Neurogenerative Diseases

What is an effective strategy to facilitate maximal independence in self-feeding with a client who has middle- to late-stage dementia?

Hand-over-hand guidance is an effective strategy to encourage maximal independence through participation in daily living tasks, including self-feeding.

A client with early-stage Alzheimer's disease has increased difficulty with spatial orientation. Which occupational performance area does this difficulty most likely affect?

People with early-stage dementia have difficulty with IADLs because of memory loss and other cognitive impairments. Difficulty with spatial orientation has an impact on their community mobility.

Dementia Stages :Early Stage:

-ADLs remain intact -memory loss manifest in IADLS -orientation to place is affected -disorientation away from home -financial management, shopping, meal prep, health management, driving skills, work performance, communication is impaired -leisure exploration becomes difficult -withdrawing from social participation -neglects old habits/routines or Clings to them -roles change

Dementia Types

-Alzheimers disease: cortical atrophy of teh frontal, parietal and temporal lobes as well as hippocampal region -Vascular Dementia: cerebrovascualr disease (often series of strokes) leading to focal lesions on the brain and neurotransmitter distruption -Frontotemporal Dementia: neuronal, intranuclear inclusions -Dementia with Lewy Bodies: lewy body proteins present in the brain, usually predominant in the limbic or neocortical areas; overall decline in acetyclholine and dopamine levels

A client with dementia presents with decreased attention to task. What strategies are effective for a COTA® to implement to assist with decreased attention?

-Avoiding overstimulating and distracting environments is a viable strategy when managing deficits in attention. - Breaking the task into manageable steps allows the COTA to control the task and provide the just-right challenge to the client to maximize attention to the task and reduce frustration. -Task and environmental modifications can lower the cognitive demands and increase occupational performance.

Guillain-Barre Syndrome Three Phases

-Onset and acute inflammatory phase: acute weakness occurs in at least two extremities that advances and reaches its maximum in 2-4 weeks -Plataeu Phase: symptoms are at their most disabling, with little or no change over a few days or weeks -Recovery Phase: Remyelination and axonal regeneration occur over a period as long as 2 years. Starts at head/neck and travels distally

A COTA® is working with the caregiver of a person with Alzheimer's disease (AD) to provide strategies to reduce the burden of caregiving. What strategies might the COTA suggest?

-Providing structure for unoccupied time is an important consideration to prevent behavior problems and maintain quality of life for clients with AD. In addition, structure promotes an increase in goal-directed activity and may aid in more regular sleep patterns. -Overstimulation can lead to behavioral issues, so avoiding overstimulation in the environment can improve optimal functioning. -Intervention should support and maintain capabilities or compensate for a decline in function.

Guillain-Barre Syndrome Symptoms

-Rapid Progression in symmetrical ascending pattern of flaccid paralysis that beging in feet -paralysis may occur in respiratory muscles -pain (mostly in lower extremities) -fatigue -edema -absence of deep tendon reflexes -mild sensory loss in the hands and legs -dysfunction of cranial nerves

Dementia: Late Stage

-all areas of occupation lost -person dependent in all ADLs -person can no longer ambulate safely -communication is losts -person has no understanding of cultural, social or spiritual contexts

Multiple Sclerosis Symptoms

-impaired balance/coordination -parital or complete paralysis of the body -muslce spacticity (LEs) -Muscle weakness -fatigue -intention tremors -dysphagia -Paresthesia: numbness or tingling - vertigo -Pain -Diplopia (double vision) -optic neuritis (can lead to partial loss of vision; nystagmus; loss of visual acuity) -slurred speech -bladder and bowel symptoms -sexual symptoms -short term memory loss -attention deficits -decreased processing speed -impaired executive functioning/judgment -depression -inappropriate euphoria -lability

Dementia: Middle Stage

-impairments occur in all areas of occupation -no longer can live alone -no longer attend to ADLs -eating problems/weight loss -IADLs are neglected -dependent in community mobility, financial management and shopping -some cooking/cleaning tasks can be done with supervision -cannot perform work/education activities -social paricipation usually =caregivers -roles continue to be lost -cultural context begins to diminish

Dementia symptoms

-memory impairment -aphasia: difficulty with expressive language -apraxia: loss of skilled, purposeful movement -agnosia: inability to recognize teh importance of sensory impressions -disturbance in execuative functioning -difficulty with topigraphical orientation -spatial task diffculties -poor judgment -anxiety/defensiveness -disinhibited behavior -psychotic symptoms -gait disturbances -dysphagia

