Therapy Ed NBCOT

Vendor/supplier

the entity that supplies services

Delusions

-False beliefs about external reality without an appropriate stimulus that cannot be explained by the individual's intelligence or cultural background

Medical management for movement disorders

-Is limited in many cases -Pharmacologic intervention may be able to dampen effects of the movement disorders -Agents utilized for this population include paroparnolol, clonazeoam, clonidine, and anticholinergic agents depending upon symptomatology

arterial ulcers

results from damage to the arteries due to lack of blood flow to tissue

Posterior deltoid innervated by the axillary nerve

§ Origin: spine of scapula § Insertion: deltoid tuberosity

Inpatient rehabilitation

(Rehabilitation for Immunological System Disorders) -Evaluation and restoration of functional abilities, 1. BADL 2. IADL 3. Energy conservation and work simplification 4. Use of the Pizzi Assessment of Productive Living for Adults with HIV (PAPL) for persons with HIV -restoration of activity/exercise tolerance, -achievement and maintenance of quality of life, -role readjustment intervention, -planning to return to community and work participation

Interventions for activity-level problems

(Rehabilitation for Immunological System Disorders) -Self-care 1. adaptations and training to do self-care tasks with greatest ease while conserving energy -Work 1. work capacity evaluations 2. modifications to worksite to allow participation in component tasks and activities 3. counseling and intervention for transition to disability status when work is no longer possible -Leisure/sports 1. modify specific tasks and activities (to protect body parts involved in scleroderma changes) 2. Evaluate interests and skills to introduce new leisure or sport activities of interest to the person to transition to less physically demanding tasks as a disease progresses -Rest and sleep 1. monitor and intervene to maximize the ability to be well positioned during rest and sleep 2. monitor rest and sleep habits and patterns and intervene when strategies are needed to relax and unwind or to schedule time and opportunity for relaxation

Home care

(Rehabilitation for Immunological System Disorders) -Use of collaborative assessment (Canadian Occupational Performance Measure [COPM]) to set client goals -evaluation and restoration of functional abilities for occupational performance -restoration of activity/exercise tolerance -community mobility

Sympathetic control of heart

(adrenergic) cardioacceleratory center, causes and increase in the rate and force of myocardial contraction and myocardial metabolism causes coronary artery vasodilation -gradual increase in heart rate is expected during active engagement in exercise or other activities

Ex Post Facto

(after the fact) research, because variables may be studies after their occurrence (post-diagnosis adjustment)

Left sided heart failure

(congestive heart failure) -blood is not adequately pumped into systemic circulation 1. characterized by pulmonary congestion, edema, and low cardiac output due to backup of blood from left ventricle (LV) to the left atrium (LA) and lungs 2. Occurs with insult to the left ventricle form myocardial disease, excessive workload of the ehart (hypertension, valvular disease, or congenital defects), cardiac arrhythmias or heart damage

Basic life support and cardiopulmonary resuscitation (CPR)

(if a person appears to be experiencing cardiac arrest [as evident by a sudden loss of responsiveness and no normal breathing], this is a medical emergency and the OT must call 911 immediately and implement and maintain CPR until emergency personnel arrive) 1. current CPR guidelines -compressions come first then focus on airways and breathing (CAB). only exception is newborn babies -no more looking, listening, feeling -push a little harder for adult CPR at least 2 inches deep on chest -push a little faster: about 100 compression/minute -hands-only CPR for untrained lay rescuers -do not stop pushing, no interruptions

Type 1 diabetes

(insulin dependent) 1. Autoimmune 2. genetic 3. environmental factors

Early mobilization programs for flexor tendons - Kleinert 4-7 weeks

(intermediate phase): continue dorsal block splint but adjust the wrist to neutral. Place/hold exercise and differential flexor tendon gliding exercises. Scar management

Type 2 diabetes

(non-insulin dependent) 1. older age 2. obesity 3. family history 4. prior history of gestational diabetes 5. impaired glucose diabetes 6. physical inactivity 7. race/ethnicity

Unstable Angina Pectoris

(preinfarction, crescendo angina), coronary insufficiency at rest without any precipitating factors or exertion, pain is difficult to control (if chest pain increases in severity, frequency and duration, there is an increased risk for myocardial infarction or sudden death (lethal arrhythmia)

complex regional pain syndrome type I

(reflex sympathetic dystrophy [RDS]): pain maintained by efferent activity of sympathetic nervous system 1. characterized by abnormal burning pain (causalgia), hypersensitivity to light touch, and sympathetic hyper-functions (coldness, sweating, etc) 2. Usually associated with traumatic injury

Reflexive stage

(sensorimotor period, ages birth to 2 years- Jean Piaget hierarchical development of cognition) -schemes begin in response to reflexes (1 month)

Inventions of new means through mental combinations

(sensorimotor period, ages birth to 2 years- Jean Piaget hierarchical development of cognition) -the child demonstrates insight and purposeful tool use, and explores insight problem-solving options. The ability to represent concepts without direct manipulation emerges (18 months to 2 years)

Secondary circular reactions

(sensorimotor period, ages birth to 2 years- Jean Piaget hierarchical development of cognition) -voluntary movement patterns emerge due to coordination of vision and hand function and an early awareness of cause and effect develops (5-8 months)

Problem solving skills 36- 48 months

- Child can build a tower of nine cubes, demonstrating balance and coordination - Child can organize objects by size and build a structure from a mental image

Problem solving skills 48-60 months

- Child can build involved structures combining various planes, along with symmetrical designs - Child is able to utilize spatial awareness, cause-and-effect, and mental images in problem solving

Problem solving skills 21-24 months

- Child recognizes operations of several mechanisms - Child matches circles, squares, triangles, and manipulates objects into small openings (shape sorters)

Neurological system changes and adaptations in the older adult - Clinical implications

- Effects on movement 1. overall speed and coordination are decreased, increased difficulties with fine motor control 2. Slowed recruitment of motonuerons contributes to loss of strength 3. both reaction time and movement time are increased 4. older adults are affected by the speed/accuracy trade-off * the simpler the movement the less is the change *more complicated movements require more preparation, leading to longer reaction and movement times *faster movements decreased accuracy, increase errors 5. Older adults typically shift in motor control processing form open to closed loop (demonstrate increased reliance on visual feedback for movement) -General lowing of neural processing: learning and memory may be affected -problems in homeostatic regulation: stressors (heat, cold, excess exercise) can be harmful, even life threatening

Signs of patient/client abuse

- Frequent unexplained injuries or complaints of pain w/out obvious injury - Burns or bruises, - Passive, withdrawn, and emotionless behavior - Lack of reaction to pain - STDs or injury to the genital area - Unexplained difficulty sitting or walking - Fear of being alone with caretakers - Obvious malnutrition - Lack of personal cleanliness - Habitually dressed in torn or dirty clothes - Obvious fatigue and listlessness - In need of medical or dental care - Left unattended for long periods - Bedsores and skin lesions

Strategies to slow, reverse and/or compensate for age-related cognitive changes

- Improve health 1. Correct medical problems: imbalances between oxygen supply and demand to CNS (cardiovascular disease, hypertension, diabetes, and hypothyroidism) 2. Assess needed pharmacological changes: drug reevaluation, decrease use of multiple drugs, monitor closely for drug toxicity 3. reduce chronic use of tobacco and alcohol 4. correct nutritional deficiencies -Increase physical activity -Increase mental activity 1. Keep mentally engage "use it or lose it" (chess, crossword puzzles, book discussion groups, reading to children) 2. Maintain an engage lifestyle: socially active (clubs, travel, work, volunteerism), allow for personal choice in activity -Provide multiple sensory cues to compensate for decreased sensory processing and sensory losses and to maximize learning (provide visual demonstrations, written instructions and verbal cues) -Provide stimulating environment, avoid environmental dislocation (hospitalization or institutionalization may produce disorientation and agitation in some older adults) -reduce stress, provide counseling and family support

Erb's palsy

- a paralysis of the upper brachial plexus including the 5th and 6th cervical nerves, C7 may also be involved in some cases 1. muscles most often paralyzed include the supraspinatus and infraspinatus as well as the deltoid, biceps, brachialis, and subscapularis 2. the arm cannot be raise, elbow flexion is weakened and weakness in retraction and protraction of scapular may be noted 3. the arm grossly presents with the arm straight and wrist fully bent (waiters tip position) 4. After the age of 6 months, contractures may begin to develop (adduction and internal rotation contractures) -supination deformity of the forearm may also develop from the imbalance between the supinator and the paralyzed pronator muscles 5. positioning and ROM exercises are necessary to retain external rotation, abduction and flexion at the shoulder as well as distal flexibility

Sexual Abuse Signs and Symptoms in Elders

- an older adults report of sexual assault or rape -bruises around the breast or genital areas -unexplained venereal disease or genital infection -unexplained vaginal or anal bleeding -torn, stained or bloody underclothing

psychiatric rehabilitation evaluation

- assessments are based on real-life situations that will provide accurate data specific to an individual, environment and activity at a moment in time -evaluation of readiness for change is an essential component of the evaluation process 1. foremost, individuals with a mental disability have to make a conscious effort to address the effects their illness on their lives 2, the effort includes acknowledging one has a mental disability and overcoming stigma or other barriers that may hinder recovery

Right heart failure

- blood is not adequately returned from the systemic circulation to the heart; d/t failure of right ventricle, increased pulmonary artery pressures with: 1. peripheral edema: weight gain, dependent edema, venous stasis 2. Nausea, anorexia 3. change in heart sounds -characterized by increased pressure load on the right ventricle with higher pulmonary vascular pressures -occurs with insult to the right ventricle from LV failure, mitral valve disease of chronic lung disease; produces hallmark signs of jugular vein distension and periperhal edema

Scleroderma

- rheumatic, connective tissue disease associated with impaired immune response -Etiology: unknown a. Three main components 1. vascular (Raynaud's phenomenon, pulmonary hypertension, decreased esophageal motility) 2. Fibrotic *scar tissue resulting from excess collagen (protein) causing thickness of skin and burning sensation in the skin) *Fibrosis of the lungs causing restrictive lung disease 3. Autoimmunity b. Two basic types of the disease 1. limited *skin involvement (with a good prognosis) *Linear scleroderma (bands of thicker skin, with a good prognosis 2. Systemic *systemic sclerosis of internal organs which is life threatening *CREST Syndrome (with a good prognosis) +Calcinosis, or calcium in the skin +Raynaud's phenomenon +Esophageal dysfunction +Sclerodactyly of fingers and toes +Telangiectasis or red spots covering the hands, feet, forearms, face and hips *General morphea -Risk factors 1. genetic 2. environment -Prevention 1. control symptoms of Raynaud's phenomenon 2. Have screening echocardiograms to rule out pulmonary hypertension 3. Smoking cessation

Spinal Nerves

-31 pairs of nerves arising from the spinal cord; spinal nerves are divided into groups (8 cervical, 12 thoraces, 5 lumbar, 5 sacral/coccygeal) and correspond to vertebral segments; each has a ventral root and a dorsal root

Gambling disorder

-4 or more of the following gambling behaviors must be true for at least 12 months 1. thoughts of gambling occupy the mind most of the day 2. the individual has made multiple unsuccessful attempts to decrease gambling behaviors and is usually restless, irritable, unhappy or preoccupied with gambling due to efforts to control behaviors 3. Gambling behaviors increase in the presence of stress 4. the individual is in serious financial trouble due to betting larger amounts of money to experience desired effect -the individual may ask for or rely on money from close friends or family members to relieve financial stress cause by gambling behavior 5. excessive gambling behavior continues on subsequent days after losing money to attempt to break even or chase losses 6. the individual lies to downplay the frequency or effects of gambling which causes marked stress in vocational, educational and personal social areas of functioning 7. Gambling behavior must be problematic and recurrent, causing clinically significant impairment that is not better explained by mania

Budget

-A budget financially projects for a specified time period the costs of managing a program and the anticipated revenue from service provision -Budget periods vary from multiyear (5-10 years) for capital expenses to annual for personal and supply expenses -Budget revisions may be needed as programs or services change due to ongoing program evaluation

Disinhibited Social engagement disorder diagnostic criteria

-A child initiates active interaction with unfamiliar adults, while displaying at least 2 of the following 1. little reservation when approaching unfamiliar adults 2. overly familiar use of words or actions despite novelty and unfamiliarity of relationship 3. the child is willing to leave with an unfamiliar adult without much of any hesitation, consideration or checking back with the primary caregiver -the childs upbringing is characterized by patterns of social neglect, deprivation, or constant changing of primary caregivers, resulting in insufficient care for forming stable relationships with adults and caregivers -the child is a minimum of a 9 month old developmental age

Management by Objectives (MBO)

-A complete system of management based upon a core set of goals to be accomplished by a program 1. Mission and goals are established 2. Measurable objective are quantified 3. Specific time frame for accomplishment of objectives are established 4. Staff training needs and deterrents to progress are identified 5. Program evaluation is instituted

Measures of central tendency

-A determination of average or typical scores 1. Mean: the arithmetic average of all scores (the most frequently used measure of central tendency for interval or ratio data) 2. Median: the midpoint, 50% or scores are above the median and 50% of scores are below; appropriate for ordinal data 3. Mode: the most frequently occurring score, appropriate for nominal data

Measures of variability

-A determination of the spread of a group of scores 1. Range: the difference between the highest score and the lowest score 2. Standard deviation (SD): a determination of variability of scores (difference) from the mean. (the most frequently used measure of variability, appropriate with interval or ratio data) 3. Normal distribution: a symmetrical bell-shaped curve indicting the distribution of scores, the mean, median and mode are similar -half the scores are above the mean and half the scores are below the mean -most scores are near the mean, approximately 68% of scores fall within +1 or -1 SD of the mean -frequency of scores decreases further from the mean -distribution may be skewed (not symmetrical) rather than normal: scores are extreme, clustered at one end or the other, the mean, median, mode are different 4.Percentiles and quartiles: describe a scores position within the distribution, relative to all other scores -Percentiles: data is divided in 100 equal parts, position of score is determined -Quartiles: data is divided into 4 equal parts, and position of score is placed accordingly

Delirium

-A disturbance in consciousness (awareness of environment) with a decreased ability to attend -There is a change from previous cognition and perception -It covers a short period of time (hours to days) and tends to fluctuate -There are many causes 1. brain dysfunction 2. medication 3. endocrine disorders 4. cardiac disorders 5. fever 6. liver function disorders

Ataxic cerebral palsy

-A lesion in the cerebellum results in hypotonia and ataxic movements. Characterized by a lack of stability so coactivation is difficult, resulting in more primitive patterns of movement. classification is according to level of severity 1. previously classified as mild, moderate and severe 2. current gross motor classification: the Gross Motor Functional Classification System (GMFCS) which delineates 5 levels of functional motor performance for children aged 6-12 years 3. Current manual abilities classification: the Manual Ability Classification System (MACS) for children with cerebral palsy which describes 5 levels of handling objects placed within easy reach and everyday function tasks

Physical therapist

-A licensed professional who is a graduate of an accredited physical therapy education program at a baccalaureate, graduate or doctoral level -Evaluates clients physical motor skills -Develops plan of care, and administers or supervises treatment to develop, improve and/or maintain clients physical motor skills, to alleviate pain, and to correct or minimize physical deformity -Delegates portions of treatment program to supportive personnel, PTA -Supervises and directs supportive staff (assistants, aides) in designated tasks -Reevaluates and adjusts plan of care as appropriate -Performs and documents final evaluation and establishes discharge and follow-up plans

Social worker

-A licensed/registered professional who is a graduate of an accredited educational social worker program at a baccalaureate level (BSW) or at a graduate level (MSW) -Upon passing a national certification exam a social worker is eligible to used the credentials Certified social worker (CSW) (instates with licensure requirements a social worker may have the credential of licensed clinical social worker (LCSW) -Assesses clients social history and psychosocial functioning via clinical interviews and structured assessments -Assists clients families and caregivers with accessing social support services (home care, support groups) and obtaining needed reimbursement/funding (medicaid, food stamps) through the completion of required application processes and through active advocacy -Provides individual, couple and family counseling -Serves as a primary care manager, enabling individuals to function optimally and maintain quality of life -Provides crisis intervention and recommendations for additional services -Contributes to discharge plan and completes tasks needed for implementation of discharge orders (application to a SNF) -Supervises and is assisted by social work assistants

Psychiatrist

-A physician who specializes in mental health and psychiatric rehabilitation -Leads the rehabilitation team and works directly with occupational therapists, psychologists, social workers, and others to maximize rehabilitation outcomes for persons with psychiatric disorders -Diagnoses and medically treats individuals with psychiatric disorders -Responsible for ordering transfers to long-term care settings and for determining competence and the need for involuntary treatment

Physiatrist

-A physician who specializes in physical medicine and rehabilitation and is certified by the American board of Physical Medicine and Rehabilitation 0Leads the rehabilitation team and works directly with occupational, speech, and physical therapists and others to maximize rehabilitation outcomes for persons with physical disorders -Diagnoses and medically treats individuals with musculoskeletal, neurological, cardiovascular, pulmonary and/or other body systems disorders.

Intervention plan documentation

-A prioritized problem list -Goals related to problem list and indicating potential for function and improvement The structure of a goal statement 1. the person who will exhibit the skill, almost always written as the "the patient/client will". However, the caregiver, family member and/or teacher may be the focus of the goal 2. The desired functional behavior that is to be demonstrated or increased as the outcome of intervention 3. The underlying factors (performance component deficits) that must be remediated to achieve functional outcomes 4. The circumstances under which the behavior must be performed or the conditions necessary for the behavior (independent, with cueing, with assistance) 5. The degree at which the behavior is exhibited (three out of four times, minimum number of repetitions)

Special educator/teacher

-A professional teacher certified to provide education to children with special needs 1. visual and/or hearing impairments 2. emotional and psychosocial disabilities 3. physical and sensorimotor disabilities 4. developmental disabilities 5. learning and cognitive disabilities -Assesses and monitors student learning, plans and implements instructional activities and addresses the special developmental and educational needs of each student. -Advanced training in instructional methods for teaching children with special needs to develop to their fullest educational potential is required -Additional training in teaching children with multiple disabilities is often needed -May be assisted by teacher aides who provide direct care and hands on support to students in the classroom (collaboration with aides is required for effective follow-through of OT programming in school settings)

Recreational therapists/therapeutic recreation specialist

-A professional who is a graduate of a baccalaureate or graduate-level recreation therapy education program -Conducts individual and/or group interventions to develop leisure interests and skills, to facilitate community social and recreational integration to manage stress and symptoms and to adjust to disability -May be called an activities therapist but the two positions are not synonymous. Activities therapists may only have on-the-job training

Speech0language pathologist (SLP) or speech therapist (ST)

-A professional who is a graduate of an accredited educational program in speech language pathology -Assesses ,language and speech abilities and impairments -Develops and conducts intervention programs to restore, improve, augment the communication of persons with speech and/or language impairments -May receive advanced training and specialized in oral-motor functioning (the evaluation and treatment of dysphagia)

Optometrist/vision specialist

-A professional who is a graduate of an educational program in optometry -Examines the eye to determine visual acuity, level of visual impairments and damage to or disease in the visual system -Prescribe assistive devices (corrective lenses) and recommends other appropriate treatment (visual-motor training) -Optometrists can refer individuals to outpatient occupational therapy

Vocational rehabilitation counselor

-A professional who is a graduate of an educational program in vocational rehabilitation -If certified, the counselor is able to sued the credential of Certified Rehabilitation Counselor (CRC) -Evaluates prevocational skills and vocational interests and abilities via standardized and non-standardized assessments to determine an individuals employability -Provides counseling to maximize the individuals vocational potential -refers individual to appropriate vocational programming and/or job placement -Serves as liaison between the individual and state educational and vocational departments for persons with disabilities to obtain funding for needed services

Overview of team roles and principles of collaboration

-A team is a group of equally important individuals with common interests collaborating to develop shared goals and build trusting relationships to achieve these shared goals -Members of the team include the service recipient, their family, significant others and/or caregivers; healthcare professionals and the reimburses gatekeepers (service recipients are typically called patients in medical model setting (hospitals), clients in community-based settings (outpatient clinics), consumers in recovery-orientated programs (clubhouses) and residents in residential settings (group homes, SNFs) -The service recipient, family, significant other, and/or caregiver role on the team has become increasingly important. collaboration with these individuals is even mandated by law (Omnibus budget reconciliation act [OBRA], Individuals with Disabilities Education Act [IDEA])

Respiratory therapy technician, certified

-A technically trained professional with an associates degree who has passed a national certification exam -Administers respiratory therapy as prescribed and supervised by a physician -Performs pulmonary function tests and intervenes through oxygen delivery, aerosols and nebulizers

Low vision

-A visual impairment that standard eyeglasses, contact lenses, medication or surgery cannot correct 1. person with low vision have some usable vision, but impairments are severe enough to make it difficult to perform everyday activities 2. 4 chronic, progressing eye diseases are the main conditions contributing to the development of low vision (age related macular degeneration (AMD), diabetic retinopathy, glaucoma, cataracts

Intrinsic muscles innervated by the median nerve

-Abductor pollicis brevis -Opponens pollicis -Flexor pollicis brevis: superficial head -Lumbricals (radial side)

Cognitive skills (mosey)

-Ability to perceive, represent and organize sensory information to think and problem-solve 1. Utilization of inborn behavioral patterns for environmental interaction (0-1 month) 2. Interrelation of visual, manual, auditory, and oral responses (1-4 months) 3. Early exploration of the environment and interest in outcomes of actions: remember action responses, believes that own actions cause responses and has an awareness of the relation of these actions and events (4-9 months) 4. Utilization of deliberate actions to achieve a goal: object permanence begins, anticipation of familiar events, imitation, interest in sizes/shapes, and perception of other objects as partially causal (9-12 months) 5. Utilization of a trial and error approach to problem-solving : tool use, begins to realize that alternate routes can be used, remembers that order of a simple sequence and realizes that others can cause events to happen (12-18 months) 6. Formulation of mental pictures: pretends, early cause and effect, manipulates objects in space, has a clearer understanding that others can manipulate the environment (18 months-2 years) 7. Representation of objects in terms of felt experiences: understands that there are consequences to actions, that others cannot read your ming and recognizes that events have causes (2-5 years) 8. Representation of objects by name: begins to understand that other people may have different opinions (6-7 years) 9. Comprehensions that different labels can be used for the same object, use of formal logic and speculation (11-13 years)

Symptoms of CVA

-Abrupt onset of unilateral neurological signs (weakness, vision loss, sensory changes, etc) -Symptoms progress over several hours to 2 days -Specific symptoms are determined by the site of the infarct and the involved artery -Middle cerebral artery (MCA) stroke results in contralateral hemiplegia, hemianesthesia, homonymous hemianopsia, aphasia, and/or apraxia -Internal carotid artery (ICA) stroke results in symptoms similar to those associated with MCA CVA -Anterior cerebral artery (ACA) stroke results in contralateral hemiplegia, grasp reflex, incontinence, confusion, apathy, and/or mutism -Posterior cerebral artery (PCA) stroke results in homonymous hemianopsia, thalamic pain, hemi-sensory loss, and/or alexia -Vertebrobasilar system results in pseudobulbar signs (dysarthria, dysphagia, emotional instability), tetraplegia -Hemispheric specialization information is based on lateralization in most indivduals (hemispheric asymmetry and functional localization can vary in individuals)

Early intervention programs (Community-based practice)

-Acceptance criteria for an early intervention evaluation are base on at risk status of the infant/child or toddler who is under the age of 3. 1. birth complications 2. suspected delays in development 3. failure to thrive 4. maternal substance abuse during pregnancy 5. birth to an adolescent teen month 6. established disability diagnosis -Acceptance criteria for early intervention services are based on the following criteria 1. the extent of the developmental delay (typically a 33% delay in one area of development or a 25% delay in two areas) 2. an established diagnosis/disability -Length of service provision 1. if the infant/child qualified for services, an infant family service plan (IFSP) is completed by the service coordinator after a review of all assessments and in collaboration with the family and early intervention team 2. 6 month reviews are submitted by all professionals to determine if services should continue OT evaluation 1. assessment of 5 developmental areas -cognitive -physical -communication -social-emotional -adaptive 2. determination of the effects of current development on the occupational areas of play and activities of daily living 3. evaluations need to be written in a strength oriented manner 4. functional goals must be written in family friendly terms and include levels of functioning, unique needs and recommended services OT intervention process 1. development of cognitive/process, psychosocial/communication/interaction, and sensorimotor skills 2. development of play and activities of daily living skills 3. provision of family education 4. provisions of advocacy and advocacy training

Home health care (Community-based practice)

-Acceptance criteria for home health services 1. presence of a medical or psychiatric condition that is not serious enough to warrant hospitalization or for a condition that has sufficiently stabilized to enable the individual to be discharged from a hospitals but that still has remaining symptoms requiring active treatment 2. reimbursers can have strict and variable criteria for qualifying for home health care. -Treatment is usually provided in 60 minute sessions once a day for up to 5 days a week as determined by insurance coverage -LOS is determined by diagnosis, presenting symptoms, response to treatment, insurance coverage, or ability to pay for a fee for service -OT evaluation is focused on the individuals client factors and functional skills and deficits in their performance skills and patterns, areas of occupation, and the occupational roles that are required in the current and expected environments -OT intervention focus 1. active engagement of the client, family and caregivers in the treatment planning and other places of accommodation, implementation and reevaluation processes 2. functional improvement in areas of occupation and occupational role functioning within the home 3. remediation of underlying performance skill deficits and compensation for client factors that affect functional performance within the home 4. education of the family, caregivers, and/or home health aides to provide appropriate care and/or assistance as needed 5. environmental modifications and activity adaptations that maintain optimal functioning and improve quality of life 6. increasing ability to resume occupational roles outside of the home 7. Prevention of hospitalization and avoidance or delay of residential institutional placement

Hospice (Community-based practice)

-Acceptance criteria for hospice services 1. terminal illness that has a life expectance of 6 months or less -Services are most often provided in the home with the type and quantity of services determined by the needs of the individual, their family, significant others and caregivers 1. hospice services may also be provided in an independent facility or in a special unit of a SNF or a hospital -LOS is determined by the persons terminal outcome -OT evaluation is focused on determining the individuals occupational functioning and their physical, psychosocial, spiritual and environmental needs that are most important to them -OT intervention focus 1. maintenance of the individuals control over their life 2. facilitation of engagement in meaningful occupations and purposeful activities that are consistent with the individuals roles, values, choices, interests, aspirations, abilities and hopes and that contribute to a satisfactory quality of life 3. reduction or removal of distressing symptoms and pain 4. environmental modifications and activity adaptations that maintain optimal functioning and improve quality of life 5. caregivers and family education and support to maintain optimal functioning and improve quality of life for all

Vocational Program (Community-based practice)

-Acceptance is for the development of specific vocational skills 1. Person has the prerequisite abilities to work (goos task skills and work habits) but requires training for a specific job and/or ongoing structure, support and/or supervision to maintain employment 2. Person has to develop their work capacities to a level acceptable for competitive employment (strength and endurance) -LOS is determined by agency's funding and attainment of goals 1. In rehabilitation workshops (formerly called sheltered workshops) and supportive employment programs, discharge is not always a goal (maintenance of the person in these structures work environments can be the desired objective for some individuals while other will be discharged to other programs or to work) 2. Transitional employment program (TEPs) are generally time limited (3 to 6 months) with discharge to competitive employment, supportive employment or rehabilitation workshops 3. Employee assistance programs (EAPs) provide ongoing support, intervention and referrals as needed to a company's employees to enable these individuals to maintain this employment -OT evaluation is focused on the individuals functional skills and deficits related to work in their current and expected vocational environment -OT intervention focus 1. Remediation of underlying performance skill deficits and compensation for client factors that affect the work performance area 2. Development of general work abilities and specific job skills 3. Consultation to and/or supervision of vocational direct care staff 4. Identification and implementation of reasonable accommodations in accordance with ADA 5. Referral to state offices of vocational and educational services (One-stop centers) for persons with disabilities for further evaluation, education and training

Self-Care Intervention

-Activities of daily living intervention -Determine whether the self-care activity should be modified to enable individual performance, performance with external assistance, or eliminated -Activities that are valued, meaningful, and enjoyable to the person and related to desired role performance should be modified for individual performance, with appropriate supports provided as needed (eg. brushing one's hair using an adapted brush to maintain one's appearance at school/work) -Activities that are difficult to perform and/or are not enjoyable should be eliminated or performed with the assistance of others (eg. dressing requires a great deal of exertion that can exhaust an individual; fasteners can be modified or eliminated, assistance can facilitate task) -Provide adaptive equipment to compensate for functional impairments during self-care activity performance -Recognize the multiple dimensions of a person with a disability and the complexities of many disorders. For example, Friedrich's ataxia is characterized by tremors that may indicate the need for weighted utensils, but muscle strength is also limited so utensils may be too heavy for functional use -Train in safe use of adaptive equipment and assistive technology -Practice to attain proficiency in activity performance at appropriate times and in real environments (eg. brush teeth in the bathroom in the morning) -Provide cues and assistance as needed (verbal reminders and prompts; nonverbal gestures, written directions, physical prompt to initiate; physical hand-over-hand assistance through complete activity movement; visual supervision to ensure safety with minimal or no verbal or nonverbal cues) -Use thematic and topical groups to develop needed skills (eg. grooming group, medications management) -Teach principles and methods of energy conservation, work simplification, joint protection, and proper body mechanics -Educate and train caregivers to provide needed cues, physical assistance, and/or supervision: teach organizational strategies (eg. place clothing in proper sequence for dressing); teach activity analysis, gradation, simplification, and adaptation skills (eg. for a person with Alzheimer's disease, provide multiple small meals to decrease the amount of attention required to eat) -Educate the individual with disabilities on personal care attendant training: practice methods for directing self-care in the personally desired and acceptable manner; provide assertiveness and personal advocacy training -Modify the environment to maximize performance and ensure safety

Meningitis (Rehabilitation for lyme disease)

-Acute care: positioning, splinting, supportive care while hospitalized -rehabilitation if there is recovery-related sequelae (neurological impairment, motor impairment, sensory impairment, cognitive impairment or activity of daily living impairment)

Forensic setting (Institutional practice 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 a psychiatric diagnosis has been made 1. Jail: a city or county facility that is the individuals 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 providers inpatient psychiatric care for individuals convicted of a crime and found guilty but mentally ill or not guilty by reason of insanity -LOS is determined by court-ordered directive and criminal sentence -The availability and quality of services vary greatly from none in most jails to extensive in some forensic hospitals -Due to serious gaps in mental health and social services the incarceration rate of persons with mental illness has increased significantly (a homeless person with schizophrenia steals food due to hunger) -OT evaluation and intervention focus 1. determination of individuals 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 their 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 (Community-based practice)

-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 1. residential programs are on a continuum from 24-hour supervised quarter way houses, halfway houses or group homes, to supportive apartments with weekly or biweekly check-in supervision 2. the degree of functional impairment determines the residential level of care needed -LOS for transitional living programs (quarter way and halfway house programs) is determined by agency's funding 1. Long-term and permanent housing options (group homes and supportive apartments) are available and are funded through the individuals social service benefits -OT evaluation is focused on assessment of the individual skills for living in the community and determination fo the social and environmental resources and supports needed to maintain the individual in their current and expected living environments -OT intervention focus 1. consultation to and/or supervision of residential program staff 2. Remediation of underlying performance skill deficits and compensation for client factors that affect independent living skills 3. ADL training, activity adaptation, and environmental modifications to facilitate community living skills 4. Referral to appropriate residential services along the continuum of care as individuals functional level improves 5. Education about ADA the Fair housing act and section 8 housing

Rehabilitation hospitals (Institutional practice settings)

-Admission is for a disability that is medically stable but which has residual functional deficits requiring skilled rehabilitation services -Length of stay (LOS) is determined by presenting deficits and rehabilitation potential: 1) LOS can range from a week to months 2) documentation requirements supporting the need for an extended LOS are dependent upon institutional, state, and third party payer guidelines 3) LOS ends when coverage is expended. The client is then discharged to the appropriate environment (skilled nursing facility; a supportive community residence; home/independent living) -OT evaluation can be extensive and focus on all performance skills and patterns, areas of occupation, and occupational roles that will be required in the expected environment (environmental assessments of planned discharge environment must be completed) -OT intervention focus: 1) functional improvement in performance skills and patterns, areas of occupation, and occupational roles 2) development of compensatory strategies for residual deficits and client factors 3) provision of adaptive equipment and training in use of the equipment to promote independent function 4) modification of the discharge environment, as needed, to enhance function 5) education of the individual, family, and caregivers on abilities, limitations, compensatory techniques, and advocacy skills

Partial hospitalization/day hospital program (Community-based practice)

-Admission is for a medical or psychiatric condition that has been sufficiently stabilized to enable an individual to be discharged home or to a community residence (halfway house or supported apartment) however, the individual still has symptoms remaining which require active treatment -Treatment is up to 5 days per week with multiple interventions scheduled each day -LOS is determined by diagnosis, presenting symptoms and response to treatment 1. LOS can vary from 1 week to 6 months 2. Documentation requirements supporting the need for an extended LOS are dependent on institutional, state and/or third party payers guidelines. 3. Once LOS is extended, discharge is usually a less intensive community day program -OT evaluation is focused on the individuals functional skills and deficits in their performance areas and the occupational roles that are required in their current and expected environments -OT intervention focus 1. functional improvements in areas of occupation and occupational role functioning 2. remediation of underlying performance skill deficits and compensation for client factors that affect functional performance 3. Development of skills for community living and identification of community supports for community participation

Outpatient/ambulatory care

-Admission is for a medical or psychiatric condition that is not serious enough to warrant hospitalization or for a condition that has sufficiently stabilized to enable the individual to be discharged from a hospital but remaining symptoms require active treatment - Treatment is usually provided in short 30 to 60 minute sessions once a day for up to 5 days a week -LOS is determined by diagnosis, presenting symptoms, response to treatment and insurance coverage or ability to pay a fee for service -OT evaluation focused on the individual's client factors and functional assets and deficits in their performance skills and patterns, areas of occupation and their home, work and leisure environments -OT intervention focus 1. Active engagement of the client in the treatment planning, implementation, reevaluation and discharge process 2. remediation of underlying performance skill deficits that affect functional occupational performance 3. Functional improvements in performance areas and occupational roles 4. compensatory strategies for remaining performance skill deficits and client factors 5. consumer, family and caregiver education

Acute care hospitals (Institutional practice settings)

-Admission is for a medical or psychiatric diagnosis that cannot be treated on an outpatient basis 1. Initial onset of a new illness or major health problem 2. Acute exacerbation of a chronic illness 3. In psychiatry, a person may be involuntarily admitted to an acute unit if he/she is considered to be a danger to self or others, or as having a grave disability -Length of stay (LOS) is determined by diagnosis and presenting symptoms 1. LOS can be limited to 1-7 days 2. Longer LOS requires significant documentation to justify need for further hospitalization 3. Ongoing need for acre frequently results in discharge to another setting -OT evaluation process focuses on quick and accurate screening of major difficulties impeding function (eg. cognitive status, home safety skills) -OT intervention focus: 1) stabilization of client's status 2) engagement of the client in the therapeutic relationship and purposeful activities/meaningful occupations so that he/she can see that change is possible, thereby increasing motivation to pursue follow-up 3) discharge planning and after-care referrals 4) family, caregiver, and consumer education -The role of an acute care OT can be a generalist or a specialist (eg. neonatology, burns) (specialized practice roles require advanced knowledge and skills and therefore would not be evaluated on the NBCOT examination)

Subacte care/intermediate-care facilities (ICFs) (Institutional practice settings)

-Admission is for a medical or psychiatric diagnosis that has progressed from an acute stage but has not stabilized sufficiently to be treated on an outpatient basis -LOS is determined by diagnosis and presenting symptoms 1. LOS can range from 5-30 days 2. Longer LOS requires significant documentation to justify need for further hospitalization 3. Ongoing need for intervention or long-term care frequently results in discharge to another setting. -OT evaluation can include more in-depth assessments and more thorough observation of clients functional performance -OT intervention focus 1. functional improvements in performance skills and areas of occupation 2. active engagement of the client in the treatment planning implementation and reevaluation process 3. discharge planning to expected environments -Subacute care and ICFs can be housed in hospitals or SNFs

Skilled nursing facilities (SNFs)/extended care facilities (ECFs) (Institutional practice settings)

-Admission is for a medical or psychiatric diagnosis that is chronic and requires skilled care, but the individuals illness is stable with not acute symptoms -Due to managed care constraints on acute hospital stays, many individuals are being admitted to SNFs for medical care and rehabilitation -LOS can range from one month to the individuals lifetime. Several factors influence LOS 1. the progression of the illness 2. availability of family or community supports 3. insurance coverage -OT evaluation and intervention is guided by Medicare standards 1. for individuals with rehabilitation potential the focus of evaluation and intervention is the same as identified under rehabilitation hospitals 2. For individuals without rehabilitation potential, evaluation, and intervention is more concerned with palliative care and the maintenance of quality of life

Long-term hospitals (Institutional practice settings)

-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

Long-term acute care hospital (LTAC) (Institutional practice settings)

-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

medical management/relevant pharmacology for CF

-Aerosol (mist) -Chest physical therapy to loosen secretions that block lung airways -Vitamin and mineral supplements, enzymes -Antibiotics

Omnibus Budget Reconciliation Act (OBRA)

-Affirmed application of Section 504 of the rehabilitation act of 1973, which prohibits discrimination in federally funded programs to a diversity of services (headstart programs, block grant programs, community development programs) -Provide Medicaid financing for community-based services for people with developmental disabilities when services were demonstrated to be less expensive than institutional care

Interdisciplinary team

-All professional disciplines relevant to the case at hand agree to collaborate for decision-making -Evaluation and intervention are still conducted independently within defined areas of each professions expertise. However, there is greater understanding of each professions perspective -Members are directed toward a common goal and not bound by discipline-specific roles and functions -Members tend to use group process skills effectively (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

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 trained by OTAs/COTAs or OTs to perform specific non-skilled tasks -Tasks performed by OT aides must be supervised by a COTA or occupational therapist (this supervision must be documented) Nonskilled non-client tasks aides -include: routine maintenance and clerical activities (preparation of clinic area for intervention, organizing supplies) Nonskilled client tasks (contact guarding a client during transfers) -Can only be delegated to an OT aide after the occupational therapist has determined that the following conditions have been met. 1. Anticipated result of the delegated task is known 2. The performance of the delegated task is clearly established, predictable and will not require the aide to make any interpretations, adaptations and/or judgement calls 3. the patients situation and the practice environment are stable and will not require the aide to make any interpretations, adaptations and/or judgement calls 4. the patient has previously demonstrated some capabilities in performing the task 5. The aide has been appropriately trained in the competent performance of the task and is able to demonstrate service competency in task performance 6. the aide has received specific instructions on task implementation relevant to the specific patient with whom the aide will be performing the delegated task 7. The aide knows the precautions of the designated task and patient signs and symptoms that could indicate the need to seek assistance from the OTA/COTA or occupational therapist

Functional mobility aids

-Ambulation aids: 1) orthotic devices (sometimes referred to as braces) are used to prevent contractures and provide stability to joints involved (AFO - ankle-foot orthosis; KAFO - knee-ankle-foot orthosis; HKAFO - hip-knee-ankle-foot orthosis) 2) 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) 3) walkers (standard - requires a person to have fair balance and the ability to lift device with upper extremities to advance; hemi-walker - for those who do not have the ability to use two 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 upper extremity weakness or impaired balance; walker bags, trays and baskets to assist in transporting personal items) 4) crutches (standard - situated in person's axillary region to allow ambulation; platform - forearms are neutral and are supported and hands are in neutral position; lofstrand - proximal arm has closure around it instead of support in axillary region) 5) slings provide support to upper extremity which may have fractured, and prevent poor handling of flaccid upper extremity -Wheelchairs and wheelchair training -Scooters provide mobility to those who are not able to ambulate for distances -Sliding boards allow independent transfers from different surfaces for those who are not able to stand-pivot -Upper extremity mobility aids for task performance

Nurse practitioner (NP)

-An advanced-practice nurse who has completed postprofessional graduate education to obtain a masters or a doctoral degree in nursing -NPs are nationally certified in specific areas of speciality (pediatrics, geriatrics, family practice, acute care) -Depending on a states scope of practice act, NPs can serve as primary care providers, prescribe medications and complete referrals for OT and other rehabilitative services -Diagnoses, treats and manages acute and chronic medical conditions

Athletic trainer

-An allied health professional -Assesses athletes' risk for injury, conducts injury prevention programs, and provides treatment and rehabilitation under the supervision of a physician when athletic trauma occurs

Intravascular stents

-An endoprosthesis (pliable wire mesh) implanted postangioplasty to prevent restenosis and occlusion in coronary or peripheral arteries -Often coated in medication to prevent thrombosis

Spina bifida cystica

-An exposed pouch composed of the spinal cord and meninges 1. Spina bifida with meningocele: protrusion of a sac through the spin, containing cerebral spinal fluid and meninges; however does not include the spinal cord 2. Spina bifida with myelomeningocele: protrusion of a sac through the spine, containing cerebral spinal fluids and meninges as well as the spinal cord or nerve roots -most commonly located in the lubmar region; however it can occur at any point along the spinal column

Quasi-experimental design (quantitative methods)

-An independent variable manipulated to determine its effect on a dependent variable but there is a lesser degree of researcher control and/or no randomization 1. Used often in health-care research in which it is unethical to control or withhold treatment 2. used to study intact groups created by events or natural processes

Major marketing tasks

-Analyze the market opportunities 1. conduct a self-audit to assess the strengths and weaknesses of oneself and/or ones organization 2. conduct a consumer analysis to determine consumer needs and desires for services or products 3. Identify potential competitors to clarify areas of service overlap/product similarity and to identify areas that are underserved or unserved 4. Asses the environment to determine political, sociocultural, economic and/or demographic factors that may impact on the products or services -Analyze the market to be targeted for purchase of products or services 1. research selected target markets to determined validity of perceived market needs and wants 2. divide market into segments to identify groups of consumers with similar characteristics, interests and needs that will influence their purchase of products or services -Develop marketing strategies to address the 5 P's (product, price, place, promotion, and position) of a market plan for the OT service -Implementation and evaluate the marketing plan 1. the implementation and evaluation of marketing efforts must always consider ethics (truth in advertising) 2. Undifferentiated marketing 3. Differentiated marketing 4. Concentrated marketing 5. Ongoing assessment and periodic review is needed to determine market plans effectiveness and to modify as needed

Wheelchair Components: additional attachments

-Anti-tippers to prevent wheelchair from tipping backwards or forward (can get caught on doorsills and curbs) -Seatbelts for safety during mobility and functional activities (attach at hip level not waist level; extend across hips and into lap at 45 degree angle) -Harnesses to position a person lacking sufficient trunk control -Arm troughs to position and support a flaccid upper extremity and prevent edema through elevation -Lapboards can serve the same purpose as an arm trough, but are also beneficial as a working "table top" surface -Head supports allow for improved eye contact, improved communication, and feeding assistance, as the head is kept in a neutral position -Mobile arm supports allow for use of an upper extremity with proximal weakness to engage in feeding and other activities -Brake extensions allow a person with limited range in one upper extremity to independently manipulate the wheelchair's brakes -Handrim projections ease independent propulsion (these increase the width of the chair and can decrease mobility through narrow doors and/or narrow spaces) -Hillholder devices allow the wheelchair to move forward but automatically brake when the chair goes backward (useful for individuals unable to ascend a long ramp or hill without rest) -Seating and positioning systems

Depressive episode symptom management

-Antidepressant medications (SSRI= prozac, zoloft, paxil, celexa, and lexapor) *side effects include nausea, headache, sexual dysfunction and insomnia -Tricyclics (side effects include dry mouth, blurred vision, sedation, postural hypotension and other anticholinergic effects) -SNRIs (side effects vary but may include hypertension, anxiety, dizziness, sedation, nervousness, weight gain, nausea, and sweating) -Atypical antidepressants (similar to SSRIs and SNRIs) -Monoamine oxidase inhibitors (MAOIs) (side effects include weight gain, hypotension, insomnia, and liver damage) - the most effective treatment involves antidepressants medication combined with psychotherapy -cognitive approaches (CBT) are helpful for those who demonstrate self-awareness, intact cognitive skills and the ability to actively participate in the intervention process -Electroconvulsive therapy (ECT) is very effective and the treatment of choice for those who have been unresponsive to trials on medications and other interventions

Manic episode symptom management

-Antipsychotics -Mood stabilizing medications (first line of psychopharmacologic treatment) 1. Lithium (side effects include excessive thirst, tremors, excessive urination, weight gain, nausea, diarrhea, and cognitive impairment) (blood levels must be monitored to maintain the narrow therapeutic window. high levels of lithium may cause nerve damage and death. Early symptoms of toxicity include motoric disturbances) 2. Anticonvulsants (side effects include dizziness, drowsiness, ataxia, weight gain and sedation) 3. Mood stabilizers also used to prevent Bipolar disorder 4. Antipsychotic medications such as zyprea, seroquel, risperdal, geodon and abilify

Omnibus Budget Reconciliation Act (OBRA) of 1990

-Applied to all nursing homes that receive federal money for Medicare or Medicaid patients -Emphasizes attending to residents rights, autonomy and self-determination, providing quality of care and enhancing quality of life within nursing homes -Mandated a comprehensive resident assessment system the Minimal Data Set (MDS), which is administered upon admission and thereafter on an annual basis, unless there is a significant change in the residents condition 1. MDS is coordinated by an RN. Occupational therapists can contribute information -Psychosocial well-being and activity pursuits patterns must be considered along with the residents physical condition and cognitive abilities (this has broadened OT's role in nursing homes) -Mandated that the evaluation and treatment of conditions found during the MDS follow specific guidelines called the Resident Assessment Protocols (RAP) 1. The structured approach to assessment is called the Resident Assessment Instrument (RAI) 2. Individualized care plans mist be established within specific time frames -The enhancement of quality of life through restraint reduction and the provision of restraint-free environments are strongly emphasized 1. Nursing homes must show evidence of consultation by an occupational or physical therapist for consideration of interventions that are less restrictive than restraints 2. Occupational therapists are frequently consulted for ADL treatment, seating adaptations, positioning ideas, environmental modifications, psychosocial interventions and activity programming -Aims to guarantee that residents have the right to choose how they want to receive care and live their lives 1. Residents should have a choice in determining their ADL and community participation activities 2. Residents should be able to function as independently as possible -Postdischarge plans must meet specific criteria including client or caregiver education

Intervention for oral motor control

-Appropriate positioning to allow for neutral pelvic alignment and trunk stability, either in caregiver's lap or chair (infant seat or wheelchair); avoid head extension to prevent asphyxiation as a result of closing the airway -Hand Positioning of the Caregiver: place the index finger longitudinally under the child's lip, middle finger under the jaw, and place the thumb on the lateral end of the mandible -Facilitate lip closure by applying slight upward pressure of the index finger under the child's lip -Facilitate jaw closure by firm upper pressure of the middle finger under the jaw -Hand positioning of the index and middle fingers to assist in inhibiting tongue trust (press bowl of spoon downward and hold onto tongue) -Facilitate swallow by lip closure and by placement and slight downward pressure of the spoon on the middle aspect of the tongue -Facilitate chewing by placement of foods, such as long soft-cooked vegetables between the gum and teeth -Consider and utilize the appropriate texture of foods as related to the child's feeding problems. Thick foods are easier to swallow and manage, especially if a tongue thrust is present -Integrate preventive measures to work out of abnormal patterns: 1. provide firm downward pressure, using a spoon, on the middle aspect of the tongue in presence of a tonic bite reflex 2. prevent tongue retraction avoid choking 3. facilitate lip closure for a tongue thrust that can result in loss of liquid and food, drooling and failure to thrive 4. decrease tactile sensitivity prior to feeding as well as at other times, by providing firm pressure; encourage sucking/chewing on a cloth; rub gums, palate and tongue; promote oral exploration of toys; use a NUK toothbrush and vary texture of foods, gradually introducing mashed potatoes mixed with other vegetables and soft meets -A major role of the therapist is to assist the caregiver in considering and promoting a pleasant social atmosphere for feeding by utilizing positioning and handling techniques to promote eye contact and bonding in a relaxed environment

Group Dynamics

-Are the forces which influence the nature of small groups, the interrelationships of their members, the events that typically occur in small groups and ultimately, the outcomes of these groups -Group dynamics can be examined according to the groups structure, content and process

Service delivery models and practice settings overivew

-As a result of legislative initiatives and health-care system changes, service delivery is evolving from medical-based models and settings to more community and home based models and settings (IDEA has solidified schools as practice settings) -Implications for OT practice 1. Fewer practitioners will work in hospitals and long-term care facilities 2. More practitioners will work in community and home based settings (primary care, day treatment, home care, school settings)

White mater: anterior (ventral), lateral and posterior (dorsal) white columns or funiculi

-Ascending fiber system (sensory pathways) 1. Dorsal columns/medial lemniscal system: convey sensations of prioprioception, vibration, and tactile discrimination; divided into fasciculus cuneatus (upper extremity tracts, laterally located) and fasciculus gracilis (lower extremity tracts, medially located); neurons ascend to medulla where fibers cross (leminscal decussation) to form medial lemniscus, ascend to thalamus and then to somatosensory cortext 2. Spinothalamic tracts: convey sensations of pain and termperature (lateral spinothalamic tract), and crude touch (anterior spinothalamic tract); tracts ascend one or two ipsilateral spinal cord segments (Lissauer's tract), synapse and cross in spinal cord to opposite side and ascend in ventrolateral spinothalamic system 3. Spinocerebellar tracts: convey proprioception information from msucle spindles, Golgi tendon organs, touch and pressure receptors to cerebellum for control of voluntary movements, dorsal spinocerebellar tract ascends to ipsilateral inferior cerebellar peduncle while ventrospinocerebellar tract ascends to contralateral and ipsilateral superior cerebellar peduncles 4. Spinoreticular tracts: convey deep and chronic pain to reticular formation of brain stem via diffuse, polysynaptic pathways

Occupational therapy evaluation and intervention for kidney disease

-Assess performance skills, client factors, areas of occupation and performance contexts to develop and individualized intervention plan. -Provide interventions to remediate deficits and compensate for limitations to enable occupational performance. Interventions can include 1. Education about activity and participation precautions to minimize risks (behaviors and habits that can cause strain to kidney function) 2. Training in the safe and effective use of adaptive equipment (tub bench, built-up handled utensils, reachers, button hooks) 3. Training in the safe and effective use of assistive mobility devices (ankle-foot orthoses, canes, walkers) and/or wheeled mobility 4. Energy conservation and work simplification techniques to compensate for fatigue during BADL, IADLs, leisure and work 5. Lifestyle redesign to change unhealthy habits and routines, develop new habits that support health and well-being and implement new routines that include activities that support health and well-being 6. health promotion and prevention to facilitate health management and maintenance 7. education in community resources that enable participation (accessible public transportation 8. referrals to obtain supportive counseling and social support, during therapy and complementary medicine if indicated 9. referrals to driving rehabilitation programs if needed 10. physical or cognitive assistance may be indicated for complex ADL and IADL

Sexual Expression/Activity Evaluation

-Assessment for evaluation of activities of daily living -The evaluation of the ADL skill of sexual expression/activity does not have a published OT assessment available for clinical use -The OT practitioner should assess this ADL during routine screenings and interviews, as appropriate. -Determine if sexual expression/activity is valued -Identify potential obstacles for the attainment and maintenance of safe, satisfying sexual expression/activity (pathophysiological changes related to disease, disability, and/or aging process; psychological and/or cognitive changes related to disease, disability, and/or the aging process - judgement, impulse control and decision-making skills must be assessed to ensure safety; limited partner availability due to social demographics and/or sociocultural attitudes -Determine is a person's knowledge of his/her sexuality is adequate and appropriate for his/her age, developmental level, expected roles, and environmental contexts -If an individual is reticent about discussing his/her sexuality during the OT evaluation, the therapist must respect and accept this preference (sexual concerns that are unexpressed during initial OT sessions are often brought forth during later session as a therapeutic relationship develops between the individual and his/her OT; sessions focused on intimate self-care issues frequently precipitate questions regarding sexuality; an atmosphere of continuing permission to discuss sexual expression should be maintained throughout the person's engagement in OT) -The potential realities of sexual abuse, protective legislation, and our professional code ethics to report any suspected incidents of child, adult, or elder abuse or assault to the appropriate agency and/or local law enforcement

Evaluation and reevaluation documentation

-Assessments administered and the results -Summary and analysis of assessment findings in measurable, functional terms 1. Sufficient baseline objective data 2. In reevaluation, compare findings to initial findings 3. Indicate change, if any -References to other pertinent reports and information including relevant psychological, social, and environment data -OT problem list, specific and sufficient to develop intervention plan -Recommendations for OT services (can include recommendation that no OT services are indicated) -Clients understanding of current status and problems and clients subjective complaints -Clients interest and desire to participate in therapy

Neurological system changes and adaptations in the older adult- Age related changes

-Atrophy of nerve cells in cerebral cortex:overall loss of cerebral mass/brain weight 6-11% between ages of 20 and 90, accelerating loss after age 70 -Changes in brain morphology 1. Gyral atrophy: narrowing and flattening of gyri without widening of sulci 2. ventricular dilation 3. Generalized cell loss in cerebral cortex: especially from frontal and temporal lobes, association areas (prefrontal cortex, visual) 4. Presence of lipofucins, senile or neuritic plaques and neurofibrillary tangles (NFT): significant accumulations associated with pathology (Alzheimers disease) 5. More selective cell loss in basal ganglia (substantia nigra and putamen), cerebellum, hippocampus, locus coeruleus, brain stem minimally affected -Decreased cerebral blood flow and energy metabolism -Changes in synaptic transmission 1. decreased synthesis and metobolism of major neurotransmitters (acetocholine, dopamine) 2. slowing of many neural processes, especially in polysynaptic pathways -changes in spinal core/peripheral nerves 1. neuronal loss and atrophy 2. Loss of motoneurons resulting in increase in size of remaining motor units (development of macro motor units) 3. Slowed nerve conduction velocity: sensory greater than motor 4. loss of sympathetic fibers: may account for diminished autonomic stability, increasing incidence of postural hypotension in older adults -Age related tremors (Essential tremor [ET]) 1. occurs as an isolated symptom, particularly in hands, head and voice 2. Characterized as postural or kinetic, rarely resting 3. Benign, slowly progressive, in late stages may limit function 4. exaggerated by movement and emotion

Wheelchair dimensions and accessibility needs

-Average wheelchair width is 24"-26" rim to rim -Some doorways and room spaces may be too narrow, limiting clear mobility -The minimal clearance width for doorways and halls: 32" doorway width minimum, with ideal being 36" (an additional 26" is needed beside the door to allow for door swing; doorways can be widened or removed if necessary [removing doorstops can add 3/4" in width; replacing existing hinges with offset hinges can add 1 1/2"-2" in width]; doorway saddles can be removed and the floor patched, or a wedge can be placed in front of the saddle, or a thin rubber mat can be placed over the saddle); hallways should be 36" wide -Average wheelchair length is 42"-43": adequate turning spaces are needed; a 360 degree wheelchair turning space requires a clearance space of 60"x60" -The maximal height the individual can reach forward from sitting is 48" and at least 15" is needed to prevent tipping -Maximal height for reaching sideways is 48" and when an obstruction is present is 46" -The maximal height for countertops should be 31" -Parking spaces should have an adjacent 4' aisle to allow wheelchairs to maneuver -Pathways and walkways should be 48" wide -Ramps should be a minimum of 36" wide and should have a non-skid surface on upper and lower levels: 1) the ratio of slope to rise is 1:12 (for every 1" of vertical rise, 12" of ramp is required) 2) railings should be between 29" and 36" high depending on person's arm reach, 32" is average 3) curbs on ramps should be at least 4" high 4) level platforms must be included in the ramp design (if the ramp is excessively long, 4'x4' landing(s) are required to allow for rest; if the person using the ramp has limited upper extremity strength or decreased cardiopulmonary capacity, 4'x4' landing(s) are required; if there is a sharp turn in the direction of the ramp, landing(s) are required for turning space. A 90 degree turn requires a minimum 4'x4' landing; a 180 degree turn requires a minimum 4'x8' landing) 5) if the ramp leads to a door, there must be a 5'x5' platform before the door that extends at least 12" (18" is preferred) along the side of the door to allow for door swing without backing up -Electric porch lifts and stair lifts are alternatives to ramps

Identification of study's participants/population sample

-Based on literature review, the study's hypothesis and goals determine a target populations characteristics -Describe criteria for selecting a sample of the population to be study's participants -Determine sampling method (random, systematic, stratified, purposive, convenience, network/snowball) -Obtain informed consent from all participants

The role of the team in environmental considerations

-Basis for team construction 1. the facility in which the individual with disability presently resides and or participates 2. the individuals needs, abilities and functional status 3. geographical location 4. funding available to the individual with disability (both individually and through 3rd party payers and state offices for individuals with disabilities) 5. support available from caregivers -the team should always include the person and caregivers if any -professional team members may belong to the rehabilitation engineering and assistive technology society of north America (RESNA) and national registry of rehabilitation technology suppliers (NRRTS) 1. both professional organizations help to develop standards and measuring tools to ensure proper design, fabrication, prescription and delivery of rehabilitation technology 2. RESNA offers certification programs for assistieve technology professions (ATPs) and seating and mobility Specialists (SMSs)

Developmental/genetic theory

-Biological theories addressing aging at the cellular, molecular and organism levels -Aging is genetically programmed 1. Lifespan is largely determined by the genes one inherits 2. Functional decreases in the immune system, neurons and hormones

Neurological Injuries (CVA, TBI, and brain tremors)

-Can also lead to irreversible vision damage -with neurological diagnoses, the structures of the eye remain functionally intact; impairment depends on where damage in the visual pathway occurs -Aspects of vision that may be affected include visual acuity, visual fields, oculomotor control, bunocularity, contrast sensitivity, visual attention, visual scanning. vision perception and visual memory

Hemodynamics

-Cardiac output: amount of blood ejected from the heart per minute; dependent on heart rate and stroke volume -Stroke volume: average amount of blood ejected per heartbeat -Ejection fraction: percentage of blood emptied from the ventricle during systole; a clinically useful measure of left ventricle function 1. this measure is used in the diagnosis and monitoring of left-sided heart failure

Clinical implications for cardiovascular changes

-Changes at rest are minor: resting heart rate and cardiac output relatively unchanged, resting blood pressure increases -Cardiovascular responses to exercise: blunted, decreased heart rate acceleration, decreased maximal oxygen uptake and heart rate; reduced exercise capacity, increased recovery time -decreased stroke volume due to decreased myocardial contractility -maximum heart rate declines with age -cardiac output decreased, 1% per year after age 20: due to decreased heart rate and stroke volume -orthostatic hypotensions: common problem in older adults due to reduced baroreceptor sensitivity and vascular elasticity -increased fatigue, anemia common -systolic ejection murmor -possible electrocardiogram changes: loss of normal sinus rhythm; longer PR and QT intervals; wider QRS, increased arrhythmias

Muscular system changes and adaptation in the older adult: Age-related changes

-Changes may be due more to decreased activity levels (hypokinesis) and disuse than from the aging process -Loss of muscle Strength: peaks at age 30, remains fairly consistent until age 50; after which there is an accelerating loss, 20-40% loss by age 65 in the nonexercising adult -Loss of power (force/unit time): significant declines, due to losses in speed of contraction and changes in nerve conduction and synaptic transmission -Loss of skeletal muscle mass (atrophy): both size and number of muscle fibers decrease by age 70, 33% of skeletal muscle mass is lost -Changes in muscle fiber composition: selective loss of Type II, fast-twitch fibers, with increase in proportion of Type I fibers -Changes in muscular endurance: muscles fatigue more readily 1. decreased muscle tissue oxidative capacity 2. decreased peripheral blood flow, oxygen delivery to muscles 3. Altered chemical composition of muscle decreased myosin ATPase activity, glycoproteins and contractile protein 4. Collagen changes: denser, irregular due to cross-linkages, loss of water content and elasticity; affects tendons, bones and cartilage

Pulmonary system age-related changes

-Chest wall stiffness, declining strength of respiratory muscles results in increased work of breating -loss of lung elastic recoil, decreased lung compliance -changes in lung parenchyma: alveoli enlarge, become thinner, fewer capillaries for delivery of blood -Changes in pulmonary blood vessels: thicken, less distensible -Decline in total lung capacity: residual volume increases, vital capacity decreases -forced expiratory volume (airflow) decreases -altered pulmonary gas exchange: oxygen tension falls with age -Blunted ventilatory responses of chemoreceptors in response to respiratory acidosis, decreased homeostatic responses -Blunted defense/immune response, decreased ciliary action to clear secretions, decreased secretory immunoglobulins, alveolar phagocytic function

Exploratory play, zero to 2 yeas

-Child engages in play experiences through which the child develops a body scheme -Sensory integrative and motor skills are also developed as the child explores the properties and effects of action on objects and people -child plays mostly with parents/caregivers

Problem solving skills 6-9 months

-Child finds object after watching it disappear (toy covered by cloth) -Child uses movement as a means to an end (rolling to secure a toy) -Child anticipates movement of objects in space (looking toward trajectory of object circling the child's head) -Child attends to consequences of actions (banging toy and realizing it makes noise) -Child repeats actions to repeat consequences (banging toy to hear noise)

Games, 7-12 years

-Child participates in play with rules, competition, social interaction, and opportunities for development of skills. - Child begins to participate in cooperative peer groups with a growing interest in competition. - Friends become important for validation of play items and performance, while parents assist and validate in the absence of peers.

Problem solving skills 12-15 months

-Child recruits the help of an adult to achieve a goal -Child attempts to activate a simple mechanism -Child turns and inspects objects -Child uses trial and error approach to new challenges

Reactive attachment disorder Impact on function

-Children with RAD exhibit challenging behaviors (can be frustrating to work with and parent due to these behaviors) 1. high need to be in control 2. frequent lying 3. affectionate and overly related with strangers 4. frequent episodes of hoarding or gorging on food without physical need 5. denial of responsibility 6. projecting blame for their actions on others

Glaucome

-Chronic elevated pressure in the eye that may cause optic nerve atrophy and loss of peripheral vision. This is more prevalent in persons over 40 years old -Vision loss starts peripherally and moves toward central vision (tunnel vision) -Symptoms include difficulty scanning the environment and decreased visual acuity, contrast sensitivity, light sensitivity, and sensitivity to glare. Orientation and mobility within the environment are often affected, especially with dim illumination and at night -Medical intervention is available to decreased the intraocular pressure. Can also be prevented with eye drops -this condition is painless and is often detected too late when the person experiences vision deficits. At this point the goal is to decrease further vision loss

angina pectoris (chest pain)

-Clinical manifestation of ishchemia characterized by mild to moderate substernal chest pain/discomfort; most commonly felt as pressure or dull ache in the chest and left arm but may be felt anywhere in the upper body including neck, jaw, back, arm, epigastric area -usually lasts less than 20 minutes due to transient ischemia -represents an imbalance in myocardial oxygen supply and demand, brought on by 1. increased demands on heart: exertion/exercise, emotional upset, smoking, extremes of temperature (especially cold), overeating, tachyarrhythmias

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

Supervision Types

-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

Fieldwork education managerial tasks

-Collaboration with the academic education program to develop specific fieldwork learning objectives and activities consistent with the facilities and schools philosophies and missions -development of professional development plans and activities for the students clinical supervisors to ensure adequate fieldwork supervision -establishment of departmental policies and procedures for a student program and its supervision -Assurance of quality of care provided by students according to established program standards and professional ethics -evaluation and supervision of students performance and completion of ACOTE's evaluation tool -Completion of cost-benefit analysis to collect data for institutional support of clinical education

Heuristic (qualitative research)

-Complete involvement of the researcher in the experience of the subjects to understand and interpret a phenomenon 1. Aim is to understand human experience and its meaning 2. Meanings can only be understood if personally experienced

Autonomic nervous system (ANS)

-Concerned with innervations of involuntary structures: smooth muscles, heart, glands, helps maintain homeostasis (constant internal body environment) -Divided into two divisions: sympathetic and parasympathetic; both have afferent and efferent nerve fibers; preganglionic and postganglionic fibers 1. Sympathetic (thoracolumbar) divison 2. Parasympathetic (craniosacral) division -Autonomic plexuses: cardiac, pulmonary, celiac (solar), hypogastric, pelvic -Modulated by brain centers 1. Descending autonomic system: arieses frome control centers in hypothalamus and lower brain stem (cardiac, respiratory, vasomotor) and projects to preganglionic ANS segments in thoracolumbar (sympathetic) and craniosacral (parasympathetic) segments 2. Cranial nerves: visceral afferent sensations via glossopharyngeal, and vagus nerves; efferent outflow via oculomotor, facial, glossopharyngeal, and vagus nerves

Intervention Documentation (Medicare)

-Content must indicate that the treatment shows a level of complexity and sophistication or the condition of the person must be of a nature that requires the judgement, knowledge, and skills of a qualified therapist. This statement is as per Medicare Skilled rehabilitation intervention is mandatory 1. Delineate the specific skilled care rendered. This is the biggest cause for retroactive denial 2. Notes must reflect skilled therapeutic intervention -Skilled care rendered must match the diagnosis and the physicians order -Services must be unique to OT and not sound like PT/SLP. Medicare does not pay for duplication of services In home care, homebound status due to functional limitations must be clearly delineated 1. If the diagnosis may not render the individual homebound, explain why this particular person is homebound 2. Do not give a reviewer any doubt that this person does not meet Medicare homebound criteria (do not state client not a home when you arrive. Rather state there was not answer to a locked door) -Document honestly, but not over-optimistically, Medicare reviewers are interested in determining the need for continued intervention -Documentation must demonstrate that the person is making significant functional improvement in a reasonable and generally predictable period of time. 1. Improvement should bed noted with a description of functional changes 2. If a person has improved bu can benefit from further intervention, the therapist should clearly document why continued treatment is medically necessary (provide behavioral observations and evaluation results that substantiate the need for further care) 3. If improvements are not observed and/or progress is slower than expected, the reasons for lack of progress including extenuating circumstances and/or limiting factors (secondary diagnosis) should be documented -If improvement is not made or expected, justifiable interventions to prevent deterioration and maximize function are covered 1. Occupational therapists are reimbursed for the documented design of a maintenance program performed by others (CNA, HHAs, PCAs) and periodic evaluations of the program effectiveness 2. Occupational therapists can continue to provide OT services to persons not expected to improve if they adequately substantiate the need for skilled services 3. Medicare no longer denies payment due to lack of improvement, coverage is denied due to inadequate documentation of the need for skilled services -All documented service must be reasonable and necessary 1. Was the service effective and completed in a timely fashion? 2. In long-term care, if the treatment does not lessen the mount of care needed by staff, what made the service worthwhile? -If there is no medical justification for continued treatment, the person should be discharged in a timely fashion

Cerebral Hemispheres (telencephalon)

-Convoluntions of gray matter composed of gyri (crests) and sulci (fissures): 1) lateral central fissure (Sylvian fissure) separates temporal lobe from frontal and parietal lobes 2) longitudinal cerebral fissures separates the two hemispheres 3) central sulcus separates frontal lobe from the parietal lobe -Paired hemispheres, consisting of 6 lobes on each side: frontal, parietal, temporal, occipital, insular, limbic -White matter: myelinated nerve fibers located centrally: 1) transverse (commissural) fibers - interconnect the two hemispheres, including the corpus callosum (the largest), anterior commissure, and hippocampal commissure 2) projection fibers - connect cerebral hemispheres with other portions of the brain and spinal cord 3) association fibers - connect different portions of the cerebral hemispheres, allowing cortex to function as an integrated whole -Basal ganglia: 1) masses of gray matter deep within the cerebral hemispheres, including the corpus striatum (caudate nucleus and lenticular nuclei), amygdaloid nucleus, and claustrum. The lenticular nuclei are further subdivided into the putamen and globus pallidus 2) forms as associated motor system (extrapyramidal system) with other nuclei in the subthalamus and midbrain 3) has numerous fiber connections (caudate loop [complex loop] functions in association with association cortex in the formation of motor plans; putamen loop [motor loop] functions in association with sensorimotor cortex to scale and adjust movements

Gastrointestinal changes

-Decreased salivation, taste, smell, inadequate chewing, & poor swallowing reflex may lead to poor dietary intake/nutritional deficiencies -Esophagus: reduced motility and control of lower esophageal sphincter, acid reflux and heartburn, hiatal hernia common -Stomach: reduced motility, delayed gastric emptying, decreased digestive enzymes, decreased digestion and absorption, indigestion common -Decreased intestinal motility, constipation common

Vestibular processing disorder manifestation

-Deficits in modulation 1. hypersensitivity to movement, characterized by aversion to movement impacting on the sympathetic system 2. Hyposensitivity to movement characterized by the individual seeking intense vestibular stimulation without complaints of feeling dizzy, and by a tendency to be a thrill seeker unaware of potential dangers 3. Gravitational insecurity characterized by excessive fear during typical activities, especially when the individuals feet are off the ground, when moving backwards or upward in space, waking on uneven terrain, jumping, getting on/off elevators, using any playground equipment involving movement and when handling even minimal heights -vestibular discrimination deficits, characterized by the above symptoms; however symptoms are demonstrated on a subtle level -low muscle tone -postural-ocular deficits -decreased balance and equilibrium reactions -deficits in bilateral coordination -low endurance -deficit motor planning and sequencing -behavior responses include difficulty with attention, organization of behavior and communication

Child Abuse Prevention and Treatment Act (CAPTA)

-Defines child abuse and neglect as mental or physical injury, negligent treatment, maltreatment or sexual abuse of a child less than 18 years of age by a person responsible for the child's welfare under circumstances that indicate that a child's welfare or health is being threatened or harmed -OT practitioners can serve as child welfare advocates -Direct OT intervention may be needed to remediate the emotional or physical disorders that result from abuse

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)

Delirium onset/prognosis

-Delirium occurs in approximately 1 in 5 hospitalized individuals with greater prevalence reported for older adults 1. it may resolve quickly or take several days 2. it is more severe with advanced age 3. it may indicate a poor prognosis over time -the prevalence of neurocognitive disorder increases with age 1. there may be periods of plateauing with a gradual decline over time

Methods of Program Evaluation

-Describe program objectives and goals to determine program outcome criteria -Identify measurable indicators based on objectives and goals -Describe population, staff, services provided, intervention methods, scope of care, and length of treatment -Design an evaluation study -Select methods to collect data: 1) direct observation and/or review of client charts 2) safety checklists, incident reports, and/or client/family complaints 3) surveys of clients, families and/or staff 4) review of treatment sessions and missed treatments 5) initial, discharge, and follow-up assessments 6) review of statistics on costs and service volume -Collect and organize data -Evaluate and analyze results and limitations of the study -Report results, highlighting information to determine program's efficacy -Use results to initiate appropriate program actions: 1) continue and/or expand programs that have demonstrated good efficacy/positive outcomes 2) change or modify programs that have demonstrated limited efficacy/satisfactory outcomes 3) discontinue programs that have demonstrated poor efficacy/unsatisfactory outcomes -Evaluate effectiveness of actions

Group roles

-Describe the patterns of behavior that are typical within groups-Instrumental roles are functional and assumed to help the group select, plan, and complete the group's tasks (eg. initiator, organizer) -Expressive roles are functional and are assumed to support and maintain the overall group and to meet members' needs (eg. encourager, compromiser) -Individual roles are dysfunctional and contrary to group roles, for they serve an individual purpose and interfere with successful group functioning (eg. aggressor, blocker)

Curative factors of groups

-Described by Irving Yalom 1. altruism is the giving of oneself to help others 2. catharsis is the relieving of emotions by expressing ones feelings 3. universality comes from recognizing shared feelings and that ones problems are not unique 4. existential factors address accepting the fact that the responsibility for changes comes from within oneself 5. self understanding (insight) involves discovering and accepting the unknown parts of oneself. 6. family re-enactment leads to understanding what is was like growing up in ones family through the group experience 7. guidance comes form accepting advice form other group members 8. identification involves benefiting from imitation of the positive behaviors of other group members 9. instillation of hope is experiencing optimism through observing the improvement of others in the group 10. interpersonal learning occurs when receiving feedback from group members regarding ones behavior (input) 11. interpersonal learning also occurs by learning successful ways of relating to group members (output) 12. the conscious understanding and facilitation of these curative factors enhances the therapeutic value of a group

Assessment of pain

-Determine location of pain: localized or diffuse -Evaluate intensity of pain: 1) pain intensity scale of 0-10 is most commonly used 2) identify the time of day the pain is most intense -Determine the onset and duration of pain: 1) gradual or sudden onset 2) the length of time pain has been experienced -Description of pain: common descriptors include sharp, throbbing, tender, burning, and shooting -Functional assessment of pain: 1) pain scales that commonly address function (McGill Pain Questionnaire, Pain Disability Index, Functional Intereference Estimate)

Relationship of swallowing dysfunction to occupation

-Disruption of the persons role relative to their family unit can result from decreased ability to comfortable eat at the dinner table 1. modified diet could be infantilizing 2. tube feeding may preempt persons ability to partake in a meal in a cultural/social context -Disruption of swallowing ability may contribute to decreased comfort level for eating out in public 1. person may choose not to dine in a public social context 2. If business lunches or dinners are part of a vocational role, the person may not be able to resume their vocation without modification of expectations regarding how participation in social meals related to vocational performance -Alteration of self concept concerning life roles are appearance 1. If person is tub fed how does that alter how they perceive self? -sex appeal can be questioned -self-image as it impacts on life roles (foodie or fashonista) can be altered 2. if tube fed, how does that alter how others perceive them -accepted, feared, or pitied by children, grandchildren, family, friends and colleagues

Purposeful Activities

-Doing processes that are directed toward a desired and intended outcome and require energy and thought to engage in and complete -The goal-directed tasks and/or behaviors that make up occupations Characteristics of purposeful activity -Universally people participate in purposeful activities, although there are personal a sociocultural differences in the manner in which activities are performed (dressing) -Fundamental to the development and acquisition of performance skills is active participation in purposeful activities -Fundamental to performance in areas of occupation is engagement in purposeful activities -Purposeful activities are composed of identifiable parts that can be analyzed -They are holistic -They can be manipulated and adapted to be appropriate to and/or therapeutic for the individual -Can be graded along many dimensions to meet the needs of an individual -Determination of the individuals differential responses to purposeful activities can provide information for the selection of appropriate activities for use in evaluation and intervention -Verbal and nonverbal communication is facilitated through engagement -Organization and ability to focus are enhanced because purposeful activities provide concrete structure -Doing is emphasized -Involvement in and with the nonhuman environment is enhanced -Vary on a continuum from conscious to not conscious/unconscious -Vary on a continuum from real to symbolic -Vary on a continuum from simulated in a clinical setting to real in the individuals environment

Medical treatment for TB

-Drug therapy is frequently used to teat TB infection or prevention after an exposure -Persons who have TB disease may need to take several different drugs to effectively kill the bacteria -If a person stops taking the drugs before the prescribed interval, the drugs may become ineffective in fighting the infection -development of multidrug-resistant TB (MDR TB) can occur -Types of drugs 1. Isoniazid (INH) which must be taken fo 6 months 2. Rifampin 3. Pyrazinamida 4. Ethambutol 5. Streptomycin -serious side effects of all of the above drug therapies 1. no appetite 2. nausea/vomiting 3. jaundice 4. fever lasting more than 3 days 5. abdominal pain 6. tingling in the fingers or toes 7. easy bruising 8. blurred vision 9. tinnitus, hearing loss

Medicaid reform

-Due to rapidly rising costs there is an increased press for cost containment -States are examining ways to reformulate Medicaid benefits -Reform options may include placing caps or other limitations on types and length of therapy, reducing or eliminating optional benefits, and/or developing and implementing managed care approaches -Individual states can apply to the federal government for a waiver which gives the state flexibility in the types of services and delivery systems they provide under Medicaid

Medical management of spina bifida

-During the neonatal period precautions are taken to protect the sac from rupturing and from infection which may result in meningitis 1. all or part of the sac may be removed 24-48 hours after birth -Ventriculoperitoneal or other types of shunt is indicated should the complication of hydrocephalus occur, in which the cerebral spinal fluid is not absorbed resulting in an increase in size of the ventricles and the infants head 1. brain damage as a result of increased intracranial pressure can cause an intellectual disability 2. increased pressure may also result in Arnold Chiari syndrome in which a portion of the cerebellum and medulla oblongata slip down through the foramen magnum to the cervical spinal cord 3. shunts can become blocked, resulting in increased intracranial pressure -signs and symptoms during the 1st year of life include extreme head growth and often a soft spot on the forehead -Signs and symptoms by the 2nd year of life include severe headache, vomiting and irritability -Signs and symptoms in adolescents include increasing head size, change in the function of UE, regression in milestones or decline in academic performance, neck pain, severe headache and loss of balance -Signs and symptoms in adults can include vomiting, severe headache, vision or memory problems, irritability, personality change, loss of coordination, numbness in the upper extremities, head and neck pain, and difficulty swallowing -intracranial pressure can possibly lead to paralysis of the 6th cranial nerve resulting in visual impairments -intracranial pressure may contribute to seizure disorders and deterioration of physical and cognitive functioning -blocked shunts are revised by removing the blocked section and replacing it with a catheter 4. shunts can become infected 5. urological management and if indicated intermittent catheterization 6. orthopedic management for motor deficits 7. surgical intervention may be indicated for tethered cord syndrome

