on each side; frontal, parietal, temporal, occipital, insular, and limbic

Curb-to-curb

Passengers are picked up at the curb of their point of origin and dropped off at the curb of their destination. Drivers may assist riders with getting on and off the vehicle but do not assist riders into buildings or with things they are carrying.

Arm-through-arm

Passengers may be physically assisted by drivers to board, disembark, and safely reach their final destination (similar to door-through-door, but specifies physical assistance).

Early Mobilization Programs for Flexor Tendons - Kleinert Protocols

Passive flexion (w/ rubber band traction) and active extension to hood of splint. 0-4wks: (early phase) dorsal blocking splint. wrist in 20*-30* flexion, MCP joints in 50*-60* flexion and IPJ extended. Passive flexion and active extension within splint limits 4-7wks (intermediate phase) dorsal blocking splint, adjust wrist to neutral. place/hold exercises and differential flexor tendon gliding exercises. scar management. 6-8wks AROM, differential tendon gliding, light/purposeful activities D/C splint 8-12wks strengthening. work/leisure activities

Early Mobilization Programs for Flexor Tendons - Duran Protocols

Passive flexion and extension of digits 0-4.5wks: dorsal blocking splint w/ exercises including passive flexion of PIPj, DIPj and to DPC 10 reps every 1hr 4.5-6wks: active flex/extension within splint limits 6-8wks: tendon gliding and differential tendon gliding, scar massage, and light activities 8-12wks: strengthening and work activities.

Axonotmesis (2nd degree

Peripheral nerve injury -Seddon's classification: a nerve compression that recovers spontaneously, but is more severe compared to neuropraxia, -Characteristics include: axon and myelin sheath disruption, endoneurium remains intact, valerian regeneration occurs during healing - Causing loss of function and Wallerian degeneration distal to lesion; with no disruption of the endometrium, regeneration is possible (crush injury) - grows 1-4mm/day and may take several months. If axons, and their myelin sheath are damaged, but schwann cells, the endoneurium, perineurium and epineurium remain intact is called axonotmesis. Intervention: include: pain relief, orthotic positioning, A/AA/PROM exercises, activity modification, patient education

Myofascial Pain Syndrome

Persistent, deep ache in muscle Nonarticular in origin Well-defined, highly-sensitive tender spots (trigger points)

paratransit eligibility criteria

Person cannot access fixed-route public transportation and is therefore eligible for complementary services inability to navigate fixed route transport system -unavailability of public transport and time or place person needs to travel -impairment related inability to enter or disembark at location (ADA)

Occupational Adaption Model

Practice model that includes 3 basic tents of person, environment, and the interaction of the person and environment Adaption is achieved once there is experience with activity modification flowed by mastery of the occupation Occupational Adaptation Model (OAM) is proposed as a frame of reference that aims to integrate the two main domains (occupation and adaptation) for occupational therapy. It defines occupation as self-perceived meaningful activities that require active participation and lead to a product. Adaptation is one's adaptive response to meet an occupational challenge, when ordinary response is insufficient to master the activity, and is evaluated in relation to the concept "relative mastery" (i.e., evaluating occupational performance from the client's viewpoint). The increase and maintenance of competence in activities are described as an interaction between a person and his/her environment. Occupational adaptation process begins with the environmental demands for mastery in activities. This OAM assumes that individuals have the desire to master activity and gain the environmental control. It emphasizes on the person's interaction with the natural setting for occupational performance. With this frame of reference, the patient should actively participate and engage in goal setting, treatment planning, and evaluation. In the assessment, questions based on the OAM are asked to identify the person's occupation environments, roles, and meaningful activities. During treatment planning, the client chooses meaningful activities that he/she would like to master. Treatment focuses on the self-chosen activities and the client's environment and roles. The evaluation will be based on the concept of relative mastery

Biomechanical Model

Practice model used in rehabilitation to improve: range of motion: postural alignment, strength, functional mobility The theoretical base of biomechanical frame of reference (FOR) is considered as a remedial approach focusing on impairments that limit occupational performance. This FOR assumes clients are able to acquire the voluntary motor skills necessary to perform the desired human occupation, meaning that the underlying impairment is amenable to remediation. It also assumes that engaging in occupation and therapeutic activities has the potential to remediate the underlying impairment, and results in improvement in occupational performance. The goals are to prevent deterioration and maintain existing movements for occupational performance, to restore movements for occupational performance, and to compensate/adapt for loss of movements in occupational performance. Individuals who have limitations in performing occupations due to limitations in movements, inadequate muscle strength, loss of endurance, or other biomedical conditions are suitable to use this FOR. The goals are to prevent limitation of range of motion, to move the target body part through full range of motion, either passively or actively appropriately, and to position the body to prevent contractures and edema. Assessment includes assessing the performance components on movements, strength and endurance. Some assessments associated with this FOR include standardized objective tests of occupational performance, pain scales, examination of skin/wounds, sensory testing, etc. Interventions associated with this FOR include ADL retraining, work hardening, static and dynamic orthoses, active, active assistive, passive range of motion exercises, nerve gliding, etc. The variety of interventions aims to amend underlying impairment and result in enhanced occupational performance in desired occupations.

Nondirectional hypothesis

Predicts the existence of a relationship, not its direction -the researcher cannot predict if the outcomes related to the variable manipulation will be positive or negative (i.e. two-tailed)

Lifestyle Redesign

Preventive intervention model approach for older adults with a focus on establishing methods for continued participation in meaningful activities and healthy habits, and to identify solutions for self-identified barriers

Cognitive Orientation to Occupational Performance (CO-OP)

Problem solving intervention approach that involves: client-centered goal setting, cognitive strategies, guided discovery Cognitive Orientation to daily Occupational Performance (CO-OP; the CO-OP Approach) is a performance-based treatment approach for children and adults who experience difficulties performing the skills they want to, need to or are expected to perform. CO-OP is a specifically tailored, active client-centered approach that engages the individual at the meta-cognitive level to solve performance problems. Focused on enabling success, the CO-OP Approach employs collaborative goal setting, dynamic performance analysis, cognitive strategy use, guided discovery, and enabling principles. These elements, all considered essential to the Approach, are situated within a structured intervention format, and with parent/significant other involvement as appropriate.