Huntington's Disease Symptoms

-rapid, involuntary, irregular movements -motor restlessness (akathisia) -abnormal, sustained posturing of a body part (dystonia) -bradykinethisia: slowed movement -akinesia: delayed initiation of movement -incoordination of movement -hypertonicity (late stages) -gait and balance problems; disturbances in memory and decision making (middle stages) -difficulties with smaller movements and hand-eye coordination -large bursts of movement when small movements are intended (later stages) -forgetfullnes -difficultiy concentrating -difficulty maintaining work performance (initail stages) -depression -saccadic eye movements slow -dysphagia

Parkinsons Symptoms

-resting tremor -muscle rigidity -bradykinesia -postural instability -Muscle stiffness -gait dysfuntion: festinating gait; shuffling steps -fine motor and bimanual impairments -freezing, or inability to initiate or continue movement -impaired executive funtioning -memory loss -visupspatial deficits -dementia -micrographia (small writing) -reduced volume of speech (hypophonia) -muffeld speech -reduced facial expression -sensory loss -dysphagia -mood/behavior disturbances

A client with Parkinson's disease is experiencing difficulty in executive functioning. The client's spouse would like the client to continue participating in leisure activities. Which intervention would be the MOST appropriate for this client?

Providing simple instructions best addresses the client's difficulty in executive functioning.

The intervention plan for a client who has a new diagnosis of Parkinson's disease (PD), Stage 1, includes the client's goal to maintain employment as an administrative assistant in a moderate-paced law firm. What is the FIRST intervention with which the COTA® should begin treatment?

A client with Stage 1 PD may present with a resting tremor, a typical first symptom -a resting tremor will make fine motor tasks more difficult. Most people with PD experience their worst symptoms just before the next medication dosage. Timing more difficult fine motor tasks with medication is the most nonintrusive intervention.

A client with advanced amyotrophic lateral sclerosis (ALS) presents with a stiff forward-flexed neck that is at risk for developing a contracture and impairing social participation. Which intervention would the COTA® use to BEST prevent a contracture?

ALS's progressive nature, many of the interventions for clients with ALS focus on client and caregiver education to address the increasing symptoms and preventing secondary complications such as contractures. Caregiver training on gentle neck stretching and how to help don a soft cervical collar is the most appropriate because using the collar will help maintain the neck in a neutral position, and gentle stretches to the neck will lessen stiffness and discomfort.

A client who has Parkinson's disease reports increased tremors, problems knocking items over while eating, and poor articulation, leading to recent social isolation. Which intervention strategy would be MOST effective for this client?

Activities should be timed during medication "on" times. Determining a client's optimal time of day for activities promotes increased success in occupational performance.

What strategy might a COTA® appropriately recommend to caregivers of a client with Alzheimer's disease to assist with fall prevention?

Engagement in activity-based interventions, along with daily structure, has been documented to assist in fall prevention.

On an inpatient rehabilitation unit, the COTA® observes a newly evaluated patient with Parkinson's disease eating breakfast seated in a bedside chair. The COTA® observes a fork on the floor and milk spilled on the patient's gown and tray. The patient begins coughing, spitting up pieces of pancake, and then says hello with unswallowed food in the mouth. What should the COTA® do FIRST with this patient?

Clear the unswallowed food from the patient's mouth and then notify the nurse supervisor and the OTR®. food in the mouth could cause a choking episode. A speech therapist may be needed to evaluate for dysphagia and advise on appropriate diet changes or recommend further testing such as a video swallow. It is appropriate to discuss with the client whether the client wants increased independence with feeding using adaptive techniques or equipment, and providing education on the role of occupational therapy with feeding would help initiate this part of the intervention planning process.

Which of the following clients is MOST likely to be characteristic of a person in the middle stage of Alzheimer's disease (AD)?

Confusion is commonly associated with the middle stage of AD.

An OTR® has completed an initial evaluation with a client who has relapsing and remitting multiple sclerosis. Sensorimotor skills assessment indicates that the client's daily activities are limited by low endurance and decreased upper-extremity coordination. In addition, the client has been unable to remain in a job as a clerical worker. What additional information, that the COTA® can gather, is MOST important before developing an intervention plan?

Contextual and environmental factors provide information about a client's available support systems, which can influence his or her ability to adapt to the diagnosis.