Occupational Therapy Intervention for Pain

-Educate the individual about contributing factors -Assist the individual in identifying and responding adaptively to pain behaviors: 1) remove behavioral reinforcers 2) establish a behavior contract 3) provide positive reinforcers, educational support 4) demonstrate change, allow person to experience success 5) practice well behaviors -Assist the individual in developing strategies and using techniques to manage pain: 1) teach coping skills/stress management/assertive communication 2) provide relaxation training (progressive relaxation techniques [eg. Jacobson's], deep breathing exercises; guided imagery; Yoga, Tai Chi, Ai Chi; biofeedback -Refer to other professionals for direct pain/symptom control interventions -Establish a realistic daily activity program: 1) improve overall level of conditioning; daily walking program 2) improve overall functional mobility skills, activities of daily living and meaningful occupations 3) prescribe assistive devices as appropriate 4) teach energy conservation techniques 5) provide meaningful diversional activities -Prescribe assistive devices as needed -Provide family education

Reauthorization and Amendment of Individuals with Disabilities Education Act

-Emphasizes that the purpose of the IEP is to address each students unique needs as related to their disability and decide how these needs can be served so that students with disabilities have full access to the general education curriculum and can participate in the general education classroom -Clarifies that the IEP can include consideration of assistive technology and behavioral intervention 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 them for independent living and employment in adult life 1. Transitional planning begins at the age of 14 (of 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 instruction and/or ADL and vocational assessment and intervention) 3. The student must be invited to attend IEP meeting that discuss their 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 students with disabilities -Students with disabilities may be punished in the same manner as other students for serious offenses (carrying illicit drugs or weapon). However, disciplinary prevention measures are stressed 1. If disciplined students are removed to an alternative placement they must still receive education and related services -Clarifies early intervention services and systems 1. Mandates and Individual Family Service Plan (IFSP) for children brith through 2 years of age 2. OT is identified as a primary early intervention service

Work Investment Act (WIA)

-Established a federally sponsored national employment and vocational training system -Established a "One-Stop" delivery system for all adults aged 18 or older seeking access to employment and training services. This means traditionally separate "unemployment" offices and "vocational rehabilitation services" are now available at a "One-Stop Center" -Availability of all employment and training services at a One-Stop Center is aimed to allow for "universal access" for people with disabilities - a core principle of WIA Categories of One-Stop services: 1) core services, which include outreach intake and orientation; initial assessment; eligibility determination for services; assistance with job search and placement; job market information and career counseling 2) intensive services for individuals who do not attain successful employment after receipt of core services. Services can include comprehensive assessments of service needs and skill level, development of individualized plans for employment, case management, and counseling 3) training services for individuals who do not attain successful employment after receipt of core and intensive services. These services are typically provided off-site from the One-Stop Center and can include adult education and literacy training, on-the-job training, and individualized vocational training -The One-Stop system of services is provided through a network in each state. The names of these systems can vary from state to state -Persons determined to be eligible for WIA services receive an Individual Training Account (ITA) which is used to obtain services from any approved provider. Specific ITA procedures can vary from state to state -Services for youth (aged 14-21) with disabilities are also provided for in the WIA to assist in a successful transition from school to work

cerebral palsy (CP)

-Etiology 1. caused by an injury or disease prior to, during or shortly after birth resulting in brain damage and secondary neurological and muscular deficits 2. common causes during the perinatal period include lack of oxygen, intracranial hemorrhage, meningitis, chronic alcohol abuse, toxicosis, infections, genetic factors and metabolic disorders -Prognosis 1. is dependent on the severity of the brain injury and the location 2. it is nonprogressive; however deformities and contractures may develop depending on the level of involvement 3. it may be accompanied with seizure, intellectual and behavioral disorders 4. the individual can have normal intelligence, which is masked by significant motor deficits

Heat syndromes/hyperthermia

-Etiology 1. heat production increases with infection, exercise or drugs 2. heat loss decreases with high humidity and temperature, excess clothing, obesity, cardiovascular disease, dehydration, sweat gland dysfunction, lack of acclimatization and drugs 3. When an individuals heat loss is not sufficient to offset their heat production their body will retain heat and a heat syndrome can develop 4. older adults and individuals who are obese or taking drugs are at increased risk

Autism Spectrum Disorder (ASD): Etiology/prognosis

-Etiology 1. organic brain pathology 2. may or may not be seen with other disorders *Rett's syndrome, if associated with ASD is not specified as "Known Genetic Condition" -Onset 1. may occur from birth to 3 years of age 2. 4 times more common in boys -Prognosis for children with this condition is dependent upon the combined impact of the following 3 diameters 1. the severity 2. Level of general intelligence 3. change in symptom expression overtime -life expectancy is not affect, although a supervised living setting may be necessary

Rotator cuff tendonitis

-Etiology: 1) repetitive overuse 2) curved or hooked acromion 3) weakness of rotator cuff 4) weakness of scapula musculature 5) ligament and capsule tightness 6) trauma -Occupational therapy conservative intervention: 1) activity modification - avoid above shoulder level activities until pain subsides 2) educate in sleeping posture - avoid sleeping with arm overhead or combined adduction and internal rotation 3) decrease pain - positioning, modalities, and rest 4) restore pain free ROM 5) strengthening - below shoulder level 6) occupational and role specific training -Surgical interventions: 1) arthroscopic surgery 2) open repair - small, medium, large, and massive tears -Occupational therapy post-operative intervention: (the surgeon will determine when exercise should begin based on the size of the tear and tension of the repair site. The OT must communicate with the surgeon about when exercise can be initiated and what types of exercise should be used) 1) PROM (0-6 weeks); progress to AA/AROM 2) decrease pain - being with ice, progress to heat 3) strengthening (6 weeks post-operative) - begin with isometrics, progress to isotonic (below shoulder level) 4) activity modification - light ADL and meaningful role activities; progress as tolerated 5) leisure and work activities (8-12 weeks post-operative)

Hip Fractures

-Etiology: 1) trauma 2) osteoporosis 3) pathological fractures (ie. cancer) -Types: 1) femoral neck fracture 2) intertrochanteric fracture 3) subtrochanteric fracture -Medical management: 1) closed reduction for minimally displaced fractures 2) open reduction internal fixation (ORIF) 3) joint replacement -Occupational therapy evaluation: 1) review precautions and weight bearing status before initiating evaluation 2) occupational role requirements and expectations 3) ADL focus on dressing, bathing and transfers 4) ROM and strength of upper extremities 5) conduct other assessments as needed, (eg. cognitive) -Occupational therapy intervention: 1) bed mobility and bedside ADL 2) upper extremity strengthening 3) functional ambulation and transfers with appropriate weight bearing status and appropriate ambulation device (ie. walker, crutches) (the type of ambulation device is determined by the person's weight bearing status) 4) instruct in and practice use of assistive devices for use in the home (eg. shower chair, elevated commode seat) 5) practice role activities (eg. small meal preparation) using proper weight bearing status and ambulatory device -Precautions: 1) weight bearing status and the amount of ROM allowed at the hip will be determined by the surgeon 2) time frames for beginning OT intervention are also determined by the surgeon -Complications: 1) avascular necrosis 2) non-union 3) degenerative joint disease 4) the result of complications can be the need for a total hip replacement

Friedrich's ataxia

-Etiology: autosomal recessive inheritance -Onset: occurs in childhood or early adolescents -Symptoms: the prototype of spinal ataxia 1. this process is characterized by gait unsteadiness, upper extremity ataxia and dysarthria 2. tremor may be a minor feature 3. presentation also includes areflexia and loss of large fiber sensory modalities 4. as the disease progresses, scoliosis and cardiomyopathy are common

Obesity and Bariatric Issues

-Etiology: health disparity; result of complex social, behavioral, cultural, environmental, physiological and genetic factors +Social 1. education and income level 2. occupation 3. family background +behavioral 1. eating on the run/fast food 2. eating alone 3. eating for solace/comfort foods 4. binge eating + cultural 1. food and love cultures (food given as a sign of affection) 2. Larger body size is more highly valued in several cultures 3. Post-depression-era eating (consuming more because there is money to buy) 4. Restaurant cultures (larger portions, greater food diversity, high fat content) +Environmental 1. lack of time to devote to meal planning and preparation 2. Lacck of time to develop and maintain a proper exercise routine (the sandwich generation who provides simultaneous caregiving for their parents and children resulting in a real or perceived lack of time for self) 3. Lack of access to resources 1. no facilities in which to exercise 2. no exercise coach/partners +Physiological 1. A nutritionally related imbalance that occurs resulting in excess body fat -por diet and nutrition -eating processed foods -excessive food consumption: excess calories are consumed that are not expended by work or exercise -activity level: lack of exercise, poor choice of exercise in proportion to what is consumed -compulsive overeating: psychiatric disorder 2. Excess body fat that occurs from a metabolic imbalance -gestational diabetes (passively introduced to fetus: results in oversized infants at birth) -adrenal disorders: cortisol and stress 3. Side effects of the atypical second-generation antipsychotic (SGAs) medications -SGAs affect metabolism process, alter resting metabolic rate and increase cravings for carbohydrates -The rate of metabolic syndrome is substantially higher for persons with mental illness as compared to the general population

Stress incontinence

-Etiology: local damage to bladder sphincter associated with aftereffects of bearing children, morbid obesity, weakening of accessory musculature associate with normal aging -Intervention 1. Kegel exercises to strengthen pelvic floor 2. Timed routines for emptying bladder before it is full enough to cause spillage 3. Lifestyle adjustments to used incontinence supporting garments for a socially acceptable solution and to decrease public attention to the incontinence 4. Medications may be used when the physician feels the client can tolerate the side effects of drug therapy support 5. Electric stimulation may be used, if client fits the parameters of recovery for the condition

Progressive Supranuclear Palsy (PSP)

-Etiology: manifested by loss of voluntary but preservation of reflexive eye movements, bradykinesia, rigidity, axial dystonia, pseudobulbar palsy and dementia -Prevalence/onset 1. occurs in later middle life, with onset typically occurring between 45 and 75 years of age -death occurs approximately 15 years after onset

Amyotropic Lateral Sclerosis (Lou Gehrig's Disease)

-Etiology: motor neuron disease unknown etiology characterized by progressive degeneration of corticospinal tracts and anterior horn cells or bulbar efferent neurons -Onset/prevalence: occurs at an average age of 57, death usually occurs in 2 to 5 years

respiratory distress syndrome (RDS)

-Etiology: premature birth; insufficient production of surfactant to keep alveoli (air pockets of the lungs) open -Diagnosis: lungs collapse after each breath; X-ray of lungs reveals "ground glass" appearance; collapsed alveoli are dense and appear white on the x-ray as opposed to the black appearance on an x-ray of air filled alveoli; RDS is also called Hyaline Membrane Disease (HMD) -Prenatal management: to stimulate surfactant production and to reduce the risk of RDS, the mother is treated prophylactically with steroid medication 24-36 hours before delivery of a premature infant

Guyon's canal

-Etiology: repetition, ganglion, pressure, and fascia thickening -Symptoms: 1. Numbness and tingling in the ulnar nerve distribution of the hand 2. Motor weakness of the ulnar nerve-innervated musculature 3. Positive Tinel's sign at Guyon's canal 4. Advanced stages can lead to atrophy of ulnar nerve-innervated musculature in the hand -Conservative treatment 1. wrist splin in neutral 2. Work/activity modification -Surgical intervention: decompression -Postoperative intervention 1. edema control 2. AROM 3. Nerve gliding 4. Strengthening (2-4 weeks): focus on power grip 5. Sensory re-education

Neurogenic bowel

-Etiology: sympathetic nerve impairment, generally occurring in persons who have spinal cord injury above the (thoracic) T-6 level 1. loss of control of anal sphincter; 2.sensory loss resulting in a lack of awareness of feces in the bowel; 3. motor loss, decreased or lost ability to self-initiate or control a bowel movement -Flaccidity of muscles results in incontinence -Autonomic dysreflexia: an extreme rise in blood pressure can result (is a medical emergency if not reverse)

Known Genetic Condition (Rett's syndrome): Etiology/prognosis

-Etiology: unknown, however since deterioration occurs after a periods of normal development, it is through to be attributed to a genetic metabolic disorder -Onset: motor and social skills are age appropriate from 6 months to 2 years of development when the onset of progressive encephalopathy develops 1. Development of physical growth and head circumference plateau resulting in progressive encephalopathy 2. A child may live for over 10 years following onset

Certified orthotist

-Evaluates the need for orthotic equipment (splints, braces) -Designs, fabricates, and fits orthoses for individuals to prevent or correct deformities and/or support body parts weakened by injury, disease, or congenital deformity -Educates the client on purpose of orthoses, recommended care and wearing schedule -May be an occupational therapist, a physical therapist or an individual with specialized training

OT Evaluation/Intervention- Superficial partial thickness burns

-Evaluation 1. occupational profile 2. ROM, 72 hours postoperative 3. sensation, when wounds are healed 4. strength, when wounds are healed 5. ADL and meaningful role activities, as soon as possible -Intervention 1. Wound care and debridement, sterile whirlpool and dressing changes 2. Gentle AROM and PROM to individuals tolerance 3. Edema control 4. Splinting if necessary 5. ADLs and role activities

Pulmonary edema

-Excessive seepage of fluid from the pulmonary vascular system into the interstitial space -May eventually cause alveolar edema

Wrist extensors innervated by the radial nerve

-Extensor carpi radialis brevis (ECRB) -Extensor carpi radialis longus (ECRL) -Extensor carpi ulnaris (ECU)

Hallucinations

-False sensory perceptions that are not in response to an external stimulus -responding to internal stimuli

Sequelae/complications of diabetes

-Fatigue/decreased activity tolerance -Urinary disturbance -Visual loss, low vision, blindness -Peripheral neuropathy (amputations) -Propensity to develop wounds -Poor general health/increased rate of infections disrupting life roles and activity participation -Connective tissue disease associated with diabetes 1. there is a significantly higher incidence of Dupuytren's disease, limited joint motion, carpal tunnel syndrome, and flexor tenosynovitis in the diabetic population 2. characterized by development of soft tissue thickening in the palms of the hands and the soles of the feet -Hypoglycemia (very low blood sugar) : symptoms include vagueness, dizziness, tachycardia (abnormal increased heart rate), pallor (redness of face), weakness, diaphoresis (increased sweating), seizures, and/or coma; if person is conscious, immediately provide carbohydrates in the form of hard candy, fruit juice or honey; if person is unconscious immediately call for emergency medical care -Hyperglycemic crises (a metabolic emergency): ketoacidosis - signs include dehydration, rapid and weak pulse and acetone breath (sweet smell); hyperosmolar coma - signs include stupor (decreased cognition), thirst, polyuria (large production of urine), and neurologic abnormalities; call for emergency medical services as IV fluids and insulin are required

Wheelchair Components: leg rests

-Fixed: minimal benefit but may be seen in older wheelchairs and/or rentals -Swing-away: allows feet to be placed on the floor to prepare for transfers and for a front approach to wheelchair -Detachable: allows for a safe path for transfers -Elevating: allows for edema control and reduction

Wheelchair Components: frame

-Fixed: minimal benefit but may be seen in older wheelchairs or sports chairs -Folding: eases storage and facilitates mobility in community as it can fold to fit in car or van -Weight: ultra-light, active-duty lightweight, lightweight, standard and heavy duty frame construction are available (the lighter the weight of the chair generally the greater the ease of use; the demands of the individual's expected and desired activities must be considered)

Wrist flexors innervated by the median nerve

-Flexor carpi radialis (FCR) -Palmaris longus (PL)

Modular groups

-Focus of each session is rotated in a way that allows an individual to join the group at any time and still cover each topic -this approach is similar to the current treatment mall approach that allows for patient choice among a variety of treatment topics

Discharge planning groups

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

Educator (Consumer, peer)

-Functions to develop and provide training or educational offerings related to OT's domain of concern to consumer, peer and community groups or individuals -Can be an occupational therapist or an OTA/COTA with appropriate supervision

Academic Fieldwork coordinator

-Functions to manage fieldwork within the OT academic setting -Can be an occupational therapist or a OTA/COTA with a recommended three years of practice experience and experience in supervising fieldwork students -General supervision by the OT academic program director is recommended -Close to routine supervision is recommended for new faculty

Program director (academic setting)

-Functions to manage the occupational therapist or OTA education program with an appropriate advanced professional degree, experience as a faculty member and experience or continuing education in academic management -General to minimal administrative supervision from designated administrative officer (academic dean)

Faculty

-Functions to provide formal academic education to occupational therapist or OTA students -Can be occupational therapist or a OTA/COTA with an appropriate advance professional degree and intermediate to advanced skills in teaching -General supervision is recommended by academic program director -Close to routine supervision for new adjunct, and part-time faculty by program director

Occupational therapist (OT)

-Functions to provide quality of OT services (assessment, intervention, program planning, and implementation, discharge planning, related documentation and communication) -Can be direct, indirect or consultative in nature and can range from entry-level ti advanced level depending on experience, education and practice skills -The occupational therapist has utlimate responsibility for service provision -Occupational therapists who do not have access to formal supervision are advised to seek mentoring to facilitate professional growth and develop best practice skills

Occupational Therapy assistance (OTA)

-Functions to provide quality of OT services to assigned individuals under supervision of an occupational therapist -Can range from an entry level to advanced level depending on experience, education, and practice skills. -Development from entry level to advanced level is dependent upon development of service competency -OTAs who are certified by the NBCOT and participate in the NBCOT certification renewal program use the designation of COTA

Fetal sensorimotor development

-GESTATIONAL AGE: Age of the fetus or newborn, in weeks- from 1st day of mother's last normal menstrual period (Normal gestational period- 38-42 weeks; Gestational period divided into 3 trimesters) -CONCEPTUAL AGE: Age of a fetus or newborn in weeks since conception

Sequelae of HIV infection

-Generalized lymphadenopathy/enlarged lymph nodes: fatigue; weight loss (malabsorption of nutrients [wasting syndrome]); general malaise -Fever -Diarrhea -All of the above results in decreased tolerance for activity participation and lack of energy -Neurological impairments: 1. cognitive impairment (eg. safety issues, communication and expression impairments, alteration of personality, decreased ability to engage as before in interpersonal relationships); 2. affective changes; 3. sensory changes (associated with dementia); 4. basic ADL impairments such as inability to hold and manipulate objects for use (money, combs, tooth brushes, writing implements, feeding utensils, telephone, remote control, etc.); 5. myelopathy (spinal cord pathology); 6. peripheral neuropathy; 7. visual impairment (ie. peripheral: cytomegaloviral (CMV) infection, retinopathy, central: neurobehavioral loss/impairment)

Complications of BPD

-Greater risk for hypotonia and gross motor delays -Feeding problems can lead to poor nutrition - malabsorption problems; fragile bones with an increased risk of fractures -Central nervous system problems, such as damage to parts of the brain, can lead to delays or impairments in motor, sensory, speech, and cognitive function -Recurrent otitis media can lead to conductive hearing loss that can affect the development of speed and language as well as cognition

Health Care Regulations

-Health care is a highly regulated industry with most regulations mandated by law -Legally mandated regulations are set forth by the Center for Medicare and Medicaid Services (CMS), a division of US Department of Health and Human Services (HHS) (federal agency) -CMS is the federal agency which develops rules and regulations pertaining to federal laws, in particular the Medicare and Medicaid programs -Facilities that participate in Medicare and/or Medicaid programs are monitored regularly for compliance with CMS guidelines by federal and state surveyors -Facilities that repeatedly fail to meet CMS guidelines lose their Medicare and/or Medicaid certification(s) -Long-term settings, ie. skilled nursing facilities (SNFs), are strongly influenced by CMS regulations since Medicare and/or Medicaid pays for all or most of the expense of long-term care -CMS is divided into three centers: 1) the Center for Beneficiary Choices which focuses on Medicare Choice and Medigap 2) the Center for Medicare Management which focuses on traditional fee-for-service Medicare 3) the Center for Medicaid and State Operations which focuses on state administered programs like Medicaid and State Children's Health Insurance Program (SCHIP) -Standards related to safety are set forth and enforced by the Occupational Safety and Health Administration (OSHA), a division of the US Department of Labor -Structural standards and building codes are established and enforced by OSHA to ensure the safety of structures -The safety of employees and consumers is regulated by OSHA standards for handling infectious materials and blood products, controlling blood borne pathogens, operating machinery, and handling hazardous substances -State accreditation to obtain licensure for a health care facility is mandatory. Individual states develop their own requirements, with state agencies enforcing these regulations -Local or county entities also develop regulations pertaining to health care institutions (eg. physical plant safety features such as fire, elevator and boiler regulation)

Dietary and lifestyle interventions for heart failure

-Healthy food choices, low-salt and low-cholesterol diets, physical activity, weight reduction, and smoking cessation

Heat Syndromes/Hyperthermia: intervention

-Heat stroke: while waiting for emergency medical services to arrive, lower the persons body temperature by getting them to a cooler areas, placing ice packs on arterial pressure points or spraying body with a cool mist -hypothermia blankets, IV infusions and medications are necessary -heat cramps and heat exhaustion usually do not require hospitalization 1. loosen clothing and have the person lie in a cool place 2. replace fluid and electrolytes with fruit juice or a balanced electrolyte drink. If these are not available give fluids and seek additional medical care 3. massage muscles if cramps are severe 4. IV infusion and oxygen may be indicated if symptoms are severe

Assessment of Chronic pain

-History: determine chief complaints, description of onset, and mechanism of injury -Determine localization: chronic pain is poorly localized, not well defined -Identify nature of pain: constant, intermittent -Determine irritating stimuli/activities -Determine subjective assessment using pain intensity rating scale: 1) simple descriptive scales - verbal report (eg. select the words that best describe your pain) 2) semantic differentiation scales (eg. McGill Pain Questionnaire) 3) numerical rating scales (rate pain on a scale of 1 to 10, eg. 8/10) 4) visual analog scale (eg. bisect line where your pain falls, from mild to severe pain) 5) spatial distribution of pain - using drawings to plot location, type of pain -Physical examination: identification of underlying pathology (cause of pain); objective physical findings are usually not readily identified: 1) assess all systems - musculoskeletal, neurologic, and cardiopulmonary. Check for muscle guarding. 2) check for postural stress syndrome (PSS) - chronic muscle lengthening and/or shortening that causes postural malalignment and stress to soft tissues 3) check for movement adaptation syndrome (MAS) - habituated movement dysfunction 4) check for autonomic changes (sympathetic activity) - typically present with acute pain but not with chronic pain 5) assess for abnormal movements -Assess degree of suffering: 1) verbal complaints are out of proportion to degree of underlying pathology; include emotional content 2) the person exhibits a stooped posture, antalgic gait 3) the person exhibits facial grimacing -Assess for functional changes: 1) check for self-imposed limited activity; disrupted lifestyle; disuse syndrome 2) check for avoidance of work, home management, leisure, social, and/or sexual activity -Assessment for consequences of pain, behavioral impact, and secondary gains: 1) monetary benefits (malingering, insurance claims) 2) sympathy and attention 3) avoidance of undesirable tasks -Assess for depression, anxiety -Assess for prescription drug misuse -Assess for dependence on health care system; multiple health care providers, clinical services; "shopping around" behaviors -Determine responsiveness of pain to physiological interventions/treatments: chronic pain is often unresponsive -Determine motivational/affective components: 1) previous experience with pain 2) learned responses to pain 3) perception of control over pain 4) ethnic/cultural aspect of pain 5) familial response to pain behavior

OT intervention for suicide

-Identification of the motivation behind the suicidal intention and the identification of alternatives -Development of problem solving skills and stress management techniques to increase the individual's ability to manage life stressors -Identification of positive goals and interests to increase motivation for recovery -Identification of positive personal attributes and support systems to increase hopefulness (this may be facilitated by a review of past successes) -Activities that produce successful outcomes, especially those with a visible end-product, promote positive thinking -Activities designed for the expression and validation of feelings -Moderate physical activity elevates mood -Development of skills that increase functional performance -activities that are future oriented -patient/client and family education 1. managing relapse and disappointment with a plan in place for dealing with active suicidal ideation 2. developing strategies for dealing with hopelessness 3. reinforcing and supporting engagement in treatment 4. maintaining medication compliance 5. increasing family involvement 6. identifying support groups and resources 7. developing strategies to handle setbacks in recovery

Medical management of CVA

-Immediate care: 1) airway maintenance 2) adequate oxygenation 3) nutritional intervention (IV fluids, alternative feeding routes) 4) decubiti prevention 5) treatment of underlying cardiac dysfunction (dysrhythmias) -Pharmacologic therapies: 1) antithrombotic therapy (antiplatelet and anticoagulation) is used for rapid recanalization and reperfusion of occluded vessels to reduce infarction area, eg. aspirin, heparin 2) thrombolytic therapy is used in acute strokes to open occluded cerebral vessels and restore blood flow to ischemic areas, eg. t-PA

Sequelae and symptoms of Lyme disease

-Impairs the immune response and affects the neurological and orthopedic systems -Early symptoms: fatigue, severe headache, chills and fever, muscle and joint pain, swollen lymph nodes, rash (erythema migrans - a circular red patch occurring 3 days - 1 month after the bite from an infected tick; commonly in the groin, thigh, trunk and armpits; the center of the rash may clear as it enlarges, resembling a bull's-eye) -Late symptoms: arthritis in large joints, nervous system abnormalities (numbness, pain, Bell's palsy, meningitis); heart rate irregularities

ADHD impact on function

-Infants over-active, difficult to soothe, poor sleepers -defensiveness to environmental stimuli, frequent irritability, aggressive behavior, emotional lability, fluctuating/ unpredictable performance -difficulty with delayed gratification -deficits in perceptual motor tasks -disorders of memory, thinking, speech, hearing -depression 2/2 frustration, difficulty with learning -can be prone to antisocial personality disorders -at risk for substance-related disorders

Dietary restrictions for individuals taking MAOIs

-Ingesting foods or beverages that contain the amino acid tyramine can suddenly increase blood pressure and may lead to stroke or other serious cardiac reactions -Foods and beverages with tyramine must be completely avoided. These include 1. aged cheese (chedder) 2. pickled foods (Sauerkraut, herring) 3. Cured or smoked meats (salami, sausage, pepperoni, hot dogs) 4. liver 5. yogurt 6. sour cream 7. fruits that must ripen to eat (avocados, bananas) 8. fava beans 9. pea pods 10. chocolate 11. beer and red wine 12. meat tenderizers 13. soy products (soy sauce, tofu) 14. yeast extract 15 any product that has been improperly stored, overripened, not fresh, and past an expiration date -Many over-the-counter drugs also contain ingredients that can cause a serious interaction with MAOIs. These include cold, sinus and hay fever medications, nasal decongestants, asthma inhalants, pep pills, and appetite suppressants -severe headaches or palpitations can be the first sign of a hypertensive crisis. The medications should be stopped immediately and a physician consulted

Mandated Medicaid Services (pre-ACA)

-Inpatient and hospital services -Outpatient (laboratory work, x-rays, skilled nursing) and physicians services -Home health (level and amount of care can vary) Early periodic screening diagnosis, and treatment services (EPSDT) for persons 21 years old and younger -Services identified as needed to treat a condition during EPSDT (including OT) must be provided -SNFs receiving Medicaid must provide skilled rehabilitation services (Including OT) to residents who require them

Diencephalon: Hypothalamus

-Integrates and controls the function of the autonomic nervous system and neuroendocrine system. -Maintains body homeostasis: regulates body temperature, eating, water balance, anterior pituitary function/sexual behavior and emotion

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

Types of teams

-Intradisciplinary team -Multidisciplinary team -Interdisciplinary team -Transdisciplinary team -Team efficacy: interdisciplinary and transdisciplinary teams are the most common and considered the most effective in today's health care system

fourth degree burn

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

superficial (first-degree) burns

-Involves the epidermis only 1. minimal pain and edema, but no blisters 2. healing time is 3 to 7 days

Wheelchair measurements: seat height

-Knees and ankles should be positioned at 90 degrees measure from distal thigh to heel 1. measure both LEs and use the shortest length if the person will be self-propelling the wheelchair using their LEs -because foot rest should have 2" clerance from the floor add, 2" to this measurement (the w/c cushion selected will affect this measurement -standard height: 20" -hemi-height: 17.5" Chair: Minimum clearance is 2" between floor and footplate measured from lowest point on bottom of footplate. Add 2" to pt's leg length measure.

Medicare - General information

-Largest single payer for OT services -Administered by CMS -Intermediaries determine if services provided are within Medicare guidelines -Persons eligible for Medicare medical coverage for health care services: 1) persons 65 years or older 2) individuals of all ages with end-stage renal disease/permanent kidney failure that may require dialysis treatment or a kidney transplant 3) Persons with a long-term disability (ALS, MS) who have received government-funded disability benefits for 24 months may be eligible 4) Retired railroad workers -The primary difference between Part A and Part B is 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 a week outpatient services -Medicare does not cover chronic illness, long term supportive care, or all medical expenses incurred when ill -OT hospice care is provided to persons who are certified as terminally ill (medical prognosis of fewer than 6 months to live). OT services are provided to enable a patient to maintain functional skills and ADL performance and/or control symptoms -OT is covered as an outpatient service when provided by or under arrangements with any Medicare Certified provider (ie. hospital, SNF, home health agency, rehabilitation agency, a clinic) or when provided as part of comprehensive rehabilitation facility services (CORF) -OT services can also be covered if provided by a Medicare certified OT in independent practice (OTIP) when services are provided by the OT in the OT's office or in the patient's home (payment is according to the fee schedule entitled the Resource Based Relative Value Scale (RBRVS) -All of these standards can change when and if new federal legislative guidelines are passed for Medicare

Private insurance and managed care plans

-Largest source of insurance payment in US (there are broad variations among plans and plan options; they can be for profit or not for profit, organizations or networks) -Many private insurers contract with Medicare to handle the day to day operations of Medicare. They are called intermediaries -Insurers (eg. Blue Cross/Blue Shield, Aetna, MetLife, and Prudential), offer many insurance products including PPOs, HMOs, and managed care -Coverage cannot be assumed based on the name of plan alone (co-insurance, deductibles and co-payments are common; most plans cover for OT in hospitals; outpatient coverage varies greatly; total number of visits and/or type and amount of services per diagnosis are limited) -Insurers are not federally regulated. Each state determines its own requirements and regulations for insurers who operate within their borders -Under the ACA, federal regulations were established for private insurance coverage. Key ones include the following: insurers must provide essential benefits to participants in their plans, these included mental health, substance abuse and behavioral health treatment; rehabilitative, habilitative and chronic disease management services and devices and preventative and wellness services. Insurers could no longer refuse coverage to persons with preexisting conditions -Cost controlling payment strategies such as case management, precertification or preauthorization, mandatory second opinions, and preferred provider networks are often implemented -Occupational therapists can join health care provider panels and/or a preferred provider network

Brain stem: Cerebellum

-Located behind dorsal pons and medulla in posterior fossa -Structure 1. Jointed to brain stem by three pairs of peduncles: superior, middle and inferior 2. Composed of two heispheres and midline vermis; have cerebellar cortex, underlying white matter and four paired deep nuclei 3. Archicerebellum (flocculonodular lobe) connects with vestibular system and is concerned with equilibrium and regulation of muscle tone 4. Paleocerebellum (anterior lobes and bermis) recieves input from proprioceptive pathways and is concerned with modifying msucle tone and synergistic actions of muscles; it is important in maintenance of posture and voluntary movement control -Neocerebellum (middle lobes) recieves input from corticopontocerebellar tracts and olivocerebellar fibers; it is concerned wit the smooth coordination of voluntary movements; ensures accurate forces, direction and degree of movement

Anorexia Nervousa: Diagnostic criteria

-Low body weight due to difficulty maintaining body weight within or above normal paramateres for sex, age and height or due to an inability to gain weight as expected during growth periods (in this case, body weight is 85% or less than expected) -despite being underweight, there is a fear of gaining weight or becoming fat, the individual tends to perceive self as being heavier than in actuality -Alternation in self-perception of body weight or shape 1. physical body weight or shape is considered important in determination of self-evaluation of self-worth 2. the individual may not realize or may deny the presence of low body weight and the seriousness of the effects despite being ill or hospitalized -2 types may be identified either food restrictive type or binge eating/purging types -Most commonly beings in midteens (more common in girls)

Carpal tunnel syndrome (CTS)

-MEDIAN nerve compression -Etiology: repetition, awkward postures, vibration, anatomical anomalies, and pregnancy. -Symptoms: numbness and tingling of the thumb, index, middle, and radial half of the ring finger 1. Paresthesia usually occur at night (most characteristic) 2. Person will complain of dropping things 3. Positive Tinel's sign at wrist. Positive Phalen's sign 4. Advanced stage of CTS can result in muscle atrophy of the thenar eminence -Conservative treatment 1. wrist splinting in neutral: should be work at night and during the day of performing repetitive activity 2. Median nerve gliding exercises (gentle sliding should not place tension on the nerve) and differential tendon gliding exercises 3. Activity modification: avoid activities with extreme positions of wrist flexion, wrist flexion with repetitive finger flexion and wrist flexion with a static grip 4. Ergonomics: appropriate workstation design. CTS is the most common work-related injury of the UE -Surgical interventions: carpal tunnel release (CTR) -Postoperative treatment of CTR 1. edema control: elevation, retrograde massage, compression glove, and/or contrast bath 2. AROM 3. Nerve and tendon gliding exercises 4. Sensory re-education 5. Strengthening of thenar muscles (usually 6 weeks postoperative) 6. Work/activity modification

Pronator teres syndrome (proximal volar forearm)

-Median nerve compression between the two heads of pronator teres. -Etiology: repetitive pronation and supination and excessive pressure on volar forearm. -Symptoms: Sames as carpal tunnel with aching pain in the proximal forearm. 1. Positive Tinel's sign at the forearm 2. No night symptoms -Conservative treatment 1. Elbow splint at 90 degree with forearm in neutral 2. Avoid activities that include repetitive forearm pronation and supination -Surgical intervention: decompression -Postoperative treatment 1. AROM 2. Nerve gliding 3. Strengthening (2 weeks postoperative) 4. Sensory re-education 5. work/activity modification

Clubhouse programs (Community-based practice)

-Membership is open to adults and elders with a current mental illness or a history of mental illness 1. All members have equal access to all clubhouse functions and opportunities regardless of functional level or diagnosis 2. Individuals who pose a significant and direct threat to the safety of the clubhouse community are the only persons excluded -Services are provided by staff and members with the responsibility of operating the clubhouse shared equally by staff and members under the oversight of a director 1. Due to this role equality, it can be difficult to distinguish between members and paid staff 2.Staffs main role is to engage membership, provide needed support and structure and enable recovery -Individual schedules will vary to meet each persons unique needs and interests 1. Clubhouses are open at least 5 days per week. Many are open 7 days per week 2. The daily schedule is organized around the work-ordered day which parallels typical working hours to engage members and staff in the running of the clubhouse 3. Evening and weekend schedules are focused on avocational interests and recreational pursuits 4. Additional services that can be provided include literacy and education programs, transitional employment placements, independent employment assistance, community support and out-reach services, housing programs and legal and financial advisement -LOS is indefinite and members can exit and reenter a clubhouse community at will -OT evaluation and intervention are not provided in a formalized manner 1. the role of the OT practitioner is integrated into generalists who contribute to the development and enrichment of members abilities and the promotion of their recovery

Shoulder abduction muscles

-Middle deltoid-Innervated by the axillary nerve -Supraspinatus- Innervated by the supra scapular nerve- abduction & flexion of shoulder

Risk factors for CVA

-Modifiable risk factors: 1) hypertension 2) cardiac disease 3) atrial fibrillation 4) diabetes mellitus 5) smoking 6) alcohol abuse 7) hyperlipidemia -Nonmodifiable risk factors: 1) age - relative risk increases with age 2) gender - males are at higher risk 3) race - African-American and Latino are at greater risk 4) heredity

Early Intervention and Education Acts

-Multiple acts have provided the foundation for current early intervention and education services. These include: 1. Mandates for free and appropriate education (FAPE) for all children regardless of ability or disability, (aged 3-21) in the least restrictive environment (mainstreaming [ie integrating children with disabilities into classrooms] was the means to ensure education is provided in the least restrictive environment) 2. Requirements that public schools provide OT to special education students if OT is needed for the student to benefit from the special education 3. The designation of occupational therapy as a primary early intervention service 4. Funding for family support services and programs to train professionals in early intervention 5. Recommendations for states to develop infant and toddler programs (birth to 3 years) (programs are voluntary and vary from state to state but all states participate to some degree; OT is considered a primary developmental service)

Symptoms of ALS

-Muscle weakness in one or more of the following: hands, arms, legs, or the muscles of speech, swallowing, or breathing -Twitching (fasciculation) and cramping of muscles, especially those in the hands and feet -LMN signs are soon accompanied by spasticity, hyperactive deep tendon reflexes and evidence of corticospinal tract involvement -Dysarthria and dysphagia are evident -Sensory symptoms, eye movements and urinary sphincters are often spared -symptom severity is documented by scores on the ALS functional rating scale (symptoms are quantified include speech, salivation, swallowing, handwriting, cutting food, dressing/hygiene, turning in bed, walking, climbing stairs, dyspnea, othopnea, respiratory insufficiency, number of years with symptoms) -Impairment of the use of the arms and legs -"Thick speech" and difficulty projecting the voice

Neurons: Structure

-Neurons vary in size and complexity -Cell bodies (genetic center) with dendrites (receptive surface area to receive information via synapses) -Axons conduct impulses away from the cell body (one-way conduction) -Synapses allow communication between neurons; chemical neurotransmitters are released (chemical synapses) or electrical signals pass directly from cell to cell (electrical synapses) -Neuron groupings and types: 1) nuclei are compact groups of nerve cell bodies; in the peripheral nervous system these groups are called ganglia 2) projection neurons carry impulses to other parts of the CNS 3) interneurons are short relay neurons 4) axon bundles are called tracts or fasciculi; in spinal cord, collections of tracts are called columns, or funiculi -Neuroglia: support cells that do not transmit signals; important for myelin and neuron production; maintenance of K+ levels and reuptake of neurotransmitters following neural transmission at synapses

Grasping skills according to Erhardt Prehension Developmental Levels: Grasping of Pellet (Prone or sitting)- 8 mo

-No voluntary grasp or visual attention to object (natal) -No attempt to grasp, but visually attends to the object (3 months) -Raking and contacting object (6 months) -Inferior scissors grasp: raking object into palm with adducted, totally flexed thumb and all flexed fingers or two partially extended fingers (7 months) -Scissors grasp: between thumb and side of curled index finger, distal thumb joint slightly flexed, proximal thumb joint extended (8 months) -Inferior pincer grasp: between ventral surfaces of thumb and index finger, distal thumb joint extended, beginning of thumb opposition (9 months) -Pincer grasp: between distal pads of thumb and index finger, distal thumb joint slightly flexed, thumb opposed (10 months) -Fine pincer grasp: between fingertips or finger nails, distal thumb joint flexed (12 months)

Neurodevelopmental treatment (NDT)/The Bobath technique

-Normalization of postural limb tone is prerequisite to normal movement 1. tone abnormalities include flaccidity (low tone) or spasticity (high tone) -avoidance of movements and activities that increase tone -inhibition of primitive reflexes and abnormal postureal limb movements -development of normal patterns of posture and movement -improvement of the quality of movement and performance of the involved side -associated reactions (nonfunctional and involuntary changes in the uninvolved limb position and tone) should be avoided -postural reactions are considered the basis for control of movements 1. these reactions include righting, equilibrium, and protective responses -loss of postural control results in overuse of sound side and limits functional movements -the stereotypical patterns of the trunk and limbs observed in persons with CNS dysfunction are viewed as abnormal patterns of motor coordination -focus is on improving the quality of movement 1. normalization of movement patterns 2. integration of both sides of the body/reestablishment of symmetry of the sides of the body to increase functional use 3. establishment of the ability to weight bear and weight shift through the limbs 4. establishment of normal righting and equilibrium patterns -handling is the primary intervention to promote normal movement

Bathroom considerations

-Number of bathrooms in the home -Location of bathroom(s) relative to the bedroom, living room, kitchen, and other living spaces important to the individual -Width of the bathroom doorway -Type of bathing the individual with the disability performs (ie. bath, shower, sponge bath) -Type of shower: separate stall, glass door tub with shower, curtain-enclosed tub with shower -Presence and location of grab bars (the soap dish and towel bar are not grab bars) -If home is a rental, landlord's agreement to allow grab bars to be installed if needed -Height of tub, sink, and toilet -Presence of a non-skid mat or skid-free surface in the shower/tub -Presence of a throw rug outside of shower -Availability of a hand-held shower -Presence of anti-scald valves and/or faucets

OT practitioner roles - general information

-OT practitioners include occupational therapists (OTs) and occupational therapy assistants (OTAs) -Due to the implementation of the voluntary NBCOT certification renewal program, all OTs may not be OTRs and all OTAs may not be COTAs -OT aides have an important role but are not considered OT practitioners -OT practitioners can assume a variety of roles including entry to advanced level practitioner, peer and/or consumer educator, fieldwork educator, supervisor, administrator, consultant, fieldwork coordinator, faculty member, academic program director, researcher/scholar, and/or entrepreneur -Role development and advancement depends on practitioner's experience, education, practice skills, and professional development activities (ie. self study, continuing education, advanced degrees)

Optional medicaid services (Pre-ACA)

-OT, PT, speech-language therapy) -Durable medical equipment -Services provided by independently practicing licensed professionals including psychologists, psychiatric social workers, and other mental health professionals -Targeted case management -Prescription medications -Dental care, eyeglasses -Crisis response services -Transportation -Psychiatric inpatient services for persons aged under 21 and over 65 -Related services (including OT) provided by school systems to children with disabilities. (1) This provision overlaps with IDEA legislation and has led to questioning as to whether services to individual children should be funded as an educational or a health-care service)

OTA/COTA

-OTAs are graduates of Accreditation Council for Occupational Therapy Education (ACOTE) accredited technical educational programs, which are generally two years in duration, resulting in an associate degree or a Certificate (COTAs are certified by the NBCOT and participate in the NBCOT certification renewal program) -OTAs/COTAs primary role is to implement treatment -OTAs/COTAs can contribute to the evaluation process but the cannot independently evaluate or initiate treatment prior to the occupational therapist evaluation -OTAs/COTAs can contribute to development and implementation of the intervention plan and the monitoring and documenting of the individuals response to intervention under the occupational therapists supervision -OTAs/COTAs can expand their role by establishing service competency (Service competency is the ability to complete the specified task in a safe, effective and reliable manner [the OTA/COTA and occupational therapist can perform the same or equivalent procedure and obtain the same results]. OTAs/COTAs who establish service competent do not become independent; they continue to work with the occupational therapist supervisor) -OTA/COTAs can be activities directors in skilled nursing facilities and can supervise OT aides -AOTA supports the independent practice of OTAs/COTAs with advanced-level skills who work for independent living centers (state licensure laws and scope of practice legislation may superseded this recommendation)

OT Evaluation for fractures

-Occupational profile -History should include mechanism of injury and fracture management -Results of special tests (x-rays, magnetic resonance imaging, and computed tomography scan) -Edema -Pain -AROM 1. Do not assess PROM or strength until ordered by physician 2. Exceptions are humerus fractures that often begin with PROM or AAROM -Sensation -Roles, occupations, ADLs and activities related to roles

OT profile in cardiopulmonary assessment

-Occupational profile obtains information from the persons medical record and interview to determine their medical and occupational history, activity patterns, roles, interests, values, priorities, needs and desired outcomes 1. medical record review -review current medical record and past medical history to learn about the onset of a cardiac incident or cardiopulmonary condition past and current diagnoses, chronic or concurring conditions, medications and prognosis -review diagnostic tests: review results to determine implications for OT intervention including activity restrictions, vital sign parameters and prognosis 2. Client interview -interview person and family/caregiver to *establish client-centered priorities and outcomes through formal interview and causal conversation *establish rapport and foundation for therapeutic relationship with person and family caregivers -obtain social history *information used to determine implications for OT intervention including activity selection, educational/learning needs, social supports, discharge needs *areas includes educational history, vocational/avocational history, leisure pursuits and activities history, presence/absence of substance abused, diet, family configuration and social supports

Sexual Expression/Activity Intervention

-Occupational therapy intervention is provided to enable satisfying, safe sexual expression/activity regardless of disability, disease, or advanced age -Myths about the sexuality of the aged and individual's with disability or disease processes must be confronted and debunked. -Occupational therapists should use the PLISSIT model as a guide for appropriate interventions -Methods of intervention can include one-on-one counseling sessions, therapeutic groups, and/or dissemination of printed materials -Interventions for individuals with cognitive impairments (eg. poor impulse control, limited judgement) are essential to ensure safety and to protect the individual from sexual abuse, assault and/or exploitation 1. assertiveness training to increase understanding of the right and develop the ability to set limits 2. training and practice in physical self-protection techniques 3. role playing to stimulate potential scenarios that can challenge the individuals sexual judgement 4. sex education -Caregiver and family education

General principles of motor development

-Occurs in a cephalocaudal/proximal to distal direction -Progresses from gross to fine movement -Progresses from stability to controlled mobility -Occurs in a spiraling manner, with periods of equilibrium and disequilibrium -Sensitive periods occur when the infant/child is affected by environmental input

Fascioscapulohumeral muscular dystrophy

-Occurs in early adolescence -Involves the face, upper arms, and scapular region, causing masking and decreased mobility of the face and the inability to lift the arms above shoulder level -as it progresses the weakness can extend to the abdominal muscles and sometimes the hip muscles -progresses slowly and rarely affects the cardiac or respiratory systems, thus life expectancy can be relatively normal

Co-leadership

-Occurs when there is sharing of group leadership between two or more therapists -Advantages: 1) each leader can assume different leadership roles, tasks and styles 2) both leaders can provide and obtain mutual support 3) observations and objectivity can increase 4) co-leaders can share knowledge and skills 5) co-leaders can model effective behaviors- Disadvantages may arise and must be dealt with for effective co-leadership: 1) splitting by group member(s) of one leader against the other 2) excessive competition among co-leaders 3) unequal responsibilities resulting in an unbalanced work load among co-leaders

Bulimia Nervosa (BN): Diagnostic criteria

-Ongoing binge eating of much larger portions than would be expected and feeling the inability to control consumption to avoid gaining weight -Attempts are made to avoid gaining weight through vomiting, using laxatives, fasting and engaging in extreme amounts of exercise -Begins in adolescence or in early adulthood (more common in women than men) -Adolescents with bulimia have reported higher rates of suicide ideation and suicide attempt than adolescents with anorexia

Schizophrenia Diagnostic criteria

-Onset: early adolescence and the early 30s -Criterion A: the presence of two or more of the following symptoms: delusions; hallucinations; disorganize speech; grossly disorganized or catatonic behavior (positive symptom); negative symptoms -Criterion B: disturbance in one or more areas of function such as work, interpersonal relations, or self care -Criterion C: continuous signs of the illness for 6 months including at least one month of symptoms that meet criterion A -Criterion D: other related disorders including schizoaffective disorder or depressive/bipolar disorder with psychotic features, have been rules out as diagnosis -Criterion E: the disturbances is not being caused by another medical condition or substance use -Positive symptoms are the excesses or distortions of normal function as found in criterion A -Negative symptoms represent a loss or absence of function: 1. restricted emotion (affective flattening) 2. decreased thought and speech (alogia) 3. lack of motivation/energy (anergia) and initiative; 4. Difficultly in experience pleasure (anhedonia) 5. inability to relate to others (anergia is often incorrectly interpreted as a lack of motivation) -Specifiers are provided for each diagnosis to further describe and clarify what the presenting individual is experience in terms of the disorder 1. the identification of the frequency of the presenting conditions (first episode or multiple episodes) and the current status of the presenting condition (acute episode, in partial remission or in full remission) 2. Additional specifiers can include noting if the condition is continuous, unspecified or with catatonia 3. the current severity of the condition is also specified.

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.

Supported education programs (Community-based practice)

-Participant criteria include adolescents of adults who require intervention to develop skills that are needed to succeed in secondary and/or postsecondary education 1. The person may have never developed these skills or lost them due to a psychiatric disability or mental health problems -LOS is determined by agency's funding and persons attainment of goals 1. Discharge is upon entry into or completion of an educational program or the attainment of a graduate equivalency degree (GED) -OT evaluation is focused on the individual's client factors and performance skills and patterns that impact on the occupational role of student -OT intervention focus 1. Improvement in performance skills and patterns that are needed for the occupational role of student (time management and task prioritization) 2. Education and training in compensatory strategies to support academic performance (studying in a quiet room) 3. Exploration of participants educational interests and aptitudes to ensure self-determined engagement in a school, college, technical training program or community-based adult education class(es)

Prevocational programs (Community-based practice)

-Participant criteria include adolescents or adults who require intervention to develop skills that are prerequisite to work. 1. The person may have never developed these skills due to developmental delays, environmental insufficiencies, illness, or disability 2. The person may have lost these skills due to illness or disability -LOS is determined by agency's funding and persons attainment of goals 1. discharge is usually to a vocational program, 2. discharge to a work setting can occur in sufficient abilities are developed -OT evaluation is focused on the individuals tasks skills, social interaction skills, work habits, interests and aptitudes -OT Intervention focus 1. Improvement in task skills and social skills that is prerequisite to vocational training or work 2. Development of work habits and abilities 3. Exploration of work interests and aptitudes to ensure discharge to a relevant vocational training program, school or work setting

Ethnographic (qualitative research)

-Patterns and characteristics of a cultural group, including values, roles, beliefs and normative practices are intensely studied 1. Extensive field observations, interviews, participant observation, exam of literature and materials and cultural immersion are used 2. used in health care to understand an insiders perspective to develop meaningful services (study of a nursing home)

Avoidant/Restrictive Food Intake Disorder (ARFID)

-Persistent failure to meet nutritional needs and expectations, resulting in any of the following symptoms 1. nutritional deficiency 2. significant weight loss 3. reliance on oral nutritional supplements or alternative feeding methods (enteral feeding via pump) 4. Clinical disturbance is psychological functioning

narcissistic personality disorder

-Persons with this disorder are characterized by a heightened sense of self-importance and a grandiose feeling that they are special in some way

Avoidant personality disorder

-Persons with this disorder show an extreme sensitivity to rejection, which may lead to a socially withdrawn life -These individuals are not however asocial. they show a great desire for companionship but consider themselves inept or unworthy -Individuals with this disorder need unusually strong and repeated guarantees of uncritical acceptance -these persons are commonly referred to as having and inferiority complex

Sequelae of scleroderma and recommendations

-Poor circulation, as in Raynaud's phenomenon: 1) use of dressing in layers of clothing and clothing style modifications for neutral warmth; 2) biofeedback (guided imagery to concentrate on improving distal circulation); 3) education to encourage skin inspection; 4) activity modifications to prevent trauma to fingers and toes -Contractures: 1) splinting at optimal resting length for hands/wrists to attempt to slow progressive development of contractures; 2) use of silicone gel in the palms of the hands; 3) use of electrical/mechanical vibration to decrease burning sensation in hands -Facial disfigurement and alteration in body image and self-identity: "look good/feel better" programs; support groups in person and online 1. work with people to help them choose adaptations and new accessories to ease their adjustment to their changing appearance -Thoracic spinal lesions can result in paraparesis, neurogenic bowel/bladder, altered mobility, altered activity of daily living activities: 1) neuro rehabilitation and 2) biomechanical approaches is indicated -Space occupying lesions in the brain produce stroke-like symptoms: 1) rehabilitation for functional deficits

Skeletal System Changes and Adaptations in the Older Adult: strategies to slow, reverse and or compensate for age related skeletal system changes

-Postural exercises: stress components of good posture -Weightbearing (gravity-loading) exercise can decrease bone loss in older adults (walking, stair climbing, all activities that are performed in standing) -Nutritional, hormonal and medical therapies

Criteria for coverage of OT services (Medicare)

-Prescribed by a physician or furnished according to a physician-approved plan of care -Performed by a qualified occupational therapist of a OTA/COTA with the general supervision of an occupational therapist -Service is reasonable and necessary for treatment of individuals injury or illness -Diagnosis can be physical, psychiatric or both. There are no diagnostic restrictions for coverage -OT must result in a significant, practical improvement in the person's level of functioning within a reasonable period of time

Autism Spectrum Disorder (ASD): Diagnostic characteristics

-Presence of at least 2 core symptom domains 1. impaired social communication and social interaction 2. restricted, repetitive patterns of behavior, interests or activities -Delay or impairment in social interaction, language, and play (symbolic or imaginative) is present before three years of age -Not better described as Rett's syndrome or childhood disintegrative disorder -Difficulty with sensory processing and perception of various sensory stimuli; difficulty in modulation of stimuli at various levels of the continuum, (hyper-or hypo-responsiveness) -Commonly associated behaviors may include unanticipated mood swings, temper tantrums, lack of ability to focus, insomnia and enuresis -Deficits tend to be more severe in verbal sequencing and abstraction versus abilities in visuospatial and rote memory skills (calculation, musical abilities)

Ergonomic program characteristics

-Prevention is the main focus to fit the work place to the human body -Types of programs: 1) ergonomic survey 2) specific job site analysis 3) manager and employee training 4) educational seminars 5) exercise and stretch programs

muscles of ventilation

-Primary muscles of inspiration: diaphragm, intercostals -Accessory muscles of inspiration: (used when a more rapid or deeper inhalation is required or in disease) sternocleidomastoid, scalenes, levator costarum, serratus, trapezius, and pectorals -Expiratory muscles: 1. Resting expiration- done by passive relaxation of inspiratory muscles and elastic recoil tendency of lungs; 2. Expiratory muscles used when quicker, fuller expiration is desired or in disease-quadratus lumborum, intercostals, rectus abdominis, triangular sterni -mechanics of breathing: forces acting upon the rib cage include elastic recoil of lungs, bony thorax, muscles -respiration: diffusion of gas across the alveolocapillary membrane

Specific Documentation formats

-Problem Oriented Medical Record (POMR): a system of providing structure for progress note writing that is based on a list of problems based on assessment (SOAP notes) 1. Subjective: information reported by the client, family, or significant other 2. Objective: diagnosis, medical information, history and measurable, observable data obtained through formal assessments 3. Assessment: therapist's interpretation and clinical reasoning based on objective data includes analysis of clients status and goals and a prioritized problem list 4. Plan: the therapists specific plan of intervention to resolve identified problems and meet state goals -Consultation reports: meetings and/or phone conversations with team members, other professionals, the individual, and his/her caregivers -Critical incident reports: significant, out of the norm events that may occur during OT evaluation or intervention (eg. the individual slips during a transfer) -All of the above must comply with general documentation standards and contain all fundamental components of documentation

Job coach

-Provide on-site one-on-one training to employees with disabilities to help them learn to perform their jobs accurately, efficiently and safely, and acclimate to the work environment -Performs job analysis at work sites to match people with optimal positions -Conducts assessments, develops jobs and provides counseling required to retain employment -The job coaches degree of involvement with the employee decreases over time as the employee masters the job with follow-up services provided as needed

Lifespan development

-Psychological theories address changes in cognitive, personality and social development in the middle and later years of life -Development is both biologically and socially constituted 1. the second half of life is characterized by developing as an individual 2. Successful aging is associated with greater cognitive plasticity 3. Individuals interpret their life situation in terms of their aging process

Socioeconomic selectivity

-Psychological theories address changes in cognitive, personality and social development in the middle and later years of life -Individuals make choices regarding those with whom they choose to interact 1. selected interactions are baed on self-interest and a need for emotional closeness 2. With aging individuals reduce interactions with some people and increase emotional closeness with those who are viewed as important

selective optimization with compensation theory

-Psychological theories address changes in cognitive, personality and social development in the middle and later years of life -Model of psychological and behavior adaptation identifying three fundamental mechanisms (selection, optimization, and compensation) for managing adaptive development in later life 1. Selection: developing, elaborating and committing to personal goals 2. optimization: the resources required and applied for meeting goals 3. Compensation: how older people maintain positive functioning in the face of health-related constraints and losses

Cognition and Aging Theories

-Psychological theories address changes in cognitive, personality and social development in the middle and later years of life -Selected cognitive changes are a component of normal aging 1. Fluid intelligence reflects genetic/biological determinants and abilities (learning, memory and reasoning)- these capabilities decline with age 2. Crystallized abilities represent the influences of society and culture on general knowledge, these capabilities are more stable and may even increase with age

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 continuums 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 -Evaluation 1. Focuses on gathering data indicative of function/dysfunction in the above categories -Intervention 1. Focuses on the acquisition of the specific skills people need to function in their environment 2. the principles of learning are used to promote skill development 3. general postulates for changing are provided to guide the intervention process -long term goals are set based on the person expected environment -initially, tasks and interpersonal skills can be taught separately or they can be taught within the context of the learning of social roles -an adequate repertoire of behavior is acquired through activities that elicit the desired behavior are interesting to the client, include socializing and apply the principles of learning -intrapsychic content is shared matter-of-factly with the client and reality testing is provided -the occupational therapist must know specifically what kind of behaviors they wish to promote or enhance 4. specific postulate are provided for each of the continuums 5. any treatment activities or strategies that employ the teaching-learning principles are acceptable

Extensor digiti minimi

-Radial nerve § Origin: lateral epicondyle § Insertion: inserts into EDC at MCP level of the 5ht digit § Function: extension of MCP joint of the 5th digit and contributes to extension of the IP joints

Extensor carpi radialis longus (ECRL)

-Radial nerve § Origin: supracondylar ridge of the humerus § Insertion: 2nd metacarpal, base § Function: extension of wrist and radial deviation

Every Student Succeeds Act (ESSA)

-Reauthorized the No Child Left Behind act, which was formerly call the Elementary and Secondary education Act (ESEA) -A general education law that emphasizes standards based on education with a focus on improving the educational opportunities and outcomes for children from lower-income families -Considers occupational therapists to be pupil services personnel and sets no requirements for OT services -Requires schools to provide accommodations, if needed by students for mandates tests 1. OT practitioners can recommend testing alternatives and/or classroom accommodations

Substance Use-disorder prevention that promotes optimal recovery and treatment (SUPPORT) for Patients and communities Act (HR6)

-Requires the CMS to develop acute care practice guidelines for nonpharmological pain management and opioid use disorder prevention (These guidelines are to be developed with input from health-care professional including OT practitioners) -Promotes Medicaid coverage for nonpharmological therapies for the management of pain, including coverage of OT services -Requires training programs about pain care for health professionals to include information about nonpharmological alternatives for pain management

Prenatal period (Development of sensorimotor integration)

-Responds first to tactile stimuli -Reflex development -Innate tactile, proprioceptive and vestibular reactions

Report and dissemination of research findings

-Results section: 1) in quantitative/experimental research, report all factual data with no interpretation 2) in quantitative/experimental research report all findings with no bias towards reporting only results supportive of the study's hypothesis 3) in qualitative/naturalistic research, results, conclusion and interpretations are discussed in an integrated manner (descriptions, illustrative quotations, and brief examples are used; writing format used depends on the qualitative/naturalistic design of the study) -Conclusion section: 1) interpretation of the results 2) comparison of study's findings to those presented in the literature review 3 ) analysis of findings supportive and non-supportive of the hypothesis -Summary: 1) major contributions, practical or theoretical implications that can be drawn from the study 2) brief suggestions for improvements to the study's design and procedures 3) proposals for new research based on study's findings

Tremor

-Rhythmic, alternating, oscillatory movements produced by repetitive patterns of muscle contraction and relaxation 1. classified by rate, rhythm and disruption 2. are identified as to whether they occur at rest (resting tremor) or during activity (action or intention tremor)

pulse/heart rate

-Rhythmical throbbing of arterial wall as a result of each heartbeat; influenced by force of contraction, volume and viscosity of blood, diameter and elasticity of vessels; emotions, exercise, blood temperature, hormones -Assessment: done by palpation of peripheral pulses; with normal rhythm palpate 30 seconds with irregular rhythm palpate one or two minutes; taken prior to activity, during activity and after activity -Palpation sites 1. radial: most common monitoring site, radial artery, radial wrist at base of thumb 2. temporal: superior and lateral to eye 3. carotid: on either side of anterior neck between sternocleidomastoid muscle and trachea; best reflects cardiac function 4. brachial: medial aspect of the antecubital fossa; used to monitor blood pressure 5. femoral 6. popliteal 7. pedal

Coronary circulation

-Right coronary artery (RCA): supplies right atrium, most of right ventricle and most individuals the inferior wall of left ventricle, artioventricular (AV) node and bundle of His, 60% of the time supplies the sinoatrial (SA) node -Left coronary artery (LCA): supplies most of the left ventricle; has two main divisions 1. left anterior descending (LAD) supplies the anterior wall of the left ventricle 2. Circumflex supplies the lateral and inferior walls of the left ventricle and portions of left atrium; supplies SA node 40% of the time -Veins: parallel arterial system

Bed mobility

-Rolling, bridging, sidelying, supine, and sitting -Some diagnoses require special positioning in bed to: 1) maintain alignment of vulnerable joints 2) provide variation in postures 3) decrease the effect of pathological reflex activity 4) provide variations in ranges of motion 5) provide stretch to muscles prone to contracture 6) increase comfort 7) include supine as well as right and left side positioning -Specific mobility/positioning techniques: 1) status-post total hip replacement (may not be permitted to roll on the operated side. This may result in internal rotation of the operated hip, which may cause dislocation; may require use of abductor pillow between lower extremities to prevent adduction of the operated hip) 2) status-post CVA (may need education regarding proper positioning of upper extremity to increase awareness, minimize pain, decrease swelling, and promote normalization of tone; may also require use of pillows between knees while in sidelying to increase comfort and promote proper positioning) 3) status-post amputation of the lower extremity (may require training regarding use of pillows to prevent edema in the lower extremity; may also need training on how to provide passive stretching to residual limb while in bed to prevent shortening or contracture, which would make prosthetic training difficult and painful) -Bed mobility aids: 1) hospital beds, usually with bedrails and elevating head and foot surfaces 2) trapeze frame attached to bed 3) Hoyer lift/trans-aid: a hammock device that is attached to either hydraulic or manual lift systems to transfer individuals who are dependent 4) bedpans and urinals to decrease need to leave bed

Prevocational Assessment Process

-Screen to identify deficits in occupational performance areas and/or performance components that could impact on work abilities and potential -Determine if the individual is interested in prevocational assessment and intervention -Gather relevant work, educational, social and medical history information -Identify prevocational interests through the use of interest inventories and/or structured interviews -Assess current level of work-related skills: 1. conduct structured observations of an individual performing work tasks in a prevocational group or sheltered workshop or during a job simulation (rating scales or checklists of prevocational skills and behaviors are used); 2. administer standardized work assessments (aptitude tests to determine individual's strengths and weaknesses in a variety of areas such as verbal and numerical abilities; behavioral and personality tests to determine personality characteristics, attitudes, motivators, and intra- and interpersonal strengths; manual dexterity tests to determine motor coordination skills such as speed and accuracy in performing motor tasks -Determine if individual can return to past employment: identify existing abilities and supports; identify existing limitations and barriers; identify needed reasonable accommodations -Determine if pre-vocational and/or vocational training is indicated

Value of Accreditation to Occupational Therapy

-Self-study and self-assessment can be an opportunity to identify areas of strength, validated competence, and promote excellence -Areas needing improvement can be identified (ie. procedures can be streamlined and additional resources can be obtained, team communication can be enhanced) -Programs goals are clarified -Practice is defined and documented -Accreditors can share information regarding "best practice" -An increased recognition of OT's contributions to the agency and identification of functional outcomes can result in increased visibility for OT and increased referrals

Median nerve laceration

-Sensory Loss 1. central palm (thumb to radial half of ring finger) 2. palmar surface of thumb, index middle and radial half of ring fingers 2. dorsal surface of index, middle and radial 1/2 ring fingers (middle and distal phalanges) -Motor loss (low lesion at the wrist): 1. Lumbricals I & 2 (MCP flx, IP ext), 2. Opponens pollicis (opposition), 3. Adductor pollicis brevis (adduction), 4. flexor policis brevis (MCP flex of thumb) -Motor loss (high lesion at or proximal to the elbow): 1. Above + FDP to index and middle fingers, FPL (flex tip of index, middle and thumb), 2. FCR (inability to flex to radial aspect of wrist) -Deformity: 1. "ape hand" flattening of thenar eminence 2. Clawing of index and middle fingers (low lesion), 3. Benediction sign for high lesion (straight index and middle) -Functional Loss: no thumb opposition, weak pinch -OT Treatment 1. Dorsal protection splint with wrist positioned in 30 degree flexion if a low lesion. Include elbow (90 degree flexion) if a high legion 2. Begin A/PROM of digits with wrist in flexed positions at 2 weeks postopreative 3. Scar management 4. AROM of wrist at 4 weeks, include elbow if high lesion 5. Begin strengthening at 9 weeks -Splinting considerations: C-bar to prevent thumb adduction contracture -Sensory reeducation: begin when individual demonstrates a level of diminished protective sensation on Semmes- Weinstein

Prevention, early intervention and control of cancer

-Specific type of cancer 1. recommended screening tests include mammograms and ultrasound, prostate and testicular exams, skin checks, colonoscopies, pap smears, blood tests, and abdominal ultrasounds (cancer type and family history determine the screening method and its frequency) 2. Recommended preventative measures -avoid environmental contributing factors (chemically contaminated land, lead paint) -avoid and/or change contributory habits *OT practitioners can provide wellness interventions for people who want to quit or change habits (cease smoking) *wellness interventions can: +foster the use of self-regulatory behaviors +Support person-directed actions to change habits +Provide health-promoting occupation-based alternative to unhealthy habits +promote participation in programs that increase engagement in health-promoting behaviors (12 steps, support groups, individual treatment)

OT intervention for fractures immobilization phase

-Stabilization and healing are the goals 1. AROM of joints above and below the stabilized part 2. Edema control: elevation, manual edema mobilization, gentle retrograde massage, and compression garments 3. Light ADLs and role activities with no resistance, progress as tolerated (if the patient is in a sling, shoulder immobilizer, LAC, fracture brace or ORIF they should be instructed in one-handed techniques

Funding for driver rehabilitation

-State Vocational and Educational Services for Individuals with Disabilities (VESID), Office for Vocational Rehabilitation (OVRs), and Divisions of Vocational Rehabilitation (DVRs) will pay for driver rehabilitation if it will enable a person to go to work or school -Private insurance, Medicare, Medicaid, and Worker's Compensation will possibly reimburse for certain driver rehabilitation devices/adaptations

Inverse stretch (myotatic) reflex

-Stimulus: muscle contraction -Reflex arc: afferent Ib fiber from Golgi tendon organ via inhibitory interneuron to muscle of origin (polysynaptic) -functions to provide agonist inhibition, diminution of force of agonist contraction

crossed extensor reflex

-Stimulus: noxious stimuli and reciprocal action of antagonist; flexors of one side are excited causing extensors on same side to be inhibited; opposite responses occur in opposite limb -Reflex arc" cutaneous and muscle receptors diverging to many spinal cord motor neurons one same and opposite side (polysynaptic) -Function: coordinates reciprocal limb activities such as gait -While stimuli are applied during testing to evoke reflex responses, any stimulus that evokes an abnormal response that hinders function should be avoided. for example a quick stretch to spastic muscle may in fact increase spasticity

Ticket to Work and Work Incentives Improvement Act (TWIIA)

-Strives to make it more realistic and easier for a person with a disability to work -Removes a major disincentive to work by allowing individuals with disabilities to maintain their Medicare or Medicaid health-care benefits 1. Allows an individual with a disability to keep Medicare benefits for an additional 54 months after starting work 2. Eliminates limits on Medicare "buy-in" options -Enables consumers to have a choice in their service provider beyond public assistance programs -Establishes community-based vocational planning and assistance programs -Increases consumer choices for accessing employment support services -All states can design their own program

Discharge plan documentation

-Summary of evaluation and intervention -Compare initial and discharge status -Specify number of sessions, goals, achieved and functional outcome -Home programs to be followed after discharge -Client and family education -equipment provided and/or ordered -Follow up plans/recommended with rationales -Referrals to other health-care providers and community agencies Reasons for discharge 1. Goals attained 2. Client no longer making functional gains 3. Client refuses or does not follow the intervention plan 4. Client moves to another location 5. Setting foes not match the individuals needs

Supervision continuum

-Supervision occurs along a continuum that includes close, routine, general, and minimum -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

Medical management of PD

-Surgical interventions: thalamotomy, pallidotomy, fetal tissue transplant, deep brain stimulators -Pharmacology: Levodopa (the metabolic precursor of dopamine), sinemet (carbidopa/levodopa), dopamine agonists, anticholinergics (benadryl, artane, cogentin) for rigidity and tremors, dopamine releasers (amantadine) -Side effects are common when the disease is being managed pharmacologically 1. during early treatment, side effects from carbidopa/levodopa therapy are usually not a major problem 2. as the disease progresses, the drug works less evenly and predictable -as a result, some people may experience involuntary movements (dyskinesia), primarily when the medication is having its peak effects -the length of time for which each dose is effective may begin to shorten (wearing off effect) leading to more frequent doses (the on-off effect of long-term carbidopa/levodopa usage can cause Parkinson's related movement problems to appear and disappear suddenly and unpredictably) Other side effects may include: hallucinations, a drop in blood pressure when standing (orthostatic hypotension), nausea

Multiple Sclerosis (MS) Medical management

-Symptom specific -during acute exacerbation, anti-inflammatory drugs are used to control symptoms -antispasmodics (baclofen) may be effetive to counteract spasticity -mangement of bowel and bladder dysfunction may require pharmacologic intervention 1. Catheterization (indwelling or intermittent) is necessary in many cases of bladder dysfunction -Disease-modifying drugs are used to slow progression

Dunn's Model of Sensory Processing

-Symptoms are classified according to the interaction of sensory stimuli that are needed to stimulate a behavioral response 1. there are 2 types of neurological threshold: high neurological threshold and low neurological threshold -high neurological threshold: failure to register or respond to routine environmental sensation or sensation must be experienced over a prolonged time period to elicit a behavioral response -Low neurological threshold: the minimal stimulus facilities a behavioral overresponse 2. There are two types of behavioral responses -Passive behavioral response: the individuals makes no attempt to change the intensity or duration of sensory input -Active behavioral response: the individual avoids or seeks to avoid sensory stimuli 3. Neurological thresholds and behavioral responses combine to form 4 categories - Poor registration: high neurological thresholds and passive behavioral responses -Sensory seeking: high neurological thresholds and active behavioral responses -Sensory sensitivity: low neurological thresholds and passive behavioral responses -Sensory avoiding: low neurological thresholds and active behavioral responses

Performance assessment and improvement (PAI)

-Systematic method to evaluate appropriateness & quality of services 1. Interdisciplinary systems focus 2. Client-centered approach focusing on rights, assessment, care, and education of the person 3. Emphasizes organizational ethics, improved organizational performance, leadership, and management

Immediate memory

-The ability to recall material within seconds or minutes -short term memory

Task/Activity analysis

-The break down and identification of the component parts of a task/activity -Determination of the abilities needed to effectively perform and successfully complete the task/activity -Determination if the task/activity has therapeutic values Methods of task/activity analysis 1. Specify the exact activity to be analyzed (not just dressing but donning a sweater) 2. Identify and know the procedures, materials, and tools needed to complete the specific task/activity 3. Analyze the task/activity as it is typically performed under ordinary circumstances 4. analyze the task/activity to be certain that all client factors, performance skills and patterns and task/activity performance components are contexts are considered 5. select a frame of reference to determine which aspects of the task/activity are to be emphasized in the analysis

Signs and symptoms of sexual abuse

-The child reports being inappropriately approached, touched, and/or assaulted -Abuse may be physical (eg. touching), non-physical (eg. indecent exposure), or violent (eg. rape), so signs may include emotional and physical indicators -Precocious sexual behavior or knowledge -Copying adult sexual behavior -Inappropriate sexual behavior (eg. putting tongue in other's mouth when kissing) -Soreness or injury around the genitals -Reluctance or refusal to let caregivers wash parts of the body -Sexual play

Signs and symptoms of physical abuse

-The child reports being physically mistreated -Unexplained injuries -Repeated injuries -Abrasions and lacerations -Small circular burns such as cigarette or cigar burns -Burns with a "doughnut" shape on the buttocks that may indicate scalding, or any burn that shows the pattern of an object used to inflict injury, i.e. an iron -Friction burns such as those from a rope -Unexplained fractures -Denial, unlikely explanations, or delays in treatment on the part of the caregiver

Signs and symptoms of emotional or mental abuse

-The child reports being verbally and/or emotionally mistreated -Aggressive or acting out behavior such as lying or stealing -Shy, dependent, or defensive appearance -Verbally abuses others with language that appears to have been directed toward them

Intellectual developmental disorders: diagnostic criteria and functional implications

-The essential features include 1. Criterion A: deficits in general mental abilities 2. Criterion B: impairments in everyday adaptive functioning, in comparison to an individuals age-, gender, and socioculturally matched peers 3. Criterion C: onset is during the developmental period -The diagnosis of intellectual disability is determined by clinical assessment and standardized testing of intellectual and adaptive functioning -deficits in adaptive functioning impact the every day life activities (occupations) and are a central focus of OT intervention -Adaptive functioning is defined in 3 domains 1. Conceptual skills- language, literacy, money, time and number concepts and self-direction 2. Social skills- interpersonal skills, social responsibility, self esteem, gullibility, naïveté (wariness), social problem-solving and the ability to follow rules/obey laws and to avoid being victimized 3. Practical skills- activities of daily living (personal care), occupational skills, health care, travel/transportation, schedules/routines, safety, use of money, use of telephone -diagnosis is based on the measurement of intelligence or IQ tests; however, it should be noted that IQ scores fo not provide a full profile of individuals capabilities 1. individuals who score more than 2 standard deviations below the norm or below an IQ of 70 are considered to have an intellectual disability -multiple disabilities such as hearing, and other sensory impairments, seizures and other neurologic abnormalities may be associated with various syndromes (fetal alcohol syndrome)

OT Tools of practice

-The established, legitimate means by which the practitioners of a profession achieve the profession's goals and meet society's needs

Mandatory Reporting (role of OT)

-The federal Child Abuse Prevention and Treatment Act (CAPTA) defined child abuse and neglect and established mandates for professionals to report abuse and neglect to law enforcement officials -All states must have child abuse and neglect reporting laws to qualify for federal funding under CAPTA -All states require reporting of known or suspected cases of child abuse or neglect by health-care providers 1. standards for reporting may vary 2. reporting to the therapists direct supervisor may/may not be sufficient (the therapist should immediately report any and all concerns to their supervisor by must be prepared to follow-up as necessary) -Failure to report suspected child abuse may be considered a crime -In most states, good faith reporting is immune from liability -All states required reporting to be made to a law enforcement agency or child protective services

schizophreniform disorder

-The individual meets the criteria for schizophrenia, however, the episode lasts more than one month but less than the 6 months required for a diagnosis of schizophrenia

Determination of diagnosis by the psychiatrist

-The individual's psychiatric history and physical status is reviewed -A clinical interview, which includes a mental status examination, is conducted -Clinical observation of the individual: appearance, speech, actions, thoughts

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

National Board for Certification in OT

-The national credentialing agency for OT practitioners. Certifies qualified persons as occupational therapists, registered (OTR) and certified occupational therapist assistances (COTA), initially through a written exam for entry-level practitioners -NBCOT also maintains the OTR and COTA certification through a voluntary certification renewal program -Jurisdiction over all NBCOT certified OY practitioners as well as those eligible for NBCOT certification -As a voluntary credentialing agency, NBCOT has not direct authority over OT practitioners who are not certified by NBCOT and no direct legal mechanisms for preventing uncertified practitioners who are incompetent, unethical or unqualified from practicing. -NBCOT has developed investigatory and disciplinary action procedures for NBCOT certified practitioners whose practices raise concern due to incompetence, unethical behavior and/or impairment

Criteria for coverage of OT services rendered in a physicians office or in a physician-directed clinic

-The occupational therapist or OTA is employed by the physician or clinic -The service is furnished under physicians direct supervision, and the services are directly related to the condition for which the physician is treating the patient -OT service fees are included on the physicians bill to Medicare

Complications with TDs

-The occurrence of the following complications can negatively impact a persons health, impede function and compromise the safe and effective use of prosthetic devices 1. Neuromas: nerve endings adhered to scar tissue (these can be vary painful and hypersensitive) 2. Skin breakdown 3. Phantom limb syndrome: sensation of the presence of the amputated limb 4. Phantom limb pain: sensation of the presence of the amputated limb but is also painful 5. Infection 6. Knee flexion contractures in transtibial amputation 7. Psychological impairments due to shock/grief

Fee for service

-The payment system under which the provider is paid the same type of rate per unit of service. Traditionally, payer pays 80% and patient or provider is responsible for the remaining 20%

Staff development

-The process of continually upgrading employees knowledge and skills to provider competent current and caring OT services in changing and challenging delivery systems -staff development steps 1. assess employees development needs and interests 2. assess organizations strategic plan to identify existing and new areas planned for OT service that may require staff training 3. provide mentorship and supervision 4. provide educational in-services, workshops. and practical on-site experiences 5. support self-directed learning such as journal reviews, self-study courses, online networking teleconferencing, off-site workshops, and/or postprofessional education

Activity Synthesis (Activity analysis)

-The process of designing an activity for OT evaluation or intervention -Combines information obtained form the activity analysis with assessment information about the individual to ensure that a suitable match is made between the activity requirements and the persons needs and abilities -effective activity synthesis often requires the adaptation and gradation of the selected activity

Performance evaluation/appraisal

-The process of evaluating staff performance according to established performance expectations -steps in performance expectations 1. articulate specific and clear expectations for performance 2. document positive performance to substantiate quality care and to support recommendations for merit pay, raises, bonuses, and/or promotions 3. document substandard performance to identify areas requiring quality improvement, further training, increased supervision, and/or disciplinary action 4. meet privately with employee to discuss written performance appraisal, allow employee feedback, and develop a plan for remediation if needed, and a plan for ongoing professional development