Non-standardized sensory screening : Vibration

Procedure involves touching an activated tuning fork (e.g., 30 cycles per second, 256 cycles per second) to the fingertip to screen awareness of rapidly adapting sensory fibers

Non-standardized sensory screening : Modified Moberg pick-up test

Procedure used to determine general functional sensibility of the hand, involves picking up small common objects on at a time and placing the objects in a cup with and without vision occluded Requires client to be able to identify/name the objects in advance of screening

Handling characteristic of thermoplastic material: Drapability

Properties of thermoplastic material that indicates its ability to conform, contour and shape to the underlying structures, material effective for: -small orthoses -experienced orthotic makers

Measure of Central tendency: Descriptive statistics

Provides insight into the general characteristics of data collected during a study -Values that describe the center point of a data set Mean: average score (calculated by finding the sum of all numbers and dividing the sum by the total number of scores in the set Median: middle value ( determined by placing all scores in numerical order and locating the number in the middle Mode: the value that occurs most frequently within a data set

Measure of Variability: Descriptive statistics

Provides insight into the general characteristics of data collected during a study -represents how much the group varies from the mean, and the degree to which the data spread across the distribution -Variance -Standard deviation: measures the distribution and variation of data points around the mean

Miller Assessment for Preschoolers (MAP) (Development Assessment)

Purpose: A standardized task performance screening tool that assess sensory and motor abilities, that identifies children with moderate developmental delays: assesses neural foundation, coordination, verbal/nonverbal cognitive function, and complex task Methods: age related items are administered, non-standardized observations Scoring: measure sensory and motor abilities (and combined), performance is compared with norms (index), results used for treatment planning Population: standardized, 2 years 9 months - 5 years 8 months; school-related problems

Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) (Motor Assessment)

Purpose: A standardized test of motor proficiency: fine/gross motor, (speed, duration, accuracy, and hand/foot placement) Method: long/short form w/ 8 sub test (fine motor (precision/integration), manual dexterity, bilateral coordination, balance, speed, agility, UE coordination, and strength Scoring: total motor composite score in 4 areas: fine manual control, coordination (manual/body), strength, and agility that are used as a basis for suggesting treatment goals and to evaluate change Population: 4 years to 21 years

Developmental Test of Visual Perception (2nd edition) (DTVP-2) (Visual Motor and Visual Perception Assessment)

Purpose: Assesses visual perceptual skills, and visual motor integration for levels of performance Method: 8 subtest including: hand-eye coordination, copying, spatial relations, visual motor-speed, position in space, figure-ground, visual closure, form-constancy Scoring: Age equivalent, percentile, with 3 indexes Population: children aged 4 to 10 years, adolescents and adults aged 11 to 74 years (DTVP-4)

Hawaii Early Learning Profile (HELP) (Development Assessment)

Purpose: NON-standardized, curriculum; administer in child's NATURAL environment; family-centered assessment; monitors growth and development and identifies needs based on developmental delay, disabilities, or at risk (HELP for preschool is available for 3-6 years w/out delays Method: administered in natural environment during family's typical routine, warm-up period, structured play, and snack-time is recommended Scoring: developmental age range of skills in each of 6 domains: cognition, language, gross/fine motor, social-emotional, self-help Population: 0-3 years with delays and 3-6 years with/without delays

Pediatric Evaluation of Disability Inventory (PEDI) (Development Assessment)

Purpose: Standardized behaviors checklist and rating scale that assesses capabilities and detects functional deficits, to determine developmental level, monitor progress, and complete a program evaluation. (Assesses key functional capabilities and performance in children) Method: Observation, interview and scoring of 3 domains: self-care, mobility, and social skills and their functional sub-units Scoring: areas of functional skills, caregiver assistance, and modifications to identify children with a pattern of delay and monitor outcomes Population: 6 months to 7. 5 years

Erhardt Developmental Prehension Assessment (EDPA) (Motor Assessment)

Purpose: observation checklist, 3 cluster areas: involuntary arm-hand patterns, voluntary movements of approach, and prewriting skills; (chart/monitor prehensile development, and identify developmental gaps and the need for further assessments Method: administered by age, 341 test composites according 3 cluster areas Score: 3 parts based on cluster areas, gaps in hand skills and developmental levels Population: Children of all ages and levels, cognitive levels, and neuro-developmental disorders

Red-Yellow-Black System

Red-pink granulation tissue. (protect wound; maintain moist environment) Red indicates normal healing. When a wound begins to heal, a layer of pale pink granulation tissue covers the wound bed. As this layer thickens, it becomes beefy red. Yellow-moist, yellow slough (remove exudate and debris, absorb drainage) If the wound bed is yellow, patients need to take caution. Yellow is the color of exudate produced by micro-organisms in an open wound. A yellow color in the wound bed may be a film of fibrin on the tissue. Fibrin is a sticky substance that normally acts as a glue in tissue rebuilding. However, if the wound is unhealthy or too dry, fibrin builds up into a layer that can't be rinsed off and my require debridement. This exudate appears whitish yellow, creamy yellow, yellowish green, or beige. The fibrin or water content influences shade. Tissue that has recently died due to ischemia or infection may also be yellow and need to be debrided. Black-black, thick eschar firmly attached (Debride necrotic tissue) Black is the least healthy color, and this is a direct signal towards necrosis or tissue death. Dead, vascular tissue slows healing and provides a site for micro-organisms to proliferate. Debridement is always necessary for a black wound. After removing dead tissue, the surgeon will make sure that wound is guarded against external contamination. Enzyme products, surgical debridement, hydrotherapy with whirlpool or high pressure irrigation is commonly used to help necrosis healing. Multi-colored: Sometimes the wound exhibits more than one color, and can have up to three colors in a wound. Classify the wound according to the least healthy color present. If the wound is red and yellow, the wound would be classified as a yellow wound.