A client with multiple sclerosis (MS) states that fatigue is negatively affecting work performance. What is the BEST action for the COTA® to take next?

Further evaluation is needed to determine appropriate interventions; this approach goes beyond typical energy conservation education and involves the COTA® and OTR® working with the client to identify the specific work tasks that cause fatigue.Work tasks must be identified before determining work demands.

What skills might a client with middle-stage dementia have difficulty performing on the basis of typical psychosocial or cognitive abilities present during this stage of dementia?

In middle-stage dementia, a person will begin having moderate impairment in IADLs, such as finances, shopping, medication management, and complex meal preparation.

A COTA® is treating a client in the recovery stages of Guillain-Barré syndrome (GBS). According to the biomechanical frame of reference, what is a preparatory method that would BEST address upper-body dressing?

Instruct the client in hand-strengthening exercises using therapy putty. -This addresses hand weakness and its effects on fine motor tasks of dressing. The biomechanical frame of reference is a common theory used in practice and focuses on restoring or remediating skills to enhance occupational performance. A hand-strengthening program would restore needed ROM and muscle power to adequately perform fine motor tasks.

The caregiver of a client with middle-stage dementia requests assistance from the COTA®. The caregiver wants to ease the client's morning personal care routine. What is the BEST recommendation related to the bathroom environment that the COTA® can provide to the caregiver?

Labeling physical structures with symbols, such as arrows for direction, is helpful to people with dementia.

Allen's Cognitive Levels

Level 6 (planned actions): independent; disability absent Level 5 (exploratory actions): caregiver standby/supervision is needed for cognitive assist; client learns through visible, concrete & meaningful stimuli; external cueing can be used; explores effects of sefl-initiated motor actions;uses overt trial-and-error problem solving; can follow 4-5 step processes adn learn new concrete ideas; client HAS DIFFICULITY with judgement, reasoning,planning, semantic memory, and episodic memory Level 4(goal directed): requires minimum cognitive assist; attention is directed to visual and tactile cues;client i able to understand cause and effect; no longer problem solve; can follow 2-3 step acitivty; activities shoudl be simple, concrete and supportive of desired roles; task set up for bathing/grooming required; client needs protection against safety hazards and wandering; NEEDS 24hr supervision Level 3 (manual actions): client requires moderate cognitive assistance; attention should be directed to tactile cues; goals are NOT related to outcomes; 1 step familiar and action oriented activities; cannot learn new behaviors; needs routine; avoid sensory overload; able to wash hands, face and brush teeth; NEEDS 24hr supervision Level 2 (postural actions): client requires max cognitive assistance; thinking is highly disorganized; attention involves internal cues; motor actions are one step and involve gross motor patterns; ADLs can be accomplished by imitating the caregiver; able to eat finger foods; should be taken to restroom every 2 hours; REQUIRES round the clock supervision Level 1 (automatic actions): requires total cognitive assistance; attention is limited to subliminal internal cues; motor actions are in response to one-word directions; needs monitoring to ensure adequate nutrition; needs assistance wiht ambulation and transfers; needs passive, active or assistive ROM for prevention of bed sores, osteoporosis, infections, and contractures; dependent for all ADLs; constant 24 hour supervision THIS LEVEL IS TERMINAl

A COTA® is working on bed mobility with a client with Guillain-Barré syndrome (GBS) 2 weeks into the plateau phase. The client reports dizziness on performing supine to sit at the edge of the bed and begins to lie back down. What is MOST appropriate for the COTA® to do next?

People with GBS are at risk for autonomic nervous system dysfunction such as postural hypotension or experiencing a significant drop in systolic blood pressure on moving from a horizontal to an upright position. -Common among people who endure a prolonged time in bed, the change in position causes blood to rush to the lower extremities, resulting in feelings of lightheadedness or dizziness. -The best option is to slowly and carefully assist the client back to supine, monitor blood pressure, position the client in Trendelenberg (lower the head of the bed and raise the lower extremities), recheck blood pressure, and then alert nursing and the OTR®, leaving the call bell in reach.

A client with multiple sclerosis (MS) was referred to occupational therapy because of impaired sensation in both upper extremities. After the COTA®'s service competency was established, the OTR® asked the COTA® to examine the client's stereognosis skills. Which action should the COTA® instruct the client to do after closing the eyes?

People with MS may experience sensory deficits that affect perceptual skills such as stereognosis.

A client with multiple sclerosis (MS) experiences ataxic movements when performing fine motor self-care tasks. During treatment addressing oral hygiene, what should the COTA® FIRST do?