Group communication

-The process of giving, receiving, and interpreting information through verbal and non-verbal expression -Effective group communication is a prerequisite to, and a requirement for, all group functioning -Effective communication occurs in a group when a member sends a message and the message is interpreted by the other group members receiving the message in the manner that the sender intended -Sending and receiving messages often takes place simultaneously due to the dynamic process of verbal and non-verbal communication -Communication can take many forms, including monologue, criticism, orders, questions and answers, and open give-and-take -Group communication that is adaptive may include clarifying goals and the sharing of ideas, experiences, and feelings -Group communication that is maladaptive may include seeking to control the group by controlling the channels of communication, and avoidance of specific issues or persons

Retention and Motivation of Staff

-The process of identifying understanding and meeting employees needs, expectations and desired rewards -motivating job characteristics 1. a fair and competitive salary and benefits package 2. job security, realistic performance expectations and fair employment policies 3. a good working environment with a relaxed, friendly atmosphere, adequate physical space and sufficient current equipment and supplies 4. challenging, satisfying work and diverse caseloads 5. competent supervision with adequate feedback on job performance 6. active mentorship and support for professional development 7. tuition reimbursement and financial support for conferences, workshops, and/or postprofessional education 8. recognition of contributions and achievements

Disciplinary action

-The process of informing an employee that their job performance is unacceptable, the organizations procedures for an administrative review of disciplinary actions, and the organizations employee grievance procedures -criteria for fair disciplinary action 1. written documentation of problem behaviors and expectations for improvement 2. referral to counseling and/or other services needed to improve performance 3. clear and documented warnings of consequences for unremediated behavior 4. consequences that are impersonal, immediate and consistent 5. continuous documented monitoring of employees behavior until the employee achieves satisfactory job performance, resigns voluntary or is terminated

Stroke/CVA specific type and etiology (transient ischemic attack)

-The term CVA or stroke applies to clinical syndromes that accompany ischemic or hemorragic lesions 1. Cerebral insufficiency: due to transient disturbances of blood flow, transient ischemic attack (TIA) * A TIA is a transitory stroke that for the most part lasts only a few minutes -TIAs occur when the blood supply to part of the brain is briefly interrupted -TIA symptoms, which usually occur suddenly are similar to those of stroke but do not last as long. Most symptoms of a TIA disappear within an hour, although they may persist for up to 24 hours -Symptoms can include: 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 -TIAs are often warning signs that a person is at risk for a more serious and debilitating stroke. About 1/3 of those who have a TIA will have an acute stroke at some point in the future

Documentation red flags

-The use of certain words, terms, and/or physicians errors can result in delay, denial, and/or discharge from services -Avoid these in all documentation, unless they are tru and accurate representations of a clients status -If a client has met their goals and/or is not longer making sufficient functional gains, this must be documented and the client may need to be discharged from services Words to carefully consider for they do no reflect progress 1. chronic 2. status quo, no change in status 3. maintaining 4. little change 5. plateau 6. making slow progress 7. stable or stabilizing Words to carefully consider for they do not reflect potential for improvement 1. same as 2. uncooperative, noncompliant 3. dislikes therapy 4. confused/disoriented 5. inability to follow directions 6. custodial care needed 7. treatment repeated 8. repeated instruction 9. unmotivated 10. extreme depression 11. fair to poor potential 12. chronic/long-term condition 13. general weakness Errors in physicians orders, for they can result in denial or delay of payment for OT services 1. incomplete or nonspecific orders 2. orders with a span of frequency over the duration of intervention (two to three times/week for 4 to 6 weeks) 3. Orders that do not state a specific type of intervention (activities, splint or equipment, as needed) 4. Orders that cover only evaluation but intervention has been initiated 5. Order is specific to a certain type of treatment but the treatment plan does not include it 6. Order does not include duration of treatment 7. The plan changes mid-month, but the order is not updated to meet the new plan change 8. There is no discharge order or there is no order immediately after treatment ends

Case management programs (Community-based practice)

-There are two different focuses to case management programs: one is clinical and one is administrative -Services can be provided in an office and/or in the individuals home and community -LOS is determined by the individuals ability to independently access needed services and by funding availability -OT evaluation is focused on the individuals client factors and functional skills and deficits in their performance skills and patterns, areas of occupation, and the occupational roles that are required in their current expected environment 1. Assessment of the individuals supports and barriers for community integrations is critical -Case management interventions can be purely referral-based in the administrative model or encampass the full range of interventions in the clinical model (one-on-one counseling, family education, ADL training, community reentry etc.) 1. Bothe models aim to prevent regression and rehospitalization and promote optimal functioning and quality of life 2. Both models actively engage the individual and family in the treatment planning implementation and the reevaluation process 3. Both models plan discharge if appropriate to an environment that will best serve and individuals needs

Histrionic personality disorder

-This disorder is characterized by colorful, dramatic, extroverted behavior in excitable, emotional persons -An inability to maintain deep, long-lasting attachments with accompanying flamboyant presentation is often characteristic

Elements of a group protocol

-Title/Name:reflect purpose/goal not media used -Purpose:brief statement-what hopes to accomplish -Rationale: explains value of group to members &why it's important to offer this service to this population -Theoretical base/FOR:explain-brief &understandable terms the theory intervention is based on & rationale -Criteria for membership:explains who should/'nt be in the group&when they will no longer benefit from it -Goals/anticipated outcomes:expectations of what members will be able to do as a result of this group: pt. will...statements -Method/Format:how group will be carried out:format, scheduling, activities, materials, procedures,etc.; info another therapist would need to lead this group -Role of therapist:tasks to prepare & for leading it: supplying materials, designing activities, facilitating interaction, providing a safe environment, etc. -Quality Assurance: explains how need for this intervention&its effectiveness will be monitored -Actual format used to write protocols varies w/ setting

Coding and billing for services

-To be reimbursed OT services must be properly coded and billed as required by payers -Practitioners must represent their services in terms of diagnosis and procedure codes -Diagnosis codes describe a persons condition or medical reason for requiring services (The Internal Classification of Diseases (ICD) is the most frequently used diagnosis-coding system in the United States- each services, procedure, supply or piece of equipment must be related to a current ICD code; in 2014, the ICD-10 clinical modification (ICD-10CM) replaced the ICD-9) Procedure codes describe the specific services provided by health-care professionals 1. HCFA Common procedure coding system (HCPCS) is most widely used 2. HCPC includes the Physicians Current Procedural Terminology (CPT) 3. The most current HCPCs and CPT codes must be used in practice. 4. Specific codes that most closely describe the services provided should be used. Each procedures, modality and/or treatment should be coded -Specific billing forms are used by institutional providers (hospitals and home health agencies) and by physicians practice for Medicare, Medicaid and most states workers compensation programs. Form numbers may change. Outpatient OT services provided under Medicare Part B must report functional data on their claims in the form of G-codes. 1. G-codes identify the primary issue being addressed by therapy, modifiers are used to report the persons impairment/limitation/restriction -All G-codes are available to be used by all therapy disciplines (OT practitioners can use the codes for mobility, memory, swallowing and cognition) 2. G-codes will be used to track patient outcomes over time -OTAs/COTAs are generally not eligible for direct payment because they require supervision and do not perform evaluations

Overall characteristics of the home

-Type of dwelling: private house, one-family, two-family, apartment, walk-up, elevator access -Protection from weather/environmental changes -Presence and use of a driveway -Level of the dwelling in which the person lives -Entrance to the dwelling: wheelchair access, ramp, level entrance, stairs -Number of entrances that are accessible to the individual; some apartment buildings allow residents to use delivery entrance because it has a ramp -Steps: the number present outside dwelling, inside the dwelling, to the laundry room, and to the mailbox -Railings: the location and number of railings when outside and facing the entrance door; the presence of secure railings for interior stairways (interior railings should be mounted 1 1/2" from the wall to ease grasp; exterior railings should be waist high for those who walk: 34-38" depending on the person's height; railings should be 1 1/2" - 2" in diameter with non-skid surfaces) -Door sills: identify where they are present ie. entrance to dwelling, bedroom doors, bathroom doors, kitchen doorway -Width of elevator doorway -Width of hallway entrance -Width of entrance door(s); measure from open door to frame; not frame to frame -Direction of opening for entrance door(s) and any other doors throughout the dwelling which must be opened -Space to accommodate door swing must be available (a minimum of 18" is needed for those using walkers; a minimum of 26" is needed for those using wheelchairs) -Type(s) of door handles: lever handles are more functional than round knobs -Identification of objects which may be obstructing doorways and/or pathways -Presence of pets: they can become obstacles and/or safety concerns to those with low vision, balance problems, and those who require assistive devices -Carpeting location and type ie. wall to wall, throw rugs, height of pile -Electrical cords: placed out of flow of traffic, in good condition or frayed, overloaded or under rugs/carpeting -Presence of a firm chair in the dwelling and its height -Light switches: accessibility from various levels (standing and chair) -Amount and quality of natural and artificial light throughout home -Presence of accessible and safe storage and organization spaces that meets a persons needs -Telephones: numbers of phones, their location, cordless phone availability, type of phones (push button or rotary), emergency numbers by telephone -Presence of working smoke detectors -Presence of accessible working temperature systems for central heating system and air condition system -Presence of fans, space heaters or wood burning equipment -Presence of an emergency call system and an emergency exit plan -Overall sanitation and orderliness fo the home

Adductor pollicis

-Ulnar nerve § Origin: · Oblique head: base of the second and 3rd metacarpal, trapezoid and capitate · Transverse had: palmar border and shaft of 3rd metacarpal § Insertion: sesamoid, base of proximal phalanx, tendon of extensor pollicis longus § Function: adducts CMC joint of thumb

Sensory Processing disorders etiology

-Unknown -Subtle, primarily subcortical, neural dysfunction with impaired processing of sensory information and modulation of multisensory systems -Symptoms are classified under the categories of : 1) sensory modulation disorder (SMD) 2) sensory-based motor disorder (SBMD) 3) sensory discrimination disorder (SDD)

Classification of amputations

-Upper extremity level of amputation: 1) forequarter = loss of clavicle, scapula and entire upper extremity 2) shoulder disarticulation = loss of entire upper extremity 3) above-elbow (AE)(long or short) = amputation above the elbow at any level on the upper arm 4) elbow disarticulation = amputation of the upper extremity distal to the elbow joint 5) below-elbow (BE)(long or short) = amputation below the elbow at any level of the forearm 6) wrist disarticulation = amputation distal to the wrist joint. Loss of entire hand -transmetacarpal 7) finger amputation = amputation of digit(s) at any level -Lower extremity level of amputation: 1) hemipelvectomy = amputation of half of pelvis and entire lower extremity 2) hip disarticulation = amputation at the hip joint. Loss of the entire lower extremity 3) above-knee amputation (transfemoral) = amputation above knee at any level on the thigh 4) knee disarcticulation = amputation at the knee joint 5) below-knee amputation (transtibial) = amputation below knee at any level on the calf. Most common 6) complete tarsal = amputation at the ankle -Syme's amputation: or ankle disarticulation -Ray amputation: (amputation of the entire digit from the metacarpal and distal) 7) partial tarsal = amputation of metatarsals and phalanges 8) complete phalanges = amputation of toe(s)

General Documentation standards

-Use legible handwriting must be used for handwritten documentation (illegible notes may result in denial of reimbursement) -Documentation for an EMR/EHR must adhere to all established documentation standards -Be correct in grammar and spelling (errors detract from a professional presentation) -Be concise but complete (if it is not written down it does not exist and never happened; non-important, extraneous details [ie color of clothing] should be left out) -Be objective, with clear distinctions between facts and behavioral data and opinions and interpretations are required -Be current, relevant and accurate (occupational therapy notes/record are legal documents) -Follow institution and/or program guidelines, as well as reimbursers'/third party payers' guidelines ( non-compliance can result in services and/or payment being denied) -Only use standard, well recognized abbreviations (ie. ROM) (avoid alphabet soup; write in functional terms using uniform terminology consistent with AOTA's Standards of Practice and state practice acts) -Use person first language at all times (eg. "a mother with schizophrenia", or "the student with developmental delays", not "the schizophrenic", "the retarded") -Client's name and ID number should be on every page -No whiting out or blocking out of information is accepted (in handwritten notes, errors must be crossed out with one line, initialed, and dated. Black or blue ink is used at all times) -Include the date, including month, day and year -Identify the type of documentation (ie. initial note, progress note, discharge plan) -Comply with confidentiality standards (ie. do not put other clients' names in a note) -Informed consent for treatment can only be given by a competent adult (minors or adults determined to be incompetent must have written consent provided by a parent, legal guardian, person with power of attorney, or proxy) -Sign with a full signature (first and last name with professional designations) directly following content with no space left between content and signature -Countersignature by an occupational therapist on documentation written by an OTA or a student if required by law or the facility -All documentation may be subject to subpoena; therefore, documentation standards must be adhered to

Spina bifida with meningocele specific symptoms

-Usually does not present with symptoms impacting on function as the spinal cord itself if not entrapped 1. Occasionally slight instability and neuromuscular impairments, such as mild gait involvement and bowel and bladder problems may occur

OT intervention for pain

-Utilize physical agent modalities and massage in prep for functional activs -Teach proper positioning techs -Splint in resting position -Gentle ROM -Teach progressive relaxation techniques (Jacobson's): reduce anxiety by alternating tensing and relaxing the muscles. -Utilize proper body mechanics -Correct environmental factors -Correct standing/seated posture -Provide alternative exercise programs (e.g. aquatic therapy, Ai chi, tai chi)

Vestibular/balance changes

-Vestibular system changes, conditions and clinical implications 0Decreased number of vestibular neurons, vestibular ocular reflex decline begins at age 30 at ages 55-60 there is accelerating decline which results in diminished vestibular sensation 1. Diminished acuity, delayed reaction times, longer response times 2. Reduced function of vestibular ocular reflex, affects retinal image stability with head movements, produces blurred vision 3. altered sensory organization: older adults more dependent upon somatosensory inputs for balance 4. Less able to resolve sensory conflicts when presented with inappropriate visual or proprioceptive inputs die to vestibular losses 5. Postural response patterns for balance are disorganized" characterized by diminished ankle torque, increased hip torque, increased postural sway

First 6 months (Development of sensorimotor integration)

-Vestibular, proprioceptive and visual system become more integrated and lay the foundation for postural control, which facilitates a steady visual field -Tactile and proprioceptive systems continue to be refined, laying the foundation for development of somatosensory skills -visual and tactile systems become more integrated as the child reaches out and grasp objects, laying the foundation for eye-hand coordination -Infant movement patterns progress from reflexive to voluntary and goal directed

6 to 12 months (Development of sensorimotor integration)

-Vestibular, visual and somatosensory responses increase in quantity and quality as the infant becomes more mobile -Tactile and proprioceptive perceptions become more refined, allowing from development of fine motor and motor planning skills -Tactile and proprioceptive responses also lead to midline skills and eventual crossing of midline -Auditory, tactile, and proprioceptive perceptions are heightened, allowing for development of sounds for the purpose of communication -Tactile, proprioceptive, gustatory and olfactory perceptions are integrated, allowing for primitive self-feeding

Community model

-Views the individual with a disability as lacking skills, resources, and supports for community integration -Focus is placed on identifying and developing the skills needed for one's expected environment -If skills cannot be developed, community resources and supports are identified and developed to enable functioning within one's chosen environment -OT frames of reference promote development of performance components and/or performance areas within the individual's performance contexts (eg. life-style performance, occupation adaptation)

Adjustment disorders: diagnostic criteria

-a clearly identifiable stressor causes onset of emotional and behavioral symptoms within 3 months of experiencing the stressor 1. symptoms resolve and disappear within 6 months of the stressor or its consequences being removed -symptoms cause marked distress in important areas of function, including social and occupational, due to reactions that are disproportionate to the frequency or severity of the stressor -the symptoms are not better explained by another disorder, attributable to an exacerbation of symptoms from a preexisting diagnosis, or warranted as part of a normal bereavement response

Diabetic retinopathy

-a complication of diabetes that affects the eyes. this is caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina) -this condition affects central and peripheral vision, causing blurred or hazy vision in affected areas -Nonproliferative diabetic retinopathy is the early stage of the disease, in which symptoms will be mild or not apparent, leaving more vision intact. this form can progress to proliferative -Proliferative diabetic retinopathy is a more advanced form of the disease, characterized by new blood vessel growth in the retina and leakage of blood vessels, which causes scar formation and possible retinal detachment (can lead to total blindness) -maintaining control of blood glucose levels helps prevent vision loss

reclining back w/c

-a high back reclines independently of the rest of the chair -used to provide pressure relief, regulate blood pressure, improve respiration, and provide support for individuals who are unable to independently maintain an upright sitting position (reclining back w/cs extend the seat to back angle, thus, they can elicit flexor or extensor spasms, and should not be prescribed to persons with spasticity) (reclining back w/cs should not be prescribed to persons with limited hip and knee WOM as the resultant reclined angles may exceed their available range

Managing difficult behaviors: acting out behavior in children

-acting out is the expression of thoughts and feelings through maladaptive behavior instead of verbalizing these -depending on the severity of the situation, therapeutic options include 1. interpretation: a therapeutic technique where the therapist puts words to observed behavior enabling the child to effectively express the feelings they are experiencing 2. redirection: a verbal tactic that refocuses the child on the assigned or current activity that provides cues for appropriate participation 3. limit setting: informing the child of what is permissible and what is unacceptable 4. time-out: an intervention technique that results in behavioral changes by removing the child from a probkematic situation to a specific area

Interventions for driver rehabilitation

-adaptive driving equipment can be prescribed for individuals with specific limitations a. hand controls can replace accelerators and brake foot pedals b. steering knobs for one-handed steering control can include a: 1. standard round spinning knob for a person with one intact UE 2. ring to accommodate a prothesis 3. tri-pin or cuff to accommodate absent or weak grasp -pedal extensions can be added if feed do not reach standard foot pedals -zero effort or reduced effort steering can accommodate for decreased range, strength, and endurance -steering wheel positioning adjustments can place steering wheel in atypical positions to allow for access -if, and when, a person is determined to be unsafe or unable to drive, alternatives to maintain community mobility must be explored and implemented a. support must be provided to the individual to deal with this loss and its ramifications on the persons daily life

Age-related macular degeneration (AMD)

-affects the macula, the part of the eye that allows you to see fine detail -Appears as a blank spot in the central visual field, blurring details and the sharp/central vision needed for many daily activities -The affected areas on the macula is called a scotmoa. Scotomas can be relative (some vision can be processed with increased light) or dense (no vision despite light changes) -All scotomas are not the asme, they can be in different sizes, shapes, and locations. variations may also exist between the two eyes -Less common symptoms of AMD include metamorphopsia which is the appearance of spinning and swirling of images and Charles Bonnet syndrome (phantom vision) which leads to visual hallucinations that the individual knows are not real -Affects occupational performance such as reading, driving, managing medication and watching television

Personal assessment (wheelchair)

-age and developmental status -determine the individuals medical status including prognosis (condition temporary, permanent, stable, or progressive) and functional level/needs -education and work interests and pursuits (the need for desk arms) -leisure interests and pursuits (special sports chair can enable the individual to pursue past or new interests) -daily routines and habits -goals and desired occupations -assess the ability of the w/c to interact/interface with other ATs and medical equipment used while in the w/c (communication board, ventilator)

Asthma

-an increased reactivity of the trachea and bronchi to various stimuli (allergens, exercise, cold) -etiology: unknown -Risk factors: childhood asthma, family history, maternal smoking, occupational exposure, environmental exposure, exposure to secondhand smoke -manifests by widespread narrowing of the airways due to inflammation, smooth muscle constriction and increased secretions -Signs ans symptoms 1. wheezing, dyspnea, chest pain, facial distress, nonproductive couch with acute exacerbation where airways may become obstructed with vicious, tenacious mucous (more severe in children than adults) 2. symptoms in adults may include paroxysmal nocturnal dyspnea, morning chest pain and increased symptoms with exposure to cold -Interventions 1. prevention 2. smoking cessation and minimizing exposure to secondhand smoke for pregnant women 3. annual flu shot 4, avoidance of stimulants that precipitate asthmatic episode 5, use of short and long acting dilators 6. common medications: albuterol (ventolin, proventil), atrovent with albuterol, combivent 7. establishment of a routine exercise program

Restraint reduction for environmental modifications for cognitive and sensory deficits

-assessment of behaviors that result in agitation, restlessness, and/or wandering a. pain, physical discomfort b. hunger, thirst, need for toileting c. loneliness, fear d. boredom e. unfamiliar environment

Sensory Models evaluation

-assessment used in sensory models include the Adolescent/Adult sensory profile, and the Allen's cognitive level screen

ADHD diagnostic-specific considerations for OT

-behaviors impact on school, home, play and social participation must be considered -environmental modifications and activity adaptations to structure the clients home environment can enhance function -environmental modifications and activity adaptations to structure the childs environment at school and adults environment at work can support more successful outcomes (the elimination of sensory distractors, the use of lists, datebooks, and or texted reminders) -training in social skills and self management (use of humor, personally initiated time outs) can improve adaptive behaviors -Interventions to promote sensory modulation are emphasized -consultation is provided to parents, family, members, teachers, and employees regarding strategies for the provision of structure and expectations in a manner that fosters the person psychosocial adaptation -in school-based practice, ongoing collaboration with individualized education planning, team members and parents it vital

Cardiovascular age related changes

-changes due more to inactivity and disease than aging -degeneration of heart muscles with accumulation of lipofuscins (characteristic of brown heart): mild cardiac hypertrophy of left ventricle wall -decreased coronary blood flow -Cardiac valves thicken and stiffen -Changes in conduction system: loss of pacemaker cells in SA node -Changes in blood vessels: arteries thicken, less distensible, slowed exchange capillary walls, increased peripheral resistance -Resting blood pressures rise: systolic greater than diastolic -Decline in neurohumoral control: decreased responsiveness of end organs to Beta adrenergic stimulation of baroreceptors -Decreased blood volume, hemopoietic activity of bone -Increased blood coagulability

Persistent Depressive Disorder (Dysthymia)

-characterized by at least 2 years of a depressed mood, most days with depressive symptoms -criteria for major depressive disorder may be continuously present for 2 years

obsessive-compulsive personality disorder

-characterized by emotional constriction, orderliness, perseverances, stubbornness, and indecisiveness -The essential feature is a pervasive patter on perfectionism and inflexibility -it should not be confused with obsessive compulsive disorder

ADHD diagnostic criteria

-children 1. the presence of 6 or more symptoms in the inattention domain, the hyperactivity-impulsivity domain or both 2. Symptoms in the inattention domain or hyperactivity-impulsivity domain that interfere with occupational activities are present for at least 6 months or more - symptoms of the inattention domain may include lack of attention to detail, poor listening, limited follow through of tasks, difficulty with organization and avoidance of tasks that require sustained attention, tendency to lose things, distractibility and forgetfulness -symptoms of the hyperactivity domain may include fidgeting, inability to remain seated, inappropriate activity level, for a given situation, difficulty with quiet sedentary activities, frequent movement and excessive talking -Symptoms of impulsivity include answering questions before they are filly stated, difficulty with turn taking, and interrupting the conversations or activities of others 3. visual perceptual, auditory perceptual, language and cognitive problems may be present 4. some of the symptoms that result in impairment were evident before even 7 years old 5. Symptoms that result in impairment are present in 2 settings such as school, home or work -Adolescents/adults 1. are required to present with a minimum of 5 symptoms 2. symptoms should have been present before age 12 (not before age 7) 3. motor symptoms of hyperactivity may appear less in adolescence and adulthood, however restlessness, inattention, poor planning and impulsivity may persist 4. impairments tend to be present into adulthood 5. A diagnosis of ASD may accompany

Heart failure (HF)

-clinical syndrome in which the heart is unable to maintain adequate circulation of the blood to meet the metabolic needs of the body -Etiology: may be caused by coronary artery disease, valvular disease, congenital heart disease, hypertension, infections -Physiological abnormalities: decreased cardiac output, elevated end diastolic pressure (preload) increased heart rate and impaired ventricular contractility -Types of heart failure 1. left sided 2. right sided 3. Biventricular

Strategies to slow, reverse and/or compensate for age-related changes in cardiopulmonary systems

-complete a cardiopulmonary assessment prior to commencing an exercise program (this is essential in older adults due to the high incidence of cardiopulmonary pathologies) 1. select an appropriate graded exercise testing protocol 2. Standardized test batteries and norms for older adults are not available -many older adults cannot tolerate maximal testing, submaximal testing commonly used 3. testing and training modes should be similar -individualized exercise prescription is essential 1. choice of training program is baed on: fitness level, presence or absence of cardiovascular disease, muskuloskeletal limitations and the individuals goals roles and activity interests. 2.Prescriptive elements (frequency, intensity, duration and mode) are the same as for younger adults 3. Walking, chair and floor exercises, yoga, tai chi, and modified strength/flexibility calisthenics are well tolerated by most older adults 4. Consider pool programs (exercises, ai chi, walking swimming) for persons with musculoskeletal and neurological impairments 5. Consider multiple modes of exercise on alternate days to maintain interest and reduce likelihood of muscle injury, joint overuse, pain, fatigue and boredom -Aerobic training programs can significantly improve cardiopulmonary function in older adults

Trichotillomania (Hair-Pulling Disorder)

-compulsive, irresistible desire to pull out ones hair, typically of the scale, eyelashes or eyebrows although sites may vary over the body, resulting in hair loss -Hair-pulling often results in bald or patchy spots potentially impacting social and occupational functioning

Neurocognitive Disorders

-conditions for which the primary symptoms are cognitive deficits. This may be from substance abuse, medical conditions, or other known or unknown causes

Generalized Anxiety Disorder (GAD)

-consists of 6 months of persistent and excessive unfocused anxiety and worry

Major personnel management tasks

-design work roles and write job descriptions -recruit, select and orient personnel to perform the roles -supervise and evaluate personnel to ensure adequate role performance and the attainment of organizational goals -support personnel's ongoing professional development -deal with difficult personnel issues as they arise

Recreational w/c

-designed with large thick inner tube tires and large front casters for all terrain use including sand, mud, snow, and off-road surfaces

Role of OT in abuse

-develop a trusting relationship -use the RADAR approach to screen for and respond to domestic abuse 1. R= routinely ask: inquiring about potential abuse when interviewing all clients can be the first step in intervention, this acknowledges that abuse is not an acceptable secret 2. A=affirm and ask: acknowledge and support the person who discloses abuse. ask direct questions of all clients to determine risk (do you feel safe with partner) 3. D=document objective findings (the person has multiple bruises) and record client statements in quotes 4. A= assess the address the persons safety (has abuse become more violet? are there weapons in the home) 5. R=review options and referrals: refer the person to domestic violence hotlines, domestic violence shelters, and safe houses that have staffed trained in family violence and safety planning -areas to discuss with the person who has been abused 1. stress and safety 2. fear and abuse 3. family, friends and support networks 4. emergency plan - provide information about treatment and support programs that enable empowerment of the individual -provide intervention for physical and emotional injuries and to develop skills needed to live an independent empowered life -inform supervisor and other treatment staff -mandatory reporting is required in some states but laws vary

Tasks of Middle Childhood (Havighurst)

-develop physical skills needed for games -establish health self-concept -make friends with children of the same age -read, write, and calculate -acquire information necessary for everyday life -develop morality and values -formulate opinions about social groups & institutions

Mental Health Intervention foci during periods of long term hospitalization

-development and implementation of a plan of self-determined goal achievement -provision of a normalizing environment that enables participation in meaningful and desired occupational roles -engagement of the person in the treatment process -provision of graded activities to develop the skills needed for competence in ADLs, IADLs, social participation, leisure, school or work -development of relaxation and stress management skills to help decrease the incidence and severity of symptoms and facilitate recovery -continuation of assessment to determine realistic and meaningful discharge goals -development of the skills and external supports needed to pursue desired post-discharge occupational roles, participate in the anticipated discharge environment and self-determined discharge goals

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

Varicose veins

-distended, swollen superficial veins, tortuous in appearance, may lead to varicose ulcers

Reasons for failure to report or leave an abusive/violent relationship

-economic pressure -religious beliefs -feeling of love for abuser -believing the abuse is deserved -viewing abuse as normal due to exposure to abuse/violence as a child -fear of increasing abuse/violence -fear of retaliation -belief things will change -concern for children -nowhere to go -lack of support systems

cognitive-behavioral therapy (CBT)

-effective in the treatment of individuals with depression 1. individuals with depression tend to distort reality through dysfunctional through processes 2. works to alter these individuals negative thoughts about themselves -used with individuals with schizophrenia, anxiety, bipolar, personality, somatoform, and eating disorders Principles -combines principles of cognitive therapy and behavioral therapy 1. cognitive therapy looks at a persons thoughts and beliefs, while behavioral therapy looks at a persons actions and attempts to change maladaptive patterns of behavior -cognitive restructuring is a key concept which alters cognitions and cognitive processes in order to facilitate behavioral and emotional changes -the three components of cognitive therapy are didactic aspects, cognitive techniques and behavioral techniques (1) Didactic techniques involve the therapist explaining the basic concepts and principles of CBT to the client (2) cognitive techniques involve eliciting automatic thoughts, testing automatic thoughts, identifying maladaptive underlying assumptions and testing the validity of maladaptive assumptions (3) Behavioral techniques are used with cognitive techniques to test and challenge maladaptive and inaccurate cognitions - A pattern of negative thinking termed the cognitive triad is identified 1. this triad is composed of negative self-evaluation, a pessimistic world view and a sense of hopelessness regarding the future 2. this triad underlies depression in particular and is evident in other disorders -three basic principles of cognitive therapy can help the individuals with depression 1. all moods are created by a persons thoughts and the way they look at and interpret situations and events 2. when people are depressed, their thoughts are pervasively negative 3. research has indicated that negative thoughts that cause emotional distress usually contain distortions -the development of insight is necessary for growth and change 1. thinking influences behavior 2. changing the way a person thinks reduces symptoms 3. thinking can be self-regulated 4. change occurs through clients involvement in learning and developing skills

Methicillin-resistant Staphylococcus aureus (MRSA)

-etiology: mild infections (pimples or boils) on the skin, more serious infections on skin or infection in surgical wounds 1. the infection can be locally confined or systemic (entering the bloodstream and affecting primarily the lungs or the urinary tract) -Risk factors: 1. having a weakened immune system 2. confinement in a hospital or other health-care institutions 3. living in close quarters (military barracks, college dormitory) 4. Direct skin contact with an infected body part of another person (contact sports) 5. Secondary skin contact from something used by someone with an infection (shared towels during sports activities) -the infection resists treatment from known antibiotics, even broad-spectrum antibiotics. Some antibiotics still work to fight it

Peripheral neuropathies

-etiology: peripheral neuropathy of a single nerve may be the result of trauma, pressure paralysis, forcible overextension of a joint, hemorrhage into a nerve exposure to cold or radiation or ischemic paralysis 1. multiple nerves may be affected in cases of collagen vascular disease, metabolic diseases (diabetes) ir infectious agents (lyme disease) 2. other causes include nutritional deficiency, malingnancy, microorganisms, exposure to toxic agents and chronic alcohol abuse -Diagnosis 1. focused on the cause of symptoms 2. specific tests utilized include electromyography, nerve conduction velocity, muscle biopsy, and examinations to identify systemic disorders -Symptoms 1. a syndrome of sensory, motor, reflex and vasomotor symptoms 2. symptoms include pain, weakness and paresthesias in the disruption of the affected nerve -Medical management 1. guided by the underlying disease process, not the symptoms of the neuropathy 2. treatment of the underlying systemic disorder (diabetes, tumor, multiple myeloma) may slow progression although recovery is slow

Lyme disease

-etiology: tick bites 1. ticks are usually found on animals, on the tips of grasses and shrubs 2. ticks attach to people as they brush by the object to which the tick is attached -Prevention 1. Walk on trails to avoid contact with grass and brush 2. avoid tick-infested areas, especially in May, June and July 3. Wear light colored clothing so ticks can be easily seen 4. tuck in clothing and tape clothing seams (whee pants meet socks) to prevent entry 5. spray insect repellent containing DEET on clothes and exposed skin, excluding the face 6. After being outdoors, change clothes and inspect skin for presence of ticks 7. remove any ticks with tweezers, grasping the tick as close to the skin surface as possible and pulling straight back

Autism Spectrum Disorder (ASD): diagnostic specific considerations for OT

-evaluate developmental and functional levels -develop sensorimotor, social interaction, vocational readiness, and community participation skills relevant to the child's levels -provide sensory integrative intervention if indicated -if indicated prescribe and train in technologically based augmentative communication -provide adaptive and positioning equipment to facilitate function (the stereotypical movements of licking, biting, and slapping fo the hands in a child with Rett's syndrome may require adaptations to maintain the integrity of the skin such as dynamic elbow splints that inhibit a hand to mouth pattern by limiting full elbow extension) -collaborate with family and interdisciplinary team to promote occupational performance and social participation

Physical/nonhuman environment

-everything that is natural (animals, trees, sand dunes) or built (tools, devices, buildings, transportation system) -includes the sensory qualities of the environment 1. visual: lighting, colors, clutter 2. Auditory: sound quality and volume 3. Tactile: room temperature, seating textures 4. Olfactory: pleasant or offensive odors 5. Gustatory: pleasant or offensive tastes

Reactive attachment disorder etiology

-exact cause is unknown -early poor experiences with initial caregiver and or pathologic care may contribute to the disorder. Indicators of pathogenic care 1. Persistent disregard of the childs basic emotional needs 2. Persistent disregard of the childs basic physical needs 3. Repeated changes of primary caregiver or a succession of caregivers prevents the establishment of stable, appropriate attachments

Ryan & Deci's self-determination theory

-examines how self-determination can enhance or weaken intrinsic motivation, self-regulation and well-being -The key elements of self-determination are competence, autonomy and relatedness -Competence promotes children's desire to continue engaging in an activity with the belief that they will succeed 1. Success leads to continued engagement and additional success 2. Children who consistently fail during engagement in activities tend to discontinue engaging due to a perceived sense of failure -Autonomy promotes intrinsic motivation, which leads children to enthusiastic, directed behaviors and a desire to explore 1. these characteristics are associated with a high level of self-esteem and well-being 2. external pressures to engage can result in decreased initiative and learning -Relatedness, which is dependent on secure relationships, promotes motivation for increased engagement, exploration autonomy and success

post-traumatic stress disorder (PTSD): diagnostic criteria

-exposure to threats or actual events which can result in sexual violence, bodily injury or death by 1. personally and directly experiencing the trauma 2. firsthand witnessing of the traumatic event happening to another individual 3. Learning about traumatic events experienced by close friends or family after the fact 4. repeated or extreme exposure to visuals or explanations of aversive details associated with traumatic events and negative consequences -Presence of intrusion symptoms (for more than one month) 1. recurrent, unwanted, intrusive memories and dreams related to or depicting the traumatic event 2. physical or mental exposure to the traumatic event of related situations causes the individual to believe and act as if the traumatic event is reoccurring 3. experience of marked, prolonged physiological reactions and psychological distress associated with exposure to internal or external cues related to the traumatic event -notable changes in pattern or behaviors as an attempt to avoid external stimuli or reminders associated with the traumatic event -reminders of the traumatic event may have adverse reactions on cognition, focus, mood, sleep patterns, arousal and reactivity or exaggerate vigilance, startle responses and irritability

Shock (hypoperfusion)

-failure of the circulatory system to perfuse (supply) vital organs -at first, blood is shunted from the periphery to compensate 1. the victim may lose consciousness as the brain is affected 2. heart rate increases, resulting in increased oxygen demand (organs ultimately fail when deprived of oxygen. Heart rhythm is affected, ultimately leading to cardiac arrest and death. Knowledge about the types, causes, signs, and symptoms of shock is essential to effectively recognize shock, provide needed care and obtain emergency medical care)

CBT Intervention

-general postulates for change are used to guide the intervention process 1. dysfunctional cognitive processes produced psychological disorder 2. altering a persons cognition can improve psychological health 3. cognitions are the prime cause of psychopathology and therefore are the focus of intervention (automatic thoughts cause psychological disorder and through cognitive restructuring these thoughts are brought to awareness to be confronted and facilitate change -approaches using CBT emphasize the following 1. assist the client in the identification of current problems and potential solutions 2. use active and collaborative therapist-client interactions as an essential part of the therapeutic process 3. helping the client learn how to identify distorted or unhelpful thinking patterns recognize and change inaccurate beliefs and relate to others in more positive ways 4. gaining insight and acquiring skills that maximize client functioning and quality of life through the development of coping skills and meaningful healthy occupational patterns 5. facilitating the clients active role in the therapeutic process by frequently providing homework and structured assignments as part of the intervention process (intervention goals are designed to help the client monitor and refute negative thoughts about themselves) 6. scheduling activities 7 cognitive rehearsal 8. self-reliance training 9. role playing 10. diversion techniques and visual imagery 11. engaging in physical, work, leisure and social participation activities

Intellectual developmental disorders: etiology/prognosis

-genetic conditions such as chromosomal abnormalities (Down syndrome, fragile x syndrome, prader-willi syndrome, klinefelters syndrome) -metabolic conditions -prenatal infections such as rubella and aids -maternal substance use -perinatal factors such as trauma and prematurity -acquired conditions including infections such as encephalitis and meningitis -head trauma sustained in motor vehicle accidents, falls, child abuse -begins in the developmental period

Concurrent feedback

-given during task performance · While practicing reaching the therapist says: "don't hike your shoulders"

Immediate feedback

-given immediately after performance · Right after an attempt at a tub transfer the therapist says "that was perfect"

psychiatric rehabilitation intervention

-goal is to assist individuals with a psychiatric disability to perform the physical, emotional, social and intellectual skills needed to live and work in the community at their highest functional level with the least amount of professional support as the individual deems necessary -Assertive Community treatment (ACT) uses a variety of interdisciplinary interventions aimed at restoring function and role performance in the community -Interventions take place where a person chooses to live, work, and socialize -day program that embed psychiatric rehabilitation principles include clubhouses where the goals it to improve quality of life by instilling self-worth and determination in its members -Case management services strive to offer continuity of care, accessibility, accountability and efficiency -vocational rehabilitation views work as a natural activity and provides services and supports to enable the assumption or reassumption of the role of a worker based on the belief that all individuals are capable of achieving success -Supported education offers normalization, structure, self-determination and fosters both hope and empowerment

psychiatric rehabilitation

-goals is to help individuals develop skills necessary to compensate for, adapt to and control the influence symptoms have on function, including any disability caused by social or environmental barriers -Principles 1. individualization: any service provided to an individual is structured to support each persons unique needs 2. Client involvement: individuals control their recovery 3. Partnership with service providers: a mutual rapport between all persons involved nurtures a commitment based on respect and trust for everyone 4. Community-based services: all services are provided where the individual lives, works and socializes 5. Strengths focused: build on a persons strengths rather than focusing on their weaknesses 6. Situational assessments: the focus is on collecting data while observing the individual in the environment where challenges are experienced 7. Holistic approach: treatment and rehabilitation services are viewed as equal and mutually dependent methods that support recovery 8. Continued, accessible, coordinated services: services are always available for any given period time 9. vocational focus: work is healing a psychiatric rehabilitation professional partners with individuals (regardless of their abilities) to develop work skills, habits and resources needed to become successful 10. Skills training: includes all actions or behaviors necessary to accomplish a task 11. Environmental modification: changing the environment so it supports function 12. Partnership with family: family is viewed as a consistent source of support, thus, family education is provided to nurture healthy relationships 13. evaluation of outcomes: service providers are expected to monitor the services they provide for effectiveness to ensure compatibility with the individuals being served

Heat Syndromes/Hyperthermia: signs and symptoms

-heat cramps are characterized by a normal body temperature, nausea, diaphoresis, muscle twitching or spasm, weakness and severe muscle cramps -heat exhaustion is characterized by a rapid pulse, decreased blood pressure, nausea, vomiting, cool, pallid skin, mental confusion, headache, and giddiness, but no fever (heat stroke is characterized by hot, dry red skin, a body temperature higher than 104 degree; slow deep respiration, tachycardia, dilated pupils, confusion, progressing to seizures and possible loss of consciousness. Heat stroke is a medical emergency and emergency medical services must be called immediately

Assistive device evaluation focus

-identify the activities the individual wants to engage in, the occupational roles the person wants to pursue, and potentially the home functions the individual wants to control -determine the persons values about the use of AT -assess the individuals abilities and deficits including client factors and performance skills 1. stability of positioning and seating must be assessed as it will affect ability to use device 2. the anatomic site at which the person demonstrated purposeful controlled movement must be determined as this will influence devices control site (device activated by should, head, elbow, hand, tongue, or eye movement) -determine the environments in which the device will be used and when it will be used

Initiating factors that can trigger lymphedema

-inactivity and changes in cabin pressure during air flight -fluctuation in weight gain and fluid volumes -hyperemia -hypoproteinemia

Borderline personality disorder

-individuals experience extraordinary unstable affect, mood, behavior, relationships and self-image -Fear of real or imagined abandonment leads to frantic efforts to avoid it -A pattern of unstable and intense interpersonal relationships with alternating extremes of idealization and devaluation (splitting) -Recurrent self-destructive or self- mutilating behavior may be threatened or carried out -chronic feelings of emptiness -majority of persons with this condition have a history of trauma (physical, sexual, emotional abuse)

Seperation Anxiety Disorder (SAD)

-individuals typically young children, become excessively attached to another individual and experience severe anxiety when separated -the level of anxiety caused by separation is considered developmentally inappropriate and unwarranted given the circumstances

Weakness of the tongue/base of tongue structures

-inefficient propulsion of bolus at an efficient rate of speed past the base of the tongue into the pharyngeal cavity. -Lack of closure at the cricopharygeal junction can result in 1. suboptimal propulsion of the bolus 2. interference with the normal timing of the swallow sequence 3. failure to trigger closure of the vocal folds during swallow, aspiration Failure to trigger closure of vocal folds during swallow; aspiration.

Augmented feedback

-information about task performance that is supplemental to inherent feedback · A therapist provides feedback related to task performance "you need to lock your w/c brakes"

Psychosocial intervention: the relationship of intervention activities to desired goals

-initial intervention may need to focus on the performance skills needed for desired occupational performance -once basic skills are in place, intervention focuses on performance of functional activities specifically relevant to the individual 1. activities that require the actual desired skills or behaviors in their natural environment are often the most effective (assisting the client to use a checking account to pay bills) 2. activities that simulate desired behaviors in a clinical setting may be less effective (using kits that simulate checking materials) 3. activities that utilize the performance skills of desired behaviors and rely on generalization may be the least effective (practicing arithmetic calculation)

Phase 1: Inpatient Rehabilitation/Hospitalization Stage --Evaluation and intervention (acute, cardiopulmonary rehab)

-initiated at bedside with a monitored, functional assessment of self-care and mobility -if person is pain free, exhibits no arrhythmia and has regular pulse of 100 or less, and activity program is initiated (intense monitoring is required during activity, especially in the coronary care unit (CCU)) -beginning activities at MET level= 1-2 1. bed mobility, static standing 2. transfer from bed to chair/bedside commode 3. bed bath, feeding, grooming at sink in sitting 4. active range of motion/warm up exercises 5. wheelchair mobility/ambulation in room -all activities use energy conservation techniques. general principles of energy conservation and work simplification include; 1. pace oneself 2. monitor body position during activities 3. organized daily activities and work areas 4. delegate responsibilities -breathing exercises -vital signs are monitored prior to each activity, at peak of each activity, immediately upon cessation of activity and 4 or 5 minutes post activity -exertion scales are monitored prior to each activity, at peak of each activity, 30 seconds before cessation of activity, immediately upon cessation of activity and 3 to 5 minutes post activity -adhere to activity guidelines and MET levels 1. as the patients activity tolerance improves more strenuous, higher MET level activities are added in progression from basic ADL to IADL -Adhere to contraindications/precautions as per physicians order -patients are generally discharged to phase 2 when they are able to carry out activities at MET level 3.5 -educate individual about heart disease and the recovery process, provide emotional support

Rest and Sleep Intervention

-intervention must be client centered and focus on behavioral and environmental modifications to enable restorative rest and sleep. the therapist should help the person 1. develop a daily pattern of relaxation activities (meditation, prayers, progressive muscle relaxation, visualization) and pre-sleep routines (turning off electronic devices, saying goodnight) *presleep meals should be consumed at least 2 hours before sleep is initiated *pre-sleep use of stimulants (caffeine, nicotine, alcohol) should be avoided -establish health and restorative sleep wake patterns (going to bed at a consistent time each evening) -remediate symptoms that hinder rest and sleep (use energy conservation techniques, effective pain management) -modify the rest and sleep environment (cool, dark, quiet environments are most conducive to sleep) -implement sleep restriction training 1. wake up at the same time everyday 2. avoid naps until nighttime sleeping improves 3. limit the bedroom to sleep and sexual activities 4. when sleepy go to sleep 5. if sleep is not attained, get up and do an activity that is boring until sleepy again 6. allow time for sleep restriction training to work (2-3 weeks) -employ CBT strategies to address thought processes that cause anxiety and hinder sleep (make a list of concerns to address when awake, leave them outside bedroom door)

Types of fractures

-intraarticular vs. extraarticular -closed vs. open -dorsal displacement vs. volar displacement -midshaft vs. neck vs. base -complete vs. incomplete -transverse vs. spiral vs. oblique -comminuted

Stages of Lymphedema

-is it a progressive disease 1. Stage 0= no visible changes in limb or upper body, may notice difference in feeling- mild tingling, unusual tiredness, or slight heaviness, may remain in this stage for months or years before obvious symptoms develop 2. Stage 1= reversible lymphedema: limb is soft and pitting, swelling may increase overnight 3. Stage 2= spontaneously irreversible lymphedema: swelling with increase in fibrotic tissue, risk for infection 4. Stage 3= lymphostatic elephantiasis: extreme increase in swelling; skin changes (fibrosis, sclerosis, papillomas)

Amount and quality of natural and artificial light throughout home

-it is important to have evenly and well-lit stairways, entrances, and hallways especially if elevation changes are present -task-specific lighting is achieved through use of adjustable lamps. Light position and intensity should be specific for each activity such as reading versus writing -increasing light intensity and altering light source positions can reduce/eliminate glare -lightening is even more essential to consider if a low vision diagnosis is present -older individuals need 6 to 8 times more light than people in their 20s. 1. Lumen refers to the amount of brightness 2. Lux is the standard measure of luminescence and is defined as the amount of light from a source on a uniform surface (there are devices to measure the amount of lux available)

Manic episode impact on function

-lack of inhibition --> increased spending, impulsive behaviors -euphoric in early phases, but may become labile, threatening, assaultive -high energy levels, little sleep -poor judgement (safety), self-care, relationships, work performance -increased risk for substance abuse

Skeletal System Changes and Adaptations in the Older Adult: clinical implications

-maintenance of weightbearing is important for cartilaginous/joint health and mobility

Bell's palsy (Rehabilitation for lyme disease)

-make a facial splint to prevent long-term asymmetry of facial muscles. Clip or pincer mold of the inside and outer lip of the mouth on the involved side. Elastic attaching mouth mold to earpiece (similar to eyeglass ear rim) -used eletric stimulation to stimulate denervated muscles -teach person to use their fingers to assist buccal closure and prevent spillage of the bolus through the lips -provide counseling concerning alternations in body image, since the individual is coping with a facial deformity

Managing difficult behaviors: the effects of dementia

-make eye contact and show that you are interested in the person 1. value and validate what is said by the person -maintain a positive and friendly facial expressions and tone of voice during all communications 1. do not give orders 2. use short, simple words and sentences 3. do not argue or criticize -do not speak about the individual as if they were not there -use nonverbal communication -create a routine that uses familiar and enjoyable activities 1. use activities that demonstrate and promote personal interests and independence 2. do not introduce infantilizing activities 3. analyze and grade activities carefully 4. do not rush activities (it is the process of engaging in an activity that is important, task completion is not needed) -note that effects of the time of day on behavior and activity performance -attend to safety issues at all times

Wheelchair measurements: back height

-measurement is based on the need for postural stability, UE movements and potential for independent w/c propulsion -take measurement from seated surface (including cushion) upward to one of the following depending on the persons trunk control, activity level, strength, and size 1. mid-back under scapula: 1-2 inches below 2. mid-scapula or axilla 3. top of the shoulder -lower back height can increase functional mobility as in sports chair (lower back height can increase back strain) -higher back height may be needed if trunk stability is poor

Lumbricals (radial side)

-median Nerve -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 -Function: MCP flexion and extension of the IP joints

Autism Spectrum Disorder (ASD): Symptom management

-medications prescribed will depend on the presenting symptoms 1. seizure medication 2. medication for muscle deterioration and complications due to abnormal tone 3. medications to increase alertness 4. medications to modulate behavior

Consideration in group planning

-member demographics include gender, age, culture and ethnicity -individual characteristics of members 1. cognitive level 2. functional skill level 3. individual goals 4. contraindications and safety issues -logistical considerations 1. number of people in the group 2. length of session 3. number of sessions 4. space availability 5. environmental characteristics 6. budget and materials required 7. number of leaders 8. open group versus closed group -Frame of reference

Medical management/relevant pharmacology for RDS

-mild case 1. supplemental oxygen along, or in combination with positive airway pressure (CPAP) a mixture of oxygen and air provided under pressure through short, two pronged tubes placed in nose -severe cases 1. intubation and a mixture of oxygen and air provided by a ventilator under positive endexpiratory pressure (PEEP) 2. to reduce the severity of RDS and the risk of chronic long disease, a single does of surfactant replacement is given within 6 hours of development of RDS

External bleeding

-minor bleeding 1. usually clots within 10 minutes (if a person is taking aspirin, or nonsteroidal anti-inflammatory drugs (NSAIDS), clotting may take longer -severe bleeding characteristics 1. blood spurting from a wound 2. blood fails to clot even after measures to control bleeding have been taken 3. arterial bleed: high pressure, spurting, red 4. venous bleed: low pressure, steady flow, dark red or maroon blood 5. capillary bleed: low pressure, oozing dark red blood

Capillaries

-minute blood vessels that connect the ends of arteries (arterioles) with the beginning of veins (venules); forms an anastomsing network -Function for the exchange of nutrients and fluids between blood and tissues -capillary walls are thin, permeable

OT intervention for CRPS

-modalities to decrease pain -edema management: elevation, manual edema mobilization, compression glove -AROM to involved joints -ADLs to encourage pain-free active use -Stress loading (weight bearing and joint distraction activities, including scrubbing and carrying activities) -Splinting to prevent contractures and enable ability to engage in occupation-based activities -encourage self-management -interventions to avoid or to proceed with caution include PROM, passive stretching, joint mobilization, dynamic splinting and casting

Blood pressure (BP)

-monitor at rest during evaluation/activity, post activity -normal adult BP is <120/80 mmHG; range between 110 and 140 systolic, 60-80 diastolic -pediatric: 1 month-80 systolic, 45 diastolic, 6 years-105-125 systolic, 60-80 diastolic -hypertension: BP above 120/80 -increased BP may be related to stress, pain, hypoxia, drugs and disease -decreased BP may be related to bed rest, drugs, arrhythmias, blood loss/shock and MI -Orthostatic hypotension: a sudden drop in blood pressure that can occur with positional changes, especially from supine or sitting to standing 1. also called postural hypotensions, it can cause dizziness, weakness, blurred vision and syncope (fainting) 2. Orthostatic hypotension can occur after surgery, several days of bed rest, secondary to other conditions (PD, SCI) and as a side effect of medications (people at risk for othrostatic hypotension should be advised to move slowly when changing positions [standing up slowly after crouching to garden])

Respiration

-monitor at rest, during evaluation/activity and post activity -rate and depth of breathing: normal is 12-18 breaths per minute -Auscultation of lungs/respiratory sounds 1. normal: soft, rustling sound heard throughout all aspiration and start of expiration 2. Abnormal: crackles/rale -rattling, bubbling sounds; may be due to secretions in lungs -wheezes, whistling sounds

Proximal phalanx fractures

-most common with thumb and index -common complication is loss of PIP A/PROM

Muscular system changes and adaptation in the older adult: Clinical Implications

-movement becomes slower -increased complaints of fatigue -connective tissue becomes denser and stiffer 1. loss of range of motion: highly variable by joint and individuals activity level (leads to an increased risk of muscle sprains, strains, and tendon tears and increased tendency for fibrinous adhesions and contractures) -decreased functional mobility, limitations to movement -gait may become unsteady due to changes in balance and strength; increased need for assistive devices (increased risk for falls)

Multiple Sclerosis (MS) Symptoms

-multiple and varied neurologic symptoms and signs, usually with remissions and exacerbations -onset of symptoms is usually insidious -parasethesias in one or more extremities on the trunk or in the face -weakness or clumsiness in the leg or hands is common -Visual disturbance (diplopia, partial blindness, nystagmus, eye pain) -Emotional disturbances (lability, euphoria and reactive depression) -balance loss and vertigo -bladder dysfunction -cognitive features may include apathy, memory loss, lack of judgement and inattention -sensorimotor findings may include: spasticity, easy fatigue, hemiplegia, or quadriplegia -The course of the symptoms is highly variable and may follow one of 4 patterns 1. relapsing remitting 2. secondary progressive 3. primary progressive 4. progressive relapsing

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

Signs and symptoms of emphysema

-patients present with a mixture of clinical features 1. primary complaint of dyspnea on exertion 2. diminished breath sounds, wheezing (typically associated with exertion) 3. prolonged expiratory phase 4. pursed lip breathing 5. physical presentation may include: enlarger anterior/posterior dimensions of the chest wall (barrel chest), hypertrophied accessory muscle from overuse, use of accessory muscles for breathing, forward leaning posture 6. presence of chronic cough and sputum production will vary and depend on the infectious history of the person 7. disease advancement may result in patient becoming cachectic (emaciated) signs of right heart failure due to secondary pulmonary hypertension

High tech assistive devices

-potentially costly devices that may require custom ordering and may require specific training to use (environmental control units, augmentative and alternative communication devices, computers) 1. Domotics is the integration of technology and services for a better quality of life (information technology and electronics that make a home become smart) ECU- allow people to control the electric functions of their hom ein a cost effective practical sociallu relevant and reliable manner

MD medical management

-prescribed medications to decrease pulmonary and cardiac complications and prolong life -nutritional management for difficulties with feeding and the tendency to gain weight secondary to inactivity -prevention of skin breakdown and decubitus ulcers -steroids to help delay or reverse muscle weakness; however the undesirable side effects associated with steroids being their use into question

Etiology and risks of wounds and pressure ulcers

-pressure that interrupts normal circulation causing localized areas of cellular necrosis -greatest risk is over bony prominences (ischial tuberosity) -Intensity and duration of the pressure determine the severity of the decubiti -Wound management including occlusive dressing debridement, surgery and or grafting may be needed depending on the severity of the decubitus ulcer

myocardial infarction (MI) (heart attack)

-prolonged ischemia, injury and death of an area of the myocardium caused by occlusion of one or more of the coronary arteries; results in necrosis of heart tissue -Precipitating factors: atherosclerotic heart disease with thrombus formation, coronary vasospasm or embolism, cocaine toxicity -Presenting signs and symptoms 1. severe substernal pain of more than 20 minutes duration which may radiate to neck, jaw, arm, and or epigastric area (pain may be misinterpreted as indigestion) 2. Dyspnea, rapid respiration, shortness of breath 3. indigestion, nausea, and vomiting 4. pain unrelieved by rest and/or sublingual nitroglycerin 5. women are more likely than men to experience the common symptoms of shortness of breath, nausea/vomiting and back or jaw pain (presenting signs in women may vary and are often mistaken as something else [the flu or acid reflux] and not an MI. these include *chest pain that is not severe or long-lasting but characterized by uncomfortable pressure, squeezing, fullness or pain in the center of the chest that may persist for more than a few minutes or go away and come back *pain or discomfort in one or both arms, the back, neck, jaw, or stomach with or without chest pain *breaking out in a cold sweat and or being light headed -results of impaired ventricular function 1. decreased stroke volume, cardiac output and ejection fraction 2. increased end diastolic ventricular pressure -electrical instability and arrhythmias present in injured and ischemic areas

OT intervention for swallowing dysfunction

-provide family-centered intervention to determine an acceptable dinner table alternative for family interaction -work with person toward developing new roles and occupations to transition from old role (head of table) -provide ongoing education and information to family regarding persons feeding/nutrition

Purposes of therapeutic use of self

-provided reassurance and/or information -give advice -alleviate anxiety and/or fear -obtain needed information -improve and maintain function -promote growth and development -increase coping skills

Mental Health Intervention foci in community settings

-provision of services that facilitate recovery and assistance in the maintenance of existing skills -Assistance with the continued development of skills needed for community living, social participation, and the pursuit of valued occupational roles -development of skills and supports to enable ongoing recovery (WRAP, NAMI) -Development of skills and the provision of assistance, if needed to obtain concrete practical resources to support community living (supplemental social security, affordable housing and food stamps) -monitoring of the individuals changing clinical, personal and social needs

Control of ventilation

-receptors: baroreceptors, chemoreceptors, irritant receptors, stretch receptors -Central control centers: brain and autonomic nervous system -ventilary muscles

human immunodeficiency virus (HIV)

-retrovirus 1. the virus can eclipse into the cell, remaining dormant until stimulated by the body -HIV attacks the lymphatic system, the system that protects the body's immunity to opportunistic infections 1. The T cells attack the cells of the body including central nervous system cells, gastrointestinal tract cells and uterine/cervical cells -4 stages of infection 1. Acute infection: flu-like response to initial contact with the virus 2. Asymptomatic disease: HIV replicates and affects the immune system, but no visible signs other than blood abnormalities 3. Symptomatic HIV: signs and symptoms appear 4. Advanced disease or AIDS, severely compromised immunity -Complications of advanced disease occur with less frequency in current medical environment -treatment advances using drugs in combinations and personal adherence to drug treatment regimens that suppress the infection has result in transforming the outcome of AIDS from an immediate life-threatening diagnosis to a chronic condition

Complications of CP

-seizures 50% -language and cognitive 50-75% a. speech and language b. coordinating breathing and swallowing c. dyarthria d. aphasia e. cognitive deficits are more typically associated with the presence of seizures -visual impairments 40-50% 1. Strabismus 2. Nystagmus 3. Refractive Errors -feeding disturbances a. difficulty swallowing and chewing -diminished sensation is common is spastic hemiplegia

Assistive devices intervention principles

-select and use several devices on trial basis to determine what serves the individuals needs best -determine the specific device, after reviewing and incorporating all of the team members information -keep devices as simple as possible -if device is stationary, ensure that it is positioned to enable ease of access -provide multiple training sessions

Managing difficult behaviors: manic or monopolizing behavior

-select or design highly structured activities that hold the individuals attention and require a shirt of focus from person to person -thank the individual for their participation and redirect attention to another group member -refer to limit-setting

Small bowel obstruction rehabilitation issues

-self-care aspects of stoma care must be addressed for persons with decreased fine motor skills (individuals with peripheral neuropathy secondary to chemotherapy treatment) -decreased mobility in gross movements (bending or stooping during daily tasks, including lower body dressing) can cause traction on the healing scar -appetite may be altered in postoperative phase (cognitive impairments may impede a persons ability to safely maintain stoma care (forgetting to properly clean and restore the collection bag can lead to the development of abscesses)

Managing difficult behaviors: offensive physice/verbal behavior

-set limits and immediately address the behavior during a session -the reasons the behavior is not acceptable should be clearly presented in a manner that is not confrontational or judgemental -the consequences of continued offensive behavior should be clearly communicated -it is required that staff protects all clients from the threat of harm or abuse by another person (the need and safety of the entire unit/program/group must be considered when addressing offensive behaviors)

Wheelchair measurements: armrest height

-shoulders should be neutral, arms positioned at sides, elbow flexed to 90 degrees -measure under each elbow to cushioned seating surface -armrests that are too low will encourage learning forward -armrests that are too high will cause should elevation

Psychosocial intervention: factors that influence the effectiveness of intervention

-skillful therapeutic use of self -an understanding of the individuals cognitive abilities -exploration of the needs and wants of the individual -the establishment of realistic goals -skills with activity analysis -an understanding of the realities of the treatment conditions and intervention contexts -prioritization of the most goal-directed use of the persons time

Functional observation for swallowing

-staff report questioning swallowing dysfunction 1. person coughs during or after drinking water or other thin liquid -The persons face changes color during or after eating 1. Flushed/reddened color, ashened appearance for persons with darker skin 2. blanches (the person gasps for breath, possibly indicating partial or complete airway obstruction) -if an obstruction is visualized, it may be possible to remove the object and restore respiratory function Aspiration required immediate action: 1. the Heimlich maneuver is used to clear the obstruction and raise the bolus that has been aspirated as long as the person is aware and responsive 2. If the persons loses consciousness, basic life support procedures are used to continue to try to reestablish the airway. This includes abdominal thrusts, back blows, and periodically looking in the oral cavity to try to visualize the object

Five-Stage Group as developed by Mildred Ross

-stage I: orientation consists of orienting the members to the session and each other -Stage II: movement uses a variety of vigorous gross motor activities designed to be stimulating and alerting -stage III: perceptual-motor uses brief (30 minutes or less) activities that utilize perceptual motor skills designed to be calming and to increase ability to focus -Stage IV: cognitive includes activities to provide cognitive stimulation to promote organized thinking -Stage V: closure consists of brief discussions to promote a sense of satisfaction and closure

Stretch (myotatic) reflex

-stimulus: muscle stretch -reflex arc: afferent Ia fiber from muscle spindle to alpha motoneurons projecting back to muscle of origin (*monosynaptic*) -Function: maintain muscle tone, support agonist muscle contraction, provide feedback about muscle length -Clinically, sensitivity of the stretch reflex and intactness of spinal cord segments are tested by applying stretch to the deep tendons (DTR) -Reciprocal inhibition: via an inhibitory interneuron the same stretch stimulus inhibits the antagonist muscle -Reciprocal innervation: describes the responses a stretch stimulus can have on agonist (autogenic facilitation), antagonist (reciprocal inhibition) as well as on synergistic muscles (facilitation) -Apply stretch to deep tendons to test intactness of SC segment

Anatomy of rotator cuff

-supraspinatus 1. Function: abduction and flexion -infraspinatus and teres minor 1. Function: external rotation -subscapularis 1. Function: internal rotation -The rotator cuff functions together to control the head of the humerus in the glenoid fossa -Site of impingement: coracoacromial arch (acromion, coracoacromial ligament and coracoid process)

Surgical interventions for heart failure

-surgical procedures often result in deconditioning and impact on the clients occupational performance 1. angioplasty 2. intravascular stents 3. revascularization surgery 4. transplantation 5. ventricular assistive devices (VADs)

Random or variable practice

-tasks being practice are ordered randomly. Attempt multiple tasks or variations of a task before mastering any one of the tasks · Practice transferring to multiple surfaces (couch, toilet, bench, chair, stool, car) in one OT session. Practice sequence of tasks "A", "B", "C": ACBACABCCBACABCAACBBACCACB

Full time equivalent (FTE)

-the amount of time a full-time staff employee works, in the US eight hours/day 5 days a week -a budget formula used to determine the number of personnel providing direct care 1. two practitioners who do administrative tasks half of the day and direct care half of the day would equal one FTE 2.Three part time employees would equal 1.5 FTEs

Intellectual developmental disorders: impact on development

-the developmental impact can vary 1. the impact is greatest in children with severe and profound intellectual disability -cognitive development 1. slower learning ability 2. shorter attention span 3. difficulty with problem solving and critical thinking 4. difficulty generalizing information and mastering abstract thinking 5. increased distractibility -Motor development 1. slower development with the attainment of physical milestones occurring at a later age than typical 2. uncoordinated appearance and movements 3. low muscle tone -Sensory development 1. diminished sensory modulation and abilities 2. hyper-hyposensitivity to all sensory stimuli -Language development 1. decreased ability in recalling and retrieving words secondary to cognitive deficits (intention and impaired memory) 2. Difficulty grasping and expressing concepts secondary to cognitive deficits (impaired abstract thinking) 3. Difficulty with the motor aspects of creating language secondary to motor deficits (low tone) -psychosocial development 1. impaired ability to respond to social cues can result in a number of behavioral outcomes (excessive shyness, aggressiveness) 2. hyperactivity and distractibility can also impeded psychosocial development

Speech

-the expression of ideas, thoughts and feelings through language -Disturbances in speech 1. pressured speech 2. poverty of speech 3. poverty of content 4. nonspontaneous speech 5. stuttering 6. perseveration in speech

Ventilation and profusion

-the movement of gas in and out of the pulmonary system 1. measurements include volumes, capacities, flow rates 2. optimal respiration occurs when ventilation and profusion (blood flow to lungs) are matched 3. body position/gravity affects distribution of ventilation and profusion. Breathing patterns and rate of respiration may change depending on the persons position

Interventions for wounds

-the need for assistance or accommodations for participation in activities and context specifically related to the wound should be addressed 1. management of the wound site including applying wound car treatments and products to promote healing as well as manage drainage or oder 2. management of clothing and footwear that may no longer fit correctly or that may worsen the wound condition 3. education regarding donning/doffing care of and recommended wear schedule for pressure garments for scar management 4. the promotion of restful sleep, despite the presence of pain 5. Physical activity and functional mobility to prevent impairments in endurance, overall strength, cardiovascular status, pulmonary status and cgnition as well as reduce pain at the wound site 6. Bed mobility and positioning to relieve pressure on wounds, minimize pain and prevent further skin breakdown from occuring 7. social participation opportunities to address potential self-efficacy and body image issues due to skin discoloration or scarring and or compression garment use

Recovery Model

-the primary focus of the recovery process is to improve quality of life and the ability to attain desired life goals through self-advocacy -Principles 1. Self-direction: consumers identify their own goals and their own personal track to recovery 2. Individualized and person-centered: recovery is unique as dictated by each individuals personal strengths, needs, past experiences, cultural background and desires 3. Empowerment: people take control over their lives by making educated decisions that impact on their recovery 4. Holistic: recovery signifies the interrelatedness of the mind, body, spirit and community 5. Nonlinear: recovery can include episodes that disrupt the track of recovery, but individuals can learn from setbacks and proceed in a manner that supports continued recovery 6. strength-based: recovery builds on and exercises an individuals strength 7. Peer support: reciprocal relationships with others who have lived experience in supporting recovery principles are formed 8. respect: recovery is based on the premise of social acceptance of self and by others including society, ones community and service providers 9. responsibility: personal commitment to self working toward personal goals, including taking care of oneself to promote overall health and wellness 10. hope: being a change agent in recovery enables the person to embrace an optimistic future 11. Family: play an essential role in a persons recovery. They remain committed to supporting an individuals potential and personal strengths, despite potential setbacks 12. community: supports includes and remains steadfast in eliminating barriers to recovery

Aging

-the process of growing old 1. describes a wide array of physiological changes in the body system -complex and variable process -common to all members of a given species -aging is developmental, occurs across the lifespan -progressive with time -evidence of aging 1. decline in homeostatic efficiency 2. decline in reaction time (increased probability that reaction to injury will not be successful) -varies among and within individuals

Diagnostic-specific considerations for OT for depressive episode

-the provision of a safe environment and the management of behaviors that threaten the safety and well-being of the individual are paramount 1. individuals must be closely monitored for self-destructive and suicidal behavior (the most dangerous time for self-destructive or suicidal behavior may be when the depression begins to lift and the person becomes mobilized. This includes the days after inpatient admission and just prior to discharge)

Credibility: Trustworthiness

-the researchers level of confidence that their findings truthfully reflect the reality of a study's participants and the study's context 1. Credibility is attained when the researcher does not have preconceived notions about a study and allows for multiple truths to emerge from the findings as revealed by participants *Credibility can be enhanced by extended and varied field experience, reflexivity via completion of a field journal, sampling, triangulation of data, interview techniques and member checks

Proprioceptive Neuromuscular Facilitation (PNF)

-the response of the neuromuscular mechanism can be hastened through stimulation of the proprioceptors 1. utilized for neurological and orthopedic populations throughout the lifespan -techniques are superimposed on patterns of movement (diagonals) and posture, focusing on sensory stimulation from manual contacts, visual cues, and verbal commands -normal motor development proceeds in a cervicocaudal and proximodistal direction -early motor behavior is dominated by reflex activity 1. mature motor behavior is supported or reinforced by postural reflexes that are integrated throughout the lifespan -early motor behavior is characterized by spontaneous movement, which oscillates between extremes of flexion extension 1. these movements are rhythmic and reversing in character -developing motor behavior is expressed in an orderly sequence of total patterns of movement and posture -in development, there are shifts between flexor and extensor dominance -locomotion depends on reciprocal contraction of flexors and extensors -the maintenance of posture requires continual adjustment for nuances of imbalance -frequency of stimulation and repetitive activity are used to promote and retain motor learning and to develop strength and endurance -goal-directed activities coupled with techniques of facilitation are used to hasten learning of total patterns fo walking and self care activities -goal-directed activity is made up of reversing movements -diagonal patterns or mass movement patterns are utilized during functional activities 1. all patterns cross midline and encourage rotary components to movement 2. UE patterns are identified as D1 or D2 flexion or extension

Cardiac cycle

-the rhythmic pumping action of the heart -Systole: the period of ventricular contraction -Diastole: the period of ventricular relaxation and filling of blood -Atrial contraction occurs during the last third of diastole and completes ventricular filling

Whole practice

-the task is practiced in its entirety and not broken into parts · Practicing dressing

Part practice

-the tasks is broken down into its parts for separate practice -Don/doff shirt

Criteria for determining model of practice

-the type of setting -philosophy and mission of the particular setting and department - the role the therapist plays as a team member within that particular setting

Nonexperimental/Correlational (quantitative methods)

-there is no manipulation of independent variable, randomization and researcher control are not possible 1. used to study the potential relationships between two or more existing variable (attendance at a day program and social interaction skills) 2. describes relationships, predicts relationships among variables without active manipulation of the variables 3. limitations *cannot establish cause and effect relationships, limits interpretation of results. may fail to consider all variables that enter into a relationship 4. Degree of relationship is expressed as correlational coefficient, ranging from -1.00 to +1.00 5. Examples of correlation research *Restrospective, prospective, descriptive, predictive, ex post facto

Full-thickness burn

-third-degree burn involving the epidermis and dermis, hair follicles, sweat glands and nerve endings -appearance: white, waxy, leathery, and nonelastic -sensation is absent, requires skin graft -hypertrophic scar -healing time can take months

Managing difficult behaviors: lack of initiation/participation

-together with the individual identify the reasons for lack of participation (lack of skill, irrelevance of activity, attention deficits, embarrassment, depression) -motivational hints 1. individuals are more likely to participate in activities that address issues that are of interest or concern to them 2. the more ownership people have of the activity the more they will participate 3. success is motivating 4. fun is motivating 5. positive feedback and rewards are motivating 6. everyone has their own motivators. it is important to identify what they are 7. curiosity can be used to motivate 8. food is often motivating (use secondary reinforcers such as praise is usually preferable to using primary reinforcers such as food) 9. offer choices 10. encourage the individual to remain in the group and participate when/if they are ready

Developmental considerations in assessment (wheelchair)

-transportability to, from, and in school -allowance for adjustment when growth changes are experienced -allowance for use of adaptive equipment (computer, augmentative communication) -facilitation of social acceptance

Undifferentiated marketing

-use of the same marketing strategies and activities within the complete market (promoting the OT profession to the general public)

Transplantation (heart)

-used in end-stage myocardial disease, cardiomyopathy, ichemic heart disease, valvular heart disease 1. heterotopic: involves leaving the natural heart and piggy-backing the donor heart 2. orthotopic: involves removing the disease heart and replacing it with a donor heart 3. heart and lung transplantation: involves removing both organs and replacing them with donor organs 4. major problems post-transplantation: rejection, infection, complications on immunosuppresive therapy

Diagnosis of ALS

-usually clinical with generalized motor involvement unaccompanied by sensory abnormalities -electromyography can support the diagnosis -other processes such as spinal cord tumors and myopathies must be ruled out

OT intervention for Dupuytren's contractures

-wound care: dressing changes -edema control -extension splint: initially at all times except to remove for range of motion (ROM) and bathing 1. this splint is commonly hand based and can be dorsal or volar -AROM/PROM; progress to strengthening when wounds are healed -Scar management (massage, scar pad, and compression garment) -purposeful and occupation-based tasks that emphasize flexion (gripping and extension (release)

Impact of wounds

-wounds and related conditions can negatively affect a persons ability to participate in their life roles, routines and useful habits and can affect performance with self-care, work, educational activities, leisure activities, social participation and rest and sleep -wounds affect both the physical and psychological well-being of individuals -wounds can adversely affect quality of life -reduced social participation, self-efficacy and reported quality of life due to discoloration or the skin, visible scars, contracting or hypertrophic scats, and conspicuous use of compression garments -pain, depression, social isolation, and anxiety can result from the existence of wounds in the acute and chronic phases -financial stability that can be affected by the inability to work due to a significant wounds

Hand Splints for burns

-wrist 20-30 degrees extension -MCP joints 70 degrees flexion -IP joints full extension -thumb abducted and extended

Terminal feedback

-· given after task performance · After practice of reaching the therapist says "you didn't open your hand wide enough

Strategies to slow, reverse and compensate for age-related visual system changes

1. Address for visual deficits: visual acuity, visual fields, contrast sensitivity, light and dark adaptation, depth perception, diplopia, eye fatigue and eye pain 2. maximize visual function: assess for use of magnification as indicated or the need for environmental adaptations 3. Sensory thresholds are increased: allow extra time for visual discrimination and response 4. When considering compensatory strategies, consider other client factors that may impact function such as tremors or decreased range of motion, strength, sensation, cognition, hearing or ambulation 5. Work in adequate light, increase intensity, reduce glare, avoid abrupt changes in light (light to dark) 6. Use large, high contrast print for written materials 7. Provide magnifying glasses (either portable or attached to a stand/work table) to view objects and complete tasks. (magnification levels must be prescribed by a doctor) 8. Provide an eye patch for diplopia -some state OT licensure practice acts do not allow OT practitioners to give clients eye patches. In these states the OT should refer the person to an ophthalmologist 9. decreased peripheral vision may limit social interactions, therefore stand directly in front of the person at eye level when communication with them 10. assist in color discrimination: use warm colors for identification and color coding 11. Provide other sensory cures when vision is limited (verbal descriptions to new environments, sighted guide techniques, touching to communicate you are listening and talking clocks and watches 12. provide safety education; reduce fall risk

Onset/prognosis of anxiety

1. Anxiety disorders often begin in childhood but may develop at any time 2. prevalence and prognosis vary with the specific disorder

Somatosensory system changes, conditions and clinical implications- strategies and/or compensate for age-related somatosensory system changes

1. Asses carefully: check for increased thresholds to stimulation, sensory losses by modality, area of body 2. Allow extra time for responses with increased thresholds 3. Use touch to communicate: maximize physical contact (rubbing, stroking and tapping) 4. Provide augmented feedback through appropriate sensory channels (using kitchen utensils with wide, textured grips may be easier than narrow, smooth handles) 5. Teach compensatory strategies to prevent injury to anesthetic limbs 6. Provide assistive devices and environmental modifications as needed for fall prevention 7. Provide biofeedback devices as appropriate (limb load monitor)

Strategies to slow, reverse and/or compensate for age-related auditory system changes

1. Asses for hearing: acuity, speech discrimination/comprehension, tinnitus, dizziness, vertigo, pain 2. Assess for use of hearing aids, check for proper functioning 3. Minimize auditory distractions, work in quiet environment 4. Speak slowly and clearly, directly in front of person at eye level 5. use nonverbal communication to reinforce your message (gesture, demonstration) 6. Provide written and demonstrated directions/guidelines for activities 7. orient person to topics of conversation they cannot hear to reduce paranoia, isolation 8. provide assistive devices to compensate for functional effects of hearing loss and to ensure persons safety (vibrating and flashing smoke alarms, telephones, doorbells and clocks)

Retrospective review

1. Audits of medical records after intervention were rendered 2. method to ensure appropriate care was given 3. a UR tool for third-party payers that can be time consuming and costly

Disruptive, impulse-control and conduct disorders: symptom management

1. Behavioral techniques are often the most effective forms of intervention with adolescents 2. the identification and treatment of other disorders (ADHD, learning disorders, substance use, depression) is important 3. the use of medications such as antipsychotics, antidepressants, anxiolytics and mood stabilizers may be helpful 4. a consistent approach from all team members is essential

Central Nervous System (CNS)

1. Bony structure -Skill (cranium): rigid bony chamber that contains the brain and facial skeleton, with an opening (foreman magnum) at its base 2. Meninges: three membranes that envelop the brain -Dura mater: outer tough, fibrous membrane attached to inner surface of cranium, forms falx and tentorium -Arachnoid: delicate, vascular membrane -Subarachnoid space: formed by arachnoid and pia mater, contains cerebrospinal fluid and cisterns, major arteries -Pai mater: thin, vascular membrane that covers the brain surface, forms tela choroidea of ventricles 3. Ventricles: four cavities or ventricles that are filled with cerebrospinal fluid and communicate with each other and with the spinal cord canal -Lateral ventricles: large, irregularly shaped with anterior (frontal), posterior (occiplical) and inferior (temporal) horns; communicates with third ventricle through foramen of Monro -Third ventricle: located posterior and deep between the two thalami; cerebral aqueduct communicates third with fourth ventricle -Fourth ventricle: pyramid-shaped vacity located in pons and medulla, foramina (openings) of Luschka and Magendie communicate fourth ventricle with subarachnoid space 4. Cerebrospinal fluid: provides mechanical support (cushion brain), control brain excitability by regulating iconic composition, aids in exchange of nutrients and waste products -Produced in choroid plexuses in ventricles -Normal pressure 70-180 mm/H20 -Total volume: 125-150 cc 5. Blood-brain barrier: the selective restriction of blood borne substances from entering the central nervous system (CNS); associated with capillary endothelial cells 6. Blood supply: brain is 2% of body weight with a circulation of 18% of total blood volume -Carotid system: internal carotid arteries arise off of common carotids and branch to form anterior and middle cerebral arteries, supplies a large are of brain and many deep structures - Vertebrobasilar System: vertebral arteries arise off of subclavian arteries and unite to form the basilar artery; this vessel bifurcates into two posterior cerebral arteries; supplies the brain stem, cerebellum, occipital lobe and parts of thalamus -Circle of Willis: formed by anterior communicating artery connecting the two anterior cerebral arteries and the posterior communicating artery connecting each posterior and middle cerebral artery -Venous drainage: includes cerebral veins, dural venous sinuses

Comorbidities, risks and complications of obesity

1. Cardiopulmonary compromise is typically exhibited (shortness of breath, elevated blood pressure and angina) 2. altered biomechanics affect hips, knees, ankles/foot; back and joint pain are common -increased risk of orthopedic injury 3. Increased risk of pressure ulcers due to shear forces and immobility 4. Increased occurrence of lymphedema, cellulitis, skin fold dermatitis, and other skin infections 5. increased heat tolerance, risk of hyperthermia and heat exhaustion 6. increased risk of practitioner injury when using poor body mechanics or inadequate assistance during transfer and lifts

Preprosthetic treatment

1. Change of dominance (if needed) 2. ROM of uninvolved joints 3. Prepare for prosthesis 4. Desensitization 5. Stump wrapping & shaping (dist to prox; tension decreased proximally) 6. ADL retraining including skin care 7. Supportive counseling 8. Individualize tx to enhance physical & psychological adjustment

Procedure for developing a group

1. Conduct a Needs Assessment (p. 85) -describe community, target population, and Id specific needs of target population, ID resources available to program implementation 2. Develop protocol 3. Present protocol 4. Select potential members 5. meet with each potential member to explain purpose and circumstance of group 6. Hold introductory sessions of the group -considerations in activity selection 1. degree of structure (inherent or imposed) 2. types and degree of instruction provided 3. degree of new learning required 4. complexity of the activity 5. length of time for completion 6. nature and degree of skill required for engagement and completion 7. degree of challenge to the members skills

Brain Stem: Medulla Oblongata

1. Connects spinal cord with pons 2. Contains relay nuclei of dorsal columns (gracilis and cuneatus); fibers cross to give rise to medial lemniscus 3. Inferior cerebellar peduncle relays dorsal spinocerebellar tract to cerebellum 4. Corticospinal tracts cross (decussate) in pyramids 5. Medial longitudinal fasciculus arises from vestibular nuclei and extends throughout brain stem and upper cervical spinal cord; important for control of head movements and gaze stabilization (vestibulo-ocular reflex) 6. Olivary nuclear complex connects cerebellum to brain stem and is important for voluntary movement control 7. Contains several important cranial nerve nuclei: hypoglossal, dorsal nucleus of vagus, and vestibulocochlear 8. contains important centers for vital functions: cardiac, respiratory and vasomotor centers

Program planning

1. Define a focus for the program based on the needs assessment results -problem areas, functional limitations, and unmet needs that are relevant to the majority of the target population are the priority focus -Program level of difficulty as determined by the range of populations functional levels and the level required by the current and expected environment 2. Adopt a FOR that are most likely to successfully address and meet the needs that are the programs focus 3. establish objectives and goals of the program specifically related to primary focus -Individuals goals that will be met by the program are set -programming goals that establish standards for program evaluation are determined 4. Describe integration of program into existing system of care -establish realistic timetable for program implementation -define staff roles, responsibilities and assignments -identify methods for professional collaboration -determine the physical setting and space requirements -consider potential barriers to program implementation -develop methods to effectively deal with identified obstacles before program implementation 5. Develop a system for referral for entry into completion of and discharge from the program -Evaluation protocols to standardized information to be obtained from each person referred to the program and to assess the type of program services needed -criteria for acceptance into the program and for movement through program levels -discharge criteria to determine when an individual has achieved maximum gain from the program, usually defined as the achievement of program goals 6. Described the fiscal implications of program plan -Determine projected volume or service demand to estimate revenue -identify resource utilization and projected expenses to estimate costs -directly compare estimated revenue and estimated expenses to determine financial viability of program

Conduct a comprehensive and systematic literature search

1. Define the parameters and boundaries of the search according to the research questions main concepts and constructs 2. Use databases, indices and abstracts along with the support of a reference librarian 3. Organize literature obtained according to relevance and concepts and take notes to summarize content 4. Critically evaluate literature reviewed according to established standards 5. Recognize that the literature may need to be revisited and/or re-searched as the study progresses and/or when its results are analyzed

Integumentry changes (changes in skin composition)

1. Dermis thins with loss of elastin 2. decreased vascularity, vascular fragility results in easy bruising (senile purpura) 3. decreased sebaceous activity and decline in hydration 4. appearance: skin appears dry, wrinkled, yellowed and inelastic, aging spots appear (clusters of melanocyte pigmentation); increased with exposure to the sun 5. General thinning and graying of hair due to vascular insufficiency and decreased melanin production 6. Nails grow more slowly, becomes 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 (decreased sensitivity to touch and minimized perception of pain and temperature can contribute to increased risk for injury from concentrated pressures or excess temperature, decreased sweat production with loss of sweat glads results in decreased temperature regulation and homeostasis

Jean Piaget's Theory of Cognitive Development

1. Described the process of cognitive development form birth to adolescents 2. Major constructs -Adaptation: responding to environmental challenges as they occur - Mental schemes: organizing experiences into concepts -Operations: the cognitive methods used by the child to organize schemes and experiences to direct subsequent actions -Adapted intelligence or cognitive competence -Equilibrium: the balance between what the child knows and can act on and what the environment provides -Assimilation: the ability to take a new situation and change it to match an existing scheme or generalization -Accommodation: the development of a new scheme in response to the reality of a situation or discrimination

Workers Compensation

1. Designed to compensate employees who have job related illness or injuries 2. Funded jointly by individual employers or groups of employers and state governments 3. Each state has a worker's compensation commission board that determines regulations for employer participation, benefit provision, employee coverage and insurance administration 4. Administration can be through contract with private insurance companies or through individual employers or groups of employers who administer their own programs (Self-insuring) 5. Coverage varies from state to state, with many states initiating cost-containment measures including limits on choice of providers, use of set fee schedules, utilization review and managed care 6. Workers compensation programs include cash benefits and medical benefits. OT services may be included 7. Rehabilitation and disability management to return the person to gainful employment is a primary focus

Occupational Adaptation Model

1. Developed by Janette Schkade and Sally Schultz 2. Principles -occupational adaptation os concerned with the process that the individual foes through to adapt to their environment -it consists of 3 elements: the person, the occupational environment and the interaction between the two (1) the person element consists of the sensorimotor, cognitive and psychosocial component of the individual (2) the occupation environment is viewed as the physical, social and cultural systems within which work, play/leisure and self-maintenance take place (3) the outcome of the interaction between the person and the environment is referred to as the occupational response -The occupational adaptation model makes 2 basic assumptions (1) occupation provides the means by which humans adapt to changing needs and conditions and the desire to participate in occupations is the intrinsic motivational force leading to adaptation (2)occupational adaptation is normative process that is most pronounced during periods of transition, both large and small. The greater the adaptive transitional needs the greater the importance of the occupational adaptation process and the greater the likelihood that the process will be disrupted -Evaluation 1. Focuses on occupational environment, role expectation and the individuals potential for adaptation and the best means for adaptation to occur -Intervention 1. focuses on increasing the skills needed for occupational adaptation 2. addresses both the individual and the environment

Ecology of Human Performance Model (EHP)

1. Developed by Winnie Dunn and colleagues at the University of Kansas Medical Center 2. Principles -the model emphasizes the role of an individuals context (a persons culture, physical and social environments and how the environment impacts a person and their task performance) - This model is applicable to people across the life span -the 4 main constructs of this model include: the person, task, context and personal-context-task transaction -there are 11 assumptions of this model (1) ecology refers to the interaction between a person and their environment (2) a persons performance is understood by looking at the relationship between the person, context and task (3) performance occurs when a person acts to engage in tasks within a context (4) each person is a unique individual with sensorimotor, cognitive and psychosocial skills and abilities (5) the range of a persons performance is based on the transaction between the person and the context (6) skills that a person possesses can be increase or decrease due to illness and stress a persons interests and life experiences lead to continually changing variables (7) Contexts are dynamic rather than static there is a reciprocal relationship between a person and their context where one influences the other (8) the roles that a person has in life are made up of tasks; the transactional relationship between the person, task, and context makes up occupations and roles (9) there is a difference between a persons performance in their natural contexts and simulated experiences (10) in the OT process people are empowered by increasing their self-determination (11) this model defines independence as using the supports in a persons context to meet their needs and wants 3. Evaluation -utilizes checklists that were designed along with this model. these includes checklists for the person, environment, task analysis and personal priorities -the sensory profile 4. Intervention -5 specific strategies designed to help the person, context, task or all 3 are used 1. establish and restore: enhancing a persons abilities by teaching skills lost due to illness or disability or never learned 2. Alter: assessing a persons contexts to determine which is the best match for persons abilities 3. Adapt/modify: changing the context or task in some way so that is leads the person to successful performance 4. Prevent: minimizing risks that might develop so that problems in performance do not develop 5. create: assisting the person by promoting enriching and complex performances in the persons context

Code of Ethics overview

1. Developed by the AOTA as a statement to the public identifying the values and principles used to promote and maintain high standards for the behavior of occupational therapy practitioners 2. A set of principles that apply to all levels of OT personnel 3. All OT practitioners are obligated to uphold these standards for themselves and their colleagues 4. The ethical code has two main purposes. These are to: provide aspirational core values of action in professional and volunteer roles. Delineate enforceable principles and standards of conduct that apply to AOTA members.