Clonus

Reflexive abnormal motor movements in response to a tendon stretch (as in reflex testing), indicative of a cortical lesion, characterized by a series of involuntary rhythmic contraction and relaxation of the muscle

Cumulative Trauma Disorder (CTD)

Repetitive Strain Injury (RSI) A disorder that can affect the bones, muscles, tendons, nerves and other tissues due to repetitive motion, overuse syndromes, trauma, and/or musculoskeletal disorders Risk Factors: repetition, static position, awkward postures, forceful excretion, and vibration (e.g. assembly line workers) Non-work risk factors: acute trauma, pregnancy, diabetes, arthritis, and wrist size and shape Types: Dequervain's, and Lateral/Medial epicondylitis

Literature Review

Research studies based on clinical injury including -searching relevant studies -synthesizing study data -reporting study findings

Non-experimental/ correlational research (Quantitative)

Research that lacks the manipulation of an independent variable, random assignment of participants to conditions or orders of conditions, or both -randomization and research controls are not possible -Used to study the potential relationship between two or more variables -Describes and predicts relationships among variables without active manipulation -Limitations: can not establish cause and effect, and may fail to consider all variables that enter into the relationship

Person-first language

Respectful way of communicating, includes recognizing the person before the disability. Intended to avoid dehumanization and to reduce societal perceptions (e.g., saying "person who is hearing impaired" versus "hearing impaired person")

Justice

Respecting the rights of others and giving them what is rightfully theirs "Relating in a fair and partial manner to individuals with whom they interact and respect and adhere to the applicable laws and standards regarding their area of practice"

Case manager

Responsible for the coordination of services deemed medically or educationally necessary for the client

Classification of tremors

Resting tremor occurs when the muscle is relaxed, such as when the hands are resting on the lap. With this disorder, a person's hands, arms, or legs may shake even when they are at rest. Often, the tremor only affects the hand or fingers. This type of tremor is often seen in people with Parkinson's disease and is called a "pillrolling" tremor because the circular finger and hand movements resemble rolling of small objects or pills in the hand. Action tremor occurs with the voluntary movement of a muscle. Most types of tremor are considered action tremor. There are several sub-classifications of action tremor, many of which overlap.

Tremors : Movement & Neuromuscular Disease

Rhythmic, alternating oscillatory movements produced by repetitive patterns of muscle contraction and relaxation -classified by : rate, rhythm, and distribution - resting tremor vs action/intention tremor

Hot pack

Superficial, moist heat, conduction modality Requires taking precautions to prevent: overheating of the client localized burns to the body part being treated discomfort from the weight of the pack recommended for use as an adjunct to other occupation-based interventions

Theoretical Base/ Sensory Integration : Jean Ayers (Frames of Reference and Models of Practice )

Sensory integration therapy aims to help kids with sensory processing issues (which some people may refer to as "sensory integration disorder") by exposing them to sensory stimulation in a structured, repetitive way. The theory behind it is that over time, the brain will adapt and allow kids to process and react to sensations more efficiently. -"Organization of sensation for use" -Adaptive responses are prerequisites to sensory integration, and occur in optimal arousal states -The "just right challenge" promotes growth and development -Facilitation of sensory modulation, discrimination, and integration results in improved postural control, praxis and bilateral integration, and participation, and intervention should be directed to underlying deficits. -Sensory integration impacts self-regulation, esteem, social participation, academic performance, and participation in ADLs and routines

Median Nerve Laceration

Sensory loss -Central Palm (thumb to radial 1/2 of ring finger) -Palmar side of thumb, index, middle, and radial 1/2 of ring finger -Dorsal surface of index, middle, and radial 1/2 of ring finger (middle/distal phalanges) - Motor loss for a low lesion at the wrist (Lumbricals I & II, (opposition), (abduction), (flexion of thumb MCP) -Motor loss for a high lesion at or proximal to the elbow. (FDP & FPL flexion of tip of indlex, middle, and thumb) -Deformity (Flattening of thenar eminence, "ape hand"/Clawing of index and middle fingers for a low lesion/ -Benediction sign for a high-lesion)-Functional loss (opposition, weak pinch)

Sensory Modulation Disorder (SMD)

Sensory modulation is a neurological function and is the organization of sensory information for on-going use. Efficient sensory modulation is the ability to effectively regulate the degree to which one is influenced by various sensory inputs. -Difficulty regulating responses after sensory input-- reactions not graded to the situation (PLACE YOURSELF IN THE SITUATION DAMN IT) -3 categories: Sensory Over Responsitivity (SOR), Sensory Under Responsitivity (SUR), Sensory Seeking/ Craving (SS) -Atypical responses (I.e. (unusual over-, under-, or fluctuating responsitivity) to the sensory aspects of material, activities, or situation -Under-responsive (hypo-responsiveness): the child who frequently does not notice or "register" relevant environmental stimuli -Sensory defensiveness (hyper-responsiveness): over responsiveness in multiple sensory set stems, such as over-reaction to touch, movement, sound, odor, and taste that are often associated with discomfort, avoidance, distractibility, and anxiety (an activation of the sympathetic nervous system) -Sensory Seeking: generating additional sensory inputs to compensate for weak processing in a particular sensory system (prevalent in autism)

Neural gliding exercises

Series of structured UE exercises intended to prevent nerve adhesion and preserve neural mobility often used as an adjunct intervention for compression neuropathies or nerve entrapment syndromes

Home program

Set of recommended activities provided to support carryover of skills learned in a therapeutic setting to the natural environment

Herpes zoster (Neuropathic pain)

Shingle; an acute painful mononeuropathy cause by a varcicella zoster virus. Characterized by inflammation, and pain that can last for months

Comprehensive Evaluation

Should assess: sensory skills, visual-perceptual processing skills, musculoskeletal skills, neuromuscular skills, cognitive skills, and psychosocial skills