Proximal support of the trunk, shoulder, and elbow may help increase distal control of the hands and fingers. This client may be positioned to lean against a table and prop the elbows on it, which may provide enough support to allow for improved control of the hands while performing oral hygiene

To facilitate participation in familiar daily living tasks by clients with dementia, what would be an appropriate INITIAL stage of intervention?

Task simplification is a primary intervention used with clients with dementia to maintain independence in daily living tasks

A patient has multiple sclerosis and was admitted to a rehabilitation facility due to a recent decline in function. The patient now requires a wheelchair for outdoor mobility but still uses a cane to walk indoors. The patient completes BADLs independently using assistive devices. What is MOST IMPORTANT for the COTA® to recommend as part of the discharge planning process for this patient?

The client has had a change in function and now requires wheelchair transfers for some aspects of mobility; caregivers need training for safe and proper transfers.

Why might a client with early-stage dementia appear less spontaneous when performing daily routines

The client may be aware of memory loss at this stage and compensate by becoming rigid in routines so that the client still appears to others to have intact memory skills.

A client with Alzheimer's disease (AD) perseverates on having to pick up children from daycare. At which stage of the disease process is this client likely at?

The middle stage of AD is characterized by clients' thinking that they are back in an earlier stage of life.

What is the most important safety recommendation for clients with middle-stage Alzheimer's disease (AD)?

The most important safety issue would be leaving a client with AD alone, because the client might become lost or confused, even in familiar environments.

A client will initiate dressing at the appropriate time of the day but does not choose clothing appropriate to the day, temperature, or season. The client is able to don clothing slowly but has difficulty with fasteners or fails to see errors in the back (i.e., not tucking in the shirt). At what Allen Cognitive Level is this client?

The question describes typical dressing behaviors of clients at Mode 4.0; a client would attend to visible sensory cues and ignore what is not in plain sight (e.g., not tucking in the back of the shirt).

A COTA® working in an acute care setting is treating a client in the onset stage of Guillain-Barré syndrome (GBS) who requires total assistance for most tasks. At this stage, what should be the intervention's focus?

The symptoms of GBS in the acute inflammatory stage—which include edema, muscle weakness or paralysis, sensory loss, bladder incontinence, and pain—increase a client's risk for skin breakdown, especially a client who is totally dependent for most tasks. This client is likely not able to reposition him- or herself or independently clean up incontinence issues. At this stage, focusing on preventing secondary complications such as skin breakdown and decreasing anxiety by having items such as a call bell, telephone, communication devices, and fresh water in easy reach will be paramount.

A client presents with decreased awareness of cognitive deficits. What is the most effective strategy for a COTA® to implement to intervene with this cognitive impairment?

Use of self-evaluation or self-reflection before or after a task are the most effective strategies for decreased awareness.

A client with multiple sclerosis (MS) presents with balance deficits and impaired lower-body ADL resulting from increased spasticity in both lower extremities. The OTR® asked the COTA® to promote safety during bathing tasks, What recommendation should the COTA® FIRST make to the client?

Using a shower chair addresses both the balance deficits and the spasticity that interfere with lower-body ADLs. By sitting down to wash, the client reduces the risk of falls, and flexed hips may lessen spasticity in the lower extremities.

A COTA® is asked to treat a client who has early-stage Huntington's disease (HD) at the client's home. The COTA® begins by asking the client basic questions. What should the COTA® remember about communicating with clients who have HD?

With a client with early-stage HD, it is important to use close-ended questions that require yes-no responses or use a list of choices to prevent frustration associated with word retrieval problems.

Guillain-Barre Syndrome

an inflamatory disease that causes demylenination of axons in peripheral nerves.

Multiple Sclerosis

chronic, often progressive demyelinating disease of the central nervous system -demyelination produces scar tissue or plaque (sclerosis) on teh myelin sheath of the nerve fibers that interferes with the axons' ability to conduct impulses -result= impaired nerve conduction and inflammation, whcihch causes neurological dysfuntion

Huntington's Disease

hereditary neurlogical disorder that leads to severe physical and mental disabilites; over time it causes progressive loss of nerve cells in the brain, affecting movement, cognition, emotions, and behavior

Parkinsons Disease

is a progressive, variable condition that occurs most frequently in later adulthood with a mean of 55-60yo -major degenerative changes occur in the basal ganglia (the gray matter that contribites to complx moveoments)