Person-Environment-Occupation Model

1. Developed my Charles Christiansen and Carolyn Baum 2. Principles -occupational performance is dynamic in natures -occupational performance is considered the outcome of the transactional relationship between people, their occupations and the environment -occupational performance necessarily changes across the life span 3. Evaluation -address the occupational performance issues that the client identifies -emphasize the environment of the individual to include where they live, work and play -evaluation is client centered and flexible as there are no specific evaluations 4. Interventions -considers the transactional relationships of occupations with people and their environment to address occupational performance issues and goals -recognizes the temporal nature of the occupational performance as the person, their environment and occupations are constantly changing -offers many avenues for changes, as practitioners can be flexible in their choice of intervention strategies

Osteogenesis Imperfecta (OI) Etiology

1. Disorder caused by the dysfunction of one of several genes responsible for producing collagen to strengthen bones 2. The genes responsible for osteogenesis imperfecta can be inherited from one or both parents 2. In some cases OI genes responsible for collagen begin to malfunction after the child is conceived

Diagnostic -specific considerations for OT: substance abuse

1. Due to the presence of learned "survival skills" the individual's abilities and potential may be overestimated -the OT apprises the team and the individual of the persons actual skills and deficits as evident during evaluation and intervention -the occupational therapist assists the team and the person in identifying realistic expectations and discharge plans 2. the individuals identification of the reasons for substance use is important to address during the evaluation process 3. The development of the skills necessary to cope with life stressors without substance use is critical for a substance-free lifestyle. Skills needed include: -communication and social skills to support substance-free social participation and advocate for access to needed services -skills to engage productively in work, education and other productive activities (volunteering) -skills to use leisure time without using substances 4. societal stigma and lifelong patterns of denial, resistance, and other defensive behaviors can make treatment challenging and difficult 5. Referrals to support groups including AA, NA and specialized addition providers can sustain recovery

ADA Amendments Act (ADAAA) of 2008

1. Enacted to rectify the problems resulting form post-ADA Supreme Court decisions, which drastically narrowed the ADA definitions of disability and substantially limited ADA protections 2. Reaffirmed that a disability is the actual presence of a disorder or condition that impairs participation in one or more major life activities, a record of a limiting impairment or being regarded as having an impairment -The use of mitigating measures (wheelchairs, hearing aids, taking insulin) to address a disability or the remediation or a condition (recovery from cancer, a repetitive stress disorder, or schizophrenia) does not negate the persons ability to be protected by the ADA 3. Redefines major life activities to include major body functions and organ operations performing basic and instrumental activities of daily living, completing physical movements and manual activities, sleeping, working, reading, learning, communicating and interacting, and thinking and concentrating 4. Broadened the interpretation of a substantially limited impairment to include the instability to perform on major life activity as it is typically performed by the general population

Traumatic Brain Injury

1. Etiology 2. Damage results from penetration of the skill (open TBI), from rapid acceleration or deceleration of the brain (closed TBI) or blunt external force (closed TBI) -injury occurs in the tissue at the point of impact (coup), at the opposite pole (countercoup) and diffusely along the frontal and temporal lobes Injury can result from a variety of occurrences 1. skull fractures 2. closed head injuries 3. penetrating wounds of the skull and brain 4. traumatic injury to extracranial blood vessels 5. nerve tissues, blood vessels and meninges are sheared, torn or ruptured, resulting in hemorrhage, edema and ischemia

Essentials of the research process

1. Formulation of a philosophical foundation to reflect researcher's view of, and assumptions about, learning, human behavior, and other phenomena related to health and human services 2. Identification of a broad issue, topic or problem of interest and relevance that warrants scientific investigation 3. Review and synthesis of research literature related to identified area of interest 4. Utilization of a theoretical base to frame the research problem or area of concern to ensure that the resulting research contributes to, or build upon, theory 5. Development of a specific question or focus for research (in quantitative/experimental research this is very specific, detailing the exact variables to be studied; in qualitative/naturalistic research, this is a broad question called a "query" that will develop specificity over the course of the study) 6. Selection of a research design (in quantitative/experimental research, the design is highly standardized; in qualitative/naturalistic research, the design is more fluid) 7. Formulation of methodology 8. Determination of study's length 9. Identification of study's participants/population sample 10. Collection of data using established principles for collecting research information -information obtained must be relevant and sufficient to answer the specific research question or query -the method of data collection selected must be realistic given the practical limitations of the researcher, the type of research design and the nature of the research problem -use of a combination of data collection methods can be useful and more fully answer a research question or query 11. Methods of data collection (observation; interview; written questionnaire; survey instruments; artifact and record review; hardware instrumentation; tests and assessments) 12. Analysis and interpretation of data using descriptive statistics (measures of central tendency; measures of variability) 13. Analysis and interpretation of data using inferential statistics (standard error of measurement; tests of significance; parametric statistics; nonparametric statistics; correlational statistics) 14. Report and dissemination of research findings (results section, conclusion section, summary)

Preoperative rehabilitation for cancer

1. Functional assessments, preparation for post operative phase and care, 2. client and caregiver education concerning recovery and follow up care/functional expectations and client engagement

Mental status examination

1. General description of the individual - Appearance, behavior and cooperation 2. Mood and affect -Mood (pervasive, sustained emotion) -Affect (observables expression of mood) -Appropriateness of mood and affect 3. Speech 4. Perceptual disturbances 5. Thought -process or form of though -content of thought 6. Sensorium and cognition -Level of consciousness -Orientation to person, place, time and situation -Memory -Concentration and attention -Capacity to read and write -Abstract thinking -Fund of information and intelligence 7. impulse control 8. judgement and insight 9. reliability

Substances abuse impact on function

1. Impact substance use has on the individual depends on the type of substance used and on whether the individual is abusing the substance or is dependent on it 2. Results of disorders of use -disinterest and inability to care for self and others -difficult with and loss of personal relationships -inability to be productive and maintain employment -absence of leisure and social pursuits that do not involve substance use -involvement with the legal system 3. Prolonged use may lead to severe physical, cognitive and psychiatric problems and can result in death

Ventricular assistive devices (VADs)

1. Implanted device (accessory pump) that improves tissue perfusion and maintains cardiogenic circulation. 2. Used with severely involved patients (cardiogenic shock, unresponsive to medications, severe ventricular dysfunction; those awaiting heart transplant) 3. often called the bridge to transplantation

Lungs

1. In normal swallowing, the bolus does not enter the airway and the lungs 2. a person who aspirates food or drink into their airway are at risk for pneumonia 3. All people aspirate saliva in their sleep; however for people with impaired immune systems the risk for repeat pneumonia escalates

Observation

1. In quantitative research (structured and formalized) 2. In qualitative research (are unstructured and ever-changing according to the contexts and results of the observations) 3. Observations may be made of nonhuman objects such as equipment, or human subjects during actual performance or via videotapes

Written Questionnaires

1. In quantitative research, questionnaires must be structured 2. In qualitative research, questions may be unstructured 3. Distribution may be by mail, email or in person, with instructions to complete at that moment or at respondents connivence and with directions to return the completed questionnaire to researcher by a specific date 4. Surveys are a major type of questionnaire used in research

Overview of Anxiety Disorders

1. Include a range of disorders that include episodic periods of intense anxiety to chronic periods of lower levels of anxiety 2. Anxiety is an internal sense of apprehension and psychological distress. it may or may not have a specific focus

Lela Llorens Developmental theory

1. Individual is viewed from 2 perspectives -specific period of time, referred to as horizontal development -Over the course of time, referred to as longitudinal/chronological development 2. Both of these perspectives occur simultaneously 3. The integration of these two aspects is critical to normal development 4. The roles of the occupational therapist is to facilitate development and assist in the master of life tasks and the ability to cope with life expectations 5. Llorens FOR integrated many of the concepts of Gesell, Amatruda, Erikson, Havighurst and Freud

Personal payment

1. Individuals whose health insurance has discontinued coverage of OT services may elect to pay for these services personally, providing that benefit can be derived from continued services 2. Individuals without health insurance or with no coverage for rehabilitative services may also pay for OT services personally 3. The services of Occupational therapists practicing in nonmedical settings (wellness and prevention programs) are generally not covered by insurers, so their clients must private pay

General Intervention Guidelines

1. Interventions should follow a top-down progression of considering the persons areas of occupation first rather than a bottom-up approach that focuses intentionally and solely on performance skills and client factors -the impact of performance skill deficits and client factors on occupational performance is considered after establishing the individuals desired occupational outcome -specific interventions to remediate, alleviate and compensate for the effects of performance skill deficits and client factors on occupational performance are often required -the focus of remediation interventions for performance skill deficits and client factors must be related to the individuals ability to perform meaningful occupations that are needed and desired by the individual 2. interventions for deficits that cannot be remediated should include recommendations for adaptive strategies and adaptive equipment that compensate for the deficits and ease performance in areas of occupation -strategies that can be generalized to different situations are particularly helpful (principles of energy conservation) -multiple factors should be considered when recommending adaptive strategies *these factors are also relevant to consider when selecting adaptive equipment -training in adaptive strategies and equipment use to enhance performance must consider the persons privacy and dignity *this is especially critical in interventions for the performance of BADLs/PADLs

Title II- Public Services (ADA)

1. Mandates that state and local governments and their departments, agencies and/or component parts may not discriminate against, exclude or deny persons with disabilities participation in or benefit from the services, programs, or activities of these public entities -This includes transportation, public education, employment, recreation, social services, health care, courts, town meetings and voting

Factors that influence effective team functioning

1. Member skill and knowledge 2. Membership stability 3. Commitment to team goals 4. Good communication 5. Membership composition 6. A common language 7. Effective leadership Principles of Collaboration -Recognize that all members of the team are equally important (no one's opinion or area of competence takes precedence over the other). Faculty chain of command guidelines will determine who is ultimately responsible for the teams decision`

The role of OT in Environmental Considerations

1. OT should be familiar with all aspects of a persons environment (living, vocational, leisure) whether service delivery takes place in hospital, nursing home, school or home environment 2. OT can advocate for and design environments that use principles of universal design to meet the physical, sensory, sociocultural and psychological needs of the individual 3. OT can help to identify settings and approaches to implement the ADA, OBRA and IDEA 4. OT can advocate for ADA, OBRA and IDEA compliance to enable individuals to live independently and with the least restriction possible in their environments of choice

OTA/COTA Documentation Guidelines

1. OTAs/COTAs are qualified to write notes in medical charts and other documentation formats 2. OTA/COTA notes are not required to be co-signed by an occupational therapist by the AOTA, but state and federal governments may mandate co-signing as a tangible way to demonstrate compliance with OTA/COTA supervisory laws and regulations 3. AOTA recommends OTA/COTA notes that will be included in medical charts, individualized education plans (IEPs), and other legal documents be co-signed by an occupational therapist (as official documents these records may be subject to subpoena)

Affect

1. Observable component of emotion -appropriate affect is consistent/congruent with the accompanying idea, thought or speech 2. Disturbances of affect -inappropriate affect -blunted affect -restricted or constricted affect -flat affect -labile affect 3. mood is a pervasive and sustained emotion manifested by thoughts and actions (elation, anger, depression) -rapid changes in affect (lability) are usually accompanied by rapid changes in mood -These mood changes are frequently referred to as mood swings

Additional hearing loss with pathology

1. OtosclerosisL immobility of stapes results in profound conductive hearing loss 2. Paget's disease 3. Hypothyroidism

Ethical considerations

1. Participants must be provided with full disclosure of study's purpose, methodology and the nature and scope of expected participation 2. Participants must be informed of any potential risk of discomforts and a plan to remediate risk or discomfort must be developed and provided to participants 3. Participation in the study must be voluntary -Participants right to withdraw form a study must be protected -participants refusal to answer certain questions and/or participate in a specific procedure must be respected and honored 4. Confidentiality of all participants identifying information must be ensured at all times 5. Institutional Review Boards (IRB) approval must be obtained for all human subject research -IRBs (or Human Subjects Boards) are mandated by the government to be established at all institutions that are involved in research. This includes educational and health-care settings - IRB approval is required to receive federal (and most other) research grants - Proposals for research must be submitted to and approved by an IRB prior to implementation of the research study -IRBs review research proposals to ensure that all of the previously mentions ethical standards for research have been considered by the researcher

Rehabilitation guidelines for lymphatic disease- OT intervention (phase 1)

1. Phase 1 interventions: management of edema secondary to lymphatic dysfunction -short-stretch compression bandaged, worn 24 hours/day: these provide slow resting pressure and high working pressure to enhance lymphatic return at rest, improve activity of lymphatic system and facilitate return during muscle pumping activities 2. Manual lymph drainage (MLD) with complete decongestive therapy -massage and passive range of motion to assist lymphatic flow -emphasis on decongesting proximal segments first (trunk quadrant), then extremities, directing flow distal to proximal -compression using multilayered padding and short-stretch bandages 3. exercise; stretching and low-to-moderate intensity aerobic exercise combined with rest; tai chi, yoga, movement to support lymphatic drainage (strenuous activities, jogging, ballistic movements, and rotational motions are contraindicated as they are likely to exacerbate lymphedema) 4. relaxation, deep breathing and energy conservation/work simplification techniques to address stress, pain, fatigue and breathing 5. custom compression garments; provided once limb reduction plateaus (4 to 6 months) 6. referral to certified lymphedema therapist

Frontal lobe

1. Precentral gyrus: primary motor cortex for voluntary muscle activation 2. Prefrontal cotrx: controls emotionsm judgementsm high-order cognitive functions such as ideation and abstraction 3. Premotor cortex related to planning of movements include Broca's area: controls motor aspects of speech

5 P's of Marketing

1. Product: the service or thing that is being offered to the market (work hardening program, adaptive equipment) 2. Price: the financial, physical and psychological cost of doing business 3. Place: the distribution method for getting a product or service to the target market for providing the target market with access to the product or service 4. Promotion: all efforts to communicate information about the product or service to the target market or market segment that makes the product or service visible and desirable 5. Position: the place the product or service holds in relation to similar products or services available in the market place

Title I- Employment (ADA)

1. Prohibits employers from discriminating against persons with disabilities in any aspect of phase of employment including recruitment, hiring, working conditions, hours, promotion, training opportunities, termination, social activities and other privileges of employment 2. Allows questions about ones ability to perform a job but prohibits inquiries as to whether one has a disability 3. Prohibits employment test that tend to screen out people with disabilities 4. A qualified individual with a disability means a person with a disability who is able to perform the essential functions of a job (that is the tasks fundamental to the position) with or without reasonable accommodations 5. Reasonable accommodations must be provided by businesses with 15 or more employees to persons with disabilities to enable them to perform essential job functions unless such accommodations would impose an undue hardship on the business Types of reasonable accommodations -Acquisition or modifications or equipment or devices - Modifications or adjustments to exams, training materials or publications -Provision of ancillary aids or services -Modified or part-time work schedules, job restructuring or reassignment to a vacant position Improvement of existing facilities used y employees so they are usable by and accessible to persons with disabilities and/or other similar accommodations Types of ancillary aids and services -Taped texts, qualified readers or other methods that can effectively make visually delivered materials accessible to persons with visual impairments -Qualified interpreters or other methods that can effectively make aurally delivered materials accessible to persons with hearing impairments -Modifications or acquisitions of devices or equipment -Similar actions or services that increase accessibility 6. The government, Indian Tribes and/or private tax exempt membership clubs are exempt from ADA employer guidelines

Lifespan and OT developmental theorists (Havighurst)

1. Proposed that people need to develop certain skills at different ages to meet social standards 2. Believed that these developmental tasks rely on biological, psychological and sociological conditions -Proposed that there are certain sensitive periods, when biological, psychological and sociological conditions are optimal for the accomplishment of a developmental task -Described "teachable moments" referring to the sensitive periods when conditions are optimal for integration of previous knowledge and the accomplishment of new developmental tasks with assistance 3. 6 stages of development are described along with specific developmental tasks for each stage 4. In current society, the tasks of some stages may occur later than described by Havighurst

Purpose of documentation

1. Provides a legal, serial record of clients condition, evaluation and reevaluation results, course of therapeutic intervention and response to intervention from referral to discharge. 2. Justifies the necessity of skilled services to payers by providing a rationale for service provision 3. Serves as an information resource for client care, can be used by a covering therapist in absence of primary therapist 4. Enhances communication among health-care or educational team members 5. Provides data for use in intervention, program evaluation, research and education 6. Electronic medical records (EMRs)/electronic health records (EHRs) provide digital versions of paper charts

Symptom Management for obsessive-compulsive

1. Psychotherapy to explore psychodynamic issues 2. Cognitive-behavioral therapy to develop skills to manage symptoms 3. several types of medications may be helpful depending on the specific disorder -Anxiolytic medications -Antidepressants -Antiobsessional medications Luvox may be used -In some cases, hypnotic medications to induce sleep may be used briefly 1. hypnotic medications include restoril, dalmane, ambien and benadryl 2. side affects are similar to those of anxiolytics

Anne Mosey: developmental theory

1. Recapitulation of ontogenesis FOR -the development of adaptive skills, essential learned behaviors, is considered critical for successful participation in occupational performance 2. 6 major adaptive skills along with subskills are delineated (Anne Mosey) -Sensory integration of vestibular, proprioceptive and tactile information for functional use -Cognitive skill -Dyadic interaction skill -Group interaction skills -self-identity skill -sexual identity skill

Medicare Coverage of Durable Medical Equipment, Prostheses, and Orthoses

1. Rental or purchase expenses for durable medical equipment (DME) are covered if used in beneficiary's home and if necessary and reasonable to treat an illness or injury or to improve functioning 2. A physicians prescription is needed and must include diagnosis, prognosis and reason for DME need 3. Criteria for DME - Repeated use can be withstood -Primarily and customarily used for a medical purpose (wheelchair or walker) -Generally not useful to a person in the absence of injury or illness 4. Self-help items, bathtub grab bars, and raised toilet seats are not reimbursable DME because other people can use them, and they are not considered medically necessary

Seizure Disorders etiology

1. Seizure disorders must be differentiated from epilepsy -Epilepsy is a chronic state of recurrent seizures -seizure disorder refers to a temporary disturbance in brain activity causing a group of nerve cells to fire excessively, interfering with normal brain function 2. Seizures are typically idiopathic; they also can be hereditary -in almost 2/3 of all epilepsy cases the cause remains unknown 3. Seizures are often associated with other conditions including -oxygen deprivation (during childbirth) -severe head injuries or brain hemorrhage -cerebral palsy -stroke -brain tumors -other neurological disorders (AD) -hydrocephalus -metabolic disorders -infections, meningitis, encephalitis, congenital infections -rubella

Diagnostic-specific considerations for OT with obsessive compulsive disorders

1. Skills training and using cognitive behavioral approaches may reduce obsessive thoughts and compulsive behaviors 2. developing relaxation and stress management skills may decrease the incidence and severity of symptoms 3. providing graded activities designed to promote self-efficacy may increase self-confidence, motivation and participation in intervention

Short and long-term goal written in a SMART manner

1. Specific: for example, not increase self-care skills, rather, develop ability to button shirt using non-dominant hand 2. Measurable: as to number of times or a percent 3. Attainable: as to what can be realistically achieve. For example, 100% return is unlikely 4. Relevant: to roles and expected environment 5. Time-limited: anticipated time to achieve goals -Time allotted for goal attainment must be relevant to settings LOS (in acute care, goals are measured in days, whereas in long-term care, weekly or monthly goals are acceptable) 6. The acronym RUMBA is similarly used to guide documentation (R= realistic/relevant, U= understandable, M=measurable, B= behavioral, A= Attainable/achievable) -Long-term goals must indicate the final desired functional outcome before discharge, regardless of LOS 1. A clear reason for skilled therapeutic intervention 2. Statement of potential functional outcome that is clearly related to the goal -Activities and/or treatment procedures and methods related to stated goals and problems -Type, amount, duration, and frequency of treatment needed to accomplish goals -Explanation of treatment plan to client and a provision of statement of goals in clients words

Funding for environmental modifications

1. State One-Stop Centers, Vocational and Educational Services for Individuals with Disabilities (VESID), Offices for Vocational Rehabilitation (OVRs), and Divisions of Vocational Rehabilitation (DVRs) will pay for home and work modifications if the modifications enable a person to go to work or school. 2. private companies will fund modifications to ensure ADA compliance 3. Private insurance, Medicare, Medicaid, and workers compensation will possibly reimburse for certain devices/adaptations

End-of-life (hospice) rehabilitation care for cancer

1. Support quality of life as disease advances and functional status decline s 2. Provide client with as much control as they can have and desire to have to their day-to-day life and lifestyle support 3. Be present, be accountable, listen and counsel as needed concerning the progression of the disease and sense of liminality 4. Encourage planning for death, control over goodbyes, funeral arrangements, advanced directive, etc. 5. Empower life celebration and life reflection (journaling, scrapbooks, phone call contact and recontact, letter writing) 6. Refer to legal support, if needed and requested

Survey Instruments

1. Surveys are nonexperimental instruments designed to measure specific characteristics 2. Survey questions can be open-ended questions or closed-ended questions: (semantic differential, Likert scale, Guttman scale rank ordering, multiple choice, incomplete sentences) 3. Survey design research typically uses large samples through mail, telephone or face-to-face contact 4. Benefits of survey research -The ability to obtain a large number of participants at a relatively low cost -the ability to measure numerous variables with one instrument -the ability to use the data obtained in multiple ways through statistical manipulation during data analysis 5. Disadvantages to and limitations of survey research -limited or poor response rate -missing or inaccurately completed data -the response rate issues and data collection problems of survey research can be minimized with the development and use of a good survey instrument; therefore it is advisable for all researchers to carefully critique and pilot their study measures before its use in a research study -Due to sampling limitations and potential respondent bias, the generalizability of survey research is limited

Deficits in modulation (regulation and organization)

1. Tactile defensiveness: overresponsivity to ordinary touch sensations -the individual may demonstrate irritation and discomfort from a variety of textures such as clothing, sand, grass, glue, water, paint, and/or food -the individual may dislike brushing their teeth or hair -the individual may demonstrate various behavioral responses including distractibility, anger, hostility, temper tantrums, fear and distress 2. Underresponsivity to tactile stimuli as demonstrated by diminished sensory registration and responsiveness -the individual may not respond to normal levels of tactile input and may seek disproportionate amounts of stimuli to gain environmental information (excessive touching of people and objects)

Prevention of autonomic dysreflexia

1. Teach person/caregiver frequent pressure relief principles 2. Ensure compliance with intermittent catheterization 3. Practice well-balanced diet habits 4. Ensure medication compliance 5. Educate the person with the condition (and or at risk) and caregivers to recognize cause, signs, and symptoms (i.e., sweating, headache); initiate first aid procedures to deal effectively with the occurrence, and use prevention methods for this condition.

Trigger finger

1. Tenosynovitis of the finger flexors: most commonly in the A1 pulley 2. Caused by repetition and the use of tools that are placed to far apart 3. conservative treatment -hand or finger based trigger finger splint (MCP extended, IP joints free) -scar massage -edema control -tendon gliding -activity/work modification: avoid repetitive gripping activities and using tools with handles too far apart

Rest and Sleep Evaluation

1. The OT should always assess the area of occupation during routine screenings and interviews -asking a person if they feel drowsy during the day is a quick and easy way to screen for problems with rest and sleep 2. a more in-depth evaluation of rest and sleep for those who report drowsiness should focus on the identification of - the persons ability to identify the need for restorative rest and sleep -typical rest and sleep patterns and routines intermittent or chronic insomnia *the use of OT assessments that focus on time use and temporal adaptation (Barth Time Construction, Activities Congifuration) can provide helpful information about a persons typical rest and sleep patterns -obstacles to the attainment and maintenance of satisfying rest and sleep (1) personal issues (worrying about family, work stressors, being a light sleeper who awakens easily) (2) pathophysiological changes related to disease disability and the aging processes (spasticity, chronic pain, unrelenting fatigue) (3) PTSD resulting in hypervigilance (4) sociocultural barriers (need to work a night shift job requires sleeping during daytime hours) 4. sleep checklists and sleep diaries cna be used to obtain detailed information 5. persons with chronic and unrelenting insomnia should be referred to a sleep clinic for an extensive overnight evaluation (people with parasomnias [narcolepsy, restless leg syndrome, sleepwalking] those with or at risk for obstructive sleep apnea syndrome (OSAS) and persons with pathophysiological changes as previously noted should be referred to a physician for a comprehensive medical evaluation ot ensure that a comprehensive intervention plan is formulated to effectively address the person primary conditions because OSAS is deadly, physician referrals for persons with OSAS must be completed immediately)

Pharyngeal and laryngeal structures

1. The pharynx extends from the nares (nostrils) to the mouth and the larynx; all a part of the alimentary canal -both air and food pass through the pharynx 2. The larynx is also called the voice box -it functions to protect the airway from aspiration of food -the larynx houses the vocal folds and manipulates the pitch and volume of someones voices

Perception

1. The process of organizing and interpreting sensory information received by the environment 2. Disturbances of perception -Hallucinations -Illusions 3. Disturbances associated with cognitive disorders -Agnosia -Astereognosis -Apraxia -Adiadochokinesia 4. Disturbances associated with conversion and dissociated phenomena -these disturbances are in response to repressed material and involve physical symptoms and distortions that are not under voluntary control or associated with a physical disorder -Depersonalization -Derealization -Fugue -Dissociative identify disorder -Dissociation

Thought

1. Thinking is a goal directed reasoned flow of ideas and associations -when thinking follows a logical sequence it is considered normal 2. Disturbances in form of thought -Circumstantiality -Tangentiality -Perseveration -Flight of ideas -Thought blocking -Loosening of associations 3. Disturbances in content of thought -Delusions -Compulsion -Obsessions -Concrete thinking

Diagnostic-specific considerations for OT

1. When working with persons with psychotic disorders the presence of disordered thinking requires the OT practitioner to communicate simply, clearly and concretely 2. external structure and consistency to organize the individuals thinking environment and daily activities are often required 3. the provision of supports and tools to enable recovery is essential (WRAP- wellness recovery action plan)

Anxiety

1. a panic-stricken reaction to awareness of the seriousness of the situation 2. characterized by restlessness, confusion, racing thoughts, and psychological symptoms associated with anxiety

postconcussion syndrome (PCS)

1. a set of symptoms that may continue for weeks, months or a year or more after a concussion 2. symptoms -concussion with or without loss of consciousness -headache -fatigue -cognitive impairments -dizziness -depression -impaired balance -irritability -apathy 3. Diagnostic testing -exercise testing such as treadmill exercise (concussion symptoms are typically exacerbated by exercise) -neuropsychatric evaluation -neuro-opthalmologic examination -vestibular testing 4. Medical management -prescribing a period of cognitive and physical rest -cognitive behavioral therapy (CBT) -anti-depression medications

Becker's muscular dystrophy (BMD)

1. a varient of Duchenne's muscular dystrophy that is slower to progress, less severe and less predictable 2. presenting symptoms include -loss of motor function of the hips, thighs and pelvic areas and shoulders -enlarged calves -cardiac system can be involved 3. survival can be into late adulthood -a normal life span can be attained if there is minimal cardiac involvement

Breathing exercises

1. abdominal diaphragmatic breathing: strengthens diaphragm, decreases energy required for activity. 2. Pursed lip breathing: controls respiratory rate; decreases rate of breathing, helps remove trapped air from lungs 3. Techniques are done during all exercises and activities

partial focal seizures (simple)

1. abnormal electrical impulses occur in a localized area of the rbain, often in the motor strip of the frontal lobe 2. involuntary, repetitive jerking of the hand and arm, occurs, but the individual can maintain interaction with his/her environment 3.focal seizures may become generalized and result in a loss of consciousness

Inpatient rehabilitation tertiary care (rehabilitation for obesity)

1. access devices and equipment to maximize client participation in daily activities of meaning (BADL, IADL, mobility and community participation) -bariatric equipment: wheeled mobility, assistive devices, lifters, seating adaptations, clothing adaptions 2. Activity participation to relearn lifestyle modifications and to offer practice in altering habits and patterns that require adjustment in order to maximize the individuals participation and meaningful engagement

Pressure relief cushions: flexible matrix

1. accommodates to users body to allow pressure redistribution 2. prevents accumulation of moisture

OT intervention for psychological reactions to disability

1. acknowledgement of the individuals losses 2. identification of what the individual is able to do with emphasis on personal accomplishments 3. assistance to the individual in their assumption of an active role in shaping their life 4. the use of person-centered approaches baed on empowerment theory is critical 5. reduction of limitations through changes in physical and social environment 6. development of the skills necessary to participate in values occupations and meaningful activities -stress management and coping skills -cognitive reframing/restructuring: the process of altering cognitions and cognitive processes (usually maladaptive thoughts and thinking) to facilitate changes in emotions and behaviors 7. acquisition of resources and supports to enable full social participation 8. development of peer supports

Types of pain

1. acute pain: has a recent onset and usually lasts for a short duration 2. chronic pain: is a long duration and can lead to depression and prescription drug misuse 3. myofascial pain: is specific to muscles, tendons or fascia -Myofascial pain syndrome (MPS) *persistent, deep aching pains in muscles, nonarticular in origin * characterized by well-defined, highly sensitive tendon spots (trigger points) 4. Fibromyalgia syndrome (FMS) is 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 5. low back pain - most common work-related injury -location: lumbar lordosis -etiology: *poor posture: seated and standing *repetitive bending using poor body mechanics *heavy lifting *sleeping with poor posture -Symptoms *pain *difficulty with self-care activities and other role activities (especially LE activities) *difficulty sleeping

Postseizure care

1. allow the individual to rest or sleep after the seizure 2. call a physician if this is the individuals first seizure, if the seizure is followed by another seizure (status epilepticus) of if the seizure lasts more than 5 minutes 3. notify the parents/guardians or designated emergency contact that a seizure has happened 4. observe safety precautions if the individual seems groggy, confused or weak following the seizure

externalized anger

1. an attempt to retaliate for the imposed losses, directed against those associated with the onset of rehabilitation of the situation 2. characterized by aggression, antagonism, demanding and critical attitudes and passive aggressive behavior

Depression (death and dying)

1. as the individual acknowledged impending death, they begin to identify the feelings of loss and become depression 2. the tendency is to say goodbye to all but a few and isolate oneself as thoughts and feelings turn inward 3. OT intervention assists in providing physical and psychological comfort for both the individual and their loved ones

OT therapy evaluation/intervention for seizures

1. assess and intervene for developmental delays as necessary 2. observe all medical safety precautions 3. document and report any seizure activity, medication side effects or behavioral changes

Wheelchair Mobility Training

1. assess cognitive and physical capabilities to determine the individuals ability to learn and use a w/c independently -include personal care attendants and caregivers in training as needed 2. determine goals for community mobility 3. check wheelchair and seating system for fit and needed adjustments 4. instruct in proper sitting posture 5. instruct in pressure relief (push ups, weightshifts leaning to one side, then the other) -provide time schedule for weight shifts 6. instruct in the purpose and use of additional devices used with w/c (cushion, lap board) 7. instruct in w/c propulsion (manual, joystick, head control, sip and puff) -use of w/c gloves to ease propulsion and protect hands -compensation techniques (use of feet to assist for propulsion when UE is affected) 8. Instruct in safety concerns when operating a mobility devices -need to set/release locks -use of swing-away leg rests and removable arm rests with transferring -caution when using powered w/c -dafe ways to fall from the ground, if possible 9. instruct in how to manipulate basic parts of the w/c and break them down to ease transport (removal of parts to ease storage in car trunk) 10. instruct in how to maneuver w/c throughout the community -practice in natural interior and exterior environments is essential (1) transverse over different surfaces (carpeted, asphalt, uneven) (2) ascend and descent inclines (3) negotiate lips and curbs, how to pop a wheelie (4) negotiate obstacles (garbage cans on streets, chairs in restaurants) (5) use car and stair lifts 11. train in how to transfer from w/c to diverse surfaces 12. instruct in basic maintenance of w/c parts 13. developmental considerations -teach children w/c mobility early to foster independence in their environment -discourage use of strollers that prevent child from independent propulsion

Occupational therapy evaluation foci for pediatric pulmonary disorders

1. assess for developmental strengths/capabilities (developmentally appropriate cognitive and communication skills) 2. Assess for developmental delays/deficits (difficulty engaging in developmentally appropriate play due to decreased vital capacity, poor strength, low endurance and pain) 3. Assess the psychological status of the child and family/caregivers. Typical areas of concern include -social isolation related to frequent hospitalization ongoing home treatment and school absences -physical and emotional fatigue related to the intense level of care that is required -emotional stress related to complications (infections), related symptoms (pain) and prognosis (decreased life expectancy) 4. Assess the environment to determine needed modifications to conserve energy and enable occupational performance 5.Assess positioning equipment needs and activity adaptations to enable occupational performance 6. Determine the family's need for additional supports (support groups, respite care)

Strategies to slow, reverse and/or compensate for age-related gustatory and olfactory system changes

1. assess for identification of odors, testes (sweet, sour, bitter, salty), somatic sensations (temperature and touch)

Goals and interventions for nutrition and older adults

1. assist in monitoring adequate nutritional intake 2. Assist in maintaining nutritional support -refer to dietitian, nutritional consultants, and/or nutritional education programs as needed -make recommendations for home health aide to assist with grocery shopping and meal preparation -Refer to older adults food programs: home delivered (meals on wheels, congregate meals/senior center daily meal programs, federal food stamp programs 3. maintain physical function and promote adequate activity levels 4. maintain independence in food preparation and self feeding -teach work simplification and energy conservation techniques to maximize function -modify the environment and adapt activities to enhance mastery and ensure safety

Phase 2: Outpatient Rehabilitation/Convalescence Stage (subacute)- program focus

1. begins as early as 24 hours after discharge from the hospital -frequency of visits depends on the clinical needs of the patient 2. educate person on the importance of continued exercise 3. build up activity tolerance 4. improve ability to carry out IADL and community tasks 5. improve ability to perform work activities 6. support persons efforts in smoking cessation and lifestyle changes as needed -length of outpatient program is dependent on several factors including persons physical and mental status post event and/or surgery, progress through MET levels, activity tolerance and prognosis

Phase 1: Inpatient Rehabilitation/Hospitalization Stage (acute, cardiopulmonary rehab)- program focus

1. begins when the patient is determined to be medically stable following the cardiac or pulmonary event (MI, CABG, angioplasty, valve repair/replacement, CHF) -typically after 24 hours or until the patient is stable for 24 hours -patient and family education regarding disease process and recovery 1. increased knowledge of energy conservation and work simplification principles and techniques 2. increased knowledge of the approximate metabolic costs of activities -improve ability to carry out self-care and low-level functional activities -decreased anxiety -promote risk factor modification (support smoking cessation and dietary modification efforts if warranted) -discharge home

Depression

1. bereavement for the associated losses as the realities fo those loses is identified 2. characterized by hopelessness, helplessness, isolation and decrease self-esteem

Diagnostic-specific considerations for OT

1. building of trust is essential to effective intervention due to the secrecy, guilty, anger, resistance and ego fragility often associated with the disorder and its stages of recovery 2. the OT must be honest, supportive, and gently confrontational when indicated 3. Evaluation and intervention must include the identification of the socioemotional needs the eating disorder had fulfilled for the person so that health promoting occupation-based alternatives can be explored -Non-food related areas if interest and meaningful purposeful activities should be pursued to promote a reality-based body image and foster improved coping 4. Education about nutritional food management and the development of healthy leisure time (does not involve excessive exercise) are key

Onset/prognosis for obsessive-compulsive disorders

1. can develop in childhood by may develop at any time 2. Prevalence and prognosis vary with specific disorder

Wheelchair assessments and prescription considerations

1. client factor and performance skill assessments -sensory, sensory loss paces the person at risk for the development of decubiti, therefore necessitating a special seat cushion -neuromuscular, the individuals sitting posture can require application of seating and positioning, knowledge, poor trunk control requires postural supports -musculoskeletal, physical limitations such as compromised respiratory status may impeded mobility and require a powered wheelchair prescription (1) for optimal seating and positioning distinguish between flexible deformities (where the OT can manually correct the position) and fixed or abnormal postures/deformities (changes cannot occur) (2) when assessing alignment the pelvis should be evaluated first, and then LE, trunk, UE, head and neck and feet, stability is required prior to mobility and proximal control allows for better distal function -cognition, deficits in cognitive function may impede ability to operate powered devices -psychosocial, the availability of social supports to assist with transferring to transporting a wheelchair

Symptoms of a TBI

1. concussion characterized by post-traumatic loss of consciousness 2. cerebral contusion/laceration.edema accompanied y surface wounds and skull fractures 3. a variety of symptoms can result -hemiplegia or monoplegia and abnormal reflexes -decorticate or decerebrate rigidity -fixed pupils -coma -changes in vital signs

Brain Stem: Midbrain (mesencephalon)

1. connects pons to cerebrum: superior peduncle connects midbrain to cerebellum 2. Contains cerebral peduncles (two lateral halves), each divided into anterior part of basis (Crus cerebri and substantia nigra) and a posterior part (tegmentum) 3. Tegmentum contains all ascending tracts and some descending tracts; the red nucleus receives fibers from the cerebellum and is the origin for the rubrospinal tract, important for coordination; contains cranial nerve nuclei:oculomotor and trochlear 4. Substantia nigra is a large motor nucleus connecting with the basal ganglia and cortex; it is important in motor control and muscle tone 5. superior colliculus is important relay station for vision and visual reflexes; the inferior colliculus is an important relay station for hearing and auditory reflexes 6. Periaqueductal gray contains endorphin producing cells (important for the suppression of pain) and descending autonomic tracts

Brain stem: Pons

1. connects the medulla oblongata to the midbrain, allowing passage of important ascending and descending tracts 2. anterior basal part acts as bridge to cerebellum (middle cerebellar peduncle) 3. Midline raphe nuclei project widely and are important for modulating pain and controlling arousal 4. Tegmentum contains several important cranial nerve nuclei: abducens, trigeminal, facial, vestibulocochlear

Pragmatic reasoning (types of clinical reasoning)

1. considers the context in which OT practitioners thinking occurs 2. states the mental activities are shaped by the situation (setting long term or acute) 3. considers the treatment environment and OT practitioners values, knowledge, abilities, and experiences 4. focuses on the treatment possibilities within a given treatment setting 5. reframes understanding of the influence of personal and practical constraints on OT practice 6. the most effective OT practitioners are able to negotiate pragmatic contextual issues in favor of quality care

Disruptive, impulse-control and conduct disorders: diagnostic specific considerations for OT

1. contributing disorders (ADHD, learning disorders, substance use, depression, mood disorders) and their affect on the performance skills and areas of occupation must be evaluated and addressed in intervention 2. The child's goals, stressors and family and social relationships should be considered 3. Skill development may improve emotional adjustment 4. Behavioral approaches must be consistent throughout all programming 5. the therapist should assist the parents, other family members, teachers, and other school personnel to understand the nature of the childs condition and to develop strategies for behavior management

Impact on leisure/sports activities (kidney disease)

1. cope with the presence of fatigue and impaired functional mobility to participate in chosen activity 2. Attention to participation precautions (the need to pace self and self-regulate to decrease fatigue) 3. Access leisure resources and sports facilities that provide adaptations that enable social participation and active engagement for persons whose condition and treatment (dialysis) tend to isolate them

Descending fiber systems (motor pathways) (spinal cord)

1. corticospinal tracts: arise from primary motor cortex, descend in brain stem, cross in medulla (pyramidal decussation), via lateral corticospinal tract to ventral gray matter (anterior horn cells); 10% of fibers do not cross and travel in anterior corticospinal tract to cervical and upper thoracic segments; important for voluntary motor controls 2. Vestibulospinal tracts: arise from vestibular neucleus and descend to spinal cord in lateral (uncrossed) and medial (both crossed and uncrossed) vestibulospinal tracts; important for control of muscle tone, antigravity muscles and postural reflexes 3. Rubrospinal tract: arises in contralateral red nucleus and descends in lateral white columns to spinal gray, assists in motor function 4. Reticulospinal system: arises in the reticular formation of the brain stem and descends (both crossed and uncrossed) in both ventral and lateral columns, terminates both on dorsal gray (modifies transmission of sensation, especially pain) and on ventral gray (influences gamma motor neurons and spinal reflexes) 5. Tectospinal tract: arises from superior colliculus (midbrain) and descends to ventral gray; assists in head turning responses in response to visual stimuli

Occupations defined

1. daily activities in which people engage. They include -ADL: include self-care, grooming, oral hygiene, bathing/showering, toileting, dressing, eating, functional mobility, and sexual activity (BADL or PADL [person/basic]) -IADL; activities that are more complex than ADLs and which support community living such as home establishment/management, care of others (children/pet), meal preparation, shopping, financial management and community mobility -Work: competitive employment for pay and othr productive activities that make a societal contribution such as volunteer work -Education: activities needed to participate in a learning environment and fulfill the role of a student -Play/leisure: intrinsically motivated discretionary activities done for personal pleasure, diversion and entertainment -Social participation includes activities engage in as a member of a community, family and peer/friend group -Rest/sleep: restorative activities that support health and occupational engagement

Interactive Reasoning (types of clinical reasoning)

1. deals with how the disability or disease affects the person, focuses on the client as a person 2. involves the therapeutic relationship between the therapist, the individual and caregivers 3. facilitates effective treatment as it focuses on the personal meaning off illness and disability which can influxes how a person engages in treatment (motivational issues affect clients performance) 4. congruent with the professions philosophy and heritage of caring

Narrative reasoning (types of clinical reasoning)

1. deals with individuals occupational story and focuses on the process of change needed to reach an imagined future 2. identifies what activities and roles were important to the person prior to illness/injury 3. analyzes what valued activities and roles the individual can perform now 4. explores what valued activities and roles are possible in the future, given the persons disability 5. asks what values activities and role the individual would choose as priorities for the future 6. neglects larger practice area issues in which the client/practitioner interaction is occurring (pragmatic constraints imposed by reimbursement, equipment and/or organizational culture)

Contributing factors to poor dietary intake (older adults)

1. decreased sense fo taste and smell 2. poor teeth or poor 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 1. Inability to get to a grocery store to shop 2. inability to prepare foods

Somatosensory system changes, conditions and clinical implications- Age related changes

1. decreased sensitivity of touch associated with decline of peripheral receptors, atrophy of afferent fibers, lower extremities more affected than upper 2. proprioceptive losses, increased thresholds in vibratory sensibility, beginning around age 50: greater in lower extremities than upper extremities, greater in distal extremities than proximal 3. Loss of joint receptor sensitivity, losses in lower extremities and/or cervical joints may contribute to loss of balance 4. Cutaneous pain thresholds increase; greater changes in upper body areas (upper extremities face) than in lower extremities

Lateral and medial epicondylitis

1. degeneration of the tendon origin as a result of repetitive microtrauma 2. Lateral epicondylitis: overuse of wrist EXTENSORS, especially the extensor carpi radialis brevis (tennis elbow) 3. Medial epicondylitis: overuse of wrist FLEXORS (golfers elbow) 4. Conservative treatment -elbow strap, wrist splint -ice and deep friction massage -stretching -activity/work modification -as pain decreased, add strengthening. Begin with isometric exercises and then progress to isotonic and eccentric exercises

Needs assessment

1. describe the community, its physical, social, cultural and economic factors and populations at risk 2. describe the target populations demographics, disorders, functional levels, and presenting problems 3. identify specific needs of target population -Perceived needs of the population as reported by others (family, physicians and other professionals) -Felt needs as stated by the individual members of the target population -Real needs, which are the actual disabilities and functional limitations of the target population 4. Determine discrepancy between real, perceived and felt needs 5. establish unmet needs according to priority 6. identify resources available for program implementation -formal or institutional resources such as staff, supplies, money and space -Informal resources such as family, friends, cultural or religious figures, self-help/consumer groups

Cognitive Disabilities Model

1. developed by Claudia Allen 2. Principles -based on the stages of cognitive development as described by Piaget and knowledge of the neurobiological sciences at the time of the models development -cognitive ability 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, adapting the activity or task provides opportunity's for the individual to succeed -Once the maximal level has been achieved, compensations must be made biologically, psychologically or environmentally -cognitive performance is place on a continuum divided into 6 levels that are further divided into modes 1. automatic actions 2. postural actions 3. manual actions 4. goal-directed actions 5. exploratory actions 6. planned actions -Evaluation 1. Focus on identifying the individuals current cognitive abilities and their implications for performance, independence and the need for assistance *the potential for improvement is also considered -observation during functional tasks is emphasized -several evaluation tools have been developed to assist with the identification of the individuals cognitive level *Allens cognitive level Screen-5 (ACLS-5) is structured task that allows the therapist to observe the individual performing 3 increasingly complex leather lacing stitches and make determinations about the persons cognitive level (The Allen Diagnostic Manual provides craft projects that can be used for evaluation as well as treatment that can also be used to determine the individuals level of skills according to the first 5 levels listed above) *The Routine task inventory gathers data about the individuals ADLs performance form an informed caregiver *the cognitive performance test assesses the functional performance of individuals with alzheimers disease. The focus is on the identification of the effects that particular deficits have on the performance of ADL -Intervention 1. activities are selected based on the individuals highest cognitive level 2. therapy focuses on maintaining the individuals highest level of function 3. environmental changes and activity adaptations are made to compensate for deficits and allow the greatest degree of independence 4. the OT practitioner works with the team to develop an appropriate discharge plan 5. The OT practitioner should meet with the family or other caregivers to develop understanding of the individuals abilities, deficits and care needs

Guillain-Barre Syndrome diagnosis

1. diagnosis is baed on clinical symptoms 2. lumbar puncture reveals increase protein without cells in the cerebrospinal fluids 3. electromyography and nerve conduction studies may support diagnosis 4. segmental demyelination is apparent in several cases, axonal degeneration accompanies the demylination

End stage renal disease (ESRD) treatment

1. dialysis required to stay alive 2. hemodialysis which requires presence of vascular access via a shunt or fistula 3. peritoneal dialysis (PD): inpatient treatment continuous ambulatory peritoneal dialysis (CAPD) 4. Continuous cycling peritoneal dialysis (CCPD) 5. Nocturnal intermittent PD (NIPD) 6. transplantation 7. Hypertension treatment: diet, medication, exercise, stress reduction and smoking cessation

Assessment of Nutrition

1. dietary history: patterns of eating, types of foods 2. psychosocial: mental status, desire to eat, depression, grief, social isolation, social supports 3. body composition -weight/height measures -skinfold measurements: triceps/subscapular skinfold thickness -upper arm circumferences 4. Olfactory and gustatory sensory function 5. Dental and periodental diseases, fit of dentures 6. Ability to feed self: mastication, swallowing, hand/mouth control, posture, physical weakness and fatigue 7. Integumentry: skin condition, edema 8. Compliance to special diets 9. Functional assessment: basic activities of daily living, feeding; overall exercise/activity levels, amount and type of social participation

Dupuytren's Disease

1. disease of the fascia of the palm and digits -the fascia becomes thick and contracted. Develops cords and bands that extend into the digits -Results in flexion deformities of the involved digits 2. Etiology: unknown 3. Conservative treatment such as splinting has not been successful 4. Medical treatment -fasciotomy with Z-plasty -Aponeurotomy -McCash procedure (open palm) -Collagenase enymatic injection (nonsurgical: no wound care or scar management required)

Anteriolateral hip precautions

1. do not externally rotate 2. do not extend hip 3. precautions vary for Anterior THA. Some surgeons follow a no restriction protocol

Posterolateral hip precautions

1. do not flex beyond 90 degrees 2. do not adduct or cross legs (do not internally rotate) 3. Do not pivot hip 4. Sit only on raised chair and raised toilet seat 5. Transfer sit to stand by keeping operated hip in slight abduction and extended out in front -If these precautions are not followed a dislocation could result

Modified Barium Swallow (MBS)

1. done with swallowing team and radiologist in a diagnostic radiology suite -person seated upright at edge of radiology table -person must have adequate sitting balance -person must be supervised at all times 2. person administered trial boluses of mixed food consistencies (purees, thick liquids, solids, thin liquids) laced with barium -if the person aspirates the test ceases 3. video records mocing x-ray of swallow. Still x-ray shots are taken if aspiration is observed 4. may be used to diagnose various swallowing disorders or gastrointestinal system dysfunction

Severe internal bleeding characteristics

1. ecchymosis ( black and blue) in the injured area 2. body part, especially the abdomen may be swollen, tender and firm 3. skin may appear blue, gray or pale and may be cool or moist 4. respiratory rate is increased 5. pulse rate is increased and weak 6. blood pressure is decreased 7. patient may be nauseated or vomit 8. patient may exhibit restlessness or anxiety 9. level of consciousness may decline

Prevention of obesity

1. education: raising awareness of behavioral factors that contribute to obesity (sedentary lifestyle) 2. community driven group intervention option focused on health promotion and wellness 3. habit intervention: with occupations and activities that contribute to obesity (choosing this/not that approaches, not eating while stressed, mindful eating) 4. tertiary intervention when overcoming obesity is not the issues, the focus is on the occupational needs of the client

OT intervention for lymphatic disease

1. engagement in ADL, IADL, work, and leisure activities with adaptations if needed 2. Energy conservation techniques to minimize exacerbation of swelling -Family and patient education 1. skin care, donning and doffing compression garments, environmental modifications to improve mobility and function 2. Psychosocial issues including stress, distress, depression and anxiety

productivity standards

1. establishes the amount of direct care and reimbursable services each therapist is to provide per day 2. managed care pressures have increased productivity expectations in some practice areas resulting in ethical dilemmas and/or ethical distress

Work intervention guidelines

1. evaluate the work site and adapt the environment and job tasks to enable the individual to perform essential job functions (determine feasibility to return to work) 2. provide assistive devices, adaptive strategies and equipment to compensate for functional impairments during work activity performance -smartphone application -adapted computers -typing aids -universal cuff, tenodesis splint -teach principles and methods of energy conservation and work simplification 3. practice, modify and instruct in work activities 4. provide conditioning exercises and activities 5. educate about work safety and injury prevention -teach principles and methods of joint protection and proper body mechanics 6. educate employer regarding reasonable accommodations to enable performance of essential job functions 7. collaborate with employee assistance programs to obtain additional needed services (substance abuse counseling) 8. educate family about work capacity and limitations 9. explore alternatives to competitive work if it is not an attainable goal (volunteer work) 10. use thematic and topical groups to develop needed skills -task skills to enable successful completion of work tasks -social skills to facilitate appropriate interactions with co-workers and employer -work behaviors to ensure a successful work experience 11. provide pre-retirement planning to ease transition from competitive employment 12. provide follow-up care as needed (counseling, work support group, psychosocial clubhouse) 13. refer to state offices for vocational and educational services for individuals with disabilities for further education and vocational training 14. interventions for the most common work-related injuries -cumulative trauma such as carpal tunnel syndrome and low back pain (avoid static positions, repetitions, awkward postures, forceful exertions, and vibration; design workplace and workstation to be ergonomically correct to prevent further trauma) -psychosocial and cognitive deficits (engage person in program suitable to functional vocational abilities [rehab workshops, supportive employment])

Cooking adaptive equipment

1. faucet and knob turners 2. anti-scald faucets and valves 3. jar openers, bowl holders, and saucepan stabilizers 4. nonskid pad, placement or dycem 5. cutting board with a stabilizing nail and built up edged 6. built-up or angled utensils and rocker knives 7. adapted timers 8. electric can opener 9. lightweight pots, pans, dishwasher 10. automatic hot water dispenser or hotpots 11. strap loops to open refrigerator, cabinets and oven doors 12. reachers and step stools 13. utility cart 14. high kitchen stool

Interventions for seizure disorders

1. first aide procedures for seizures -remain calm (status epilepticus can be life threatening; this is is a medical emergency and immediate medical attention must be obtained) -remove danger objects from the area -protect the individual from harm, without interfering with the individuals movements -if the person is in a hospital bed, raise the bed rails -do not place anything in the mouth -turn the individual on his/her side if there is a risk of aspiration -allow the seizure to happen, protect the head and extremities from injury could occur from violent shaking -once the clonus activity is over (for tonic-clonic type), place the person in the recovery position (side-lying) -monitor for improving mental state postictal -do not be alarmed if the individual seems to stop breathing momentarily 1. if breathing actually stops, use standard rescue breathing techniques -call for medical attention during seizures 1. if this is the individuals first seizure 2. if the person has a seizure in water 3. if the person has second seizure 4. if the individual does not regain consciousness within 5 to 10 minutes following the seizure 6. if the individual is diabetic or pregnant

Presenting signs and symptoms of sensory disorders

1. fluctuating or extreme responsiveness while engaging in everyday activities (stress and frustration demonstrated in performance of everyday activities) 2. Difficulties in interacting with the environment in play, learning, and social situations and while engaging in other developmental and health-promoting activities 3. Difficulty with conceiving, planning, sequencing or executing novel actions (dyspraxia) -Tendency to avoid or reject simple motor challenges 4. Poor initiation of activities as demonstrated in some children due to difficulty generating ideas (ideation) 5. Difficulty with goal-directed action on the environment, known as an adaptive response 6. Responses may present along a continuum of underresponsivity to overresponsivity of multi-sensory processing and sensory seeking 7. Tactile processing dysfunction manifestations Medical management -possible pharmacology intervention to decrease activity level

Activity tolerance

1. graded exercise test done by exercise physiologist or PT (6 minute walk test, physical performance test) 2. observation of activities with monitoring of vital signs (heart rate, blood pressure, respiration rate, rate of perceived exertion) 3. periodic monitoring of dyspnea, angina, and claudication pain 4. periodic monitoring of exertion -Borg rate of perceived exertion: a self-report rating scale that ranges from no exertion at al (sitting or lying0 to maximal effort (hard work that is not advisable to engage in) 5. Metabolic equivalent levels (METs) are used to determine the energy expenditure required for activity performance -because the energy expanded during an activity can vary due to personal differences in activity performance and variability in activity demands

Serious injuries from fall

1. head injury: loss of consciousness, mental confusion 2. spinal cord injury: loss of sensation or voluntary movement 3. hip fracture: complaints of pain in hip, especially on palpation, external rotation of leg, inability to bear weight on leg, changes in gait, or weightbearing status (check for dizziness that may have proceeded the fall- do not attempt to lift the individual alone get help)

Types and causes of shock

1. hemorrhagic: severe internal or external bleeding 2. psychogenic: emotional stress causes blood to pool away from the brain 3. metabolic: loss of body fluids from heat, severe vomiting or diarrhea 4. anaphylactic: allergic reaction to drugs, food, or insect stings 5. Cardiogenic MI or cardiac arrest results in pump failure 6. respiratoryL respiratory illness or arrest results in insufficient oxygenation of the blood 7. Septic: severe infections cause blood vessels to dilate 8. neurogenic: traumatic brain injury, SCI or other neural trauma causes disruption of autonomic nervous system resulting in disruption of blood vessel dilation/constriction

Kidney diseases impact on IADLs

1. home establishment and management -accept impact of physical limitations (the need for lighter workload and house keeping assistance) -coping with having and altered home maintainer role 2. Meal preparation -adhere to changes in usual meal preparation habits to accommodate dietary limitations 3. Management of personal finances -identify solutions and resources to cover the cost of care which can be prohibitive if insurances does not provide adequate coverage -plan and seek alternative participation means for coping with dialysis-related fatigue and is impact on community banking 4. Community mobility -cope with the presence of fatigue and impaired functional mobility that limits community participation -cope with altered functional mobility and to accept assistive technology solutions -engage in additional planning that is needed for long distance travel

Phase 2: Outpatient Rehabilitation/Convalescence Stage -- Evaluation and intervention (subacute)

1. home evaluation 2. consumer and family education 3. graded exercise program with slow and gradual increase of weight 4. begins with activities at MET level 4-5, gradually increasing as persons tolerance improves 5. resumption of sexual activity usually at 5-6 MET level as per physician recommendation 6. practice of functional activities in the discharge environment 7. used of energy conservation techniques and compensatory techniuqes is daily tasks 8. work site evaluation if applicable

Purposes of environmental evaluation and intervention

1. identify and prioritize the needs, goals, desires and problem areas of an individual with a disability within their environments 2, establish the individuals abilities regarding everyday functional activities within their environment 3. assess functional use of devices being considered for a particular individual to facilitate master of the environment 4. determine the individuals interest in devices and their willingness to use and accept a device being considered 5. identify a devices availability, safety and cost 6. determine a devices location and frequency of use 7. determine funding and financial resources for equipment and modifications (it is of questionable ethics and not in the best interest of the clients to show them devices or order-top-of-the-line equipment that is not covered by their insurance if they do not have the financial resources to self-pay pay for these recommendations) 8. determine environmental constraints 9. Assess if the individual with a disability and the device will allow for reevaluation -ensure the device will allow for possible modifications, if upon reassessment of the individual change in status is found

Autism Spectrum Disorder (ASD): behavioral characteristics

1. impaired nonverbal behaviors (infrequent/poor eye contact, impaired attachment behavior, anxiety with changes in typical routines) 2. Difficulty relating to others and forming relationships at an age-appropriate level 3. lack of spontaneous social-seeking behavioral interactions with others and lack of awareness of others who are seeking interactions (sharing a snack, pointing at an object of interest) 4. Lack of social reciprocation due to decreased ability to infer feelings and intentions of others 5. Difficulty with communication *lack of initiation, reflection and development of spoken language or alternative means for communication *If speech is developed, difficulty in initiating or engaging in conversation and lack of appropriate context *Stereotyped echolalia and use of indiscernible language 6. lack of spontaneous pretend, imitative or exploratory play 7. repetitive and stereotyped behaviors and movements in one or more of the following *ritualistic nonfunctional routines, preoccupation *rigid observance of nonfunctional routines or behavioral patterns *repetitive motor action (flapping and wiggling of fingers, head banging, rocking of the head or body)

Conduction of heartbeat

1. impulses originates in SA node and spreads throughout both atria, which contract together 2. Impulses stimulates AV node is transmitted down bundle of His to the Purkinje fibers; impulse spreads throughout the ventricles which contract together

peripheral resistance

1. increased peripheral resistance increases arterial blood volume and pressure 2. decreased peripheral resistance decreases arterial blood volume and pressure 3. influenced by arterial blood volume: viscosity of blood and diameter of arterioles and capillaries

Diagnostic-Specific considerations for OT with personality disorder

1. individuals assistance to help the person identify the previous diagnostic-specific issues may increase commitment to treatment and the pursuit of behavioral change 2. cognitive behavioral approaches (including dialectical behavioral therapy) can increase functional and coping skills and may decreased symptomatic behavior

shock

1. initial reaction to a sudden physical or psychological trauma 2. characterized by emotional numbness, depersonalization, and reduced speech and mobility

Program implementation

1. initiate program according to timetable and steps set forth in the program plan 2. document program activities, procedures and use 3. communicate and coordinate with other programs within the system 4. promote program to ensure it reaches target populations

Assessment Methods

1. interviews- structure and unstructured (OT profile) 2. Standardized tests 3. Clinical observation 4. Rating scales 5. Questionnaires 6. Self-report inventories

Conditional reasoning (types of clinical reasoning)

1. involves an ongoing revision of treatment 2. focuses on current and possible future social contexts 3. represents an integration of interactive procedural and pragmatic reasoning in the context of the clients narrative 4. requires multidimensional thinking

Stage IV pressure ulcer

1. involves full thickness tissue loss with bone, tendon or muscle visible or directly palpable 2. similarilu the depth of a Stage IV pressure ulcer can vary according to anatomical location and can range from shallow in areas that do not have subcuatenous tissue to very deep in areas with significant fat 3. isteomyelitis is possible if stage IV ulcers extend into msucle, fascia, tendon and/or joint capsule

behaviors often associated with depressive episodes

1. irritability, anxiety, phobias and obsessive thinking 2. difficulties in social interactions, relationships and sexual functioning 3. self destructive behavior including suicide and substance abuse 4. may be manifested as somatic complaints 5. there may be an increased use of medical services -symptoms are significant enough to cause marked disruption in important areas of daily function, including social or occupational contexts

Arthrogryposis Multiplex Congenita (AMC)

1. it is detected at birth and associated with loss of anterior horn cells 2. presence of weakness, deformities and associated joint contractures 3. position of rest for the upper extremities tends to be internal rotation of the shoulders, extension of the elbows and flexion of wrists for the LE there is flexion and internal rotation of the hips and clubfeet 4. it may be stable, mildly progressive or may improve 5. related problems include congenital heart defects, spinal defects, torticollis, and involvement of the diaphragm

Suspected deep tissue injury

1. localized discoloration of intact skins (purple or maroon) or a blister filled with blood resulting from damage of underlying soft tissue 2. Deep tissue injury may be difficult to detect in individuals with darkly pigmented skin 3. This stage may further evolve and can rapidly expose additional layers of tissue

MD specific symptoms

1. low muscle tone and weakness contributes to abnormal movement patterns and delayed developmental milestones 2. there may be difficulty with oral motor feeding, necessitating a nasogastric or gastrostomy tube 3. weakness contributes to deformities of the extremities and spine 4. Difficulty with breathing may require tracheostomies or mechanical ventilators and frequently result in death

Diagnostic-specific considerations for OT: Delirium

1. maintenance of quality of life through activity adaptation and environmental modification 2. Family education to understand the nature of the persons disorder and improve the management of its symptoms and functional effects -the OT practitioner should be aware that some of the causes of cognitive decline and neurocognitive disorders can be reversed with treatment. OT should screen for these causes and act accordingly

Osteogenesis Imperfecta (OI) signs and symptoms

1. 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 2. loose joints 3. Sclera of the whites fo the eyes look blue or purple 4. brittle teeth 5. hearing loss (often starting in the 20s or 30s) 6. respiratory problems 7. insufficient collagen

Dialysis treatment specific interventions

1. manufacture devices to protect shunts postoperatively that are used for hemodialysis 2. Encourage movement and engage the person in activity participation during dialysis -when active, the body has a better ability to eliminate the lactic acid generated during dialysis -if the person remains inactive, fatigue and muscle soreness/stiffness will result from treatment 3. Teach the person to implement energy conservation and work simplification techniques when and if they experiences chronic fatigue with dialysis treatment

Impact on functioning: Schizophrenia

1. many individuals with psychotic disorder demonstrate deficits in cognitive- perceptual and social interaction skills that affect all areas of function -the deficits in the processing of sensory information that are experiences by some individuals make interaction with the environment difficult and frightening -Individuals who have difficulty with their own ego boundaries often exhibit socially inappropriate sometimes intrusive behaviors -some individuals have lost or failed to develop the social and communication skills necessary for effective and satisfying interpersonal interactions and relations - cognitive deficits due to though disorders and difficulty performing basic skills interfere with all areas of occupation from personal activities of daily living and leisure pursuits to social participation, education and work activities -It is important to assess and continue to monitor the degree of assistance and structure needed to maintain optimum independence in all areas of occupation

Medical management for substance abuse

1. medications to help the individual refrain from substance use can be provided 2. Methadone clinics and the use of methadone for detoxification and maintenance for opioid dependence is the most accepted approach for heroin addition 3. Medical management is typically supplemented with psychotherapy and support groups

Occupational therapy intervention foci for pediatric pulmonary disorders

1. monitor development 2. provide treatment to facilitate cognitive, sensorimotor and psychosocial development 3. provide treatment to improve endurance, postural stability and feeding 4. used positioning to promote postural drainage 5. provide environmental modifications and activity adaptations to enhance occupational performance 6. train in energy conservation methods to enable occupational performance 7. promote engagement in physical activities (especially play) within child's capabilities 8. address psychosocial issues that arise 9. provider parent/caregiver/teacher education -treatment protocols for the preceding interventions -precautions for participation in activities of daily living, play and other healthful physical activities 10. foster the parents/caregivers advocacy skills to obtain respite and support services as needed and necessary modifications, equipment and services for the child in the home and school 11. refer as necessary to ophthalmologist and other relevant services (support groups, respite programs) 12. observe medical precautions during all occupational therapy sessions (respiratory/cardiac contraindications)

Refractive Errors (CP)

1. myopia (nearsightedness) 2. hyperopia (farsightedness) 3. Presbyopia: difficulty in accommodation when focusing on objects nearby and when shifting focus from near to far

Neurohumoral influences (cardiopulmonary)

1. neural control of heart rate and blood vessels 2. parasympathetic control (cholinergic): cardioinhibitory center; slows rate and force of myocardial contraction; decreases myocardial metabolism, causes coronary artery vasodilation -gradual decrease in heart rate is expected during the recovery phase following engagement in exercise or activity *abnormal, consistent decrease in heart rate (bradycardia) decrease the supply of oxygen rich blood to the body, syncope shortness of breathing, angina, confusion and decreased endurance can result (monitoring vital signs to track changes in heart rate during intervention is required to ensure safety)

Adhere to contraindications/precautions as per physicians order

1. observe/monitor for shortness of breath (SOB), chest pain, nausea, vomiting, dizziness, and fatigue 2. adhere to activity guidelines and MET levels 3. observe for decreased in systolic BP greater than 20 mmHG 4. observe facial expression, be alert to facial changes 5. monitor heart rate (use facility specific guidelines, if available) -Max HR 100 very light activity- very high risk -Max HR 120 light activity- less than 6 weeks after MI surgery -Max HR 130 recent bypass surgery, cardiomyopathy, CHF -Target HR 60-80% patients max HR, treadmill test 6. monitor BP also for resting systolic, BP <120, diastolic 80 7. monitor oxygen saturation (o2 sat) below 86% for pulmonary patients, below 90% for cardiac patients 8. monitor ECG for signs and symptoms of myocardial ischemia 9. monitor exertion for signs and symptoms of distress during activity, speed of recovery -the following precautions should be followed: 1. avoid isometric muscle work, straining breath holding (valsalva) 2. avoid overhead exercises or holding UEs over head for extensive time periods 3. avoid lateral arm movements and exercise that stretch chest and pull incision -There are clinical signs/symptoms and diagnoses for which therapy is contraindicated and should not be implemented. these include uncontrolled atrial/ventricular arrhythmias, recent embolism/thrombophlebitis, dissecting aneurysm, severe aortic stenosis, acute systemic illness, acute MI, digoxin toxicity, acute hypoglycemia or metabolic disorder, 3rd degree heart block and unstable angina

Care for shock

1. obtain history, if possible 2. examine the person for airway, breathing circulation and bleeding 3. assess level of consciousness 4. determine skin characteristics and perform capillary refill test of finger tips -capillary refill test: squeeze fingernail for 2 seconds -in healthy individuals the nail will blanch and turn pink when pressure is release -if nail bed does not refill and turn pink within 2 seconds the cause could be that blood is begin shunted away from the periphery to vital organs to maintain core temperature 5. treat specific conditions if possible (control bleeding, splint a fracture, use a epipen for anaphylaxis) 6. keep the person from getting chilled or overheated 7. Elevate the legs 12 inches unless there is suspected spinal injury or painful deformities of the lower extremities 8. reassure the person and continue to monitor A, B, Cs 9. administer supplemental oxygen if near by 10. do not give food or drink

Clinical implications for cognitive changes and adaptations in the older adult

1. older adults utilize different stategies for memory: context-based strategies versus memorization (young adults)

Limb Girdle Muscular Dystrophy (LGMD)

1. onset begins between the first and third decades of life 2. proximal muscles of the pelvis and shoulder are initially affected 3, typically progresses slowly

Psychosocial assessment

1. overt signs and symptoms of depression, anxiety and stress and the observed effects on the individuals ability to complete/engage in activities 2. stress management/coping styles and psychosocial family/caregiver and spiritual supports

Acute pain

1. pain provoked by noxious stimulation 2. associated with an underlying pathology (injury or acute inflammation/disease) 3. Signs include sharp pain and sympathetic changes (increased heart rate, increased blood pressure, pupillary dilation, sweating, hyperventilation, anxiety, protective/escape behaviors)

Chronic pain

1. pain that persists beyond the usual course of healing 2. symptoms present for greater than 6 months for which an underlying pathology is no longer identifiable or may never have been present

Panic attacks and agoraphobia

1. panic attacks are symptoms of anxiety 2. panic attacks are discrete periods of intense fear or discomfort in which 4 or more symptoms develop abruptly and reach a peak within 10 minutes -physical symptoms: heart palpitations, sweating, shaking, sensations of choking or feeling short of breath, chest pain, nausea/vomiting, feeling dizzy or faint and chills or hot flashes -psychological symptoms; de-realization, feelings of loss of control and fear of dying -neurologic symptoms: paresthesia 3. agoraphobia associated with panic attack -anxiety about being in places or situations from which escape may be difficult or embarrassing or in which help may not be available if needed -situations are avoided or endured with anxiety about having a panic attack