Serial casting

Specialized intervention technique used to increase range of motion ROM of a joint, involves applying a series of well-padded casts to the limb to hold the target joint in a sub-maximal stretch Requires changing the cast at scheduled intervals to progressively increase ROM -reduce joint contracture and restore joint mobility for pts with contractures -require frequent remolding -used to increase ROM -does NOT address functional thumb use b/w therapy sessions

Mentorship

Supports lifelong learning and involves establishing a relationship with an experienced individual who is able to provide professional guidance and support

Medical Management: Parkinson's Disease

Surgical: thalamotomy, pallidotomy Pharmacology: (Levodopa) side effects are common -During early treatment side effects are not a major problem -As the disease progresses the drugs work less evenly and predictably cause dyskinesia (involuntary movements) during medication peak effects -Other side effects may include: hallucinations, a drop in BP when standing (orthostatic hypotension), and nausea -Carbidpa-levodopa extends the time person's with Parkinson's Disease are Able to lead normal lives and is effective for a number of years

Stage 1 -4 pressure ulcer

Stage 1 sores are not open wounds. The skin may be painful, but it has no breaks or tears. The skin appears reddened and does not blanch (lose colour briefly when you press your finger on it and then remove your finger). In a dark-skinned person, the area may appear to be a different colour than the surrounding skin, but it may not look red. Skin temperature is often warmer. And the stage 1 sore can feel either firmer or softer than the area around it. At stage 2, the skin breaks open, wears away, or forms an ulcer, which is usually tender and painful. The sore expands into deeper layers of the skin. It can look like a scrape (abrasion), blister, or a shallow crater in the skin. Sometimes this stage looks like a blister filled with clear fluid. At this stage, some skin may be damaged beyond repair or may die. During stage 3, the sore gets worse and extends into the tissue beneath the skin, forming a small crater. Fat may show in the sore, but not muscle, tendon, or bone. At stage 4, the pressure injury is very deep, reaching into muscle and bone and causing extensive damage. Damage to deeper tissues, tendons, and joints may occur. In stages 3 and 4 there may be little or no pain due to significant tissue damage. Serious complications, such as infection of the bone (osteomyelitis) or blood (sepsis), can occur if pressure injuries progress.

precontemplation stage: Transtheoretical Model

Stage of change in the TTM where individuals do not intend to change their high-risk behaviors in the foreseeable future. -client has not yet considered, or is resistant to change

Action stage

Stage of change in which people are actively changing a negative behavior or adopting a new, healthy behavior -Client has made observable changes in behavior and is committed to continuing to acquire new behaviors for a more positive lifestyle

Contextual Memory Test (CMT)

Standardized screening tool and questionnaire used to evaluate self-awareness and use of cognitive compensatory strategies -based on Dynamic Interactional Model of Cognition -used with adults who have memory impairments

DeQuervain's Tenosynovitis

Stenosing Tenovaginitis/Tenosynovitis Etiology: Inflammation of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) resulting in pain, crepitation and swelling over the radial styloid Causes: Forceful, repetitive, or sustained thumb abduction with ulnar deviation of the wrist. 4X more likely to occur in woman than men between 35-55, pregnant woman in the 3rd trimester and mothers of young children. Wringing out rags, opening jars, and needlepoint may provoke pain Testing: Finklestein's test is typically positive, and pain with resisted thumb exten/abd Conservative intervention includes: activity modification. orthotic positioning, tendon gliding exercises, ergonomic education Operative Treatment:

Splitting

Strain between therapist-client relationship and/or interprofessional team members where the staff response to manipulative behaviors of a client include: blurring professional boundaries creating team division

Medication compliance program

Strategy used to support a client's participation in their prescription medication regimen, includes the use of assistive aids such as: -pill storage boxes (e.g., 7-day dosage box) -electronic reminders (e.g., pre-programmed alarm) -diary (e.g., calendar) -pill splitter or crusher -insulin holders

CVA: Internal Carotid Artery (ICA)

Stroke results and symptoms similar to those associated with MCA CVA

CVA: Posterior Cerebral Artery (PCA)

Stroke results in homonymous hemianopsia, thalamic pain, hemi-sensory loss, and or alexia

Cardiac rehabilitation

Structured interprofessional team approach used to assist individuals recover from myocardial infarction, heart surgery, percutaneous coronary intervention procedures (e.g., angioplasty), phases include: -phase 1: inpatient -phase 2: outpatient -phase 3: community-based

Work hardening

Structured rehabilitation program aimed at maximizing a client's physical ability to return to a specific job function after an injury, may include: -job simulation activities -work conditioning exercises

Community health

Study of trends and characteristics that promote wellbeing within a community includes three broad categories: -primary -secondary -tertiary

Co-leadership style: Group leadership style

Style of group leadership that includes two or more practitioners from same or different discipline Benefits include: -leaders can support each other -greater objectivity when measuring performance of group members -knowledge of the group leaders can be combined -group leaders can take on different roles

Authoritarian style: Group leadership style:

Style of group leadership that involve a high level of control Features include: -leader directs group members -members minimally contribute to the group decision-making process

Paraffin therapy

Superficial, conduction, heat modality that involves use of thermostatically controlled, warmed wax and mineral oil, methods include: immersion dip immersion pouring Recommended for use as an adjunct to other occupation-based interventions

Fluidotherapy

Superficial, dry heat, convection modality that involves inserting a distal extremity into a thermostatically-controlled machine of circulating particles, typically used for: desensitization edema and pain reduction improving range of motion Recommended for use as an adjunct to other occupation-based interventions

Fluidotherapy

Superficial, dry heat, convection modality that involves inserting a distal extremity into a thermostatically-controlled machine of circulating particles, typically used for: desensitization edema and pain reduction improving range of motion recommended for use as an adjunct to other occupation-based interventions