Phase 3: maintenance/training stage (Community exercise programs)

1. patients generally attend maintenance/training sessions once a week following the completion of phase 2 2. groups may be integrated into individual exercise programs 3. OT intervention is provided as necessary for IADLs, leisure pursuits and work 4. Maintenance gym program -weight training to maintain upper and lower body strength -cardiovascular training to maintain cardiopulmonary health

Areas address during psychosocial evaluation

1. performance skills (cognitive, perceptual, psychological, and social) and their impact on performance in areas of occupation 2. client factors and physical conditions or limitations that impact functional behaviors and performance in areas of occupation 3. the impact of the individuals social, cultural, spiritual, and physical contexts 4. identification of the roles and behaviors that are required of the individual either by society or for the achievement of their desired goals 5. precautions and safety issues such as suicidal and aggressive behaviors 6. history of behavior patterns 7. individual goals, values, interests and attitudes 8. consideration and involvement of family, caregivers and significant others 9. presenting problems and issues identified by the client 10. desired outcomes -if the person is hospitalized, discharge planning begins one day one of hospitalization 11. probable (and possible) living environments of choice

Evaluation of Performance Skills & Client Factors: Environmental Evaluation

1. performance skills and client factors are essential to assess when conducting and environmental evaluation; they are fundamental abilities that allow a person to function in their environment 2. There are numerous assessments available for specific performance skills and client factors 3. A comprehensive evaluation should assess: -sensory functions (tactile, pain, visual acuity) to determine if there is an impairment that could influence safety in the manipulation of devices -visual-perceptual processing skills (unilateral neglect, figure-ground discrimination) to assess for potential difficulties with device use -muscle functions (ROM, strength, tone, and endurance) to assess if the person will be able to physically use the devices to optimal capability -movement functions (reflexes, involuntary reactions, and coordination) to assess the persons ability to utilize all limbs rhythmically in mobility and environmental manipulation -Motor skills (stabilizing, reaching, and manipulating) to assess a persons ability to interact with objects and to move tasks and objects in the environment -cognitive functions (following directions, memory, attention and judgement) to assess if a person is aware of limitations and able to follow and recall directions regarding operation of AT and w/c and the safe use of devices -process skills (pacing, choosing, using and initiation) to assess a person ability to select, interact with and use tools and materials, to carry over actions and to modify performance when problems are encountered -psychosocial skills (social interaction, emotional regulation) to assess if an individual with a disability can ask for assistance and obtain needed information from the right person to assess the individuals ability to give instructions -cardiovascular, respiratory, and voice and speech functions (stamina, endurance, and alternative vocalization) to assess a persons ability to use alternative methods to control devices

Peripheral Nervous System (PNS)

1. peripheral nerves are referred to as lower motor neurons (LMN). Functional components include: -Motor (efferent) fibers: originate from motor nuclei (cranial nerves) or anterior horn cells (spinal nerves) -Sensory (afferent) fibers originate in cells outside of brain stem or spinal cord with sensory ganglia (cranial nerves) or dorsal root ganglia (spinal nerves) -ANS fibers: sympathetic fibers at thoracolumbar spinal segments and parasympathetic fibers at craniosacral segments 2. Cranial nerves: 12 pairs of cranial nerves all nerves are distributed to head and neck except CN X which is distributed to thorax and abdomen -CN I, II, VIII are pure sensory; carry special senses of smell, vision, hearing and equilibrium -CN III, IV, VI are pure motor, controlling eye movements and pupillary constriction -CN XI, XII are pure motor, innervating sternocleidomastoid, trapezius and tongue -CN V, VII, IX, X are mixed: motor and sensory involved in chewing (V), facial expression (VII), swallowing (IX,X) vocal sounds (X), sensations from head (V, VII, IX), alimentary tract, heart, vessels, lungs (IX, X) and taste (VII, IX, X) -CN III, VII, IX, X carry parasympathetic fibers of ANS; involved in control of smooth muscles of inner eye (III), salivary and lacrimal glands (VII), parotid gland (IX), muscles of heart, lung and bowel (X)

Development Considerations for play interventions

1. plan play interventions that consider the childs developmental level -facilitate active participation in cause and effect learning 2. provide opportunities for culturally relevant solitary play and environmental mastery 3. facilitate active participation in cause and effect learning 4. provide opportunities for play with siblings and peers 5. provide toys that are safe and durable and colorful 6. provide toys and activities that are visually and auditory stimulating

Palliative care rehabilitation for cancer

1. prevent and relieve suffering for persons with life-threatening illness through early identification, assessment and treatment of pain 2. Address physical, psychosocial and spiritual needs 3. Enhance quality of life by supporting clients engagement in daily life occupations that they find meaningful and purposeful 4. Consider environmental and contextual factors (accessibility of objects or places in the environment, social contexts available to prevent isolation) and client factors (decreased endurance, increased anxiety) that may limit a clients abilities and satisfaction when performing desired occupations 5. Collaborate with the client and family members throughout the OT process to identify occupations that are meaningful, incorporate strategies that support occupational engagement and provide caregiver training as needed

Risk factors for suicide

1. previous attempt or fantasized suicide 2. anxiety, depression, exhaustion, pervasive pessimism or hopelessness 3. availability of means of suicide (firearms in the home) 4. concern for effect of suicide on family members 5. verbalized suicidal ideation, plan or intent 6. preparation of a will 7. resignation agter agitated depression 8. proximal life crisis (death of family member/significant other, job loss, disciplinary or legal problems) 9. family history, exposure to suicide of others 10. family violence, physical or sexual 11. clinically diagnosed depression or other mental disorders 12. co-occuring mental health and substance abuse disorders 13. incarceration 14. impulsive and aggressive tendencies

Oral motor development

1. prior to 33 weeks of gestation an infant is fed by non-oral means 2. 35 weeks of gestation or after: jaw and tongue movements are strong enough to allow for feeding 3. 40 weeks of gestation: rooting, gag and cough reflexes are present for up to 4 months, protecting the airway and decreasing the changes of aspiration 4. 4-5 months: munching occurs, consisting of a phasic bite and release of a soft cookie 5. 6 months: strong up and down movement of the tongue 6. 7-8 months: beginning of mastication of soft and mashed foods with diagonal jaw movement 7. 9 months: lateral tongue movements make mastication of soft and mashed food effective able to drink from a cup, however, jaw is not firm 8. 12 months: jaw is form, there is rotary chewing allowing for a good bite on a hard cookie 9. 24 months: able to chew most meats and raw vegetables

Cognition

1. provide baseline of persons ability to understand process, retain and apply information taught during rehabilitation -orientation -memory -concentration -judgement

Pressure relief cushions: viscoelastic fluid

1. provides a stable base for posture 2. has good thermal and dampening properties

Dressing equipment

1. reachers, dressing stick, and pants dressing poles 2. built up, angled or long handled shoe horn 3. pull on clothing, velcro-type closure, and front opening closures for clothing 4. elastic shoelaces, slip on shoes 5. button hook, zipper pull, and zipper loop or ring 6. sock aid

General intervention guidelines for play/leisure intervention

1. recognize that the acquisition of a disability often results in increase leisure time due to loss of roles -provide support for losses, refer to support group and disability advocacy groups -renew or adapt old interests 2. leisure activities that are valued, meaningful and enjoyable to the person should be adapted, modified and simplified to facilitate satisfying engagement 3. provide assistive technology and adaptive equipment to compensate for functional impairments during leisure activity performance -universal cuff -card holders -book holders and page turners -writing orthosis, typing aids, weighted pens -headsticks, mouthsticks -environmental control unit (ECU) to activate electronic equipment -adapted computer, keyboard guards, and voice activated computer -smartphone applications -speaker phones -switches to activate toys that child with a disability cannot operate by conventional means 4. use thematic and topical groups to develop needed skills (parenting play group, a retirement planning group) 5. teach principles and methods of energy conservation, work simplification, joint protection, and proper body mechanics 6. refer to relevant community and national resources 7. explore and present internet and web-based opportunities for play and leisure participation

Complications of SCI

1. respiratory complications, decreased vital capacity, pneumonia 2. Decubitus ulcer formation 3. Othrostatic hypotension 4. Deep vein thrombosis (DVT) 5. Autonomic Dysreflexia 6. Urinary tract infection 7. Heterotopic ossification, the formation of bones in abnormal anatomical locations

Denial (reaction to adjustment of disability )

1. retreat from the realization of the seriousness and implications of the situation 2. characterized by minimalism, negation, aloofness, and unrealistic expectations

activities of daily living (ADLs)/IADLs for cardiopulmonary

1. self care 2. household management tasks 3. leisure activities 4. community activities 5. note level of function and type of assistance required 6. note level of dyspnea and angina reported during activities

Guillain-Barre Syndrome medical management

1. sever cases constitute a medical emergency requiring constant monitoring of vital signs 2. respiratory support may be necessary in some cases 3. plasmapheresis may be utilized to slow symptoms or halt progression 4. intravenous immuniglobulin has been utilized effectively

Overview of depressive disorders

1. share the common presentation of sad, sometimes irritable mood that along with changes in cognitive and physical health affects ones ability to function 2. they are differentiated by length of time, number of episodes and specific type and number of symptoms

Shunts can become infected (Spina bifida)

1. signs and symptoms include vomiting, lethargy and fever 2. seizures and deterioration of physical and cognitive functioning may result 3. infections are treated by withdrawing fluid through or replacing the tubing. Intravenous antibiotics are also administered 4. medications to reduce cerebrospinal fluid production and intracranial pressure are sometimes used as interim measure (early identification of blocked and infected shunts is vital as these conditions are life threatening. Immediate notification of signs and symptoms to the childs/facility neurosurgeon is required

Interventions for emphysema

1. smoking cessation 2. short acting and long acting beta2 agonists/bronchodilators 3. anticholinergic drugs to block bronchoconstriction 4. Xanthine derivatives for bronchodilation, limitation of inflammatory response 5. corticosteroids for anti-inflammatory effects 6. Preventice vaccination against influenze and pneumococcus 7 oxygen therapy to -reduce level of dyspnea -improve/decrease maximal voluntary ventilation, polycythemia, by correcting hypoxemia -decrease pulmonary hypertension -improve quality and quantity of sleep -improve cognitive function and exercise tolerance 8. surgeries may include bullectomy, volume reduction and lung transplant

De Quervain's Tenosynovitis (APL+EPB muscles)

1. stenosing tenosynovitis of the abductor pollices longus (APL) and the extensor pollicis brevis (EPB) muscles 2. pain and swelling over the radial styloid 3. Positive Finkelstein's test 4. Conservative treatment -thumb spica splint (IP joint free) -Activity/work modification -ice massage over radial wrist -gentle AROM of wrist and thumb to prevent stiffness 5. Postoperative treatment -thumb spica splint and gentle AROM (0-2 weeks) -Strengthening, aDLS and role activities (2-6 weeks) -Unrestricted activity (6 weeks)

Overview of substance-related and addictive disorders

1. substance related disorders are diagnosed based on the taking of a drug of abuse (including alcohol and prescription medication), the side effects of medications and exposure to toxins (inhalants, lead) 2. Substance-related disorders are categorized by the specific substance (alcohol or opioid) -Used: consumption that causes impairment that adversely affects daily functioning in occupational roles, fulfilling personal responsibilities and interacting socially; it may cause personal harm (alcohol use disorder) -Intoxication: use that causes problems both behaviorally and mentally and changes in the pupils followed by feeling drowsy, slurring words, and experiencing attention and memory problems (opioid intoxication disorder) -Withdrawal: stopping significant consumption which causes physical symptoms (tremors, difficulty sleeping) as well as mental symptoms (hallucinations, anxiety) -nonsubstances related disorders (gambling disorder) 3. Addictive disorders including gambling disorders that produce addictive behaviors that appear comparable to the substances use disorders

Cleaning Adaptive equipment

1. suction bottom bottle and glass brushes 2. reachers 3. aerosol can holders 4. built up, angled, or long-handled sponges, dusters, brooms, mops, dustpans

Partial Focal Seizures: Complex Partial or Psychomotor Seizures

1. symptoms vary 2. there are alternations in consciousness and unresponsiveness 3. may appear confused or dazed, unable to respond to questions or directions 4. automatic motions such as lip smacking, chewing, and swallowing and nervous movements of the hands/fingers and repetitive movements occur 5. visual or auditory sensations occur just before seizure

Blood flow through the heart

1. systemic circulation to RA to RV then to lungs for oxygenation 2. LA receives oxygenated blood from the lungs, sends blood to LV 3. LV pumps blood to the body via the aorta

Role of COTA for mental health evaluation

1. the COTA can contribute to the evaluation process in collaboration with the OT -supervision by and OT is required -the level of supervision require will be determined by the COTA's experience 2. Service competency must be established 3.The COTA cannot independently evaluate or interpret evaluation results

Role of COTA in mental health intervention

1. the COTA implemented intervention with supervision of the OT -the level of supervision required depends upon the COTAs experience and established service competence 2. During the implementation of intervention the COTA informs the supervising occupational therapist of any change in the individuals status and any other relevant information that may affect treatment

Attention

1. the ability to remain focused on the various aspects of an activity or experience or the ability to concentrate 2. Disturbances of attention -distractibility -selective attention -Hypervigilance

Accounts receivable

1. the assets within a budget 2. indicates payments that are owed to the program, setting, or institution (consultation fees)

Deliriums impact on function

1. the degree of impact varies according to the nature and severity of symptoms 2. the individual may require intervention varying from education in compensatory strategies to the need for total care

Anxiety disorders impact on function

1. the degree of impact varies with the severity and type of anxiety disorder 2. reactions may vary from temporary discomfort to severely avoidant and paralyzing behavior

General Environmental Considerations

1. the environment is the aggregate of phenomena that surrounds the individual and influences development and existence 2. The environment in which a person lives and the exposure to various settings, influences their development and adaptation 3. the environment can facilitate growth because it allows for adaptation and problem-solving strategies to be developed 4. Conversely the environment can hinder development and adaptation if it is impoverish, inaccessible and hostile 5. A persons abilities, skills, limitations, problems, activities and occupations cannot be fully understood without considerations of their current and expected environment

Environmental modifications for cognitive and sensory deficits: general intervention strategies

1. the environment needs to be familiar, consistent and predicable -provide structure in the environment to increase orientation to time, place, person and situation -remove clutter -provide visual reminders or tactile cues -keep things in the same place for consistency and ease 2. use contrasting colors to discriminate background from foreground or figures from background 3. use restraint reduction techniques if a person is confused, agitated and wandering 4. educate consumer, caregiver and family -train caregivers for persons with memory and sensory impairments on effective communication techniques -facilitate carryover of intervention techniques to modified environment -increase awareness of potential resources available to the individual and their family -increase awareness of their rights to access these resources 5. monitor changes and adjustment after a disability to assess carryover of information 6. make home modifications 7. provide a personal emergency system and train in use

Anger (death and dying)

1. the individual becomes angry as they accept the reality of impeding death 2. this anger may be projected onto anyone who is seen as healthy or in a better position 3. Rages, outbursts, and hurtful behavior must be identified for the purposes they serve 4. OT intervention allows the individual to vent anger while identifying its source and developing more effective coping stategies

Onset and prognosis of substance abuse

1. the onset of substance abuse beginning in early adolescence is increasing 2. Prognosis varies depending on several factors including level of engagement and personal investments in treatment for substance used, and degree and type of support -various adverse effects of substance use may include brain and liver damage, heart disease and fetal damage during pregnancy

Identification of risk for suicide

1. the person is asked if they were trying to hurt themselves how they would do it -the degree of detail that is given indicates the seriousness of intent -the potential for the plan to succeed also indicates the degree of risk

Seizures, impact on occupational performance

1. the seizure disorder and the anti-convulsive medications prescribed to control the seizures may affect the individuals alertness and learning potential 2. the amount of brian damage incurred by the seizures and associated conditions and the effects of medication can influences performance in all areas of occupation

Lifestyle redesign (rehabilitation for obesity)

A combination of changes in the daily habits, patterns, and routines to decrease body weight through changes in nutrition (emphasis on fruit, vegetables, whole grains and lean protein), and changes in level of physical activity and leisure time 1. personalized plan to change lifesytle habits that contribute to obesity risk 2. personalized activity-focused exercise program combining personal interests, desired participation, goals and positive meaning (OT walks with national alliance on mental illness [NAMI]) 3. Instruction in self-monitoring of exercise respinse (heart rate, perceived exertion) 4. Supportive coaching/counseling to improve compliance and make long-term, life altering change

Case Study

A single subject or a group of subjects is investigated in an in-depth manner 1. Purpose can be description, interpretation or evaluation 2. This method is easy to use in most practice settings

Chorea

Brief, purposeless, invol. mvmts. of distal extremities and face. Usually considered to be a manifestation of dopaminergic overactivity in basal ganglia

Tics

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

sensorineural hearing loss

Central or neural hearing loss from multiple factors (noise damage, trauma, disease, drugs, arteriosclerosis, etc.)

Common law related to professional misconduct and malpractice

Common law evolves from legal decisions and can impact occupational therapists -Malpractice suits can be filed by individuals and/or their caregivers if the occupational therapist is viewed to be personally responsible for negligence or other acts the resulted in harm to a client -Supervisors or superiors may also assume the liability of their workers if they provided faulty supervision or inappropriately delegated responsibilities -The institution usually assumes liability if an individual was harmed as a result of an environmental problem (falls resulting form slippery floors, poorly lit areas, lack of grab bars) -The institution is also liable if an employee was incompetence or no properly licensed -Personal malpractice insurance is advisable for all levels of OT practitioners

Brunnstrom's Movement Therapy

Focused on facilitating recovery through a specific sequence -Treatment is focused on the promotion of movement from reflexive to volitional in seven stages of motor recovery. -7 stages of motor recovery following the onset of hemiplegia that the individual progresses through in a stereotypical fashion were identified -This recovery pattern includes the identification of developing synergies.

Basic task skills groups

Includes intervention activities designed to develop the basic cognitive skills (attention, ability to follow multistep directions, problem-solving) necessary for the completion of simple tasks (not the same as a task-oriented group--focuses on the skill not the dynamic)

Medicare and maintenance plans

Medicare does cover a therapist's design of a maintenance plan and the occasional reevaluation of this plans effectiveness -Reimbursement is not provided for a therapist to carry out maintenance plan that does not provide skilled services -In 2013, existing Medicare policy about reimbursable status and quality of life was clarified 1. Restorative potential of a person was determined to not be the sole payment criteria for skill therapy services 2. Therapy services to prevent or slow deterioration and maintain a person at their highest possible functional level was recognized as skilled and covered if these services are reasonable and necessary (if maintenance services can be performed safely and effectively by unskilled personnel, coverage for skilled therapy services is not mandated) -Evaluation and training of caregivers are considered part of the design and reevaluation of a maintenance plan -The competence of caregivers to carry out the maintenance plan must be documented prior to discharge from OT

Facilitative leadership

Occurs when the OT practitioner shares responsibility for the group and the group process with the members: 1) this style is advised when members' skill levels and engagement are moderate (eg. ego-centric cooperative, or cooperative) 2) facilitative leaders collaborate with group members to select the activities to be used in a group 3) members and leaders share instruction throughout the group's process 4) group maintenance roles and feedback are provided by members with the leader facilitating the process 5) facilitative leader's goal is to have members acquire skills through experience

PLISSIT model

P - Permission: which requires the therapist to create an atmosphere that gives the individual permission to raise concerns about their sexuality and sexual activities LI - Limited Information: that is provided by the therapist to ensure that the individual has accurate knowledge about their sexual abilities and potentials SS - Specific Suggestions: that are provided by the therapist to facilitate the individuals pursuit of satisfying sexual expression, either alone or with a partner IT - Intensive Therapy: which is indicted when the individual requires intervention for long-standing relationship problems and enduring sexual problems

TB infection

People who breathe in TB bacteria; cells inactive but remain alive in body: asymptomatic, do not feel ill, not contagious, do not have pos. TB skin test, can develop TB if no drug tx for infection 1. are asymptomatic 2. do not feel ill 3. are not contagious 4. do usually have a positive TB skin test 5. can develop full-blow TB later, if they do not get drug treatment for the TB infection

HIPAA Privacy Rule

Requires that all providers protect patient confidentiality in all forms (oral, written, electronic) and implement appropriate physical, technical and administrative safeguards to assure this privacy -Settings must reduce the physical identifiability of patient information such as door tags and white boards can only list last names, no diagnoses or treatment procedures may be listed, sign-in sheets with names only are allowed -Charts and any documentation with patient names or other identifiers must be stored out of public view and in secure locations -Opaque covers should be used for clipboards that contain paperwork with patient information -All computers that are used to records, document or transmit patient information should be equipped with monitor privacy screens -All faces must contain cover sheets noting confidentiality of accompanying information and be sent only to dedicated fax machines in secure locations -All emails must use password protection and encryption if going over the internet -All faxes and computer printouts must be immediately destroyed or placed in the persons chart as most appropriate -All conversations regarding a persons health status must be done in private areas in low tones and with minimal disclosure

Group cohesiveness

The degree to which group members are attracted to one another and share the group's goals Factors that contribute to cohesiveness 1. extensive interaction between members 2. similarities or complementariness in member characteristics 3. perception of relevance of group to individual needs 4. members expectation of goal attainment and successful group outcomes 5. democratic leadership and member cooperation

Continuous tasks (Motor learning)

There is no recognizable beginning and end. Tasks are performed until they are arbitrarily stopped. (Jogging, driving, swimming)

Palm to finger translation

With stabilization, a linear movement of an object from the palm of the hand to the fingers e.g. placing coins in a slot 2 - 2 1/2 years (Manipulating skills according to Exner's classification system)

Analysis of covariance (ANCOVA)

a parametric test used to compare two or more treatment groups or conditions while also controlling for the effects of intervening variables (covariates) (two groups of subjects are compared on the basis of UE functional reach using two different types of assistive devices, subjects in one group have longer arms than subjects in the second group, arm length then becomes the covariate that must be controlled during statistical analysis)

Status epilepticus

a prolonged seizure or situation when a person suffers two or more convulsive seizures without regaining full consciousness -can be sometimes triggered when medication is stopped abruptly -can be life threatening 1. rarely does sudden death occur, however, it is possible due to resulting erratic heart rhythm -typically occurs with tonic clonic sizures that are not well controlled

Intraclass correlation coefficient (ICC)

a reliability coefficient based on an analysis of variance

Pain

a sensory and emotional experience associated with actual or potential tissue damage

Homonumous Hemianopsia

a visual field deficit in which half of the visual field is lost i each eye (nasal half of one eye and temporal half of other eye); occurs after neurological injury, especially CVA. This results in inability to receive information from right or left sides, corresponding to the side of sensorimotor deficit

BPD Effects on function

a. Poor autonomic and sensory state regulation, can impact on the alert state which is necessary for proper feeding. b. Poor exercise/activity tolerance d/t illness and compromised respiration c. Reduced ability to socialize d/t long periods of poor health and the increased susceptibility to infection d. Isolation and stress on the child and family members can lead to psychosocial problems e. Greater risk for attachment disorder, affecting the child's ability to relate to others d/t isolation and dependence on technological equipment

secondary lymphedema

acquired due to injury of one or more parts of the lymphatic system 1. surgery, radical mastectomy, femoropoliteal bypass (femoral popliteal bypass), lymph node removal 2. Tumors, trauma, or infection affecting the lymph nodes 3. radiation therapy with fibrosis of tissues 4. chronic venous insufficiency 5. in tropical and subtropical areas, fibariasos (nematode worm larvae in the lymphatic system)

Early mobilization programs for flexor tendons- Duran 4 1/2- 6 weeks

active flexion and extension within limits of splint

Othrostatic hypotension

an excessive fall in blood pressure upon assuming the upright position

Degree of freedom

based on number of subjects and number of groups, allows determination of level of significance based on consulting appropriate tables for each statistical test

Manual Actions Level 3

begins with the use of the hands to manipulate objects. The individual may be able to perform a limited number of tasks with long-term repetitive training

Elbow flexion

biceps brachii, brachialis, brachioradialis -biceps and brachialis innervated by musculocutaneous nerve, -brachioradialis innervated by radial nerve

Variable expenses

change in direct proportion to the amount of services provided (splinting materials)

Sensorimotor period, ages birth to 2 yeas

child progresses from reflexive activity to mental representation to cognitive functions of combining and manipulating objects in play

Unspecified Disruptive, Impulse-Control, and Conduct Disorder

children who do not meet the criteria for conduct disorder or ODD, however they display significant functional impairment and conduct and oppositional behaviors are present

chronic bronchitis

chronic inflammation of the teacheobronchial tree with cough and sputum production lasting at least 3 months for 2 consecutive years

Thromboangiitis obliterans (Buerger disease)

chronic inflammatory vascular occlusive disease of small arteries and also veins 1. most common in young males who smoke 2. begins distally and progresses proximally in both lower and upper extremities 3. symptoms include pain, paresthesias, cold extremities, diminished temperature sensation, fatigue, risk of ulceration and gangrene

stable angina pectoris

classic external angina occurring during exercise or activity; relieved with rest and/or sublingual nitroglycerin

Undue hardship (ADA)

defined as action that would be significantly difficult or overly expensive given the financial resources of the employer, its size and major functions

Abuse

deliberately hurting a person physically, mentally or emotionally

Neglect

deliberately withholding services that are necessary to maintain an individuals physical, mental and emotional health

Nerve roots

exit from the vertebral column through intervertebral foramina 1. In cervial spine, numbered roots exit above the corresponding vertebral body, with C8 exiting below C7 and above T1 2. In the thoracic and lumbar segments the roots exit below the corresponding vertebral nody -Spinal cord ends at the level of L1, below L1, nerve roots descent vertically to form the cauda equina

Palmar grasp

fingers on top surface of object press it into center of palm with thumb adducted (5 months)

Convenience sampling

individuals are selected who meet population criteria based upon availability to the researcher

Lifespan

maximum survival potential the inherent natural life of the species in humans 110-120 years

Phantom Limb pain

pain in a limb (or extremity) that has been amputated, differentiated from far more common phantom limn sensation

emphysema

permanent abnormal enlargement and destruction of air spaces distal to terminal bronchioles; may result in destruction of acini, the functional units for gas exchanges in the lungs 1. Etiology: based on the assumption that there is an imbalance between protease and antipotease enzymes -causes tissue breakdown and antiprotease enzymes -leads to loss of lung parenchyma, elastic recoil during exhalation and normal airway resistance during inspiration -results in airway dilation, premature airway closure, air trapping, and increased residual air volume or hyperinflation -prognosis: varies depending on degree of obstruction, presence of hypercapnia (increased levels of CO2) recurrence of infections and developmental of right heart failure

pneymocystis pneumonia

pulmonary infection caused by a fungus (Pneymocytis carinii) in immunocompromised hosts; most often found in patients following a transplantation, neonates and those infected with HIV -acute disease

Prospective correlation research

recording and investigation of present data

Displacement

redirecting an emotion or reaction from one object to a similar but less threatening one (child gets angry with their parents and hits a younger sibling)

Personal context

refers to demographic features of the individual such as age, gender, socioeconomic status and educational level that are not part of the health condition

Early mobilization programs for flexor tendons - Kleinert 8-12 weeks

strengthening, work and leisure activities

Suspension

the loss of membership, certification or licensure for a specific time period

Bronchioles/bronchi

the major air passages of the lungs that diverge from the windpipe

speech-language pathologist

to assess, recommend and train in the use of augmentative communication aids

Vendor

to provide items requested by therapists and consumers

Pearson product-moment coefficient (r)

used to correlate interval or ratio data

Humor

using comedy to express feelings and thoughts without provoking discomfort in self and others (making fun of yourself for coming inappropriately dressed for a specific function)

Latissimus dorsi innervated by the thoracodorsal nerve

§ Origin: T6-T12, L1-L5, sacral vertebrae, ribs 9-12, iliac crest and inferior angle of scapula § Insertion: intertubercular groove of the humerus

Subscapularis innervated by the subscapular nerve

§ Origin: anterior surface of scapula § Insertion: lesser tuberosity § Function: internal rotation

Teres minor innervated by the axillary nerve

§ Origin: axillary border of scapula § Insertion: greater tuberosity § Function: external rotation

Anterior deltoid innervated by axillary nerve

§ Origin: clavicle § Insertion: deltoid tuberosity

Coracobrachialis innervated by the musculocutaneous nerve

§ Origin: coracoid process § Insertion: medial aspect of deltoid

Teres major innervated by the subscapular nerve

§ Origin: inferior angle of scapula § Insertion: intertubercular groove of the humerus

Infraspinatus innervated by the suprascapular nerve

§ Origin: infraspinatus fossa § Insertion: greater tuberosity § Function: external rotation

Anconeus

§ Origin: lateral epicondyle and capsule of elbow joint § Insertion: olecranon and upper ¼ of dorsal ulna § Function: elbow extension

Pectoralis major innervated by the axillary nerve

§ Origin: medial clavicle, sternum, and ribs 1-7 § Insertion: greater tuberosity

Abductor pollicis longus (APL)

§ Origin: middle 1/3 of ulna and radius § Insertion: first metacarpal, radial side § Function: abduction and extension of CMC joint

Serratus anterior innervated by the long thoracic nerve

§ Origin: ribs 1-8 and aponeurosis of intercostals § Insertion: superior and inferior angels of scapula and vertebral border of scapula

Sensory-Based Motor Disorder (SBMD)

-deficits in proprioceptive and vestibular system -Dyspraxia: difficulty with planning movements, particularly those that are complex or new -Postural disorder: decreased muscle tone impacting on stability

Intrinsic inhibitory mechanism (pain):

-gate control theory: transmission of sensation at spinal cord level is controlled by balance between large fibers (A alpha, A beta) and small fibers (A delta, C) 1. activity pf large fibers at the level of first synapses can block activity of small fibers and pain transmission (counterirritant theory) -Descending analgesic systems: endogenous opiates (endorphins, enkephalins) produced throughout CNS in periaqueductal gray, raphe nuclei, and pituitary gland/hypothalamus, can depress pain transmission at various sites through mechanisms of presynaptic inhibition

Value of clinical reasoning in for OT's in practice

-improves clinical decision making by giving therapist tools for self-conscious reflection on their decisions -improves ability to explain the rationales behaving therapists decisions to consumers, family members, team members, and medical finance agencies (insurers) -improves job satisfaction bu making therapists more aware of complexity of their work and the value of their practice

Role of OT in Self-Harm

-improving self management by teaching stress, anger and emotional regulation skills -instructing client in the use of alternative, less destructive coping skills -implementing interventions using CBT principles -using DBT techniques if appropriate for client -providing instruction in the use of sensory approaches -developing problem-solving skills -improving communication

Releasing skills

-initially, involuntary dropping, then object is pulled out of one hand by the other hand 1. Development progresses from no release (0-1 month) to involuntary release (1-4 months) to two-stage transfer (5-6 months) to one-stage transfer (6-7 months) to voluntary release (7-9 months) 2. By 9 months, release by full arm extension 3. refinement continues up to age 4 with the attainment of graded release

Sports w/c

-specially designed for racing, cycling, basketball, and other competitive sports -typically, ultra light weight

enviromental assessment

1. accessibility issues related to safety, risk for falls and environmental barriers in the discharge environment 2. Physical demands of the discharge environment. presence of stairs, airborne irritants

Osteogenesis Imperfecta (OI) medical mangement

1. care for broke bones 2. dental care for brittle teeth 3. medication for pain 4. surgery -fix bone malformations -prevent bone malformations -rodding in which metal rods are put inside the long bones

Purpose of wheelchairs and wheelchair seating and positioning

1. enable functional mobility with what means the person with a disability has available 2. facilitate master of the environment 3. enable occupational engagement and social participation 4. promote functional posture by provision of appropriate back, trunk, arm and leg supports 5. facilitate upper limb function that can occur with proper trunk support 6. promote comfort during upright ADL 7. provide psychological maintenance and issue protection through prevention of shearing 8. Promote sensory readiness through provision of proper eye and head position 9. decrease progression of deformity through customized seating as needed 10. decreased pain through provision of proper support

Dorsal forearm muscles innervated by the radial nerve

Supinator

Discrete tasks (Motor learning)

Tasks with a recognizable beginning and end Kick a ball, push a button

Social phobia

a clinically significant anxiety from certain types of social or performance situation leading to avoidance

Preferred provider organization (PPO)

a form of managed care that is similar to an HMO but usually offers a greater choice of providers. However, as choices increase, percentage of payment decreases

Medical History (OT Developmental Evaluation)

admission and length of hospitalizations for illness, disease, surgery and medications

Venous stasis ulcer

poor lower extremity circulation, varicose veins

Revocation

the permanent loss of membership, certification or licensure

Reprimand

the private communication of the respective agency's disapproval of a practitioners conduct

Administrative case management

connects a person with serious illness to appropriate and needed community services and programs, overseeing this service provision to ensure that quality of care in a cost-effective manner is achieved

Goal-setting groups

consists of activities designed to identify personal objectives and treatment goals and the steps needed for their achievement

Rationalization

creating self-justifying explanations to hide the real reasons for owns own or another's behavior (parent believes a lazy adult child is not working because the job market is poor)

Pleural effusion

excessive fluid between the visceral and parietal pleura, caused mainly by increased pleural permeability to proteins from inflammatory diseases (pneumonia, RA, systemic lupus), neuroplastic disease, increased hydrostatic pressure within pleural space (congestive heart failure) decrease in osmotic pressure (hypoproteinanemia), peritoneal fluid within the pleural space (ascites in cirrhosis) or interference of pleural reabsorption from a tumor invading pleural lymphatics

Radial palmar grasp

fingers on far side of object press it against opposed thumb and radial side of palm (6 months), with wrist straight (7 months)

Boutonniere deformity

flexion of PIP joint and hyperextension of DIP joint

Virtual context

interactions that occur in simulated, real-time, or near-time situations absent of physical contact and may include email, video conferencing, web-based social networking

Bathing/showering equipment

1. grab bars and nonskid mat 2. tub transfer bench/shower bench 3. Shower commode chair 4. handheld shower 5. antiscald valves and faucets 6. built-up, angles and long handled bath sponge or bath mitt 7. soap on a rope, soal dish with suction cup 8. storage units

Toileting and toilet hygiene equipment

1. grab bars and toilet safety frame 2. bedside (3 in 1) commode or raised toilet seat 3. bowel training device, bladder control devices 4. skin inspection mirror 5. toilet paper holder

Supinator

-Radial nerve § Origin: lateral epicondyle and ulna § Insertion: radius § Function: forearm supination

other types of diabetes

(1-2% of all cases) genetic syndromes surgery drugs malnutrition infections

Schools (Community-based practice)

-Acceptance criteria for OT services as a related service in an educational setting 1. The child requires special education services and OT will enable the child to benefit from special education 2. OT will facilitate the child's participation in educational activities and enhance the child's functional performance 3. Referrals are received from the previous agency that provided early intervention services the child's teacher and/or school's child study team 4. The school reviews the referral and if indicated recommends an OT evaluation (If an OT evaluation has already been completed the need for OT intervention services is discussed, the frequency, length of sessions and duration of the intervention are also determined) -Length of services is dependent on the impact of OT services on the child's abilities and prevention of loss of abilities 1. 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 2. A review of services and progress made toward the child's individualized education plan (IEP) is conducted on an annual basis -OT Evaluation 1. Assess client factors, performance skills and patterns and areas of occupation that impact on the education and functional performance of the child within the school (findings are used to contribute to the IEP, in which goals and objectives are formulated to address the overall educational needs of the student) 2. Assess the child's functional and developmental level to contribute to the Functional Behavioral Analysis OT intervention focus 1. Based on an educational model versus a medical model 2. Addresses the students functional performance along with academic performance 3. Activities are utilized to address the goals and objectives documented in the IEP using both corrective and compensatory methods 4. Assistive technology and transition services in accordance with the regulations of IDEA are provided 5. Performance skills deficits and client factors (sensorimotor, cognitive/process, and psychosocial/communication/interaction) are treated to improve the child's ability to participate in and perform education-related activities within a school setting. 6. Skills in the performance areas of ADL, school, and play are developed to improve the child's ability to participate in and perform education-related in accordance with the students transition plan 7. Skills for adult life post-school are developed in accordance with the student's transition plan -The OT practitioner needs to know the school district's and states funding resources and regulations and interpretations of the federal laws regarding education -The role of OT practitioners in school-based practice has expanded beyond education-related services to include programs that address students psychosocial needs and prevent school violence 1. Behavioral Intervention Plans which include Response to Intervention (RtI) and Positive Behavioral Supports (PBS) may be a component of school-based OT service provision a. RtI is an evidence-based, structured intervention approach that uses EIS to address academic difficulties and PBS to address behavioral problems early in child's education + An RtI is designed to meet the needs of children who are having difficulty learning without requiring a full evaluation as require for an IEP +The provision of classroom modifications (the use of a therapy ball as a seat instead of a standard desk chair) and the use of educational strategies (incorporating movement into the class lessons) can positively impact children's ability to learn +If the RtI approach is not effective, the occupational therapist can recommend the completion of a comprehensive evaluation and the development and implementation of an IEP

Gestational diabetes

1. usually resolves after pregnancy 2. occurs at a greater frequency in race/ethnicity risk groups 3. obesity is another risk factor

Analysis of Variance (ANOVA)

A parametric test used to compare two or more treatment groups or conditions at a selected probability level

Perseveration

A persistent focus on a previous topic or behavior after a new topic or behavior has been introduced

Laterally (Motor Development)

Hemispheric specialization for specific tasks varies with different individuals (handedness is considered to be stable by age 5, however, strong preferences can be seen much earlier)

Specific phobia

a clinically significant anxiety from a specific object or situation leading to avoidant behavior

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

Illusions

are misperceptions or misinterpretations of real external stimuli

Bilateral Integration (Motor Development)

as the child experiments with movement, the nervous system is stimulated and the resulting sensations help the child to coordinate the two sides of the body (begins at 9-12 months)

adjustment to death & dying ==> 5 stages

denial, anger, bargaining, depression, acceptance

Ventral (anterior) root

efferent (motor) fibers to voluntary muscles (alpha motoneurons, gamma motoneurons) and to viscera, glands, and smooth muscles

Diaphoresis

excessive sweating associated with decreased cardiac output

Body temperature

heart rate changes analogously to temperature

surgical wounds

incisions, resections, grafts, amputations

mid-tech devices

inexpensive household devices that are readily available for use but tend to be electronic and may require programming/set up (talking alarm clocks, automatic coffee pots)

Restrospective correlation research

investigation of data collected in the past

OT working with L CVA

need to consider the impact on the persons communication abilities

Declarative memory

recall specific to consciously learned facts, such as school subjects

Scapular abduction muscles

serratus anterior

Purkinje tissues

specialized conducting tissue of the ventricles

Reaction formation

switching unacceptable impulses into their opposites (hugging someone you would like to hit)

Early mobilization programs for flexor tendons- Duran 6-8 weeks

tendon gliding and differential tendon gliding, scar management and light purposeful and occupation-based activities

Psychosomatic pain

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

Certified orientation and mobility specialists

to train visually impaired persons in specific skills to move independently, safely, and efficiently within the community

Complex rotation

The rotation of an object 360 degrees, e.g. turning a pencil over to erase 6-7 YEARS (Manipulating skills according to Exner's classification system)

Stage 8: Integrity vs. Despair (erikson)

the mature adult reflects on their own value and shares with the younger generation the knowledge gained, wisdom is acquired (maturity, older adulthood)

Empirical-inductive thinking

(Concrete operations 7 to 11 years- Jean Piaget hierarchical development of cognition) -the child solves problems with the information that is obvious and present

Categories of older adults

- young-old: ages 65-74 - middle-old: ages 75-84 - very-old: ages > 85

Substance abuse counselor

-A professional who may come from a diversity of educational backgrounds (psychology, social work, OT) who has completed a specialized training program -Provides individual and/pr group intervention -Certified Alcohol Counselor (CAC) and Certified Alcohol and Drug Counselor (CADC) are the two main credentials designating this specialized role

Reminiscence group

-Activities designed to review past life experiences to promote cognition & sense of personal worth -current memory not necessary nor is it facilitated

Guillain-Barre Syndrome symptoms

-Acute, rapidly progressive form of polyneuropathy characterized by symmetric, muscular weakness and mild distal sensory loss/paresthesias. -Weakness is always more apparent than sensory findings and is at first more prominent distally -Relatively minor sensory signs and symptoms occur 1. the pt may complain of painful extremities 2. subjective and objective sensory disturbances are common initially (most common occurring in distal [stocking glove] distribution) -Deep tendon reflexes are lost and sphincters are spared -Respiratory failure and dysphagia may be seen in some cases

Complications/secondary diagnosis of RDS

*-Risk of severe intracranial hemorrhage *-Risk of bronchopulmonary dysplasia (BPD) *-Risk for developmental delay;severe developmental delay *-Risk is far greater for infants who do not receive appropriate treatment

Pulmonary function test (heart failure)

*-Used to determine cause of dyspnea, degree of lung disease *-Provides information related to endurance potential for functional activities. -Diagnostic procedures

Problem solving skills 24-27 months

-Child discriminates sizes

Thought blocking

Interruption of a thought process before it is carried through to completion

Nonmaleficence

Principle 2: Occupational therapy personnel shall intentionally refrain from actions that cause harm

Catatonia

characterized by immobility and rigidity

Auscultation of heart

done with stethoscope to assess heart sounds. Note the addition of extra, abnormal heart sounds

Visual-motor integration (Motor Development)

is dependent on the lower levels of visual attention, visual memory, visual discrimination, kinesthesia, position in pace, figure ground, form constancy and spatial relations

labile affect

is rapid and abrupt changes in affect

Upward rotation muscles

trapezius, serratus anterior

Symbolic play 12-18 months

- Child can project "make believe" play on objects and others - Child uses variety of schemes in imitating familiar activities

Pulmonary system function

-Respiration, delivers oxygen to cardiovascular system -Removes carbon dioxide and other by-products from body Anatomy: 1. bony thorax 2. airways 3. lungs 4. pleura

Behavior management (teaching method)

-The identification of behaviors that require development (appropriate social skills) and/or require extinction (hitting people) -The implementation of structured program to facilitate the desired behavior change For example, interactions that are consistent with societal norms are rewarded with praise, whereas aggressive acts are addressed with "time out" periods

Stages of Kidney Disease

-There are 5 stages of kidney disease with progressive worsening of the glomerular filtration rate (GFR) which characterizes each stage of the disease 1. Stage 1: prevention of progression of the kidney disease 2. Stage 2: management of health conditions 3. Stage 3: management of anemia and bone loss 4. Stage 4: education for further management of kidney failure should be provided (hemodialysis versus peritoneal dialysis versus transplantation) 5. Stage 5: for life to be sustained the person must recieve either dialysis or a kidney transplant

Peripheral nerve injuries

-Three major nerves: median, ulnar, and radial -Two types of nerve injuries: 1) Incomplete: compression or nerve entrapment 2) Complete: laceration or avulsion injury

General signs of abuse

-Withdrawal -Nightmares -Running away -Anxiety or depression -Guilt -Mistrust of adults -Fear -Aggressiveness

mild intellectual disability

-an IQ range of 50 to approximately 70 indicates a 1. focus is place on the individual acquiring social and vocational skills to function independently in desired occupational roles 2. minimal support is required 3. additional intermittent support may be required in special circumstances

Sequelae of MRSA

-chance of recurrence of infection in the future -Organ system damage that occurs as a result from untreated or unmanaged infections

Knowledge of performance (KP)

-feedback given after task about the nature of performance -The OT says: "Next time, dress your right arm first" or "Your elbow was bent"

Bipolar II disorder

-one or more major depressive episodes -there must be at least one hypomanic episode -there is no history of manic episode

Cataracts

-opacity of the lens, including protein changes and lens hardening/thickening, which results in diminished visual acuity and gradual loss in vision -field vision is not affected -vision is overall hazy and blurry, especially in glaring light or when reading printer materials -central vision is predominately affected because of the glare, haziness and decrease in contrast sensitivity

Sensory processing disorders symptom classification

1.Ayre's sensory integration model 2.Dunns Model

Strabismus (CP)

Deviation of how one eye aligns with the other

Social interaction groups

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

Simulation (teaching method)

The individual acts out an activity performance using simulated tasks and/or objects -For example using a simulator prior to driving in a car on a roadway

Hemiballismus

Usually characterized by involuntary flinging motions of the extremities. The movements are often violent and have wide amplitudes of motion. They are continuous and random and can involve proximal and/or distal muscles on one side of the body.

projection

attributing attributes to unacknowledged feelings, impulses or thoughts to others (some who feels guilty attributes what others say as blaming them)

Pulses

decreased or absent pulses associated with peripheral vascular disease.

Social networks

the web of voluntary relationships that make up an individuals social environment

Ethical dilemmas (book definition)

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

Oral-motor control (Motor Development)

which is redeveloped in the area of feeding, provides the foundation for early oral communication and later language development

OT working with a R CVA

will need to consider its impact on the persons ability to attend to the left side of the environment and body

panic disorder

recurrent panic attacks followed at least once by concern for recurrence

Cystic Fibrosis (CF)

- Eti.: genetically inherited autosomal recessive trait, gene mutation; both parents carriers-neither parent has disease - Chronic, progressive lung dis. (production of abnormal mucus) -Diagnosis: 1. chronic, progressive lung disease characterized by production of abnormal mucous 2. salt concentration in the sweat 3. decreased release of certain enzymes by the pancreas 4. failure to grow properly 5. certain abnormalities revealed on x-ray

Varient angina

(Prinzmetal's angina) caused by vasospasm of coronary arteries in the absence of occlusive disease. Responds well the nitroglycerin or calcium channel blocker long term

Interventions for impairment level-problems

(Rehabilitation for Immunological System Disorders) -Encourage screening and treatment regimens, -Set personal goals to invest behaviorally in ones health -provide support for those dealing with chronic illness, -provided supportive counseling and social support for psychological disorders that can develop (depression or anxiety disorder), -refer to physician for drug therapy

Acute hospitalization phase

(Rehabilitation for Immunological System Disorders) -early mobilization -preservation of function -positioning -psychological/emotional support -prevention of long term disability

Symbolic play 18-24 months (24-48 months)

- Child increases use of non-realistic objects in pretending (substituting block for train) - Child has inanimate objects perform familiar activities (doll washing itself)

Anterior cord syndrome

- caused by flexion injuries 1. The result is bilateral loss of motor function, pain, pinprick, and temperature sensation below the lesion while proprioception and light touch are preserved

Knowledge of results (KR)

- feedback given after task performance about the outcome · The OT says: "your shirt is on backwards" or "you dropped the cup"

Signs and symptoms of TB

-A bad cough for more than 2 weeks -Chest pain -Blood tinged sputum or phlegm -Weakness or fatigue -Weight loss -Loss of appetite -Chills/fever -Night sweats

Palmar-supinate grasp (prewriting skills)

writing tool held with fisted hand, wrist slightly flexed and slightly supinated away from mid-position; arm moves as a unit (1-1 ½ years)

Levator scapulae innervated by C3-C4 nerves

§ Origin: C1-C4 transverse processes § Insertion: vertebral border of scapula

Justice (book definition)

Principle 4: OT personnel shall promote fairness and objectivity in the provision of occupational therapy services

Veracity

Principle 5: OT personnel shall provide comprehensive, accurate, and objective information when representing the profession

Triceps

§ Origin: · Long head: infraglenoid tuberosity · Lateral head: posterior humerus · Medial head: distal to lateral head § Insertion: olecranon § Function: elbow extension

Chiropractor

-A professional who is a graduate of an educational program in chiropractic who is usually licensed by state boards -Assesses the individuals spinal column and intervenes to restore and maintain health and decrease and eliminate pain

Voluntary opening (VO) terminal device

hook remains closed until tension is placed on cable and then it opens -this is prescribed more than VC

Weakness of the elevation of the pharynx during swallow

incomplete triggering (diminished neural stimulation) of the pharyngeal phase of swallowing

Regression

returning to an earlier stage of development to avoid the tension and conflict of the present one (an individual becomes needy/childlike during a period of stress or illness)

Biventricular failure

severe LV pathology producing back up into the lungs, increased PA pressure and RV signs of HF -associated symptoms: muscle wasting, myopathies, osteoporsis

Mild neurocognitive disorder (delirium)

similar to major neurocognitive disorder, with the difference that the cognitive deficits do not interfere with independence in everyday activities

Hypomanic

symptoms of mania but are not severe enough, to a milder degree for at least 4 days; cannot include delusions or hallucinations, to cause marked impairment in social or occupational function or to require hospitalization

goal-directed actions Level 4

the ability to carry simple tasks through to completion. The individual relies heavily on visual cues. They may be able to perform established routines but cannot cope with unexpected events

Stage 7: Generativity vs. Self-absorption (erikson)

the adult finds security in the contribution of their chosen personal/professional roles; the capacity to care is achieved (middle adulthood)

Reversibility

(Concrete operations 7 to 11 years- Jean Piaget hierarchical development of cognition) -an expansion of conversation, leads to increased spatial awareness

Hypervigilance

-Excessive attention and alertness that guards against potential danger

Cauda Equina Syndrome

-Injury at the L1 level and below resulting in a LMN lesion -Flaccid paralysis w/no spinal reflex activity -An areflexic bowel and bladder

Extensor carpi radialis brevis (ECRB)

-Radial nerve § Origin: lateral epicondyle § Insertion: 3rd metacarpal, base § Function: extension of wrist and radial deviation

Scapula depression muscle

-trapezius (lower)

Pressure relief cushions: visoelastic

1. has memory that delays return to original shape 2. provides good envelopment and stable base for posture 3. has good thermal properties

Rehabilitation counselor

Assess and advise on vocational issues

Myoclonus

Brief and rapid contraction of a muscle or group of muscles.

Superficial vein thrombophlebitis

Clot formation and acute inflammation in a superficial vein; localized pain usually in saphenous vein

Suppression

Consciously and intentionally pushing unpleasant feelings out of one's mind (cleaning closets and drawers while waiting for the results of a medical test)

Descriptive correlation research

Investigation of several variables at once, determines existing relationships among variables

variable motionless tasks (Motor learning)

Involve interacting with a stable and predictable environment, but specific features of the environment are likely to vary between performance trials (Performance of activities of daily living outside of the usual home environment)

Examples of EADLs

Lighting and temperature controls and radios, televisions and telephones -talking pill bottles -monitoring systems -personal emergency response systems -electronically controlled door opens and closes to promote ease of access -automatic lights -smart home platforms -computers

Indirect Supervision

No face-to-face contact between supervisor and supervisee -Includes: electronic, written, and telephone communications

Excoriation disorder

Repeated picking of the skin with fingers, needles, or other objects despite efforts to stop, resulting in skin lesions and causing significant disruption in daily occupations

Telecommunication Act of 1996

Required providers of telecommunication systems and manufacturers of telecommunication equipment to make services (caller ID, operator assistance) and equipment (cell phones) useable by and accessible to individuals with disabilities if at all possible

Teaching methods

Ways to present information and/or a task to an individual on a one-to-one basis or in a group -Demonstration and Performance -Exploration and Discovery -Explanation and Discussion -Role play -Simulation -Problem Solving -Audiovisual aids -Repetition and Practice -Behavioral Management -Consumer/family/caregiver education

traumatic wounds

burns/thermal injuries, gunshot wounds, degloving injuries, compression and crash injuries

2 to 3 years (Development of sensorimotor integration)

-This is a period of refinement as the vestibular, proprioceptive and visual 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

Schizoid personality disorder

-This is frequently diagnosed in individuals who display a lifelong pattern of social withdrawal -Their discomfort with human interaction, their introversion, and their bland, constricted affect are noteworthy -Persons with schizoid personality disorder are often seen by others as eccentric, isolated or lonely

Flexor carpi ulnaris (FCU)

-Ulnar nerve § Origin: medial epicondyle and proximal 2/3 of the ulna § Insertion: pisiform and 5th metacarpal § Function: flexion of wrist and ulnar deviation

Abductor digiti minimi

-Ulnar nerve § Origin: pisiform and tendon of flexor carpi ulnaris § Insertion: proximal phalanx of the 5th digit § Function: abduction of the 5th digit

Flexor digitorum profundus

-Ulnar nerve § Origin: proximal two-thirds of the ulna and interosseous membrane § Insertion: distal phalanx § Function: flexion of DIP joints to digits IV and V

Symbolic play, 2-4 years

1) Child engages in play experiences through which he/she formulates, tests, classifies, and refines ideas, feelings, and combined actions. 2) This form of play is associated with language development 3) Prefers objects of symbolization, control and mastery 4) Mostly parallel play with peers

Reactive attachment disorder Diagnostic-specific considerations for OT

1. Close and ongoing collaboration with the childs family and caregivers facilitates successful outcomes 2. Actively involve parents/caregivers in treatment 3. assist children to form a more secure sense of self 4. limit the childs exposure to multiple caregivers 5. provide high levels of structure and consistency 6. goals need to be specific, realistic and attainable

Pressure relief cushions: Fluid

1. facilitates pelvic and LE alignment 2. provides pressure relief without changing support 3. good for individuals who need increased stability

Penetration of the bronchioles/bronchi by the bolus when aspiration occurs

1. food enters the lung; true aspiration occurs -bacteria can cause pneumonia (aspiration pneumonia). If the persons immune system is functioning weel, they may not experience pneumonia

Leading causes of disability/chronic conditions (morbidity) in persons over 65 years,

1. hypertensions 2. hyperlipidemia 3. arthritis 4. heart disease 5. diabetes 6. most older persons report having one or more chronic conditions

Rules

(Concrete operations 7 to 11 years- Jean Piaget hierarchical development of cognition) -as rules are better understood, the are also applied

Classification

(Preoperational period 2-7 years- Jean Piaget hierarchical development of cognition) -categorizing objects according to similarities and differences

Cerebellar cortical degeneration

- Eti.: pathologic changes seen in cerebellum and inf. olives - Onset b/t 30 and 50 - Symp.: cerebellar symp. only signs detectable

Physicians Assistant (PA)

-A professional who is a graduate of an accredited physicians assistant educational program and who has passed a national certification exam -Performs routine diagnostic, therapeutic, preventative, and health maintenance services -Specializations can include family medicine, geriatrics, pediatrics, obstetrics, orthopedics, psychiatry, and emergency care -Must work under the direction of and be supervised by a physician

Audiologist

-A professional who is a graduate of an educational program in audiology -Administers assessments to determine an individuals auditory acuity, level of hearing impairment, and damage sites in the auditory system -Provides recommendations for assistive devices (hearinf aids) and/or special training to enhance residual hearing and/or adapt to hearing loss

Peer Review

-A system in which the quality of work of a group of health professionals is reviewed by their peers

Information regarding the mothers pregnancy and specifics of birth history (OT Developmental Evaluation)

-Apgar score of the infants heart rate, respiration, reflex irritability, muscle tone and color is measured at 1,5, and 10 minutes after birth, each item receives a rating of 0,1, or 2. The highest score possible is 10 points indicating a newborns wellbeing -Number of weeks premature, adjusted age -Number of days/weeks in incubator, intubated and/or ventilator or nasogastric tube

Bipolar I disorder

-One or more manic episodes -May be combined with depressive episodes or hypomanic

Recent memory

-The ability to recall events of the past few days

Sensory Models: Intervention

-the use of sensory-based interventions in mental health practice settings is widespread, including an alternatives to the use of physical restraints method includes 1. Snoezelen rooms, multisensory environments and comfort rooms to calm/alert individuals with psychiatric illness, autism, pervasive developmental disorders and dementia 2. therapeutic weight blankets, dolls and stuffed animals as a modality for self-soothing -psychoeducation to increase personal knowledge of how to self-modulate -sensory diets including alerting/calming stimuli and heavy work patterns

Creative play, 4-7 years

1) Child engages in sensory, motor, cognitive, and social play experiences in which the child refines relevant skills 2) Explores combinations of actions on multiple objects 3) child begins to master skills that promote performance in school and work related activities 4) child participates in cooperative peer groups

Osteogenesis Imperfecta (OI) classification & diagnosis

1. 8 main types of OI: 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 2. diagnosis -family and medical history -results from a physical examination and medical including x-rays, collagen and blood testing

Title IV-Telecommunications

1. All televisions must include closed captioning 2. Telephone companies must provide telecommunication relay services (TRS) to persons with hearing or speech impairments 24 hours per day, seven days per week

Cardiovascular system function

1. Delivers oxygen to organs and tissues 2. Removes carbon dioxide and other by-products from body 3. Assists in the regulation of core body temperature

CF effects on function

1. exercise intolerance 2. poor nutrition due to malabsorption may contribute to developmental delays

Exploration and discovery (teaching methods)

A diversity of activities is made available and the individual is permitted to choose any activity and try it without specific instructions or directions -for example, in an expressive art group, members can select from a diversity of media and create individual works.

Dialectical behavior therapy (DBT)

A form of CBT 1. Addresses suicidal thoughts and actions, and self injurious behaviors 2. commonly used with individuals with borderline personality disorder since a feature of this diagnosis is suicidal thinking and behavior 3. also used to treat individuals who have depression, substance abuse issues and eating disorders OT assessments focus on functioning in performance areas and contexts Teaching assertiveness, coping and interpersonal skills

Telehealth model

A service delivery model which can include features of the above models by providing medical, rehabilitative and/or educational services to persons via telecommunications technologies.

Areas of occupation

ADLs, IADLs, rest and sleep, education, work, play, leisure, social participation

SARS (severe acute respiratory syndrome)

An atypical respiratory illness caused by a coronavirus. -acute disease

Crossing the midline (Motor Development)

As the child becomes more mobile, movement against gravity and weight shift increase, leading to eventual crossing of the midline, often in an attempt to reach for a tow, while weight-bearing on the opposing extremity for balance (begins at 9-12 months)

Cerebellar dysfunction

Hemorrhage, tumors (acoustic neuroma, meningioma) degenerative disease of the brain stem and cerebellum, progressive supra nuclear palsy Additional loss of vestibular sensitivity with pathology

Profound intellectual disability

IQ 20-25 1. Assistance and ongoing supervision are required for basic survival skills 2. significant impairments in motor functioning and physical development are typical 3. supervised living is required

Purposive sampling

Individuals are purposefully and deliberately selected for a study (all consumers of a program for an IQ study)

Pain

Personal sensation of hurt that can significantly affect an individuals quality of life

Rotator cuff muscles

SITS Supraspinatus Infraspinatus Teres Minor Subscapularis

D2 Extension

Scapula abducted and downwardly rotated, shoulder extended adducted internally rotated, elbow toward flexion, forearm pronated, wrist flexed toward ulnar side, fingers flexed adducted, thumb flexed abducted and opposed.

Circumstantiality

Speech that is delayed in reaching the point and contains excessive or irrelevant details

Diagnostic staging of cancer

Stage 1: tumor present, no perceived spread of disease, lesion operable, prognosis good (no spread of disease to the lymph nodes, not metastatic lesions) Stage 2: localized spread of the tumor, lesion operable and can be removed with margins, spread limited and usually responds well to treatment Stage 3: extensive evidence of primary tumor that has spread to other organs of the body, tumor can be surgically debunked but some may remain, deeper spread in lymphatics, evidence throughout multiple organs, Stage 4: inoperable primary lesion, multiple metastases, survival is dependent on the depth and extend of the tumor spread as well as the ability to have the tumor respond to therapy

Group interaction skill (mosey)

The ability to engage in a variety of primary groups 1. parallel group: minimal awareness of or interaction with others (18 months-2 years) 2. project group: limited in duration, cooperation, and sharing (2-4 yeas) 3. Egocentric group: cooperation, competition, longer in duration, builds self-esteem (5-7 years) 4. cooperative group: compatible group, members concerned with meeting the needs of fellow members (9-12 years) 5. mature group: differing roles, concerned with completion of tasks as well as meeting the needs of fellow members (15-18 years)

Dyadic interaction skill (mosey)

The ability to participate in a variety of dyadic relationships 1. family relationships (8-10 months) 2. Playmate relationships (3-5 years) 3. Superior/authority relationship interactions (5-7 years) 4. Friend relationships (10-14 years) 5. Peer-superior relationships (15-17 years) 6. Intimate/sharing/committed relationships (18-25 yeas) 7. Caring/unselfish relationships (20-30 years)

Clinical Reasoning

The complex mental processes the therapist uses when thinking about the individual, the disability and the personal, social, and cultural meanings the individual gives to the disability, the uniqueness of the situation and him/herself. Types of clinical reasoning -procedural reasoning/scientific reasoning -Interactive reasoning -narrative reasoning -pragmatic reasoning -conditional reasoning

Astereognosis

The inability to identify objects through touch

Problem-solving (teaching method)

The process of teaching a person to analyze a situation, define the problem, outline potential solutions, select the solution that appears to be most viable, implement the solution, evlauate the outcome to determine if problem is resolved, and retry a new solution, if needed -For example, working with an individual living in a supportive apartment who has a roommate who does not do household task to develop strategies for engaging the roommate in home maintenance tasks (use of a weekly chore list)

Repetition and practice (teaching method)

The repetitious engagement in a task to increase accuracy and speed

Demonstration and performance (teaching methods)

Therapist performs the task and the individual imitates the therapist's performance-therapist demonstrates one-handed cooking techniques and the use of adaptive equipment, and the individual with a unilateral upper extremity amputation imitate therapists task performance

Predictive correlation research

Used to develop predictive models

Explanation and discussion (teaching method)

Verbal explanation of the task and a discussion of the activity components to either plan and activity or to retire what occurred during the activity are provided by the therapist -for example, in a vocational group, the steps for applying for a job are reviewed prior to clients submitting job applications and what happened during a job interview is reviewed after the interview is completed

Senescence

Weakening of the body at a gradual but steady pace during the last stages of adulthood through death

Ethical distress (book definition)

When a practitioner knows the correct action to take but an existing barrier prevents the practitioner from taking this course of action.

major neurocognitive disorder (delirium)

a clinical assessment reveals significant impairment in cognitive functioning that is marked by a decline from a prior level of performance as reported by the individual, clinician, or other knowledgeable source

Obesity

a condition characterized by excessive deposits of fat on the body

Compulsion

a need to act on specific impulses to relieve associated anxiety

Semantic Differential

a point scale with opposing adjectives at two extremes, measuring affective meaning

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. 1. expansion of adaptive equipment 2. OT practitioners typically consider a range of ATs for the environment to support safety and independence at home

Fine pincer grasp

between fingertips or finger nails, distal thumb joint flexed (12 months)

primary lymphedema

congenital condition with abnormal lymph node or lymph vessel formation (hypoplasia or phyperplasia)

Stair-climbing w/c

designed to navigate stairs while balancing on two wheels using sensors and gyroscopes

Evoluationary theory

genetic errors/accidents over time lead to aging

Patient Protection and Affordable Care Act (ACA)

health care reform law passed in 2010 that includes incentives and penalties for employers providing health insurance as a benefit -Consisted of 10 separate legislative titles that seek to improve the accessibility, fairness, quality, efficacy, accountability, and affordability of health insurance coverage in the US

Anorexia Nervousa: behavioral characteristics

individuals often exhibit obsessive/compulsive behavior, depression, anxiety, rigidity, perfectionism, and poor sexual adjustment

Reactive attachment disorder symptom management

no standard effective treatment for RAD is apparent in the literature

Volar forearm muscles innervated by the median nerve

o Pronator teres o Pronator quadratus

Closed tasks (Motor learning)

performed in a predictable and stable environment; movements can be planned in advance (oral care, signing a check, bowling)

Sexual abuse

performing and requiring the other to perform unwanted sexual activities through force, threats or intimations

Cardiac Stress Test (heart failure)

records cardiac activity during graded exercise; used to determine the extent to which cardiac disease affects functional capacity; provides guidelines related to the type and amount of physical activity that a person can engage in safely -Diagnostic procedures

Early mobilization programs for flexor tendons- Duran 8-12 weeks

strengthening and work activities -progression of exercises

Deductible

the amount a patient must pay to a provider before the insurance benefits will pay, usually expressed as an annual dollar amount

Usual and customary rate (UCR)

the average cost of specific health-care procedures in a geographic area.This is the maximum amount the insurer will pay for a service and covered expense

Prospective memory

the capacity to remember to carry out actions in the future, such as knowing you have appointments schedules, to turn off the stove and to pay bills on time -clinically important especially with regard to an individuals ability to live safely and independently

stage 3: initiative vs. guilt (erikson)

the child gains social skills and a gender role identity, sense of purpose is integrated into the personality (preschool age)

Coinsurance

the monetary amount to be paid by a patient, usually expressed as a percentage of total charge

Simple rotation

the turning or rolling of an object held at the finger pads approximately 90 degrees or less, unscrewing a small bottle cap (2-2 1/2 years) (Manipulating skills according to Exner's classification system)

Stage 6: intimacy and solidarity vs. isolation (erikson)

the young adult establishes and intimate relationship with a partner and family; the capacity to love is achieved (young adulthood)

3rd party payers and their respective case manager

to approve and provide funding for the individuals needed AT and environmental modifications

Abrasion

trauma to the skin resulting in a breakage in skin integrity, often caused by a fall or sliding impact to the body part

Elbow extension:

triceps and anconeus innervated by radial nerve

Middle deltoid innervated by the axillary nerve

§ Origin: acromion § Insertion: deltoid tuberosity

Sensory awareness groups

-Includes activities to promote sensory functions and environmental awareness

bites

insect, animals, human

Echopraxia

meaningless imitation of another persons movements

Scapula elevation muscles

-Trapezius (upper) -Levator scapulae

Procedure codes

codes that describe specific services performed by health professionals

Random sampling

individuals are selected through the use of a table of random numbers

Arthritis

an inflammation of a joint or joints

Emotion

1. A feeling state associated with affect and mood that consists of psychological and physical components (fear, anger, joy) -physiological disturbances associated with mood are frequently automatic in nature

Pro Bono or Philanthropic care

or fee or reduced rate care may be supported by the individual therapists personal donation of services or through philanthropic donation

Concrete thinking

characterized by actual things, events and immediate experience; the inability to think abstractly

Cerebellar/Spinocerebellar disorders

characterized by ataxia, dysmetria, dysdiadochokinesia, hypotonia, movement decomposition tremor, dysarthria, and nystagmus

Automatic Actions Level 1

characterized by automatic motor responses and changes in the autonomic nervous system. Conscious response to the external environment is minimal

Differentiated marketing

design and use of marketing strategies and activities for different market segments (promoting OT specialties to different consumer self-help groups)

Physical abuse

hitting, kicking, punching, slapping, choking and or burning

Middle phalanx fractures

not commonly fractured

Likert Scale

respondents indicate their level of agreement, usually on a 5 point scale

Mass practice

rest time is much less than practice time · Constraint induced movement therapy

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

Problem solving skills 18-21 months

- Child attends to shapes of things and uses them appropriately - Child begins to think before acting. - Child uses tool to obtain favored object. - Child begins to replace trial and error with a thought process in order to attain a goal - Child can operate a mechanical toy (on-off switch) - Child can predict effects or presume causes

Effect on function- RDS

- Future intellectual development of premie who had RDS and received lastest tx appears good - For premie w/RDS, functional effects may include *visual defects and hypotonia* -the functional effects for infants who develop BPD or who incur a severe intracranial hemorrhage may include motor, sensory, cognitive and language impairments

Bilateral hand use

- asymmetric movements until 3 mos - symmetric movements until 10 mos - both hands used for different functions 12-18 mos - manipulation skills emerge 18-24 mos - use 2 different hands for 2 very different functions emerges 2 1/2 yrs

Age related cognitive changes, conditions and clinical implications

- no uniform decline in intellectual abilities throughout adulthood 1. Cognitive changes do not typically show up until mod-60s; significant declines affecting everyday life do not show up until early 80s 2. Most significant decline in measures of intelligence occurs in the years immediately preceding death (terminal drop) -tasks involving perceptual speed show early declines (by age 39): require longer times to complete tasks -Numeric ability (test of adding, subtracting and multiplying): abilities peak in mid-40s, well maintained until 60s -Verbal abilities peak at age 30, well maintained until 60s -Memory 1. Impairments are typically noted in short-term memory; long term memory retained 2. Impairments are task dependent )deficits primarily with novel conditions, new learning -Learning all age groups can learn. Factors affecting learning in older adults 1. increased cautiousness 2. anxiety 3, sensory deficits 4. pace of learning: fast pace is problematic 5. inference from prior learning

Pronator teres

-Median Nerve § Origin: medial epicondyle and coronoid process of ulna § Insertion: lateral surface of radius § Function: forearm pronation

Gamma Reflex Loop (GRL)

-Stretch reflex forms part of this loop -Allows muscle tension to come under control of descending pathways (reticulospinal, vestibulospinal and others) -Descending pathways excite gamma motor neurons causing contraction of the muscle spindle and in turn increased stretch sensitivity and increased rate of firing from spindle afferents; impulses are then conveyed to alpha motor neurons

Medical Management of ALS

-There is not specific treatment to slow the diease process -treatment is aimed at treating secondary complications such as spasticity (treated with antispasmodics) prevention of aspirations (gastrostomy and modified diets), prevention of decubiti, prevention of contracture and pain management

Humerus fractures

-U.E. Fracture -nondisplaced vs. displaced fractures 1) etiology - fall onto an outstretched upper extremity 2) fractures of the greater tuberosity may result in rotator cuff injuries 3) humeral shaft fractures may cause injury to the radial nerve resulting in wrist drop

Flexor digiti minimi brevis

-Ulnar nerve § Origin: hook of hamate and flexor retinaculum § Insertion: proximal phalanx of 5th digit § Function: flexion of MCP joint and opposition of the 5th digit

Disciplinary actions for ethical violations and professional misconduct

-When AOTA, NBCOT and or SRB determine that a person has violated their standards for ethical practice, different actions can be used as a disciplinary measure These actions are based on an agency's internal investigations to determine the severity of an infraction and can include -Reprimand -Censure -Ineligibility -Probation -Suspension -Revocation All of these actions (except for reprimand) are made public by the respective agencies. (disciplinary actions that are made public by one agency (NBCOT) can trigger an investigation into a practitioners professional conduct by other practice jurisdictions [SRBs])

Financial or material exploitation signs and symptoms in elders

-an older adults report of financial exploitation -sudden changes in bank account or banking practice -the inclusion of additional names on an older adults bank signature card -unauthorized withdrawal using an ATM card -Abrupt change in a will or other financial documents -substandard care or unpaid bills despite the availability of funds -discovery of forged signature -sudden appearance of relatives claiming rights to decision, money or possessions -unexplained transfer of funds -the provision of unnecessary services

Transfer considerations

-assess and identify an individuals assets and deficits especially cognitive and physical abilities (the OT should be aware of their own limitations to avoid personal or client injury)

Neglect signs and symptoms in elders

-elder's report of being mistreated -dehydration, malnutrition, untreated bedsores, and poor personal hygiene -unattended or untreated health problems -hazardous or unsafe living conditions

Bariatric w/c

-heavy-duty, extra-wide w/c designed to assist mobility for individuals who are obese

Downward rotation muscles

-levator scapulae -rhomboids -serratus anterior -latissimus dorsi

Flexor digitorum superficialis (sublimis) (FDS)

-median nerve § Origin: medial epicondyles § Insertion: middle phalanx (two slips) § Function: flexion of PIP joints

exploratory actions Level 5

-overt trial and error problem solving -new learning occurs -normal for 20% of population -able to imitate the single cordovan stitch using overt (physical) trial and error methods, three stitches

Home health agencies (HHA) (medicare)

Are reimbursed under a prospective payment system 1. This rate per episode of care reimbursement system applies to all home health services including all forms of therapy and medical supplies 2. Durable medical equipment is excluded 3. A classification system called Home Health Resource Groups (HHRGs) is used to determine an episode payment rate 4. An episode is defined as a 60 day period beginning with the first billable visit and ending 60 days after the start of care

Role of OT practitioners in reporting abuse

It is an ethical responsibility of all OT practitioners to report any observed or suspected incidents of patient/client abuse or neglect -the party to whom reporting is required varies from state to state as do the penalties for not reporting (minimum reporting standards require reporting to ones immediate supervisor)

Systematic sampling

Individuals are selected from a population list by taking individuals at specified intervals (every 10th name)

Using children

Making the other feel guilty about the children. Using the children to relay messages. Using visitation to harass her. Threatening to take the children away.

Conductive hearing loss

Mechanical hearing loss from damage to external aud. canal, tympanic membrane or middle ear ossicles; results in hearing loss (all frequencies); tinnitus may be present (ringing in the ears)

Community mobility

Moving self in the community and using public or private transportation, such as driving, or accessing buses, taxi cabs, or other public transportation systems.

Selective attention

is blocking out those activities, objects or concepts that produce anxiety

OT intervention for adjustment to death & dying

maintain control, coping skills, life review & legacy, pursue interests, incorporate family, active listening, do not deprive the individual of hop

Intimidation and coercion

making the other afraid, breaking things, displaying weapons, threatening to leave or report the other for something and making the other do something illegal

economic abuse

making the other ask for money, giving an allowance, and/or preventing the other from taking a job

Occult spinal dysraphism (OSD) specific symptoms

may result in the spinal cord being split (diplomyelia) or being tied down and tethered (diastematomyelia) which may lead to neurological damage and developmental abnormality as the child grows

Distributed practice

practice time is equal to or less than rest time - Practice sessions of a tub transfer are spaced to include rest breaks

Gerontology

the scientific study of the factors impacting the normal aging process & effects of aging

Static tripod posture

writing tool held with crude approximation of thumb, index and middle fingers, ring and little fingers only slightly flexed, grasped proximately with continual adjustment by other hand, no fine localized movements of digit components; hand moves as a unit (3 ½ -4 years)

OT Intervention for elder abuse

-treat for physical and emotional injuries -develop a trusting relationship -assist in developing a support system -refer to appropriate disciplines and/or agencies

Erik Erikson: Psychosocial Development

1. Ego adaptation is the adaptive response of the ego in the development of the personality 2. 8 stages of man are identified and include a critical person-social crisis that when resolved by the individuals gives the individual a sense of mastery and results in acquisition of a personality quality. -Stage 1: basic trust vs. mistrust -stage 2: autonomy vs. shame -stage 3: initiative vs. guilt

Break-even analysis

1. also called cost-volume-profit analysis 2. determines the volume of services needed to be provided for revenues to equal cost and profits to equal zero

Conditions resulting in additional loss of gustatory and olfactory sensation

1. smoking 2 chronic allergies, respiratory infections 3. dentures 4. CVA, involvement of hypoglossal nerve

Specific classifications of seizures and presenting signs and symptoms

1. two broad groups -primary generalized seizures: begins with widespread involvement of both sides of the brain -Partial seizures begin with involvement of a smaller localized area (the disturbance can still spread within seconds or minutes to widespread areas of the brain-secondary generalized seizure) 2. generalized seizures -tonic-colonic seizures/grand mal seizures *most common type of seizure disorder in children, brief warning/aura such as numbness, taste, smell, or other sensation occurs *tonic phase includes a loss of consciousness, stiffening of the body, heavy and irregular breathing, drooling, skin pallor, and occasional bladder and bowel incontinence for a few seconds before the clonic phase begins *clonic phase includes alternating rigidity and relaxation of muscles *postictal state follows the clonic phase and includes a period of drowsiness, disorientation or fatigue

Early mobilization programs for flexor tendons - Kleinert 6-8 weeks

AROM -Differential tendon gliding. Light purposeful and occupation-based activities -D/c splint

Cerebral Arteriovenous malformation (AVM)

Abnormal, tangled collections of dilated blood vessels that result from congenitally malformed vascular structures

Dorsal (posterior) root

Afferent (sensory) fibers from sensory receptors from skin, joints, and muscles; each dorsal root possesses a dorsal root ganglion (cell bodies of sensory neurons); there is no dorsal root for C1

Main clinical syndromes of CAD

Characteristics -involves a spectrum of clinical entities ranging from angina to infarction to sudden cardiac death -an imbalance of myocardial oxygen supply and demand resulting in ischemic chest pain -Subacute occlusion may produced no symptoms -symptoms present when lumen is at least 70% occluded

Medicare Part B

Pays for hospital outpatient physician and other professional services including OT services provided by independent practitioner -Part B is considered a Supplemental Medical Insurance Program and therefore must be purchased by the beneficiary, usually as a monthly premium -Part B services have no specific time lime and require 20% co-payment

Open tasks (Motor learning)

Performed in a constantly changing environment that may be unpredictable Driving in traffic, catching an insect, soccer

Wheelchair measurements: Seat depth

Pt: Posterior buttock to popliteal fossa Chair: Subtract 2-3" from pt measurement -measure both LEs and use the shortest length (this prevents rubbing and potential decubiti to posterior knee region, while also allowing maximal leg swing Too short fails to support the thigh adequately. Too long may compromise posterior knee circulation or result in kyphotic posture, posterior pelvic tilt, sacral sitting

State Regulatory Boards (SRBs)

Public bodies created by state legislatures to assure the health and safety of the citizens of that state - Their specific responsibility is to protect the public from potential harm that might be caused by incompetent or unqualified practitioners -State regulation may be in the form of licensure, registration, or certification -Each state has legal guidelines that usually specify the scope of practice of the profession and the qualifications that must be met to practice in that state

flexor (withdrawal) reflex

Stimulus: cuntaneous sensory stimuli; -Reflex arc: cutaneous receptors via interneurons to largely flexor muscles, multisegmental response involving groups of muscles (polysynaptic) -Functions as a protective withdrawal mechanism to remove body from harmful stimuli.