Canadian Model of Occupational Performance and Engagement Model

The Canadian Model of Occupational Performance and Engagement (CMOP-E) is an occupational performance model, which is evolved from the Canadian Model of Occupational Performance (CMOP). The CMOP-E includes three main components: person, environment, and occupation. In this model, the inner part represents "Person", and its center is the spirituality of a person. The other components surrounding a person's spirituality are affective, physical, and cognitive abilities. The intermediate circle represents "Occupation", which is performed by the person in the environment and includes three domains of self-care, productivity, and leisure. The outermost circle represents the external "Environment" including physical, social, cultural, and institutional environment of the client. The interaction between the person, environment and occupation results in occupational performance, which is the ability of a person to perform occupations and daily engagements. When compared to the CMOP, the CMOP-E goes beyond occupational performance to cover the concept of the occupational engagement. This expansion is related to how this model can be used to enable clients to choose and perform their meaningful occupation in their environment. In evaluation, occupational therapists can use the Canadian Occupational Performance Measure (COPM) to identify the level of difficulty in the client's occupational performance. The client can also give scores to the level of satisfaction and performance of those identified difficult occupations. Occupational therapists are thus able to provide treatment according to the client's individual needs. This will help occupational therapists to develop client-centered treatment plan, and it will also allow the client to engage in treatment planning and increase their motivation and compliance in treatment.

Dunn Model of Sensory Processing

The Dunn's Model of Sensory Processing proposes four basic patterns of sensory processing which are emerged from the interaction of the neurological threshold and self-regulation. Neurological threshold is a personal range of threshold for noticing and responding to different sensory events in everyday life. People who have low sensory threshold would notice and respond to stimuli more often because their neurological system activates easier and more readily to sensory events. On the other hand, people who have high sensory threshold often miss stimuli that others notice easily because their neurological system requires stronger stimuli to activate. Self-regulation is a continuum of behavioral construct. One end indicates those who have a passive strategy towards sensory events, for instance, remaining at a place with many sensory inputs that makes him/her feel uncomfortable and reacts with frustration. The other end indicates people who utilize an active strategy, for instance, adjusting one's position to get a manageable amount of sensory input. Therefore, the four patterns can be resulted from the intersection of the neurological threshold and self-regulation; they are (1) sensation seeking (high threshold and active self-regulation strategy), (2) sensory avoiding (low thresholds and active self-regulation strategy), (3) sensory sensitivity (low threshold and passive self-regulation strategy), and (4) low registration (high threshold and passive self-regulation strategy). Individuals with extreme responses to sensory event are likely to have interfered daily life. This model provides assessment and intervention strategies for therapists in promoting people's participation in important domains.

Model of Human Occupation (MOHO)

The Model of Human Occupations (MOHO) is a model that describes how humans generate and modify their occupations in interaction with environment, which presents a dynamic open cycle system of human actions. The system considers information from environment and the feedback of performed action as input, and then goes through the internal part of system. The internal part consists of three subsystems: Volition, Habituation, and Performance. Volition subsystem initiates one's action, consisting of three components. First, Personal causation is one's sense of effectiveness and confidence on performing action. Humans can be classified into pawn (or origin) i.e., having strong (or weak) sense of effectiveness in mastering themselves and the environment. Once the prediction of outcome is achieved, a sense of success and effectiveness is gained and vice versa. Second, Interests are one's intention to seek pleasure from certain action, objects or events. Third, Valued goals are the outcome of how a person determines the importance of various occupational behavior. Habituation subsystem maintains daily routine and action pattern, as well as the order of performing actions. It consists of two components: (1) internalized roles which guide one's automatic routines when acting as different productive roles and satisfy one's demands of social environment and volition; and (2) habits which are formed when one repeats certain occupations in his/her daily life and works without the guide of conscious decision. Lastly, performance subsystem generates skilled action. After the interaction between the input and three subsystems, the system generates output (information and action), which provides feedback to the system and becomes new input. The whole system will make adjustment according to the feedback and modify the action at the end. This model can be applied in understanding clients' formation of action during assessment, and modifying client's action through the subsystems and input during intervention.

Person Environment Occupational Performance Model

The Person-Environment-Occupation-Performance (PEOP) model is a system model that views the function in the systems a whole and considers the interaction among its components. Occupational performance is emphasized in the PEOP model and involves three components: (1) characteristics of the person (including physiological, psychological, motor, sensory/perceptual, cognitive, or spiritual), (2) features of the environment (including cultural, social support, social determinants, and social capital, physical and natural environments, health education and public policy, assistive technology), and (3) characteristics of the activity, task, or role. When people perform occupations, they also interact with environment. Thus, there are reciprocal consequences; that is, a person's goals and intentions influence his/her occupational performance, and the action changes his/her environment and his/her characteristics at the same time. The interaction between the person and environmental components positively or negatively influences occupational performance. When there is a person-environment fit in supporting the valued occupation, success in occupational performance eventually leads to participation and well-being. In addition, the PEOP model is a client-centered model; that is, client must actively set goals and participate in determining a plan that promotes occupational performance. Application of the PEOP model in practice requires a collaborative relationship with the client and practitioner. Practitioner understands the issues and options presented by the client's needs and goals by asking the appropriate questions to elicit client's narrative. The model identifies factors in the personal performance capabilities/constraints and the environmental performance enabler/barriers that are central to the occupational performance, which in turns lead to development of a realistic and sequenced intervention plan.