Shift

a linear movement of an object on the finger surfaces to allow for repositioning of the object relative to the finger pads, separating two pieces of paper (3-5), rolling a piece of clay into a ball (3-6 or more years), shifting on marker or pencil (5-6 or more years) (Manipulating skills according to Exner's classification system)

Body Mass Index (BMI)

a formula for determining obesity. Is calculated by dividing an individuals weight in kilograms by the square of the persons height in meters 1. Overweight defined as a BMI ranging from 25 to 29.9 2. Obesity defined as BMI >20 3. Morbidly obese defined as BMI >40

Health Literacy

ability of individuals to gather, interpret, and use information to make suitable health related decisions and the professional communication skills and the context or environment in which the information is being disseminated -to promote health-literacy, teaching-learning approaches and educational materials must be easy to understand, respect culture, match peoples capabilities and be presented in formats that are accessible to all

Amnesia

an inability to recall past experiences or personal identify 1. it may be cause by an organic or emotional dysfunction 2. retrograde amnesia is the inability to remember events that occurred prior to the precipitating event

consistent motion tasks (Motor learning)

an individual must deal with environmental conditions that are in motion during activity performance; the motion is consistent and predictable between trials (stepping onto an escalator, assembly line work, retrieving luggage from an airport baggage carousel)

Conduct disorder

disregard for the rights of others leading to aggression toward people and animals, destruction of property, deceitfulness, theft, or serious violation of rules -Prognosis is related to the age of onset and the severity of symptoms and behaviors 1. severe conduct disorder is often associated with the development of other disorders and substance abuse alter in life -assaultive behavior and parental criminality correlate highly with future incarceration

Electrocardiogram (ECG) (Heart failure)

done to identify cardiac arrhythmias, assess amount and location of damage to myocardium, determine adequacy of oxygenation of myocardium -Diagnostic procedures

Early mobilization programs for flexor tendons- Duran 0-4 1/2 weeks

dorsal blocking splint, exercises in splint include passive flexion of PIP joint, DIP joint and to DPC. tendon reps every hour

Colles' facture

fracture of the distal radius with dorsal displacement

Smith's fracture

fracture of the distal radius with volar displacement

Rehabilitation engineer

provides info about the technological capabilities of seating and mobility systems -to design high and low AT and assist with modifications of high and low tech AT

Medication management equipment

1. easy open, non-child proof medication bottles 2. pill organizers, medication minders

Community participation/reintegration groups

-Focuses on the identification and use of community resources and development of skills to enable full community participation -May be conducted in a modular and/or psychoeducational format

Conus Medullaris Syndrome

-Injury of the sacral cord and lumbar nerve roots -LE motor and sensory loss and an areflexic bowel and bladder -If the lesion is in the sacral segments, reflexes may be occasionally preserved

Bulimia Nervosa (BN): Behavioral Characteristics

-obsession with personal appearance and attractiveness to others -individuals maintain a normative weight

Overview and contributing factors to poor nutrition

1. Nutritional problems in older adults are often linked to health status and poverty rather than to age itself -Chronic diseases alter the overall need for nutrients, energy demands and overall activity levels - Limited fixed incomes severely limit food choices and availability 2. 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 older adults and contribute to decreased levels of vitality and fitness

Homebound status criteria (medicare)

1. The person is typically not able to leave the home. "Confined" to the home -Confinement may be die to the need for the aid of ambulatory devices, the assistance of others or special transportation -It considers medical, physical, cognitive and psychiatric conditions 2. If the person leaves the home it requires considerable effort 3. A person may leave their home for medical appointments (kidney dialysis) and non-medical short-term and infrequent appointments or events (to get haircut, attend a wedding) 4. The need for adult day care and attendance at religious services does not preclude a person from receiving home health services

Bariatric wheelchairs and prescription considerations

1. w/c users who are obese must be prescribed w/cs that are rated for their obesity category 2. bariatric client has a center of body mass that is positioned several inches forward in comparison with the nonobese person -in order to ensure wheelchair stability the rear axle is displaced forward in comparison with the standard w/c (this forward position allows for a more efficient arm push [full arm stroke with less wrist extension]) 3.w/cs can be ordered with special adaptations -hard tires versus pneumatic tires for increased durability -adjustable backrest to accommodate excessive posterior bulk -reclining w/c to accommodate excessive anterior bulk, cardiorespiratory compromise (orthostatic hypotension) -power application attached to a heavy-duty wheelchair to accommodate excessive fatigue

Unstageable pressure ulcers

involves full thickness tissue loss in which the wound bed has slough and or eschar (scab or dark crusted ulcer) which covers the base of the ulcer

Private payment

the individual receiving services is responsible for payment

Digital-pronate grasp

writing tool held with fingers, wrist neutral with slight ulnar deviation and forearm pronated, arm moves as a unit (2-3 years)

Bedroom characteristics

-Bed: size of bed, height from floor to top mattress, type of mattress, wheeled frame or not, position of bed (against the wall or freestanding) -Side of the bed from which the individual with a disability enters/exits -Accessibility of clothes and dresser drawers -Sufficient room available for a bedside commode, if needed

Management of autonomic dysreflexia

-Identify the offending stimulus and relieve the underlying issue immediately -Medications, if no impact can be made: immediate emergent (ie. Procardia, Nitroglycerin, Clonidine, Hydralazine); chronic (ie. Prazolin [Minipress], Clonidine [Catapres])

myotome

skeletal muscles innervated by motor axons in a given spinal root

Small bowel obstruction

-Etiology: secondary to scar tissue; secondary to radiation of the abdomen (long term effect); result of tumor obstruction -Surgical treatment: resection with open stoma (colostomy); closed abdominal surgery

primary circular reactions

(sensorimotor period, ages birth to 2 years- Jean Piaget hierarchical development of cognition) -Child learns about cause and effect as a result to reflexive sensorimotor patterns that are repeated for enjoyment (2-4 months)

Diminished esophageal motility

*Bolus sits in esophagus and can slowly either move toward stomach or upward toward pharynx.* - Person may feel that food is "stuck" in esophagus - Person aspirates when foods propels up and he/she cannot swallow it

Needs assessment methods

- Survey, interview or self-report of target population. A representative sample is required -Key informant, which involves the surveying of specific individuals who are knowledgeable about the target population needs -Community forums to obtain information through public meetings or panels -Service utilization review of records and reports -Analysis of social indicators to identify social, cultural, environmental, and/or economic factors that can predict problems

Disruptive Mood Dysregulation Disorder (DMDD)

- Temper outbursts that are characterized as 1. severe and recurrent verbal or behavioral episodes 2. uncharacteristic for expectations consistent with developmental level 3. the outbursts are considered an overreaction (either in intensity or duration of response based on the stimuli) -diagnosis is made between the ages of 6 and 18 based on observations from others such as parents, teachers or peers

True-experimental design (quantitative methods)

- 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. all other experiences are kept similar 1. The two levels of treatment (some and none) together constitute the independent variable being manipulated 2. The comparison of their status on some variable (the outcome) that might be influence by treatment constitutes the dependent variable 3. a cause-and-effect relationship between the independent and dependent variable is examined 4. In human subject research it is often difficult to design pure experimental designs

Early object use (cognitive milestones)

-(3-6 mth) child focuses on action performed with objects banging, shaking -(6-9 mth) child explores characteristics of objects and expands the range of schemes (pull, turn, tear, poke) -(8-9 mth) child combines objects in relational play (objects in container) -(9-12 mth) child notices the relation between complex actions and consequences such as opening doors, placing lids on containers, and differential use of schemes based on the toy being played with (push train, roll ball) -(12 months +) child acts on objects with a variety of schemes -(12-15 mth) child links schemes in simple combinations (place baby in carriage & pushing the carriage) -(24-36 mth) child links multi-scheme combinations into a meaningful sequence (putting food in bowl, scoop food w/ spoon, feed doll) -(36-42 months) Child links schemes into a complex script

Brief psychotic disorder

-Criterion A: presence of one or more sensory, behavioral, cognitive or psychomotor symptoms including delusions, hallucinations, disorganization of speech or behavior or catatonia -Criterion B: symptoms range from one day to one month in duration, followed by completed resolution of symptoms and return to prior level of functioning

Teaching-Learning process

-Definition: the process by which the OT practitioner designs experiences to facilitate the individual's acquisition of the knowledge and skills needed for living

Pronator quadratus

-Median Nerve § Origin: distal ulna § Insertion: distal radius § Function: forearm pronation

Extensor carpi ulnaris (ECU)

-Radial nerve § Origin: lateral epicondyle § Insertion: 5th metacarpal § Function: extension of wrist and ulnar deviation

Ataxia is defined as

-The irregularity or failure of muscle coordination upon movement

Rumination Disorder

-repeated, unintentional regurgitation of undigested or partially digested food, followed by rechewing and either swallowing or spitting food out, for at least 1 month

Concurrent Review

1. Evaluation of ongoing intervention program during hospitalization, outpatient, or home care treatment 2. method to ensure appropriate care is being delivered 3. often a component of a QI or PAI system

Prospective Review

1. Evaluation of proposed intervention plan that specifies how and why care will be provided 2. Used by third-party payers to approve proposed OT intervention program

Patterns of abuse

1. impulsive abuse during which the abuser has sudden attacks of rage which may be regular or random 2. premeditated abuse, during which the abuser is cool and calculating

Prosthetic Terminal Devices (TDs)

1. Function to grasp and maintain hold on an object 2. Body-operated prosthesis: use specific scapula and shoulder movements to place tension on the cable that opens or closes the TD -the two main types of body-operated TDs are the hook and the prosthetic hand (both hooks and hand are operated in one of two ways) * Voluntary opening (VO) *Voluntary closing (VC) -Myoelectric prosthesis -Determination of the most appropriate TD is based on the persons interests, roles and preferences *TDs can be interchangeably used with a prosthesis if the shaft size is the same

Diencephalon: Epithalamus

1. Habenular nuclei: integrate olfactory, visceral, and somatic afferent pathways 2. Pineal gland: secretes hormones that influence the pituitary gland and several other organs, influences circadian rhythm

Ion concentrations

1. Hyperkalemia: increased potassium ions, decreases the rate and force of contraction and produces EKG changes 2. Hypokalemia: decreased potassium ions, produces EKG changes, arrythmias, may progress to ventricular fibrillation 3. Hypercalcemia: increased calcium concentration; increases heart rate 4. hypocalcemia: decreased calcium concentration; depresses heart action

Symptom management: delirium

1. Medical treatment involves resolution of the causes of the disorder, if possible 2. there are a limited number of newer medications that appear to maintain or slow the decline of cognitive function 3. If causes of the disorder are not treatable attempts are made to mitigate symptoms where possible

Complex Regional Pain Syndrome (CRPS)

1. Type I formerly known as reflex sympathetic dystrophy (RDS) 2. Type II formerly known as causalgia 3. Vasomotor dysfunction as a result of an abnormal reflex 4. It can be localized to one specific area or spread to other parts of the extremity 5. Etiology: may follow trauma (Colles' fracture) or surgery, but actual cause is unknown 6. Symptoms includes severe pain, edema, discoloration, osteoporosis, sudomotor changes (sweating), temperature changes, trophic changes (skin, nail and fingertip appearance) and vasomotor instability

Interventions for Raynaud's phenomenon

1. keep fingers and toes warm 2. dress in layers 3, drug therapy: vasodilators 4. Biofeedback

Skier's Thumb (Gamekeeper's Thumb)

1. rupture of the ulnar collateral ligament of the MCP joint of the thumb 2. Etiology: most common cause is a fall while skiing with the thumb held in a ski pole

Documentation for reimbursement

Documentation must include essential content and adhere to established documentation standards and guidelines to receive payment for services

Rehabilitation for Immunological System Disorders

Overall goal and approaches can be preventive, restorative, supportive and or palliative depending on treatment setting, diagnosis, stage of illness and expected outcomes

Pulmonary emboli

a thrombus from the peripheral venous circulation becomes embolic and lodges in the pulmonary circulation

Parasympathetic (craniosacral) division

conserves and restores homeostasis; slows heart rate and reduces blood pressure, increases peristalsis and glandular activity

Dyskinesia

involuntary, non-repetitive but occasionally stereotyped movements affecting distal, proximal and axial musculature in varying combinations. Most are representative of basal ganglia disorders

Dissociative identify disorder

involves the appearance that an individual has developed two or more distinct personalities

Dissociation

involves the separation of a group of mental or behavioral processes from the rest of the persons psychic activity -it may involve separating and idea from its emotional tone

Fixed expenses

remain at the same level even when there are changes in the amount of services provided (rent)

stage 2: autonomy vs. shame (erikson)

the child realizes that they can control body functions; self controlled will is integrated into the personality (2-4 years)

Denial

the refusal by a payer to reimburse a provider for services rendered. Reasons for denial include benefits exhausted, duplication of services and services not indicated

Cerebrovasular disease

vertebrobasilar artery insufficiency (transient ischemic attacks, strokes), cerebellar artery stroke, lateral medullary stroke Additional loss of vestibular sensitivity with pathology

Dynamic tripod posture

writing tool held with precise opposition of distal phalanges of thumb, index, and middle fingers, ring and little fingers flexed to for a stable arch, wrist slightly extended, grasped distally, MCP joints stabilized during fine, localized movements of PIP joints (4 ½ -6 years)

Autonomy

Principle 3: OT personal shall respect the right of the individual to self-determination, privacy, confidentiality and consent

Congenital myasthenia gravis

-A disorder involving transmission of impulses in the neuromuscular junction -Onset starting near birth and occurring more frequently in males

Spastic cerebral palsy

-A lesion of the motor cortex will result in spasticity with flexor and extensor imbalance. Spasticity can be expressed as: 1. hypertonia: increased muscle tone 2. hyperrflexia: increased intensity of reflex response

Symptoms of MG

-Common symptoms include ptosis, diplopia, muscle fatigue after exercise, dysarthria, dysphagia and proximal limb weakness -Sensation and deep tendon reflexes are intact -Symptoms fluctuate over the course of the day -In relapsing periods, quadriparesis may develop -life threatening respiratory muscle involvement may occur

Spinal cord injury (SCI)

-Etiology 1. Trauma to the spinal cord as a result of compression, shearing forces, contusion secondary to motor vehicle accident, diving accident, penetration wound (gunshot, or knife), sports injury or fall -nontraumatic cord injuries may be a result of tumor, progressive degenerative disease

Certified prosthetist

-Evaluates the need for a prosthesis -Designs, fabricates, and fits prosthesis for an individual to ensure proper fit and to promote functional abilities -Educates client and/or caregiver about the use and care of the prothesis -Works directly with occupational therapists, physical therapists and physicians

Supervisor

-Function as the manager of the overall daily operation of OT services in defined practice areas -Can be occupational therapists or OTA/COTA -Experienced OTAs/COTAs may supervise other OTAs/COTAs administratively as long as service protocols and documentation are supervised by and occupational therapist

Entrepreneur

-Functions as a partially or fully self-employed individual who provides OT services -Can be an occupational therapist or a OTA/COTA who meets state regulatory requirements -OTAs/COTAs who provide direct service have the responsibility to obtain appropriate supervision from and occupational therapist

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 1. Entry level occupational therapists and OTAs/COTAs may supervise level I fieldwork students 2. Occupational therapists/COTAs with one year of practice based experience may supervise Level II OT students 3. Three years of experience are recommended for individuals supervising programs with multiple students and multiple supervisors

Transferability: Trustworthiness

-How well other researchers can fit a study's finding into similar context; the "goodness of fit" between the contexts of two studies 1. is evident when a researcher provides sufficient descriptive data to allow comparison by other researchers *can be enhanced by use of a nominated sample, comparison of sample characteristics to available demographic data and dense description of the study's participants and contexts

Severe intellectual disability

-IQ range of 25 to 39 -Focus is placed on acquiring communication skills and some basic health habits -Assistance required for performance of most tasks in all occupational performance areas on a daily basis -Supervised living is required -Significant impairments in motor functioning and physical development are typical

deep vein thrombosis (DVT)

-Inflammation of a vein in association with the formation of a thrombus -Usually occurs in lower extremity 1. associated with venous stasis (bed rest, lack of leg exercise). hyperactivity of blood coagulation and vascular trauma) 2. early mobility (out of bed activities) after surgery helps eliminate venous stasis -May be contributing factor to or a complication of cerebral vascular accident (CVA) or the result of the prolonged bed rest during a serious illness -Signs and symptoms include a change in lower extremity temperature, color circumference, appearance, or tenderness/pain -may be life threatening, its symptoms require immediate medical attention

Spinal Level Reflexes

-Involuntary responses to stimuli; basic, specific and predictable; dependent upon intact neural pathway (reflex arc): 1) reflexes may be monosynaptic or polysynaptic (involving interneurons) 2) provide basis for unconscious motor function and basic defense mechanism -Stretch (myotatic) reflexes -Inverse stretch (motatic) reflex -Gamma reflex loop -Flexor (withdrawal) reflex -Crossed extension reflex

Carrying skills

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

Duchenne's muscular dystrophy (DMD)

-Is the most common form of MD 1. it is detected between 3 and 5 years of age 2. it is inherited, sex-linked and recessive 3. symptoms include pseudohypertrophy which is enlargement of calf muscles and at times enlargement of the forearm and thigh muscles giving an appearance the child is muscular and healthy 4. weakness of the proximal joints progresses to the point that the child has significant functional mobility impairments - ambulating with a Trendelenburg (waddling) gait with frequent falls -difficulty getting up from the floor to a standing position, uses hands to crawl up the thighs to get to the standing position (Gower's sign) 5. Weakness occurs in all voluntary muscles including the heart and diaphragm 6. Behavioral and learning difficulties and delayed speech may occur 7. Individuals rarely survive beyond their early 20s due to respiratory problems, infections and cardiovascular complications, however advancements in supportive care enable some individuals to live longer

Voluntary accrediting agencies include

-Joint Commission (JCAHO) -Healthcare Facilities Accreditation Program (HFAP) -Commission on Accreditation of Rehabilitation Facilities (CARF) -The Accreditation Council for Services for Mentally Retarded and Other Developmentally Disabled Persons (AC-MRDD) and others

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

Americans with Disabilities Act of 1990

-Prohibits discrimination against qualified persons with disabilities in employment, transportation, accommodations, telecommunication and public services -Criteria for classifying and individual as disabled 1. A person with a physical or mental impairment that substantially limits one or more major life activities 2. A person having a record of such an impairment 3. A person regarded as having such an impairment -Individuals who are actively abusing substances or compulsively gambling or persons who have kleptomania, pyromania, or sexual behavior disorders are not protected by ADA

Program development

-Purposes of developing specific programs 1. to directly meet the needs of a specific population or group 2. to clearly focus evaluation and intervention efforts and activities 3. to increase visibility and use of available services (offering outpatient cardiac rehabilitation program is more visible than individuals referrals resulting in increased recognition and utilization of this service) 4. To convert an idea into a practice reality

Sensory impairments of the oral cavity

-Lack of awareness of residual food on the side of the mouth that has decreased sensation -Pocketing of food -Spillage of residual food into the airway at a time when the vocal cords are open; timing of the swallow sequence is off

Multiple Sclerosis (MS) Diagnosis

-Largely based on symptoms -Slowly progressive CNS disease characterized by patches of demyelination in the brain and spinal cord -Basic diagnostic criteria are evidence of multiple CNS lesions and evidence of at least 2 episodes of neurological disturbances in an individual between 10 and 59 years -Diagnostics may include MRI to detect lesions, evoked potentials to measure conduction along sensory pathways and cerebrospinal fluid examination

Intradisciplinary team

-One or more members of one discipline evaluate, plan, and implement treatment of the individual -Other disciplines are not involved; communication is limited, thereby limiting perspectives on the case -This "team" is at risk due to potential narrowness of perspective -Comprehensive, holistic care can be questionable

Personality Disorders criteria

-Persistent patterns in cognition, affect, behavior or interpersonal functioning are experienced or expressed despite being notable different from the expectations and norms of ones culture -the pattern is stable, inflexible and evident in wide-ranging social and personal situations -this long-lasting pattern typically begins in adolescents or early adulthood

Schizotypal personality disorder

-Persons with this disorder appear odd or strange in their thinking and behavior to those who come in contact with them -Magical thinking, peculiar ideas, ideas of reference, illusions, and derealization are part of this individual's everyday world

Utilization Review (UR)

-Plan to review the use of resources within a facility -Determines medical necessity and cost efficiency -Often component of QI/PAI system

Wheelchair Components: tires

-Pneumatic: air-filled, requires maintenance, more cushioned ride, shock absorbent -Semi-pneumatic: airless foam inserts, less maintenance, good cushioning -Solid-core rubber: minimal maintenance, tires are mounted on spoked or molded wheels

Signs and symptoms of neglect

-Poorly nourished appearance or inadequately clothed -Consistently tired or listless behavior -Inconsistent attendance in 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

Rehabilitation for diabetes

-Preventive exercise -Education concerning compliance and need for medical management of condition -Psychological and emotional support to improve self care habits -Lifestyle readjustment to complications when and if they occur: low vision; safety assessment and intervention; physical adaptations -Protective issues regarding peripheral neuropathy: safety assessment; education concerning risk associated with sensory loss; skin care; pain management; adapted equipment/techniques to facilitate participation in lifestyle; instrumental activities supporting compliance of self management -Early attention to wound management: teach skin care and inspection techniques; teach person to self advocate quickly when changes are observed -Assistance in problem solving and modifying self care as changes occur in the medical status of the condition: problem solve resources for specialized treatment; teach person to recognize changes in their functional status that warrant further attention and intervention

Fair Housing Act

-Prohibits discrimination on the bases of disability, religion, sex, color, race, national origin, and familial status -Required owners of housing to make reasonable exceptions to their standard tenant policies to allow individuals with disabilities equal housing opportunities (eg. allowing a seeing eye service dog in a "no-pets" apartment) -Required that tenants with disabilities be allowed to make reasonable modifications to common use areas and to their private living space to enable access (the housing owner is not required to fund these modifications) -Required that newly constructed multifamily residences (4 or more apartments) be built to meet established accessibility standards

Extensor indicis proprius (EIP)

-Radial nerve § Origin: ulna, middle 1/3 § Insertion: inserts into Extensor Digitorum Communis at MCP level § Function: extension of MCP joint of the second digit and contributes to extension of the IP joints

Radial nerve palsy

-Radial nerve compression. -Etiology: Saturday night palsy, a term used to describe sleeping in a position that places stress on the radial nerve. Also, compression as a result of a humeral shaft fracture. -Symptoms: weakness or paralysis of extensors to the wrist, MCPs , and thumb; wrist drop -Conservative treatment 1. Dynamic wrist and MCP extension splint 2. Work/activity modification 3. Strengthening wrist and finger extensors when motor function returns -Surgical interventions: decompression -Postoperative treatment 1. AROM 2. Strengthening (6-8 weeks postoperative) 3. ADLs and meaningful role activities 4. Avoid combined forarm pronation, elbow extension, and wrist flexion as this can place tension on the nerve

Tendon repairs

-Rationale for early mobilization: 1) prevents adhesion formation 2) facilitates wound/tendon healing -Occupational therapy goals: 1) increase tendon excursion 2) improve strength at repair site 3) increase joint ROM 4) prevent adhesions 5) facilitate resumption of meaningful roles, occupations, and activities

Human development definition

-Sequential changes in the function of the individual. 1. Qualitative or quantitative 2. Influenced by biologic determinants and biopsychosocial environmental experiences

Impact on performance contexts from kidney disease

-Social context 1. how disease affects roles in the family 2. How disease affects role in the workplace 3. how disease affects roles in the community including spiritual communities, social groups and special interests -Sociocultural context 1. How a culture and/or religious group accepts or does not accept a condition and/or its treatment (resisting invasive interventions such as dialysis) *explicit taboos on invasive treatment, some people will choose to end their lives by not starting dialysis based on cultural/religious beliefs 2. the individuals acceptance or nonacceptance of the impairments/disease (the person meaning of having a machine perform bodily function)

Quality Improvement (QI)

-System-oriented approach that views limitation and problems proactively as opportunities to increase quality -Emphasizes prevention -blame is not attributed to persons, problems are related to organizational improvement needs -prospective viewpoint is used 1. current services are critically reviewed and improvements that can enhance the efficacy of future service delivery are identified and implemented

Rheumatoid arthritis (RA)

-Systemic, symmetrical and affects many joints 1. most commonly attacks the small joints of the hands 2. Characterized by remissions and exacerbation 3. Begins in the acute phase as an inflammatory process of the synovial lining -Etiology is unknown has two theories 1. Infection theory 2. Autoimmune theory -Symptoms: 1. Pain 2. stiffness 3. Limited ROM 4. fatigue 5. weight loss 6. limited activities of daily living status, diminished ability to perform role activities 7. swelling 8. deformities -Types of deformities common with RA 1. Ulnar deviation and subluxation of the wrists and MCP joints 2. Boutonniere deformity: flexion of PIP joint and hyperextension of DIP joint 3. Swan neck deformity: hyperextension of PIP joint and flexion of DIP joint

Heart rate irregularities (Rehabilitation for lyme disease)

-Telemetry during daily performance of tasks and activities that support roles performance -pulse oximetry measurements, if oxygenation is poor during performance of daily tasks and activities -work simplification, adaptation, and moficiation to prevent further complications associated with arryhmia

Criteria for coverage of Partial Hospitalization Program (PHP) services affiliated with a hospital or a community mental health psychiatric day program

-The beneficiary would otherwise have required inpatient psychiatric care -OT services are covered under general Medicare guidelines (MD's prescription, reasonable and necessary, function expected to improve) -Active treatment incorporating an individualized multidisciplinary intervention plan to attain measurable, time-limited, medically necessary functional goals directly related to the reason for admission must be provided 1. Psychosocial programs that provide structured diversional, social, and/or recreational services or vocational rehabilitation do not meet the criteria for active treatment in a PHP and are not reimbursable under Medicare

Confirmability: Trustworthiness

-The degree to which a study's conclusions are based on the data 1. confirmability is attained when data is truthful 2. can be enhanced by a confirmability audit, member check, researcher reflexivity and triangulation of data

Dependability: Trustworthiness

-The inclusion of the full range of data, including outlier or atypical findings 1. is attained when all participants experience/perspectives are considered important and reported *can be enhanced by a dependability audit, triangulation of data, comprehensive description of research methods, peer review, member check, code-recode procedures and step-wise replication

Early mobilization programs for extensor tendons

-Zone I and II: 1) mallet finger deformity 2) 0-6 weeks - DIP extension splint -Zone III and IV: 1) boutonneire deformity 2) 0-4 weeks - PIP extension splint (DIP free); AROM of DIP while in splint 3) 4-6 weeks - begin AROM of DIP and flexion of digits to the DPC -Zone V, VI, and VII: 1) 0-2 weeks - volar wrist splint with wrist in 30 degrees of extension, MCPs in 0-10 degrees of flexion, and IP joints in full extension 2) 2-3 weeks - shorten splint to allow flexion and extension of IP joints 3) 4 weeks - remove splint to begin MCP active flexion and extension 4) 5 weeks - begin active wrist ROM. Wear splint in between exercise sessions 5) 6 weeks - discharge splint

Intellectual developmental disorders: diagnostic-specific considerations for OT

-self-determination and person-centered planning within the persons capabilities should be a priority -support and assistance may be required to address performance skills and patterns in areas of occupation -development of community and social participation skills are a major focus -interdicisplinary team and family collaboration is helpful to support the development of the persons functional and social skills and to promote participation in areas of occupation -if individual is of school age, collaboration with the educational team is needed, to develop a comprehensive educational program

Work hardening program characteristics

1. Interdisciplinary 2. Real or simulated work activities 3. Transition between acute & return to work 4. Addressed: productivity, safety, physical tolerance, worker behaviors 5. CARF accreditation is required

Myositis interventions

1. cessation of exercise 2. Drug therapy: low dose of oral steroids

Identify potential AT devices

1. consider input method and how the device will be activated (infrared, sonic, electric, touch screen, iphone app, radio frequency switches) and by what action (voice recognition, eye gaze, using a joystcik, head pointer, mouthstick, tongue, or automated su=ystems that do not require individual commands) 2. consider the processing method, how the device will process information from the input method 3. consider the output methods, results are needed (response from input occurs) 4. consider the feedback method, ensure the device is being used in the right way

Leading causes of death (morality) in persons over 65

1. coronary heart disease (CHD), 2. cancer 3. chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) 4. Cerebrovascular disease (stroke) 5. Alzheimer's disease

petit mal seizure (absence seizure)

1. occur between ages 4 and 12 years 2. loss of consciousness without loss of muscle tone occurs 3. rapid blinking or staring into space 4. the child does not fall down 5. the child does not recall the episode or any lapse in time

Disorientation

-A disturbance of orientation to person, place, or time. Situation is sometimes used as a fourth consideration

Medical treatment for fractures

-Closed reduction -Open reduction internal fixation (ORIF) -External fixation -Arthrodesis: fusion -Arthroplasty: joint replacement

Documentation for Medicare Reimbursement overview

-Many private reimbursers and state Medicaid programs follow federal Medicare guidelines, so if documentation meets Medicare standards it will generally be acceptable to other insurers -It is advisable to get copies of state and individual insurers' guidelines for OT services, as adherence to these guidelines will be critical for reimbursement. -Previously state standards and guidelines for documentation apply to reimbursement for Medicare

Medical treatment for lyme disease

-antibiotics, oral or intravenous -management of joint-related symptoms form the accompanying arthritis

systematic lupus erythematosus (SLE) treatment

1. Control symptoms to prevent complications 2. Treat with diuretics and drugs that prevent spillage of protein in the urine (angiotensin converting enzyme-ACE)

Self harm/mutilation definition

1. deliberate destruction or alteration of ones body tissue without conscious suicidal intent 2. a maladaptive coping skill for dealing with uncomfortable feelings

Beneficiary

A person receiving services

stage 1: trust vs. mistrust (erikson)

The infant/baby realizes that survival and comfort needs will be met; hops is integrated into the personality (birth to 18 months)

Problem solving skills 27-30 months

- Child begins to relate experiences to one another, based on logic and knowledge of previous experiences - Child can make mental plan of action without acting it out - Child can see relationships between experiences (balloon popping leads to loud noise)

Brown-Sequard Syndrome

-Cause by trauma (gun shot wound, infectious process, or inflammatory disease) which results in a hemi-section of the spinal cord 1. this injury disrupts the descending lateral corticospinal tracts, the ascending dorsal columns (both of which cross in the medulla), and the ascending lateral spinothalamic tracts, which cross within one or two levels of the dorsal root entrance -Results in an ipsilateral paralysis, ipsilateral loss of position sense (proprioception), ipsilateral loss of discriminative touch, contralateral loss of pain and contralateral loss of thermal sense

Osteoarthritis (OA)

-Degenerative joint disease 1. not systemic but wear and tear 2. commonly affects large weightbearing joints 3. attacks hyaline cartilage -Etiology 1. genetic 2. trauma 3. inflammation 4. cumulative trauma 5. endocrine and metabolic diseases -Symptoms 1. pain 2. stiffness 3. Limited ROM 4. bone spurs -Types of bone spurs 1. Heberden's nodes at the DIP joints 2. Bouchard's nodes at the PIP joints

Major Fiscal Management Tasks

-Develop revenue and volume projections -use cost-effective changing procedures and fee structures -manage payroll and staffing budgets -schedule staff in a cost-effective manner that meets productivity standards -plan for short and long term programs needs including capital expenses -manage general, administrative and operating expenses

Individuals with Disabilities Education Act (IDEA)

-Directly addresses the students functional performance along with academic performance 1. Requires that evaluation for IDEA eligibility include relevant functional and developmental information, not just academic achievement data. 2. Expands the IEP's annual goals to include academic and functional goals 3. Specifies that accommodations must be provided as needed to measure the functional performance and academic achievement of all students with disabilities 4. Enables services to be provided to students as soon as learning needs become apparent via a Response to Intervention (RtI) (RtI provides evidence-based early intervention services to children who are having difficulty learning to prevent academic failure) -Providers for the piloting of a multiyear (not to exceed three years) IEP to allow for long-term planning and to coincide with a students natural transition (preschool to elementary school, middle school to high school) (plan is optional for parents) -Provides for increased flexibility in IEP meetings 1. Allows IEP team members to be excused from IEP meetings if their area of concern is not being addressed or modified at the meeting or if a written report is submitted prior to the meeting (District and parental approval for a team members absence is require, parental approval must be in writing) 2. Allows IEP revision and/or amendments to be made by parents and districts after an annual IEP meeting (parents must be provided with a written copy of the revised/amended IEP 3. Allows the use of technological alternatives to face-to-face IEP meetings (videoconferences, conference calls) -Requires the recommendations for early intervention, special education, related and supplementary services and aids be made based on peer-reviewed research to the extent that this is practical 1. This requirement raises concern that established intervention methods may be questioned due to a real or perceived lack of evidence supporting their efficacy 2. This requirement may spur research on early intervention and school-based OT to support evidence-based practice -Clarifies that a screening done by a specialist is not equivalent to an evaluation for eligibility for IDEA services 1. OT practitioners can conduct informal classroom-based screenings and provide consultations for classroom modifications and other teaching strategies without completing a formal evaluation according to IDEA procedures -Requires that all students with disabilities be assessed in compliance with the Elementary and Secondary Education Act (ESEA) commonly known as No Child Left Behind Act (NCLB) 1. The IEP team determines if the student should take an alternative assessment or the standard assessment with or without accommodations -Provides for early coordinated intervening services for general education students from kindergarten through 12th grade who do not require special education services but who do need additional supports to succeed in school -Clarifies that the purpose of the IDEA is to prepare children with disabilities for further education, employment and independent living -Allows school personnel to individually consider each case of student with a disability who violates the schools code of conduct 1. Students with disabilities who are discipline must (be provided with services to continue to progress toward achieving their IEP goals. Receive appropriate functional behavioral assessments and interventions, and service modifications as needed to address their conduct violations) -Allows each state to define developmental delay criteria to determine if an infant or toddler is eligible for early intervention in the state 1. Typically states define developmental delays quantitatively (percentage of delay according to a standardized developmental assessment) Requires that an IFSP be completed to include 1. The infants or toddlers developmental level 2. Family priorities, concerns, and resources 3. The infants or toddlers natural environments 4. Measurable outcomes 5. Projected, length frequency, and duration of research-based services 6. Transition plan to preschool or other services as appropriate -Clarifies the role of the parent and IFSP team in determining the site for service provision (requires states to maximize the provision of early intervention services in the infants or toddlers natural environments as appropriate -Requires states to establish procedures for the referral of infants and toddlers who are victims of abuse and/or neglect to early intervention services 1. the provision was also included in the Keeping Children and Families Safe Act

Researcher/scholar

-Functions to perform scholarly work of the profession (examining, developing, refining, and/or evaluating the professions theoretical base, philosophical foundations and body of knowledge -Can be an occupational therapist or an OTA/COTA with additional self-study, continuing education, experience and formal education related to research and scholarly activities -OTAs/COTAs can contribute to the research process -Additional academic qualifications are needed for OTAs/COTAs to be principle investigators -Supervision needs range from close supervision to minimal depending on the skills of researcher/scholar and scope of project

Consultant

-Functions to provide OT consultation to individuals, groups or organizations -Can be an occupational therapist or a OTA/COTA at the intermediate or advanced practice level -The occupational therapist and OTA/COTA are responsible for obtaining the appropriate level of supervision to meet regulatory and professional standards

Professional review organization (PRO)

-Groups of peers who evaluate the appropriateness of services and quality of care under reimbursement and/or state licensure requirements

Taste and smell aged-related changes

-Gustatory and olfactory system changes, conditions and clinical implications 1. gradual decrease in taste sensitivity -as as result, older adults frequently increase their use of taste enhances (salt and sugar) -decreased taste can diminish the enjoyment of food and contribute to a poor diet and inadequate nutrition 2. decreased smell sensitivity -decreased home safety can result (the inability to detect gas leaks or smoke)

Leisure groups

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

Biceps brachii

-Musculocuatneous nerve § Origin: coracoid process and supraglenoid tubercle § Insertion: radial tuberosity § Function: elbow flexion with forearm supinated

Brachialis

-Musculocuatneous nerve § Origin: distal 2/3 of humerus § Insertion: ulnar tuberosity § Function: elbow flexion with forearm pronated

Paranoid personality disorder

-Persons with this disorder are characterized by long-standing suspiciousness and mistrust of people in general -They refuse responsibility for their own feelings and assign responsibility for them to others -They can often appear hostile, irritable, and angry

Stander w/c

-designed to enable a person to independently change seat height and/or elevate to a standing position

Sensory integration of vestibular, proprioceptive and tactile information for functional use (mosey)

1. Integration of the tactile subsystems (0-3 months) 2. Integration of primitive postural reflexes (3-9 months) 3. Maturation of right and equilibrium reactions (9-12 months) 4. integration of two sides of the body, awareness of body parts and their relationship and motor plan gross movements (1-2 years) 5. Motor plan fine movements (2-3 years)

Spina Bifida Diagnosis

1. detected prenatally through amniocentesis for levels of alpha-fetoprotein (AFP) and acetylcholinesterase and ultrasound if indicated 2. a less reliable means of prenatal detection involves determine the amount of AFP the unborn baby produces in the mothers blood

Myopathies

1. symptoms are similar to dystrophies, however progress slowly, resulting in a better prognosis 2. weakness of the face, neck and limbs is characteristic

Incomplete sentences

A phrase is provided to indicate a certain domain of concern and the respondent completes the sentence. Used to find out opinions, attitudes, knowledge, styles of behavior, and/or personality traits.

Directive group

Developed by Kathy Kaplan -highly structured, designed to assist low functioning patients in developing basic skills -Part I-orientation-purpose and goals (max of 5 minutes) -Part 2-review of names and introduction of new members (5-10 minutes) -Part 3-warm-up activities to make the members more comfortable and engage them in group (5-10 minutes) -Part 4-one or more activities designed to address the goals of the group and the needs of the members (10-20 minute) -Part 5-activities designed to give meaning to the activities and closure to the group (10 minutes)

Therapeutic Use of Self

The practitioner's conscious, planned interaction with the individual, family members, significant others, and/or caregivers. The conscious, planned use of one's personality, unique characteristics, perceptions and insights during the therapeutic process

Delusional disorder

The presence of one (or more) delusions with a duration of 1 month or longer and the criteria for schizophrenia has not been met

Chi square test

a nonparametric test of significance used to compare data in the form of frequency counts occurring in two or more mutually exclusive categories subjects rate treatment preferences

Rhomboids (major and minor) innervated by the dorsal scapular nerve

§ Origin: C7-T5 spinous processes § Insertion: vertebral border, distal to the spine of the scapula

Post-Polio Syndrome (PPS)

- Eti.: some motor neurons infected w/polio virus die (leaving paralyzed muscle cells); others survive and develop new terminal axon sprouts that reinnervate muscle cells. After yrs. of stability, these motor units break down and cause new muscle weakness -Prognosis/Onset: 1. onset is typically 15 years after recovery from polio 2. progress is slow with a good prognosis unless breathing or swallowing difficulties - Symptoms: 1. new onset weakness, 2. easily fatigued, 3. muscle pain, 4. joint pain, 5. cold intolerance 6. atrophy, 7. loss of functional skills -Medical management 1. bracing the orthoses and pacing daily activity 2. stretching programs 3. exercise program 4. low doses of tricyclic antidepressants to relieve muscle pain 5. pyridostigmine to reduce fatigue and improve strength

Dyskinetic cerebral palsy

-A lesion in the basal ganglia results in fluctuation in muscle tone. 1. Dystonia: excessive or inadequate muscle tone. 2. Athetosis: writhing involuntary movements which are more distal than proximal. 3. Chorea: spasmodic involuntary movements which are more proximal that distal and a lack of cocontractions.

Per-diem

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

Multidisciplinary team

-A number of professionals from different disciplines conduct assessments and interventions independent from one another -Members' primary allegiance is to his/her discipline. Some formal communications occur between team members -Limited communication may result in lack of understanding of different perspectives -Resources and responsibilities are individually allocated between disciplines; therefore, competition among team members may develop

Primary Care Physician (PCP)

-A physician who serves as the "gatekeeper" for service recipients in managed health-care systems -Provides primary health-care services and manages routine medical care -Makes referrals, as needed, to other health-care providers and services including speciality tests and exams, rehabilitation services and OT -PCPs can be a doctor of medicine (MD) or a doctor of osteopathic medicine (DO) (DOs undergo a similar education as MDs with the addition of specific training in osteopathic medicine techniques)

Psychologist

-A professional with a PhD in psychology -Evaluates psychological and cognitive status with standardized and non-standardized assessments including intelligence/IQ (Standford-Binet, Wechsler), Projective (Rorschach), Personality (Minnesota Multiphasic Personality Inventory), Neuropsychological and Interests Inventories (Strong-Campbell) -Provides individual, couple, family and group supportive therapy, cognitive retraining and behavior modification

Medicaid - general information

-A state/federal health insurance program for persons who have an income that is below an established threshold and/or have a disability -States administer the program but receive at least 50% of their funding from federal government. (Under the ACA, states receive increased federal contributions to expand their Medicaid programs) -Includes federally mandated services and state optional services -Mandated services must be provided if a state receives federal funds -Coverage of optional services varies greatly from state to state. Under the ACA, Medicaid must provide the same minimum essential benefits that are provided in the insurance exchanged established by the ACA -States were not required to expand their Medicaid programs and the current status of ACA provisions is unknown at this time

Phenomological (qualitative research)

-A study of one or more persons and how they make sense of their experience 1. Minimal interpretations by the investigator 2. Meanings can only be ascribed by participants

Wellness and prevention programs

-Acceptance is most often by individuals self-referral to meet a personal need or by an institutions provision of a program to its members or employees (parenting skills class for pregnant teens in school) -Programs have been developed to serve populations considered at risk and are help in offices or individuals residences and/or at community sites -LOS is determined by the individual. It is usually influenced by programs planned length (a 6-week joint protection program) or by individuals achievement or desired outcomes (smoking cessation) -OT evaluation focuses on risk factors for illnesses and disabilities and the individuals functional skills and deficits in the occupational roles that are required in their current and expected environment -OT intervention focus 1. Disease prevention and health promotion 2. Interventions can range from the traditional domain of OT (home safety and environmental modifications) to contemporary areas of concern (stress management, smoking cessation, life coaching)

The Accreditation Process

-Accreditation is initiated by the organization submitting an application for review or survey by the accrediting agency -A self-study or self-assessment is conducted to examine the organization based on the accrediting agency's standards -An on-site review is conducted by an individual reviewer or surveyor or a team visiting the organization -The accreditation and the re-accreditation process involve all staff. Tasks include document preparation, hosting the site visit team, and interviews with accreditors -Once accredited, the organization undergoes periodic review, typically every three years

Self-awareness group

-Activities such as values clarification, awareness of own assets, limitations & behaviors, & person's impact on others

Intervention implementation documentation

-Activities, procedures, and modalities used -Clients response to treatment and the progression toward goal attainment as related to problem list -Goal modification when indicated by the response to treatment. Rationale for changes in goal needed -Change in anticipated time to achieve goals with rationale for change and new time frame specified -Attendance and participation with treatment plan (attendance can be a check format) -Statement of reason for individual missing treatment -Assistive/adaptive equipment, orthoses, and protheses if issued or fabricated and specific instructions for the application and/or use of the item, including wearing schedule and care -Patient-related conferences and communication with physicians, third-party payers, case manager, team members etc. -Home programs developed and taught to client and/or caregivers -Client and/or caregivers compliance with home program

Legislation related to the environment

-American with Disabilities Act (ADA): a civil rights law aimed at allowing full participation in society for people with disabilities (several sections mandate accessible environments for persons with disabilities; included are policies dealing with public service, employment, and public accommodations) -Omnibus Budget Reconciliation Act (OBRA): mandates that restraints cannot be used without proper justification, agreement, and documentation -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 to be taught in a regular classroom; education must prepare children for independent living and employment environments) 1. Student directed individualized education programs (IEP) goals must be developed and implemented to prepare a student for independent living, employment and social participation 2. Accommodations must be provided as needed to measure the functional performance and academic achievement of all students with disabilities -Assistive technology (AT) act of 2004: focuses on improving access to and acquisition of AT by funding direct services to support individuals with all types of disabilities and all ages in all environments including school, work, home and leisure -Fair Housing Amendements Act of 1988: requires that all multifamily housing with an elevator and all ground-floor units of buildings without an elevator meet 7 accessible requirements. These include 1. accessible building entrance on an accessible route 2. accessible public and common use areas 3. sufficiently wide, usable doors for persons using w/c 4. accessible routes into and through the dwelling unit 5. Light switches, electrical outlets, thermostats and other environmental controls in accessible locations 6. Reinforced walls in bathrooms to allow installation of grab bars 7. Usable kitchens and bathrooms to allow a w/c to maneuver in the space -Section 504 of the Rehabilitation Act of 1973: requires that all programs receiving federal aid make reasonable accommodations for all qualified individuals with disabilities including accessible new constructions of alterations in physical spaces -The role of the occupational therapist in environmental assessment and modification has increased with the implementation of the ADA, OBRA, and IDEA

Autonomic Dysreflexia

-An abnormal response to a noxious stimulus that results in an extreme rise in blood pressure, pounding headache and profuse sweating 1. irritants that would normally cause pain to areas below the spinal cord injury specific to the bowel include bowel irritation or overdistention (constipation/impaction, distention during bowel program [digital stimulation], hemorrhoid infection or irritation 2. Irritants specific to the bladder include bladder infection or overdistention (urinary tract infection, urinary retention, blocked catheter, overfilled urine collection bag, noncompliance with intermittent catheterization program) 3. Skin related irritants can include any skin irritation below are of injury (decubitus ulcers, ingrown toenails, burns, tight or restrictive clothing or pressure of skin from clothing restrictions or wrinkles in clothing) 4. Sexual activity irritants can include overstimulation during sex, stimuli to the pelvic region that would be felt as pain if sensation were intact, menstrual cramps, labor and delivery 5. other irritants can include heterotopic oddification/myositis ossifications, skeletal fractures and appendicitis (autonomic dysreflexia is a medical emergency if not reversed by removing the irritating stimulus quickly)

Mature grasping skills

-Are needed to completed functional activities 1. grasp patterns are described according to the need to use precision and power to perform a task

Prevention, detection and early intervention of TB

-Avoid spending time with a person who is infected with TB -Avoid traveling to countries where TB is prevalent -Avoid residence in a setting where TB is common: Homeless shelter, migrant farm shelters, prison and jails, some nursing homes -Get checked frequently-every 1-2 years if person has no history of a positive skin test -Get a chest X-ray if person is TB positive or if person was injected with BCG (a vaccine for TB that is given outside of the US) -Frequent check ups if immune system is impaired or weakened (eg. HIV/AIDS, lupus, cancer, MS) or a person lives in an area of the US where TB is common -It takes 10-12 weeks after exposure to TB for a skin test to detect infection

Motor Behavior

-Behavioral and motoric expressions of impulses drives, wishes, motivations and cravings -Disturbances of motor behavior 1. Echopraxia 2. Catatonia 3. Stereotypy 4. Psychomotor 5. Hyperactivity 6. Psychomotor 7. Aggression 8. Acting out 9. Akathisia 10. Ataxia

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

Transdisciplinary team

-Characteristics of interdisciplinary teams are maintained and expanded upon -Members support and enhance the activities and programs of other disciplines to provide quality, efficient, cost-effective service -Members are committed to ongoing communication, collaboration, and shared decision making for the patient/client's benefit -Evaluations and interventions are planned cooperatively, yet one member may take on multiple responsibilities. Role blurring is accepted -Ongoing training, support, supervision, cooperation, and consultation among disciplines are important to this model, ensuring that professional integrity and quality of care is maintained

Problem solving skills 9-12 months

-Child is able to use a tool after demonstration (using a stick to secure a toy that is out of reach) -Child's behavior becomes more goal directed -Child performs an action to produce a response

3 to 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 provide opportunities to promote social development and self esteem.

Spinal Cord General Structure

-Cylindrical mass of nerve tissue extending form the foramen magnum in skull contuous with medulla to the lower border of first lumbar vertebra in the conus medullaris -Dividied into 30 segments: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, a few coccygeal segments

CP diagnosis

-Detected usually by 12 months of age -Sometimes diagnosis may not be identified in early infancy 1. an infant may initially present with hypotonia 2. as the child's neuromotor status evolves, spasticity may develop 3. the child may present with primitive reflexes and automatic reactions, hyper-responsive reflexes, clonus, variable tone, asymmetry, involuntary movements, feeding difficulties due to oral motor impairments, cognitive and other developmental delays -persistence of primitive reflexes contributes to diagnosis 1. these may extend into adulthood -the location and severity of the lesion determines the type of cerebral palsy 1. Spastic cerebral palsy 2. Dyskinetic cerebral palsy 3. Ataxic cerebral palsy -the distribution of the disorder in limbs determines the classification 1. monoplegia involves one extremity 2. hemiplegia involves the upper and lower extremity on the same side 3. paraplegia involves the lower extremities 4. quadriplegia involves all extremities 5. diplegia involves less upper extremity involvement and greater lower extremity functional impairments

Medicare Title 18-PL, 89-97

-Established Medicare and Supplemental Security Income (SSI) -SSI enables a person with disabilities to receive a monthly income enabling them to live in the community

Huntington's Chorea

-Etiology: an autosomal dominant disorder -Onset, prevalence, and prognosis: 1) begins in middle age 2) onset of this disease process is insidious 3) occurs in 1 in 10,000 4) characterized by choreiform movements and progressive intellectual deterioration 5) psychiatric disturbance (personality change, manic-depressive symptoms, and schizophreniform illness) may precede the onset of the movement disorder -Signs and symptoms are progressive until the end of life

Guillain-Barre Syndrome (GBS)

-Etiology: is unknown, may occur after an infectious disorder, surgery or an immunization -Onset: recovery is 2 to 4 weeks after first symptoms * Long terme prognosis 1. 50 % exhibit mild neurological deficits 2. 15% exhibit residual functional deficits 3. 80% are ambulatory in 6 months 4. 5% die of complications

Auditory system changes, conditions and clinical implications

-Hearing aging changes: occur as early as 4th decade; affect a significant number of older adults 1. Outer ear: buildup of cerumen (earwax) may result in conductive hearing loss, common in older men 2. Middle ear: minimal degenerative changes of bony joints 3. Inner ear: significant changes in sound sensitivity, understanding of speech, and maintenance of equilibrium may result with degeneration and atrophy of cochlea and vestibular structures, loss of neurons

Private/Independent practice

-In any and all community and institutional settings, the OT practitioner can work in an entrepreneurial manner by negotiating a fee for service agreement and/or a long term contract -Private practitioners can also open their own free-standing clinics -A provider number is required for a private practitioner to receive third-party payment -Private practitioners must abide by all state and third party payer regulations for evaluation, intervention, and documentation

Kitchen considerations

-Location of meal preparation devices that the individual uses most frequently (ie. oven, microwave, stove) -Presence of a countertop area between the stove and sink, between the stove and refrigerator -Accessibility of food, pots, pans, dishes, and preparation materials -Direction of opening for refrigerator, cabinetry, and/or pantry doors -Presence of a charged fire extinguisher -Presence of anti-scald valves and/or faucets

Methods of marketing/promotion

-Marketing instruments that can be employed to address the 5 Ps include the following: 1. advertising and publicity releases 2. sales promotions, discounts, and bonuses 3. personal contact selling and networking 4. word-of-mouth recommendations

Palmaris longus (PL)

-Median nerve § Origin: medial epicondyle § Insertion: palmar aponeurosis § Function: flexion of wrist

Flexor pollicis brevis: superficial head

-Median nerve -Origin: trapezium, trapezoid, capitate and flexor retinaculum -Insertion: base of proximal phalanx, radial side of thumb -Function: thumb MCP flexion, deep head innervated by ulnar nerve

Flexor carpi radialis (FCR)

-Median nerve § Origin: medial epicondyle § Insertion: second and third metacarpal, base Function: flexion of wrist and radial deviation

Opponens pollicis

-Median nerve § Origin: trapezium, and flexor retinaculum § Insertion: first metacarpal § Function: opposition

ADHD symptom management

-Prescribed medications depend on presenting symptoms 1. stimulants 2. antidepressants 3. anxiolytics -monitoring of medication and its impact on cognitive and psychosocial function (learning and self esteem) -Psychotherapy, behavior modifications, parent and individual counselling may be indicated

Diagnostic testing for PD

-Presence of cardinal signs -Degeneration in dopaminergic pathways in the basal ganglia, primarily in the substantia nigra -Positive response to Sinemet (carbidopa/levodopa)

Semilunar valves

-Prevent backflow of blood from aorta and pulmonary arteries into the ventricles during diastole 1. pulmonary valve: prevents right backflow 2. Aortic valve prevents left backflow

Drug therapy for HIV

-Protease inhibitors work to suppress the viral load in the bloodstream: must be take consistently on time or effectiveness is lost; has shown a dramatic change in the management, treatment and survival of person with a diagnosis of HIV/AIDS -Chemotherapy: less effective than protease inhibitors; loaded with side effects (specific to drugs used); drugs used related to neoplastic process observed (examples include Kaposi's sarcoma, lymphoma); drugs used to treat Hodgkin's (highly differentiated type, non-differentiated type); drugs used to treat opportunistic infections (examples include Foscarnet)

Flight of ideas

-Refers to rapid shifts in thoughts from one idea to another

Prevention of diabetes

-Regular physical activity may reduce the risk of type 2 diabetes -Maintaining normal body weight may be preventitive

Convalescence rehabilitation for cancer

-Rehabilitation of motor impairments -Rehabilitation of sensory impairments -Rehabilitation of cognitive impairments -Rehabilitation of neurobehavioral impairments -Psychological support to enhance coping ability during recovery from cancer treatment phase: 1. liminality (self recognition of vulnerability and self sense of mortality); 2. occupational role and body image adjustment; 3. obtainment of social support -Development of health supporting behaviors (screening, follow-up, diet, exercise, stress management, vocational skill support or assistance to change job skills)

Medicare prescription documentation

-Required from a physician as defined by state practice acts -This certification could be: 1. A signature on the bottom of the note 2. An MD or DO signed 700 or 701 form (some state licensure acts may not all allow an DO to prescribe OT) -Make sure diagnoses are acute, not chronic 1. Rephrase the diagnosis for the physician if needed 2. Use onset dates within 60 days of admission to services, if possible.

superficial partial thickness burn

-Second-degree burn involving the epidermis and upper portion of dermis (sunburn) -appears red,blistering, and wet -Painful; heals on its own -heals in 7 to 21 days

Musculoskeletal status (Assessment of the newborn, infant and child)

-Skeletal status including extremity and spine deformities -Range of motion status -Posture at rest and posture during active movement

Social exchanges

-Sociological theories: consider the context in which aging occurs -Focuses on choices of interactions 1. Individuals (including older adults) make choices on whom to interact with based on need and reciprocity

life course perspective

-Sociological theories: consider the context in which aging occurs -Focuses on expected and normal changes that occur in life 1. Addresses the process-driven nature of aging, age-related transitions, how social context, cultural meaning and social structural location, time, and cohort affiliation impact the aging process

Political economy of aging

-Sociological theories: consider the context in which aging occurs -Focuses on the interaction of economic and political forces 1. Examines how resources are allocated to older adults 2. Examines how the treatment and status of older adults are impacted by public policy, social structures and economic trends 3. Proposes that the opportunities, experiences and choices in later life are impacted by race, class, ethnicity and gender

Critical perspectives of aging

-Sociological theories: consider the context in which aging occurs -Focuses on the trends in social gerontology (political economy of aging, theories of diversity and humanistic gerontology) 1. Addresses two patterns of aging * Humanistic: how aging is interpreted by the individual * Structural components: creating positive models of aging

conduction of the heart

-Specialized tissue allows rapid transmission of electrical impulses in the myocardium; includes nodal tissue and Purkinje fibers -Sinoatrial (SA) node: main pacemaker of the heart; initiates sinus rhythm; has sympathetic and parasympathetic innervation affecting both heart rate and strength of contraction 1. This controls the flow of blood through the heart and thereby the normal perfusion of the body's system and structures 2. SA node dysfunction results in irregular heart rhythm and atrial fibrillation and it also increases the risk of stroke

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

Apraxia

-The inability to carry out specific motor tasks in the absence of sensory or motor impairment

Agnosia

-The inability to understand and interpret the significance of sensory input -visual agnosia is the inability to recognize people and objects

Schizoaffective disorder

-The person has an uninterrupted period of illness during which, at some time, there is either a major depressive episode, a manic episode, or a mixed episode concurrent with positive or negative symptoms that meet criterion A symptoms for schizophrenia

Orientation to staff

-The process of providing specific information to a new employee to increase the ease and effectiveness of their transition into their new position 1. introduce key co-workers, managers, and department heads 2. provide specific information about the organizations and departments mission, policies and procedures 3. distribute manuals, checklists, and/or handout with recommended standards on how to perform required tasks competently 4. tour the facility and department to learn locations of resources, support services, equipment, and materials

American Occupational Therapy Association (AOTA)

-The profession's official membership organization which develops, publishes, and disseminates the field's ethical code -AOTA's Code of Ethics is a statement to the public that identifies the values and principles used to develop, endorse, and sustain high standards of behavior for OT practitioners -A set of principles that apply to all levels of OT personnel -All occupational therapy practitioners are obligated to uphold these standards for themselves and their colleagues -Actions that are in violation of the purpose and spirit of AOTA's Code of Ethics are considered unethical by AOTA -These ethical standards are often the guide by which other bodies judge professional behaviors to determine if malpractice has occurred -As a voluntary membership organization, AOTA has no direct authority over practitioners (OTs and OTAs) who are not members, and no direct legal mechanism for preventing nonmembers who are incompetent, unethical, or unqualified from practicing

Program evaluation and quality improvement

-The systematic review and analysis of care provided to determine if this care is at an acceptable level of quality

Opponens digiti minimi

-Ulnar nerve § Origin: hook of hamate and flexor retinaculum § Insertion: 5th metacarpal § Function: opposition of the 5th digit

Myoelectric prosthesis

-Use muscles contractions detected by electrodes to open and close the TD. Common muscle contractions include: 1. Wrist: uses flexors and extensors to open and close the TD 2. Transhumeral amputations use biceps and triceps 3. Shoulder disarticulation use pectoralis major or infraspinatus

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

If back height of chair is extended, potential problems must be recognized

-added back height may prevent the individual from locking onto the push handle for stabilization and weight shifting -added back height may increase difficulty of fitting chair into car or van

Classification of Spina Bifida

-is dependent on the level of the lesion and the extent of tissue involved -Spina bifida occulta 1. Spina bifida dysraphism (OSD) -Spina bifida cystica 1. Spina bifida with meningocele 2. Spina bifida with myelomeningocele

Inherent (intrinsic) feedback

-normally received while performing a task · Knowing you made an error as you spill water when trying to pour from a pitcher to a cup

Veins

-transport dark, unoxygenated blood from tissues back to the heart -larger capacity, thinner walls than arteries, greater number -one way valves to prevent backflow -venous system includes both superficial and deep veins (deep veins accompany arteries, while superficial ones do not)

Wheelchair Components: wheels

-wheelchair camber: the angle of the wheels in relation to the surface of the floor 1. wheels that are completely straight and perpendicular to the ground have a camber of zero 2, the further the wheels angle away from the wheelchair the greater the camber -increased camber providers greater lateral stability, provides a less bumpy ride and increases the maneuverability of the wheelchair

Consciousness

1. A state of awareness that response to external stimuli 2. Disturbances of consciousness -These disturbances are usually a result of brain pathology -Disorientation -Delirium -Confusion -Sundowner syndrome

Cumulative Trauma Disorder (CTD)

1. Also known as repetitive strain injuries (RSIs), overuse syndromes, and/or musculoskeletal disorders 2. Risk factors: repetition, static posture, awkward postures, forceful exertions and vibration 3. Nonwork risk factors: acute trauma, pregnancy, diabetes, arthritis and wrist size and shape Most common -deQuervian's -Lateral and medial epicondylities -trigger finger -nerve compression

Integration of the theories of aging to client-centered practice in OT

1. An integrated mode; of aging assumes aging is complex, multifactorial phenomenon in which some or all of the previous processes may contribute to the overall aging of an individual (aging is not adequately explained by any single theory) 2. All theories focus on function, which is identified and described in many ways from cellular to social participation 3. The definition of function in the International Classification of Functioning, Disability and Health (ICF) is instructive to OT -In ICF the term "functioning" refers to all bodily functions, activities and participation

Critique of published research

1. Analyze the purpose, relevance and meaningfulness of the study 2. Assess the comprehensiveness of the study's literature review 3. Examine the congruence between the purpose literature, methodology, findings and conclusions 4. Assess the adequacy of research procedures to address the study's question or focus 5. Analyze the comprehensiveness of data analyses, interpretation, conclusions and limitations

Classification of heart failure-New York Heart Association (NYHA)

1. Class I: persons with cardiac disease but resulting in no limitations of physical activity -ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or angina pain 2. Class II: persons with cardiac disease resulting in slight limitations of physical activity. they are comfortable at rest -ordinary physical activity results in fatigue, palpitation, dyspnea or angina pain 3. Class III: persons with cardiac disease resulting in marked limitations of physical activity. they are comfortable at rest -less than ordinary activity causes fatigue, palpitation, dyspnea, or angina pain 4. Class IV: persons with cardiac disease resulting in inability to carry on any physical activity without discomfort -symptoms of heart failure or angina syndrome may be present even at rest. if any physical activity is undertaken, discomfort increases

Disorders of peripheral roots and nerves (pain)

1. Complex regional pain syndrome Type II (neuralgia): pain occurring along the branches of a nerve, frequently paroxysmal 2. Radiculalgia: neuralgia of nerve roots 3. Paesthesias allodynia: with nerve injury or transection

Gastrointestinal problems interventions

1. Drug therapy: Antacids 2. Dietary modifications: soft, diet, avoidance of alcoholic beverages and spicy foods 3. treatment of infection

Title III: Public Accommodations and Services Operated by Private Entities

1. Mandates that places of public accommodation (hospitals, health-care providers offices, schools, day care centers, restaurants, theaters, and other places of accommodation) may not discriminate against persons with disabilities with respect to their participation in or ability to benefit from the service, goods, facility, use, or other programming aspects 2. Public places operated by private entities must be designed, constructed, and altered to comply with accessibility standards - All new construction of public accommodation must be accessible -Physical barriers in existing facilities must be removed if removal is able to be carried out without much difficulty or expense -The US government, Indian Tribes, religious organizations, and/or private tax-exempt membership clubs are exempt from ADA accessibility standards 3. Private services that serve the public (restaurants, stores and theaters) cannot discriminate in the provision of services 4. Public transportation system must be accessible 5. Private transportation systems must be accessible and nondiscriminatory (delivery services, taxis, tour bus companies)

Impact on performance skills and client factors (kidney diseases)

1. Motor skills can be affected by fatigue, muscle pain, edema and weakness 2. sensory skills can be affected by neuropathy (diabetes related, toxicity related, cyclosporin, antirejection drug related) and vision loss (diabetes related) 3. Delusions due to sepsis or toxicity and neurocognitive disorders (multi-infarct or metabolic) can affect process skills 4. Neurocognitive disorders (multi-infarct or metabolic) can affect motor and processing skills 5. Perceptual (neurobehavioral) impairment can affect motor and process skills 6. Psychological/emotional dysfunction can affect social interaction skills 7. Impact on performance in basic activities of daily living (BADL) -bowel and bladder training and self-management -practice meticulous sanitary technique with self-dialysis -Adhere to a disease specific/highly restrictive diet 4. cope with the impact of impotence on sexual participation and alterations in self-esteem and body image 5. use adapted equipment to enable performance of self-care tasks 6. pace oneself when fatigue limits performance

Parietal lobe

1. Postcentral gyrus: primary sensory cortex for integration of sensation 2. Recieves fibers conveying touch, proprioceptive, pain, and temperature sensations from opposite side of body

Temporal lobe

1. Primary auditory cortex: receives/processes auditory stimuli 2. Associative auditory cortex: processes auditory stimuli 3, Wernicke's area: language comprehension

Health Insurance Portability and Accountability Act (HIPAA)

1. Set of standards and safeguards to assure the individuals right to continuity in health-care coverage and to ensure privacy and security of health-care records 2. All persons must be informed of the setting privacy policies and a good faith effort must be made to obtain written acknowledgement from each person about their attainment of this knowledge -If the person refuses to sign, the provider should document the efforts made; failure to obtain written acknowledgement is not a violation of the rule -Written consent must be obtained from a person before any personal health information is used or disclosed in the provision of treatment, obtainment of payment or the carrying out of any healthcare related operations (Exemptions to the written notification/acknowledgement are allowed if the attainment of this will prevent or delay timely care [emergency care]. Written acknowledgement must be obtained as soon as possible- if language barriers preclude signed acknowledgement, treatment can occur if the physician believes consent is implied) 3. Prior to discussing a persons status with a family member/significant other or other provider, the provider must obtain the persons permission or give the person the opportunity to object -Providers can use their clinical judgement to determine whether to discuss the persons case with others if the person cannot give permission or objects (documentation for this decision is essential [person is at risk of harming self due to lack of judgement, consultation with a specialist is essential to ensure quality of care]) -All information used or disclosed about a persons status must be limited to minimum needed for the immediate purpose -HIPAA does not exclude treatment from occurring in group settings or open clinics (Discussion regarding treatment should be done quietly and if possible behind a screen/room divider -HIPAA does not require a guarantee of 100% confidentiality; it does require reasonable and vigilant safeguards -HIPAA guidelines for research are complex, but they are congruent with the established guidelines for human subject research and Institutional review boards (IRB) standards (a limited data set that does not include any identifiable patient information can be used in research without patient approval (diagnosis, age, LOS) -The Administrative Simplification rule also provider standardization of codes and formats for medical data -HIPAA does not override state laws that further restrict privacy and it defers to state laws governing minors

Onset/Prognosis of personality disorders

1. Symptoms of personality disorders usually begin in childhood or early adolescence 2. The prognosis for individuals with personality disorders varies with the condition often remaining unchanged -there is an increased risk of the development of depressive disorders among persons with personality disorder -There is some evidence that the symptoms of avoidant, borderline and antisocial personality disorders will decrease with age

Tests and assessments

1. Used to measure independent variables (performance components, interests, and values_ 2. Published tests with established reliability and validity are preferred 3. If there are no existing tests or assessments available to collect information sought by the research, and instrument can be constructed un accordance with established test construction guidelines

Charco-Marie-Tooth Disease

1. a disease involving the peripheral nerves marked by progressive weakness, primarily in peroneal (fibular) and distal leg muscles 2. typically occurs in the teenage years or earlier

Medical management for seizures

1. a neurologist is most often required to medically manage seizures 2. Seizure disorders are treated with anticonvulsive medications -Phenobarbital (Luminal) -Clonazepam (clonopin)

Osteogenesis Imperfecta (OI)- OT evaluation

1. activity interests that can be safely pursued 2. environmental risk factors

Feeding/eating equipment

1. adapted nipples and bottles for infants 2. scoop dish or plate guards 3. nonslip placement or dycem 4. built-up, angled, weighted, long-handled, or swivel utensils 5. rocker knife and spork 6. adapted cups and long or angled straws

Reactive attachment disorder onset/prognosis

1. begins before 5 years of age 2. there is a high risk of prevalence for toddlers and children in foster care and orphanages and for children with frequently changing caregivers

Intervention for Occurrence of a fall

1. check for fall injury -cuts bruises painful swelling 2. provided reassurance 3. provide first aid, call emergency services if necessary 4. solicit witness of fall event 5. Document the incident as per settings established procedures 6. refer the individual to a fall prevention intervention program to prevent recurrences

Acute renal failure treatment

1. drug control of underlying medical contributory conditions 2. emergent, acute dialysis

Chronic restrictive disease

1. etiology varies 2. disease are all characterized by difficulty expanding the lungs causing a reduction in lung volumes 3. restrictive disease sue to alterations in lung parenchyma and pleura: fibrotic changes within the pulmonary parenchyma or pleura due to idiopathic pulmonary fibrosis, asbestosis, radiation penumonitis, oxygen toxicity 4. restrictive disease due to alternation in the chest wall: restricted motion of the bony thorax, with diseases such as ankylosing spondylitis, arthritis, scoliosis, pectus excavatum, arthrogyrposis or the integumentary changes of the chest wall such as thoracic burns of scleroderma 5. restrictive disease due to alteration in the neuromuscular apparatus: decreased muscular strength results in an inability to expand rib cage, seen in disease states such as MS, MS, PD, SCI, CVA

Results of falls

1. fractures: most common fracture sites are the pelvis, hip, femur, vertebrae, and humerus head 2. increased caution and fear of falling 3. loss of confidence to function independently 4. decrease engagement in activity and restriction of activities that can result in severe physical deconditioning and deterioration, contributing to the likelihood of recurrences 5. increase risk of recurrent falls

Bargaining (death and dying)

1. in an attempt to gain control, the individual may bargain with doctors, caretakers, or god 2. are an attempt to buy time 3. are often associated with guilt related to things not done or promises not kept 4. the individual should not be expected to keep to these 5. OT intervention involves responding honestly to questions

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

1. may be done at bedside or in an office setting 2. food consistencies are laced with green food coloring 3. the person is given a variety of consistencies to swallow and observation is made to determine whether the swallow is intact or impaired using a flexible endoscopic catheter containing a miniature video camera 4. sensation for light touch in the pharyngeal cavity can be tested by forcing air through the endoscopic tube generating a light touch response 5. May be used to diagnosis various swallowing disorders or gastrointestinal system dysfunction

Pressure relief cushions: hybrid cushion

1. provides a postural support 2. has good thermal and envelopment properties 3. allows for pressure redistribution

Internalized anger

1. resentment and bitterness directed toward self 2. characterized by blaming of self for the event, the extent of the loss or the failure to recover

OT intervention for victims of abuse or neglect

1. treatment for physical and emotional injuries 2. development of a trusting relationship 3. provision of support to family and loved ones 4. referral to appropriate disciplines and agencies 5. contributor to staff training programs to prevent abuse

Grooming/Oral Hygiene Adaptive Equipment

1. universal cuff to hold toothbrush, razor, comb and brush 2. built up, angled, or long-handled brushes or razors 3. blow-dryer, nail clippers, and nail polish holders 4. faucet turners 5. electrical toothbrush, floss holders and water flosser

Interview

1. used to gather information in ethnographic and survey research 2. In survey research, interviews can be face-to-face or by telephone or electronic media (Skype) 3. In ethnographic research, interview are always face-to-face

Major depressive episode

5 or more symptoms present for SAME 2 WEEK period and at LEAST 1 of the symptoms is either 1. depressed mood OR 2. loss of interest or pleasure. 3. Decrease or increase in appetite OR significant weight loss or gain. 4. Increased or decreased sleep everyday. 5. Psychomotor agitation or retardation. 6. Fatigue or low energy. 7. Feelings of worthlessness or inappropriate guilt. 8. Decreased concentration or indecisiveness. 9. Recurrent thoughts of death, suicidal ideation, or suicide attempt.

Multiple choice

A statement is provided, sometimes in a question format, and the respondent selects the item most reflective of their opinion. Used to elicit opinions or attitudes.

Child abuse

Any behavior directed toward a child by a parent, guardian, caregiver, other family member, or other adult that endangers or impairs a childs physical or emotional health and development Types of child abuse: 1. physical 2. emotional or mental 3. sexual 4. neglect

Ulnar-palmar grasp

Between 4 and 5 months the infant begins to progress toward a palmar grasp, the infants thumb begins to adduct with fingers pressed against the ulnar side of the palm, progressing in the direction of the center of the palm toward a palmar grasp.

Myoclonic-akinetic seizure

Brief, involuntary jerking of the extremities, with or without loss of consciousness, loss of tone, difficult to control

Metacarpal fractures

Classified according to location (head, neck, shaft, or base). A common complication is rotational deformities. A Boxer's fracture is a fracture of the 5th metacarpal (requires an ulnar gutter splint).

Serial tasks (Motor learning)

Composed if a series of movements linked together to make a "whole" -play an instrument, dressing, light a fireplace

Wheelchair Components: arm rests

Fixed: Minimal benefit but may be seen in older wheelchairs and/or rentals Detached: Helpful for transfers Height adjustable: allows for ease of transfers and better support of lap tray Desk Arms: allow for moving closer to work surfaces Full Arms: allow for holding of a lap tray and possibly ease transfers Wraparound, space saver arm rests: reduces overall width of chair by 1 inch.

Technology Related Assistance for Individuals with Disabilities Act of 1988

Funded the development of technology and technological aids for person with disabilities to improve communication, mobility, self-care, transportation, and education

Sensory processing nosology

Has been put forth for inclusion in diagnostic manuals which classify symptoms under the certifies of 1. Sensory modulation disorder (SMD) in any sensory system -Sensory overresponsivity (SOR) -Sensory underresponsivity (SUR) -Sensory seeking/craving (SS) 2. Sensory-based motor disorder (SBMD) includes underlying sensory discrimination disorder as well as possible sensory modulation disorder -dyspraxia -sensory based postural disorders 3. sensory discrimination disorder (SDD) -visual -auditory -tactile -vestibular -proprioceptive -tase/smell

Moderate intellectual disability

IQ 35-50 1. focus is usually placed on the individual acquiring independence in routine daily skills and skills necessary to perform in desired occupational roles with supports and structure (work in vocational rehab workshops) 2. limited support and assistance may be required in specific occupational performance areas on a daily basis 3. supervised living is required

Assistive Technology (AT) Act of 2004

Improved access to and acquisition of AT by funding direct services to support individuals with all types of disabilities and all ages, in all environments including school, work, home and leisure

Diencephalon: subthalamus

Involved in control of several functional pathways for sensory, motor and reticular function

restricted or constricted affect

Is observed as reduced affect but less so than blunted affect

Thrombolytic therapy for acute MI

Medications administered to activate body's fibrinolytic system, dissolve clot, restore coronary blood flow. (STREPTOKINASE, TISSUE PLASMINOGEN ACTIVATOR [TPA], UROKINASE)

Postural Actions Level 2

Movement that is associated with comfort. There is some awareness of large objects in the environment, and the individual may assist the caregiver with simple tasks

Wheelchair measurements: Seat width

Pt: Width of hips/thights at widest part (maximal seating space) Chair: Add 2 inches to pt measure -this allows for clearance on the sides to prevent friction/rubbing to allow the individual to wear heavier clothing without being cumbersome -The bariatric client with a pear-shape will have increased gluteal femoral weight distribution 1. measurement should consider the widest portion of the seated position (at the forward edge of the seated position) 2. also consider room for weight-shifting maneuvers for pressure relief and possible use of a lift device Excessive width increases difficulty or reaching drive wheels, getting through doorways. Too narrow results in pressure on lateral pelvis/thighs. Lateral space should allow for changes in the thickness of clothing.

Community-based care

School related includes transition from homeschooling back to school or transition of have a student return to class for the classmates Work related: participatory as per Americans with disabilities at ADA Population related intervention: coalitation-related and grant funded initiatives for prevention and out reach programs

Margaret Rood's Approach

Sensorimotor control is developmentally based - treatment must begin at person's current level and progress sequentially -Rood proposed 4 sequential phases of motor control 1. reciprocal inhibition/innervation *an early mobility pattern that is primarily a reflex governed by spinal and supraspinal centers 2.Co-contraction *defined as a simultaneous contraction of the agonist and antagonist that provides stability in a static pattern *utilized to hold a position or object for a long duration 3. Heavy work *also termed mobility superimposed on stability *in these patterns proximal muscles contract and move and the distal segments are fixed 4. Skill *considered the highest level of control and combines stability and mobility *these patterns consist of a stabilized proximal segment while the distal segment move in space -muscular responses of the agonist, antagonists and synergists are believed to be reflexively programmed according to a purpose or plan -sequence of motor development termed ontogenic motor patterns that include 8 different patterns in sequence (supine withdrawal, rollover, prone extension, neck co-contraction, prone on elbows, quadruped, standing and walking) -dependent on the type of sensory stimulation that the therapist applies

Controlling external bleeding

Standardize precautions such as wearing gloves Gauze pads with firm pressure Elevate unless deformed are causes significant pain Apply A pressure bandage Apply pressure with the heel of your hand over pressure points on areas such as femoral artery in the growing for the brachial artery in the medial aspect of the upper arm Monitor ABCs and overall status of patient; administer supplemental oxygen if nearby

Spearman's rank correlation coefficient (rs)

a nonparametric test used to correlate ordinal data

Medical treatment for cancer

a. Surgery lumpectomy, en bloc resection, reconstruction and amputation 1. positioning postoperatively in the operating room 2. early movement postoperatively 3. client education for prevention of complications such as lymphedema and loss of AROM if the shoulder joint capsule tightens after surgery b. chemotherapy (intravenous shunt, oral) 1. when people are receiving chemotherapy they may experience -fatigue -increased risk of excessive bleeding if cut or abraded (brushing teeth) -acute onset of neuropathy resulting in difficulty using feeding utensils and ADL tools -loss of protective sensation c. radiation 1. Radiation burns to skin and soft tissues in the line of radiation -the person may need to learn new skin care regimens that do not alter the pH of skin to either intensify or lessen the impact of the radiation dose d. immunotherapy -adherence to medication management if part of immunotherapy regime is important e. hormonal therapy -people receiving treatment may experience intensified signs and symptoms of estrogen withdrawal. such as hot flashes, mood swings and behavioral changes can also occur f. transplantation (bone marrow) 1. people who are undergoing bone marrow transplantation will be kept in physical isolation (the risk for developing infections that can be life threatening is great) -Providing strategies to lessen the impact of anxiety, depression, and social isolation can be useful

Bony thorax

anterior border is the sternum, lateral border is the rib cage, posterior border is the vertebral column; shoulder girdle can affect the motion of the thorax. Musculoskeletal structures support the ability of the lungs to fully inflate during inspiration and deflate during expiration

Augmentative and Alternative Communication (AAC)

assistive technology that helps individuals communicate, including devices that actually produce speech 1. speed at which message is conveyed 2. portability 3. accessibility 4. dependability 5. independence of user 6. vocabulary flexibility 7. time for repairs and maintenance 8. types range from simple communication boards to albums with a limited number of pictures

Scissors grasp

between thumb and side of curled index finger, distal thumb joint slightly flexed, proximal thumb joint extended (8 months)

Inferior pincer grasp

between ventral surfaces of thumb and index finger, distal thumb joint extended, beginning of thumb opposition (9 months)

Cerebral hemorrhage

bleed secondary to hypertension or aneurysm

repression

blocking from consciousness painful memories and anxiety-provoking thoughts (an adult child has not memory of being mistreated by a beloved parent)

Spina bifida occulta

bony malformation with separation of vertebral arches of one or more vertebrae with no external manifestations; may not be discovered until late childhood 1. Occult spinal dysraphism (OSD): when external manifestations such as red birthmark (hemangioma or flame nevus), patch of hair, a dermal sinus (opening of skin), a fatty benign tumor (lipoma), or dimple covering the site are presented -Specific conditions 1. usually does not result in any symptoms -occasionally slight instability and neuromuscular impairments such as mild gait involvement and bowel or bladder problems may occur

Benign parozysmal positional vertigo

brief episode of vertigo (less than one minute) associated with position change, the result of degeneration of the utircular otoconia that settle on the cupula of the posterior semicircular canal; common in older adults Additional loss of vestibular sensitivity with pathology

Wounds

can be a complication of any diagnosis that compromises the persons sensorimotor, cardiopulmonary, renal-genitourinary immunological or endocrine system

Problem solving skills 24-30 months

child can build with blocks horizontally and vertically

Ataxia

describes a lack of coordination while performing voluntary movements. It may appear as clumsiness, inaccuracy or instability. movements are not smooth and may appear disjointed or jerky

Psychological aspects

environmental characteristics that can affect mood and stress level (a calming, comfortable, cheerful environment vs. a chaotic, uncomfortable, bare setting)

Standard error

expected chance variation among the means, the result of sampling error

Aggression

forceful, angry or destructive speech or behavior

Developmental History (OT Developmental Evaluation)

important developmental milestones, their time or achievement, and any difficulties or problems surrounding their attainment -Parents interview to address the above and the parents perspective on developmental progress and/or concerns, home situation, family history, school history, support systems and insurance coverage

Human Activity Assistive Technology Model

includes interactions and balance among four major elements: 1. Activity 2. Context 3. Human skills 4. Assistive technologies -Created by Cook and Hussey 1995 -Describes someone (human) doing something (activity) in a context using AT. -Emphasis is on the person engaged in activities within chosen environments. -considers the cost of devices

Temporal context

includes stages of life, time of day or year, duration, rhythm of activity, or history.

Stratified sampling

individuals are selected from a population's identified subgroups based on some predetermined characteristics (by diagnosis) that correlates with the study

Carpal fractures

most common is scaphoid fracture (60% of carpal fractures) The proximal scaphoid has a poor blood supply & may become necrotic

Extrinsic flexor muscles of the hand innervated by the median nerve

o Flexor digitorum superficialis (sublimis) (FDS) o Flexor digitorum profundus (FDP) o Flexor pollicis longus (FPL)

Dystonia

results in sustained abnormal postures and disruptions of ongoing movement resulting from alterations of muscle tone. -generalized or focal

Acute distress disorder

similar symptoms of PTSD but more short-lived (do not persist past a month)

Punctures

small holes in the skin, allowing air passage into the wound

Directive leadership

takes place when the OT practitioner is responsible for the planning and structuring of much of what takes place in the group: 1) this style is needed when the members' cognitive, social and verbal skills, as well as engagement, are limited (eg. parallel or project level groups) 2) directive leaders select the activities to be used in the group 3) they provide clear verbal and demonstrated instruction to complete tasks 4) group maintenance roles and feedback is predominately provided by the directive leader 5) the directive leader's goal is task accomplishment

Stage 4: Industry vs. Inferiority (erikson)

the child gains a sense of security through peers and gains mastery over activities of their age group; a feeling of competency is integrated into the personality (elementary school age)

Diagnostic related groups (DRGs)

the descriptive categories established by CMS that requires health service

Context

the elements within and surrounding a client that are often less tangible than physical and social environments but nonetheless exert a strong influence on performance

Provider

the entity responsible for the delivery and quality of services. Providers bill Medicare, HMOs, and PPOs for service rendered

Denial

the failure to recognize or acknowledge the existence of some aspects of reality that is apparent to others (person who abuse alcohol is unable to acknowledge that their problems are a result of drinking)

Primitive squeeze grasp

the infant visually attends to object, approaches it if within 1 inch, contact results in hand pulling object back to squeeze precariously against the other hand or body, no thumb involvement (4 months)

Type I error

the null hypothesis is rejected by the researcher when it is true, the means of scores are concluded to be truly different when the differences are due to chance

Life expectancy

the number of years of life expectation from year of birth -overall life expectancy is 78.8 years in US, women live 5 years longer than men (81 versus 76 years) -for decades the following trends have contributed to increased life expectancy 1. advances in health care, improved infectious disease control 2. advances in infant/child care, decreased mortality rates 3. improvements in nutrition and sanitation

Ineligibility

the removal of eligibility for membership, certification, or licensure by the respective agency for an indefinite or specific time period.

Group Development and stages

the stages groups typically go through from their initial beginnings to their termination 1. origin phase 2. orientation phase 3. intermediate phase 4. conflict phase 5. cohesion phase 6. maturation phase 7. termination phase

Stage 5: Self-Identity vs. Role confusion (erikson)

the teenage begins to make choices about adult roles, and with the resolution of this identity crisis a sense of fidelity or membership with society is integrated into the personality (teenage years)

Transfer: purpose

to move from one surface to another safely and effectively with (dependent) or without (independent) the assistance of others

Low vision optometrists and ophthalmologists

to perform low vision eye exams, prescribe optical and nonoptical devices, prescribe low vision rehabilitation and treat conditions/disease of the eye that result in visual impairment

Driver trainer

to provide training and adaptions to enable safe driving

Surgical infections

were the largest prevalence category follow by diabetic wound infections

Trapezius (upper, middle and lower fibers) innervated by the spinal accessory nerve (CNXI)

§ Origin: · Upper fibers: occiput and ligamentum nuchae · Middle fibers: spinous processes of T1-T5 · Lower fibers: spinous processes of T6-T12 § Insertion: · Upper fibers: lateral 1/3 of the clavicle · Middle fibers: acromion and spine of scapula

Supraspinatus innervated by the suprascapular nerve

§ Origin: supraspinatus fossa § Insertion: greater tuberosity § Function: abduction and flexion

Grasp of the cube

· Neonate visually attends to object, grasp is reflexive · Infant visually attends to object and may swipe. Sustained voluntary grasp possible only upon contact, ulnar side used, no thumb involvement, wrist flexed (3 months) · Primitive squeeze grasp: the infant visually attends to object, approaches it if within 1 inch, contact results in hand pulling object back to squeeze precariously against the other hand or body, no thumb involvement (4 months) · Between 4 and 5 months the infant begins to progress toward a palmar grasp, the infants thumb begins to adduct with fingers pressed against the ulnar side of the palm, progressing in the direction of the center of the palm toward a palmar grasp. (Ulnar-palmar grasp) · Palmar grasp: fingers on top surface of object press it into center of palm with thumb adducted (5 months) · Radial palmar grasp: fingers on far side of object press it against opposed thumb and radial side of palm (6 months), with wrist straight (7 months) · Radial-digital grasp: object held with the opposed thumb and fingertips, space visible between (8 months) with wrist extended (9 months)

Blocked practice

· repetitive practice of the same task, uninterrupted by practice of other tasks · Practicing moving from sit to stand multiple times in a row. Practice sequence of tasks "A", "B", "C": AAAAABBBBBCCCCC

Kidney disease risk factors

• Diabetes* • High Blood Pressure: kidneys receive 20-30% of CO • Family History • Changes in Urination: - going more frequently or less often - color becoming darker - foamy or bubbly • Metallic taste in mouth • No desire to eat meat, anorexia • Confusion • Fatigue • Feeling cold all the time • Shortness of breath • N&V • Swelling in face, feet, hands -hypertension- uncontrolled or poorly controlled is the primary diagnosis -systematic lupus erythematosus (nephrotic syndrome) (personal lifestyle and habits can damage the kidneys)

The peroperational period is divided into 2 phases

(Preoperational period 2-7 years- Jean Piaget hierarchical development of cognition) -Preconceptual: the child expands vocabulary and symbolic representations (2-4 years) -Intuitive thought phase: the child imitates, copies, or repeats what is seen or heard and bases conclusion on what the child believed to be true rather than on logic. Inductive reasoning denotes a transition to the next stage (4-7 years) -Child progresses from dependence on perception and egocentric orientation to logical thought for solving problems. Child enjoys symbolic and verbal play

Seriation

(Preoperational period 2-7 years- Jean Piaget hierarchical development of cognition) -the relationship of one object or classification of objects to another

peripheral airways disease

- Inflammation of distal conducting airways - Associated with smoking

In hand manipulation with stabilization

- several objects held in hand and manipulation of one object occurs, while simultaneously stabilizing the others -picking up pennies with the thumb and forefinger while sorting them in the ulnar side of the same hand -6-7 years (Manipulating skills according to Exner's classification system)

Closed reduction:

- types of stabilization include short arm cast (SAC), long arm cast (LAC), splint, sling or fracture brace -Medical treatment for fractures

Physical therapist assistant (PTA)

-A skilled allied health-care technologist, usually with a 2 year associates degree -Must work under the supervision of a physical therapist (if the supervisor is off-site, delegated responsibilities must be safe and legal practice with ready access to the supervisor) (in home health, required periodic joint on-site visits or treatments with physical therapist) -Able to adjust treatment procedure in accordance with the patients status -May not evaluate, develop or change plan of care, or write discharge plan or summary

Prevention, detection and early intervention of MRSA

-Avoid high-risk situations that contribute to possible exposure -take preventative measures 1. wash your hands 2. avoid sharing personal items (razors or towels) 3. keep any wounds or cuts covered 4. avoid communal bathing/swimming where infected persons may have been 5. assure facilities you use are clean

Amputations

-Etiology: congenital, peripheral vascular disease, trauma, cancer, and infection

Maslow's Hierarchy of Needs

-Developed a hierarchy of basic human needs, proposing that is the lower-level needs are not met, the individual is unable to work on higher-level pursuits 1. psychological: basic survival needs (food, water, rest, warmth) 2. safety: the need for physical and psychological security 3. Love and belonging: the need for affection, emotional support, and group affiliation 4. self-esteem: the need to believe in ones self as a competent and valuable member of society 5. Self-actualization: after attaining all of the psychosocial developmental milestones an individual development of creativity, morality, spontaneity, lack of prejudice, acceptance of facts and problem-solving becomes integrated at this highest level of individual capability

Group Leadership styles and membership roles

-Directive leadership -Facilitative leadership -Advisory leadership

Clinical aspiration

-Food enters the airway -Person can clear airway by coughing (reflex intact) Person silently aspirates when the: -Bolus enters lung and person does not react -Bolus enters the lung and person experiences respiratory distress without a cough -Person coughs too weakly to raise the bolus in order to expel it

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.

Administrator

-Functions to manage department, program, services or agency providing OT services -Can be an occupational therapist with a graduate degree or continuing education relevant to management and experience appropriate to the size and scope of department and programs (minimum of three to five years of experience)

Horizontal abduction muscles

-Posterior deltoid-Innervated by the axillary nerve- Horizontal abduction and shoulder extension

Piaget stated that maturation of cognition is dependent on the following:

-Organic growth, especially the maturation of the nervous system and endocrine glands -experience in the actions performed on objects -social interaction and transmission -a balance of opportunities for both assimilation and accommodation

Personality disorders not otherwise specified (NOS)

-Passive-aggressive -Depressive -Sadomasochistic -Sadistic

Age Discrimination in Employment Act

-Prohibits discrimination against workers over the age of 40 and restricts mandatory retirement

Personality and aging

-Psychological theories address changes in cognitive, personality and social development in the middle and later years of life -Theories that focus on the extent and nature of personality stability and change over time (both of these theories postulate that personality traits tend to be stable as a person ages) 1. Developmental explanations (Erikson and Levinson) 2. The big 5 factors of personality (neuroticism, extroversion, openness to experiences, agreeableness and contentiousness)

Diencephalon: Thalamus

-Sensory nucei: Integrate and relay sensory info (except smell) -Motor nuclei: Relay info from cerebellum and globus pallidus to precentral motor cortex -Others: Assist in integration of visceral and somatic functions

Sexual identity skill (mosey)

-The ability to feel comfortable about ones sexual nature and to engage in continued sexual relationships that takes into account mutual satisfaction of sexual needs 1. Act on the basis of ones pregenital sexual nature (4-5 years) 2. Sexually matures as a positive growth experience (12-16 years) 3. give and receive sexual gratification (18-25 years) 4. Sustain sexual relationship with mutual satisfaction of sexual needs (20-30 years) 5. Accept sex-related physiological changes that occur as natural part of the aging process (40-60 years)

Recent past memory

-The ability to recall events of the past few months

Dorsal Interossei

-Ulnar Nerve § Origin: all 4 muscles arise from the adjacent sides of the metacarpals § Insertion: proximal phalanx on the radial aspect of the index, radial & ulnar sides of middle finger, & ulnar side of ring finger (all into extensor digitorum) § Function: abducts & assist with MCP flexion & extension of IP joints of digits II through V

Voluntary accreditation

-Voluntary accreditation and self-imposed compliance with established standards is sought by most health care organizations (hospitals, SNFs, home health agencies, preferred provider organizations (PPOs), rehabilitation centers, behavioral health [including mental health and chemical dependency] facilities physicians networks, hospice care, long-term facilities and others -Accreditation is a status awarded for compliance with establish standards -Accreditation ensures the public that a health care facility is adequately equipped and meets high standards for patient care, and employs qualified professionals and competent staff -Accreditation affirms the competence of practitioners and the quality of health care facilities and organizations -Accreditation through an accrediting agency is voluntary; however, it is mandatory to receive third party reimbursement and to be eligible for federal government grants and contracts -CMS and many states accept certain national accreditations as meeting their respective requirements for participation in the Medicare and Medicaid program and for a license to operate

chronic obstructive pulmonary disease (COPD)

-a disorder characterized by poor expiratory flow rates 1. peripheral airways disease 2. chronic bronchitis 3. emphysema

Klumpke's palsy

-a paralysis of the lower brachial plexus including the 7th and 8th cervical and first thoracic nerve 1. relatively rare when compared to the prevalence of erb's palsy 2. it results in paralysis of the hand and wrist, often with ipsilateral Horner's syndrome (miosis, ptosis, and facial anhidrosis) 3. Characteristic signs are that the hand is limp and the fingers do not move

Memory

-a process where what has been experience or learn is registered and stored, can be retained to varying degrees and can be recalled at will -Levels of memory 1. Immediate memory 2. Recent memory 3. Recent past memory 4. Remote memory 5. Procedural memory 6. Declarative memory 7. Semantic memory 8. Episodic memory 9. Prospective memory -Disturbances of memory 1. amnesia

Job description

-a statement of the jobs expectations, duties, and purpose and its supervisory relationships It should include: 1. positions title and department 2. skilled and nonskilled requirements of the job including education, special training, experience, physical demands, and licensure requirements 3. specific responsibilities, duties, and performance standards in detail 4. supervisors and supervisory relationships: decision making authority and degree of autonomy

Adult day care (Community-based practice)

-admission is for adults and elders with chronic physical and/or psychosocial impairments and for individuals who are frail but semi-independent -Services are provided in a congregate or group setting -Individual schedules will vary 1. Flexibility in scheduling is provided to address daily caregiver needs and allow for planned respite 2. Schedules can range from one afternoon per week to 5 full days -LOS is indefinite 1. ongoing services are provided to individuals with chronic conditions who might otherwise be institutionalize or to individuals who are frail and need ongoing support (cooked meals, socialization opportunities) -OT evaluation is focused on the individuals functional skills and deficits in the areas of occupation, their home environment and the adult day center's environment -OT intervention focus 1. Maintenance of the healthy, functional aspects of the individual and facilitation of adaptation to impairments 2. Engagement in purposeful activities that provide appropriate stimulation, reflect lifelong interests, develop new interests, and foster a sense of community with other participants 3. Caregiver education, support groups, home visits, consultations and referrals to community resources 4. modifications to the day care centers environment and the individuals home environment to maximize the person comfort in and mastery and control of these environments

Managing difficult behaviors: Akathisia

-allow the person to move around as needed if it can be done without causing disruption to the goals of the group -keep in mind that participation on many levels and in many forms can be beneficial to the individual -whenever possible, select gross motor activities over fine motor or sedentary ones

Managing difficult behaviors: Delusions

-do not attempt to refute the delusion -redirect the individuals thoughts to reality based thinking and actions -avoid discussions and other experiences that focus on and validate or reinforce delusional material

Emotional/psychological abuse signs and symptoms in older adults

-an older adults report of being verbally or emotionally mistreated -emotionally upset or agitated behavior -extremely withdrawn and noncommunicative or nonresponsive behavior -unusual behavior such as sucking, biting or rocking

Interventions to address agitation and wandering incidents

-approach from persons front at eye level -communicate calmly with the use of simple statements/instructions -distract with an activity or topic of interest to the person -redirect back to desired location -engage in an activity of interest or diversion -camouflage doors, exits, and elevators with full length mirrors, stop or no-crossing signs, wall paper or vertical blinds -put tape on floors or patterns to make end of hall -install locks or velcro doors -use door alarms, personal alarms or monitoring devices -make contained areas interesting and safe -rearrange furniture to deter wandering -provide a variety of comfortable seating and furniture including broad-based rockers and footstools

Skeletal System Changes and Adaptations in the Older Adult: age related changes

-cartilage changes: decreased water content, becomes stiffer, fragments and erodes -loss of bone mass and density: peak bone mass at age 40, between 45 and 70 bone mass decreases 1. loss of calcium, bone strength: especially trabecular bone 2. decreased bone marrow red blood cell production -intervertebral discs: flatten, less resilient due to loss of water content and loss of collagen elasticity, trunk length and overall height decreases -Senile postural changes 1. forward head 2. kyphosis of thoracic spine 3. flattening of lumbar spine

Simple febrile seizure

-children under 5 yrs, precipitated by a fever -lasts less than 10 min -loss of consciousness -involuntary generalized jerking of grand mal seizure -do not cause damage, do not lead to epilepsy

Tasks of Early Adulthood (Havighurst)

-choose a partner -adjust to a partner -start a family -raise children -manage a home -pursue an occupation -develop civic responsibility -join/form a compatible social group

Lymphedema

-chronic disorder with excessive accumulation of fluid due to obstruction of lymphatics -causes swelling of the soft tissues in arms and legs -results from mechanical insufficiency of the lymphatic system

OT intervention for Skier's thumb

-conservative treatment including a thumb splint (for 4 to 6 weeks) -AROM and pinch strengthening )at 6 weeks) -Focus on ADLs that require opposition and pinch strength -Postoperative treatment includes thumb splint for 6 weeks, followed by AROM. PROM can begin in 8 weeks and strengthening at 10 weeks

Selective mutism

-consistent inability to speak in social situations when it is expected (in school), despite being able to speak in other circumstances -this behavior must persist for at least one month and not be better explained by a development or communication disorder

Neurophysiologic FOR general assumptions/principles/treatment foundations

-controlled movement is preceded by stereotypic reflex responses -sensory input regulates motor output and sensation is necessary for movement to take place -normal movements are governed by hierarchical centralized motor programs that determined muscle activation patterns 1. cerebral cortex controls the middle levels (basal ganglia, brain stem) which in turn control spinal cord -damage to higher control centers release lower level or primitive reflexes and movement patterns from inhibition -when basic movements and postures are normalized skilled movement would occur automatically -integration of lower-level spinal and brain stem reflexes occurs by eliciting high level righting and equilibrium responses -controlled sensory input applied by the therapist can influence motor responses (reflex model of control) -the use of facilitation and inhibition techniques can improve motor performance

Neurological system changes and adaptations in the older adult- strategies to slow, reverse and compensate for age related neurological system changes

-correct 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 1. Allow for increased reaction and movement times: will improve motivation, accuracy of movements 2. Allow for limitations of memory: avoid long sequences of movement 3. Allow for increased cautionary behaviors: provide adequate explanation, demonstration when teaching new movement skills 4. Stress familiar: well-learned skills and repetitive movements

Assistive device documentation

-document the evaluation process -document recommended ATDs selected and the rationale for each item for reimbursement justification 1. based on individuals needs and goals 2. based on functional status, abilities and limitations 3. based on school/work/leisure status and needs 4. justify cost-effectiveness of recommended equipment -reevaluation guidelines 1. assess for change in status 2. determine efficiency and efficacy of use of assistive device 3. check parts of device for durability

Medical treatment for MRSA

-drainage of skin sore by MD -antibiotics -additional measures depending on severity and location of infection --intravenous fluids --oxygen --dialysis (if kidney failure occurs )

Driver rehabilitation

-driving is defined as an IADL -purposes: a. provide mobility within one's community b. allow for autonomy for self-directed activity pursuit c. enable engagement in life roles including vocational, avocational, social, and familial role activities -physical, cognitive, psychiatric and developmental disabilities can affect the ability to drive safely and effectively -driver rehab reqs extensive on-the-road training and behind the wheel driving in a diversity of driving environments a. knowledge of general state driving regulations and statutes specifically related to individuals with disabilities must be acquired prior to initiating a driver rehab program b. an OT who performs on-the-road driver training must become a state licensed driving instructor c. OTs who practice driver rehab should become certified driving rehab specialists

Role of OT in mandatory reporting of elder abuse

-elder abuse per se may or may not be designated as a specific rime in a state, however most physical, sexual and financial/material abuse are crimes in all states -health-care workers are required to report suspected or observed cases of elder abuse -failure to report may be considered a crime -in most states, Adult Protective Services, the areas Agency on Aging or the county Department of Social Services is designated to provide investigation and services

tilt in space wheelchair

-entire seat and back tile back to maintain hip and knee angles at 90 degrees -indicated for pressure relief, regulate blood pressure, improve respiration and minimize the impact of abnormal tone -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

Delayed feedback

-feedback is delayed by some amount of time -OT says " you did better this morning but keep checking your brakes"

Pre-vocational groups

-focuses on the identification of personal skills, limitations and interests and the development of work habits and behaviors -the desired outcome is the development of the knowledge and skills that are prerequisite for participation in vocational training, vocational rehabilitation or for the acquisition of competitive employment

Prostetic Treatment for amputations

-functional training with prosthesis 1. Practice engagement in activities of interest and occupational role activities -donning and doffing prosthesis -increase wearing tolerance -Individualize treatment to enhance physical and psychological adjustment

Tasks of Middle Adulthood (Havighurst)

-guide adolescents toward becoming responsible & well adjusted adults -engage in adult civic and social responsibility -progress in an occupational career -pursue leisure-time activities -relate to partner as a person -deal with/accept physiologic changes of middle age -accept aging parents

Heat Syndromes/Hyperthermia: Prevention

-in hot weather, wear lightweight, loose-fitting clothing -Avoid hot places; seek shade, use fans, and air conditioners -rest frequently -increase fluids intake

Binge-eating disorder: diagnostic criteria

-inability to control recurrent periods of consuming an exorbitant amount of foods in a discrete situation -episode may include 1. eating until uncomfortably full or when not feeling physically hungry 2. Eating more and at a faster pace than usual 3. experiencing feelings of guilt or depression after excessive eating 4. frequent solitary eating due to embarrassment over behaviors -binge eating behaviors result in clinically significant distress -the average frequency for a clinical diagnosis is a minimum of one time per week for at least 3 months

Lymphatic system

-include lymphatics (superficial, intermediate, and deep), lympth fluid, lymph tissues and organs (lymph nodes, tonsils, spleen, thymus, and the thoracic duct) -Drains lymph from bodily tissues and returns it to venous circulation -lymph travels from lymphatic capillaries to lymphatic vessels to ducts to left subclavian vein. Lymphatic contraction occurs 1. parasympathetic, sympathetic and sensory nerve stimulation 2. contraction of adjacent mucles 3. abdominal and thoracic activity pressure changes during normal breathing 4. mechanical stimulation of dermal tissues 5. volume changes within each lymphatic vessel -major lymph nodes are submaxillary, cervical, axillary, mesentreric, iliac, inguinal, popliteal and cubital -contributes to immune system function; lymph nodes collect cellular debris and bacteria; remove excess fluids, blood waste, and protein molecules, and produce antibodies

Reactive attachment disorder disinhibited type

-indiscriminate sociability with inability to exhibit appropriate selective attachments -demonstrated by excessive familiarity with relative strangers or lack of selectivity

Depressive episode impact on function

-individuals are often tearful, brooding and isolative -anxiety leads to excessive concerns about physical health, complaints of pain and alcohol abuse -hopelessness, lack of energy and slow thought processing lead to limited interest in activity and difficulty performing tasks in all areas of occupation, including personal and instrumental activities of daily living, leisure, social participation, education and work activities

Vocal cord paralysis

-inefficient closure of the vocal folds during the pharyngeal phase of swallow 1. vocal cords are in paramedian position; swallow may be safe 2. vocal cords fail to meet/close to protect airways; aspiration may occur

Mental Health Intervention foci during periods of acute hospitalization

-management of all behaviors that threaten the safety and well-being of the individual as well as that of others on the unit -stabilization of behavior to enable engagement in intervention -engagement in activities that are do-able (brief and structured) to enable success and promote reality-based thinking 1. graded activities are designed to promote self-efficacy which increase self-confidence, motivation and participation in treatment -engagement of the person in the treatment process -development of relaxation and stress management skills to help decrease the incidence and severity of symptoms and facilitate recovery -development of the skills needed to pursue desired occupational roles and attain self-determined goals -engagement in activities to improve communication skills and self expression -the gathering and sharing of ongoing assessment information with the treatment team 1. the person's status typically changes drastically during the course of an acute hospitalization due to the stabilizing effects of psychotropic medications *the input of OT practitioners about a patients observed symptoms and functional behaviors is critical in assisting with the effective titration of psychotropic medications -assistance with discharge planning to support recovery and healthy lifestyle

Alternative practitioners

-may include massage therapists, acupuncturists, Reiki practitioners and others -Training and licensure requirements vary greatly -The roles and tasks of alternative practitioners will be determined by state practice regulations and reimburser's guidelines

Pulse/heart rate parameters

-normal adult HR is 70 bpm range 60-100 1. as an individual ages, the normal resting heart rate range may increase up to 100 bpm 2. pediatric: newborn is 120 bpm; range 70-170 bpm 3. tachycardia: greater than 100 pbm 4. bradycardia: less than 60 pbm 5. irregular: force and frequency vary; may be due to arrhythmia, myocarditis 6. weak, thready pulse 7. bounding, full pulse 8. Bruit: abnormal sound or murmur, associated with atherosclerosis

obsessive-compulsive disorder (OCD)

-obsessions are persistent thoughts or feelings that are unwanted, intrusive and inappropriate based on the stimulus or situations -Compulsions are irresistible urges that take form of repetitive behaviors carried out in an attempt to reduce anxiety or anticipated negative consequences related to obsessions 1. behaviors are typically executed according to strict or specific rules that manifest as ritualistic (washing hands three times prior to eating, locking and unlocking a door 4 times before exiting the house) -Obsessive thoughts and compulsive behaviors are time-consuming and intrusive, although the individuals realize they are not rational

Tethered cord syndrome

-occurs in the tail end of the spinal cord when the cord is stretched as a result of compression, being trapped with a fatty mass or scar tissue, developmental abnormality, or an injury 1. visible signs include a hairy patch of skin, a hemangioma, and/or dimple of the lower spine 2. difficulties with bowel and bladder control, gait pain and/or scoliosis may result 3. may go undiagnosed until the above symptoms emerge 4. symptoms may be exacerbated with pregnancy or with age due to spinal stenosis 5. In children and adolescents, symptoms may be exacerbated by growth spurts. during growth spurts it is also possible for the spine to "re-tether" even after surgery has occurred, which may arrant additional surgery to correct.

Heart tissue

-pericardium: fibrous protective sac enclosing heart -epicardium: inner layer of pericardium -myocardium: heart muscle, the major portion of the heart -endocardium: smooth lining of the inner surface and cavities of the heart

Pica

-persistent eating of nonfood substances, which is inconsistent with cultural or developmental expectations -recurrent patterns of behavior must be present for at least one month

Wheelchair: Contextual assessments

-physical environment 1. areas of travel and w/c use 2. surfaces and terrains that will be traveled on indoors (floor surfaces) and outdoors (sidewalks) -building characteristics of school, work, leisure, worship 1. doorways 2. hallways 3, restrooms 4. workspace design 5. parking 6. other specifics as described in the home evalaution section

Beck Depression Inventory-II (BDI-II)

-primary evaluation tool for CBT 1. self completed questionnaire that assesses level of depression 2. no special training is required to administer this client-completed evaluation 3. interpretation of the results must be completed by a mental health professional who has completed require training and acquired adequate knowledge about the tool and CBT Not a comprehensive test of personality, but a brief, targeted measure of one characteristic (depression symptoms) 21 items; takes 5-10 minutes to complete Pencil & paper, self-report format Lacks validity scales, and much more limited scope than other tests discussed to this point

Brachioradialis

-radial nerve § Origin: supracondylar ridge § Insertion: distal radius § Function: elbow flexion with forearm neutral

Signs and symptoms of MRSA

-redness accompanied by swelling and pain in area of wound -drainage such as puss from area of wound -fever -skin abscess -chest pain -cough -fatigue -headache -muscle ache -rash -shortness of breath 1. testing: cultures or blood, sputum, skin or urine

Complications of CF

-reduced life expectancy 1. the abnormal mucous clogs the lungs and leads to life-threatening lung infections 2. the mucous obstructs the pancreas and stops natural enzymes from helping the body break down and absorb food -cardiac symptoms are a possible complication -diabetes, cirrhosis, and rectal prolapse are rare complications

intervention to address contributing factors/correct underlying problems

-referral to physician for medical evaluation/pain management -proper positioning -provision of snacks, unbreakable water bottles or other appropriate safe source of nourishment and hydration -adequate and client-directed toileting routine -active listening -family, peer and pastoral visits -animal assiste or pet therapy -social and leisure activities -exercise and other outlets for restless anxious behavior -night-time activities -eliminate loud speaker and other extraneous noise, provide soothing background music -inclusion of familiar and favorite objects in persons living space to personalize it -provide a structural home-like environment within a set routine to promote a sense of safety

Psychodynamic/Psychoanalytic

-requires further specialized training Narcissistic mechanisms 1. denial 2. projection 3. splitting Immature mechanisms 1. passive-aggressive 2. regression 3. Somatization Neurotic mechanisms 1. Rationalization 2. Repression 3. Displacement 4. Reaction formation Mature mechanisms 1. Humor 2. Sublimations 3. Suppression

Clinical implications for pulmonary changes

-respiratory responses to exercise: similar to younger adult at low and moderate intensities at high intensities responses include increased ventilatory cost of work, greater blood acidosis, increased likelihood of breathlessness, and increased perceived exertion -clinical signs of hypoxia are blunted; changes in mentation and affect may provide important cues -cough mechanism is impaired -gag reflex is decreased, increased risk of aspiration -recovery from respiratory illness: prolonged in older adults -significant changes in function with chronic smoking, exposure to environmental toxis inhalants

Body dysmorphic disorder

-the person is preoccupied with perceived physical flaws (whether imagined or slight) that are imperceptible, acceptable or insignificant to others -concerns regarding appearance cause repetitive thoughts or behaviors as an attempt to conceal or improve perceived flaws -Recurring thoughts of imperfections cause clinically significant interruptions in social and occupational areas of functioning in daily life

Visual system changes, conditions and clinical implications- age related changes

-ther is a general decline in visual acuity, gradual prior to 6th decade; rapid decline between ages 60 and 90; visual loss may be as much as 80% by 90, these changes include: 1. Presbyopia: visual loss in middle and older ages characterized by inability to focus properly and blurred images; due to loss of accommodation, diminished elasticity of lens 2. decreased ability to adapt to dark and light 3. increased sensitivity to light and glare 4. Loss of color discrimination, especially for blues and greens 5. decreased pupillary responses, size of resting pupil increases 6. decreased sensitivity of corneal reflex: less sensitive to eye injury or infection 7. oculomotor responses diminished: restricted upward gaze, reduced pursuit eye movements; ptosis may develop

Hoarding disorder

-there is a perceived need to save items associated with significant difficulty discarding possessions, regardless of value, need or practicality -the thought of parting with items may result in marked distress and attempts to justify why the items are needed or will be needed in the future -accumulation of items results in cramped, cluttered living conditions that may compromise cleanliness and safety within the home

Wheelchair characteristics considered in assessment

-transportability/protability -ride quality -types of w/c features available 1. control mechanism (type of brakes used, used of antitippers) 2. propulsion method (one arm drive, use of hand rim projections, motorized, use of LEs to propel) 3. personalized features (use of lap tray or backpack to hold personal items and medical equipment, hand tires instead of pneumatic tires for increased durability for more active individuals, postural supports for person with poor trunk control)

OT intervention for child abuse

-treat physical injuries, emotional injuries, and developmental delays -develop a trusting relationship with child and nonabusive caregivers -provide support to nonabusive caregivers -refer to appropriate disciplines and agencies

Medical management of MG

-treatment includes cholinestrerase inhibitors, corticosteroids, immunosuppressive agents, and plasmapheresis -the anticholinergics and plasmapheresis treat current symptoms -corticosteroid and immunosuppressives may alter the disease course by interfering with autoimmune pathogenesis

Central gray matter contains (Spinal cord)

-two anterior (ventral) and two posterior (dorsal) horns united by gray commissure with central canal 1. Anterior horns contain cell bodies that give rise to efferent (motor) neurons and gamma motor neurons to muscle spindles 2. Posterior horns contain afferent (sensory) neurons with cell bodies located in the dorsal root ganglia 3. Two enlargements, cervical and lumbrosacral, for origins of nerves of upper and lower extremities 4. LAteral horn is found in thoracic and upper lumbar segments for preganglionic fibers of the ANS

Airways

-upper airways: nose, pharynx and larynx -lower airways: conducting airways (trachea to terminal bronchioles) and the respiratory unit (respiratory bronchioles, alveolar ducts, alveolar sacs and alveoli)

Use of proper body mechanics: transfers

-use broad base of support -the therapist must known where their center of gravity is at all times -individuals to be transferred should be lifted with the therapist using their LEs to lift and not their back

medical model

-views the individual with a disability as a person who has incurred a physiological insult that has resulted in reduced functional capacity -focus us placed on identifying the disease or dysfunction -treatment addresses the disease, dysfunction, client factors, and/or performance component deficits that contribute to decreased functional skills -OT frames of reference address the pathological process of the disease or dysfunction (biomechanical, neurodevelopmental)

Tasks of infancy and childhood (Havighurst)

-walk -take in solid food -talk -control elimination of body wastes -develop sex differences and sexual modesty -develop physiological stability -understand concepts of social and physical reality -develop emotional ties with parents, siblings, and others -understand right from wrong, conscience evolves

Pulmonary artery problems interventions

1. Drug therapy: procardia SL, anticoagulation therapy 2. nasal canula oxygen

Accounts payable

1. the debts within a budget 2. indicates payments that are due for purchases or services rendered (to an equipment supplier, a landlord)

Piriform sinuses

A pear-shaped fossa located laterally to the laryngeal entrance that channels swallowed material just before it enters the esophagus

Dermatome

a specific segmental skin area innervated by sensory spinal axons

Grants

and/or Philanthropic donations can be used to support programs not typically covered by insurance (an adaptive yoga program or persons with disabilities, a lifestyle redesign program for persons aging in place)

Semantic memory

knowing the meaning of words and the ability to classify information

chemoreceptors

sensitive to changes in blood chemicals (O2, CO2, lactic acid)

Network/snowball sampling

study subjects provide names of other individuals who can meet study criteria

Self-care adaptations for scleroderma

(Rehabilitation for Immunological System Disorders) 1. alter grasp/pinch patterns and level of UE demand 2. Alter size of feeding utensils and toothbrushes to accommodate decreased ability to open mouth 3. prevent shearing forces on skin during specific personal ADL tasks

Revascularization surgery

(coronary artery bypass grafting [CABG]): surgical circumvention of an obstruction in a coronary artery using an anastomosing graft (saphenous vein, internal mammary artery) 1. multiple grafts may be necessary 2. results in improved coronary blood flow and left ventricular function, anginal relief -surgery results in deconditioning that must be addressed

Angioplasty

(percutaneous transluminal coronary angioplasty [PCTA]): under fluroscopy, surgical dilation of blood vessel using a small balloon-tipped catheter inflated inside the lumen 1. catheter is inserted into the femoral artery and guided through the arterial system into the coronary arteries 2. relieves obstructed blood flow in acute angina or acute MI 3. results in improved coronary blood flow, improved left ventricular function, anginal relief

Tertiary circular reactions

(sensorimotor period, ages birth to 2 years- Jean Piaget hierarchical development of cognition) -the child seeks out new schemes with improved gross and fine motor abilities; tool use begins (12 to 18 months)

Coordination of sensory schemata

(sensorimotor period, ages birth to 2 years- Jean Piaget hierarchical development of cognition) -voluntary movement in response to stimuli that cannot be seen such as in object permanence and early development of de-centered though (9 to 12 months)

Symbolic play 12-16 months

- Basic "make-believe" play primarily involving self (eating, sleeping)

Medications

-Antihypertensive (postural hypotension) -anticovilsants -tranquilizers -sleeping pills -aspirin -nonsteroidal anti-inflammatory drugs Additional loss of vestibular sensitivity with pathology

Brachial Plexus disorder

- Eti.: secondary to traction during birth, invasion of metastatic cancer, after radiation secondary to fibrosis or traction injury - Symp.: 1. mixed motor/sensory d/o of correponding. limb, 2. rostral injuries produce shoulder dysfunction while caudal injuries produce dysfunction in hand -Diagnosis 1. made via CT scanning of the plexus in cases where a mass is present 2. EMG/nerve conduction velocities are used to localize the plexus lesion -Common injuries of the brachial plexus seen in children: 1. Erb's palsy 2. Klumpke's palsy

Muscular system changes and adaptation in the older adult: Strategies to slow, reverse and or compensate for age-related muscular system changes

- Improve health 1. correct medical problems that may cause weakness: hyperthyroidism, excess adrenocortical steroids (Cushing's disease, steroids); hyponatermia (low sodium in blood) 2. improve nutrition 3. Address alcoholism/substance abuse -Increase levels of physical activity, stress functional activities and activity programs 1. Gradually increase intensity of activity to avoid injury 2. Plan and include adequate warm-ups and cool downs, appropriate pacing and rest periods -Provide strength training to increase/maintain muscle strength required for functional activity 1. significant increases in strength are noted in older adults with isometric and progressive resistive exercise regimes 2. High intensity training program produce quicker and more predictable results that moderate intensity programs, both have been successfully used with older adults 3. improvements in strength can improve functional abilities and occupational performance 4. maintain newly gained and existing strength and incorporate into functional activities -Provide flexibility and range of motion exercises to increase ROM needed for functional activity 1. utilize slow, prolonged stretching, maintained for 20-30 seconds 2. tissues heated prior to stretching are more distensible (warm pool) 3. maintain newly gained range: incorporate into functional activities 4. mobility gains are slower with older adults

Medical management of BPD

- Months or years of oxygen therapy and artificial ventilation -Bronchodilators and diuretics to keep the airways and lungs dry

Spina bifida with myelomeningocele specific symptoms

- Results in sensory and motor deficits occurring below the level of the lesion and may result LE paralysis and/or deformities, bowel and bladder incontinence, decubitus ulcer and DVT 1. the level of lesions determines the impact on leg movements 2. Lesions of S2-4 results in bladder and bowel problems - a neurogenic bladder impacts on the sensation of urinate and the control of the urinary sphincter -incomplete emptying of the bladder results; this often leads to infections -A neurogenic bowel causes constipation and incontinence

TBI Medical management

- Resuscitation -Management of respiratory dysfunction -cardiovascular monitoring -surgical, pharmologic, or mechanical means to decrease intracranial pressure -neurosurgery to manage lacerated vessels and depressed skull fracture -pharmacologic interventions 1. antibiotics 2. anticonvulsants 3. sedatives 4. antidepressants

Lay team members and role responsibilities

- Service recipient (Consumer): the most important and primary member of the treatment team; the consumer's occupations, values, interests, and goals must be determined and used in all treatment planning (if the consumer and the therapist do not share a common language, an interpreter must be used) -Family/primary caregiver: family's sociocultural background, socioeconomic status, and caregiving tasks, needs, and skills must be considered as they can impact on the outcome of intervention (if the family and the therapist do not share a common language, an interpreter must be used)

substance use disorder criteria

- Two of the following symptoms must be present within 12 month period, due to problematic substances use resulting in significant impairment in occupational performance 1. substances are used in larger quantities than intended and effects last for longer than anticipated (over time this may result in the development of tolerance to substances in which larger quantities are intentionally used to obtain similar or desired affects 2. a significant amount of time is dedicated to substance acquisition or use 3. the desire to use substances is strong throughout the day and attempts to reduce substance use are unsuccessful despite efforts *behaviors continue despite the potential for physical harm due to recurrent substance use *Attempts to cease and reduce substance use may result in withdrawal after prolonged, frequent substance use +withdrawal signs and symptoms include: sensory, motor and psychological changes (including autonomic hyperactivity, insomnia, nausea, vomiting, hallucinations, psychomotor agitation, anxiety or generalized tonic-clonic seizures ) that may result in recurring substance use 4. Ongoing substance use causes marked disruption in social, occupational, vocational, educational and recreational aspects of daily life. This may cause a reduction in engagement in values activities or an inability to meet expectations associated with roles *substance use continues despite the individuals awareness of the impact on function

Fieldwork Education

- a key service management function is to develop, implement, and support clinical fieldwork education for occupational therapists and OTA students 1. ACOTE guidelines for Level I and Level II fieldwork education are to be followed

Confusion

-Involves inappropriate reactions to environmental stimuli, manifested by a disordered orientation in relation to person, place, and time.

Mobility and mobility aids

-"Mobility broadly refers to movements that result in change of body position and location" -Functional mobility: prerequisite to perform self-care, work/school and leisure tasks and activities -Three major requirements for locomotion which may be applied to all functional mobility: 1) "progression or movement to the desired direction...." 2) "ability to stabilize body against gravitational forces..." 3) "ability to make changes in movements in relation to specific tasks within different environments" -Evaluation: need to conduct a full performance component assessment to determine potential ability to perform mobility (including sensation, perceptual, neuromuscular, musculoskeletal, cognitive, and psychosocial areas)

Phase 1: Inpatient Rehabilitation/Hospitalization Stage (acute, cardiopulmonary rehab)- Length of stay

-5-14 days in the hospital -commonly 3 to 5 days for uncomplicated MI (no post-MI angina, malignant arrhythmias or heart failure) -continued inpatient services may be required in a transitional setting for up to 6 weeks post cardiac event, surgery or pulmonary disease exacerbation (the contraindications for inpatient cardiac rehabilitation and adverse responses to inpatient exercise leading to exercise termination must be considered)

Biomedical engineer

-A graduate of an engineering program who specialized in the biomedical application of engineering theory an technology -Serves as a technical expert to recommend, commercial products, adapt available devices, and/or modify existing environments -Develops, designs, and fabricates customized equipment, devices and techniques

Dietician/clinical nutritionist

-A licensed professional who is a graduate of an accredited educational program and who passed a national registration exam (registered dietician) -Evaluates individuals nutritional status and dietary needs -Provides nutrition therapy for diseases such as diabetes and preventive counseling for issues such as obesity

Nurse, registered (RN)

-A licensed professional who is a graduate of an accredited nursing education program -Serves as the primary liaison between the individual and physician (often serves as the primary case manager) -Monitors vital signs, symptoms, and behaviors -Dispenses medications and assists the physician with titration of medications -Performs or supervises bedside care and assists with activities of daily living (ADL) in collaboration with the occupational therapist -Conducts group and individual interventions related to wellness and prevention and disease and symptom management (medication education) =Performs patient, family and caregiver education ot facilitate recovery and maximize quality of life -Supervises and is assisted by licensed practical nurses (LPNs), certified nursing assistants (CNAs) and aides

Marketing/Promotion

-A managerial process that analyzes consumer need(s), plans and designs a service or product to meet the identified market need(s), and implements strategies and actions to promote consumer use of the service or product

Fugue

-A state of serious depersonalization, often involving travel or relocation, in which the individual takes on a new identity with amnesia for his/her old identity

Life-Style Performance Model

-A psychosocial frame of reference -Developed by Gail Fidler -Principles: -The 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 1. Autonomy: self-determination 2. Individuality: self-differentiation 3. Affiliation: evidence of belonging 4. Volition: having alternatives 5. Consensual validation: acknowledgement of achievement and verification of perspectives -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 -Evaluation 1. focuses on obtaining an activity history and a lifestyle performance profile related to the 4 skill domains 2. environmental factors are explored -Intervention -Addresses 5 main questions that identify the focus of intervention 1. what does the person need to be able to do? 2. what is the person able to do? 3. what is the person unable to do? 4. what interventions are needed, and in what order? 5. What are the characteristics and patterns of activity and of the environment that will enhance the person quality of life? -Any interventions or activities that promote performance in the 4 domains are acceptable

Diagnostic testing for TBI

-Administration of the Glasgow coma scale 1. a neurological scale which provides an objective method to record the conscious state of a person 2. It is used for initial evaluation and continuing assessment to determine a persons level of consciousness after head injury 3. A client is assessed against the scale's criteria which delineate a range of points for three tests: eye verbal and motor responses -the resulting total points comprise the Glasgow Coma Scale (GCS) -the score sum as well as the 3 separate values are considered -the highest total GCS is 15 (fully conscious person) -the lowest possible total GCS is 3 (deep coma or death) -the GCS is interpreted as severe with GCS <8, moderate with GCS 9-12 and minor with GCS> 13 4. Individual test scores as well as the total GCS score are documented (GCS 11= E4 V3 M4 at 11:30 pm) -CT scan and MRI to visualize intracranial structure damage

Negligence

-Failure to do what other reasonable practitioners would have done under similar circumstances -Doing what other reasonable practitioners would have done under similar circumstances -The end result was harm to the individual -Every individual (occupational therapist, student occupational therapist, OTA or student OTA) is liable for their own negligence

Medication implications for occupational therapy assessment and intervention

-All medications have potential side effects. The OT must be aware of the following potential negative impacts of medications on the person and respond accordingly 1. Unusual symptoms during assessment or intervention may indicate an adverse drug reaction; the therapist must alert the cardiologist or attending physician if these occur 2. for clients taking anticoagulants, the therapist should be aware of bruising or cuts; if a cut occurs, it may take longer to stop bleeding or require immediate medical attention 3. Clients taking beta-blockers may not demonstrate the expected increase in heart rate or blood pressure during activity or exercise; therefore the therapist should adjust expected parameters accordingly and utilize rate of perceived exertion (RPE) scales as an indication of the effects of activity or exercise (combination of medications could have adverse effect on blood pressure during position changes [moving from supine to site, sit to stand] and during activity; careful monitoring of vital signs during position changes is required)

Outpatient/ambulatory care (Institutional practice settings)

-An individual who does not require hospitalization but has functional deficits requiring evaluation and intervention may receive OT services on an outpatient basis in private clinics, medical offices, and/or hospital satellite centers -Focus of outpatient care is diagnostic evaluation, interventions to increase functional performance, consumer education, and prevention

Viral pneumonia

-An interstitial or interalveolar inflammatory process caused by viral agents (influenza, adenovirus, cytomegalovirus, herpes, parainfluenza, respiratory syncytial virus, measles) -acute disease

Bacterial pneumonia

-An intra-alveolar bacterial infection -Gram positive bacteria usually acquired in the community; pneumococcal pneumonia (streptococcal) is the most common type -Gram negative bacteria usually develops in host who has underlying chronic condition, acute illness, recent antibiotic therapy; usually results in early tissue necrosis and abscess formation -acute disease

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)

Physical abuse signs and symptoms for elder abuse

-An older adults report of being physically mistreated -Bruises, black eyes, welts, lacerations -rope marks and other signs of restraint -bone and skull fractures, sprains and dislocations -Open wounds, cuts, and untreated injuries in various stages of healing -internal injuries/bleeding -broken glasses -under/overdosing of prescribed drugs -a sudden change in behavior -the caregivers refusal to allow visitors to see and older adult alone

Cubital tunnel syndrome

-An ulnar nerve compression at the elbow -Etiology: 2nd most common compression, pressure at elbow (leaning on elbow) and extreme elbow flexion -Symptoms: 1. Numbness and tingling along ulnar aspect of forearm and hand 2. Pain at elbow with extreme position of elbow flexion 3. weakness of power grip 4. positive Tinel's sigh at elbow 5. Advanced stages can lead to atrophy of FCU, FDP to digits IV and V and ulnar nerve-innervated intrinsic muscles of the hand -Conservative treatment 1. Elbow splint at 30 degrees of flexion to prevent positions of extreme flexion (especially at night) 2. Elbow pad to decrease compression of nerve when leaning on elbow 3. Activity/work modification -Surgical intervention: decompression or transposition -Postoperative treatment 1. edema control 2. scar management 3. AROm and nerve gliding (2 weeks postoperative) 4. Strengthening (4 weeks postoperative) 5. MCP flexion anticlaw splint if clawing noted

Shoulder flexion muscles

-Anterior deltoid -Coracobrachialis -Supraspinatus

aspiration pneumonia

-Aspirated material causes an acute inflammatory reaction within the lungs -Usually found in patients with impaired swallowing ability (dysphagia) -acute disease

Manic Episode Criteria

-At least three of the following symptoms must persist for the period of at least one week 1. mood is uncharacteristically and consistently elevated or irritable 2. increased in targeted, goal-directed behavior or restless, purposeless behaviors (psychomotor agitation) 3. inflated self-esteem or thoughts of grandeur, potentially resulting in grandiose and impulsive behaviors 4. decreased need for sleep 5. pressured or quick speech, potentially related to feelings of rushed/racing thoughts 6. increased engagement in subjectively pleasurable activities that may be high risk, painful, harmful or have adverse consequences -Symptoms of mood disturbances or psychotic features usually cause a marked impairment in daily function or require hospitalization to prevent harm, whether to self or to others -behaviors often associated with a manic episode 1. treatment resistance resulting from failure to recognize illness 2. suggestive or flamboyant dress 3. gambling, promiscuity, excessive spending or giving things away 4. irritable, assaultive or suicidal behavior

Stochastic (insults) Theory

-Biological theories addressing aging at the cellular, molecular and organism levels -Genetic damage leads to functional failure and death 1. as DNA replicates, factors such as radiation or mutations cause agents to attach to the newly formed DNA strands 2. Premature aging syndromes (progeria) provide evidence of defective genetic programming (affected individuals exhibit premature aging changes- atrophy and thinning of tissues, graying of hair, and arteriosclerosis) * Hutchinson-Gilford Syndrome: progeria of childhood *Werner's syndrome: progeria of young adults

OT intervention for fractures mobilization phase

-Consolidation is the goal 1. Edema control: elevation, manual edema mobilization, gentle retrograde massage, contrast baths, and compression garments (Tubigrip, Isotoner glove) 2. Some patients will require a splint for protection 3. AROM (progress to PROM when approved by the physician, exceptions are humerus fractures that often begin with PROM or AAROM) 4. Light purposeful or occupation-based activities 5. Pain management: positioning and physical agent modalities 6. Strengthening: when approved by physician (shoulder fractures most commonly begin with isometric exercises)

Obsessions

-Constitute a persistent thought or feeling that cannot be eliminated by logical thought

Deep partial-thickness burn

-Deep second-degree burn involves epidermis and Deep portions of dermis; hair follicles and sweat glands -Appears red white and a elastic -Sensation may be impaired -Potential to convert to full thickness burn due to infection -Heals in 21 to 35 days -Potential to convert to full-thickness burn due to infection)

Distal phalanx fractures

-Most common finger fracture. -May result in mallet finger (which involves terminal extensor tendon)

Electronic Aids to Daily Living (EADLs)

-Definition: EADLs were formerly known as environmental control units (ECUs) and are a "....means to purposefully manipulate and interact with the environment by alternately accessing one or more electrical devices via switch, voice activation, remote control, computer interface..." -Purposes: 1) maximize functional ability and independence in home, school, work, and other environments 2) allow energy conservation during home management and work tasks -Uses: 1) turn on/off lights and appliances open and close doors/drapes 2) allow use of phones and machinery 3) summon assistance -Considerations in device selection: 1) input method - selection requires knowledge of the distance of throughput/transmission 2) output method 3) portability 4) safety 5) reliability 6) durability 7) assembly ease 8) operation ease 9) maintenance schedule 10) current and future affordability

Analysis and interpretation of data using inferential statistics

-Determines how likely the results of a study of a sample can be generalized to the whole population -Standard error if measurement: an estimate of expected errors in an individuals score, a measure of response stability or reliability -Test of significance: an estimation of true differences, not due to chance a rejection of the null hypothesis (alpha level, degrees of freedom, errors) -Parametric statistics: testing is based on population parameters; includes tests of significance based on interval or ratio data (T test, analysis of variance [ANOVA], analysis of covariance [ANOCVA]) -Nonparametric statistics: testing not based on population parameters, includes tests of significance based on ordinal or nominal data (Used when parametric assumptions cannot be med, less powerful than parametric tests, more difficult to reject the null hypothesis, Chi square test -Correlational statistics: used to determine relationships between two variables compare progression of radiologically observed joint destruction in RA and its relationship to demographic variables (gender, age), disease severity, and exercise frequency (Pearson product-moment coefficient [r], SPearman's rank correlation coefficient [rs], Intraclass correlation coefficient [ICC], strength of relationships) -Common variance: a representation of the degree that variation in one variable is attributable to another variable

Model of Human Occupation (MOHO)

-Developed by Gary Kielhofner based on the occupational behavior model of Mary Reilly -Principles 1. occupation is dynamic and context dependent 2. personal occupational choices and engagement in occupation shape the individual 3. 3 elements are inherent to humans *volition includes thoughts and feelings that motivate people to act and is composed of personal causation, values and interest *habituation includes organized, recurring patterns of behavior and is composed of roles and habits *performance capacity include the physical and mental skills needed for performance and the subjective experience of engaging in occupation 4. the environment impacts on the individual through the opportunities, demands, resources and constraints it provides *the environment is divided into physical and social components *each component is influenced by the cultures in which it takes place -Evaluation 1. focuses on exploring the individuals occupational history, goals, volition, habits, and occupational performance 2. many tools have been designed specifically for use with MOHO (OCAIRS, OSA) however, any procedure or instrument that provides pertinent information about the environment and the person may be used -Intervention 1. focuses on occupational engagement and includes activities that are purposeful, relevant and meaningful to people and their social context

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 1. external dimensions include culture, relationships and chosen tasks 2. internal dimensions include sensation, emotion, and attention 3. Difficulty with modulation either can result in -difficulties with social and environmental interactions -difficulties with self-regulation due to mismatch between internal capabilities and external environment and activities

Evaluation of wounds

-Early assessment is critical to prevent wounds from developing and progressing 1. the skin integrity of all persons should be assessed 2. the presence of risk factors for wounds should be assessed to determine the persons potential for developing a wound -while nursing staff in medical model settings typically assume the responsibility for skin and risk assessments, OT practitioners can and should contribute to the process 1. the nonmedical model settings (home care) the OT practitioner may need to take a more active role in the evaluation process 2. Visually inspect the wound site and measure it using a disposable tape measure 3. rule out possible undermining and tunneling using a sterile cotton swab. Note the depth of the wound in centimeters 4. document observation of wound color and exudate 5. note any signs of infection 6. take circumferential measurements of a limb that has wounds just distal and proximal to the wound when compare with the noninvolved side 7. administer an analog pain scale 8. administer the Canadian Occupational Performance Measure (COPM) to determine personal goald for treatment 9. Change dressings daily and note progress of healing -caregivers should be trained by the occupational therapist to perform this assessment -persons determined to be at a low risk for developing wounds should be reevaluated whenever there is a change in their status (persons determined to be at a high risk for developing certain types of wounds [pressure ulcers] should be reevaluated every 12 hours)

Atherosclerosis

-Etiology: 1. disease of lipid-laden plaques (lesions) affecting moderate and large-size arteries 2. Characterized by thickening of the intimal layer of the blood vessel wall from the focal accumulation of lipids, platlets, monocytes, plaque and other debris -Onset: variable depending on presence of absence of risk factors -Prevalence: increases with age and presence of risk factors -Prognosis: good with early detection and treatment Multiple risk factors 1. nonmodifiable risk factors: age, sex, race, family, history of CAD 2. modifiable risk factors: cigarette smoking, high blood pressure, elevated cholesterol levels and low density lipoprotein (LDL) levels, elevated blood homocystine, emotional distress 3. contributory risk factors: diabetes, obesity, sedentary lifestyle and elevated blood homocystine and fibrinogen levels (two or more of the preceding risk factors increase the risk of CAD)

total hip arthroplasty (THA)

-Etiology: 1. trauma, from hip fracture 2. disease, most often arthritis, surgery is then elective -Types 1. Total hip joint replacement: replaces acetabulum and femoral head 2. Austin Moore: partial hip replacement. replaces femoral head -Surgical procedures 1. Cemented or uncemented 2. Anterolateral or posterolateral -OT evaluation (review precautions and weightbearing status before initiating evaluation) 1. complete and OT profile 2. Assess ADLs, focus on dressing, bathing and transfers 3. Assess ROM and strength of upper extremities 4. Conduce other assessment as needed (cogntive) -OT Intervention 1. educate the individual on hip precautions -Posterolateral -Anteriolateral 2. Instruct and practice use of long-handled equipment 3. Provide transfer training -practice with tub bench, raised toilet seat -practice car transfers -practice bed to chair transfers 4. practice occupation-based activities (small meal preparation) using proper weightbearing status and ambulatory device

Bronchopulmonary Dysplasia (BPD)

-Etiology: Respiratory disorder often as a result of barotrauma - high inflating pressures, infection, meconium aspiration, asphyxia; complication of prematurity; the walls of the immature lungs thicken, making the exchange of oxygen and carbon dioxide more difficult; the mucous lining of the lung is reduced along with the airway diameter -Diagnosis: infant must work harder than normal to obtain sufficient oxygen for survival

muscular dystrophy (MD)

-Etiology: a group of degenerative disorders resulting in muscle weakness and decreased muscle mass due to hereditary disease process 1. Are due to an absent muscle protein product, dystrophin. the responsible genes and biochemical abnormalities can be tested through a muscle biopsy to determine the level or absence of dystrophin -Onset and Prognosis 1. can begin in infancy, childhood or adulthood 2. first symptoms may not be apparent until 2.5 years of age 3. Average age of diagnosis is 5 years unless there is a known family history; whereby earlier detection is more likely to occur 4. progress may be rapid and fatal or remain stable throughout life (those starting early in life tend to be more severe and to progress more rapidly)

Spinocerebellar Degenerations

-Etiology: a group of degenerative disorders, characterized by progressive ataxia due to the degeneration of the cerebellum, brain stem, spinal cord, peripheral nerves and the basal ganglia 2. Types: these disorders are grouped as spinal ataxias, cerebellar ataxias and multiple system degeneration -Friedrich's ataxia -Cerebellar cortical degeneration -Multiple systems degeneration (olivopontocerebellar atrophies)

Hepatitis

-Etiology: a viral infection -Risk factors +Type A 1. contaminated seafood 2. protectie immunization possible +Types B, C, and other identified forms 1. body and bloodborned exposure 2. protective immunization possible for type B (Standard precautions must be used with all person in all situations to prevent contact with blood or body fluids) -Sequelae 1. fever 2. fatigue 3. These contribute to decrease tolerance for activity participation and lack of energy 4. hepatitis C infections can cause life-threatening cirrhosis over time and may contribute to chronic fatigue and disability

Tuberculosis (TB)

-Etiology: an airborne infection caused by a bacterium (mycobacterium tuberculosis) -Transmission and risk factors 1. a person with TB of the throat or chest can pass the infection by sneezing or coughing (people most at risk for infection are those who are in close contact with an infected individual on a daily/regular basis, including family members, neighbors, friends, coworkers and healthcare personnel) 2. the risk for rapid onset of Tb disease increases for persons with -HIV/AIDS, substance abuse, diabetes, scoliosis, cancer of the head or neck, Leukemia or Hodgkins disease, severe kidney disease, low body weight and certain medical conditions receiving special treatments (steroid users or organ recipients) -infants, young children, older adults and people who use intravenous frugs have a higher risk for TB -people who have had a TB infection within two years of treatment are at a high risk for reinfection

Parkinson's disease (PD)

-Etiology: hypokinetic CNS movement disorder that is idiopathic, slowly progressive and degenerative -Symptoms 1. begins insidiously with a resting "pill rolling" tremor of one hand 2. Cardinal signs include tremor, rigidity, resistance to passive motion that is not velocity dependent (cogwheel or lead pipe), akinesia, postural instability, festinating gait, falling backward (retropulsion) or forward (propulsion), mask face, micrographia

Structural Cerebellar lesions

-Etiology: includes vascular lesion (stroke) and tumor deposits, producing symptoms and signs appropriate to their locus within the cerebellum 1. Demyelinating plaques of multiple sclerosis may also arise in the cerebellum white matter and give rise to cerebellar symptoms 2. Alcoholism and nutritional deprivation can cause degeneration of the vermis and anterior cerebellum

acquired immunodeficiency syndrome (AIDS)

-Etiology: infection by the human immunodeficiency virus (HIV) -Risk factors for infection: unprotected sex; contact with blood or body fluids -Prevention: Avoid unprotected sex via abstinence or use of condoms; avoid contact with body fluids (blood procedures; breast feeding; secreations of vagina/rectum during birth [protection of baby], during sex, during hygiene); urine or feces; tears (low % of infection) -Practice standard precautions with all persons

Myasthenia Gravis (MG)

-Etiology: the disease is caused by an autoimmune attack on the acetylcholine receptor of the postsynaptic neuromuscular junction 1. this process if considered a disorder of neuromuscular transmission 2. The initiating event leading to antibody production is unknown -Onset/Prevalence 1. prognosis varies but usually is a progressive disabling process 2. death may occur form respiratory complications -Diagnosis 1. is often missed because of the rarity of the disease and the vagueness of symptoms 2. Characterized by episodic muscle weakness, chiefly in muscles innervated by cranial nerves 3. the possibility of MG is suggested by any of the symptoms and is confirmed by response to anticholinesterase drugs

Multiple Sclerosis (MS)

-Etiology: the exact cause is unknown 1. the myelin damage is probably mediated by the immune system 2. postulated etiologies include infection by a slow or latent virus and the possibility of environmental factors contributing to the disease -Onset/Prognosis 1. Occurs most often between the ages of 20 and 50; it is most often diagnoses when persons are in their 30s 2. overall prognosis is variable with an unpredictable disease course

Spina bifida

-Etiology: unknown 1. genetic intrauterine and/or environmental factors contribute to the failure of the spinal columns vertebral arches to fully form to enclose and to protect the neural tube. This defect may result in protrusion of the neural tube -Prognosis: and degree of impairment is dependent on the level of the lesion and the extent of the neural tube defect of the vertebral arches and the spinal column 1. lesions usually occur in the thoracic or lumbar spine

Cancer

-Etiology: unknown for some cancers, strong link to risk factors for others -Risk Factors 1. heredity: some tumors (breast, prostate, skin and colon) seem to have high hereditary risk 2. Environmental: cluster patterns related to chemical pollution 3. Habit or lifestyle related: smoking, alcohol consumption, high-fat diets and obesity may be linked to increased risk

OT Evaluation/Intervention- full thickness burn (requires grafting)

-Evaluation 1. ROM (5 to 7 days postoperative) AND 1. occupational profile 2. ROM, 72 hours postoperative 3. sensation, when wounds are healed 4. strength, when wounds are healed 5. ADL and meaningful role activities, as soon as possible -Postoperative Intervention 1. 72 hours: dressing changes, splints at all times 2. 5 to 7 days: begin AROM, light ALDs and meaningful activities, sterile whirlpool 3. Over seven days: PROM as tolerated, ADLs and meaningful activities 4. when wounds are healed, use message 5. order compression garments 6. provide otoform/elastomer inserts 7. strengthening

OT Evaluation/Intervention- deep partial thickness burns

-Evaluation 1. occupational profile 2. ROM, 72 hours postoperative 3. sensation, when wounds are healed 4. strength, when wounds are healed 5. ADL and meaningful role activities, as soon as possible -Intervention 1. wound care and debridement, sterile whirlpool and dressing changes 2. Gentle AROM and PROM to individuals tolerance 3. Edema control 4. Splinting 5. Occupational role activities and ADLs 6. Strengthening (when wounds are healed)

Federal Legislation Related to OT

-Federal laws establish numerous standards and provide funding for health benefits, medical services, rehabilitation, early intervention, education, vocational programming, professional training and research -The laws directly affect the profession of OT by establishing practice guidelines and reimbursement standards -Major social movements that precipitated federal legislation and/or have resulted form federal legislation include: deinstitutionalization, early intervention, mainstreaming, and full inclusion -State laws also influence OT practice

Wheelchair Components: footplates

-Fixed: minimal benefit but may be seen in older wheelchairs and/or rentals -Swing-away: allows for feet to reach floor -Heel loops: prevent feet from slipping off footrest in a posterior direction -Ankle straps: prevent slipping off footrest

ADL/IADL groups

-Focus: self-care&independent living skills, i.e.: cooking, money management, transportation, etc. -may be in a modular &/or psycho-educational format

Stage of PD disease progression

-Hoehn and Yahr's 5 stage scale 1. Stage I= unilateral tremor, rigidity, akinsia, minimal or no functional impairment 2. Stage II= bilateral tremor, rigidity or akinesia, with or without axial signs, independent with ADL no balance impairments 3. Stage III= worsening of symptoms, first signs of impaired righting reflexes, onset of disability in ADL performance, can lead independent life 4. Stage IV= requires help with some or all ADL, unable to live alone without some assistance, able to walk and stand unaided 5. Stage V= confined to a wheelchair or bed, maximally assisted

Praxis/motor planning deficits

-Inability to effectively chew and coordinate tongue movements to propel the bolus toward the base of the tongue -Residual food centrally located in the oral cavity -Difficulty forming bolus with smoother consistencies

Deep vein thrombosis (DVT)

-Inflammation of a vein in association with the formation of a thrombus -Usually occurs in lower extremity -May be contributing factor to or a complication of cerebral vascular accident (CVA) or the result of the prolonged bed rest during a serious illness -Signs and symptoms include a change in lower extremity temperature, color circumference, appearance, or tenderness/pain -Requires immediate medical attention

Work Assessment

-Initial screening and prevocational assessment -Functional capacity evaluation (FCE) which evaluates an individual's capabilities in relation to one of several dimensions: 1) the physical demands of the job, which is often termed a physical capacity evaluation, to assess the physical demands of a job according to the descriptions provided in the Dictionary of Occupational Titles (DOT) (eg. the Smith Physical Capacity Evaluation) 2) the critical demands of a specific job 3) the critical demands of an occupational group 4) the demands of competitive employment -Work capacity evaluation using real or simulated work activities to assess an individual's ability to return to work (eg. Valpar Work Samples or BTE) -Job site analysis to evaluate its expectations, supports, ergonomics, essential functions of the job, the marginal functions of the job, and the potential reasonable accommodations in accordance with ADA

Basic styles of seating

-Linear: 1) flat, non-contoured 2) custom or factory-ordered 3) firm, rigid seating 4) good for active individuals, those who perform independent transfers and/or those who perform independent transfers and/or those with minimal musculoskeletal involvement -Contoured and/or custom-contoured: 1) ergonomically supports the individual 2) provides excellent support 3) enhances postural alignment 4) decreases abnormal posturing 5) provides pressure relief 6) may be difficult for independent transfers if decreased UE muscle strength 7) good for individuals with moderate to severe central nervous system dysfunction or neurological disease

Methods of Data Collection

-Methods range along a continuum from unstructured observations to highly structured, fixed choice questionnaires -Most methods are used in both qualitative and quantitative research -Most methods are used in conjunction with other data collection techniques 1) Observation 2) Interviews 3) Written Questionnaires 4) Survey Instruments 5) Artifact and record review 6)Hardware instrumentation 7)Tests and assessments

Content of Documentation (Identification and background information)

-Name, age, gender, date of admission, treatment diagnosis, and cause number it one exists -Referral source, reason for referral, chief complaint relevant to OT's domain of concern -Pertinent history that indicates prior levels of function and support systems, including applicable developmental, educational, vocational, socioeconomic, and medical history. This can be brief -Secondary problems or preexisting conditions that may affect function or treatment outcomes -Precautions, risk factors and contraindications, medications, surgery dates

Attention-deficit/hyperactivity disorder (ADHD): Etiology

-Neurodevelopment disorders -Unknown, however: 1. genetic factors include high occurrence in the monozygotic twins than in dizygotic twins and twice the occurrence in siblings of hyperactive children 2. Neurological factors include the possibility of minimal or subtle brain damage due to circulatory, toxic, metabolic, or mechanical effects during fetal or perinatal periods, and infection, inflammation and trauma during early childhood. 3. Neurochemical dysfunction related to neurotransmitters int he adrenergic and the dopaminergic systems 4. psychosocial factors include stress, anxiety, or predisposing factors such as temperament

Occupational therapy evaluation for arthritis

-OT profile - ROM (focus on AROM): 1) PROM should be avoided, especially in the inflammatory stage 2) note deformities and nodules - Muscle strength: 1) avoid muscle testing unless requested by physician 2) document strength in relation to function - Grip strength: use sphygmomanometer or bulb dynamometer - ADL and role activities: note if ADL and role activity deficits are related to pain, limitation in motion, deformity, weakness, or fatigue - Pain: use pain scales - Edema: volumeter or tape measure

Sequelae of TB

-Once the infection settles into a person's lungs it can spread to other parts of the body -Kidney dysfunction can occur -Rood's disease can occur (vertebral collapse caused by TB resulting in compression of the spinal cord) -Spinal structural integrity can be compromised -Cervical spinal lesions can result in hand functional impairment, sensory impairment, postural changes -Thoracic spinal lesions can result in paraparesis, neurogenic bowel/bladder, altered mobility, and altered activity of daily living activities -Space-occupying lesions in the brain produce stroke-like symptoms

Neuropathic pain

-Pain as a result of lesions in some part of the nervous system; usually accompanied by some degree of sensory deficit 1. thalamic pain 2. complex regional pain syndrome type I 3. Disorders of peripheral roots and nerves 4. Herpes Zoster (Shingles) 5. Phantom Limb pain 6. Psychosomatic pain

If burns to volar surface of hand develop flexion contractures

-Palmar extension splint 1. wrist in 0-30 degree extension 2. MCP joints in neutral to slight extension and abducted (monitor collateral ligaments) 3. IP joints in full extension 4. Thumb abducted and extended

Early mobilization programs for flexor tendons - Kleinert 0-4 weeks

-Passive flexion using rubber band traction and active extension to the hood of the splint 1. protocol -0-4 weeks (early phase): dorsal block splint. Wrist is position in 20-30 degree of flexion, MCP joints in 50-60 degree pf flexion and IP joints extended. passive flexion and active extension within limits of splint

Captation

-Payment system under which the provider is paid prospectively (on a monthly basis) a set fee for each member of a specific population (health plan members) regardless of no covered health care is delivered or if extensive care is delivered -Payment is typically determined in terms of per member per month (PMPM) -The healthier the enrollees (and the fewer services used), the more the provider retains of the total PMPM payment

Medicare Part A

-Pays for inpatient hospital, skilled nursing facility (SNF), home health, and hospice care -Part A is automatically provided to all who are covered by the Social Security System that meet the coverage criteria Services provided in acute care hospitals receive a prospective, predetermined rate based on DRGs (Diagnostic Related Groups) 1. The DRG per case rate covers all services including OT 2. IT is a fixed dollar amount for patient care for each diagnosis regardless of length of stay (LOS) or number of services provided 3. Treatment supplies (ie. adaptive equipment, splints) are included in this per case rate 4. Individual hospitals determine the combination of services a patient will receive -Part A covered services have specific time limits and also require deductible and coinsurance payments by the beneficiary: 1) annual deductible fees must be paid by patient 2) twenty percent of home health care must be paid by patient

Arterial disease

-Peripheral vascular disease (PVD) Occlusive peripheral arterial disease (PAD), 1. Chronic, occlusive arterial disease of medium and large sized vessels, 2. Hypertension and hyperlipidemia, pts may also have CAD, diabetes, cerebrovascular disease, metabolic syndrome, history of smoking 3. Diminished blood supply to affected extremities with pulses decreased or absent 4. Early stages: patients exhibit intermittent claudicaction. pain is described as burning, searing, aching, tightness, or cramping. occurs regularly and predictable with walking and is relieved by rest 5. Late stages: patients exhibit rest pain, muscle atrophy, trophic changes (hair loss, skin and nail changes) 6. affects primarily lower extremities

Capital Expense Budget

-Permanent or long term purchases such as an ADL kitchen or for new facilities, such as a new wing for a work hardening program. -Typically any item or action above a fixed amount ($500) is considered a capital expenses -Capital items are separated from other expenses due to the depreciation of value and possible tax credits for purchases and investments

Dependent personality disorder

-Person with this disorder subordinate their own needs to those of others and need other sot assume -Individuals lack self confidence -They may experience discomfort when alone for more than a brief period

Reflex development and integration

-Predictable motor response elicited by tactile, proprioceptive, or vestibular stimulation -Primitive reflexes are present at or just after birth & typically integrate throughout the first year -Persistence/ re-emergence of primitive reflexes are indicative of CNS dysfunction- may interfere w/ motor milestone attainment, patterns of mvmt, musculoskeletal alignment and function

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 1. Potential risks are client or employee injury and property loss or damage with resulting liability and financial loss 2. Occupational therapists are responsible to ensure proper maintenance of equipment and a safe treatment environment 3. Staff education and training (certification/recertification in CPR) is required 4. Effective communication with consumers (informed consent) and with team members is required 5. risk management is an integral part of program evaluation 6. if risk management fails and an incident occurs, completion of an incident report according to settings standards is required

Expressive/creative arts therapist

-Professionals who are graduates of specialized education programs -Depending on the state, they may or may not be licensed or registered. -Includes art, dance/movement, music, horticulture and poetry therapists -Conducts individual and/or group interventions that use select expressive modalities to facilitate self-expression, self-awareness, social skills, symptom reduction and management

Rehabilitation Act of 1973

-Prohibits discrimination on the basis of disability in any program or activity that receives federal assistance -Required all federal agencies to develop action plans for the hiring, placement and advancement of persons with disabilities -Required contractors who received federal contracts over a preset amount to take affirmative action to employ persons with disabilities

An individual has the right to access all of their records (HIPAA)

-Providers can charge reasonable copying costs and have 30-60 days to respond -Individuals have the right to request that information in their record be amended 1. The provider can refuse the request, providing their rationale 2. The provider can comply with the request by documenting the request and the reason for compliance. The original documentation should not be removed/excised.