Pattern recognition

The ability to identify information and determine similarities and differences in the stimulus to form a meaningful pattern -matching information from a stimulus with information retrieved from memory

Visual Cognition

The ability to process visual information by integrating it with other sensory information to perform meaningful activities

Resilience

The ability to react to and cope with stressful or traumatic life events -help adapt to challenges -develops over one's lifespan

Cognitive Behavioral Frame of Reference

The cognitive-behavioral frame of reference (FOR) emphasizes five aspects of life experience: thoughts, behaviors, emotion/mood, physiological responses, and the environment. These aspects are interrelated, meaning that changes in one factor can lead to improvement or deterioration in other(s). Each is influenced by the social and physical environments. One key theoretical component in this FOR is the hierarchical levels of cognition. Automatic thoughts is the most accessible, which are uninvited and immediate thoughts. Beliefs are conditional beliefs we hold about ourselves. Core schema are absolute beliefs that we hold about ourselves, and they represent the building blocks of thought process and are challenging to shift. Assessment is ongoing within this FOR. Assessment focuses on appraising client's problem through interviews, questionnaires, and clinical observations. A case formulation is developed from conceptualization of a therapist's understanding of a client's problems, from the client's thinking, behavior, physiological responses, emotions, and environments. This formulation is introduced to the client and the process is a collaborative effort. The cognitive-behavioral FOR is integrated in occupational therapy-focused interviews, including use of cognitive behavioral techniques, for anxiety management (e.g., deep breathing exercise), phobia (e.g., systematic desensitization), and chronic fatigue (e.g., graded activity scheduling). Other cognitive behavioral techniques include activity diaries and graded activity scheduling. This FOR can be used in conjunction with an occupation-focused conceptual model such as Model of Human Occupation, to enhance a detailed understanding of clients' occupational performance and occupational identity needs.

Principle 6 of Universal Design Low physical effort

The design must be used efficiently and comfortably and with minimum of fatigue

Boutionniere Deformity

The extensor tendon (zone I) attached to the middle phalanx is injured due to: the result of an injury to the tendons that straightens the middle joint of your finger. • Synovitis causes the central tendon to become weakened, lengthened, or disrupted from the bony and capsular attachments allowing the PIPj to rest in flexion Etiology: Finger postures in PIP flexion and DIP hyperextension (open or closed) injury -Closed injury: development is slow but noticeable within 2 to 3 weeks after injury -Ct may have PIP extensor lag or PIP flexion contracture (therapy choice is affected) Causes: Laceration, Tear, Avulsion, Volar dislocation of the middle phalanx, Rheumatoid Arthritis Symptoms: Signs can develop immediately following an injury to the finger or may develop a week to 3 wks later • The finger at the middle joint can't be straightened and the fingertip can't be bent • Swelling and pain occur and continue on the top of the middle joint of the finger Treatment: Nonoperative Treatment • PIP splinting in ext. • Isolated DIP flex. Exercises (PROM/AROM) • PIP active exercises Splinting: If Pt has PIP flexion contracture • Serial splinting • Serial casting • Static progressive splints • Dynamic splint

Degrees of Freedom

The number of individual scores that can vary without changing the sample mean. Statistically written as 'N-1' where N represents the number of subjects. -based on number of subjects and number of groups; allows determination of level of significance based on consulting appropriate tables for each statistical test

Complex Regional Pain Syndrome (Condition/Location)

Type I: formerly known as reflex sympathetic dystrophy (RSD) Type II: formerly known as causalgia Vasomotor dysfunction as a result of an abnormal reflex. -Chronic pain that usually affects an arm or leg. -Can be localized to one area or spread to other parts of the extremity Etiology: May follow trauma (i.e. Colles' Fracture) or surgery, but actual cause is unknown. Typically develops after an injury (arm or leg), surgery, stroke, sprained ankle, infection, or heart attack. This can include a crushing injury, fracture or amputation. May be due to a dysfunctional interaction between the central and peripheral nervous systems and inappropriate inflammatory responses Severe pain • Edema • Discoloration • Osteoporosis • Swelling & Stiffness • Temperature changes • Vasomotor instability Tissue wasting (atrophy): skin, bone, and muscles begin to deteriorate and weaken if Pt. avoids moving arms and legs because of pain and stiffness Muscle tightening (contractures): OT Treatment: Modalities to decrease pain, Edema management (elevation, manual edema mobilization, compression glove), AROM, pain-free ADLs, Stress Loading (weight-bearing/joint distraction activities), splinting (resting hand splint (relieve muscle spasms), encourage self-management, avoid or proceed w/ PROM stretching, dynamic splinting and casting

Chemical debridement

Type of debridement that uses fast acting enzymes to slough nonviable tissue from a wound

Autolytic Debridement

Type of debridement that uses the body's own enzymes to breakdown nonviable tissue

Raised toilet seat

Type of durable medical equipment designed to increase the seat height of a standard bathroom toilet, makes sitting down or standing up from the toilet easier

Drop-arm commode

Type of durable medical equipment used for toileting that is portable and designed with adjustable legs and an easy to release arm rest feature to facilitate lateral and sliding board transfers

Over head trapeze

Type of durable medical equipment with an overhead hoist attached to a bedframe or portable stand, used to facilitate bed mobility or transition from supine to sitting by pulling up on a handle affixed to the base

High-tech communication board

Type of electronic or computerized augmentative communication device that produces a synthesized voice Allows a user with verbal deficits to express thoughts, needs, emotions, and to converse with others

Alternative and augmentative communication (AAC)

Type of high or low technology device designed to assist or replace verbal/gestural communication, assist individuals with verbal deficits express basic needs, emotions, thoughts, and/or converse with others

Low-tech communication board

Type of inexpensive augmentative communication device that does not require electronic or computer assistance Consists of letters, selected words, or pictures to assist individuals with verbal deficits express basic needs and emotions

Walker

Type of mobility device in which the hands maneuver the device in the desired direction, may be wheeled or non-wheeled, used by persons who require external support and stability during ambulation, frame types include: anterior posterior hemi (one-handed) platform reciprocal

Prone scooter mobility device

Type of mobility device that enables a child with limited lower extremity function engage in floor play while lying on a flat padded board with casters, must have adequate upper extremity strength and head control

Mobile stander

Type of mobility device that enables a client with limited lower extremity function to bear weight through the legs in a standing position, includes large wheels for manual propulsion of the device

Myoelectric prosthesis

Type of prosthesis for persons with an upper limb deficiency or amputation, uses electrical signals from existing muscles in the residual limb to control the movement of the artificial device (limb)

Pneumatic switch

Type of single-switch interface activated by airflow detection or pressure exchange, used to operate assistive devices such as environmental control units

mechanical switch

Type of single-switch interface activated by applying pressure to a button, pad or lever, used to operate assistive devices, types include: paddle plate button lever membrane

proximity switch

Type of single-switch interface activated by close proximity to a detector, used to operate assistive devices and operate light fixtures

Phonation switch

Type of single-switch interface activated by speech or sound, used to operate assistive devices such as computers and environmental control units

Electromagnetic switch

Type of single-switch interface activated through energy such as radio waves or light used to operate assistive devices, types include: fiber-optic sensor infrared sound touch

Full-length body sling

Type of sling used with a mechanical lift system that provides full support from the head to the knees, and is typically used with a client who is dependent in transfers.

Divided-leg sling

Type of sling used with a mechanical lift system that provides support for the client's torso and has straps that are positioned between the legs to prevent the client from sliding forward during the transfer.

Toileting sling

Type of sling used with a mechanical lift system that supports the torso, has straps under the thighs, and has a cut-out to allow for use during toileting and personal hygiene.

Ipsative assessment

Type of standardized test in which the client rates their own level of performance using specific testing instructions and the results are compared at separate intervals over time Ex. Canadian Occupational Performance Measure Pediatric Volitional Questionnaire

Criterion-referenced test

Type of standardized test includes comparing abilities of a client to a defined list of skills or level of performance Examples include: School Function Assessment Gross-Motor Function Measure

Norm-referenced test

Type of standardized test that compares performance of a client in relation to average performance of a peer sample

Ecology of Human Performance: Evaluation

Use the models specific checklist including: checklist for person, environment, task analysis, and person priorities -Use the sensory profile -Intervention 5 specific interventions -Establish/restore: teaching skills that are lost due to illness or disability or never learned -Alter: assess context to determine which is the best match for a person's ability -Adapt/modify: change the context or task in some way so that it leads to the person's successful performance -Prevent: minimize risk, so that problems in performance do not develop -Create: promote enriching and complex performances

Modalities

Used for pain relief and tissue healing including heat (hot pack), ultrasound, cryotherapy, paraffin wax, and transcutaneous electrical stimulation (TENS)

Stroke/CVA -Thrombolytic therapy

Used in acute stroke to open occluded cerebral vessels and restore blood flow to ischemic areas, eg. t-PA

Developmental index score

Used in developmental testing with the following features -mean score is 100 -standard deviation of 15 or 16 -intervention often beneficial if scores are 2 standard deviations below the mean

Observational research study

Used to analyze behavior or outcomes of subjects -conducted without influence from the researcher -in a natural or controlled environment

Analysis if covariance (ANCOVA)

Used to compare two or more treatment groups or conditions while also controlling for the effects of intervening variables (covariates) (-e.g. two groups of subjects are compared on the basis of UE functional reach using two different types of AE; group 1 has longer arms than group 2 so arm length becomes the covariate) that must be controlled during statistical analysis)

Correlation all statistics

Used to determine the relationship between two variables -strength of relationship: positive correlations range from 0 to +1.0 indicates as variable X increased, so does variable Y -high correlation: 0.70 to +1.00 -moderate correlation 0.35 to 0.69 -low correlation 0 to 0.34 -0 means no relationship between variables -negative correlation ranges from -1.0 to 0: indicates as variable X increased, variable Y decreases ; an inverse relationship

Fatigue management

Used to reduce feelings of exhaustion caused by physical conditions, psychosocial stressors, or work pressures strategies include: -use of ergonomic products -pacing the activity -alternating heavy and light task -practicing stress management

Third trimester of pregnancy

Vision: fixation occurs, able to focus Auditory: debris in middle ear, loss of hearing Olfactory: nasal plugs disappear, some olfactory perception Taste: can respond to different taste (sweet, sour, bitter, salt) Movement: 28 weeks primitive motor reflexes, rooting, sucking, swallow, palmar grasp, plantar grasp, MORO, crossed extension.

Second trimester of pregnancy

Vision: startled to light Auditory: will turn to auditory sounds Movement: quickening, sleep states, grasp reflex, reciprocal and symmetrical limb movement

Occipital lobe

Visual cortex, visual reception, and color recognition

Affordance

Visual cues learned through exploratory actions used to enhance understanding of an objects indeed function, may be impaired in children with autism spectrum disorder

Specific Testing : UE

Visual examination and observation, client interview, and complete medical history including history of injury Motion assessments: ROM, goniometer measurements if the client is able to track total active motion Strength: manual muscle testing, dynamometer, pinch gauge meter Edema: volumeter or centimeter tape Vascular: observe color and trophic changes, pulse, skin temperature, Allen's test Sensory assessments: Sensation Semmes: Weinstein monofilament (nerve compression) , two-point discrimination (nerve laceration and recovery) Coordination: O'Conner dexterity test, 9 whole peg test, Perdue pegboard test, Box and Block Test, Minnesota Rate of Manipulation Test , Crawford Small Parts Dexterity Test Jebson-Taylor Hand Function Test Occupational Performance: assessed using ADL and/or IADL checklist, which is also useful for goal-setting Outcome measure: DASH and QuickDASH before and after therapy 30 item and 11 item 5 point Likert scale on ADLs

Stress thermometer

Visual feedback scale used for assisting children identify and quantify emotions, moods, or perceptions of their behaviors

Oculomotor dysfunction

Visual impairment characterized by lack of efficient eye movements and eye-tracking skills due to a cranial nerve lesion or neural disruption of the extraocular muscles, functional deficits may include difficulties with: reading speed copying skills writing skills

Hemianopsia

Visual impairment secondary to a brain lesion that results in loss of vision to half the visual field Compensatory strategies may include: visual anchoring scanning training environmental modification

Diplopia

Visual impairment secondary to a neurological event, also referred to as double vision, may cause loss of depth perception and increase risk of falls. Interventions for managing symptoms may include: prism correction full occlusion eye-patching partial visual occlusion

Reaching Skills: newborn

Visual regard accompanied by swiping/batting with closed hand and abducted shoulder