Extensor digitorum communis (EDC)

-Radial nerve § Origin: lateral epicondyle § Insertion: medial band to middle phalanx and lateral band to distal phalanx § Function: extension of MCP joints and contributes to extension of the IP joints

Extensor pollicis brevis (EPB)

-Radial nerve § Origin: radius, middle 1/3 § Insertion: proximal phalanx of thumb § Function: extension of MCP and CMC joints of thumb

Extensor pollicis longus (EPL)

-Radial nerve § Origin: ulna, middle 1/3 § Insertion: distal phalanx of thumb § Function: extension of IP joint of thumb

Statistical Utilization Review (SUR)

-Reimbursement claims data analyzed to determine most efficient and cost-effective care

Dissemination of research

-Research outcomes that contribute to the professions body of knowledge and advance the provision of evidence and occupation based practice should be disseminated -Dissemination efforts should be consciously planned to target relevant audiences (consumers, OT practitioners, professionals from other disciplines, administrators, payers and policy makers) -Research dissemination can be oral (an inservice to professional colleagues, a conference panel, or poster presentation) and/or written (publication of a critically appraised topic [CAT], critically appraised paper [CAP], or peer reviewed journal article) 1. A CAT is a short summary of the best available evidence on a topic of interest, usually focused on a clinical question (it is shorter and less rigorous version of a systematic review, the AOTA publishes CATs online in the Evidence based practice tools and resources section organized by practice area) 2. A CAP is a summary of the methods, findings and study limitations of a selected individual article. (The AOTA publishes CAPS in the online evidence exchange section)

Function: neuronal signaling

-Resting membrane potential: positive on outside, negative on inside (about -70mV -Action potential: increased permeability of Na+ and influx into cell with out flow of K+ results in polarity changes (inside about +35 mV) and depolarization generation of an action potential is all or none -Conduction velocity is proportional to axon diameter, the largest myelinated fibers conduct the fastest. -Repolarization results from activation of K+ channels -Myelinated axons: many axons are covered with myelin with small gaps (nodes of Ranvier) where myelin is absent; the action potential jumps from one node to the next, termed saltatory conduction; myelin functions to increase speed of conduction and conserve energy Nerve fiber types: - A fibers: large, myelinated, fast conucting 1. Alpha- proprioception, somatic motor 2. Beta- touch, pressure 3. Gamma- motor to muscle spindle 4. Delta- pain, temperature, touch -B fibers: small, myelinated, conduct less rapidly, preganglionic autonomic -C fibers: smallest, unmyelinated, slowest conducting 1. dorsal root: pain, reflex responses 2. Sympathetic: postganglionic sympathetics

Ethical Jurisdiction (SRBs)

-SRBs usually provide a description of ethical behavior. In many instances, SRBs have adopted the AOTA's Code of Ethics for this purpose -By the very nature of their limited jurisdiction (only over practitioners practicing in their state), SRBs can monitor a profession closely -SRBs have the authority by law to discipline members of a profession if the public is determined to be at risk due to malpractice -SRBs also intervene in situations where the individual has been convicted of an illegal act that is directly connected with professional practice (fraud or misappropriation of funds through false billing practices) -Since SRBs are primarily concerned with the protection of the public from harm, they will typically limit their review of complaints to those involving such a threat

Rehabilitation guidelines for lymphatic disease- OT intervention (phase 2)

-Self management and daily home program 1. skin care 2. compression bandages 3. exercise 4. lymphedema bandaging at night 5. MLD as needed 6. Compression pumps: use with caution; limited benefits -education 1. skin and nail care 2. self-bandaging, garment care 3. infection management 4. maintain exercise while preventing lymph overload 5. incorporation of home management program into daily routine

Stages of development of scissor skills, the child sequentially

-Shows an interest in scissors (2-3 years) -Holds and snips with scissors (2-3 years) -Opens and closes scissors in a controlled fashion (2-3 years) -Manipulates scissors in a forward motion (3-4 years) -Coordinates the lateral direction of the scissors (3-4 years) -Cuts a straight, forward line (3-4 years) -Cuts a simple geometric shapes (3-4 years) -Cuts circles (3 1/2- 4 1/2 years) -Cuts simple figure shapes (4-6 years) -Cuts complex figure shapes (6-7 years)

Ulnar nerve laceration

-Sensory loss 1. Ulnar aspects of palmar and dorsal surfaces 2. Ulnar half of ring and little fingers on palmar and dorsal surfaces -Motor loss: low lesion at the wrist 1. palmar and dorsal interossei (adduction and abduction of MCP joints 2. Lumbricals III and IV (MCO flexion of digits 4 and 5) 3. FPB and adductor pollicis (flexion and adduction of thumb 4. ADM, ODM, FDM (abduction, opposition and flexion of 5th digit) Motor loss: high lesion wrist or above 1. Same as above, including FCU (flexion toward ulnar wrist) 2. FDP IV and V (flexion of DIPS of ring and little fingers) -Deformity 1. Claw hand 2. Flattened metacarpal arch 3. Positive Froments sign (assessment of thumb adductor while laterally pinching paper) -Functional loss 1. loss of power grip 2. decreased pinch strength -OT intervention 1. Dorsal protection splint with wrist positioned in 30 degree flexion if a low lesion. Include elbow (90 degree flexion) if a high legion 2. Begin A/PROM of digits with wrist in flexed positions at 2 weeks postopreative 3. Scar management 4. AROM of wrist at 4 weeks, include elbow if high lesion 5. Begin strengthening at 9 weeks -Splinting considerations: MCP flexion block splint -Sensory reeducation: begin when individual demonstrates a level of diminished protective sensation on Semmes- Weinstein

Radial nerve injury

-Sensory loss: high lesions at the level of humerus 1. Medial aspect of dorsal forearm. Radial aspect of dorsal palm, thumb and index, middle and radial half of ring phalanges -Motor loss: low lesion at the level of the forearm 1. Loss of wrist extension due to absent of impaired innervation to ECU 2. EDC, EI, EDM (MCP extension 3. EPB, EPL, APL (thumb extension) -Motor loss: high lesion at the level of the humerus 1. All of the above, including ERCN, ECRL and brachioradialis 2. If level of axilla, loss of tricpes (elbow extension) -Functional loss 1. inability to extend digits to release objects 2. difficulty manipulating objects -Deformity (wrist drop) -OT intervention 1. Dynamic extension splint 2. ROM 3. sensory re-education if needed 4. Instruct in home program 5. Activity modification 6. Neuromuscular electrical stimulation (NMES) to aide in muscle re-education

Pastoral care

-Serves as the spiritual advisor to the individual, their family, caregivers and the team -Provides individual, couple and family counseling in a nondenominational manner

Psychological reaction to disability

-Several Factors influences the individuals reactions to disability 1. permanency of the disability 2. sudden versus chronic onset 3. appraisal of life experiences 4. spiritual beliefs 5. support systems 6. cultural factors Adjustment -active participation in social, vocational and avocational pursuits -successful negotiation of the physical environment -awareness of remaining strengths and assets as well as functional limitations 1. shock 2. anxiety 3. denial 4. depression 5. internalized anger 6. externalized anger 7. acknowledgement 8. adjustment

Neurobehavioral organization (Assessment of the newborn, infant and child)

-Signs of stress or stability -Neurobehavioral subsystems: based on synactive theory of development (subsystems continuously interact with each other and with the environment as evidenced by the infants levels of stress or stability) 1. Autonomic system: physiological instability or stability 2. Motor system: fluctuating tone with uncontrolled activity or consistent tone with controlled activity 3. Emotional state: disorganized, calm, alert 4. Attention-interaction: stress signals upon attempts at attending to stimuli, difficulty shifting attention, focused responsiveness to stimuli, and fluid shifting of attention 5. Self-regulation: ability to self-organize and balance of subsystems -Testing of reflex integration -Muscle tone

Wheelchair Components: casters

-Smaller ones facilitate maneuverability -Pneumatic and semi-pneumatic types available, but solid-core are best for indoors and smooth surfaces -Caster locks can be added for increased stability during transfers

Major Styles and accessories of seating systems

-Solid wood insert prevents hammock effect, provides solid base of support -Solid seat prevents hammock effect, provides stable base of support; easy to remove, can lower seat to floor height -Lumbar back support helps to give proper lumbar curve -Foam cushions of various densities can enhance sitting posture and comfort -Contoured foam cushion enhances pelvic and LE alignment -Pressure relief cushions: 1) fluid (facilitates pelvic and LE alignment; provides pressure relief without changing support; good for individuals who need increased stability) 2) air (minimal postural support offered; provides pressure relief; good trunk control is needed) 3) Alternating pressure cushion provide pressure relief while automatically changing the pressure of the cushion -Wedge cushions or antithrust seats have a front that is higher than the back to prevent the individual from sliding out of their seat -Pelvic guides inserted on the interior sides of the wheelchair at hip level keep hips stable -Lateral supports extend up the side of the chair to just below person's armpits to provide trunk support

Occupational therapy intervention for arthritis

-Splinting: 1) resting hand splints in the acute stage 2) wrist splint only if arthritis specific to wrist 3) ulnar drift splint to prevent deformity 4) silver ring splints to prevent boutonniere and swan neck deformities 5) dynamic MCP extension splint with radial pull for post-operative MCP arthroplasties 6) hand base thumb splint for CMC arthritis -Joint protection techniques -Energy conservation techniques -ROM (focus on AROM): 1) gentle PROM if person unable to perform AROM 2) all exercises should be pain free -Heat modalities: 1) hot packs can be used before exercise 2) paraffin is recommended for the hands -Strengthening: 1) avoid during inflammatory stage 2) gentle strengthening while avoiding positions of deformity -ADL and role activities: 1) joint protection and energy conservation techniques should be incorporated 2) adaptive equipment should be provided to prevent deformity, decrease stress on small joints, and extend reach

Transfer types

-Stand-pivot: individual stands and turns to transfer surface -Pop-over or seated sitting: a full stand position is not required and is used for those with decreased endurance and/or weight bearing precautions -Sliding board for those who are not able to stand to transfer (ie. individuals with spinal cord injuries or amputations): 1) board is placed under individual's gluteal region during a weight shift, while the other end of board is placed on surface being transferred to 2) individual then uses upper extremities to push buttocks up and "slide" over to transfer surface 3) if the individual uses a tenodesis grasp or splint for functional activities, the person should weight bear on clenched fists with wrists extended -Dependent: caregiver is required to fully perform the transfer -Mechanical lift: use of ceiling lift, track lift, Hoyer lift or trans-aid -Use of adaptive or mobility devices: 1) bed transfer aids (trapeze; bedrail) 2) bath transfer aids (grab bars; active-aid commode, a commode with small wheels to allow transfer to bathroom and shower stall when otherwise not possible) 3) beside or 3-in-1 commode 4) ambulatory devices (ie. canes, walkers) 5) wheelchairs (ie. removable arms, swing arms, leg rests) -Chair lifts: chair with power control to allow elevation from surface for individuals who may otherwise not be able to transfer independently

Funding for ATDs and EADLs

-State Vocational and Educational Services for Individuals with Disabilities (VESID), Offices for Vocational Rehabilitation (OVR), and Divisions of Vocational Rehabilitation (DVR) will pay for ATDs and EADLs, if they enable a person to go to work or school -Private companies will fund ATDs and EADLs to ensure ADA compliance -Private insurance, Medicare, Medicaid and Worker's Compensation will possibly reimburse for certain devices

13 to 24 months (Development of sensorimotor integration)

-Tactile perception becomes more precise allowing for discrimination and localization of further refine fine motor skills -Further integration of all systems promotes complexity of motor planning as the toddlers repertoire of movement patterns expands -symbolic gesturing and vocalization promote ideation, indicating the ability to conceptualize -Motor planning abilities contribute to self-concept as the toddler begins to master the environment

Neonatal period (Development of sensorimotor integration)

-Tactile, proprioceptive and vestibular inputs are critical from birth onward for the eventual development of body scheme -Vestibular system, although fully developed at birth, continues to be refined and impacts on the infants arousal level 1. helps the infant to feel more organized and content -Visual system develops as infant responds to human faces and items of high contrast placed approximately 10 inches from face -Auditory system is immature at birth and develop as the infant orients to voices and other sounds

Additional considerations for ATDs and EADLs

-The appliances and electrical cords to be used with ATDs and EADLs must be determined -Charging instructions must be followed, as some have strict schedules -The individual's telephone answering machine should be evaluated to see if it permits ATDs to be attached -The computer abilities of an individual with a disability should be determined -Surge protectors must be used to avoid blown circuits -Back-up systems for electrical high-tech devices should be established -Instruction must be provided to the individual to ensure carry-over when OT is not present -Warranty information should be obtained and the consumer educated about these terms and conditions

Group goals

-The desired outcomes of the group that are shared by a sufficient number of the group's members -The group's efforts is mostly aimed at attaining these goals -Group goals provide focus for the group and guidelines for group activities and interactions -Group goals are not a compilation of individual member goals. Members may have diverse goals but attainment of the group goal will facilitate personal goal achievement -Benefits of member participation in group goal setting: 1) a match between members' goals and group's goal(s) 2) increased understanding of the requirements for achievement of the goal(s) 3) increased appreciation of each member's contribution to achieving group's desired outcomes

Personnel management

-The oversight of OT practitioners and support personnel and the services they provide -Purposes of personnel management: 1) to serve as the link between the individuals working for an organization and the larger organizational structure 2) to attain best practice from personnel

Internal bleeding

-The possible result of a fall, blunt force trauma or a fracture rupturing a blood vessel or organ (severe internal bleeding may be life threatening. Knowledge of the following sings/characteristics of severe internal bleeding is essential to effectively manage internal bleeding and ensure emergency medical care is obtained if needed)

Rehabilitation for lyme disease

-Treat joint pain and swelling: provide education regarding acute arthritic flares 1. rest 2. anti-inflammatory medicine compliance 3. splinting or wrapping to protect inflamed joints and prevent overstretching of enlarged joint 4. teach energy conservation and work simplification -Following flare, in subacute phase, provide gradual reintroduction of normal performance of daily activities -Treat nervous system abnormalities 1. numbness +safety assessment and intervention to preserve safety and prevent injury +management of esthesias that are perceived as painful +occupation-based intervention to encourage and preserve function and to cope with chronic pain conditions 2. pain +used of PAMs to reduce pain + Use of stress management (complementary care) techniques to control the intensity of the pain and to increase coping ability +use of neutral warmth to decreased intensity of pain + use of adaptive techniques to avoid triggering of movements that exacerbate pain during activity (sit on higher seat to decreased stress load in sit or stand)

Palmar interossei

-Ulnar nerve § Origin: · First palmar: ulnar surface of second metacarpal · Second palmar: radial surface of 4th metacarpal · Third Palmar: radial surface of 5th metacarpal § Insertion: · First palmar: ulnar surface of second proximal phalanx · Second palmar: radial surface of 4th proximal phalanx · Third palmar: radial surface of 5th metacarpal § Function: adduct & assist with MCP flexion & extension of IP joints of digits II through V

Education model

-Views the individual with a disability as lacking knowledge or skills -Focus is placed on learning and making the behavioral changes needed to interact successfully in the environment -An individual's skill deficits are determined, and related goals are established, to promote learning to adequately perform within a particular environment -Behaviors are measured in terms of obtaining skills, knowledge, and competency to successfully meet the demands of the environment -OT frames of reference are based on learning theories to facilitate adaptation in the environment (eg. role acquisition, cognitive remediation)

Evaluation of risk factors for falls - intrinsic factors requiring evaluation

-age-related changes in sensory system resulting in reduced sensory capacity 1. vision *presbyopia (decreased acuity) *Reduced night vision means that vision in low light situations is also reduced *impaired depth perception *decreased contrast sensitivity 2. vestibular *vertigo *postural sway combined with vision problems result is a compound risk -Age related changes in the neuromuscular system 1. decrease number of neurons results in decreased response time 2. decreased number of muscle fibers leads to decreased strength and endurance 3. two manifestations of the combination of the previous factors include difficulties in rising from a chair and maintaining gait speed 4. improper transfer techniques can lead to falls -pathological states including congestive heart failure, arrhythmias, hypotension, cerebrovascular disease, Parkinson's disease, arteriosclerosis and atherosclerosis and diabetes mellitus -medication side effects and polypharmacy -delirium and neurocognitive disorders -anxiety and depression -prior history of falls -fear of falling can lead to decreased mobility and progressive deconditioning, which increases the risk of subsequent falls

Managing difficult behaviors: escalating behavior

-avoid what can be perceived as challenging behavior (eye contact, standing directly in front of the person) -maintain a comfortable distance -actively listen -use a calm but no patronizing tone (speaking in a softer or lower than the individual is often effective in decreasing the volume and intensity of the escalating individuals speech) -speak simply, clearly, and directly. avoid miscommunication -do not make or communicate value judgments about he individuals thoughts, feelings or behaviors -clearly present what you would like the person to do (avoid positions where either you or the person feels rapped) -individuals most often calm in response to the above interventions. if an individual continues to escalate and is non-responsive to interventions additional steps are needed to ensure safety 1. remove other patients from the area 2. get or send for other staff

Objective assessment for heart failure (NYHA)

-based on measurements such as electrocrdiograms, stress tests, x-rays, echocardiograms and radiological images. 1. Class A: no objective evidence of cardiovascular disease. No symptoms and no limitations in ordinary physical activity 2. Class B: objective evidence of minimal cardiovascular disease. mild symptoms and slight limitation during ordinary activity. comfortable at rest 3. Class C: objective evidence of moderately severe cardiovascular disease. Marked limitation in activity due to symptoms, even during less-than-ordinary activity. Comfortable only at rest 4. Class D: objective evidence of severe cardiovascular disease. Severe limitations. Experiences symptoms even while at rest

Reactive Attachment DIsorder (RAD) of infancy or early childhood criteria

-childhood is characterized by social neglect or instability/inconsistency of primary caregivers leading to insufficient or frequently changing care that alters the nature of interactions with caregivers

Tasks of later adulthood (Havighurst)

-cope with decreasing physical strength and health -adjust to retirement and reduced income -adjust to death of spouse/partner -affiliate with one's age-group -change social roles -arrange for most appropriate and appealing living environment

Managing difficult behaviors: Hallucinations

-create an environment free of distractions that trigger hallucinatory thoughts and interfere with reality-based activity -use highly structured simple, concrete and tangible activities that hold the individuals attention -when the person appears to be focusing on the hallucinatory experience, attempt to redirect them to reality-based thinking and actions

Skin color and vascular status

-cyanosis: bluish - decreased cardio output or cold (nail beds) -pallor: absence of rosy color in light skinned ppl, PVD -temperature -skin changes: clubbing finger nails, pale shiny dry abnormal pigmentation, ulceration, dermatitis, gangrene. -intermittent claudication: pain, cramping, fatigue occuring during exercise and relieved by rest. -edema

sequelae of obesity

-decreased ability in performance ares of occupations (BADL, IADL, mobility, social participation) -symptomatology related to larger body size musculoskeletal pain, limited community mobility, lower activity tolerance

Important aspects in the development of upper extremity function

-head and trunk control -eye/hand interaction, sensory-perceptual interaction -Shoulder-scapular stability/mobility -humeral control -elbow control -forearm control -wrist control -thumb opposition and stability -palmar arches of the hand -isolated finger control

Classification of injury/signs & symptoms of SCI

-degree of impairment and severity of injury is graded using the ASIA impairment scale A= Complete, no sensory or motor function is preserved in the sacral segments S4-S5 B= Incomplete, sensory but no motor function is preserved below the neurological level and extends through the sacral segments C= Incomplete, motor function is preserved below the neurological level and the majority of key muscle groups below the neurological level have a muscle grade less than or equal to 3/5 D= Incomplete, motor function is preserved below the neurological level, and the majority of key muscle groups below the level have a muscle greater than or equal to 3/5 E= Normal, sensory and motor function are normal

Intellectual developmental disorders: symptom management

-dependent upon presenting symptoms and complications -psychological, audiological and speech evaluations and interventions may be identified -intermittent support may be required in special circumstances

MD diagnosis

-detection is confirmed by blood tests for muscle enzymes or muscle proteins, nerve conduction velocity, electromyography and if indicated muscle or nerve biopsy - blood tests demonstrate a high elevated level of creatine kinase (CK) -common symptoms include hypotonia, muscle weakness and atrophy

Known Genetic Condition (Rett's syndrome): Diagnostic criteria & sequelae

-deterioration of language, receptive and expressive communication and social skills may plateau at a 6 month to 1 year developmental level -motor deterioration is characterized by a loss of purposeful hand movements with development of stereotypical movements, such as hand-wringing and licking, biting and slapping of fingers 1. deterioration of the integrity of the skin results from these repetitive stereotypical movements -muscle tone becomes hypotonic and then progresses to spasticity and then rigidity 1. the result is an ataxic, uncoordinated and stiff gait -muscle wasting can make these children prone to scoliosis and eventually may necessitate the use of a wheelchair -breathing patterns become irregular, marked by hyperventilation, apnea, and holding of breath -regression occurs in cognition and praxis -electroencephalograms are abnormal and seizures are common

Tasks of Adolescence (Havighurst)

-establish relationships with male and female friends of same age, increasing in quantity and quality -develop masculine/feminine social role -become comfortable with & respect changing body -decrease emotional reliance on parents/other adults -prepare for marriage and family life -prepare for economic career -develop a value system to shape behavior or develop one's own philosophy -behave in a socially responsible manner

Sociocultural/human environment

-relationships with persons, groups or populations with whom people have contact

Heart chambers

-four chambers arranged in pairs, functioning as two pumps working in sequence 1. right atrium (RA): receives blood from systemic circulation (from the superior and inferior cava); during systole (contraction) blood is sent into right ventricle 2. Right ventricle (RV): pumps blood via the pulmonary artery to the lungs for oxygenation; the low-pressure pulmonary pump 3. Left atrium (LA): receives oxygenated blood from the lungs and the 4 pulmonary veins; during systole, blood is sent into the left ventricle 4. Left ventricle (LV) pumps blood via the aorta throughout the entire systemic circulation; walls of left are thicker and stronger than right ventricle and form most of the lift side and apex of the heart, the high-pressure systemic pump

Bipolar onset/prognosis

-median age of onset for is 25 years, although the illness can start in early childhood or as late as the 40s and 50s -while the prognosis for repeated recurrence of bipolar and related disorders is poor, recovery is possible 1. early intervention is more effective than later intervention 2. the use of effective medications and interventions based on recovery model have increased the number of individuals with bipolar and related disorders whoa re able to maintain satisfying lifestyles resulting in more favorable overall prognosis 3. minimizing the frequency of episodes helps with recovery

Flexor digitorum profundus (FDP)

-median nerve § Origin: proximal two-thirds of the ulna and interosseous membrane § Insertion: distal phalanx § Function: flexion of DIP joints to digits II and II

Flexor pollicis longus (FPL)

-median nerve § Origin: radius, middle one-third § Insertion: distal phalanx of joint § Function: flexion of IP joint of thumb

Pharmaceutical interventions for heart failure

-medications designed to manage specific aspects of existing cardiovascular function to prevent or decreased the risk of cardiac events and the progression of related disease, drugs aimed at reducing oxygen demand on the heart and increasing coronary blood flow, drugs may be prescribed alone or in combinations

Rehabilitation (sheltered) workshops, supported employment programs, transitional employment programs (TEPs)

-multidisciplinary or interdisciplinary approach is used -real work activities are used 1. participants are pain at a piece-work rate in rehabilitation workshops 2. participants are paid at the prevailing competitive wage for positions in TEPs and supported employment programs -participants are considered as employees with supports provided as needed 1. job coaches used 2. reasonable accommodations are provided -a transition between program participation and competitive employment is provided according to participants functional level -rehabilitation workshops and supported employment can be the final and permanent employment goal for individual -accreditation is not required (rehab workshops, TEPs, and support employment programs are usally part of an accredited hospital system or a major agency [The ARC])

Self-identity skill (mosey)

-the ability to perceive the self as a relatively autonomous, holistic, and acceptable person who has permanence and continuity over time 1. self as a values person (9-12 months) 2. assets and limitations of the self (11-15 yeas) 3. self as self-directed (20-25 years) 4. Self as productive, contributing member of a society (30-35 years) 5. self-identity as an independent individual (35-50 yeas) 6. Understanding the aging process of one's self and eventual death as part of the life cycle (45-60 years)

Ethics Commission of AOTA

-the component of AOTA that is responsible for the Code of Ethics, and the Standards of Practice for the profession -the Ethics Commission is responsible for informing and educating members about current ethical issues, upholding the practice and education standards of the profession, monitoring the behavior of members, and reviewing allegations of unethical conduct -Ethical complaints filed with the Ethics Commission initiate an extensive, confidential review process according to AOTA's established enforcement procedures for occupational therapy Code of Ethics

Operating expense budget

-the daily financial activity of program or service -information on revenue, volume and direct/indirect expenses (direct expense, indirect expense, fixed and variable expenses)

Recovery Model Intervention

-the development and implementation of a Wellness Recovery Action PLan (WRAP) is an essential part of the recovery process -storytelling is a means of decreasing stigma and supporting others by sharing experiential life experiences -advocacy through the dissemination of knowledge, skill development in activism and forming support groups to prevent discrimination and improve acceptance in society

Personality disorders impact on function

-the type and degree of impact on areas of occupation, personal relationships and daily life depend on the severity and type of personality disorder

Antisocial personality disorder

-this disorder is characterized by continual antisocial or criminal acts, but it is not synonymous with criminality -It is an inability to conform to social norms that involves many aspects of the individuals adolescent and adult development -Persons with this disorder have no regard for the safety or feelings of others and they lack remorse -Individuals diagnosed with a conduct disorder that does not respond to treatment or is untreated can be a precursor to developing this disorder

Purpose of fiscal management

-to ensure cost-effective services and programs are planned and implemented -to meet the demands of managed health-care system -to remain competitive in a market-driven practice environment

Purpose of program evaluation

-to measure the effectiveness of a program; that is, were program goals are accomplished -to use information obtained in the evaluation to improve services and assure quality -to meet external accreditation standards -to identify program problems/limitations and to resolve them

Infarction sites (MI)

-transmural (Q-wave infarction), full thickness of myocardium -nontransmural (non-Q wave infarction), subendocranial, subepicardial, intramural infarctions -coronary artery occlusion 1. inferior MI, right ventricle infarction, disturbances of upper conduction system: right coronary artery 2. Lateral MI, ventricular ectopy: circumflex artery 3. Anterior MI, disturbances of lower conduction system: left anterior descending artery

Arteries

-transport oxygenated blood from the areas of high pressure to lower pressure in the body tissue -arterial circulation maintained by heart pump -Influenced by elasticity and extensibility of vessel walls, peripheral resistance and amount of blood in body

Mobility assessment

1) Bed mobility 2) transfers 3) wheelchair mobility 4) ambulation status

Discharge criteria from work programs

1) Individual exhibits limited potential for improvement 2) Individual has declined services 3) Individual is non-compliant with the program 4) Individual has met program goals 5) Individual has returned to work

Reaching skills (development of hand skills)

1) visual regard with swiping/batting with closed hand and abducted shoulder (New Born) 2) hands together at midline - bilateral reaching with shoulders abducted with partial internal rotation, forearm pronation and full finger extension (4 months) 3) increased dissociation of body sides - unilateral reaching with less abduction and internal rotation of the shoulder and the hand is more open (6 months) 4) trunk stability improves shoulder flex/ ext rot, elbow ext, forearm supination, wrist ext emerge (9 months)

Qualitative Methodology

1. A form of descriptive research that studies people, individually or collectively, in their natural social and cultural context 2. A systematic, subjective approach to describe real-life experiences and give them meaning 3. It is rich in verbal descriptions of people and phenomena based on direct observation in naturalistic settings 4. The process of the study is considered as important as the specific outcome state 5. Types of qualitative research -phenomenological, ethnographic, heuristic, case study 6. To attain rigor in qualitative research the trustworthiness of a study should be critiqued and strategies to increase trustworthiness should be employed. Trustworthiness criteria includes (Credibility, transferability, dependability, confirmability)

Feeding/Eating disorders impact on function

1. ADLs such as self-care, eating and feeding can be severely disrupted 2. IADLs such as shopping for clothing and good, meal preparation an cleanup and health management and maintenance can be significantly affected 3. Work skills can be intact unless food-restriction behaviors or medical problems interfere with work performance or prevocational/vocational skill development -focus on weight control may interfere with pursuits of vocational goals and the development of prerequisite skills 4. leisure skills can be intact unless affected by food restricting behaviors or medial complications -activities may focus mainly on appearance, rather than on those that have meaning or purpose -exercise activities previously done for fun (running, swimming, cycling) may now be done excessively without enjoyment to decreased weight 5. social participation (including family, community and friends) can be greatly impacted by the excessive use of food restricting behaviors, the need to maintain secrecy about the behaviors and feeling ashamed, guilty, embarrassed and depressed about atypical and disturbed eating habits and patterns

Lennox-Gastaut syndrome

1. Children with severe seizures, intellectual disability and specific EEG pattern 2. Seizures of different types begin during the first 3 years of life and are difficult to control 3. Associated with various brain disorders from structural abnormalities to birth asphyxia 4. a regression of developmental status can occur in some cases

Adhesive Capsulitis

1. Also known as frozen shoulder 2. Restricted passive should range of motion (greatest limitation is external rotation, then abduction, internal rotation and flexion) 3. Anatomy: glenohumeral ligaments and joint capsule 4. etiology -inflammation and immobility -Linked to diabetes mellitus and Parkinson's disease 5. OT conservative intervention -encourage active use through ADL and role activities -PROM -Modalities 6. Surgical interventions: manipulation and arthroscopic surgery 7. OT postoperative intervention 1. PROM immediately following surgery 2. Pain relief: modalities 3. Encourage use of extremity for ADLs and role activities

Bipolar and related disorders overview

1. Bipolar and related disorders are diagnosed based on the incidence of manic, hypomanic, or major depressive episodes 2. mood episodes are not coded diagnoses in and of themselves 3. treatment addresses the symptoms of the episode experienced by the person -interventions will vary with shifts in mood

limbic system

1. Consists of the limbic lobe (cingulate parahippocampal and subcallosal gyri), hippocampal formation, amygdaloid nucleus, hypothalamus, anterior nucleus of thalamus 2. Phylogenetically oldest part of the brain concerned with instincts and emotions contributing to preservation of the individual 3. Basic functions include feeding, aggression, emotions, endocrine aspects of sexual response and long-term memory formation

Home Management Intervention

1. Determine the home management expectations and demands of the individual's current and expected environment -Supportive living environments can range in expectations from requiring that a resident only clean his/her room (eg. in a group home) to complete management of a home with minimal supervision (eg. supported apartment) -Independent living environments can also have a range of expectations and demands (eg. only wife does the budget, only husband cooks) 2. Determine whether the home management activity should be modified to enable independent performance, self-directed performance with external assistance, or eliminated -Activities that are valued, meaningful and enjoyable to the person and related to desired role performance should be modified for individual performance, with appropriate supports provided as needed (eg. preparing after school snacks for children) -Activities that are difficult to perform and/or are not enjoyable should be eliminated or performed with the assistance of others (eg. cleaning a refrigerator can be delegated to another person, or a self-cleaning oven can eliminate a task 3. Recommend adaptive strategies for home management task performance 4. Provide adaptive equipment to compensate for functional impairments during home management activity performance 5. Train in safe use of adaptive equipment and assistive technology 6. Teach principles and methods of energy conservation, work simplification, joint protection, and proper body mechanics 7. Provide cues and assistance as needed: verbal reminders and prompts; nonverbal gestures, written directions, physical prompt to initiate; physical hand-over-hand assistance through complete activity movement; visual supervision to ensure safety with minimal or no verbal or nonverbal cues 8. Practice to attain proficiency in activity performance at appropriate times and in real environments (eg. cooking a meal in a kitchen at lunchtime) 9. Recognize and respect personal, sociocultural, and socioeconomic differences (eg. standards of cleanliness, dietary restrictions and preferences) -Use equipment that is socioeconomically appropriate (eg. do not use an oven to teach meal preparation if someone only uses a hot plate) 10. Use thematic and topical groups to develop needed skills (eg. cooking group, money management group) 11. Modify environment to maximize performance and ensure safety 12. Educate and train caregivers to provide needed cues, physical assistance, and/or supervision 13. Refer to relevant social service programs (eg. food stamps, home energy assistance program HEAP) 14. Refer to appropriate supportive living environment if independent living is not attainable (eg. group home, halfway house, supported apartment)

Esophagus

1. Food or liquid normally enters the esophagus during a swallow 2. the upper esophagus sphincter (UES) is a bundle of muscles at the top of the esophagus -the muscles of the UES are consciously controlled and used when breathing, eating, belching and vomiting

Formal operations, ages 11 through the teen years

1. Hypothetical-deductive thinking, the ability to analyze and plan 2. 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

Four basic steps of program development

1. Needs assessment 2. Program planning 3. Program implementation 4. Program evaluation

Rehabilitation guidelines for lymphatic disease

1. OT evaluation tools and foci -occupation-based assessments to determine impact on occupational performance -Biomechanical assessments: UE ROM and MMT, pain, activity tolerance, endurance and edema * measurement of lymphedema swelling circumferential girth measurement (volumeter is the best objective measurement tool, the time of day when measurements are taken should be recorded)

Home evaluation general considerations

1. OTs perform home assessments and make adaptations, modifications and recommendations to the anticipated dwelling to increase safe, independent functioning 2. if an individual with a disability is to be discharged to home from a facility the on-site home evaluation should be done before the discharge date 3. the person's current status (abilities and limitations) will drive the need for modification

Evaluation Guidelines

1. Occupational profile (top-down approach-consider areas of occupation first) 2. Assess client factors, performance skills, patterns/contexts and activity demands (identify strengths/limitations) (based on the results of screening, this warrants further evaluation) 3. Occupational performance assessment tools include interviews, checklists, task performance, rating scales and standardized assessments

Work conditioning program characteristics

1. One discipline provides services 2. Real or simulated work activities 3. Transition between acute & return to work 4. Addressed: flexibility, strength, movement, & endurance 5. No accreditation required

Occipical lobe

1. Primary visual cortex: receives/processes visual stimuli 2. Visual association cortex: processes visual stimuli

Symptom management: personality disorder

1. Psychotherapy and certain medication may reduce symptomatology for some patients 2. Dialectical behavior therapy (DBT) has demonstrated success in the treatment of borderline personality disorder 3. monitoring, supervision and hospitalization may be required during periods of increased symptoms and aggressive or self-destructive behavior

Specific Symptoms of SCI

1. Spinal shock (4-8 weeks), all reflex activity is obliterated below the level of the injury presenting as flaccid paralysis 2. Sensory deficits may be partial loss or complete 3. Loss of bowel/bladder control 4. Loss of temperature control below the lesion 5. Decreased respiratory function 6. Sexual dysfunction 7. changes in muscle tone: spasticity in upper motor neuron lesions and flaccidity in lesions below L1 8. Loss of motor function resulting in tetraplegia (quadriplegia) or paraplegia; may be complete or incomplete

Artifact and record review

1. Used to gather information in all types of research 2. May be the sole data collection method in historical research 3. a review of written records can include medical records, publications, letters and/or minutes of meeting and conferences 4. A review of artifacts may include physical items such as personal objects in a persons home adaptive equipment and/or audiovisuals

Denial (death and dying)

1. a coping strategy that allows the individual to refuse to accept or address the reality of their illness 2. denial may lead to the individual to see many health professionals hoping to find the one who will give a different prognosis 3. denial may be a response to the denial or discomfort experienced by others 4. denial will end when the individual is psychologically prepared to face the reality of the situation 5. OT intervention includes allowing the person to ask questions and discuss the situation at their own pace

Prevention is the most effective treatment for all wound types

1. Use of a wheelchair cushions, flotation pads, and pressure relief bed aids to distribute pressure over a larger skin surface. the Centers for Medicare and Medicaid services as divided pressure reducing devices into 3 categories for reimbursement purposes -Group 1: cousins or mattresses that use nonelectrical means (air, foam, gel or water) to distribute pressure -Group 2: dynamic, electric-powered devices (alternating and low air loss mattresses) for persons with full thickness ulcers or those at moderate to high risk -Group 3: dynamic, electric-powered devices (air-fluidized beds) for persons with nonhealing full thickness ulcers 2. Train the individual/caregiver in positioning and weight shifting techniques and schedules -full push-ups, lateral leans, forward leans, or wheelchair tilt/recline options are common techniques used depending on the abilities of the individual -weight shifts should occur every 30 minutes for 20 seconds or every 60 minutes for 60 seconds -integrate weight-shifting into daily activities (lean forward to pick up the phone, lean sideways when reading the mail) (the presence of substance abuse, cognitive deficits and psychological impairments can jeopardize the individuals ability to understand and complete the required daily wound prevention regimen, increasing their risk for the development of wounds) 3. Train the individual/caregiver in proper skin care -keep skin free of excessive moisture, dryness and heat -check sin at leaast 2 times per day for any evidence of breakdown. most individuals perform this in bed in the morning before arising and in the evening before sleep -target for inspection of the scapula, elbows, ischia, sacrum, trochanters, heels, ankles, and knees when checking for pressure sores 4. encourage adequate intake of fluids and food to maintain nutrition, promote healing and achieve a recommended body weight

Adjustment

1. an emotional acceptance of the situation and reintegration into identified roles 2. characterized by a positive sense of self and potentialities and achievement of meaningful goals

Consumer/family/caregiver education (teaching method)

1. an organized systematic approach to formally present information to increase knowledge 2. the nature of the illness or disease, including etiology, signs and symptoms, functional implications, prognosis and intervention are explained 3. the maintenance of tools and occupational performance is emphasized 4. Methods for the prevention of secondary problems are provided 5. Community resources and supportive services are explored with appropriate referrals made

Architectural Barriers

1. architectural features in the home and the community make negotiation of space difficult ot impossible may require modifications to allow accessibility (steps, narrow doors) 2. Modifications should be made according to established standards such as the international code council

Acceptance of death and dying

1. as the individual recognizes impending death, they begin to make plans and think about the future for self and family 2. it may be a time of peace without fear or despair 3. as time goes on, the need to communicate diminishes 4. OT intervention is to provide ongoing support to the individual and family

Selected seizure syndromes: infantile spasms or west syndrome, infantile myoclonic seizures or jackknife epilepsy

1. begins at 3 to 9 months of age 2. dropping of the head and flexion of the arms occurs 3. seizures may occur hundreds of times per day 4. prognosis is generally poor 5. spasms sometimes decrease after several years, but they are often replaced by other seizure disorders 6. the seizures often indicate and underlying disorder such as tuberous sclerosis

Spinal Muscular Atrophy (SMA)

1. caused by a decrease of a motor neuron protein called Survival of Motor Neuron (SMN), Chromosome 5 2. weakness of the voluntary muscles of the shoulders, hips, thighs and upper back which can result in spinal curvatures 3. muscles for breathing and swallowing can be affected 4. the earlier the age of diagnosis the greater the severity of functional deficits and the shorter the life expectancy -Type I, birth or infancy: the infantile form know as Werdnig-Hoffman disease has a life expectancy up to approximately two years of age -Type II children: the intermediate form is detected 6 months to 3 years of age and progresses rapidly with a life expectancy of early childhood -Type III older children: later onset, less severe form -Type IV adolescent or adult: later onset, less severe form

Disruptive, impulse-control and conduct disorders: impact on function

1. children with these behavior disorders have difficulty at school and with the formation of healthy social and familial relationships 2. Difficulties within the family affect not only the child but all family members, impacting their role performance

Diagnostic criteria for seizures

1. clinical observation of the obvious manifestations associated with the specific seizure disorder 2. The EEG alone is not sufficient to diagnose a seizure disorder since the disorder does not always show up on the EEG, conversely abnormal EEG patterns may appear when there is not clinical evidence of seizure

Performance context evaluation for neurological system disorders

1. cultural barriers 2. architectural barriers 3. societal limitations -financial barriers, stigma 4. home evaluation 5. school/work site evaluations

OT mental health evaluation focus

1. determination of values, interests, desired occupational roles, and self-determined goals 2. identification of cognitive, perceptual and psychosocial strengths and skills and their ability to facilitate recovery 3. identification of cognitive, perceptual and psychosocial deficits and limitations and their impact on function and lifestyle 4. determination of functional problems associated with psychiatric symptoms (safety awareness and judgement) 5. Treatment history and ability and interest to engage in recovery (readiness of change) 6. Identification of coping skills, stressors and environmental and social supports

Evaluation of client factors and performance skills for neurological system disorders

1. determine sensory and motor dysfunction and strengths -extent of paralysis/weakness -severity and distribution of spasticity -gross and fine motor coordination loss -evaluation of sensory modalities: light touch, pain, pressure, propriocpetion, kinesthesia, temperature, gustatory, olfactory, auditory -postural control evaluation -ROM testing -MMT -skin integrity 2. Determine cognitive/perceptual dysfunction and strengths -evaluation of foundational visual skills: acuity, visual fields, ocular range of motion, accommodation, pursuits, saccades -Evaluation of pervasive impairments: decreased arousal, decreased alertness, loss of selective/sustained attention, concrete thinking, decreased insight, impaired judgement, confusion, disorientation, language dysfunction, impaired motivation, and impaired initiative -Evaluation of the impact of specific deficits on basic and instrumental ADLs and mobility including apraxia, spatial neglect, body neglect, perseveration, spatial relations dysfunction, various agnosias, organization and sequencing dysfunction and memory loss 3. Determine psychosocial dysfunction and strengths -evaluation of emotional/affective disturbances: liability, euphoria, apathy, depression, aggression, irritability and frustration tolerance -coping mechanisms -adaptation to change in occupational role functioning or to difficulty in assuming occupational roles

Additional loss of sensation with pathology

1. diabetes, peripheral neuropathy 2. CVA, central sensory losses 3. Peripheral vascular disease, peripheral ischemia

Deficits in Tactile Discrimination

1. difficulty interpreting tactile info in a precise and efficient manner -Impaired body scheme and somatodyspraxia (a disorder in motor planning due to poor tactile perception and proprioception) -Awkwardness in fine and gross motor tasks and impaired manipulation skills, visual perception, and eye-hand coord -Hinders ability to learn about properties and substances 2. Difficulty with localizing tactile stimuli -impaired streognosis and decreased fine motor and eye-hand coordination skills may be demonstrated in difficulties with writing and cutting with a scissors and knife

Occupational therapy interventions for wounds

1. encourage participation in meaningful and productive activities 2. individuals who pursue active lifestyles have fewer decubiti

Cardiopulmonary analysis of occupational performance

1. identify the impact of presenting symptoms on occupational performance through the client interview and observation of performance 2. pain/angina: note location, severity, type 3. Dyspnea (shortness of breath): not severity, position, or times at which discomfort is experienced 4. fatigue/perceived exertion: note severity, time of occurrence, association with activities 5. Palpitations: note person's awareness of heart rhythm abnormalities including pounding, fluttering, racing heartbeat, skipped beats 6. Dizziness: note time of occurrence and association with postural changes during activity 7. Edema -fluid retention may be identified by swelling especially in the lower extremities or sudden weight gain -note location, measurement, time of day when edema is most prominent, resolution with activity

Vital Signs

1. important and reliable indicator of activity/tolerance response to evaluation and treatment -must be monitored before activity, during activity, and after activity, to ensure compliance with parameters (possible side effects of medications must be reviewed and taken into account when monitoring vital sings)

Facial Paralysis

1. incomplete closure of mouth 2. loss of the bolus out of the front of the oral cavity

Stage III pressure ulcer

1. involves full thickness tissue loss with subcutaneous fat possibly visible 2. the depth of tissue loss is not obscured if slough (dead matter/necrotic tissue) is present 3. Bone, tendon, or muscle are not exposed or directly palpable 4. The depth of pressure ulcer can vary according to anatomical location and can range from shallow in areas that do not have subcutaneous tissue (the nose or ear) to very deep areas with significant fat (buttocks)

Procedural reasoning/scientific reasoning (type of clinical reasoning)

1. involves identifying OT problems, goal setting and treatment planning 2. involves implementing treatment strategies via systematic gathering and interpreting of client data 3. the actual technical doing of practice 4. the resining that is documented the most fo reimbursement purposes.

Stage II pressure ulcers

1. involves the dermis with partial thickness loss, which presents as a shallow open ulcer that can be shiny or dry 2. can also present as a blister that is intact or open/ruptured 3. the wound bed is red/pink color without slough or bruising

Manic episode diagnostic-specific considerations for OT

1. limit setting to set and improve boundaries, reduce the individuals fears of losing control, increase participation in the intervention process ad promote safety 2. engagement in activities that provide structure and the opportunities for release of excess energy in a positive and therapeutic manner 3. periods between episodes should be used to educate the individual, the family and significant others on symptom management

Pressure relief cushions: air

1. minimal postural support offered 2. provides pressure relief 3. good trunk control is needed

Hypertrophic scar

1. most common with deep second and third degree burns 2. Appears 6 to 8 weeks after wound closure 3. one to two years to mature 4. Compression garments should be worn 24 hours daily -applied when wounds are healed -recommendation is to wear 24 hours a day for one to two years until scar is matured 5. Additional interventions include ROM. skin care, ADLs, role activities and patient/family education

OT evaluation in sensory processing disorders

1. parent/caregiver interview regarding medical and developmental history 2. Teacher interview regarding school performance, play and behaviors (Sensory Processing Measure [SPM]) 3. Formal assessment of sensory processing (the sensory profile) 4. Informal observations of performance and behavior in a variety of settings (classroom, playground, home and work) 5. Formal assessment of clinical observations using Ayres unpublished and nonstandardized tools -items observed include specific reflexes, crossing body midline, bilateral coordination, muscle tone 6. standardized tests for tactile processing, vestibular proprioceptive processing, visual perception, practicability and their impact on occupational functioning

General considerations for death and dying

1. people vary in the way they go through each stage 2. they may stop at any stage 3. the needs of loved ones must be considered as they are likely going through stages similar to the dying individual 4. OT should assist the individual in coping with each stage without pushing for progression to the next stage

General Intervention and treatment guidelines for Neurological system disorders

1. positioning -seating and wheeled mobility prescription -bed positioning -pressure reduction and pressure relief techniques 2. postural control training for seated and standing activities 3. motor learning approaches 4. motor control retraining/relearning for functional integration of affected limbs 5. Specific ADL training/retraining/adaptation 6. Prescription of assistive devices and technology 7. Splinting for contracture prevention and/or enhancement of function (tenodesis splint) 8. Family/caregiver education 9. Cognitive-perceptual retraining/compensation in the context of functional activities 10. visual skills retraining and/or adaptation (visual occlusion for diplopia) 11. intervention for sexual dysfunction 12. Bowel and bladder training with adaptive techniques and equipment 13. skin care education 14. Durable medical equipment prescription 15. sensory re-education, compensation and safety training for those without return of sensation 16. assistance with the development of coping strategies 17. community re-integration 18. return to work or work hardening programs for adults 19. collaboration with educational team for children

Medical management for SCI

1. prevention of further cord damage via stabilization 2. traction and rest for unstable injuries 3. surgery with internal and external fixation 4. diuretic prescription to decreased inflammation 5. bladder care 6. decubiti prevention 7. control of autonomic dysreflexia and orthostatic hypotension 8. prevention of thrombus formation 9. treatment for heterotopic ossification

Landau-Kleffner Syndrome or acquired epileptic aphasia

1. progressive encephalopathy 2. loss of language skills 3. auditory agnosia (inability to distinguish different sounds) 4. Behavioral disturbances such as inattention

Symptom management of anxiety

1. psychotherapy to explore psychdynamic issues 2. cognitive behavioral therapy to develop skills to manage symptoms 3. several types of meducations may be helpful depending on the specific disorder -anxiolytic medications include Xanax, Valium, Ativan, Klonopin, Serax and Buspar *side effects include drowsiness, ataxia, heachaches, nausea, depression and dependence -antidepressant medications are helpful in some cases -In some cases hypnotic medications include Restoril, Dalmane, Ambien and Benadryl *side effects are similar to those of anxiolytics

Pediatric seating systems and positioning devices

1. purpose -accommodate for contractures and deformities -enable function in home, school and community settings -facilitate eye contact and parent/teacher/sibling/peer interactions -attain general positioning goals as previously stated 2. types -usually custom-molded created systems -standers provide weightbearing experience that maintains hips, knees, ankles, and trunk in optimal position, facilitates formation of acetabulum and long bone development and aids in bowel and bladder function (1) prone standers decrease effect on tonic labyrinthine reflex (2)supine standers provide more support posteriorly -sidelyers decrease effects of TLR and put hands in visual field -triwall construction for infants adn toddlers -abductor pads at hips decrease scissoring extensor pattern

Diagnostic-Specific Considerations for OT with anxiety

1. skills training and using cognitive behavioral approaches may reduce anxiety and avoidant behavior 2. developing relaxation and stress management skills may decrease the incidence and severity of symptoms 3. providing graded activities designed to promote self-efficacy may increase self-confidence, motivation and participation in intervention 4. using systematic desensitization which involved incremental exposure in attempts to diminished anxiety related to specific fears through the use of imagery and relaxation and then contact with the image or actual objects -use most often with phobic disorders and requires special training

Stage I pressure ulcer

1. skin is intact with visible nonblanchbale redness over a localized area, typically over bony prominence 2. visible blanching may not be evidence in darkly pigmented skin the color may appear different from the surrounding area 3. the area may be soft or firm and or cooler or warmer when compared to adjacent skin 4. the area may be painful or itchy (A stage I pressure ulcer may indicate at risk persons, but its signs can be difficult to detect)

acknowledgement

1. the first step toward acceptance of the situation 2. characterized by acceptance of a new self-concept and the identification of values and goals

Major depressive disorder

1. the presence of one or more major depressive episodes

CVA diagnosis

1. usually diagnosed clinically using symptoms as a guide to lesion location 2. Infarction visualized via computerized axial tomography (CT) scan (may initially read as negative) 3. Arteriography 4. Position emission tomography (PET)and single photon emission computerized tomography (SPECT) scanning to distinguish between infarcted and noninfarcted tissue 5. Magnetic resonance imaging (MRI) to rule out other conditions and screen for acute bleeding 6. Diagnostic testing -transcranial and carotid Doppler for noninvasive visualization of plaque or occlusion of the cerebral vessels -Electrocardiogram (ECG) to detect arrhythmias -Echocardiography to evaluate presence of cardiac emboli and cardiac disease -Blood work to rule out metabolic abnormalities

Osteogenesis Imperfecta (OI)- OT intervention

1. weighbearing activities to facilitate bone growth 2. Activity adaptation and assistive device prescription and fabrication to facilitate safe participation in daily occupations 3. Environmental modifications to maintain safety 4. Preventitive positioning and protective splinting/padding 5. Activities to increase muscle strength 6. Health education to promote a healthy lifestyle -healthy diet and weight control -avoid smoking, caffeine, alcohol, steroids -exercise: swimming, water therapy, walking 7. family caregiver and teacher education about proper handling, positioning, activity adaptations, environmental modifications, and the need to observe all safety precautions

Diagnosis code

A code that describes a patients medical reason or condition that requires health service

Herpes Zoster (Shingles)

An acute, painful mono-neuropathy caused by the varicella-zoster virus. - Char. by vesicular eruption and inflammation of post. root ganglion of affected spinal nerve or sensory ganglion of cranial nerve - Infection can last 10 days- 5 weeks; pain may persist for months -Pain may persist for months (postherpetic neuralgia)

Bedside Swallow Evaluation

Assess- -Level of alertness, ability to follow directions, level of awareness of impairment, orientation to activity -sensory and motor components of swallowing -ability to manage own secretions -clinical observations of person -swallowing function during trial boluses 1. suggest diet modification as indicated 2. recommend further testing if needed

Web space burn

C-splint

Insula

Deep within lateral sulcus, associated with visceral functions

Direct supervision

Face to face contact between supervisor and supervisee -includes co-treatment, observation, instruction, modeling and discussion

Coping skills group

Focus on identifying problem-solving and stress-management techniques needed to cope with life stress.

Evaluation of risk factors for falls- Extrinsic factors requiring evaluation

General 1. floors: slippery or uneven presence of throw rugs 2. trip hazards, including clutter on floors/stairs, pets, elevation changes, thresholds, throw rugs, extension cords, and high-pile carpets 3. low-lying furniture 4. stairs: excessive steepness, lack of loose handrails 5. improper footwear 6. poor lighting or glare 7. use of furniture or other unstable objects for support 8. problems with adaptive equipment or lack of needed equipment Bathroom 1. no grab bars 2. utilization of unstable soap dish or towel bar 3. toilet seat too low 4. wet floor surfaces 5. utilization of wet sink surface for support Kitchen 1. low cabinet doors open 2. step stool without handles 3. chairs pulled out Bedroom 1. bed too high or too low 2. reaching into closets Living rooms 1. wires and clutter across floor 2. chairs too high or too low

Postoperative rehabilitation for cancer

Intervention planning based on medical status and blood value guidelines; precautions related to structural change from surgery (postoperative precautions related to structural changes from surgery must be followed. These will be dependent on the location of the tumor and procedure done; for example. abdominal precautions when the tumor is in the abdominal cavity and regional precautions when there is an incision near a joint)

management of internal bleeding

Minor: follow R I CE procedure (rest ice compression elevation) Major: seek advanced medical personnel, monitor ABCs and vital signs; keep comfortable and quiet; prevent from getting killed or overheated; reassure; administer supplemental oxygen if available and nearby

OT in home care is covered IF the individual is HOMEBOUND and needed intermittent skilled nursing care, PT, or ST BEFORE OT BEGAN.

OT services can continue after need for skilled nursing, PT, or ST has ended -An initial assessment visit and a comprehensive assessment using the Outcome and Assessment Information Set (OASIS) must be completed to verify the person's eligibility for Medicare home health benefits, to verify the continuing need for home care and to plan for the persons nursing, medical, social, rehabilitative and discharge needs 1. Occupational therapists can complete the initial OASIS if the need for OT establishes program eligibility 2. The initial assessment must be completed within 48 hours of referral or within 48 hours of the persons return home 3. Occupational therapists can conduct follow up, transfer and discharge evaluations -the AOTA is actively working to change federal legislation to have OT identified as an initially qualifying service for home health care, so barriers to OT home health services may be removed in the future

signs and symptoms of shock

Pale, gray, or blue, cool skin Increased weak pulse Increased respiratory rate Decreased blood pressure Irritability or restlessness Diminishing level of consciousness Nausea or vomiting

T test

Parametric test of significance used to compare two group means and identify a difference at a selected probability level (.05)

Paraprofessional team members and role responsibilities

Personal Care assistants (PCAs)/home health aides (HHAs) -Individuals who provide primary care to enable a person with a disability to remain in his/her own home -Most states require some minimum training and certification as a PCA/HHA. Standards and educational requirements can vary greatly from state to state -Due to the tremendous importance this role has in maintaining a person with a disability in their own home, OT practitioners collaboration wit PCAs/HHAs is critical -OTs can educate and train service recipients and/or their family members/caregivers on the hiring, training, and supervision of PCAs/HHAs. Responsibilities 1. personal care such as bathing, grooming, dressing and feeding 2. Home management such as shopping, cleaning and cooking 3. Supervision of home programs as directed by a health-care professional (therapist, nurse)

Fidelity

Principle 6: OT personnel shall treat clients, colleagues and other professionals with respect, fairness, discretion and integrity

Inferior scissors grasp

Raking object into palm with adducted, totally flexed thumb and all flexed fingers or two partially extended fingers (7 months)

D2 Flexion

Scapula adducted, downwardly rotated Shoulder extended, abducted, IR Elbow extended and forearm supinated Wrist extended towards radial side Fingers extended, abducted eg. pulling up seatbelt from starting position

D1 Flexion

Scapula: Abducted and upwardly rotated Shoulder: Flexed, adducted, externally rotated Elbow: :SLightly flexed Forearm:Supinated Wrist: Flexed toward radial side Fingers: Flexed, adducted Thumb:Flexed, adducted

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

Advisory leadership

Takes place when the OT practitioner functions as a resource to the members, who set the agenda and structure the group's functioning: 1) this style is assumed when members' skills and engagement are high (eg. mature groups) 2) members select and complete the group's activity with leader's advice, if needed 3) group maintenance roles are independently assumed by group members 4) feedback occurs as a natural part of the group's self-directed process 5) the advisory leader's goal is to have members understand and self-direct the process

Group Decision Making

The process of agreeing on a resolution to a problem. The solution may be obtained through different processes -Unanimous decision in which all group members agree -Consensus in which members agree to the majority's decision but retain the right to reconsider their decision -Majority rule in which the majority's decision is accepted with no reevaluation of the decision by members -Compromise in which a combination of different points of view results in a decision that is different from each distinct point of view

Clinical/critical pathway

a standardized recommended intervention protocol for a specific diagnosis

Managed care

a method of maintaining some control over costs and utilization of services while providing quality health care. managed care organizations (MCOs) include HMOs and PPOs

Proprioceptive processing disorder manifestations

a. Deficits in modulation b. Discrimination deficits demonstrated by poor awareness of position of body, body parts and body schema c. clumsiness, awkwardness d. Distractibility e. Motor planning and movement difficulties f. Reliance on visual cues or other cognitive strategies to motor plan, guide movements, and perform tasks g. Use of too much or too little force e.g., stomping when walking, breaking objects unintentionally h. Poor awareness of personal space i. seeks heavy resistance and pressure

Third Party payers

agencies and companies who are the primary reimburses for health care in the United States (Blue Cross). HMOs and PPOs are also third-party payers

Passive-Aggressive

aggression towards others which is indirectly or unassertively expressed (a person is late for a treatment session when they are angry with the practitioner)

Psychomotor

agitation is excessive motor and cognitive activity, usually nonproductive and in response to inner tension -retardation is decreased or slowed motor and cognitive activity

Delirium

an acute, reversible disorder that presents as a disoriented reaction with confusion, lability and disturbances in behavior (aggression) 1. it may be associated with fear and hallucinations

Social roles

an organized pattern of behavior that is characterized and expected of the occupant of a defined position in a social system (student, worker, parent)

Pincer grasp

between distal pads of thumb and index finger, distal thumb joint slightly flexed, thumb opposed (10 months)

chronic venous insufficiency

characterized by chronic leg edema, skin pigmentation changes, scaly appearance, itchy

Cyclothymic disorder

characterized by several periods of hypomanic and depressive symptoms which do not meet the criteria for a manic, hypomanic, or major depressive episode, lasting for at least 2 years

Planned actions-Level VI

characterized by the absence of disability. The person can think of hypothetical situations and do mental trial-and error problem solving

Atelectasis

collapsed or airless alveolar unit, caused by hypoventilation secondary to pain during the ventilator cycles (due to pleuritis, postoperative pain, rib fracture), internal bronchial obstruction (aspiration, mucus plugging) external bronchial compression (tumor or enlarged lymph node) low tidal volumes (due to narcotic overdose, inappropriately low ventilator setting) or neurogenic insult

ADHD subtypes

combined presentation predominantly inattentive presentation predominantly hyperactive/impulsive presentation -Onset: symptoms are noted during toddler years, usually by age 3 (caution is advised to not make a diagnosis in early childhood years, diagnosis is most often made during elementary school years when behavior interferes with adjustment to school)

thalamic pain

continuous, intense pain occurring on the contralateral hemiplegic side; the result of a stroke involving the ventral posterolateral thalamus; poor rehab potential

Concentrated marketing

design and use of specific marketing strategies and activities to concentrate on one market segment (older adults)

Loosening of associations

disorder of the logical progression of thoughts where seemingly unrelated and unconnected ideas shift from one subject to another

Chest x-ray (heart failure)

done to evaluate evidence of congestion in lungs, heart chamber hypertrophy, and structural abnormalities -Diagnostic procedures

Meniere's disease

episodic attacks characterized by tinnitus, dizziness, and a sensation of fullness or pressure in the ears; may also experience sensorineural hearing loss Additional loss of vestibular sensitivity with pathology

Raynaud's phenomenon

episodic spasm of small arteries and arterioles abnormal vasoconstriction reflex exacerbated by exposure to cold or emotional stress, tips of fingers develop pallor cyanosis, numbness, and tingling; affects largely females

Health insurance marketplace

established by the ACA to allow consumers to compare the cost of insurance plans in their area (also known as health-care exchanges)

Stalking

following, having followed, invading homes and privacy and or creating fear of immediate harm

Occupation

goal-directed pursuits which typically extend over time. -Every individual has multiple occupations that are meaningful -Humans are innately occupational beings and are driven by and inherent need for mastery, self-actualization, self-identity, competence and social acceptance -Occupations have social, cultural, physical and temporal contextual dimensions because they involve activities within specific settings and extend over time -Occupations have symbolic and spiritual dimensions as individuals infuse individualized meanings into occupations -Occupations are interdependent (one must work to play for leisure, one must have leisure to sustain and renew oneself for work) -Health is attained when the dynamic balance between occupations and rest is appropriate and meets the needs of the individual -Occupation can also be view and used as a means (or a method to change an individuals performance) -Occupation can also be viewed and used as an end (desired outcome) -Engagement in occupation to support the individuals participation in environments of choice is the overriding desired outcome of OT

Atrioventricular (AV) node

has sympathetic and parasympathetic innervation; merges with bundle of His

Voluntary closing (VC) terminal device

hook remains opened until tension is placed on cable and then it closes

Swan neck deformity

hyperextension of PIP joint and flexion of DIP joint

Adiadochokinesia

inability to perform rapidly alternating movements

Direct expenses

include costs related to OT service provision, such as salaries and benefits e.g. vacation and sick time, office supplies (e.g. pen, paper), and treatment equipment (e.g. ADL materials)

Indirect expenses

include costs shared by the setting as a whole such as utilities, housekeeping, and marketing

Administrative functions of management

include program development, fiscal and personal management and program evaluation

Cultural context

includes customs, beliefs, activity patterns, behavior standards, and expectations accepted by the society of which the client is a member.

low-tech devices

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

cardiac catheterization (heart failure)

invasive procedure used to visualize coronary circulation to determine the degree of CAD, congenital heart defect, valvular disease, myocardial damage -Diagnostic procedures

Anxiety

is a feeling of apprehension or worry associated with anticipation of future danger -free-floating anxiety is pervasive anxiety that does not have a specific focus

Fear

is an anxiety that is focused on a real danger

Procedural memory

is an automatic sequence of behavior such as conditioned responses

Reactive attachment disorder, inhibited type

is characterized by persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions

inappropriate affect

is consistent/incongruent with the accompanying idea, though or speech

blunted affect

is severe lack of affect. As seen clinically, an affect that does not demonstrate the ability to change is observed

Remote memory

is the ability to remember things that happened in the distance past (long-term memory)

flat affect

is the absence of any effective signs of emotion

Distractibility

is the inability to concentrate ones attention without attention being drawn to unimportant or irrelevant stimuli

Supervision

is the process in which two or more individuals collaborate to establish, maintain, promote or enhance a level of performance and quality of service 1. It is a mutually respectful joint effort between supervisor and supervisee 2. It promotes professional growth and development and facilitates mentoring 3. It ensures appropriate training, education and use of resources for safe and effective service provision 4. Supervision facilitates innovation, supports creativity, and provide encouragement, guidance and support while working toward attainment of shared goal 5. Only OT practitioners can supervise OT practice; OT aides cannot supervise OT practice 6. Occupational therapists can practice autonomously and do not require any supervision to provide OT services (occupational therapists are responsible and accountable for all aspects of OT service delivery. To develop best practice competencies and foster professional growth, occupational therapists should use supervision and mentorship 7. OTAs/COTAs must be supervised by occupational therapists for any and all aspects of the OT service delivery process

Episodic memory

knowledge we have about ourselves and our personal, past experiences

Shoulder extension muscles

latissimus dorsi, posterior deltoid, teres major

Posterior Cord Syndrome

least frequent syndrome; injury to posterior columns results in proprioceptive loss. Pain, temperature, touch preserved. Motor function preserved to varying degrees.

Extrinsic extensor muscles of the hand innervated by the radial nerve

o Extensor digitorum communis (EDC) o Extensor digiti minimi o Extensor indicis proprius (EIP) o Extensor pollicis longus (EPL) o Extensor pollicis brevis (EPB) o Abductor pollicis longus (APL)

Radial-digital grasp

object held with the opposed thumb and fingertips, space visible between (8 months) with wrist extended (9 months)

Sundowner syndrome

occurs in late afternoon and at night in older people, often seen in those with dementia -characterized by drowsiness, confusion, ataxia, falling, agitation, and sometimes aggression -associated with sedation/over sedation, dementia and changes in orienting cues such as light, familiar people and objects

Referred pain

pain arising from deep visceral tissues that is felt in a body region remote from site of pathology, resulting in tenderness and cutaneous hyperalgesia, medial left arm pain with heart attach, right subscapular pain from gallbladder attack -headache and craniofacial pain, temporomandicular joint syndrome (TMJ)

Horizontal adduction muscles

pectoralis major innervated by the axillary nerve

Acting out

physical expression of thoughts & impulses

Strength of relationships

positive correlations range from 0 to +1.0; indicates as variable X increases, so does variable Y. 1. High correlations: .70 to +1 2. Moderate correlations: .35 to 0.69 3. Low correlations: 0 to .34 -Negative correlations range from -1.0 to 0; indicates as variable X increases, variable Y decreases; an inverse relationship. -0 means no relationship between variables; negative correlations range from -1.0 to 0

Alpha level

preselected level of statistical significance, allows rejection of the null, often expressed as a value of P -Most commonly .05 or .01 indicates that the expected difference is due to chance at .05 only 5 times out of every 100 or a 5% chance, often expressed a s a value of p -there are true differences on the measured dependent variable

pressure injuries

prolonged exposure to pressures exceeding capillary pressure

Clinical case management

provides individualized support and intervention to a client with serious illness which significantly limits their ability to access or engage in existing community services, ensuring that the person is able to remain in the community and not be re-hospitalized

Holter monitor (heart failure)

records ECG readings, usually 24 hours, on a portable tape recorder to document arrhythmias and link them to activities or to symptoms, such as chest pain -Diagnostic procedures

Sumlimation

redirecting energy from socially unacceptable impulses to socially acceptable activities (an angry individual channels anger into aggressive sports play)

Splitting

rigid separating of positive and negative thoughts and feelings (staff members may be seen as all good or all bad when variations of behavior are anxiety provoking)

D1 Extension

scapula: adducted, downwardly rotated shoulder: extended, abducted, internally rotated elbow: extended forearm: pronated wrist: extended toward ulnar side fingers: extended, abducted thumb: extended, abducted

Depersonalization

subjective sensation of unreality about oneself or the environment

Treatment authorization request (TAR)

the Medicaid form a primary care provider must complete to document the need for requested medically necessary covered services with a supporting rationale

Edema

the body's initial response to injury -it is the transfer of exudate in which the fluids from the bloodstream moves to the interstitial tissue -edema can be localized or diffuse Types: 1. pitting- acute 2. brawny-chronic

Geriatrics

the branch of medicine concerned with the illnesses of old age and their care

Oppositional Defiant Disorder (ODD)

the negative, hostile, or defiant behaviors that result in functional impairment -Negative behaviors begin in early childhood (higher in boys) -The course and prognosis depend on the severity of behaviors, the presence of other disorders and the intactness of the family -most likely to progress into a conduct disorder if aggression is prominent

Type II error

the null hypothesis is not rejected by the researcher when it is false the means of scores are concluded to be due to chance when the means are truly different

Groups Norms

the standards of behavior and attitudes that are considered appropriate and acceptable to the group Therapeutic norms 1. encourage self reflection, self-disclosure, and interaction among members 2. reinforce the value and importance of the group by being on time and well prepared 3. establish an atmosphere of support and safety 4. maintain confidentiality and respect 5. regard group members as effective agents of change by not placing the group leader in the expert role.

Assistive technology professional (ATP)

to analyze consumer needs, help select AT that can effectively meet identified needs and provide training in the use of the AT

Computer expert

to assist with the design and provision of efficient computer-based technology

Teacher

to identify students learning needs, integrate AT into students education and implement modifications into the school setting

Fast pain

transmitted over A delta fibers, -Processed in spinal cord dorsal horn lamina, -crosses to excite lateral (neo) spinothalamic tract. -terminates in brain stem reticular formation and thalamus with projections to cortex

Slow pain

transmitted over C fibers, -Processed in spinal cord lamina (II& III to V) -crosses to excite anterior (paleo) spinothalamic tract. -Terminates in brain stem reticular formation -excites reticular activating system (RAS) -Functions for diffuse arousal (protective/aversive reactions), affective and motivational aspects of pain -also terminates in thalamus with projections to cortex

Open Reduction Internal Fixation (ORIF)

types include nails, screws, plates, or wire

Echocardiogram (ECHO) (heart failure)

ultrasound used to record size, structure, and motion of the heart and vessels reveals valvular defects and structural abnormalities -Diagnostic procedures

Conservation

(Preoperational period 2-7 years- Jean Piaget hierarchical development of cognition) -The end product of the preoperational period. The child is able to recognize the continuities of an object or class of objects in spite of apparent changes

Interventions for participation problems

(Rehabilitation for Immunological System Disorders) Identification and facilitation of procurement of system changes to allow a person to access and ability to participate as a contributing member of society Needs assessment to determine individual issues the person has with mobility, social or political access to their personal home or community environments

Central Cord Syndrome

-Caused by hyperextension injuries 1. presents with more UE deficits than lower extremity deficits

Wrist flexors innervated by the ulnar nerve

-Flexor carpi ulnaris (FCU)

abductor pollicis brevis

-Median Nerve § Origin: scaphoid, trapezium, flexor retinaculum, and tendon of the abductor pollicis longus § Insertion: base of proximal phalanx, radial side of thumb § Function: palmar abduction

Lumbricals (ulnar side)

-Ulnar nerve § Origin: tendons of flexor digitorum profundus for digits IV and V § Insertion: radial side of digits IV and V into extensor expansion § Function: MCP flexion and extension of IP joints of digits IV and V

Wheelchair measurement considerations general

-the size of a w/c should be proportional to the person 1. standard-sized should be matched to a person whenever possible due to the increased expense of customized chairs -measure on a firm surface, bu also observe a variety of positions to account for tonal influences on posture -the cushion that will be selected for the individual needs to be considered

Sensory systems changes and adaptations in the older adult- age related changes

1. older adults experiences a loss of function of the senses -may lead to sensory deprivation, isolation, disorientation, confusion, appearance of senility and depression -may strain social interactions and decrease ability to interact socially and with the environment -alters quality of life

Fibrosis of the skin and lung interventions

1. protective gloves: cotton, insulated, mildly compressive 2. Drug therapy (lung only) (under investigation)

Symptom management: Feeding/Eating disorders

1. the use of antidepressant medications may be useful in anorexia nervosa but they are more effective for individuals with bulimia (antipsychotics can be used as well to improve distorted thinking and perceptions) 2. treatment of any of the resulting medical complications such as cardiac disturbances (hypotensions, slow heart rate) , reduced thyroid metabolism, osteoporosis, seizures, severe dehydration, electrolyte imbalances, irregular bowel movements, pancreatitis, peptic ulcers, gastric, or esophageal inflammation and possible rupture, tooth decay, may also be necessary 3. treatment most often takes place in outpatient or day care programs 4. Hospitalization may be necessary if the individual has medical difficulties, is suicidal, cannot care for themselves, or need to be removed from their environment 5. Behavioral programs designed around a privileging system are not often used 6. Medical management also typically includes individuals psychotherapy, family counseling, and behavioral and cognitive therapies

Vocal Folds

1. tissue that opens when breathing or vibrating (when speaking or singing); also called the vocal cords -controlled by the vagus nerve -the vocal cords protect the airway from choking and regulate the flow of air into the lungs -they are also important in producing sounds used for speech

Nephrotic syndrome treatment

1. treat with diuretics and drugs that prevent spillage of protein in the urine 2. drug control of fluid overload and/or spillage of protein into the urine (proteinuria) 3. encourage compliance with drug therapy and dietary and exercise recommendations

Symptom management for schizophrenia

1. treatment consists of primarily of the use of antipsychotic medications, the provision of a structured supportive environment and the implementation of an individualized intervention program to develop illness management skills and competencies to enable occupational performance 2. Psychopharmacology -traditional antipsychotic medications (Thorazine, prolaxin, haldol, navane, mellaril, stelazine and trilafon *side effects of traditional antispychotics medications may include dry mouth, blurry vision, photosensitivity, constipation, orthostatic hypotension, parkinsonism, dystonias [impaired tonicity], akathisia [restless, anxiety provoking need for movement] and cardiovascular disease -atypical antipsychotics (Clozaril, risperdal, zyprexa, seroquel, geodon, saphris, fanapt, latuda, symbyaz, invega and abilify -neuromuscular side effects may be treated by Congentin, Artane, Benadryl and symmetrel *side effects include: dry mouth, blurry vision, sedation, dizziness, hypotension, insomnia, and confusion (complications of clozaril may include agranulocytosis, which is a decrease in certain white blood cells that is potentially fatal. A result of this potentiality necessitates weekly blood count monitoring initially, biweekly after 6 months and monthly after a year of treatment. The resulting disruptions in lifestyle can be problematic for those on this medication, which can negatively impact adherence to medication regimen)

Finger to palm translation

A linear movement of an object from the fingers to the palm of the hand e.g. picking up coins 12-15 MONTHS (Manipulating skills according to Exner's classification system)

Tangentiality

Abrupt changing of focus to a loosely associated topic

Coronary artery disease (CAD)

Atherosclerosis disease process that narrows the lumen of coronary arteries resulting in ischemia to the myocardium

oral facial musculature

Controls maintenance of the bolus in the oral cavity during mastication and swallowing

Extrinsic flexor muscles of the hand innervated by the ulnar nerve

Flexor digitorum profundus

Signs and symptoms of diabetes

Frequent urination, excessive thirst, unexplained wt loss, extreme hunger, visual changes, sensory changes (tingling/numbness in feet/hands), fatigue, dry skin, slow healing wounds, inc. rate of infections

Stages of Moral Development (Kohlberg)

Level 1: Pre-conventional morality: occurs up until the age of 8 years 1) Stage 1: Obedience and punishment: the child is obedient in order to avoid punishment 2) Stage: instrumental relativism: the child makes moral choices based on the benefit to self and sometimes to others Level 2, Conventional morality: occurs at about 9 or 10 years of age 1) Stage 1 social conformity: the child desires to gain the approval of others 2) stage 2, Law and order: rules and social norms are internalized Level 3, Post- conventional morality: age range can vary, and not all will achieve this level 1) social contracts: the young adult has social awareness and an awareness of the legal implications of decisions/actions

Contextual evaluation for environmental evaluation

Physical considerations: -Arrangement of furniture -Accessibility of items needed for desired activities and for safety -Ease of use -Housing/workplace design -Neighborhood characteristics: (availability and use of transportation; overall accessibility) Sociocultural considerations: -The individual's social network; the relationship between the individual with the disability and others -Social roles: expectations for role performance of the individual with a disability and others -Opportunities for socialization -Sociocultural norms, values, and expectations for independent functions -Community resources available

Sympathetic (Thoracolumbar) Division

Prepares body for fight or flight, emergency responses, raises heart rate and blood pressure, constricts peripheral blood vessels and redistributes blood; inhibits peristalsis

Beneficence

Principle 1: OT personnel shall demonstrate a concern for the safety and well-being of the recipients of their services

OT in SNFs is covered by Medicare if the patient requires what?

Skilled nursing or skilled rehabilitation (OT, PT, ST) -The RUGS reimbursement system has been used since 1998 to pay for therapy services provided in SNFs As of October 2019 the Patient Driven Payment Model (PDPM) is replacing the RUGS system -This is a substantial change in payment for OT services -Under RUGs, the provision of more services (including OT) resulted in higher reimbursement rate to the SNF (This payment system resulted in a press to provide more services to clients and at times unrealistic productivity standards) Under PDPM, the reimbursement paid to SNFs will no longer be based on services provision -Payment to SNFs will be based on the clients characteristics regardless of the amount or type of provided services -To be reimbursed under PDPM, OT practitioners will need "to clearly articulate the value of their services"

Myocardial fibers

Striated muscle tissue/fibers which exhibit rhythmicity of contraction; fibers contract as a functional unit; myocardial metabolism is primarily aerobic, sustained by continuous O2 delivery from the coronary arteries

Purposes and methods of activity analysis and synthesis

Teaching an activity 1. Analyzing the natures and sequence of the subtasks within the activity 2. Synthesize to determine the best way to present the activity as a learning experience Determining whether an individual can perform an activity 1. Analyze the performance skills requirements of the activity 2. synthesize by comparing the activity requirements with the individuals functional level. Adapting an activity 1. evaluate the individuals functional capacities 2. analyze what parts of the activity can be changed identify what functional aids can be used t allow the individual to successfully perform the activity Grading an activity 1. determine what aspects can be changed along a continuum of performance 2. identify the individuals performance skill deficits and/or client factors requiring intervention and their assets/strengths that support activity performance synthesize to upgrade or downgrade complexity or difficulty level of the activity to meet the needs of the individual and provide the "just right challenge" to attain goals

Role play (teaching method)

The OT practitioner and/or individuals assume roles and act out scenarios to practice behaviors prior to doing the behavior in a real situation

Audiovisual aids (teaching methods)

The use of slides, videos and/or audio cassettes to teach material with or without the presence of a therapist

Censure

a public statement of the respective agency's disapproval of a practitioners conduct

Nystagmus (CP)

a reflexive response of the eyes triggered by head movement

emotional abuse

criticizing, humiliating, playing mind games, abusing or killing pets, withholding affections, isolating and dominating

Diabetic angiopathy

consistent and noncontrolled elevation of blood glucose levels and accelerated atherosclerosis, neuropathies are a major problem; ulcers and diabetic retinopathy are common outcomes -untreated ulcers can lead to gangrene and amputation -unmanaged diabetic retinopathy can result in blindness

Somatization

conversion of psychological symptoms into physical illness (a person who feels stuck in an unhappy marriage develops low back pain)

Cerebral infarction

due to either embolism or thrombosis of the intra or extracranial arteries

Certified Rehabilitation and technology suppliers (CRTS)

for individuals who require complex and specialized rehabilitation tech that is different from standard durable medical equipment

Elbow Fracture

involvement of the radial head may result in limited rotation of the forearm

Stereotypy

is the repetition of fixed patterns of movement and speech (echolalia)

Akathisia

is the state of restlessness characterized by an urgent need for movement, usually as a side effect of medication

Baroreceptors

main mechanism controlling heart rate, respond to changes in blood pressure 1. rapid decreased in blood pressure could result in syncope

Hardware instrumentation

mechanical or physical instruments with established reliability and validity that measure independent variables (goniometers)

Scapula adduction muscles

o Middle trapezius o Rhomboid Major

Hyperactivity

restless, sometimes aggressive or destructive activity, often associated with brain pathology

Derealization

subjective sense that the environment is unreal

Prospective payment system (PPS)

the nationwide payment schedule that determines the Medicare payment for each inpatient stay of a Medicare beneficiary based on DRGs

Recruitment

the process of determining staffing needs, predicting turnover and vacancies, and identifying and recruiting potential replacements to maintain the staffing levels required to meet program objectives -identify the position available and determine its job description -attract potential qualified applicants 1. advertise in trade publications, state and national OT association newsletters, and/or online 2. Network internally within own organization and externally at local, state, and/or national OT meetings and conferences and through established OT contacts 3. Conduct open houses, job fairs, and workshops 4. Direct mail recruitment information to OT practitioners 5. Use placement agencies 6. Train and educate fieldwork students -Screen interested applicants for an interview 1. review applications and resumes 2. check references -Interview screened applicants to determine experience ability for position 1. obtain information about relevant experience and career goals 2. verify knowledge and skills 3. use open-ended semi-structured questions to facilitate discussion 4. ask the same questions of every candidate 5. take notes of applicants responses 6. questions to the applicant that violate civil rights legislation or ADA should not be asked -age -sexual orientation -marital status or family composition -race or national origin, religion, or political beliefs -physical, mental or cognitive disabilities 7. share information about the positions salary, benefits, work hours, job description and advantages and limitations of the organization -make the job offer 1. contact selected applicant to offer position 2. upon applicants acceptance of position, confirm terms of employment, starting date, salary and licensure requirements

Probation

the requirement that a practitioner meet certain conditions (further education, extensive supervision, individual counseling, participation in a substance abuse rehabilitation program) to retain membership, certification or licensure by the respective agency

Guttmann scale rank ordering

the respondent places a number alongside a list of items, indicating their order of importance. Sometimes only two or three items are asked for, other times a whole list may be prioritized. It is difficult (and irrelevant) to prioritize more than 10

Cultural aspects

the social structures, values, norms and expectations that are accepted and shared by a group of people

Certified vision rehabilitation specialist or certified low vision therapist

to provide training in the use of optical devices and compensatory strategies for visually impaired persons