Active assistive exercise

Voluntary contraction and relaxation of muscles aided by an external force used with presence of severe muscle weakness to: restore range of motion regain muscle strength

Active exercise

Voluntary contraction and relaxation of muscles to move a body part through the available range of motion, used to: preserve joint mobility minimize atrophy increase strength increase endurance

A whole-learning

When entire task is practiced at once More effective when complex task has relatively high organization -a technique for teaching skills in which the client learns the entire sequence of steps within the task

Ethical dilemma

When it is difficult to identify what the best ethical course of action would be because of conflict that occurs when determining the resolution (e.g. family does not want the client to know that he/she has a terminal condition) -when there are two or more potentially morally correct ways to solve a problem, However, these solutions are exclusive, therefore, choosing one course of action prohibits acting on the other choices

Retrieval (3rd stage of memory)

Where the brain searches for and recalls relevant information -Brain structures: frontal lobe

Individualized Education Program (IEP) & Plan

Written document required by the Individuals with Disabilities Education Act (P.L. 94-142) for every child with a disability; includes statements of present performance, annual goals, instructional objectives, specific educational services needed, extent of participation in the general education program, evaluation procedures, and relevant dates, and must be signed by parents as well as educational personnel. (IEP) Plan: -written document developed by the multidisciplinary team for the student in public school who is eligible for special education. Includes: -students present level of performance -annual goals and how and when progress will be measured -special education services and modifications that will be provided -the extent to which the student will not participate in regular school activities with other students -accommodations for assessments and testing -start date, frequency, location, and duration of services

Railings

interior: 1 (1/2) from the wall to ease grasp exterior: waist high for those who walk; 34-38" depending on height railing should be 1(1/2)-2 " in diameter w/ non-skid surface

Manual Muscle Testing (MMT)

allows therapist to assign specific grade to a muscle, based on whether patient can hold the limb against gravity, how much manual resistance can be tolerated and whether joint has full ROM. Traditional grading uses either descriptive terms "zero," "trace," "poor," "fair," "good," and "normal," or uses a numerical scale from 0 through 5. For large practices, it is recommended to have practitioners agree on the terms using for grading MMT. A grade is determined by a patient's ability to move the tested body part through its full range of motion (against gravity) and whether they can hold in the test position. This ability earns a grade of fair, or 3, and is the most objective observation made during testing due to the consistency of gravity. However, a poor grade, or 2, is given when a patient is able to move throughout the full range of motion, only when gravity has been removed. Trace grades, or 1, is given when a patient is unable to move throughout the range of motion, however a slight contraction is noticeable upon palpitation. When there is no evidence of even a slight contraction, a grade of zero is given. -structured approach to measure muscle strength and apply grade to the maximal effort put forth -grade scale range : Zero (0/5) to Normal (5/5)

Partial tarsal amputation

amputation of metatarsals and phalanges

emotional dysregulation

an inability to control negative emotions in response to stressful life events -emotional action or behavior that is not within the typically expected range of emotional responses for a particular social situation

Escharotomy (emergent phase)

an incision made through burned skin (tissue) to help with healing, and to relieve pressure on extremities (the scab or crust that forms after a third degree burn is called 'eschar')

Primary circular reactions: Sensorimotor Period (Hierarchical development of cognition)

cause and effect learning ; with reflective sensorimotor patterns that are repeated for enjoyment (2-4 months)

Compulsion

compelling; strong desire that is difficult to control; irresistible impulse -Repetitive behavior performed in responses to obsessive thoughts used to minimize anxiety -Psychological state commonly seen in obsessive compulsive disorder

Cleft lip and palate

congenital split of the lip and roof of the mouth -Structural deformity in which the upper lip and/or palate has a congenital separation requiring surgery -Intervention: safe feeding strategies pre and post-operatively

Goal setting groups

consists of activities designed to identify personal objectives and treatment goals and the steps needed for their achievement

Pitting Edema 3+

deep pitting, indentation remains for a short time, leg looks swollen -interstitial swelling in the extremities in which an indent appears after pressure is applied, typically graded from absent (0) to severe (3+)

Electronic Aides to Daily Living (EADL)

environmental control units (ECU) are means to purposely manipulate and interact with the environment by alternately accessing one or more electrical devices via switch, voice activation, remote control, and computer interface -eye gaze: for individuals with severe mobility impairments and speech impairments (e.g ALS) -delayed touch keyboard activation systems for persons with poor motor control (e.g. individuals with athetoid movements)

Spasticity

increased muscle tone -Abnormal motor movement resulting from impairment in the CNS, and characterized by hypertonia (muscle over-reactivity when communication between the brain and spinal board is affected by injury or illness)

Ulnar nerve injury

ulnar claw deformity and numbness of the ulnar side of the hand and the 5th and half of the fourth digits; generalized weakness of the ulnar side of the hand and pain

Lumbricals (ulnar side),

ulnar nerve ,MCP flexion and extension of IP joints of digits IV and V origin: tendons of flexor digitorum profundus for digits IV and V insertion: radial side of digits IV and V into extensor expansion

Abductor digiti minimi

ulnar nerve, abduction of the 5th digit origin: pisiform insertion: proximal phalanx of the 5th digit

Flexor digiti minimi,

ulnar nerve, flexion of MCP joints, and opposition of the 5th digit origin: hook of hamate, and flexor retinaculum insertion: proximal phalanx of 5th digit

Flexor digitorum profundus

ulnar nerve, flexion of the DIP joints to digits IV and V origin: proximal 2/3rds of the ulna and interosseous membrane insertion: distal phalanx

Opponens digiti minimi,

ulnar nerve, opposition of the 5th digit origin: hook of hamate, and flexor retinaculum insertion: 5th metacarpal

Altruism

unselfish regard for the welfare of others "The individuals ability to place the needs of others before their own"

Conductive Hearing Loss

—hearing impairment caused by interference with sound or vibratory energy in the external canal, middle ear, or ossicles -tinnitus (ringing in the ears)